BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      



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          |SENATE RULES COMMITTEE            |                   SB 177|
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                              UNFINISHED BUSINESS


          Bill No:  SB 177
          Author:   Strickland (R), et al.
          Amended:  8/18/11
          Vote:     21


           SENATE HEALTH COMMITTEE  :  7-0, 04/13/11
          AYES:  Hernandez, Strickland, Alquist, Anderson, De León, 
            DeSaulnier, Rubio
          NO VOTE RECORDED:  Blakeslee, Wolk

           SENATE APPROPRIATIONS COMMITTEE  :  9-0, 05/23/11
          AYES:  Kehoe, Walters, Alquist, Emmerson, Lieu, Pavley, 
            Price, Runner, Steinberg

           SENATE FLOOR  :  33-0, 05/31/11
          AYES:  Alquist, Anderson, Blakeslee, Calderon, Cannella, 
            Correa, De León, DeSaulnier, Dutton, Evans, Fuller, 
            Gaines, Hancock, Harman, Hernandez, Huff, Kehoe, Leno, 
            Lieu, Lowenthal, Negrete McLeod, Padilla, Pavley, Rubio, 
            Runner, Simitian, Steinberg, Strickland, Walters, Wolk, 
            Wright, Wyland, Yee
          NO VOTE RECORDED:  Berryhill, Corbett, Emmerson, La Malfa, 
            Liu, Price, Vargas

           ASSEMBLY FLOOR  :  76-0, 08/22/11 - See last page for vote


           SUBJECT  :    Congregate living health facilities

           SOURCE  :     Visiting Nurse & Hospice Care


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           DIGEST  :    This bill raises the bed limit from 12 to 25 for 
          congregate living health facilities that serve terminally 
          ill patients in Santa Barbara County.

           Assembly Amendments  allow, for the purposes of hospital 
          licensing requirements, dietary services to be provided 
          either at the hospital, or in another hospital immediately 
          adjacent to the hospital, as long as dedicated facilities 
          are in place to accommodate the delivery of these services, 
          and the Department of Public Health determines that all 
          applicable statutory and regulatory standards pertaining to 
          dietary services have been met, and provide chaptering 
          amendments with SB 844 (Price).

           ANALYSIS  :    Existing law:

          1.Provides for the licensure and regulation of health 
            facilities, including hospitals, skilled nursing 
            facilities, and congregate living health facilities 
            (CLHFs).

          2.Defines a CLHF as a residential home with a capacity of 
            no more than 12 beds, that provides inpatient care, 
            medical supervision, 24-hour skilled nursing and 
            supportive care, and other services to persons who meet 
            one of the following:

             A.   Persons who are mentally alert who have physical 
               disabilities, who may be ventilator dependent;

             B.   Persons who have a diagnosis of terminal illness, 
               or life-threatening illness, or both, as defined; or 

             C.   Persons who are catastrophically and severely 
               disabled, as defined.

          1.Provides, notwithstanding the 12-bed limit, that a CLHF 
            that is operated by a city and county may have 59 beds, 
            and provides that a CLHF that is not operated by a city 
            and county that serves persons who have a diagnosis of 
            terminal illness or life-threatening illness, or both, 
            that is located in a county of 500,000 or more persons, 
            may have not more than 25 beds.


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          2.Provides that the primary need of CLHF residents shall be 
            for skilled nursing care on a recurring, intermittent, 
            extended, or continuous basis, and provides that this 
            care is generally less intense than that provided in 
            general acute care hospitals but more intense than that 
            provided in skilled nursing facilities.

          3.Provides for the licensure and regulation by the 
            Department of Public Health of persons or agencies that 
            provide hospice services in a person's home or other care 
            setting, defined as a specialized form of 
            interdisciplinary health care that is designed to provide 
            palliative care, alleviate the physical, emotional, 
            social, and spiritual discomforts of an individual 
            diagnosed with a terminal illness, and provide supportive 
            care to the primary caregiver and the family.

          4.Allows, for the purposes of hospital licensing 
            requirements, dietary services to be provided either at 
            the hospital, or in another hospital immediately adjacent 
            to the hospital, as long as dedicated facilities are in 
            place to accommodate the delivery of these services, and 
            the Department of Public Health determines that all 
            applicable statutory and regulatory standards pertaining 
            to dietary services have been met.

          5.Provides chaptering amendments with SB 844 (Price).

          This bill raises the bed limit from 12 to 25 for congregate 
          living health facilities that serve terminally ill patients 
          in Santa Barbara County.

           Background
           
          In order to provide options for providing care to 
          chronically ill patients outside of hospitals, CLHFs were 
          established as a category of licensed health facilities in 
          1986.  CLHFs were initially limited to having no more than 
          six beds and were limited to serving mentally alert, 
          physically disabled residents, who can be 
          ventilator-dependent.  In 1988, a second category of CLHFs 
          was authorized to provide 24-hour inpatient care to 
          terminally ill patients.  These facilities were allowed to 
          have 25 beds in counties which have a population of 500,000 

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          or more persons.  In 1989, a third category of CLHFs was 
          established, to serve persons who are catastrophically and 
          severely disabled, which were allowed to have 12 beds in 
          counties with more than 500,000 persons.  In 2005, 
          legislation was enacted which raised the bed-size limit for 
          CLHFs in all counties to 12 beds, while retaining the 
          higher 25-bed limit for CLHFs serving terminally ill 
          patients in counties with more than 500,000 persons.

          The impetus for the 1988 legislation establishing the new 
          CLHF category for terminally ill patients, with a bed limit 
          of 25 in counties with over 500,000 persons, was to enable 
          a proposed 25-bed hospice facility serving persons with 
          AIDS, which was proposed to be operated by Barlow Hospital 
          in Los Angeles, to be licensed as a CLHF.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes   
          Local:  Yes

          According to the Senate Appropriations Committee:

           Major Provisions                2011-12     2012-13    
           2013-14   Fund  
          Increased CLHF-B                                  
          potentially minor to significant costs            General/*
             capacity                                       Federal

          Cost avoidance                                    
          potentially minor to significant                       
          General/*
                                cost avoidance              Federal

          *Medi-Cal costs shared 50 percent General Fund, 50 percent 
          federal funds.

           SUPPORT  :   (Verified  8/22/11)

          Visiting Nurse & Hospice Care (source) 
          Alliance for Living and Dying Well
          Alzheimer's Association
          American Dream Concepts Business Development Group
          Brown & Brown Insurance
          California Hospice & Palliative Care Association
          California Hospital Association

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          CenCal Health
          City of Goleta
          Community Home Health
          Cottage Health System
          Donate Life
          Dream Foundation
          Easy Lift
          Frank Schipper Construction Co.
          Grace House
          Hutton Parker Foundation
          Orfalea Foundations
          PMSM Architects
          Santa Barbara County Board of Supervisors
          Santa Barbara County Medical Society
          Santa Barbara Foundation
          Santa Barbara Neighborhood Clinics
          Sharon Kennedy Estate Management
          St. Francis Foundation
          The Council on Alcoholism and Drug Abuse
          United Way of Santa Barbara County
          Vista Del Monte Retirement Community

           OPPOSITION  :    (Verified  8/22/11)

          State Council on Developmental Disabilities 

           ARGUMENTS IN SUPPORT  :    Visiting Nurse &Hospice Care 
          (VNHC) states that as the only licensed hospice inpatient 
          facility in Santa Barbara County, Serenity House has 
          struggled to meet demands for end-of-life beds.  Between 
          2008 and 2009, Serenity House saw a 71 percent increase in 
          the number of patients served and has a growing waiting 
          list due to the lack of available beds for end of life 
          patients.  VNHC states that based on current population 
          projections, the number of people over the age of 65 in 
          Santa Barbara County will increase by 24 percent by 2050.  
          While VNHC acknowledges that it made an error in assuming 
          it would be able to build an 18-bed facility, because it 
          believed that a waiver or exception process existed to 
          allow it to operate at the higher bed-size, VNHC states 
          that the need for additional end-of-life beds continues to 
          be critical in Santa Barbara County and this bill will 
          enable it to meet these needs and continue providing 
          compassionate care to persons at the end of life.  

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           ARGUMENTS IN OPPOSITION  :    The State Council on 
          Developmental Disabilities (SCDD) opposes this bill and 
          writes, "This bill would allow an increase in the number of 
          beds allowed in congregate living health facilities in the 
          county of Santa Barbara.

          "The SCDD is aware that this bill seems to be directed to 
          one specific instance; however, it creates the unintended 
          consequence of increasing the size of facilities for 
          persons with disabilities now and in the future.  
          Therefore, the SCDD opposes this bill as being inconsistent 
          with the direction of individuals being supported in their 
          own homes and inclusive communities."


           ASSEMBLY FLOOR  :  76-0, 08/22/11
          AYES:  Achadjian, Alejo, Allen, Ammiano, Atkins, Beall, 
            Bill Berryhill, Block, Blumenfield, Bonilla, Bradford, 
            Brownley, Buchanan, Butler, Charles Calderon, Campos, 
            Carter, Cedillo, Chesbro, Conway, Cook, Davis, Donnelly, 
            Eng, Feuer, Fletcher, Fong, Beth Gaines, Galgiani, 
            Garrick, Gatto, Gordon, Grove, Hagman, Halderman, Hall, 
            Harkey, Hayashi, Roger Hernández, Hill, Huber, Hueso, 
            Huffman, Jeffries, Jones, Knight, Lara, Logue, Bonnie 
            Lowenthal, Ma, Mansoor, Mendoza, Miller, Mitchell, 
            Monning, Morrell, Nestande, Nielsen, Norby, Olsen, Pan, 
            Perea, V. Manuel Pérez, Portantino, Silva, Skinner, 
            Smyth, Solorio, Swanson, Torres, Valadao, Wagner, 
            Wieckowski, Williams, Yamada, John A. Pérez
          NO VOTE RECORDED:  Dickinson, Fuentes, Furutani, Gorell


          CTW:nl  8/23/11   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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