BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
SB 1228 (Alquist) - Small house skilled nursing facilities.
Amended: May 1, 2012 Policy Vote: Health 6-3
Urgency: No Mandate: Yes
Hearing Date: May 24, 2012 Consultant: Brendan McCarthy
SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
Bill Summary: SB 1228 would create a new licensing category for
"small house skilled nursing facilities" with specified
characteristics and regulatory requirements.
Fiscal Impact:
Startup costs of about $120,000 per year for three years to
develop regulations (Licensing and Certification Program
Fund).
Minor ongoing costs to license and inspect facilities
(Licensing and Certification Program Fund).
Background: Under existing law, the Office of Statewide Health
Planning and Development enforces building standards on
hospitals and nursing facilities.
Under existing law, the Department of Public Health licenses
skilled nursing facilities. Existing regulations address issues
of facility size, standards of care provided to residents, and
safety standards.
Proposed Law: SB 1228 would create a new licensing category -
the "small house skilled nursing facility". The intention of the
bill is to allow for the development of skilled nursing
facilities that are smaller in size, with a less institutional
and more home-like atmosphere.
Under the bill, small house skilled nursing facilities would
serve ten or fewer residents, certified nursing assistants could
perform a variety of tasks in the facility, facilities would be
allowed to prepare meals on-site, facilities would be required
to provide no less than four hours of direct-care staffing per
resident per day, certain training standards for staff would be
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mandated, and facilities would be required to generally have the
characteristics of a home-like environment.
The bill specifies timelines for the review of license
applications by the Department of Public Health and requires the
Department to adopt implementing regulations.
Related Legislation: SB 135 (Hernandez) would establish hospice
facilities as a new type of skilled nursing facility regulated
by the Department of Public Health. That bill is in the Assembly
Health Committee.
Staff Comments: Existing law requires skilled nursing facilities
to provide no less than 3.2 hours of direct patient care
staffing per day. This bill would require at least 4.0 hours of
direct patient care per day. Compared to existing regulations,
the higher level of care mandated by the bill may increase
operational costs of small house skilled nursing facilities,
compared to existing facilities.
There are indications that facilities with similar
characteristics to a small house skilled nursing facility
authorized in this bill operate at costs similar to traditional
skilled nursing facilities in other states. Whether that would
be the case in California is unknown, as there are no facilities
of this type currently in operation.
The state's Medi-Cal program is a major provider of skilled
nursing care services in the state. In the current year, the
state will pay for skilled nursing facility services to over
60,000 individuals, at a total cost of more than $4 billion (50
percent General Fund). Payments made by Medi-Cal to skilled
nursing facilities are generally based on actual costs incurred.
Even minor increases in the cost of providing skilled nursing
care could have significant effects on the Medi-Cal program. For
example, if even one percent of current skilled nursing facility
residents covered by Medi-Cal eventually shift to a small house
skilled nursing facility, and average costs in those facilities
are only one percent higher than average costs other facilities,
the cost to Medi-Cal would be in the hundreds of thousands per
year.
The only local mandates imposed by the bill relate to
misdemeanor penalties and are not reimbursable by the state
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under the California Constitution.
Proposed Author Amendments: The proposed amendments would remove
the requirement for 4.0 hours of direct care. The proposed
amendments would also provide for additional flexibility by
allowing up to 12 beds, allowing the small house skilled nursing
facility to be a distinct part of a larger facility, provide
flexibility on training requirements, and allow more than one
resident per room.