BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1228|
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THIRD READING
Bill No: SB 1228
Author: Alquist (D)
Amended: 5/29/12
Vote: 21
SENATE HEALTH COMMITTEE : 6-3, 4/25/12
AYES: Hernandez, Alquist, De León, DeSaulnier, Rubio, Wolk
NOES: Harman, Anderson, Blakeslee
SENATE APPROPRIATIONS COMMITTEE : 5-2, 5/24/12
AYES: Kehoe, Alquist, Lieu, Price, Steinberg
NOES: Walters, Dutton
SUBJECT : Small house skilled nursing facilities
SOURCE : NCB Capital Impact
DIGEST : This bill adds small house skilled nursing
facility (SHSNF), as defined, to the skilled nursing
facility category of facilities licensed by the Department
of Public Health (DPH), and permits an SHSNF to be licensed
by DPH beginning on January 1, 2014, if the SHSNF meets
specified requirements.
ANALYSIS :
Existing law:
1. Provides for the licensure of health facilities,
including skilled nursing facilities (SNFs), by DPH.
CONTINUED
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2. Defines "SNF" as a health facility that provides skilled
nursing care and supportive care to patients whose
primary need is for availability of skilled nursing care
on an extended basis.
3. Requires the Office of Statewide Health Planning and
Development (OSHPD), under the Alfred E. Alquist
Hospital Facilities Seismic Safety Act, to assume
responsibility for the enforcement of all building
standards related to hospital buildings, including SNFs.
Existing regulations:
1. Further define "SNF" as a facility providing 24-hour
inpatient care and, at a minimum, includes physician,
skilled nursing, dietary, and pharmaceutical services
and an activity program.
2. Require each SNF licensed for 59 or fewer beds to have
at least one registered nurse or a licensed vocational
nurse, awake and on duty, in the facility at all times,
day and night.
3. Require each SNF to employ sufficient nursing staff to
provide a minimum of 3.2 nursing hours per patient day.
Requires this staffing ratio to only include direct
caregivers, which is defined to include registered
nurses, licensed vocational nurses, psychiatric
technicians, or certified nurse assistants, who are
performing nursing services.
4. Specify that while all SNFs are required to maintain
compliance with licensing requirements, these
requirements not to prohibit the use of alternate
concepts, methods, procedures, techniques, equipment,
personnel qualifications or the conducting of pilot
projects, as long as such exceptions have prior written
approval of DPH.
This bill:
1. Adds SHSNFs, as defined, to the SNF category of
facilities licensed by DPH, and permits an SHSNF to be
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licensed by DPH beginning on January 1, 2014, if the
SHSNF meets specified requirements.
2. Defines "SHSNF" as a SNF that is either a stand-alone
home or that consists of more than one home, licensed
pursuant to the provisions of this bill, for the
purposes of providing skilled nursing care in a
home-like, noninstitutional setting.
3. Defines "home" for purposes of a SHSNF as an apartment,
home, or other similar unit that serves 10 or fewer
residents.
4. Defines "versatile worker," for purposes of SHSNF
licensing requirements, as a certified nursing assistant
who provides personal care, socialization, meal
preparation services, and housekeeping services.
Requires the SHSNF, to the extent permitted under
federal law, to utilize versatile workers for purposes
of resident care.
5. Requires the SHSNF to be certified to participate as a
provider of care either as a SNF under the federal
Medicare Program or as a nursing facility under the
federal Medicaid Program.
6. Requires the SHSNF to comply with all state laws and
regulations that govern SNFs, except to the extent that
those laws and regulations are inconsistent with the
provisions of this bill. Specifies that the provisions
of this bill supersede any conflicting state law or
regulation.
7. Requires the SHSNF, to the extent permitted under
federal law, to provide meals cooked on the premises of
each home, and not prepared in a central kitchen and
transported to the home.
8. Provides for additional flexibility by allowing up to 12
beds, allowing the SHSNF to be a distinct part of a
larger facility, provides flexibility on training
requirements, and allows more than one resident per
room.
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9. Requires the SHSNF to provide for consistent staff
assignments and self-directed work teams of direct care
staff supervised by a leadership team member who is not
acting as a nurse or nursing supervisor in the home.
10.Requires the SHSNF to provide training for all staff for
not less than 120 hours for each versatile worker and
not less than 60 hours for each leadership and clinical
team member, to be completed prior to initial operation
of the home, concerning the philosophy, operations, and
skills required to implement and maintain self-directed
care, self-managed work teams, and a noninstitutional
approach to long-term care, among other elements.
Requires replacement staff to undergo the training
within six weeks of employment, and exempts staff
employed on a short-term, temporary basis.
11.Requires the SHSNF, to the extent permitted under
federal law, to ensure that the percentage of residents
in each facility who are short-stay rehabilitation
residents does not exceed 20% at any time. Exempts
long-term residents returning to a facility after a
hospital stay who are receiving rehabilitation services
under the Medicare Program from counting toward this
limitation, and specifies that this limitation does not
apply to a SHSNF that is licensed solely to provide
rehabilitation services.
12.Requires the SHSNF, to the extent permitted under
federal law, to consist of a home-like, rather than
institutional, environment, including having the
following characteristics:
A. The home is accessible to disabled persons, and is
designed as a house or apartment that is similar to
housing available in the surrounding community, and
that includes shared areas that would only be
commonly shared in a private home or apartment;
B. The home does not, to the extent practicable,
contain institutional features, such as nursing
stations, medication carts, room numbers, and
wall-mounted licenses or certificates;
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C. The home includes private, single-occupancy
bedrooms that are shared only at the request of a
resident to accommodate a spouse, partner, family
member, or friend, and that contain a full private
and accessible bathroom;
D. The home contains a living area where residents
and staff socialize, dine, and prepare food together
that provides, at a minimum, a living room seating
area, a dining area large enough to accommodate all
residents and at least two staff members, and a full
kitchen that may be utilized by residents;
E. The home contains ample natural light with window
areas, not including skylights, being a minimum of
10% of the area of each room;
F. The home has built-in safety features to allow
areas of the facility to be accessible to residents
during the majority of the day and night; and
G. The home provides access to secured outdoor space.
13.Requires DPH, within two months of receipt of a license
application, to notify the applicant of any information
necessary to process the application, and requires DPH
to review each application and render a decision within
six months.
14.Requires DPH and OSHPD, to consult with providers,
employee organizations, consumer advocates, and other
interested stakeholders, including groups with
demonstrated experience in SHSNF operations on the
physical, operational, and other aspects of SHSNFs.
15.Requires DPH to adopt regulations to implement this
bill.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Startup costs of about $120,000 per year for three
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years to develop regulations (Licensing and
Certification Program Fund).
Minor ongoing costs to license and inspect facilities
(Licensing and Certification Program Fund).
SUPPORT : (Verified 5/30/12)
NCB Capital Impact (source)
Aging Services of California
Alzheimer's Association
California Association of Health Facilities
California Commission on Aging
California Senior Legislature
Congress of California Seniors
Mount San Antonio Gardens
ARGUMENTS IN SUPPORT : This bill is sponsored by NCB
Capital Impact (NCB), which states that this bill will
allow Californians access to the proven benefits of SHSNFs
following Dr. William Thomas' Green House model. NCB
states that current California nursing home regulations
were written for institutional care approaches, which are
not considered to be best practice today. While California
regulations have been incrementally updated over the years,
NCB states that their institutional origins still pervade
SNF requirements and impede best practices of small home
operations and environments.
CTW:kc 5/30/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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