BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1228|
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UNFINISHED BUSINESS
Bill No: SB 1228
Author: Alquist (D), et al.
Amended: 8/27/12
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
SENATE FLOOR : 36-0, 5/30/12
AYES: Alquist, Anderson, Berryhill, Blakeslee, Calderon,
Cannella, Corbett, Correa, De León, DeSaulnier, Dutton,
Evans, Fuller, Gaines, Hancock, Harman, Hernandez, Kehoe,
La Malfa, Leno, Lieu, Liu, Lowenthal, Negrete McLeod,
Padilla, Pavley, Price, Rubio, Simitian, Steinberg,
Vargas, Walters, Wolk, Wright, Wyland, Yee
NO VOTE RECORDED: Emmerson, Huff, Runner, Strickland
ASSEMBLY FLOOR : Not available
SUBJECT : Small house skilled nursing facilities
SOURCE : NCB Capital Impact
DIGEST : This bill, until January 1, 2020, establishes
the Small House Skilled Nursing Facilities (SHSNFs) Pilot
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Program within the Department of Public Health (DPH) for
the purposes of providing skilled nursing care in a
homelike, noninstitutional setting. This bill requires
that pilot facilities, as defined, meet specified
requirements and pay specified fees. This bill requires the
DPH to submit a report to the Legislature on the results of
the pilot program at least 24 months prior to the
termination of the pilot program.
Assembly Amendments narrow the bill's scope to a pilot
program.
ANALYSIS :
Existing law:
1. Provides for the licensure of health facilities,
including skilled nursing facilities (SNFs), by DPH.
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.
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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. Establishes within DPH the SHSNFs Pilot Program to allow
DPH to authorize the development and operation of up to
10 SHSNFs.
2. Defines SHSNFs as a health facility that provides
skilled nursing care and supportive care in a small,
homelike, residential setting in an apartment, cottage,
house, or similar residential unit, to patients whose
primary need is for the availability of skilled nursing
care on an extended basis. Permits a SHSNF to consist
of a group or cluster of such residential homes, or a
distinct area within an existing SNF that otherwise
meets the definition of a SHSNF, is physically separate
and distinguishable from the remainder of the SNFs, and
has a distinct entry with no traffic of staff,
residents, or visitors not affiliated with the SHSNF.
Permits a SHSNF to also be a distinct part of a general
acute care hospital or an acute psychiatric hospital.
3. Establishes characteristics for facilities that are
eligible for the SHSNF pilot program.
4. Permits a facility to be licensed by DPH as a SHSNF
pilot facility if the facility meets both of the
following requirements:
A. The facility has been determined by DPH to comply
with all provisions necessary to be certified to
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participate as a provider of care either as a SNF in
the federal Medicare Program or as a nursing facility
in the federal Medicaid Program; and,
B. The facility has been determined by DPH and the
OSHPD to fully comply with all pilot program
requirements.
5. Requires each SHSNF pilot facility to be subject to the
same licensing enforcement provisions, in existing law,
that apply to other SNFs.
6. Requires each SHSNF pilot facility to be subject to
DPH's Licensing and Certification program fee for SNFs.
7. Requires each SHSNF pilot facility to receive a peer
group weighted average Medi-Cal reimbursement rate as
calculated by the State Department of Health Care
Services.
8. Requires DPH to permit the formulation of new standards
for long-term care that may extend beyond, or vary from,
traditional long-term health care facility models,
including but not limited to, facility layout and design
consistent with newly adopted revisions to the
California Building Standards Code, nursing care levels,
staffing levels, infection control, sanitation, dietary
services, and other personal care and habilitation
provisions that may be more flexible that those
currently required in California for SNFs and continuous
nursing facilities.
9. Requires DPH, together with OSHPD of the State Long-Term
Care Ombudsman, in developing the standards for the
SHSNF pilot program to consult long-term care providers,
health advocacy organizations, health care employees
organizations, consumer advocates, elder care advocates,
and others identified as having a vested interest in
long-term health care.
10.Requires DPH to issue, by July 1, 2013, one or more All
Facilities Letters that provide the standards to be used
by providers accepted into the pilot program for the
development and operation of all pilot facilities.
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11.Establishes several definitions , including defining:
(a) "versatile worker" which means a certified nursing
assistant who provides personal care, socialization,
activity aid services, meal preparation services, and
laundry and housekeeping services; (b) "supportive care"
which includes the provision of socialization, activity
aide services, and homemaker services; and, (c)
"homemaker services" which means food preparation,
housekeeping, laundry, and maintenance services.
12.Requires each pilot facility to provide for consistent
staff assignments and self-managed work teams of direct
care staff, including staff working as versatile
workers. Requires licensed nursing staff to direct
versatile workers in all activities delegated under the
licensed nurses' scope of practice. Permits a versatile
worker to be supervised by nonclinical staff when
performing nonclinical duties, at the discretion of the
facility.
13.Requires DPH to establish criteria to measure the
benefits and successes of SHSNFs, as a whole, and to
compare the results achieved by each model variant.
Requires DPH to evaluate and analyze the emerging
concepts in long-term SNFs developed pursuant to the
pilot program for purposes of considering future
regulatory modification.
14.Requires DPH to prepare and submit a report to the
Legislature on the results of the SHSNF pilot program.
Requires the report to be submitted to the Legislature
at least 24 months prior to the termination of the pilot
program, and requires the report to include an
evaluation of the pilot program's cost, safety, and
quality of care.
15.Sunsets the SHSNF pilot program on January 1, 2020.
16.Makes conforming changes to avoid chaptering out
problems with SB 135 (Ed Hernandez, 2012) regarding free
standing hospice facility licensure.
17.Makes other technical and clarifying changes.
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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
years to develop regulations (Licensing and
Certification Program Fund).
Minor ongoing costs to license and inspect facilities
(Licensing and Certification Program Fund).
SUPPORT : (Verified 8/29/12)
NCB Capital Impact (source)
Aging Services of California
Alzheimer's Association
California Alliance for Retired Americans
California Association of Health Facilities
California Commission on Aging
California Culture Change Coalition
California Senior Legislature
Congress of California Seniors
Mount San Antonio Gardens
ARGUMENTS IN SUPPORT : This bill is sponsored by NCB
Capital Impact (NCB), which has established The Green House
Project, funded by the Robert Wood Johnson Foundation, to
help spur replication of The Green House concept. NCB
describes The Green House concept as an innovative model
for residential long-term care that involves a total
rethinking of the philosophy of care, architecture, and
organizational structure normally associated with long-term
care.
According to NCB, a Green House home is an independent,
self-contained home for six to 12 people, designed to look
like a private home or apartment in the surrounding
community. NCB states that Green House homes are typically
licensed as SNFs and meet all applicable federal and state
regulatory requirements. Each home is staffed by a team of
universal workers, who have core training as Certified
Nurse Assistants (CNA), plus extensive training in the
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Green House philosophy, the self-managed work team
structure of the Green House home, culinary skills, and
household management. These CNAs provide personal care,
meal preparation, and light housekeeping and laundry, among
other duties.
Preliminary studies have suggested that care in Green
House-model SNFs may lead to small improvements in certain
outcomes, such as more direct care time per day in Green
House models as compared to similar residents in
traditional nursing homes. Studies are ongoing to attempt
to tease out whether Green House offers better care than
traditional nursing homes and, if so, which specific
elements and practices are making the difference.
According to the author's office, Green House homes are
currently operating in 21 states. The author's office
states that one California nursing home provider has been
working for three years to implement the Green House model,
but the provider has experienced significant delays and
added costs because the Green House model does not fit well
with California's current law.
CTW/DLW:k 8/30/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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