BILL ANALYSIS Ó
AB 852
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Date of Hearing: April 9, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 852 (Quirk) - As Amended: April 1, 2013
SUBJECT : Skilled nursing facility construction, alteration, or
addition: review.
SUMMARY : Requires the Office of Statewide Health Planning and
Development (OSHPD) to develop with stakeholders reasonable
timeframes for review and approval of skilled nursing facility
(SNF) construction, alteration, or addition projects and
authorizes OSHPD to assess a reasonable fee for this review.
Specifically, this bill :
1)Requires that documents submitted to OSHPD for new
construction of, alteration of, or addition to skilled nursing
facilities include the name and contact information for an
individual designated to be the project coordinator, and
requires these documents to be reviewed and approved within
the timeframes established by this bill.
2)Requires that upon receipt of the document submitted pursuant
to 1) above, each submittal to be logged in by OSHPD and given
preliminary review within 48 hours by designated qualified
professional staff familiar with health facilities providing
skilled nursing care to determine if the submittal is
complete.
3)Requires OSHPD, within 48 hours, to notify the project
coordinator telephonically if the submittal is incomplete and
of the specific documents that may be missing or require
correction.
4)Indicates that upon notification, the project coordinator may
request the submittal to be returned for correction and
resubmission, or an appointment with OSHPD to meet and deliver
any missing documents or make corrections to the documents as
necessary to meet the requirements of OSHPD.
5)Requires that for projects not qualifying for rapid review, as
specified, the Facilities Development Division to meet
reasonable timeframes developed by OSHPD, in conjunction with
stakeholders, that include all of the following:
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a) First review of new projects;
b) Backchecks; and,
c) Amended construction documents.
6)Requires new projects that qualify for review by the Rapid
Review Unit to be completed within an average of 15 business
days.
7)Requires OSHPD to charge a reasonable fee for the review and
approval of plans under this bill. Requires the fee to be
based on the estimated cost, including costs associated with
the designated qualified professional staff, but not exceed
the reasonable cost of the entire phased review and approval
process for those plans.
8)Increases from $50,000 to $100,000 the existing project cost
threshold of construction or alteration projects that may be
exempt from the plan review process.
9)Authorizes OSHPD to seek outside assistance through contracts
with qualified professional architectural or engineering
firms, or coordinate with local building officials to delegate
jurisdiction on specific types of projects.
10)Requires OSHPD to monitor document submissions related to new
or comparative design concepts meeting approval and, when
feasible, publish standard requirements for use by
stakeholders. Allows design concepts to include new
construction, renovation, or replacement. Indicates that
design concepts, to be considered, may include, but are not
limited to, reduction in beds; installation and use of new
technology, such as electronic medical records; space
conversion dedicated to changes in care delivery models; and
common replacement of major infrastructure equipment,
including roofing HVAC, generators and emergency power
systems, water heaters and boilers, and kitchen and laundry
room equipment.
11)Requires OSHPD to work with stakeholders to establish
education and outreach programs directed at reducing document
submission error rates and turnaround times.
12)Finds and declares that improving the efficiency of health
care building plan review and construction efforts will not
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only reduce the time to design, review, and complete facility
construction, but also lower the cost of the project and
reduce overall cost pressures on the health care system,
allowing more resources to be directed to direct patient
services.
13)Provides that it is the intent of the Legislature to codify
the timeframes and due dates for completion by OSHPD of the
review of facility construction documents and to require OSHPD
to notify applicants of the anticipated date the review will
be completed and returned to them.
EXISTING LAW :
1)Establishes the Alfred E. Alquist Hospital Facilities Seismic
Safety Act (Act) of 1983 which specifies design and
construction standards for hospital buildings. Defines a
hospital building to include any building, unless exempted,
that is used, or designed to be used, for a health facility of
a type required to be licensed. Exempts from the definition
of hospital building any building used, or designed to be
used, for a SNF or intermediate care facility if the building
is a single-story, wood-frame or light steel frame
construction or any building of single-story, wood-frame or
light steel frame construction where only skilled nursing or
intermediate care services are provided if the building is
separated from a building housing other patients of the health
facility receiving higher levels of care.
2)Establishes within OSHPD, a Hospital Building Safety Board to
advise the director and act as a board of appeals in all
matters relating to the administration and enforcement of
building standards relating to the design, construction,
alteration, and seismic safety of hospital building projects
submitted to OSHPD.
3)Requires the governing board of each hospital or other
hospital governing authority, before adopting any plans for
the hospital building, to submit the plans to OSHPD for
approval and pay the fees, as specified.
4)Requires the application for approval of the plans to be
accompanied by the plans, including full, complete, and
accurate specification, and structural design computations,
which must comply with the requirements of OSHPD.
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5)Requires OSHPD to pass upon and approve or reject all plans
for the construction or the alteration of any hospital
building, independently reviewing the design to assure
compliance with specified requirements. Requires OSHPD to
review structural systems and related details, including the
independent review of the geological data.
6)Requires OSHPD to determine an application filing fee that
will cover the costs, as specified. Provides that for a SNF,
the fee shall not exceed 1.5% of the project's estimated
construction cost.
7)Requires OSHPD to issue an annual permit upon submission of an
application for one or more projects of a SNF, if the total
estimated cost is $25,000, or less per fiscal year. Requires
the fee for the annual permit to be $250 and is in lieu of an
application filing fee. Requires the annual permit to cover
all projects undertaken for a particular SNF up to a total
estimated construction cost of $25,000 during the fiscal year
in which the annual permit is issued. Requires if a SNF
chooses not to apply for an annual permit for a project
costing $25,000 or less, to instead submit the project for
review and approval as specified in 4) above.
8)Requires all plans and specifications to be prepared under the
charge of an architect or structural engineer or both.
Requires that before commencing any construction or alteration
of any hospital building, the written approval of the
necessary plans as to safety of design and construction, by
OSHPD, to be obtained.
9)Requires, whenever OSHPD finds a violation of existing law, as
specified, that requires correction, a citation of the
violation to be issued to the hospital governing board or
authority in writing and to include a proper reference to the
regulation or statute being violated.
10)Requires OSHPD to establish a program for training fire and
life safety officers to provide a sufficient number of
qualified persons to facilitate the timely performance of
OSHPD's duties and responsibilities relating to the review of
plans and specifications relating to the design and
observation of construction of hospital buildings, as
specified.
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11)Requires OSHPD to exempt from its plan review process
construction or alteration projects for hospital buildings, as
specified, with estimated construction costs of $50,000 or
less.
12)Defines a SNF as a 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.
Requires SNFs to be licensed by the Department of Public
Health.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . The California Association of Health
Facilities (CAHF) is the sponsor of this bill. According to
the author, OSHPD's review of renovation and compliance
projects is a source of significant frustration for the
skilled nursing provider community. Repetitive reviews at the
local and state levels lengthen the review process. The
Facilities Development Division (FDD), a subdivision of OSHPD,
is responsible for monitoring construction plans to ensure
conformance to federal and state requirements. The aspects of
the FDD's responsibility that have the greatest negative
impact on long term care providers are: a) cumbersome and
confusing plan review; b) duplicative field review and
inspection; and, c) the difficulty in altering projects to
meet compliance. In addition, project cost thresholds for an
exemption, currently set at $50,000, are too low to cover
small projects such as the replacement of a generator or a
kitchen oven, which can cost more than $70,000. Removing
some of the barriers for facilities to make changes to
physical plants efficiently will allow for improvements in
care delivery.
2)BACKGROUND . The Act, originally passed in 1973 and updated in
1983, requires all new hospital construction to meet building
standards specifically designed for hospital buildings. These
standards, however, were not originally applied to hospitals
built before March 1973, except when those existing buildings
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undergo major renovations. Following the 6.7 magnitude
Northridge earthquake in January 1994, the Legislature passed
and then-Governor Wilson signed into law SB 1953 (Alquist),
Chapter 740, Statutes of 1994. Hospitals built in accordance
with the standards of the Act resisted the 1994 Northridge
earthquake with minimal structural damage, while several
facilities built before the Act experienced major structural
damage and had to be evacuated. In addition, certain
nonstructural components of the hospitals did incur damage,
even in facilities built in accordance with the structural
provisions of the Act.
Current law requires that the governing board of each hospital
or other hospital governing authority, before adopting any
plans for the hospital building, to submit the plans to OSHPD
for approval. The application for approval of the plans must
include architectural, mechanical and electrical
specifications and structural design computations. OSHPD then
reviews the plans, and issues the necessary permits for the
construction. During construction or alteration, inspections
are conducted by OSHPD. Hospitals that apply for construction
or alteration permits must pay specified fees, depending on
the cost of the construction. According to OSHPD, it has
implemented a 60-30-30 policy where the review of a project is
undertaken within 60 days. If a project design does not meet
all the requirements, it is sent back to the owner of the
facility and is deemed non-compliant. After corrections are
re-submitted, OSHPD takes 30 days to do the re-review
(commonly referred to as the first backcheck). After the
owner resubmits the corrected design, OSHPD conducts a
re-review (second backcheck) usually within 30 days. OSHPD
indicates that it is meeting these timeframes 91% of the time.
It should be noted that these timeframes depend on the
quality of the designs that are submitted and resubmitted to
OSHPD. Additionally, OSHPD points out that if there are
changes that need to be done during project construction, it
usually conducts a post-approval of the changes within 30days.
OSHPD submitted the following goals for plan review to the
Committee:
a) Remodel and renovation projects d $175,000.00 excl.
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fixed equip. costs :
i) Initial review: 21 days
ii) Back check: 21 days
b) Remodel and renovation projects > $175,000.00:
i) Initial review: 60 days
ii) Back check: 30 days
iii) Post-approval documents: 30 days
c) Large, complex projects with major structural work:
i) Initial review: 80 days
ii) Back check: 40 days
iii) Post-approval documents: 30 days
d) Goals do not apply to Managed Projects or Phased Plan
Reviews
i) Schedules negotiated on a case by case basis
OSHPD's Rapid Review Unit was established to provide expedient
review times for qualified projects not involving unusual
proximity. According to OSHPD, projects that qualify for
rapid review are approved within 15 days. To be eligible for
rapid review, new projects must cost between $100,000 -
$175,000. Construction or alteration projects with estimated
construction costs of $50,000 or less may be exempt from the
plan review process. This bill increases this threshold to
$100,000.
3)SUPPORT . CAHF indicates that this bill will improve the
efficiency for SNF building plan review and construction
efforts through OSHPD's development of standardized time
frames for plan review/approval and will authorize OSHPD to
participate in joint training and educational efforts to
assist in reducing document submission error rates. These
changes will not only reduce the time to design, review, and
complete facility construction, but will also lower the cost
of the project and reduce overall cost pressures on the health
care system, allowing more resources to be directed to direct
patient services. The Associated General Contractors indicate
that OSHPD's process includes a cumbersome plan check and
review process to meet compliance requirements. Existing
project cost thresholds for a streamlined review are also too
low even for small projects. The Construction Employers'
Association states that any measure which expedites the
construction process in SNFs is in the best interest of the
facility, and the individuals relying on the facility.
4)PREVIOUS LEGISLATION . SB 1838 (Perata and Florez), Chapter
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693, Statutes of 2006, authorizes OSHPD to establish a
training program for personnel who review hospital and
construction plans, exempts hospital and SNFs projects that
cost less than $50,000 from OSHPD's plan review process, and
requires presubmittal meeting with OSHPD plan review staff on
hospital and SNF facility projects costing over $20 million.
5)AUTHOR'S AMENDMENTS . The author proposes to amend this bill
to increase the application filing fee of SNFs or ICFs from
1.5% of the project's estimated construction cost to no more
than 2%, the same fee that applies to general acute care
hospitals, acute psychiatric hospitals, or special hospitals.
6)POLICY CONSIDERATIONS .
a) Timeframes . This bill requires OSHPD to provide
preliminary review of documents submitted by SNFs for
construction or alteration projects within 48 hours. It is
unclear if these timeframes are attainable. The author may
wish to amend this bill to require OSHPD to develop these
timeframes with stakeholders.
b) Review exemption for projects less than $50,000 . This
bill changes existing cost threshold of projects that are
exempt from the plan review process from $50,000 to
$100,000. The author may wish to clarify that this change
only applies to SNF projects.
c) Publication of requirements and timeframes . In an
effort to inform SNFs and other stakeholders of the
requirements and timeframes for construction projects, the
author may wish to amend this bill and require OSHPD to
publish on its Internet Website the requirements for SNF
construction and alteration projects, including the
timeframes that would be developed pursuant to this bill.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Health Facilities (sponsor)
Associated General Contractors
Congress of California Seniors
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Construction Employers' Association
Opposition
None on file.
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097