BILL NUMBER: AB 973 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Quirk-Silva
FEBRUARY 22, 2013
An act to amend Section 1417.2 of, and to add Section 1417.5 to,
the Health and Safety Code, relating to long-term health care
facilities, and making an appropriation therefor.
LEGISLATIVE COUNSEL'S DIGEST
AB 973, as introduced, Quirk-Silva. Long-term health facilities:
culture change.
Existing law provides for the licensure of long-term health care
facilities by the State Department of Public Health. Existing law,
the Long-Term Care, Health, Safety, and Security Act of 1973,
authorizes the department to assess penalties for violation of
prescribed requirements and requires the moneys collected as a result
of the imposed penalties to be deposited into the State Health
Facilities Citation Penalties Account. Existing law provides that
moneys derived from civil penalties for violations of federal law
shall be deposited into the Federal Health Facilities Citation
Penalties Account. Moneys in both accounts are to be used, upon
appropriation by the Legislature, for the protection of health or
property of residents of long-term health care facilities, as
specified. Exiting law also authorizes the department to use up to
$150,000 of moneys from the Federal Health Facilities Citation
Penalties Account for the improvement of quality of care and quality
of life for facility residents.
This bill would require moneys from both accounts to be
continuously appropriated and used, as specified. By creating a
continuously appropriated fund, the bill would make an appropriation.
The bill would authorize the department to use up to $150,000 of
moneys each fiscal year from the State Health Facilities Citation
Penalties Account for the improvement of quality of care and quality
of life for facility residents, as specified. The bill would require
the department to use up to $250,000 each fiscal year from the
Federal Health Facilities Citation Penalties Account for the
promotion of culture change and person-centered care, as specified.
This bill would also require the director of the department to
contract with a nonprofit community agency, as specified, to act as
the Statewide Culture Change Consultant. The bill would require the
Statewide Culture Change Consultant to serve long-term health care
facilities stakeholders, including, among others, residents and
long-term health care facility personnel, to perform a variety of
tasks, including serving as the centralized information and technical
assistance clearinghouse for best practices in long-term health care
facilities for implementing person-centered care and culture change,
as defined, and to submit annual reports.
Vote: 2/3. Appropriation: yes. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) The federal Nursing Home Reform Act allows the federal
government to issue sanctions against nursing homes that fail to
comply with federal Medicare and Medicaid quality of care
requirements.
(b) Civil money penalties are one of the sanctions established by
the federal government to encourage nursing homes to comply with
federal requirements and to prevent poor quality of care.
(c) The federal government contracts with state licensing and
certification agencies to inspect nursing homes and to issue civil
money penalties for violations of federal conditions of
participation.
(d) Moneys collected as a result of civil penalties imposed due to
violations of federal and state statutes are deposited into two
separate accounts that are established in the Special Deposit Fund
pursuant to Section 16370 of the Government Code.
(e) These civil money penalties offer an opportunity to better the
lives of nursing home residents by providing additional resources to
the state to improve the quality of care and quality of life for
residents.
(f) The federal Patient Protection and Affordable Care Act allows
a portion of the federal civil money penalty funds to be used to
support activities that promote quality of care and the well-being of
nursing home residents in certified nursing homes. Specifically,
federal regulations allow these funds to be used for the promotion of
culture change.
SEC. 2. Section 1417.2 of the Health and Safety Code is amended to
read:
1417.2. (a) Notwithstanding Section 1428, moneys collected as a
result of state and federal civil penalties imposed under this
chapter or federal law shall be deposited into accounts that are
hereby established in the Special Deposit Fund created pursuant to
Section 16370 of the Government Code. These accounts are titled the
State Health Facilities Citation Penalties Account, into which moneys
derived from civil penalties for violations of state law shall be
deposited, and the Federal Health Facilities Citation Penalties
Account, into which moneys derived from civil penalties for
violations of federal law shall be deposited. Moneys from these
accounts shall be continuously appropriated and used,
notwithstanding Section 16370 of the Government Code, upon
appropriation by the Legislature, in accordance with state
and federal law for the protection of health or property of residents
of long-term health care facilities, including, but not limited to,
the following:
(1) Relocation expenses incurred by the department, in the event
of a facility closure.
(2) Maintenance of facility operation pending correction of
deficiencies or closure, such as temporary management or
receivership, in the event that the revenues of the facility are
insufficient.
(3) Reimbursing residents for personal funds lost. In the event
that the loss is a result of the actions of a long-term health care
facility or its employees, the revenues of the facility shall first
be used.
(4) The costs associated with informational meetings required
under Section 1327.2.
(5) Support for the Long-Term Care Ombudsman Program established
pursuant to Chapter 11 (commencing with Section 9700) of Division 8.5
of the Welfare and Institutions Code in an amount appropriated from
the State Health Facilities Citation Penalties Account for this
purpose in the annual Budget Act.
(b) ( 1) Notwithstanding
subdivision (a), the balance in the State Health Facilities Citation
Penalties Account shall not, at any time, exceed ten million dollars
($10,000,000).
(2) Moneys from the State Health Facilities Citation Penalties
Account, in the amount not to exceed one hundred fifty thousand
dollars ($150,000) each fiscal year, may be used for specific
projects for the improvement of quality of care and quality of life
for long-term health care facility residents pursuant to Section
1417.3.
(c) Moneys from the Federal Health Facilities Citation Penalties
Account, in the amount not to exceed one hundred thirty
thousand dollars ($130,000), may also be used, notwithstanding
Section 16370 of the Government Code, upon appropriation by the
Legislature, in accordance with state and federal law for the
improvement of quality of care and quality of life for long-term
health care facilities residents pursuant to Section 1417.3
two hundred fifty thousand dollars ($250,000) each fiscal year,
shall be used for the promotion of culture change and
person-centered care in the state's long-term health care facilities
pursuant to Section 1417.5 .
(d) The department shall post on its Internet Web site, and shall
update on a quarterly basis, all of the following regarding the funds
in the State Health Facilities Citation Penalties Account and the
Federal Health Facilities Citation Penalties Account:
(1) The specific sources of funds deposited into the account.
(2) The amount of funds in the account that have not been
allocated.
(3) A detailed description of how funds in the account have been
allocated and expended, including, but not limited to, the names of
persons or entities that received the funds, the amount of salaries
paid to temporary managers, and a description of equipment purchased
with the funds. However, the description shall not include the names
of residents.
SEC. 3. Section 1417.5 is added to the Health and Safety Code, to
read:
1417.5. (a) The director shall contract with a nonprofit
community agency meeting the requirements of this section to act as
the Statewide Culture Change Consultant, to be selected through a bid
procedure.
(b) (1) The Statewide Culture Change Consultant, in consultation
with the director, shall serve long-term health care facility
stakeholders, including, but not limited to, residents, family
members of residents, facility personnel, representatives of
long-term health care facilities and facility personnel, long-term
health care facility resident advocacy organizations, educational
institutions, representatives of state licensing agency personnel,
and state ombudsmen.
(2) The Statewide Culture Change Consultant shall do all of the
following:
(A) Serve as the centralized information and technical assistance
clearinghouse for the best practices for implementing person-centered
care and culture change in long-term health care facilities.
(B) Develop and conduct training that is appropriate for a variety
of long-term health care facility stakeholders.
(C) Assist the director in conducting data collection regarding
the impact of culture change best practices on long-term health care
facilities and its residents and personnel.
(D) Determine the need for, and conduct, conferences for long-term
health care facility personnel, residents, families, advocacy
organizations, educational institutions, community groups, and the
general public, in order to improve the quality of life and resident
satisfaction in facilities.
(E) Develop training materials, and under the direction of the
director, distribute the training materials to appropriate
stakeholders and report to the director on their distribution, and
when possible, the results of the distribution.
(c) In choosing an appropriate nonprofit community agency to act
as the Statewide Culture Change Consultant, the director shall give
priority to an agency that meets both of the following requirements:
(1) The agency that has a proven record of experience in providing
information, technical assistance, and direct services to long-term
health care facilities and other stakeholders.
(2) The agency includes on its board of directors, or advisory
council, or both, any of the following persons:
(A) Residents or family members of residents.
(B) Personnel and representatives of long-term health care
facilities and facility personnel.
(C) Long-term health care facility resident advocacy
organizations.
(D) Representatives of state licensing agency personnel.
(E) State ombudsmen.
(d) (1) The Statewide Culture Change Consultant shall submit
annual progress reports on its activities, as required by the
director. These reports shall provide a summary and evaluation of the
activities of the organization. The report shall also include all of
the following:
(A) An annual budget that includes the costs of specific programs,
services, and materials provided and the overhead costs for
providing specific programs, services, and materials.
(B) Recommendations for improving the effectiveness of the efforts
to disseminate the principles of culture change to long-term health
care facilities.
(C) Recommendations for the continued efforts in the subsequent
year.
(2) It is recognized that in order for the Statewide Culture
Change Consultant to conduct the duties specified in this section
some portion of the funds will support core operations of the
organization, such as staffing salaries and operational expenses.
(e) Nothing in this chapter shall prohibit the Statewide Culture
Change Consultant from raising additional funding through charitable
contributions, fees for conferences and training, and grants made
from foundations or other organizations, including other governmental
agencies, for the purpose of disseminating the principles of culture
change.
(f) As used in this section, the following terms have the
following meanings:
(1) "Culture change" means the national movement for the
transformation of older adult services, based on person-centered
values and practices where the voices of elders and those working
with them are considered and respected. Core person-centered values
are choice, dignity, respect, self-determination, and purposeful
living, and include all of the following:
(A) Resident care and activities that are directed by the
resident.
(B) A living environment that is designed to be a home rather than
an institution.
(C) Close relationships between residents, family members, staff,
and community.
(D) Work that is organized to support and empower all staff to
respond to residents' needs and desires.
(E) Management that enables collaborative and decentralized
decisionmaking.
(F) Systematic processes that are comprehensive,
measurement-based, and utilized for continuous quality improvement.
(2) "Person-centered care" means treatment and care that places a
person at the center of his or her own care and considers the needs
of the older person. Principles of person-centered care include all
of the following:
(A) Sharing power and responsibility with a person in
decisionmaking about all matters of care and treatment.
(B) Ensuring that care is delivered in a manner that honors a
person's customary preferences and routines.
(C) Ensuring that a person's quality of life is taken into account
along with quality of care.