Amended in Assembly April 11, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 973

Introduced by Assembly Member Quirk-Silva

February 22, 2013

An act to amend Section 1417.2 of, and to add begin insert and repeal end insert Section 1417.5 begin delete to end delete begin insert of end insert , the Health and Safety Code, relating to long-term health care facilities, and making an appropriation therefor.

LEGISLATIVE COUNSEL’S DIGEST

AB 973, as amended, 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 begin delete both accounts end delete begin insert the end insert begin insert State Health Facilities Citation Penalties Account end insert 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 begin delete improvement of quality of care and quality of life for facility residents end delete begin insert general promotion of culture change and person-centered care in the state’s long-term care facilities end insert , 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 begin delete the promotion of culture change and person-centered care end delete begin insert specific projects as directed by the federal government for improvement of quality of life for long-term care residents end insert , as specified.

This bill would also require begin insert , for 4 years after the receipt of funds from the State Health Facilities Citation Penalties Account, end insert the director of the department to contract with a nonprofit begin delete community agency end delete begin insert org end insert begin insert anization end insert , as specified, to begin delete act as the Statewide Culture Change Consultant end delete begin insert promote culture change end insert . The bill would require the begin delete Statewide Culture Change Consultant end delete begin insert nonprofit organization end insert 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. begin delete Moneys end delete begin insert Except as
provided in paragraph (5), moneys end insert from begin delete these accounts end delete begin insert the State
Health Facilities Penalties Account end insert shall be continuously
appropriated and used, notwithstanding Section 16370 of the
Government Code, 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. begin insert If the
amount of moneys in the account falls below eight million dollars
($8,000,000), funding for the Long-Term Care Ombudsman
Program shall receive priority over funding for the purposes
described in paragraph (6). end insert

begin delete

(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).

end delete begin delete

(2)

end delete

begin insert (6) end insert  Moneys from the State Health Facilities Citation Penalties
Account, in the amount not to exceed one hundred fifty thousand
dollars ($150,000) begin delete 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 end delete begin insert shall be used for the general promotion of culture change
and person-centered care in the state’s long-term care facilities end insert .

begin delete

(c)

end delete

begin insert (b) end insert   begin insert (1) end insert begin insert   end insert Moneys from the Federal Health Facilities Citation
Penalties Account, in the amount not to exceed two hundred fifty
thousand dollars ($250,000) each fiscal year, shall be used for begin delete the
promotion of culture change and person-centered care in the state’s
long-term health care facilities pursuant to Section 1417.5 end delete begin insert specific
projects as directed by the federal government for the improvement
of quality of care and quality of life for long-term care residents,
including the promotion of person-centered care and culture
change end insert .

begin insert

(2) In order to promote culture change as specified in paragraph
(1), projects undertaken by the nonprofit organization under the
direction of the state and federal government shall specify the
desired outcomes, deliverables, and how the project is to be
evaluated. At the commencement of the projects, the state shall
post on its Internet Web site a description of the project to be
undertaken, including a timeline for activities and evaluation.
Within six months of the completion of the project, the state shall
post on its Internet Web site the outcomes of the projects.

end insert begin delete

(d)

end delete

begin insert (c) end insert  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)  begin delete The end delete begin insert In order to promote culture change, as
specified in paragraph (6) of subdivision (a) of Section 1417.2,
the end insert director shall contract with a nonprofit begin delete community agency
meeting the requirements of this section to act as the Statewide
Culture Change Consultant, to be selected through a bid procedure. end delete
begin insert organization that meets both of the following requirements: end insert

begin insert

(1) The organization has a proven record of experience in
providing information, technical assistance, and direct services
to long-term health care facilities and other stakeholders.

end insert begin insert

(2) The organization includes on its board of directors, advisory
council, or both, the following persons:

end insert begin insert

(A) Residents or family members of residents.

end insert begin insert

(B) Personnel and representatives of long-term health care
facilities and facility personnel.

end insert begin insert

(C) Long-term health care facility resident advisory
organizations.

end insert begin insert

(D) Representatives of state licensing agency personnel.

end insert begin insert

(E) The state ombudsman and a representative from the
California Long-Term Care Ombudsman Association.

end insert begin delete

(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.

end delete begin delete

(2)

end delete

begin insert (b) end insert  The begin delete Statewide Culture Change Consultant end delete begin insert nonprofit
organization end insert shall do all of the following:

begin delete

(A)

end delete

begin insert (1) end insert  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.

begin delete

(B)

end delete

begin insert (2) end insert  Develop and conduct training that is appropriate for a variety
of long-term health care facility stakeholders.

begin delete

(C)

end delete

begin insert (3) end insert  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 begin insert upon request end insert .

begin delete

(D)

end delete

begin insert (4) end insert  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.

begin delete

(E)

end delete

begin insert (5) end insert  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.

begin delete

(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)

end delete

begin insert (c) end insert  (1) The begin delete Statewide Culture Change Consultant end delete begin insert nonprofit
organization end insert 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 begin delete that includes the costs of specific
programs, services, and materials provided and the overhead costs
for providing specific programs, services, and materials end delete begin insert and
summary of expenditures end insert .

(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.

begin delete

(2)

end delete

begin insert (d) end insert  It is recognized that in order for the begin delete Statewide Culture
Change Consultant end delete begin insert nonprofit organization end insert to conduct the duties
specified in this section begin delete some portion of the end delete begin insert these end insert funds will
support core operations of the organization, such as staffing salaries
and operational expenses.

(e) Nothing in this chapter shall prohibit the begin delete Statewide Culture
Change Consultant end delete begin insert nonprofit organization end insert from begin delete raising end delete begin insert seeking end insert
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.

begin insert

(g) This section shall remain in effect only until the January 1
of the year that is four years after the date funds are received by
the nonprofit organization for expenditure from the state fund, and
as of that date is repealed, unless a later enacted statute, that is
enacted before that date, deletes or extends that date.

end insert