Amended in Assembly April 25, 2013

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 and repeal Section 1417.5 of, 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. begin delete Exiting end delete begin insert Existing end insert law also authorizes the department to use up to begin delete $150,000 end delete begin insert $130,000 end insert 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 the State Health Facilities Citation Penalties Account 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 general promotion of culture change and person-centered care in the state’s long-term care facilities, 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 specific projects as directed by the federal government for improvement of quality of life for long-term care residents, as specified.

This bill would also require, for 4 years after the receipt of funds from the State Health Facilities Citation Penalties Account, the director of the department to contract with a nonprofit organization, as specified, to promote culture change. The bill would require the nonprofit organization 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. Except as provided
in paragraph (5), moneys from the State Health Facilities Penalties
Account 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. 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).

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

(b) (1) 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
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.

(2) In order to promote culture change as specified in paragraph
(1), projects undertaken by the nonprofit organization under the
direction of the begin delete state end delete begin insert department end insert and federal government shall
specify the desired outcomes, deliverables, and how the project is
to be evaluated. At the commencement of the projects, the begin delete state end delete
begin insert department end insert 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 begin delete state end delete begin insert department end insert shall post on its Internet Web site the
outcomes of the projects.

(c) 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)  In order to promote culture change, as specified
in paragraph (6) of subdivision (a) of Section 1417.2, the director
shall contract begin insert through a competitive bid process end insert with a nonprofit
organization that meets both of the following requirements:

(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.

(2) The organization begin delete includes on its board of directors, advisory
council, or both, end delete begin insert demonstrates that it includes the involvement of end insert
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 advisory
organizations.

(D) Representatives of state licensing agency personnel.

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

(b) The nonprofit organization shall do all of the following:

(1) 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.

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

(3) 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 upon request.

(4) 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.

(5) 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) (1) The nonprofit organization 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 and summary of expenditures.

(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.

(d) It is recognized that in order for the nonprofit organization
to conduct the duties specified in this section these funds will
support core operations of the organization, such as staffing salaries
and operational expenses.

(e) Nothing in this chapter shall prohibit the nonprofit
organization from seeking 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.

(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.