BILL ANALYSIS �
AB 973
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ASSEMBLY THIRD READING
AB 973 (Quirk-Silva)
As Amended April 25, 2013
2/3 vote
HEALTH 12-6 APPROPRIATIONS 16-1
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|Ayes:|Pan, Ammiano, Atkins, |Ayes:|Gatto, Harkey, Bigelow, |
| |Bonilla, Bonta, Gomez, | |Bocanegra, Bradford, Ian |
| |Roger Hern�ndez, | |Calderon, Campos, Eggman, |
| |Lowenthal, Mitchell, | |Gomez, Hall, Ammiano, |
| |Nazarian, | |Linder, Pan, Quirk, |
| |V. Manuel P�rez, | |Wagner, Weber |
| |Wieckowski | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Logue, Maienschein, |Nays:|Donnelly |
| |Mansoor, Nestande, | | |
| |Wagner, Wilk | | |
| | | | |
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SUMMARY : Requires the Department of Public Health (DPH) to use
specified funds from the state and federal Health Facilities
Citation Penalty Accounts to contract through a competitive bid
process with a nonprofit organization that meets specified
criteria to promote culture change and person-centered care in
long-term care (LTC) facilities. Specifically, this bill :
1)Requires moneys from the State Health Facilities Penalty
Account (state penalty account) to be continuously
appropriated rather than subject to appropriation by the
Legislature, except with regard to the existing LTC Ombudsman
Program.
2)Deletes existing law prohibiting the balance in the state
penalty account from exceeding $10 million dollars. Requires
no more than $150,000 from the state penalty account to be
used for the general promotion of culture change and
person-centered care in the state's LTC facilities.
3)Provides that if the amount of money in the state penalty
account falls below $8 million, funding for the existing LTC
Ombudsman Program must receive priority over funding for the
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purpose of culture change and person-centered care required by
this bill.
4)Requires no more than $250,000 from the Federal Health
Facilities Citation Penalties Account (federal penalty
account) each fiscal year to be used for specific projects as
directed by the federal government for the improvement of
quality of care and quality of life for LTC residents,
including the promotion of person-centered care and culture
change.
5)Requires the Director of DPH to contract through a competitive
bid process with a nonprofit organization that meets specified
requirements, and requires projects undertaken by the
nonprofit organization under the direction of the state and
federal government to specify the desired outcomes,
deliverables, and how the project is to be evaluated.
6)Defines, for purposes of this bill, "culture change" to mean
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, as specified.
FISCAL EFFECT : According the Assembly Appropriations Committee,
this bill would incur costs of up to $150,000 from the State
Penalty Fund and up to $250,000 from the Federal Penalty Fund.
This bill also changes a legislative appropriation to a
continuous appropriation.
COMMENTS : The author notes that nearly all states now have
coalitions dedicated to promoting the values and practices of
culture change in LTC and finding pragmatic ways to encourage
nursing homes to adopt these values. The author states that the
federal government recognizes that states need additional
funding to support and amplify the work of the state coalitions
and federal approval for states to use civil money penalties
represents a significant contribution to the survival of these
fledgling organizations. However, the author maintains that
additional funding is needed to sustain these efforts and such
funding is imperative in California in particular, because it is
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a large, geographically and culturally diverse state with over
1,200 nursing homes, all of which are in need of funds to
enhance the quality of life for those who live in them. The
author reports that, as of September 2012, the state penalty
account had a balance of over $11 million. According to the
author, by continuously appropriating a small portion of these
funds, this bill seeks to make California the national leader in
promoting culture change and best practices in the delivery of
long-term health care in nursing home settings.
According to the California HealthCare Foundation (CHCF), recent
literature shows that nursing homes embracing culture change
have improved quality outcomes and offer preliminary evidence of
positive business impacts. However, CHCF indicates that
California has lagged behind other states in implementing
culture change. According to a January 2013 issue brief from
the Kaiser Family Foundation (KFF) describing provisions of the
federal Patient Protection and Affordable Care Act (ACA) aimed
at improving nursing home transparency, care quality, and abuse
prevention, the federal Centers for Medicare and Medicaid
Services has supported the culture change movement with
information, technical assistance to facilities, training of
surveyors, and review of regulations to remove unnecessary
barriers to creating more home-like environments. KFF reports
that, although some nursing homes have the necessary information
technology (IT) infrastructure, overall the nation's 15,800
nursing homes have lagged behind other health care settings in
the use of information technology to improve clinical care and
personalize care delivery.
KFF indicates that the ACA authorizes two national demonstration
projects to improve resident care through culture change and
information technology. One grant would be awarded to
facilities that are involved in culture change to develop best
practice resources and the other grant opportunity would develop
best practices in the use of IT to improve resident care. As of
January 2013, KFF reports that no funds have been allocated to
conduct these projects.
California Advocates for Nursing Home Reform (CANHR) objects to
diverting funds from the state and federal penalty accounts to
pay for culture change. CANHR argues that if skilled nursing
facilities were truly interested in culture change, they would
fund it on their own. CANHR writes that while it supports
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culture change practices in nursing homes, including consistent
staffing, reduction of psychotropic drugs, and patient-centered
care, it is not appropriate to use funds paid by facilities with
serious violations of the law to provide those same facilities
with culture change services. Disability Rights California
raises concerns about the lack of involvement of residents.
Analysis Prepared by : Ben Russell / HEALTH / (916) 319-2097
FN: 0000908