BILL ANALYSIS �
SENATE HUMAN
SERVICES COMMITTEE
Senator Leland Y. Yee, Chair
BILL NO: SB 534
S
AUTHOR: Hernandez
B
VERSION: April 9, 2013
HEARING DATE: April 23, 2013
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FISCAL: Yes
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CONSULTANT: Mareva Brown
SUBJECT
Health and care facilities
SUMMARY
This bill requires that until the California departments of
Public Health (DPH) and Developmental Services (DDS) adopt
regulations for Intermediate Care Facilities for the
Developmentally Disabled (ICF/DD), so that these facilities
comply with applicable federal certification standards.
Also requires chronic dialysis clinics, surgical clinics,
and rehabilitation clinics to comply with federal standards
until DPH has adopted regulations for those facilities.
ABSTRACT
Existing law
1) Requires DPH to license and regulate various types
of facilities, including intermediate care
facilities/developmentally disabled-nursing
(ICF/DD-N), which are defined as facilities with a
capacity of 4 to 15 beds that provide 24-hour personal
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STAFF ANALYSIS OF SENATE BILL 534 (Hernandez)
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care, developmental services, and nursing supervision
for persons with developmental disabilities who have
intermittent recurring needs for skilled nursing care
but have been certified by a physician as not
requiring continuous skilled nursing care.
2) Requires DPH to license and regulate various
clinics, including primary care and specialty clinics
which include: surgical clinics, chronic dialysis
clinics, and rehabilitation clinics.
3) Requires DPH to adopt reasonable rules and
regulations as may be necessary to enable DPH to carry
out the purposes of provisions of law governing the
various types of clinics licensed by DPH.
4) Requires DPH to propose licensing fees for all of
its clinics and facilities at a level that will not
require the licensing and certification program to
seek General Funds to support its activities unless
otherwise specified in statute.
5) Requires DPH and DDS to jointly develop and
implement licensing regulations appropriate for
intermediate care facilities for the developmentally
disabled-nursing (ICF/DD-N) and intermediate care
facility for the developmentally disabled-continuous
nursing (ICF/DD-CN).
This bill
1) Requires that intermediate care facilities for the
developmentally disabled-nursing (ICF/DD-N) comply
with applicable federal certification standards for
intermediate care facilities for individuals with
intellectual disabilities in effect immediately
preceding January 1, 2013 until DPH and DDS jointly
develop licensing regulations.
2) Deletes a requirement that regulations developed by
DPH and DDS pertaining to ICF/DD-Ns and ICF/DD-CN
include licensing fee schedules appropriate to
facilities which will encourage their development.
3) Requires DDS to review and approve an applicant's
STAFF ANALYSIS OF SENATE BILL 534 (Hernandez)
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facility program plan as a prerequisite to the
licensing and certification process, rather than as a
part of the process.
4) Requires, until DPH adopts regulations relating to
the provision of services by a chronic dialysis
clinic, surgical clinic or a rehabilitation clinic,
for those clinics to comply with the following federal
certification standards in effect immediately
preceding January 1, 2013:
a. Requires a chronic dialysis clinic to
comply with applicable federal certification
standards for an end stage renal disease clinic;
b. Requires a surgical clinics to comply
with applicable federal certification standards
for an ambulatory surgical clinic; and
c. Requires a rehabilitation clinic to
comply with applicable federal certification
standards for a comprehensive outpatient
rehabilitation facility.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the bill
The author states that this bill would require four health
facility categories currently regulated by DPH to comply
with facility-specific federal certification requirements
to meet state licensing requirements until DPH adopts state
regulations. These facilities already meet federal
requirements in order to receive Medicare and Medicaid
funding; this bill simply gives authority to state
regulators to enforce these standards until such time that
DPH adopts regulations specific to these facilities.
Department of Public Health
The Licensing and Certification program is housed within
DPH's Center for Health Care Quality, which includes about
1,200 staff located in 14 District offices. Among its
duties is to act as the "state survey agency" for the
STAFF ANALYSIS OF SENATE BILL 534 (Hernandez)
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federal Centers for Medicare and Medicaid (CMS). In that
role, DPH is responsible for certifying to the federal
government that the health care facilities are eligible for
payments under CMS programs. DPH makes a certification
recommendation after surveying the health care facilities
and establishing that they are in compliance with all
federal Conditions of Participation.
Intermediate Care Facilities for the Developmentally
Disabled
An ICF/DD provides 24-hour personal care, habilitation,
developmental, and supportive health services to
developmentally disabled clients whose primary need is for
developmental services and who have a recurring but
intermittent need for skilled nursing services. There are
three specialty types of ICF/DDs operating in California.
One of them is the subject of regulations in this bill.
Intermediate Care Facilities for the Developmentally
Disabled / Nursing
The ICF/DD-N is a 4- to 15-bed facility that provides
24-hour personal care, developmental services, and nursing
supervision for developmentally disabled persons who have
intermittent recurring needs for skilled nursing care but
have been certified by a physician and surgeon as not
requiring continuous skilled nursing care. This type of
facility serves medically fragile persons who have
developmental disabilities or demonstrate significant
developmental delays that may lead to a developmental
disability if not treated.<1>
POSITIONS
Arguments in support
DPH, the bill's sponsor, states that this language is
necessary to enable it to adopt existing federal regulatory
standards as the state licensing standards for chronic
dialysis clinics, rehabilitation clinics, surgical clinics,
and ICF/DD-Ns. DPH states that it functions as the
regulatory agency for approximately 30 different types of
health care facilities and clinics. While federal standards
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<1> http://www.dds.ca.gov/livingarrang/icf.cfm
STAFF ANALYSIS OF SENATE BILL 534 (Hernandez)
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for these facilities exist, DPH lacks the statutory
authority to enforce them. In the absence of such
authority, DPH states that it may only recommend action by
the federal CMS to stop Medicare/Medicaid program funding
if the health care facility is out of compliance.
Support: California Department of Public Health
(sponsor)
Oppose: None received
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