BILL ANALYSIS Ó
SB 534
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Date of Hearing: August 6, 2013
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Mariko Yamada, Chair
SB 534 (Hernandez) - As Amended: July 3, 2013
SENATE VOTE : 34-0
SUBJECT : Health and other care facilities.
SUMMARY :
1)Requires chronic dialysis clinics, surgical clinics, and
rehabilitation clinics to comply with federal certification
standards in effect immediately preceding January 1, 2013
until the Department of Public Health (DPH) adopts regulations
relating to the provision of those services.
2)Requires DPH, by July 1, 2017, to conduct at least one public
hearing and submit a report to appropriate legislative
committees, describing the extent to which the federal
certification standards are sufficient, or not, as a basis for
state licensing standards, and make recommendations for any
California specific standards which may be necessary.
3)Requires health facilities categorized as "intermediate care
facility/developmentally disabled-nursing" (ICF/DD-N), and
"intermediate care facility/developmentally
disabled-continuous nursing" (ICF/DD-CN), to comply with
specified federal certification standards until the DPH and
the Department of Developmental Services (DDS) comply with
existing law to jointly develop and implement appropriate
licensing regulations.
4)Repeals these provisions on January 1, 2018.
EXISTING LAW :
1)Establishes a range of duties and powers for the DPH,
including adopting, and occasionally amending or repealing,
reasonable rules and regulations, including those for various
types of clinics, necessary to carry out the purposes of law.
2)Requires those regulations to prescribe standards of adequacy,
safety, sanitation, staffing, and standards for providing the
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services offered.
3)Requires DPH to propose licensing fees for all clinics and
facilities within its regulatory jurisdiction at a level that,
along with support from federal funds, will not require the
Licensing and Certification Division to seek General Funds to
support its activities.
4)Requires DPH and DDS to jointly develop and implement
licensing and Medi-Cal regulations appropriate for ICF/DD-N
and ICF/DD-CN facilities to assure residents receive
appropriate medical and nursing services, along with
developmental program services, in the least restrictive
physical and programmatic environment appropriate to resident
need.
5)Requires DDS to review and approve an applicant facility's
program plan as a prerequisite to the licensing and
certification process, rather than as a part of the process.
FISCAL EFFECT : The Assembly Appropriations Committee has not
yet analyzed this measure. SB 534 was placed on Senate Second
Reading pursuant to Senate Rule 28.8.
COMMENTS :
AUTHORS STATEMENT : "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."
FEDERAL, STATE REGULATIONS : Technical, operational, and legal
details that make laws work on a day-to-day basis, known as
regulations, are often required to implement laws. The federal
regulatory standards for chronic dialysis clinics (referred to
as "end stage renal centers" in federal regulations), surgical
clinics (known as "ambulatory surgical clinics" in federal
regulations), and rehabilitation clinics, describe standards
which would qualify them to seek reimbursement from the Medicare
program or the Medicaid program. The federal regulations
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currently in place which impact the facilities addressed in SB
534 are known as Title 42 of the Code of Federal Regulation and
pertain to public health, social welfare, and civil rights.
They set forth standards to assure quality, cleanliness,
adequate medical and/or nursing staff, patient's rights, and
privacy. In addition, regulations for ICF/DD-N and ICF/DD-CN
address active treatment services, client behavior and facility
practices.
BACKGROUND : According to the DPH, health care facilities in
California are licensed, regulated, inspected, and/or certified
by a number of public and private agencies at the state and
federal levels, including the DPH Licensing and Certification
Program (L&C) and the federal Centers for Medicare and Medicaid
Services (CMS). These agencies have separate -- yet sometimes
overlapping -- jurisdictions. L&C is responsible for ensuring
health care facilities comply with state laws and regulations.
In addition, L&C cooperates with CMS to ensure that facilities
accepting Medicare and Medi-Cal meet federal requirements. L&C
also oversees the certification of nurse assistants, home health
aides, hemodialysis technicians, and the licensing of nursing
home administrators.
L&C serves as the regulatory authority for about 30 separate
types of health care facilities and clinics. DPH does not
currently have state-level enforcement standards in place for
licensed ambulatory surgery clinics, chronic dialysis clinics,
rehabilitation clinics, or intermediate care facility
classifications. Nonetheless, federal Medicaid and Medicare
certification standards exist. State law does not authorize the
use of those standards in lieu of state-specific standards.
When compliance with federal standards is lacking, the only
existing recourse for DPH is to recommend action by CMS to stop
funding, which carries long-term consequences which could be
detrimental to access. SB 534 links state licensing enforcement
to federal certification standards and allows the state to
enforce the federal standards without resorting immediately to a
recommendation to withhold federal funding. DPH reports that
draft regulations for the ICF/DD-N category are expected to be
submitted to the Office of Administrative Law by March of 2014.
According to DPH, SB 534 will link enforcement to standards
which will likely improve care for patients being treated in
these settings. The following are descriptions of the classes
of facilities addressed by SB 534:
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Surgical clinics are entities that operate exclusively for the
purpose of providing surgical services to patients not
requiring hospitalization and in which the expected duration
of services would not exceed 24 hours following an admission.
Chronic dialysis clinics provide outpatient maintenance
dialysis services, or home dialysis training and support
services, or both, and may be independent or hospital-based.
Rehabilitation clinics are nonresidential facilities
established for the purpose of providing diagnostic,
therapeutic, and restorative services to outpatients for the
rehabilitation of injured, disabled, or sick persons, at a
single fixed location, generally under the supervision of a
physician.
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.
The Department has prioritized its regulation packages such that
those that have an impact to the health and safety of patients
are completed first. The Department anticipates using the
federal standards at licensed dialysis, surgical and
rehabilitation clinics, and no state level regulations are under
development. Federal standards are focused on the provision of
quality healthcare and patient safety in health care facilities.
RELATED LEGISLATION :
AB 2308 (Plescia) of 2006, would have required the Department of
Health Services (now DPH) to convene a workgroup to develop
licensure criteria to protect patients receiving care in
surgical centers and to submit workgroup conclusions and
recommendations to the appropriate policy committees of the
Legislature no later than March 1, 2007. AB 2308 was vetoed by
the Governor.
AB 543 (Plescia) of 2007 would have established licensing
requirements for surgical clinics and would have required,
effective January 1, 2008, that all surgical clinics meet
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specified operating and staffing standards. AB 543 was vetoed
by the Governor.
AB 2122 (Plescia) of 2008 would have established the California
Outpatient Surgery Patient Safety and Improvement Act which
would have required surgical clinics to meet prescribed
licensing requirements and standards, including compliance with
Medicare Conditions of Participation. AB 2122 was held in the
Assembly Appropriations Committee.
SB 1170 (Alquist ) of 2008 would have required the DPH, the DDS,
and the DHCS to promulgate emergency regulations setting forth
training standards for intermediate care facility (ICF) and
intermediate care facility/developmentally disabled-nursing
(ICF/DD-N) staff.
SB 1180 was held in Senate Appropriations Committee.
AB 832 (Jones) of 2009, was also sponsored by DPH and would have
required DPH to convene a workgroup, no later than February 1,
2010, to consider and develop recommendations for state
oversight and monitoring of surgical clinics, to ensure public
health and safety. AB 832 was held in the Assembly
Appropriations Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
California Department of Public Health (CDPH) - Sponsor
Opposition
None on file.
Analysis Prepared by : Robert MacLaughlin / AGING & L.T.C. /
(916) 319-3990