BILL ANALYSIS Ó SB 534 Page 1 SENATE THIRD READING SB 534 (Ed Hernandez) As Amended July 3, 2013 Majority vote SENATE VOTE :34-0 HEALTH 19-0 AGING 6-0 ----------------------------------------------------------------- |Ayes:|Pan, Logue, Ammiano, |Ayes:|Yamada, Wagner, Brown, | | |Atkins, Bonilla, Bonta, | |Daly, Gray, Levine | | |Chesbro, Gomez, Roger | | | | |Hernández, Lowenthal, | | | | |Maienschein, Mansoor, | | | | |Mitchell, Nazarian, | | | | |Nestande, | | | | |V. Manuel Pérez, Wagner, | | | | |Wieckowski, Wilk | | | | | | | | ----------------------------------------------------------------- APPROPRIATIONS 17-0 -------------------------------- |Ayes:|Gatto, Harkey, Bigelow, | | |Bocanegra, Bradford, Ian | | |Calderon, Campos, | | |Donnelly, Eggman, Gomez, | | |Hall, Holden, Linder, | | |Pan, Quirk, Wagner, Weber | | | | | | | -------------------------------- SUMMARY : Requires, until the California Departments of Public Health (DPH) and Developmental Services (DDS) adopt regulations for licensure for Intermediate Care Facilities for the Developmentally Disabled - Nursing (ICF/DD-N), these facilities comply with applicable federal certification standards. Requires chronic dialysis clinics, surgical clinics, and rehabilitation clinics to comply with federal certification standards until DPH has adopted regulations for those facilities. Specifically, this bill : 1)Requires, until DPH adopts regulations relating to the SB 534 Page 2 provision of services by a chronic dialysis clinic, a surgical clinic, or rehabilitation clinic, the following facilities licensed or seeking licensure 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 clinic to comply with applicable federal certification standards for an ambulatory surgical clinic (ASC); and, c) Requires a rehabilitation clinic to comply with applicable federal certification standards for a comprehensive outpatient rehabilitation facility. 2)Requires until the DPH and DDS adopt regulations pursuant to existing law, relating to services by ICF/DD-N, licensed facilities to comply with applicable federal certification standards in effect immediately preceding January 1, 2013. 3)Deletes a requirement that regulations developed by DPH and DDS pertaining to ICF/DD-N and ICF/DD-continuous nursing include licensing fee schedules appropriate to facilities which will encourage their development. FISCAL EFFECT : According to the Assembly Appropriations Committee, one-time costs for analysis of standards, development of recommendations, report to the Legislature, and a public hearing in the range of $200,000 (Licensing and Certification Fund). Currently, the California Department of Public Health (CDPH) has the authority to cite facilities under federal law. If the authority to cite facilities under state law is used instead, revenue may accrue to the State Facilities Citation Penalty Account instead of the federal Facilities Citation Penalty Account. These are both special fund accounts that are used for purposes of the CDPH Licensing and Certification program and related activities. The state account is available for funding of long-term care ombudsman programs and for quality improvement activities, while the federal account is used for temporary SB 534 Page 3 management costs of facilities whose certification or licensure is revoked. COMMENTS : According to the author, 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 are already required to 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. According to DPH, as of April 2, 2013, there are 173 designated health care facilities that have been issued a state license. This includes 98 chronic dialysis clinics, 57 ICF/DD-N's, 16 surgical clinics, and two rehabilitation clinics. Among these four facility types, 166 facilities (96%) had an active license while the rest, seven (4%) did not. To date, DPH has not adopted state regulations for these facilities, but relies on the federal certification standards to determine licensure. DPH is currently in the process of drafting regulations for the ICF/DD facilities, however, the Assembly Health Committee staff is not aware of any regulations in process for the surgical clinics, chronic dialysis clinics, and rehabilitation clinics. The federal regulatory standards for chronic dialysis clinics (referred to as End Stage Renal Centers in federal regulations), surgical clinics (referred to as ASC in federal regulations), and rehabilitation clinics, among other things, set forth the various standards required at each facility in order to qualify for Medicare and Medicaid participation by the Centers for Medicare and Medicaid Services (CMS). Depending on the facility in question, the regulations set requirements for the facilities management and governing body, what services may be offered and safety and cleanliness standards. Standards also include, but are not limited to, requirements covering patient rights, the administration of anesthesia, if applicable, medical records, privacy, and infection control. The federal regulatory standards for ASCs also include as part of their requirements for coverage with CMS that the ASC must comply with state licensure requirements. DPH is the sponsor of this bill, and states that this bill will SB 534 Page 4 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. DPH states that it does not have state licensing standards in place for chronic dialysis clinics, rehabilitation clinics, surgical clinics, and ICF/DD-Ns. Federal standards for these facilities exist, but DPH lacks the statutory authority to enforce the standards. In the absence of such authority, DPH states that it may only recommend action by CMS to stop Medicare and Medicaid program funding if the health care facility is out of compliance. Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097 FN: 0002148