BILL ANALYSIS Ó
SB 534
Page 1
Date of Hearing: September 10, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
SB 534 (Ed Hernandez) - As Amended: September 4, 2013
SENATE VOTE : Not relevant.
SUBJECT : Health and care facilities.
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. Creates a specific exemption to current law, which
requires congregate living health facilities (CLHFs) to be
freestanding, that allows for multiple CLHFs to exist in one
multifloor building if certain requirements are met.
Specifically, this bill :
1)Requires, until DPH adopts regulations relating to the
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.
1)Requires until the DPH and DDS adopt regulations pursuant to
existing law, relating to services by ICF/DD-N, licensed
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facilities to comply with applicable federal certification
standards in effect immediately preceding January 1, 2013.
2)Creates a specific exemption to current law, which requires
CLHFs to be freestanding, that allows for multiple CLHFs to
exist in one multifloor building if all of the following
requirements are met:
a) Each facility meets other applicable building standards
not related to multiple floors;
b) Each facility is separated by a wall, floor, or other
permanent partition but may share an elevator, stairs, or
stairwell, and need not be freestanding;
c) The proposal to develop proximate CLHFs is supported by
the county health department and the board of supervisors
in the county in which the facilities are proposed for one
of the following locations:
i) McClellan Air Force Base Building No. 522, located
at 3201 James Way, McClellan, California;
ii) McClellan Air Force Base Building No. 523, located
at 3207 James Way, McClellan, California;
iii) McClellan Air Force Base Building No. 524, located
at 5621 Dudley Blvd, McClellan California; and,
iv) McClellan Air Force Base Building No. 525, located
at 5327 Dudley Blvd, McClellan, California.
4)Adds finding and declarations that this is a special law and
is necessary and a general law cannot be made applicable
within the meaning of the California Constitution because of
the unique circumstances relating to the need for CLHFs in and
around Sacramento County.
EXISTING LAW :
1)Establishes licensure for specified clinics by DPH, including
primary care clinics as well as specialty clinics which
include: surgical clinics, chronic dialysis clinics, and
rehabilitation clinics.
2)Requires DPH to adopt reasonable rules and regulations as may
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be necessary to enable DPH to carry out the purposes of
provisions of law governing the various types of clinics
licensed by DPH.
3)Requires those regulations to prescribe the kinds of services
which may be provided by clinics in each category of licensure
and the minimum standards of adequacy, safety, and sanitation
of the physical plant and equipment, minimum standards for
staffing with duly qualified personnel, and minimum standards
for providing the services offered. Requires these minimum
standards to be based on the type of facility, the needs of
the patients served, and the types and levels of services
provided.
4)Licenses and regulates various types of facilities by DPH,
including ICF/DD-N, which is defined as a facility with a
capacity of four to 15 beds that provides 24-hour personal
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.
5)Requires DPH and DDS to jointly develop and implement
licensing regulations appropriate for ICF/DD-N and ICF/DD-CN
facilities. Requires, among other things, that the
regulations ensure that residents of an ICF/DD-N and ICF/DD-CN
receive appropriate medical and nursing services and
developmental program services in a normalized, least
restrictive physical and programmatic environment appropriate
to individual resident need.
6)Defines a CLHF as a residential home with a capacity of no
more than 12 beds that provides inpatient care, including the
following basic services: medical supervision, 24-hour
skilled nursing and supportive care, pharmacy, dietary,
social, and recreational.
7)Requires CLHFs to provide one of the following services:
a) Services for mentally alert, physically disabled persons
who may be ventilator dependent;
b) Services for persons who have a diagnosis of terminal
illness, a diagnosis of a life-threatening illness, or
both; or,
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c) Services for persons who are catastrophically and
severely disabled.
8)Requires a CLHF license to specify which of the types of
persons described in 7) above to whom a facility is licensed
to provide services.
9)Requires a CLHF to have a non-institutional, homelike
environment.
10)Prohibits, pursuant to state regulations, a license from
being issued to any skilled nursing facility which does not
conform to the State Fire Marshal's requirements on fire and
life safety, state requirements on environmental impact, and
to local fire safety, zoning, and building ordinances.
FISCAL EFFECT : As amended, this bill has not been analyzed by a
fiscal committee.
COMMENTS :
1)PURPOSE OF THIS BILL . 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
gives authority to state regulators to enforce these standards
until such time that DPH adopts regulations specific to these
facilities.
According to the author, McClellan Business Park wishes to
establish CLHFs within the former McClellan Air Force Base in
North Highlands in Sacramento County. The health care
facilities would be housed initially in two three-story
buildings that were formerly used to house military personnel.
There are two more buildings in close proximity that could be
used for CLHFs at a later date. Each floor would be
separately licensed, there would be no co-mingling of patients
between floors, and all facilities would provide a home-like
environment for residents. However, current law requires
CLHFs to be "freestanding."
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According to the author McClellan Business Park believes that
it can comply with all CLHF requirements except for the
requirement to be "freestanding" as interpreted by DPH and
this legislation is needed to grant such authority in this
very limited situation. This bill only grants the authority
for the four specific buildings described by their addresses.
2)BACKGROUND . 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 Committee staff is not aware
of any regulations in process for the surgical clinics,
chronic dialysis clinics, and rehabilitation clinics.
With regard to CLHFs, California Health and Safety Code
(Section 1267.15) states that CLHFs shall be freestanding, but
this does not preclude their location on the premises of a
hospital. Congregate living health facilities shall be
separately licensed.
According to DPH, because neither code nor regulation defines
"freestanding" DPH defers to the common dictionary definition
of freestanding which is "standing alone, on its own
foundation, free of support or attachment."
3)FEDERAL REGULATORY STANDARDS . 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
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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.
4)SUPPORT . DPH, in support of the prior version of this bill,
states that this bill will 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.
McClellan Business Park supports the recent amendment which
would help to establish CLHFs within the former McClellan Air
Force Base in North Highlands (Sacramento County), stating,
current law requires CLHFs to be "freestanding" but does not
define whether this means having separate foundations or, as
is used more commonly, independently standing relative to a
hospital. By defining the term "freestanding" for McClellan
Business Park only, this bill will help DPH to determine
whether this project should go forward based on its merits.
The Sacramento County Public Health Officer, Olivia Kasirye,
MD, MS, writes in support of this bill that with the
implementation of the Patient Protection and Affordable Care
Act and changes to requirements for hospitals to take measures
to prevent readmission of patients, the CLHFs will provide
much needed services for those patients that still require
skilled nursing care, while at the same time help free up
hospital beds and prevent readmissions.
Phil Serna, District 1 Supervisor for Sacramento County, which
includes McClellan Business Park, also supports this bill,
stating, it has been demonstrated that injuries sustained by
service men and women in the Iraq and Afghanistan conflicts
coupled with California's aging demographics, and advances in
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medical care, have all increased the demand for CLHFs.
5)RELATED LEGISLATION . AB 1312 (Brown) of 2013 authorizes DPH
to, without taking regulatory action, update references in
regulations to health care standards of practice adopted by a
recognized state or national association. AB 1312 was held in
Assembly Health Committee.
6)PREVIOUS LEGISLATION .
a) The California Ambulatory Surgery Association has
sponsored several bills intended to establish
state-specific licensure criteria for ASCs:
i) 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 ASCs 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.
ii) 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 specified operating and staffing
standards. AB 543 was vetoed by the Governor.
iii) 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.
b) 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 ASCs,
to ensure public health and safety. AB 832 was held in the
Assembly Appropriations Committee.
c) SB 135 (Ed Hernandez), Chapter 673, Statutes of 2012,
establishes a new health facility licensing category of
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hospice facility, and permits a licensed and certified
hospice services provider to provide inpatient hospice
services through the operation of a hospice facility,
either as a free-standing health facility, or adjacent to,
physically connected to, or on the building grounds of
another health facility or a residential care facility
d) SB 177 (Strickland), Chapter 331, Statutes of 2011,
raises the bed limit for congregate living health
facilities that serve terminally ill patients in counties
that have populations of more than 400,000 but less than
500,000 persons.
e) SB 666 (Aanestad), Chapter 443, Statutes of 2005,
increases the capacity of a CLHF from no more than six beds
to no more than 12 beds. Maintains an exception to allow
CLHFs which serve terminally ill patients and which are
located in counties with 500,000 or more persons to have 25
beds.
f) AB 3535 (Wright), Chapter 1459, Statutes of 1986,
creates the CLHF licensure category, and defines a CLHF as
a residential home with a capacity of no more than six
beds, which provides inpatient care to mentally alert,
physically disabled residents, who may be ventilator
dependent.
REGISTERED SUPPORT / OPPOSITION :
Support
Olivia Kasirye, MD, MS, Sacramento County Public Health Officer
Phil Serna, District 1, Sacramento County Supervisor
California Department of Public Health (prior version)
McClellan Business Park
Sacramento County Board of Supervisors
Opposition
None on file.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097
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