BILL ANALYSIS �
SB 534
Page 1
SENATE THIRD READING
SB 534 (Ed Hernandez)
As Amended September 4, 2013
Majority vote
SENATE VOTE :Vote not relevant
HEALTH 17-0
--------------------------------
|Ayes:|Pan, Logue, Ammiano, |
| |Atkins, Bonilla, Bonta, |
| |Gomez, |
| |Roger Hern�ndez, |
| |Lowenthal, Maienschein, |
| |Mitchell, Nazarian, |
| |Nestande, V. Manuel |
| |P�rez, Wagner, |
| |Wieckowski, Wilk |
| | |
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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;
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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
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
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meaning of the California Constitution because of the unique
circumstances relating to the need for CLHFs in and around
Sacramento County.
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, DPH 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 DPH 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 management costs of facilities
whose certification or licensure is revoked. It should be noted
that the September 4th amendments were not included in the fiscal
analysis.
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 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." 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.
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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.
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."
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.
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 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
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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.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097
FN: 0002752