BILL ANALYSIS Ó
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UNFINISHED BUSINESS
Bill No: SB 534
Author: Hernandez (D)
Amended: 9/4/13
Vote: 21
SENATE HEALTH COMMITTEE : 8-0, 4/17/13
AYES: Hernandez, Anderson, Beall, De León, DeSaulnier, Monning,
Nielsen, Wolk
NO VOTE RECORDED: Pavley
SENATE HUMAN SERVICES COMMITTEE : 6-0, 4/23/13
AYES: Yee, Berryhill, Emmerson, Evans, Liu, Wright
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SENATE HEALTH COMMITTEE : 8-0, 9/12/13
(Pursuant to Senate Rule 29.10)
AYE: Hernandez, Anderson, Beall, DeSaulnier, Monning, Nielsen,
Pavley, Wolk
NO VOTE RECORDED: De León
SENATE FLOOR : 34-0, 5/13/13 (Consent)
AYES: Anderson, Beall, Berryhill, Block, Cannella, Corbett,
Correa, De León, DeSaulnier, Emmerson, Evans, Fuller,
Galgiani, Hancock, Hernandez, Hill, Hueso, Huff, Jackson,
Knight, Lara, Leno, Lieu, Liu, Monning, Nielsen, Padilla,
Pavley, Roth, Steinberg, Wolk, Wright, Wyland, Yee
NO VOTE RECORDED: Calderon, Gaines, Price, Walters, Vacancy,
Vacancy
ASSEMBLY FLOOR : Not available
CONTINUED
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SUBJECT : Health and care facilities
SOURCE : Department of Public Health
DIGEST : This bill requires chronic dialysis clinics, surgical
clinics, rehabilitation clinics, and intermediate care
facilities/developmentally disabled-nursing to meet federal
certification standards under the Department of Public Health
(DPH) and adopts licensing regulations for these facilities.
Assembly Amendments 1) create a specific exemption to current
law which requires congregate living health facilities to be
freestanding, that allows for multiple congregate living health
facilities to exist on one multi-floor building if specified
requirements are met, 2) add findings and declarations, and 3)
add co-authors.
ANALYSIS :
Existing law:
1.Licenses and regulates various clinics by Department of Public
Health (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
be necessary to enable DPH to carry out the purposes of
provisions of law governing the various types of clinics
licensed by DPH.
3.Licenses and regulates intermediate care
facilities/developmentally disabled-nursing (ICF/DD-N) by DPH,
which are defined as facilities with a capacity of 4 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.
4.Licenses and regulates congregate living health facilities
(CLHFs) by DPH, which are defined as residential homes with a
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capacity of no more than 12 beds that provide inpatient care,
including 24-hour skilled nursing care. Requires CLHFs to be
freestanding, but specifies that this does not preclude their
location on the premises of a hospital.
5.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.
This bill:
1.Requires, until DPH adopts regulations relating to the
provision of services by a chronic dialysis clinic, surgical
clinic or a rehabilitation clinic, 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.
1.Requires, until DPH and the Department of Developmental
Services (DDS) jointly develop regulations regarding CF/DD-N,
these facilities to comply with applicable federal
certification standards for ICF for individuals with
intellectual disabilities in effect immediately preceding
January 1, 2013.
2.Deletes a requirement that regulations developed by DPH and
DDS pertaining to ICF/DD-Ns and ICF/DD-continuous nursing
include licensing fee schedules appropriate to facilities
which will encourage their development.
3.Permits multiple CHLFs to exist in one multi-floor building,
notwithstanding an existing law requirement that CHLFs be
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freestanding, if all of the following requirements are
satisfied:
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. Proposals to develop proximate CLHFs are supported by
the county in which the facilities are to be located; and
D. The CLHFs are proposed for one of four specified
buildings located on the former McClellan Air Force Base.
Background on CLHFs.
CLHFs are required to provide a non-institutional, home-like
environment, while providing medical care that is generally less
intense than that provided in general acute care hospitals, but
more intense than that provided in skilled nursing facilities.
CLHFs are licensed to provide services to one of three types of
persons: persons who are mentally alert but have physical
disabilities and may be ventilator dependent; persons who have a
diagnosis of terminal illness or a life-threatening illness, as
defined; or persons who are catastrophically and severely
disabled, as defined.
Comments
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.
In addition, this bill would remove an obstacle to establishing
CLHFs on the former McClellan Air Force Base. Current law
requires these facilities to be "freestanding," which DPH
interprets as requiring a separate foundation. McClellan
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Business Park would like to convert a three story building into
three separately licensed CLHFs, and this bill would grant the
necessary flexibility from the "freestanding" requirement, while
also ensuring that all other requirements are met.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
This bill has not been analyzed by a fiscal committee.
SUPPORT : (Verified 5/7/13)
McClellan Business Park
Sacramento County Board of Supervisors
Sacramento County Public Health Officer
California Department of Public Health (prior version)
ARGUMENTS IN SUPPORT : The Sacramento County Board of
Supervisors states in support of the CLHF provisions that this
bill would provide DPH with clear statutory authority to permit
the conversion of existing military housing units into CLHFs at
locations within McClellan Business Park that are specified in
the bill. Sacramento County states that these provisions will
remove any ambiguity over whether CLHFs in former military
housing with multiple floors would meet the existing requirement
that such facilities by freestanding. Sacramento County states
that this bill will help it meet the growing demand for CLHFs,
with facilities in two separate three-story buildings that
formerly were military housing. This arrangement would allow
for greater specialization in the types of units provided for
shorter -term stays, as well as the ability to create a
home-like environment for longer-term clients. McClellan
Business Park also supports the CLHF provisions of this bill to
help establish contiguous CLHFs within the former McClellan Air
Force Base in North Highlands.
DPH states, in support of the prior version of the bill (before
the CLHF provisions were added), that this bill would 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
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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 the federal Centers for Medicare
and Medicaid Services to stop Medicare/Medicaid program funding
if the health care facility is out of compliance.
JL:nl 9/12/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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