BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 534
AUTHOR: Hernandez
AMENDED: September 4, 2013
HEARING DATE: September 12, 2013
CONSULTANT: Marchand
PURSUANT TO SENATE RULE 29.10.
SUBJECT : Health and care facilities.
SUMMARY : 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
and adopts licensing regulations for these facilities.
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
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.
Continued---
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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.
2.Requires, until DPH and the Department of Developmental
Services (DDS) jointly develop regulations regarding
intermediate care facilities/developmentally disabled-nursing
(ICF/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.
3.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.
4.Permits multiple CHLFs to exist in one multi-floor building,
notwithstanding an existing law requirement that CHLFs be
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;
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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.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's 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.
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
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.
2.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.
3.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.
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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 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.
SUPPORT AND OPPOSITION :
Support: Sacramento County Board of Supervisors
Sacramento County Public Health Officer
McClellan Business Park
California Department of Public Health (prior version)
Oppose: None received
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