BILL ANALYSIS Ó
AB 348
Page 1
Date of Hearing: May 6, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
348 (Brown) - As Amended April 14, 2015
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|Policy |Health |Vote:|18 - 0 |
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| |Aging and Long Term Care | |7 - 0 |
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill establishes requirements for complaint investigations
conducted by the Department of Public Health (DPH).
Specifically, this bill:
AB 348
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1)Requires DPH to complete investigations of complaints in
long-term care facilities within 45 working days from receipt
of the complaint, and allows extension of this time frame
under specified circumstances.
2)Establishes notification requirements if the time frame is
extended, and requires each determination as a result of an
investigation to include specific findings concerning each
alleged violation, and a summary of the evidence upon which
the determination is made.
3)Allows complaint timelines for hospital-related complaints to
be extended beyond the 45-day period specified in current
law, under specified circumstances.
FISCAL EFFECT:
1)Additional staff costs in the range of $15 million annually,
for the first one to two years, to DPH to meet the tighter
time frames for completion of investigations (Licensing and
Certification (L&C) Fund, paid for by facility licensing
fees). Of this amount, about 6.5% ($1 million) is
attributable to state-run facilities, whose licensure fees are
paid for with GF dollars.
Once the significant backlog of complaints is cleared, ongoing
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annual costs associated with the 45-day requirement are
expected to be much smaller, but it is unclear what level of
program resources are sufficient to establish a steady state,
where complaints can be processed on a smooth and expeditious
basis. Work has been piling up for years, leading to long
time lags between complaint and resolution, providing little
basis for imagining what a steady state would look like.
However, according to the 2015-16 Licensing and Certification
Program estimate, complaint workload is calculated by
multiplying two factors: (1) number of complaints, times (2)
standard average hours per complaint. Neither of these factors
are materially increased by shortening the time frame to 45
days. It does not appear to take more work per complaint to
process it faster-it is the same workload whether it is done
over the course of 45 days or 90 days, or six months.
Arguably, it may be more efficient to process an investigation
faster, as it may be more difficult to ascertain truth if an
investigation takes place months after an incident. Thus,
once a sufficient level of staff is established and the
backlog is cleared, the ongoing costs logically do not appear
all that significant.
2)Unknown one-time costs to develop policies and procedures for,
and for training on, the requirement to include a summary of
the evidence upon which the determination is made. This
provision would also result in significant ongoing costs,
potentially in the range of $1 million overall (L&C special
fund).
3)Additional minor costs to DPH to expand notification pursuant
to the bill's requirements and report specified data.
AB 348
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COMMENTS:
1)Purpose. According to the author, timely investigations are
critical to reduce risk by identifying and acting to protect
dependent adults from dangerous situations. The author
indicates DPH struggles to meet its workload demands and often
does not complete investigations of complaints in a timely
manner. This bill is intended to address this issue by
establishing a 45-day limit on the length of an investigation,
with allowable extensions for difficult conditions.
2)Background. Existing law requires DPH Licensing and
Certification (L&C) division to issue state licenses and to
certify a number of facility types meet federal requirements
for participation in Medicare and Medicaid. The department's
duties include inspecting facilities to verify compliance with
licensing and certification standards, citing and penalizing
facilities that fail to meet requirements, investigating
alleged complaints, certifying and investigating related
personnel, and conducting various quality improvement
programs. Although DPH L&C is responsible for a wide variety
of facility types and personnel, the majority of staff time is
devoted to inspections and complaint investigations of
long-term care facilities. DPH L&C is funded through facility
license fees, which are based on the staff time devoted to
different facility types.
3)Complaints. The timeliness of L&C complaint investigation has
been a subject of criticism by advocates, as well as long-term
care facilities themselves, for several years. Information
provided by DPH indicates the department receives about 5,500
complaints per year. Over the last several years, about half
were resolved within 90 days. The department does appear to
be making progress in resolving more cases within a 90-day
AB 348
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time frame.
4)Recent Oversight. Numerous oversight hearings and audit
reports have been conducted on L&C's performance. In October
2014, the California State Auditor released its report
regarding the L&C Program citing ineffective management of
nursing home complaint investigations, among other
deficiencies. The audit report stated, among other findings,
that DPH should establish timeframes for complaint
investigations. DPH is in the process of implementing most of
the State Auditor's recommendations, but disagrees with the
recommendation to establish a timeframe to complete
investigations of nursing home complaints.
5)The 2015-16 budget proposes funding to support the
implementation of the quality improvement recommendations made
by a private consultant and funds to improve oversight of its
LA County contract, as well as funding to fill and add new LA
County positions. The Governor proposes 237 new L&C positions
and increased expenditure authority to reduce complaint volume
and decrease investigation time. With these added positions,
DPH estimates that it will take four years to complete
pending, back-logged investigation workload while keeping up
with new workload and avoiding backlogs.
6)Staff Comments. This bill establishes an expectation for DPH
to go from a status quo where over 40% of complaints take
longer than 90 days to complete, to a process where the vast
majority are completed within 45 days. DPH is likely to be
out of compliance with this standard immediately.
In addition, staff notes the L&C division has many competing
priorities, including timely licensing and certification
inspections of long-term care facilities and other facility
types, as well as personnel. Placing time and documentation
constraints on certain aspects of L&C duties may be desirable,
but any new mandate should be considered in context of the
universe of L&C priorities. The relative importance of speedy
complaint investigations could differ depending on L&C
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performance in other areas. For example, placing greater
emphasis on speedy resolution of new cases may conflict with
addressing a backlog of older cases or allocating staff to
meet federally mandated time frames for annual certification.
It is certainly possible to prioritize certain areas over
others, or set higher expectations for certain functions, but
trade-offs in terms of higher resource levels and/or the
possibility of deprioritizing other functions should be
considered.
7)Prior Legislation. AB 1816 (Yamada) was very similar to this
bill. It was amended out of this Committee to, instead of
imposing a statutory timeline, require DPH to create and
follow a performance benchmark for length of time for
completing investigations and specified the performance
benchmark may not exceed 60 working days. The bill was
dropped by the author in the Senate Appropriations committee.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081