BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                       AB 348


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          ASSEMBLY THIRD READING


          AB  
          348 (Brown)


          As Amended  May 28, 2015


          Majority vote


           ------------------------------------------------------------------- 
          |Committee       |Votes |Ayes                |Noes                  |
          |                |      |                    |                      |
          |                |      |                    |                      |
          |----------------+------+--------------------+----------------------|
          |Health          |18-0  |Bonta, Maienschein, |                      |
          |                |      |Bonilla, Burke,     |                      |
          |                |      |Chávez, Chiu,       |                      |
          |                |      |Gomez, Gonzalez,    |                      |
          |                |      |                    |                      |
          |                |      |                    |                      |
          |                |      |Roger Hernández,    |                      |
          |                |      |Lackey, Nazarian,   |                      |
          |                |      |Patterson,          |                      |
          |                |      |                    |                      |
          |                |      |                    |                      |
          |                |      |Ridley-Thomas,      |                      |
          |                |      |Rodriguez,          |                      |
          |                |      |Santiago, Thurmond, |                      |
          |                |      |Waldron, Wood       |                      |
          |                |      |                    |                      |
          |----------------+------+--------------------+----------------------|
          |Aging           |7-0   |Brown, Hadley,      |                      |
          |                |      |Gipson, Gray,       |                      |
          |                |      |Levine, Lopez,      |                      |
          |                |      |Mathis              |                      |








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          |                |      |                    |                      |
          |----------------+------+--------------------+----------------------|
          |Appropriations  |17-0  |Gomez, Bigelow,     |                      |
          |                |      |Bonta, Calderon,    |                      |
          |                |      |Chang, Daly,        |                      |
          |                |      |Eggman, Gallagher,  |                      |
          |                |      |                    |                      |
          |                |      |                    |                      |
          |                |      |Eduardo Garcia,     |                      |
          |                |      |Gordon, Holden,     |                      |
          |                |      |Jones, Quirk,       |                      |
          |                |      |Rendon, Wagner,     |                      |
          |                |      |Weber, Wood         |                      |
          |                |      |                    |                      |
          |                |      |                    |                      |
           ------------------------------------------------------------------- 


          SUMMARY:  Establishes a 45-working-day timeframe by which the  
          Department of Public Health (DPH) would be required to complete  
          investigations of long-term health care facility complaints or  
          reports.  Specifically, this bill:  
          1)Requires DPH to complete its investigation of a long-term health  
            care facility complaint or report within 45 working days of its  
            receipt, and authorizes DPH to extend the 45-working-day  
            timeframe by an additional 30 days if DPH has diligently  
            attempted, but has not been able to obtain necessary evidence  
            related to the investigation.
          2)Requires DPH, in the case that it extends an investigation  
            beyond 45 working days, to notify the complainant, in writing,  
            of the basis for the extension, any outstanding evidence sought  
            to complete the investigation, the source of the outstanding  
            evidence, and the anticipated completion date.


          3)Effective January 1, 2018, applies the 45-working-day, and  
            30-day extension timeframes to investigations of entity-reported  
            incidents (ERIs), which are incidents such as epidemics,  
            outbreaks, disasters, fires, disruptions of services, major  








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            accidents, or other unusual occurrences that long-term health  
            care facilities are required to self-report to DPH.


          4)Effective January 1, 2018, requires long-term health care  
            facilities that self-report to DPH pursuant to existing law, in  
            the case that they extend an investigation beyond 45 working  
            days, to notify the complainant, in writing, of the basis for  
            the extension, any outstanding evidence sought to complete the  
            investigation, the source of the outstanding evidence, and the  
            anticipated completion date.


          5)Requires DPH, effective July 1, 2016, to include in its written  
            notice of investigation determinations, specific findings  
            concerning each alleged violation, and a summary of the evidence  
            upon which its determination is made.  Prohibits the written  
            determination from disclosing the names of individual residents.  



          6)Grants complainants 15 days, rather than five days, to request  
            an informal conference with DPH if the complainant does not  
            agree with the findings of the investigation. 


          7)Requires DPH to analyze its compliance with the complaint and  
            ERI investigation timeframes in its annual system and staffing  
            analysis.


          8)Provides that none of the provisions proposed in this bill are  
            to be interpreted to diminish the DPH's authority and obligation  
            to investigate any alleged violation of state or federal law, or  
            to enforce applicable state and federal requirements.  


          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee:








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          1)Assuming the significant backlog of complaints is cleared by  
            2018, ongoing costs may be in the range of $1 million to $2  
            million beginning in 2018.


          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 (Licensing and Certification  
            Program special fund).


          3)Additional minor costs to DPH to expand notification pursuant to  
            the bill's requirements and report specified data.


          COMMENTS:  According to the author, DPH is charged with protecting  
          nursing home residents from harmful events and with investigating  
          complaints filed by the public and facilities.  However, the  
          author contends that, by any measure, DPH's system of  
          investigation is not functioning as expected.  The author states  
          that in 2009, DPH eliminated its policy calling for complaint  
          investigations to be completed within 40 days, and now has no  
          specific time frames for completing investigations of nursing home  
          complaints.  Despite the elimination of this policy, the author  
          cites numerous reports issued by federal and state agencies,  
          private organizations, and the media documenting DPH's failures to  
          investigate nursing home complaints in a timely manner.  The  
          author also states that DPH has been the subject of two recent  
          lawsuits for failing to investigate nursing home complaints with  
          timeliness.  The author concludes by stating that legislation to  
          improve timeliness of complaint investigations is critically  
          needed.


          Supporters of this bill state this bill is critical to establish  








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          meaningful complaint investigation deadlines, that the timely  
          investigation of nursing home complaints is a matter of life and  
          death for nursing home residents, and that by improving complaint  
          investigation standards, this bill will help restore public  
          confidence in California's nursing home oversight system.  Other  
          supporters state that this bill will provide certainty about DPH's  
          responsiveness and dedication to completing investigations,  
          thereby strengthening and improving the state's nursing home  
          oversight and enforcement process.  Other supporters state that,  
          due to chronic understaffing within the Licensing and  
          Certification Program, health facility evaluator nurses have not  
          had the ability to consistently complete and close investigations,  
          resulting in a serious backlog of complaints.  


          There is no known opposition to this bill.


          Analysis Prepared by:                     An-Chi Tsou / HEALTH /  
          (916) 319-2097   FN: 0000851