BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular Session AB 348 (Brown) - Long-term health care facilities: complaints: investigations ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: July 8, 2015 |Policy Vote: HEALTH 9 - 0 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: No | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: August 17, 2015 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- This bill meets the criteria for referral to the Suspense File. Bill Summary: AB 348 would require the Department of Public Health to meet the same deadlines for investigating incidents reported by long-term health care facilities that the Department is required to meet when investigating incidents reported to the Department by members of the public. Fiscal Impact: Ongoing costs of $18 million per year, for additional staff to meet the required timelines for investigating incidents reported by facilities (General Fund and Licensing and Certification Fund). Under current practice, the Department of Public Health closes about 70% of entity reported incidents outside of Los Angeles County and not occurring in state-owned facilities within 90 days. In Los Angeles County, about 40% of investigations are completed within 90 days. For state-owned facilities, about 55% of investigations are completed within 90 days. To complete all AB 348 (Brown) Page 1 of ? investigations of entity reported incidents within 90 days, the Department anticipates that it will need 123 additional positions (including positions under contract with Los Angeles County). Most of those costs would be recovered by licensing fees imposed on private facilities. However, about $2.5 million of the total cost will come from the General Fund, as it represents the costs to regulate state-owned facilities. Unknown potential impact to the Medi-Cal program and the General Fund due to potential impacts on the "quality assurance fee" assessed on long-term care facilities. Under current law, long-term health care facility operators are assessed a quality assurance fee, which is used by the state to draw down additional funding for the long-term care services provided by the Medi-Cal program and to provide General Fund savings related to Medi-Cal. Federal law limits the amount of any quality assurance fee (including other fees assessed by the states). The Department of Public Health indicates that the fee increases necessary to pay for the increased costs of this bill may limit the state's ability to collect quality assurance fees (or limit the Department's ability to raise fee revenue sufficient to pay for the costs of this bill). Background: Under current law, the Department of Public Health licenses and regulates various health care facilities, including long-term health care facilities such as skilled nursing facilities, intermediate care facilities, and other facility types. Under current law and regulation, licensed operators of long-term health care facilities are required to report to the Department all incidents of alleged or suspected abuse of a resident. These reports from facilities are referred to as "entity reported incidents". In addition, any member of the public can report a complaint to the Department. If the Department determines that there is a reasonable basis to believe that there was a violation of state law or regulation, the Department begins an investigation. In recent years, issues have been raised about the Department's ability to investigate complaints from the public and entity reported incidents in a timely and effective way. An audit by the Bureau of State Audits completed in 2014 indicates that the AB 348 (Brown) Page 2 of ? Department has a very large number of open investigations, the Department lacks data on the status of investigations, and the Department has not established formal procedures or timelines for completing investigations. As part of the 2015 Budget Act, the Department received a budget augmentation of $30 million to add 237 additional staff in its Licensing and Certification Division ($30 million is the projected cost in 2016-17 when all the new positions are filled). These additional positions were proposed by the Administration to reduce the existing backlog of open complaints and make quality improvements in the Licensing and Certification Program. The Legislature also adopted trailer bill language requiring the Department to meet specified timelines when investigating complaints to the Department from the public. Specifically, the trailer bill language requires: (1) investigations of complaints that involve a threat of imminent danger received after July 1, 2016 to be completed within 90 days; (2) investigations of complaints that do not involve a threat of imminent danger received after July 1, 2017 must be completed within 90 days, and (3) investigations of all complaints received after July 1, 2018 must be completed within 60 days. The Department indicated at that time that the additional positions would be sufficient to allow it to meet the new timelines for investigations of complaints made by the public. The trailer bill language does not apply to entity reported incidents. Complaints from the public represent about 25% of the notifications received by the Department in this area. About 75% of reports to the Department come from long-term health care facilities themselves. Proposed Law: AB 348 would require the Department of Public Health to meet the same deadlines for investigating incidents reported by long-term health care facilities that the Department is required to meet when investigating incidents reported to the Department by members of the public. The bill would require the Department to report quarterly on its compliance with timelines for investigations and post that information on its website. AB 348 (Brown) Page 3 of ? Related Legislation: AB 1816 (Yamada, 2014) would have required the Department of Public Health to set a performance benchmark of 60 days for completing investigations of complaints against long-term health care facilities. That bill was held on this committee's Suspense File. AB 799 (Negrete-McCleod, 2011) would have required the Department to complete investigations of complaints against long-term health care facilities within 90 days. That bill was held on this committee's Suspense File. Staff Comments: As noted above, there is uncertainty about whether the fee increases on long-term care providers that would be necessary to pay for the costs of this bill can be assessed on long-term care facilities without impacting the quality assurance fee assessed on long-term care facilities. -- END --