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
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|Version: July 8, 2015 |Policy Vote: HEALTH 9 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 17, 2015 |Consultant: Brendan McCarthy |
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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
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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
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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.
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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.
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