BILL ANALYSIS Ó
AB 1147
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Date of Hearing: April 21, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 1147
(Maienschein) - As Introduced February 27, 2015
SUBJECT: Health facilities: pediatric day health and respite
care facilities.
SUMMARY: Creates a licensing category for pediatric day health
and respite care facilities (PDHRCFs), codifies all the
requirements and standards that such facilities must adhere to,
and allows an individual who is 22 years of age or older to
continue to receive care in a PDHRCF if the facility receives
approval from the California Department of Public Health (DPH).
Specifically, this bill:
1) Exempts PDHRCFs from specific skilled nursing facility (SNF)
regulatory requirements, including requirements for multiple
facility committees and instead requires PDHRCFs to have a
patient care committee to address quality of care provided in
the facility, including, but not limited to, patient care
policies, pharmacy services, and infection control.
2)Specifies that the patient care committee membership includes
the medical director, dietician, pharmacist, nursing staff,
nurse supervisor, center administrator or director, and other
staff as may be required by facility policies and procedures.
Specifies the committee is responsible for all of the
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following:
a) Reviewing and approving all policies relating to patient
care, and based on reports from the facility's
administrator, that the committee will review the
effectiveness of policy implementation and make
recommendations to the administrator for the improvement of
patient care. Requires the committee to review patient
care policies annually, and revise the policies as
necessary.
b) Establishing, reviewing, monitoring, and approving
policies and procedures for investigating, controlling, and
preventing infections in the facility, and maintaining,
reviewing, and reporting statistics of thenumber, types,
sources, and location of infectionswithin the PDHRCRF.
c) Establishing, reviewing, and monitoring the storage and
administration of drugs and biologicals (insulin),
reviewing and taking appropriate action based on any
findings from a pharmacist hired to consult with the
committee and internal quality assurance reviews, and
recommending improvements of services to the administrator
of the facility.
3) Requires PDHRCFs to comply with licensing requirements,
allows PDHRCFs to apply to DPH for program flexibility
waivers, and requires DPH, when approving waivers to provide
for the terms and conditions under which a waiver is granted.
Requires DPH, when reviewing requests for program flexibility,
to consider the unique nature of services provided to
individuals served by the PDHRCF when compared to the
requirements for DLHFs for individuals requiring inpatient
care.
4)Establishes specific requirements for PDHRCFs provision of
pharmacy services, that satisfy all of the following:
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a) Requiring all medications to be provided by the child's
parent, foster parent, or legal guardian in the original
container that specifies administration instructions;
b) That medications be administered only upon written and
signed orders of the child's physician;
c) The PDHRCF shall not order medications from a pharmacy
or take delivery of medications from a pharmacy; and,
d) That a PDHRCF shall not accept a child into the facility
if the child's medications have expired or are scheduled to
expire during the child's stay at the facility.
5)Requires physician orders to be current and maintained in the
child's medical record, and allows verbal orders from the
physician for services to be rendered at the facility to be
received and recorded by licensed nursing personnel, and be
signed by the attending physician within 30 days.
6)Prohibits medications from being administered to a child
unless the facility first verifies that the medication was
ordered by a physician, and requires PDHRCFs to maintain
records of medication administered for at least one year as
part of the child's plan of care.
7)Allows a PDHRCF to treat changes in a child's condition, such
as new onset pain, nausea, diarrhea, infections, or other
similar changes in accordance with the child's plan of care if
the child has been prescribed medications to treat these
anticipated symptoms and does not present a risk to the health
and safety of themselves, other children, staff, or other
individuals with whom the child may come into contact.
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8)Allows a PDHRCF to implement policies and procedures that
prohibit smoking by clients, parents, staff, visitors, or
consultants within the facility or on the premises.
9)Specifies that in order to establish, conduct, or maintain a
PDHRCF, a person or entity must file an application with DPH
on a form prescribed, prepared and furnished by DPH,
containing information as required for the proper
administration and enforcement of these provisions. Requires
DPH to initiate an initial licensing inspection within 60 days
of receipt of a completed application.
10)Allows a previously unlicensed PDHRCF to receive a
provisional license to operate a facility . Specifies a
provisional license will terminate six months from the date of
issuance, or the date DPH is able to conduct a full and
complete inspection, whichever is later.
11)Requires, 30 days prior to the termination of a provisional
license, DPH to give the facility a full and complete
inspection, and if the facility meets all requirement for
licensure, a regular license to be issued, or, if the facility
does not meet the requirments but has made substantial
progress toward meeting the requirements, the provisional
license to be renewed for six months.
12)Specifies that if DPH determines there has not been
substantial progress toward meeting licensure requirements at
the time of the first full inpection, or if upon its inpection
within 30 days of the termination of a renewed provisional
license, that there is a lack of full compliance, DPH will not
issue a further license.
13)Clarifies that an applicant denied a provisional license can
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contest the denial by filing a request for a hearing.
14)Specifies that a PDHRCF licensee must pay an annual fee, not
to exceed the reasonable regulatiory cost to DPH, that a
license expires 12 months from the date of issuance, that a
license shall be deemed renewed upon payment of the necessary
fee, and that at least 45 days prior to the expiration of a
license DPH will mail a notice for renewal to the licensee.
15)Requires periodic inspections of PDHRCF by DPH for the
purpose of ensuring that the facility is complying with these
provisions and applicable rules and regulations.
16)Allows DPH to deny an application, or suspend or revoke a
license upon any of the following grounds:
a) A serious violation by the licensee of any of the
provision of this chapter, or of the rules and regulations
promulgated under this chapter that jeopardizes the health
and safety of clients;
b) Aiding, abetting, or permitting the commission of any
illegal act; or,
c) Willful omission or falsification of a material fact in
the application for a license.
17)Specifies the proceeding for a denial, suspension, or
revocations of a license, or denial or withdrawal of approval,
and clarifies that the suspension, cancellation, or surrender
of a license without the written consent of DPH does not
deprive the department of its authority to institute or
continue a disciplinary proceeding against the licensee upon
any ground provided by law.
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18)Grants DPH the authority to make reasonable accommodation for
exceptions to the standards of these provisions if the
health, safety, and quality of patient care is not
compromised. Requires written approval regarding the terms
and conditions of the exception, and that an applicant request
an exception in writing.
19)Provides for the ability of PDHRCFs to organize a
Transitional Heatlh care Needs Optioanl Service Unit, or
optional service unit, that is organized, staffed, and
equipped to provide care to individulas who are 22 years of
age or older, and specifies that PDHRCFs are not required to
operate an optional service unit.
20)Specifies that in order to continue receiving care in the
PDHRCF, participants who are 22 years of age or older must
have a developmental age of 18 years or younger as evidenced
by their Individual Education Plan, Regional center
Assessment, physician's assessment, or other nationally
recognized assessment tool.
21)Requires an optional serice unti to be approved by DPH, and
that care for clients who are 22 years of age or older be
provided in a distinct part of the PDHRCF, separate from the
area where care is provided to younger clients.
22)Requires the facility to establish policies and procedure for
determining the age ranges of clients who are cared for in the
optional service unit, and for those policies to include, but
not be limited to, consideration of the client's chronological
age, developmental age, and size.
23)Requires the PDHRCF to ensure its staffing and equipment are
sufficient to provide services to clients who are 22 years of
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age or older and to have written policies and procedures for
the management of the services as established an implemented
by the patient care policy committee.
EXISTING LAW:
1)Defines a PDHRCF as a facility which provides an organized
program of therapeutic social and day health activities and
services, and limited 24-hour inpatient respite care, to
medically fragile children 21 years of age or younger,
including terminally ill and technology dependent children.
2)Requires DPH to adopt regulations and license PDHRCFs and to
set minimum standards for the adequacy, safety, and sanitation
of the physical plant and equipment, staffing requirements,
staff training, and the services offered.
3)Requires DPH to establish an advisory committee of experts to
assist in the development of the regulations.
4)Allows, pending adoption of the regulations, for an entity to
be licensed as a PDHRCF if it meets interim regulations for
congregate living health facilities (CLHF).
5)Requires the services offered to include medical, nursing,
pharmacy, nutrition, socialization, and developmentally
appropriate activities.
6)Specifies services which may be provided, but are not limited
to, include physical therapy, developmental services,
occupational and speech therapy, educational and psychological
services, respite care, instruction for parents or guardians,
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and comprehensive case management, if not otherwise available
for the client.
7)Allows a PDHRF to establish admission criteria based on the
compatibility of the developmental needs of the persons
served, and the facility's ability to meet those needs.
Requires admission criteria to be approved by DPH.
8)Requires a child accepted for care in a PDHRCF to meet the
following requirements:
a) Be medically stable as determined by their attending
physician;
b) Be under the care of a physician who approves the
PDHRCF's plan of care; and,
c) Have current immunization records unless medically
contraindicated as stated by their physician at the time of
admission and to pose no significant risk of infection to
others in the facility.
9)Requires DPH to adopt regulations for the licensure of CLHFs
no later than January 1, 1991, and for PDHRCFs on July 1,
1993.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee
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COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, medically
fragile children, as they begin to approach the age of 22,
have been faced with untenable choices of how to cobble
together the types of services that could provide the same
type of care and support received at PDHRCFs. Unfortunately,
these services simply do not exist; and families are again
facing similar unacceptable choices as they faced before
PDHRFs were established. The author states this bill will
guarantee the continuity of care this population desperately
needs by allowing medically fragile children and young adults
to continue to receive the quality services from PDHRCFs as
they grow older than the age of 22.
2)BACKGROUND. AB 3413 (Polanco), Chapter, 1227, Statutes of
1990, added a new category of health facility: Pediatric Day
Health and Respite Care Facility. Prior to that date,
families with medically-fragile children had very few choices
to find day health and respite care that would allow the child
to remain at home, keep the family intact, and keep parents
working. When this category of facility was first
established, most of the medically-fragile children were not
expected to survive to become adults; this model did not
envision a system of care that would provide a seamless
transition for these children as they age out of the PDHRCF
programs.
When enacted, AB 3413 required the Department of Health
Services, now DPH, to adopt regulations by July 1, 1993, and
allowed PDHRCFs to operate under a provisional license until
the regulations were adopted by complying with the regulations
for CLHFs. At that time regulations for CLHFs were to be
final by January 1, 1991, and CLHFs were operating under SNF
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regulations with some exceptions to those regulations allowed
through program flexibility waivers.
Neither the CLHF, nor the PDHRCF regulations were ever adopted
and both types of facilities have had to be licensed and
operate under SNF requirements and regulations, with some
exemptions as granted by DPH. The failure of DPH to adopt
regulations specific to each type of facility, and to use
portions of the SNF regulations, constitutes the promulgation
of underground regulations, which is a violation of the
Administrative Procedures Act.
PDHRCFs are very different than SNFs. SNFs are long term care
facilities whose adult residents are receiving 24-hour
inpatient care. PDHRCFs are daycare centers that offer
occasional over-night respite care to clients' and their
families. PDHRCFs have found it challenging over the years to
meet the requirements of SNF licensure. For example, a SNF
will have a Pharmacist on staff who orders medications for the
residents. A PDHRCF may administer medication to a client,
but does not have a Pharmacist, and is simply checking the
medications each day as they are brought to the facility by
the parent or guardian. Yet under current licensure
requirements, both facilities must have a pharmaceutical
service committee with a pharmacist member.
3)SUPPORT. Together We Grow, a PDHRCF in San Diego is the
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sponsor of this bill and states, unlike the care provided by
PDHRCFs, long-term care for medically-fragile young adults is
fragmented and does not provide the same essential choices to
medically-fragile adults and their families. The sponsors
note that current state licensing law permits children to
receive care up until the child turns 22 years of age, and
then they and their families are faced with the possibility of
institutionalization (leaving their families), attending an
adult day health care center that does not have the level of
expertise, programming, or activities necessary to engage and
provide safe care for this population, foregoing any family
respite support, or forcing family members to quit their jobs
to provide care to their loved ones. Together We Grow
concludes that this bill will permit medically fragile young
adults to remain at the PDHRCF in a separate transitional care
unit, and that the costs of these services are less than the
state would pay for institutional care.
The California Children's Hospital Association (CCHA) supports
this bill pointing out that as a result of the advances made
in medicine over the past 25 years, more medically fragile
children are living into adulthood and aging out of PDHRCF
service. CCHA notes that this can be disastrous for patients
and families, both financially and emotionally, as they enter
a fragmented adult system that does not have the same level of
services. CCHA concludes that this bill will protect their
access to the facilities they have essentially grown up in,
while ensuring they are being cared for in a transitional unit
appropriate to their age.
Easter Seals supports this bill because it provides for a
smooth transition into adulthood by allowing individuals to be
supported in a transitional care unit after they turn 22 years
of age.
4)TECHNICAL AMENDMENTS. Amendments to this bill are technical
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and clarifying, and add an Urgency clause.
REGISTERED SUPPORT / OPPOSITION:
Support
Together We Grow (sponsor)
California Children's Hospital Association
Easter Seals
Exceptional Family Resource Center
Home Start
Kaplan College, San Diego
Loretta's Little Miracles
San Diego Brain Injury Foundation
San Diego Regional Center
University of California, San Diego
Numerous individuals
Opposition
None on file
Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097
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