BILL ANALYSIS Ó
AB 1147
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CONCURRENCE IN SENATE AMENDMENTS
AB
1147 (Maienschein)
As Amended July 7, 2015
2/3 vote. Urgency
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|ASSEMBLY: | 78-0 | (May 14, |SENATE: |39-0 | (July 13, 2015) |
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Original Committee Reference: HEALTH
SUMMARY: Creates a licensing category for pediatric day health
and respite care facilities (PDHRCFs), including all the
requirements and standards that such facilities must adhere to,
and revises the definition of a pediatric day health and respite
care facility, which is currently limited to children 21 years
of age or younger, to also permit an individual who is 22 years
of age or older to receive care if the facility receives
approval for a Transitional Health Care Needs Optional Service
Unit, which is established by this bill. Contains an urgency
clause to ensure that the provisions of this bill go into
immediate effect upon enactment.
The Senate amendments clarify the Department of Public Health's
(DPH) ability to ensure that PDHRCFs meets minimal standards
prior licensure, and to deny the approval of the optional
service unit if does not meet DPH standards.
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FISCAL EFFECT: According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS: 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 PDHRCFs 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.
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
Congregate Living Health Facilities (CLHFs). At that time
regulations for CLHFs were to be final by January 1, 1991, and
CLHFs were operating under Skilled Nursing Facility (SNF)
regulations with some exceptions to those regulations allowed
through program flexibility waivers.
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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.
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, an 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.
Together We Grow, a PDHRCF in San Diego is the 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,
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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.
There is no known opposition to this bill.
Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN:
0001203