BILL ANALYSIS Ó
AB 1211
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Date of Hearing: April 28, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 1211
(Maienschein) - As Amended March 24, 2015
SUBJECT: Health care facilities: congregate living health
facility.
SUMMARY: Increases the maximum number of beds allowed in
congregate living health facilities (CLHFs) to provide basic
services for inpatient care, as specified. Specifically, this
bill:
1)Defines a CLHF as a residential home, with no more than 18
beds, to provide specified basic services for in-patient care.
2)Prohibits a CLHF not operated by a city and county that is
serving persons who are catastrophically and severely
disabled, as defined, and which is located in a county of
500,000 or more persons from having more than 18 beds if they
are for the purpose of serving persons who are
catastrophically and severely disabled.
3)Requires CLHFs to provide one or more of the following, in
addition to other basic services in existing law:
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a) Services for persons who are mentally alert, persons
with physical disabilities, who may be ventilator
dependent;
b) Services for persons who have a diagnosis of terminal
illness, a diagnosis of a life-threatening illness, or
both. Terminal illness means the individual has a life
expectancy of six months or less as stated in writing by
his or her attending physician and surgeon. A
"life-threatening illness" means the individual has an
illness that can lead to a possibility of a termination of
life within five years or less as stated in writing by his
or her attending physician and surgeon; and,
c) Services for persons who are catastrophically and
severely disabled. Requires services offered by a CLHF to
a person who is catastrophically disabled to include, but
not be limited to, speech, physical, and occupational
therapy.
EXISTING LAW:
1)Requires the Department of Public Health (DPH) to regulate and
license health facilities, including CLHFs.
2)Authorizes CLHFs to have up to 12 beds to provide basic
services for inpatient care, including medical supervision,
24-hour skilled nursing and supportive care, pharmacy,
dietary, social, recreational, and at least one of the
following services:
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a) Services for persons who are mentally alert, persons
with physical disabilities, who may be ventilator
dependent;
b) Services for persons who have a diagnosis of terminal
illness, a diagnosis of a life-threatening illness, or
both; or,
c) Services for persons who are catastrophically and
severely disabled. Requires services offered by a
congregate living health facility to a person who is
catastrophically disabled to include, but not be limited
to, speech, physical, and occupational therapy.
3)Requires CLHFs to identify which of the types of persons to
whom a facility is licensed to provide services.
4)Allows for the following maximum capacities for CLHFs:
a) A facility operated by a city and county to have a
capacity of 59 beds;
b) CLHFs not operated by a city and county servicing
persons who are terminally ill, persons who have been
diagnosed with a life-threatening illness, or both, that is
located in a county with a population of 500,000 or more
persons, or located in Santa Barbara County, may have a
maximum of 25 beds for the purpose of serving persons who
are terminally ill; and,
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c) CLHFs not operated by a city and county serving persons
who are catastrophically and severely disabled, that is
located in a county of 500,000 or more persons may have a
maximum of 12 beds for the purpose of serving persons who
are catastrophically and severely disabled.
5)Requires CLHFs to have a noninstitutional, homelike
environment.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. The author states the demand for CLHF
services to provide alternative, non-institutional settings
for patients is increasing beyond current capacity. The
author asserts the only current alternative to expanding the
number of beds from 12 to 18 is for operators to construct new
CLHFs within the same community, which lengthens the time it
takes to place in-need patients in a CLHF and increases the
number of facilities that DPH must oversee. The author
maintains that by increasing the number of licensed beds from
12 to 18, providers may reduce the fixed costs related to
operating a CLHF, rather than increasing costs due to new
construction, to meet the increasing demand. The author also
explains a cap of 18 would allow the program to stay
residential in nature but provide additional economies of
scale to help keep average fixed cost per bed of the program
down. The author states this bill will increase parity
between the restrictions placed upon private and public sector
CLHF-licensed programs.
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2)BACKGROUND.
a) CLHFs in California. CLHFs are one type of long-term
care facility licensed by DPH in California. DPH requires
that the primary need of CLHF residents be for skilled
nursing care on a recurring, intermittent, extended, or
continuous basis. CLHFs are designed to provide care that
is generally less intense than that provided in general
acute care hospitals but more intense than that provided in
skilled nursing facilities. There are currently 84
licensed CLHFs operating throughout the state, with a total
bed capacity of 661. The sponsor states occupancy rates at
its facilities have consistently run over 92% within the
last few years.
There are currently three classifications of licensure for
CLHFs:
i) CLHF "A" facilities provide services for individuals
who are mentally alert, physically disabled individuals
who may be ventilator dependent;
ii) CHLF
"B" facilities allow for services for individuals who
have a diagnosis of terminal illness, a diagnosis of a
life-threatening illness, or both; and,
iii) CLHF
"C" facilities provide services for individuals who are
catastrophically and severely disabled. Services offered
to catastrophically disabled persons include, but are not
limited to, speech, physical, and occupational therapy.
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b) Expansion of CHLFs. The sponsors of the bill point to
referral records demonstrating the necessity to turn
patients away due to the lack of availability of beds with
the current CLHF bed capacity limits. Anecdotal evidence
from supporters of the bill suggests there is a great
demand for increased access to CLHF facilities. Current
statute mandates CHLFs to maintain a residential, home-like
setting for its patients in order to maintain valid CLHF
licensure; thus, unless legislation is enacted to change
these requirements, a simple expansion on the maximum
allowable beds in CLHFs in statute must adhere to these
provisions. However, existing law also allows for
exemptions on maximum bed capacity for CHLFs in specified
locations in California, with some capacities of 25 or 59
beds. The expansion allowed in this bill still remains
significantly under the current allowable maximum capacity
of those counties exempt from the current 12 bed limit for
CLHFs.
3)SUPPORT. CareMeridian, the sponsor of the bill, states as
healthcare inflation continues to increase, providers must
look for ways to lower the cost of patient care. The sponsor
states by increasing the number of licensed beds from 12 to
18, providers may reduce the fixed costs related to operating
a CLHF, rather than increasing costs due to other factors,
such as new construction, to meet patient demand. The sponsor
asserts that CLHFs with greater than 12 beds can still
maintain the same high quality, home-like appearance and feel
as programs operating at the lower bed threshold.
Supporters contend with the rising demand from
non-institutional settings, increasing the number of beds in
current CLHFs provides more options for patients needing more
intense medical care and rehabilitation than what can be
provided in a standard skilled nursing facility. Supporters
state this bill will allow for improved access to
community-based, highly-skilled care for patients and comfort
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to their families.
4)PREVIOUS LEGISLATION.
a) SB 534 (Ed Hernandez), Chapter 722, Statutes of 2013,
authorizes the establishment of multiple CLHFs in one
multi-floor building if certain requirements are met,
including, among others, that each facility is separated by
a wall, floor, or other permanent partition, and is located
on former McClellan Air Force Base, as specified.
b) SB 620 (Buchanan), Chapter 674, Statutes of 2013,
requires specified health facilities, including CLHFs, to
develop and comply with an absentee notification plan for
the purpose of addressing issues that arise when a patient,
resident, or participant, as applicable, is missing from
the facility.
c) SB 135 (Ed Hernandez), Chapter 673, Statutes of 2012,
establishes a new health facility licensing category of
hospice facility, and permits a licensed and certified
hospice services provider to provide inpatient hospice
services through the operation of a hospice facility,
either as a free-standing health facility, or adjacent to,
physically connected to, or on the building grounds of
another health facility or a residential care facility.
d) SB 177 (Strickland), Chapter 331, Statutes of 2011,
raises the bed limit from 12 to 25 for CLHFs that serve
terminally ill patients in Santa Barbara County.
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e) SB 666 (Aanested), Chapter 443, Statutes of 2005,
increases the capacity of a CLHF from no more than six
beds, to no more than 12 beds. Maintains an exception to
allow CLHFs which serve terminally ill patients, and those
which are located in counties with greater than 500,000
people, to have 25 beds.
REGISTERED SUPPORT / OPPOSITION:
Support
CareMeridian (sponsor)
Adaptive Business Leaders
Anthem Blue Cross
DaVita
Merit Profiles
Rehabilitation Associates Medical Group
San Diego Brain Injury Foundation
San Dimas HEROES
Select Data
Numerous individuals
Opposition
None on file.
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Analysis Prepared by:An-Chi Tsou / HEALTH / (916) 319-2097