BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1211
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|AUTHOR: |Maienschein |
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|VERSION: |May 28, 2015 |
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|HEARING DATE: |July 1, 2015 | | |
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|CONSULTANT: |Vince Marchand |
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SUBJECT : Health care facilities: congregate living health
facility.
SUMMARY : Increases the maximum capacity of congregate living health
facilities, except those that are specifically permitted to have
larger capacities due to meeting specified exemptions, from 12
to 18 beds.
Existing law:
1)Licenses and regulates congregate living health facilities
(CLHFs) by the Department of Public Health (DPH), which are
defined as residential homes with a capacity of no more than
12 beds that provide inpatient care that is generally less
intense than that provided in a general acute care hospital,
but more intense than that provided in a skilled nursing
facility, and that includes medical supervision, 24-hour
skilled nursing care, pharmacy, dietary, social, recreational,
and at least one of the following types of services:
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. Defines terminal illness as a life
expectancy of six months or less; or,
c) Services for persons who are catastrophically
and severely disabled, which is defined as a person
whose origin of disability was acquired through trauma
or nondegenerative neurologic illness, for whom it has
been determined that active rehabilitation would be
beneficial and to whom services such as speech,
physical, and occupational therapy are being provided.
AB 1211 (Maienschein) Page 2 of ?
2)Requires a CLHF to have a noninstitutional, homelike
environment.
3)Permits a CLHF operated by a city and county to have a
capacity of 59 beds.
4)Permits a CLHF serving the terminally ill or those who have
been diagnosed with a life-threatening illness that is located
in a county with a population of 500,000 or more, or in Santa
Barbara County, to have up to 25 beds.
5)Requires CLHFs to be freestanding, but permits multiple CHLFs
to exist in one multi-floor building, if certain requirements
are met, including that the CLHFs must be located on the
former McClellan Air Force Base.
6)Requires a CLHF serving six or fewer persons to be considered
a residential use of property for purposes of any zoning
ordinance, but requires any CLHF of more than six beds to be
subject to the conditional use permit requirements of the city
or county in which it is located, unless waived by the city or
county.
7)States it is the policy of the state to prevent
overconcentrations of intermediate care facilities, CLHFs, and
pediatric day health and respite care facilities, and requires
DPH to deny an application for a new license of one of these
types of facilities if the location of the new facility is in
close proximity to an existing facility. For purposes of
CLHFs, overconcentration means facilitates that are separated
by less than 1,000 feet.
This bill: Increases the maximum capacity of congregate living
health facilities, except those that are specifically permitted
to have larger capacities due to meeting specified exemptions,
from 12 to 18 beds.
FISCAL
EFFECT : According to the Assembly Appropriations Committee,
this bill would have negligible state fiscal effect.
PRIOR
VOTES :
AB 1211 (Maienschein) Page 3 of ?
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|Assembly Floor: |78 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
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|Assembly Rules Committee: |11 - 0 |
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COMMENTS :
1)Author's statement. According to the author, CLHFs provide
critical services for patients who are deemed sufficiently
stable to no longer meet criteria for an acute hospital stay
but are too medically fragile to go a skilled nursing facility
or directly home. Presently, CLHFs not operated by a city or
county are limited to a maximum of 12 beds; however, CLHFs
operated by a city or county can be licensed up to a capacity
of 59 beds. Patient and family demand for alternative,
non-institutional settings is increasing. As required by law,
CLHFs provide a home-like setting for patients who meet
licensed criteria. CLHFs also provide younger, non-geriatric
patients an age-appropriate alternative to a skilled nursing
facility. Presently, demand for CLHF services is increasing
beyond the current capacity and the only alternative to
expanding the number of beds permitted from 12 to 18 is for
operators to construct new CLHFs in the same community. New
and unnecessary construction lengthens the time it takes to
place patients who need care in a CLHF, and adds to the number
of facilities that DPH would have to oversee. Further, as
healthcare inflation continues its upward climb, providers
must look for ways to lower the cost of patient care. 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,
etc. to meet patient demand. This does not diminish the
residential, home-like feeling of the CLHF but it does offer
the following:
a) Better economies of scale as fixed costs can be spread
among a larger patient population, and therefore reduced
cost to patients.
b) Increased access to appropriate and necessary care.
c) Reduced burden on the state to oversee additional CLHF
facilities to meet same demand
d) Greater parity between the restrictions placed upon
private and public sector CLHF licensed programs.
AB 1211 (Maienschein) Page 4 of ?
1)DPH has still not adopted CLHF-specific regulations. Ever
since the CLHF licensure category was created in 1986, DPH has
been required to adopt regulations for the licensure of CLHFs.
Originally, DPH had a deadline of January 1, 1991 to adopt
these regulations, though in 1992, AB 3347 (Wright, Chapter
494, Statutes of 1992) eliminated this deadline. These
regulations are to include minimum standards of adequacy,
safety, and sanitation of the physical plant and equipment,
minimum standards for staffing with duly qualified personnel,
and training of the staff, and minimum standards for providing
the services offered. Until these regulations are adopted,
existing law requires CLHFs to be licensed by DPH if they meet
certain statutory requirements that are specific to CLHFs
(which would become inoperative upon the adoption of
regulations), and if they conform to regulations that govern
licensed skilled nursing facilities, with a long list of
specific exemptions from certain sections of these
regulations. According to DPH, it is in the process of hiring
and redirecting staff to address these and other longstanding
licensing and certification regulatory needs, but does not
have an estimated completion date at this time.
2)Related legislation. AB 1147 (Maienschein) revises the
definition of a pediatric day health and respite care facility
(PDHRCF), 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 in a PDHRCF if the facility
receives approval from DPH for a Transitional Health Care
Needs Optional Service Unit.
3)Prior legislation. SB 534 (Hernandez, Chapter 722, Statutes of
2013), among other provisions not related to this bill,
permitted multiple CHLFs to exist in one multi-floor building,
notwithstanding the requirement that CHLFs be freestanding, if
certain conditions were met, including being located on the
former McClellen Air Force Base.
SB 620 (Buchannan, Chapter 674, Statues of 2013), required
specified health facilities, including congregate living
health facilities, 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.
AB 1211 (Maienschein) Page 5 of ?
SB 177 (Strickland, Chapter 331, Statutes of 2011), raised the
bed limit for congregate living health facilities that serve
terminally ill patients in Santa Barbara County from 12 to 25
beds.
SB 666 (Aanestad, Chapter 443, Statutes of 2005), increased the
capacity of a CLHF from no more than six beds, to no more than
12 beds. Maintained an exception to allow CLHFs which serve
terminally ill patients and which are located in counties with
500,000 or more persons to have 25 beds.
AB 3347 (Wright, Chapter 494, Statutes of 1992) deleted the
January 1, 1991 deadline for DPH to adopt regulations for CLHF
licensing standards, extended requirements for CLHFs serving
the terminally ill or catastrophically disabled to CLHFs
serving the mentally alert but physically disabled.
AB 3535 (Wright, Chapter 1459, Statutes of 1986), created the
CLHF licensure category, and defined a CLHF as a residential
home with a capacity of no more than six beds,(which provides
inpatient care to mentally alert, physically disabled
residents, who may be ventilator dependent.
4)Support. According to the author, this bill is sponsored by
CareMeridian, which states that with the rising demand for
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. CareMeridian
states that it is a leader in post-acute neuro-rehabilitation
for patients suffering from catastrophic injuries or
illnesses. According to CareMeridian, many of these patients
are too fragile to go to a post-acute facility and too
medically complex to enter an acute rehabilitation program,
and that it offers a home-like, community-based setting with
highly skilled staff to bring individualized treatment to
patients and comfort to the family. DaVita states in support
that it is the largest provider of dialysis services in
California, and that a certain amount of the patients they
serve rely on CLHFs for their health care needs. DaVita states
that this bill provides more options for patients, like those
with kidney failure, who need more intense medical care.
5)Striking a balance between residential settings and access.
One of the distinguishing features of a CLHF is its
AB 1211 (Maienschein) Page 6 of ?
requirement to be a home-like setting, rather than the more
institutional-like feel of a traditional skilled nursing
facility. As originally created, CLHFs were limited to six
beds. Over the years, there have been some exceptions added,
including for CLHFs in large counties (counties with more than
500,000 people are permitted to have CLHFs with up to 25 beds
when they are serving the terminally ill, though not when
serving the catastrophically disabled). In 2005, legislation
was enacted increasing the capacity of all CLHFs to 12 beds.
CLHFs are limited to having no more than two residents per
room. By expanding capacity to 18 beds, these homes could have
up to 9 bedrooms. At some point, if the Legislature continues
to allow for larger and larger capacities, these CLHFs will
start to lose the home-like quality that is their
distinguishing characteristic. The proponents argue that the
demand is outstripping the current availability of CLHF beds,
and that expanding capacity will better allow California to
meet the demand for noninstitutional inpatient care, while
still maintaining the residential quality of these facilities.
The policy question for the Legislature is whether an increase
to 18 beds continues to strike this balance.
6)Policy comment. As noted above, while DPH has not adopted
CLHF-specific regulations, this is not to suggest that these
facilities do not have a regulatory structure. There are a
number of statutory requirements specific to CLHFs, and these
facilities must adhere to a large body of regulations that
were adopted for skilled nursing facilities, but that have
been applied to CLHFs in the absence of CLHF regulations.
However, this is another example of the longstanding problem
in DPH of ignoring mandates to adopt regulations. In some
instances, the lack of the timely adoption of regulations by
DPH has left some facilities unregulated entirely. While this
Committee has approved a piecemeal approach to the problem of
outdated or nonexistent regulations, the longstanding
reluctance of DPH to utilize the standard rulemaking process
is troubling. It is encouraging that DPH is currently engaged
in an effort to update Title 22 regulations. DPH should also
examine what the barriers have been to using the
Administrative Procedures Act process in an effort to make
that a more routine part of their role as a regulator.
SUPPORT AND OPPOSITION :
Support: CareMeridian (sponsor)
Adaptive Business Leaders Organization
AB 1211 (Maienschein) Page 7 of ?
CareMeridian, Granite Bay
DaVita
HealthCap Partners
Heart to Heart Health Care
Learning Services
Long Term Care Medical Group
Merit Profiles
Rehabilitation Associates Medical Group
Rehabilitation Nurses Society
Sabra Health Care REIT, Inc.
San Diego Brain Injury Foundation
San Dimas H.E.R.O.E.S.
Select Data
Winways Rehab and Solutions Rehab
Numerous individuals
Oppose: None received
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