BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1211| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 1211 Author: Maienschein (R) Amended: 8/19/15 in Senate Vote: 27 - Urgency SENATE HEALTH COMMITTEE: 8-0, 7/1/15 AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen, Pan, Roth NO VOTE RECORDED: Wolk SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8 ASSEMBLY FLOOR: 78-0, 5/14/15 (Consent) - See last page for vote SUBJECT: Health care facilities: congregate living health facility SOURCE: CareMeridian DIGEST: 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. Senate Floor Amendments of 8/19/15 add an urgency clause, so that this bill will take effect immediately upon enactment. ANALYSIS: AB 1211 Page 2 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. 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 AB 1211 Page 3 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: 1)Increases the maximum capacity of CLHFs except those that are specifically permitted to have larger capacities due to meeting specified exemptions, from 12 to 18 beds. 2)Contains an urgency clause, so that this bill will take effect immediately upon enactment. States that this urgency clause is necessary to ensure that eligible patients of congregate living health facilities are able to obtain essential care, and to enable these facilities to provide care for patients currently on a waiting list. 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, AB 1211 Page 4 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. 1)Striking a balance between residential settings and access. One of the distinguishing features of a CLHF is its 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 AB 1211 Page 5 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 nine 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. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: Yes SUPPORT: (Verified8/20/15) CareMeridian (source) Adaptive Business Leaders Organization 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 OPPOSITION: (Verified8/20/15) AB 1211 Page 6 None received ARGUMENTS IN 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. ASSEMBLY FLOOR: 78-0, 5/14/15 AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins NO VOTE RECORDED: Linder, Medina Prepared by:Vince Marchand / HEALTH / 8/21/15 10:34:58 AB 1211 Page 7 **** END ****