BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1211|
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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:
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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
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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,
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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
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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)
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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
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