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  ****