BILL ANALYSIS Ó
AB 2079
Page 1
ASSEMBLY THIRD READING
AB
2079 (Calderon)
As Amended May 31, 2016
Majority vote
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |12-6 |Wood, Burke, Campos, |Maienschein, |
| | |Chiu, Dababneh, |Bonilla, Lackey, |
| | |Gomez, |Olsen, Patterson, |
| | | |Steinorth |
| | | | |
| | |Roger Hernández, | |
| | | | |
| | | | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Thurmond, Waldron | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |12-7 |Gonzalez, Bloom, |Bigelow, Bonilla, |
| | |Bonta, Calderon, |Chang, Gallagher, |
| | |Eggman, |Jones, Obernolte, |
| | | |Wagner |
| | | | |
| | |Eduardo Garcia, | |
| | | | |
AB 2079
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| | | | |
| | |Roger Hernández, | |
| | |Holden, Quirk, | |
| | |Santiago, Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Provides for an incremental increase in the equivalent
direct care service hours in freestanding skilled nursing
facilities (SNFs), as specified. Specifically, this bill:
1)Requires the Department of Public Health (DPH) to adopt
regulations requiring SNFs, except those that are distinct
part of a general acute care facility or state hospital, to
increase their equivalent direct care service hours
incrementally, as specified below:
a) Commencing January 1, 2018, these SNFs must have a
minimum number of equivalent direct care service hours of
3.5 per patient day, with 2.4 hours per patient day for
certified nurse assistants (CNAs) and 1.1 hours per patient
day for licensed nurses, as specified;
b) Commencing January 1, 2019, these SNFs must have a
minimum number of equivalent direct care service hours of
3.8 per patient day, with 2.6 hours per patient day for
CNAs and 1.2 hours per patient day for licensed nurses;
and,
c) Commencing January 1, 2020, these SNFs must have a
minimum number of equivalent direct care service hours of
4.1 per patient day, with 2.8 hours per patient day for
CNAs and 1.3 hours per patient day for licensed nurses, as
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specified.
2)Includes in the existing definition of direct caregiver: a) a
nurse assistant in an approved training program, as specified;
and, b) a licensed nurse serving as a minimum data set
coordinator. Excludes from this definition the director of
nursing services in a facility with 60 or more licensed beds.
3)Revises the existing requirement for DPH to consult with
consumers and other stakeholders every five years to determine
the sufficiency of the SNF staffing standards no later than
January 1, 2019.
4)Requires SNFs to post information about resident census, which
includes an accurate report of the number of direct care staff
working during the current shift, including a report of the
number of registered nurses (RNs), licensed vocational nurses
(LVNs), psychiatric technicians, and CNAs. Requires
information on the posting to be on paper that is at least 8.5
inches by 14 inches and printed in at least 16 point font.
Requires this information to be posted daily, at a minimum in
the following locations:
a) An area readily accessible to members of the public;
b) An area used for employee breaks; and,
c) An area used by residents for communal functions,
including dining, resident council meetings, or activities.
5)Requires each SNF, upon oral or written request, to make
direct caregiver staffing data available to the public for
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review at a reasonable cost within 15 days after receiving a
request. Defines "reasonable cost" to include a $0.10 per
page fee for standard reproduction of documents that are 8.5
inches by 14 inches or smaller or a retrieval or processing
fee not exceeding $60 if the requested data is provided on a
digital or other electronic medium and the requestor requests
delivery of the data in a digital or other electronic medium,
including electronic mail.
6)Deletes existing references to direct care service hours and
replaces it with equivalent direct care service hours.
7)Makes other, technical and conforming changes.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)Significant costs for additional Medi-Cal payments to skilled
nursing facilities (General Fund (GF)and federal funds).
Under current law, the Department of Health Care Services
(DHCS) pays SNFs that care for Medi-Cal beneficiaries on a
cost-based system. Under current law, DHCS is required to
increase reimbursement rates to skilled nursing facilities to
offset any additional costs mandated by the state or federal
government. Currently, the average nursing hours is about 3.8
per patient day, comprised of 0.42 RN, 0.78 LVN, and 2.45 CNA
hours per day. It is not clear whether current law will
require DHCS to offset the increased cost to go from 3.8 to
4.1 hours, or whether DHCS will be required to pay for the
costs to go from the currently required 3.2 hours to 4.1
hours.
Assuming DHCS will increase payments to a SNF based on the
cost to increase staffing levels from current practice to the
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newly mandated hours requirement, DHCS estimates costs of $140
million ($70 million GF) for full implementation of the 4.1
hours ratio. It is unclear whether this estimate accounts for
planned increases in the minimum wage. This estimate is based
on a 14.2% increase in CNA hours, from 2.45 to 2.8.
Assuming current law requires DHCS to increase payments to
facilities to pay the full costs of increasing staffing levels
from the currently mandated level to the level mandated in
this bill, the California Association of Health Facilities,
based on their facility-specific model which accounts for
planned minimum wage increases, projects annual Medi-Cal costs
for increased reimbursement to SNFs of $126 million in 2018
($63 million GF), $266 million ($133 million GF) in 2019, and
increasing annually until 2022 and thereafter when costs are
projected at $462 million annually ($231 million GF).
2)One-time costs in the range of $100,000 to adopt regulations
and modify internal tracking systems by the California
Department of Public Health (DPH) (Licensing and Certification
Fund).
3)Minor additional ongoing enforcement costs to DPH (Licensing
and Certification Fund). DPH already licenses SNFs, including
compliance with existing nursing hours requirements, and the
increased workload is not expected to be significant.
COMMENTS: According to the author, the current minimum of 3.2
hours per patient per day staffing requirements for SNFs does
not meet the direct care needs of nursing home residents. This
chronic understaffing of CNAs in SNFs creates unsafe living
conditions for the residents. Nursing home residents are among
the most vulnerable populations that include individuals who
have limited ability to care for themselves due to physical,
cognitive, or chronic health conditions. Additionally, although
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SNFs are required to report their compliance with the 3.2 hours
staffing requirement, facility workers continue to report
chronic understaffing of direct care providers, creating unsafe,
stressful, and at times unpleasant living conditions for
residents.
The current staffing requirement of 3.2 nursing hours per
resident per day was adopted in 2000. Prior to this date, the
requirement was for 2.9 hours. In 2001, legislation was passed
requiring DPH to convert the 3.2 nursing hour requirement into
staff ratios by 2003. However, DPH did not meet this deadline
and subsequent litigation required DPH to complete the
regulations. Under these regulations, the ratios must be based
on the anticipated individual patient needs for the activities
of each shift and are required to be distributed throughout the
day to achieve a minimum of 3.2 nursing hours per resident per
day. SNFs are required to employ and schedule additional staff
to ensure patients receive nursing care based on their needs.
These regulations require SNFs to use the following ratios, with
"direct caregiver" defined as RNs, LVNs, psychiatric
technicians, CNAs, or nursing assistants in an approved training
program: 1) on the day shift, at least one direct caregiver for
every five patients or fraction thereof; 2) on the evening
shift, at least one direct caregiver for every eight patients or
fraction thereof; and, 3) on the night shift, at least one
direct caregiver for every 13 patients or fraction thereof.
As part of these ratios, there is a requirement that there be
one licensed nurse (either an RN or a LVN) for every eight or
fewer patients, which can be counted toward the above shift
ratios. Beyond this requirement, these existing ratios do not
differentiate between types of direct caregivers. This bill,
however, requires specific ratios for both CNAs and licensed
nurses, and includes specified minimum ratios for CNAs.
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Analysis Prepared by:
Rosielyn Pulmano / HEALTH / (916) 319-2097 FN:
0003285