BILL ANALYSIS Ó
AB 2341
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ASSEMBLY THIRD READING
AB
2341 (Lackey)
As Amended April 4, 2016
Majority vote
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |18-0 |Wood, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Campos, Chiu, | |
| | |Dababneh, Gomez, | |
| | | | |
| | | | |
| | |Roger Hernández, | |
| | |Lackey, Olsen, | |
| | |Patterson, | |
| | | | |
| | | | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |20-0 |Gonzalez, Bigelow, | |
| | |Bloom, Bonilla, | |
| | |Bonta, Calderon, | |
AB 2341
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| | |Chang, Daly, Eggman, | |
| | |Gallagher, Eduardo | |
| | |Garcia, Roger | |
| | |Hernández, Holden, | |
| | |Jones, Obernolte, | |
| | |Quirk, Santiago, | |
| | |Wagner, Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Authorizes the California Department of Public Health
(DPH) to allow nursing facilities (NFs) and skilled nursing
facilities (SNFs) to provide dialysis, peritoneal, and infusion
services that are not defined in regulation, if certain
quality-of-care and other criteria are met. Defines the minimum
standard for quality of care for these identified services to be
equivalent to, or greater than, that of current community
standards for quality of care for that type of service.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, costs to DPH Licensing and Certification are expected
to be minor and absorbable, assuming the availability of this
new option does not lead to a large number of facilities
pursuing the delivery of these services (Licensing and
Certification Fund). Any costs are supported by nursing
facility licensure fees.
COMMENTS: According to the author, this bill provides nursing
facilities with flexibility to be innovative in their provision
of care to residents, and increases access to care to
communities. This bill will allow facilities to provide
additional, targeted services to individuals both inside the
facility and on an outpatient basis. The author argues
authorizing these services in a way that explicitly does not
require DPH to issue regulations will enhance care without the
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cost and burden of the regulatory process. This bill is
sponsored by Leading Age California, an advocacy organization
representing nonprofit senior living and care facilities.
California's Title 22 regulations relating to optional services
have not been updated by DPH since the federal changes were
made, and specify that physical therapy, occupational therapy,
speech therapy, speech pathology, audiology, social work
services, and special treatment program services are "special,"
or "optional services," and as such must be listed on a
facilities licensing application. The regulations also specify
that outpatient services that are provided for the special
services mentioned above must meet certain operational
conditions, such as ensuring that the special service units do
not traverse a nursing unit, and providing waiting areas with
sufficient space for patients. In order to be able to provide
special services, all SNFs must receive approval from DPH. DPH
evaluates applications and either approves or denies the request
on a case-by-case basis, using all relevant state and federal
requirements for the special service. Additionally, DPH
regulations require SNFs to comply with all licensing
requirements. However, these regulations also allow SNFs to use
alternate procedures, equipment, personnel qualifications, or
conduct pilot projects, as long as these additional activities
are carried out to the same standards of safety and care listed
in statute and through regulation. These exceptions are only
authorized with prior written approval of DPH and must be
accompanied with substantiating evidence supporting the request.
In August of 2007, DPH published a memo stating that peritoneal
and hemodialysis services may be provided in SNFs, and that the
services will be delivered in compliance with DPH regulations on
optional or special services. Neither the regulations nor the
memo waived the statutory requirements for the development of
regulations for these services to be provided by SNFs.
The services authorized by this bill include dialysis,
peritoneal, and infusion services. Hemodialysis is a
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life-support treatment that uses a machine to filter harmful
wastes, salt, and excess fluid from the blood. Peritoneal
dialysis is a different means to clean the blood, which can be
done while sleeping or going about daily activities. Infusion
is a process whereby medicine, nutrients or special fluids are
delivered through a needle directly into the body.
LeadingAge California, the sponsor of this bill, contends that
by allowing SNFs and NFs to provide special services as
authorized by this measure, the continuity of care for residents
could be enhanced. The sponsor maintains that the inability of
DPH to adopt or update regulations has been a barrier to the
expansion of services that can be provided by SNFs and NFs to
residents and members of the community-at-large and forces
residents to obtain services outside the SNF and NF community.
The California Advocates for Nursing Home Reform (CANHR), in
opposition, contends that this bill would allow SNF and NFs to
create special services of their own design and establish the
standards of care for their delivery. CANHR also states that
DPH would be required to approve these special services without
any regulatory or statutory standards to guide its
determinations.
The California Dialysis Council, in opposition of this bill,
states that current law and regulations establish a robust set
of licensure standards for dialysis clinics which are intended
to ensure appropriate and safe multi-disciplinary services to
the dialysis patients and this bill will put dialysis patients
at risk. While current law sets forth various equipment,
facility, personnel and care team standards, this bill makes
vague references to current community standards for quality of
care but would not require these facilities to meet current
requirements for licensure as a dialysis clinic.
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Please see the policy committee analysis for full discussion of
this bill.
Analysis Prepared by:
Kristene Mapile / HEALTH / (916) 319-2097 FN: 0002762