BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 2414


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          (Without Reference to File)





          CONCURRENCE IN SENATE AMENDMENTS


          AB  
          2414 (Eduardo Garcia)


          As Amended  August 19, 2016


          Majority vote


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          |ASSEMBLY:  |50-25 |(May 12, 2016) |SENATE: |27-11 |(August 29,      |
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          Original Committee Reference:  L. GOV.




          SUMMARY:  Establishes an annexation process for the Desert  
          Healthcare District (District).  




          The Senate amendments:  











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          1)Require the District, instead of the Riverside County Board of  
            Supervisors (Board of Supervisors), to file the resolution of  
            application to expand the District's boundaries and to pay for  
            any associated fees.  




          2)Authorize the Riverside County Local Agency Formation  
            Commission (Riverside LAFCO) to condition the annexation on  
            the District's imposition of sufficient revenues to provide  
            services within the annexed territory including, but not  
            limited to the concurrent approval of special taxes for  
            benefit assessments.  




          3)Require the District's Board of Directors (Board), following  
            the expansion of the Board, to adopt a resolution to divide  
            the District into seven voting districts, number the voting  
            districts consecutively, and to elect Board members by voting  
            district beginning with the first District election after  
            January 1, 2020.  




          4)Require the Board, in establishing the voting districts, to  
            provide for representation in accordance with demographic,  
            including population, and geographic factors, of the entire  
            are of the District.  




          5)Require the Board to fix the time and place and give public  
            notice for a hearing on the proposed establishment of the  
            voting districts, at which and elector of the District may  
            present his or her views and plans for the proposed division  
            of District.  








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          6)Require the Board's resolution pursuant to 3) above, to  
            declare the voting districts and describe the boundaries of  
            each voting district.  Require any necessary procedures for  
            implementing the election of the Board by voting districts to  
            be established and implemented on or before January 1, 2020.  




          7)Require one member of the Board to be elected by the electors  
            of each of the voting districts.  Prohibit a person from  
            holding office as a Board member unless he or she has been a  
            resident of the voting district from which he or she is  
            elected from for the 30 days next preceding the date of the  
            election.  Provide an appointment process for a vacancy on the  
            Board, as specified.  




          8)State that it is the intent of the Legislature that the  
            District maximizes the use of its assets to provide direct  
            health services to individuals within the District through  
            direct operation of or funding to provide to organizations  
            that own or operate hospitals and other facilities and  
            services.  




          AS PASSED BY THE ASSEMBLY, this bill:


          1)Established an annexation process for the District to include  
            the East Coachella Valley region, as specified, and provided a  
            new governance structure for the expanded District's Board.  










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          2)Required the Board of Supervisors, on or before January 5,  
            2017, to file a resolution of application with Riverside  
            LAFCO, to initiate LAFCO proceedings for the District's  
            expansion.  


          3)Required the Board of Supervisors to pay any fees associated  
            with the resolution of application, and to hold a hearing and  
            provide specified notice.  


          4)Required Riverside LAFCO to complete the proceeding and direct  
            the election.  Prohibited the resolution of application from  
            being subject to any protest proceedings.  Prohibited  
            Riverside LAFCO from disapproving the resolution of  
            application.  


          5)Required Riverside LAFCO to order the expansion of the  
            District subject to a vote of the registered voters residing  
            within the territory to be annexed to the District at an  
            election.  


          6)Required Riverside LAFCO to direct the Board of Supervisors to  
            conduct the election for the District's expansion and any  
            necessary funding source that requires voter approval.  


          7)Required the Board, 30 days after the expansion of the  
            District, to adopt a resolution to appoint two additional  
            Board members that are registered voters and residents of the  
            territory annexed pursuant to this bill.  


          8)Found and declared that a special law is necessary and general  
            law cannot be made applicable as specified.  


          FISCAL EFFECT:  According to the Senate Appropriations  
          Committee, there are:









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          1)Unknown reimbursable one-time costs, likely over $50,000, for  
            the District to pay for costs to prepare an application for  
            the expansion of the District and to conduct the specified  
            election (General Fund).  Actual reimbursable costs would be  
            subject to a determination by the Commission on State Mandates  
            (Commission), if the County files a successful reimbursement  
            claim.  


          2)Unknown, likely minor reimbursable ongoing costs until 2020  
            related to the mandatory addition of two at-large District  
            board members, should the election on the District expansion  
            be approved by the voters (General Fund).  Actual reimbursable  
            costs would be subject to a determination by the Commission,  
            if the District files a successful reimbursement claim.


          3)Additional estimated one-time reimbursable costs of  
            approximately $300,000 to conduct activities related to the  
            establishment of seven voting districts, to the extent the  
            District expansion is approved by the voters  (General Fund).   
             Redistricting costs could include public outreach as well as  
            legal, demographic, and communications consultant contracts.   
            Actual reimbursable costs would be subject to a determination  
            by the Commission.


          


          COMMENTS:  


          1)LAFCO Law.  LAFCOs regulate local government boundary changes  
            through the approval or denial of proposals by other public  
            agencies or individuals for these procedures.  The Act  
            establishes procedures for local government changes of  
            organization, including annexations to a special district.   
            The Act prescribes a process for the inclusion or addition of  
            territory to a district (district annexation), which is  
            similar to most boundary changes that require numerous steps:   








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            a) application to LAFCO, by petition or resolution; b) noticed  
            public hearing, testimony, and approval or disapproval by  
            LAFCO in which they can impose terms and conditions; c)  
            additional public hearing for protests (if more than 25% of  
            voters file protest, the LAFCO must order an election on the  
            proposed annexation, and if more than 50% of voters protest,  
            then the LAFCO must terminate the proceedings); d) an  
            election, if there were significant protests; and, e) LAFCO  
            staff files documents to complete the annexation.  


            In the past several years, the Legislature has established a  
            modified LAFCO process or exempted specified requirements in  
            the LAFCO process for the formation of several special  
            districts following a history of failed attempts at the local  
            level, including AB 2453 (Achadjian), Chapter 350, Statutes of  
            2014, for the creation of the Paso Robles Water District; and,  
            AB 3 (Williams), Chapter 548, Statutes of 2015, for the  
            formation of the Isla Vista Community Services District.  


          2)Bill Summary.  This bill establishes an annexation process for  
            the District to include the East Coachella Valley region that  
            is exempt from the statutes that govern the usual process  
            under LAFCO for district annexations.  This bill requires the  
            District, on or before January 5, 2017, to submit to Riverside  
            LAFCO a resolution of application to initiate LAFCO  
            proceedings to expand the District's boundaries to include the  
            East Coachella Valley region.  This bill requires Riverside  
            LAFCO, within 150 days of receiving the resolution of  
            application, to complete specified proceedings and direct the  
            election for the expanded District.  


            Under this bill, the expanded District must include all  
            communities currently served by the District and the  
            communities of Indian Wells, La Quinta, Indio, Coachella, and  
            the unincorporated area of Bermuda Dunes, Mecca, Thermal  
            Oasis, North Shore, and Vista Santa Rosa.  Riverside LAFCO  
            would not have the usual power to disapprove the application  
            and the protest provision would not apply to the proposed  
            annexation.  The District would only be expanded, if supported  








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            by a majority of voters within the territory proposed to be  
            annexed to the District and the passage of any necessary  
            funding.  If the District is expanded, this bill requires,  
            within 30 days, the five-member Board to appoint two new Board  
            members, who are residents and registered voters in the area  
            annexed to the District.  This bill also requires after  
            January 1, 2020 for Board members to be elected by seven  
            voting districts and prescribes the process by which the board  
            must divide the District.  This bill is author-sponsored.  


          3)Author's Statement.  According to the author, "Currently,  
            there are significant barriers preventing Eastern Coachella  
            Valley residents' access to health care providers and  
            services.  This has been well-documented by numerous  
            stakeholders in the region.  Some of the barriers include  
            shortages in the number of primary care providers, shortages  
            in various medical and surgical specialties, a lack of urgent  
            care services, and a lack of transportation.  Solving the  
            persistent barriers has proven to be challenging.  Even with  
            expanded Medicaid or commercial insurance coverage for  
            eligible residents through the Affordable Care Act, industry  
            analysts remain concerned that the number and capacity of  
            providers will prove inadequate to meet demand.  Eastern  
            Coachella Valley stakeholders and I believe that expanding the  
            current healthcare district is best to address these  
            persistent needs.  Pointing to the impact and success of the  
            [District] in addressing the health needs of its current  
            constituency."  


          4)Desert Healthcare District.  The District was created in 1948  
            to provide healthcare services to residents in the Coachella  
            Valley within a 457 square mile area that includes Palm  
            Springs, Desert Hot Springs, Cathedral City, Thousand Palms,  
            Rancho Mirage, Mountain Center, San Gorgonio, and the area of  
            Palm Desert west of Cook Street.  The District built and began  
            operating Desert Hospital, which is now known as Desert  
            Regional Medical Center.  Since 1986, the District's Board had  
            leased hospital operations to medical facility providers, and  
            in 1997, the Board voted to lease the hospital to Tenet Health  
            Systems for a 30-year period.  The District continues to own  








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            the lease and other assets, including the Las Palmas Medical  
            Plaza, while Tenant runs the operations of the 387-bed acute  
            care hospital.  


            According to the District, with an operating budget of roughly  
            $9 million, the District allocates more than $3 million each  
            year on grants and other programs.  The District is funded by  
            property tax paid by the residents of the District, revenue  
            for working capital for the hospital in the event the lease  
            with Tenet is terminated, and rental income from the medical  
            plaza.  The District is governed by a five-member Board  
            elected at-large.  


            The relationship between LAFCOs and healthcare districts is  
            unique in comparison to other special districts.  The  
            principal act for healthcare districts and the formation of  
            some healthcare districts predate the Knox Nisbet Act, which  
            created LAFCOs.  As a consequence of the ambiguity in current  
            law, the District has experienced past issues with allegations  
            of grant recipients providing service outside of the  
            boundaries of the District and within the communities  
            identified for potential annexation by this bill.  Due to the  
            unique nature of healthcare services and the long history of  
            healthcare district's principal act, the Legislature may wish  
            to consider, beyond the scope of this individual bill, if  
            there is a need to more clearly define the relationship  
            between LAFCOs and healthcare districts, and undertake a  
            closer examination of healthcare district's service  
            boundaries.  


          5)Arguments in Support.  The Borrego Community Health Foundation  
            argues, "The [District] has a long history of acknowledged  
            success in serving [their] residents.  [The District's]  
            leaders are acutely aware of and are sympathetic to health  
            disparities in the East Coachella Valley and have collaborated  
            with other agencies to provide services within the limitation  
            of their fiduciary obligations to the District's residents.   
            Expanding the current District will take away their limitation  
            to help end the healthcare disparities that currently exist." 








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          6)Arguments in Opposition.  Riverside LAFCO argues,  
            "Unfortunately, our primary issue, stripping LAFCO of its  
            discretionary authority, remains unaddressed.  While we have  
            been and will continue to be available to assist the District  
            with expansion of its boundaries, we do not believe additional  
            legislation is necessary to accomplish this intended  
            annexation."  


          Analysis Prepared by:                                             
                          Misa Lennox / L. GOV. / (916) 319-3958  FN:  
          0004852