BILL ANALYSIS Ó
AB 2747
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Date of Hearing: April 5, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 2747
(Hadley) - As Amended March 17, 2016
SUBJECT: Chronic dialysis clinics.
SUMMARY: Requires the Department of Public Health (DPH) to
complete the licensing of chronic dialysis clinics within 90
days. Specifically, this bill:
1)Requires DPH, within 90 calendar days after it receives an
initial and complete chronic dialysis clinic application, to
complete the application paperwork and conduct a licensure
survey, if necessary, to inspect the clinic and evaluate the
clinic's compliance with state licensure requirements.
2)Requires DPH to forward its recommendation and any other
necessary information to the federal Centers for Medicare and
Medicaid Services (CMS) within the same 90 calendar days.
3)Requires DPH, for an applicant seeking to receive
reimbursement under the Medicare or Medi-Cal Program, to
complete the initial application paperwork and conduct an
unannounced certification survey, if necessary, within 90 days
after DPH's receipt of a letter from the chronic dialysis
clinic notifying DPH of its readiness for the certification
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survey.
4)Requires DPH, no later than 30 calendar days after the
certification survey, to forward the results of its licensure
and certification surveys and all other information necessary
for certification to CMS.
EXISTING LAW:
1)Defines a chronic dialysis clinic as a clinic that provides
less than 24-hour care for the treatment of patients with
end-stage renal diseases, including renal dialysis services.
2)Prohibits a person or entity from providing chronic dialysis
services to patients unless the services are provided under
the direction of a chronic dialysis clinic or a general acute
care hospital.
3)Establishes the Office of Statewide Health Planning and
Development (OSHPD), to among other functions, monitor the
construction, renovation of various health facilities
(including chronic dialysis clinics), and seismic safety of
hospitals.
4)Establishes the California Building Standards Code (commonly
referred to as Title 24) which governs the building standards
for various health facilities, including chronic dialysis
clinics.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
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COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, this bill
brings dialysis centers' inspection times in line with
existing inspection times required of nursing homes and
long-term care facilities. This bill eliminates the year long
wait and ensures patients have access to quality care. The
author states that in his district, there is a dialysis
center, which has been fully operational since January 2015,
and has still not been inspected. The author concludes that
it is unconscionable that patients are denied medically
necessary facilities due to inspection backlogs. This bll
will remedy this problem by giving dialysis centers a
reasonable wait time for certification.
2)BACKGROUND.
a) Chronic Kidney Disease (CKD). According to a National
Chronic Kidney Disease Fact Sheet, 2014 found on the Center
for Disease Control and Prevention's (CDC) Website, CKD is
a condition in which the kidneys are damaged and cannot
filter blood as well as healthy kidneys and wastes from the
blood remain in the body and may cause other health
problems. CDC estimates that more than 10% of adults (20
million) in the U.S. may have CKD of varying levels of
seriousness. The chances of CKD increase with age; it
increases after 50 and is most common among adults older
than 70 years. Adults with diabetes or high blood pressure
or both have a higher risk of developing CKD than those
without these diseases. Approximately 33% of adults with
diabetes and 20% of adults with high blood pressure has
CKD. In 2011, over 100,000 patients started treatment for
end-stage renal disease where the kidneys stop working and
there is kidney failure.
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b) Licensure of Chronic Dialysis Clinics. According to the
DPH's Website, among other requirements, to apply for a
licensure, a chronic dialysis clinic must submit written
certification of Title 24 compliance from a California
licensed architect or a local building authority. The
written statement must show that the building meets the
California Building Code, California Electrical Code,
California Mechanical Code and California Plumbing Code and
possesses a certificate of occupancy. In addition,
dialysis providers that need to bill Medicare for their
services must be certified by CMS and CMS contracts with
DPH to conduct the Medicare certification surveys.
According to the author, many dialysis clinics are waiting
for more than nine months for state licensure and Medicare
certification surveys and this can be costly. According to
the California Dialysis Council (Council), the costs per
day can vary depending upon the size of the dialysis center
and the location and a new clinic has to operate like it is
fully treating patients so that the delivery systems do not
become contaminated. The Council notes there is a high
fixed cost associated with the physical plant (lease rate,
utilities, equipment and fixed salaries) and one facility
in Beverly Hills that has been waiting 10 months for its
Medicare survey lost $1.2 million last year and is losing
approximately $120,000 per month.
c) Home Health Agencies (HHAs). Current law requires DPH
to complete the application paperwork and conduct a
licensure survey of a HHA within 90 calendar days. HHAs
are private or public organizations, including but not
limited to, any partnership, corporation, political
subdivision of the state, or other government agency within
the state, which provides, or arranges for the provision
of, skilled nursing services, to persons in their temporary
or permanent place of residence. This bill seeks to adopt
similar licensing and certification survey requirements
that apply to home health agencies.
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3)SUPPORT. According to the California Dialysis Council, this
bill ensures that new dialysis clinics are able to serve
patients in a timely fashion.
REGISTERED SUPPORT / OPPOSITION:
Support
California Dialysis Council
DaVita
Fresenius Medical Care
Opposition
None on file.
Analysis Prepared by:Rosielyn Pulmano / HEALTH / (916) 319-2097
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