Amended in Assembly June 22, 2015

Amended in Senate May 5, 2015

Amended in Senate April 13, 2015

Senate BillNo. 315


Introduced by Senators Monning and Hernandez

(Coauthor: Senator Pan)

February 23, 2015


An act to amendbegin delete Sectionend deletebegin insert Sections 15432 andend insert 15438.10 of the Government Code, relating to health care, and making an appropriation therefor.

LEGISLATIVE COUNSEL’S DIGEST

SB 315, as amended, Monning. Health care access demonstration project grants.

Existingbegin delete lawend deletebegin insert law, the California Health Facilities Financing Authority Act,end insert establishes a program for the California Health Facilities Authority to award grants that do not exceed $1,500,000 to one or more projects designed to demonstrate specified new or enhanced cost-effective methods of delivering quality health care services to improve access to quality health care for vulnerable populations or communities, or both, that are effective at enhancing health outcomes and improving access to quality health care and preventive services. Existing law requires a recipient of that grant to adhere to all applicable laws relating to scope of practice, licensure, staffing, and building codes. Existing law authorizes the authority, if a demonstration project receiving a grant is successful at developing such a new method of delivering high-quality and cost-effective health care services, to implement a 2nd grant program, as specified, to replicate in additional California communities the model developed by that demonstration project. Existing law requires the authority to prepare and provide a report to the Legislature and the Governor on the outcomes of the demonstration grant program that includes, among other information, the total amount of grants issued and the amount of each grant issued.

This bill would create the California Health Access Model Program Two Account within the California Health Facilities Financing Authority Fund for purposes of administering a 2nd competitive grant selection process, in accordance with existing grant provisions, to fund one or more projects designed to demonstrate specified new or enhanced cost-effective methods of delivering quality health care services to improve access to quality health care for vulnerable populations or communities, or both. The bill would transfer up to $6,500,000 from the California Health Facilities Financing Authority Hospital Equipment Loan Program Fund to the account for the purposes of the bill, and would require that any moneys remaining in the account as of January 1, 2023, revert to California Health Facilities Financing Authority Hospital Equipment Loan Program Fund. By expanding the purposes for which a continuously appropriated fund may be used, this bill would make an appropriation.

The bill would also require the authority to prepare and provide a report to the Legislature and the Governor every 2 years, commencing January 1, 2017, on the 2 grant selection programs, that includes, among other information, the total amount of grants issued and the amount of each grant issued, as specified.

This bill would also make the existing requirement for adherence to all applicable laws relating to scope of practice, licensure, staffing, and building to codes applicable to a recipient of a grant provided pursuant to the 2nd grant program described above.

begin insert

Existing law defines health facility, for purposes of the act, to include a multilevel facility that is an institutional arrangement where a residential facility for the elderly is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Existing law defines elderly, for purposes of this provision, to mean a person 62 years of age or older.

end insert
begin insert

This bill would instead define elderly to mean a person 60 years of age or older.

end insert

Vote: majority. Appropriation: yes. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P3    1begin insert

begin insertSECTION 1.end insert  

end insert

begin insertSection 15432 of the end insertbegin insertGovernment Codeend insertbegin insert is
2amended to read:end insert

3

15432.  

As used in this part, the following words and terms
4shall have the following meanings, unless the context clearly
5indicates or requires another or different meaning or intent:

6(a) “Act” means the California Health Facilities Financing
7Authority Act.

8(b) “Authority” means the California Health Facilities Financing
9Authority created by this part or any board, body, commission,
10department, or officer succeeding to the principal functions thereof
11or to which the powers conferred upon the authority by this part
12shall be given by law.

13(c) “Cost,” as applied to a project or portion of a project financed
14under this part, means and includes all or any part of the cost of
15construction and acquisition of all lands, structures, real or personal
16property, rights, rights-of-way, franchises, easements, and interests
17acquired or used for a project, the cost of demolishing or removing
18any buildings or structures on land so acquired, including the cost
19of acquiring any lands to which those buildings or structures may
20be moved, the cost of all machinery and equipment, financing
21charges, interest prior to, during, and for a period not to exceed
22the later of one year or one year following completion of
23construction, as determined by the authority, the cost of insurance
24during construction, the cost of funding or financing noncapital
25expenses, reserves for principal and interest and for extensions,
26enlargements, additions, replacements, renovations and
27improvements, the cost of engineering, service contracts,
28reasonable financial and legal services, plans, specifications,
29studies, surveys, estimates, administrative expenses, and other
30expenses of funding or financing, that are necessary or incident to
31determining the feasibility of constructing any project, or that are
32incident to the construction, acquisition, or financing of any project.

33(d) “Health facility” means a facility, place, or building that is
34licensed, accredited, or certified and organized, maintained, and
35operated for the diagnosis, care, prevention, and treatment of
36human illness, or physical, mental, or developmental disability,
37including convalescence and rehabilitation and including care
38during and after pregnancy, or for any one or more of these
P4    1purposes, for one or more persons, and includes, but is not limited
2to, all of the following types:

3(1) A general acute care hospital that is a health facility having
4a duly constituted governing body with overall administrative and
5professional responsibility and an organized medical staff that
6provides 24-hour inpatient care, including the following basic
7services: medical, nursing, surgical, anesthesia, laboratory,
8radiology, pharmacy, and dietary services.

9(2) An acute psychiatric hospital that is a health facility having
10a duly constituted governing body with overall administrative and
11professional responsibility and an organized medical staff that
12provides 24-hour inpatient care for mentally disordered,
13incompetent, or other patients referred to in Division 5
14(commencing with Section 5000) or Division 6 (commencing with
15Section 6000) of the Welfare and Institutions Code, including the
16following basic services: medical, nursing, rehabilitative,
17pharmacy, and dietary services.

18(3) A skilled nursing facility that is a health facility that provides
19the following basic services: skilled nursing care and supportive
20care to patients whose primary need is for availability or skilled
21nursing care on an extended basis.

22(4) An intermediate care facility that is a health facility that
23providesbegin delete the following basic services:end delete inpatient care to ambulatory
24or semiambulatory patients who have recurring need for skilled
25nursing supervision and need supportive care, but who do not
26require availability or continuous skilled nursing care.

27(5) A special health care facility that is a health facility having
28a duly constituted governing body with overall administrative and
29professional responsibility and an organized medical or dental staff
30that provides inpatient or outpatient, acute or nonacute care,
31including, but not limited to, medical, nursing, rehabilitation,
32dental, or maternity.

33(6) A clinic that is operated by a tax-exempt nonprofit
34corporation that is licensed pursuant to Section 1204 or 1204.1 of
35the Health and Safety Code or a clinic exempt from licensure
36pursuant to subdivision (b) or (c) of Section 1206 of the Health
37and Safety Code.

38(7) An adult day health center that is a facility, as defined under
39subdivision (b) of Section 1570.7 of the Health and Safety Code,
P5    1that provides adult day health care, as defined under subdivision
2(a) of Section 1570.7 of the Health and Safety Code.

3(8) A facility owned or operated by a local jurisdiction for the
4provision of county health services.

5(9) A multilevel facilitybegin insert thatend insert is an institutional arrangement
6where a residential facility for the elderly is operated as a part of,
7or in conjunction with, an intermediate care facility, a skilled
8nursing facility, or a general acute care hospital. “Elderly,” for the
9purposes of this paragraph, means a personbegin delete 62end deletebegin insert 60end insert years of age or
10older.

11(10) A child day care facility operated in conjunction with a
12health facility. A child day care facility is a facility, as defined in
13Section 1596.750 of the Health and Safety Code. For purposes of
14this paragraph, “child” means a minor from birth to 18 years of
15age.

16(11) An intermediate care facility/developmentally disabled
17habilitative that is a health facility, as defined under subdivision
18(e) of Section 1250 of the Health and Safety Code.

19(12) An intermediate care facility/developmentally
20disabled-nursing that is a health facility, as defined under
21subdivision (h) of Section 1250 of the Health and Safety Code.

22(13) A community care facility that is a facility, as defined under
23subdivision (a) of Section 1502 of the Health and Safety Code,
24that provides care, habilitation, rehabilitation, or treatment services
25to developmentally disabled or mentally impaired persons.

26(14) A nonprofit community care facility, as defined in
27subdivision (a) of Section 1502 of the Health and Safety Code,
28other than a facility that, as defined in that subdivision, is a
29residential facility for the elderly, a foster family agency, a foster
30family home, a full service adoption agency, or a noncustodial
31adoption agency.

32(15) A nonprofit accredited community work activity program,
33as specified in subdivision (e) of Section 4851 and Section 4856
34of the Welfare and Institutions Code.

35(16) A community mental health center, as defined in paragraph
36(3) of subdivision (b) of Section 5667 of the Welfare and
37Institutions Code.

38(17) A nonprofit speech and hearing center, as defined in Section
391201.5 of the Health and Safety Code.

P6    1(18) A blood bank, as defined in Section 1600.2 of the Health
2and Safety Code, licensed pursuant to Section 1602.5 of the Health
3and Safety Code, and exempt from federal income taxation
4pursuant to Section 501(c)(3) of the Internal Revenue Code.

5(19) A residential facility for persons with developmental
6disabilities, as defined in Sections 4688.5 and 4688.6 of the
7Welfare and Institutions Code, which includes, but is not limited
8to, a community care facility licensed pursuant to Section 1502 of
9the Health and Safety Code and a family teaching home as defined
10in Section 4689.1 of the Welfare and Institutions Code.

11(20) A nonpublic school that provides educational services in
12conjunction with a health facility, as defined in paragraphs (1) to
13(19), inclusive, that otherwise qualifies for financing pursuant to
14this part, if the nonpublic school is certified pursuant to Sections
1556366 and 56366.1 of the Education Code as meeting standards
16relating to the required special education and specified related
17services and facilities for individuals with physical, mental, or
18developmental disabilities.

19“Health facility” includes a clinic that is described in subdivision
20(l) of Section 1206 of the Health and Safety Code.

21“Health facility” includes information systems equipment and
22 the following facilities, if the equipment and facility is operated
23in conjunction with or to support the services provided in one or
24more of the facilities specified in paragraphs (1) to (20), inclusive,
25of this subdivision: a laboratory, laundry, a nurses or interns
26residence, housing for staff or employees and their families or
27patients or relatives of patients, a physicians’ facility, an
28administration building, a research facility, a maintenance, storage,
29or utility facility, an information systems facility, all structures or
30facilities related to any of the foregoing facilities or required or
31useful for the operation of a health facility and the necessary and
32usual attendant and related facilities and equipment, and parking
33and supportive service facilities or structures required or useful
34for the orderly conduct of the health facility.

35“Health facility” does not include any institution, place, or
36building used or to be used primarily for sectarian instruction or
37study or as a place for devotional activities or religious worship.

38(e) “Participating health institution” means a city, city and
39county, or county, a district hospital, or a private nonprofit
40corporation or association, or a limited liability company whose
P7    1sole member is a nonprofit corporation or association authorized
2by the laws of this state to provide or operate a health facility or
3a nonprofit corporation that controls or manages, is controlled or
4managed by, is under common control or management with, or is
5affiliated with any of the foregoing, and that, pursuant to this part,
6undertakes the financing or refinancing of the construction or
7acquisition of a project or of working capital as provided in this
8part. “Participating health institution” also includes, for purposes
9of the California Health Facilities Revenue Bonds (UCSF-Stanford
10Health Care) 1998 Series A, the Regents of the University of
11California.

12(f) “Project” means construction, expansion, remodeling,
13renovation, furnishing, or equipping, or funding, financing, or
14refinancing of a health facility or acquisition of a health facility
15to be financed or refinanced with funds provided in whole or in
16part pursuant to this part. “Project” may include reimbursement
17for the costs of construction, expansion, remodeling, renovation,
18furnishing, or equipping, or funding, financing, or refinancing of
19a health facility or acquisition of a health facility. “Project” may
20include any combination of one or more of the foregoing
21undertaken jointly by any participating health institution with one
22or more other participating health institutions.

23(g) “Revenue bond” or “bond” means a bond, warrant, note,
24lease, or installment sale obligation that is evidenced by a
25certificate of participation or other evidence of indebtedness issued
26by the authority.

27(h) “Working capital” means moneys to be used by, or on behalf
28of, a participating health institution to pay or prepay maintenance
29or operation expenses or any other costs that would be treated as
30an expense item, under generally accepted accounting principles,
31in connection with the ownership or operation of a health facility,
32including, but not limited to, reserves for maintenance or operation
33expenses, interest for not to exceed one year on any loan for
34working capital made pursuant to this part, and reserves for debt
35service with respect to, and any costs necessary or incidental to,
36that financing.

37

begin deleteSECTION 1.end delete
38begin insertSEC. 2.end insert  

Section 15438.10 of the Government Code is amended
39to read:

40

15438.10.  

(a) The Legislature finds and declares the following:

P8    1(1) Many Californians face serious obstacles in obtaining needed
2health care services, including, but not limited to, medical, mental
3health, dental, and preventive services. The obstacles faced by
4vulnerable populations and communities includebegin insert theend insert existence of
5complex medical, physical, or social conditions, disabilities,
6economic disadvantage, and living in remote or underserved areas
7that make it difficult to access services.

8(2) With the recent passage of national health care reform, there
9is an increased demand for innovative ways to deliver quality
10health care, including preventive services, to individuals in a
11cost-effective manner.

12(3) There is a need to develop new methods of delivering health
13services utilizing innovative models that can be demonstrated to
14be effective and then replicated throughout California and that
15bring community-based health care preventive services to
16individuals where they live or receive education, social, or general
17health services.

18(4) For more than 30 years, the California Health Facilities
19Financing Authority has provided financial assistance through
20tax-exempt bonds, low-interest loans, and grants to health facilities
21in California, assisting in the expansion of the availability of health
22services and health care facilities throughout the state.

23(b) (1) Following the completion of a competitive selection
24process, the authority may award one or more grants that, in the
25aggregate, do not exceed one million five hundred thousand dollars
26($1,500,000) to one or more projects designed to demonstrate
27specified new or enhanced cost-effective methods of delivering
28quality health care services to improve access to quality health
29care for vulnerable populations or communities, or both, that are
30effective at enhancing health outcomes and improving access to
31quality health care and preventive services. These health care
32services may include, but are not limited to, medical, mental health,
33or dental services for the diagnosis, care, prevention, and treatment
34of human illness, or individuals with physical, mental, or
35developmental disabilities. More than one demonstration project
36may receive a grant pursuant to this section. It is the intent of the
37Legislature for a demonstration project that receives a grant to
38allow patients to receive screenings, diagnosis, or treatment in
39community settings, including, but not limited to, school-based
40health centers, adult day care centers, and residential care facilities
P9    1 for the elderly, or for individuals with mental illness or
2developmental disabilities.

3(2) A grant awarded pursuant to this subdivision may be
4allocated in increments to a demonstration project over multiple
5years to ensure the demonstration project’s ability to complete its
6work, as determined by the authority. Prior to the initial allocation
7of funds pursuant to this subdivision, the administrators of the
8demonstration project shall provide evidence that the demonstration
9project has or will have additional funds sufficient to ensure
10completion of the demonstration project. If the authority allocates
11a grant in increments, each subsequent year’s allocation shall be
12provided to the demonstration project only upon submission of
13research that shows that the project is progressing toward the
14identification of a high-quality and cost-effective delivery model
15that improves health outcomes and access to quality health care
16and preventive services for vulnerable populations or communities,
17and can be replicated throughout the state in community settings.

18(3) Except for a health facility that qualifies as a “small and
19rural hospital” pursuant to Section 124840 of the Health and Safety
20Code, a health facility that has received tax-exempt bond financing
21from the authority shall not be eligible to receive funds awarded
22for a demonstration project. Such a health facility may participate
23as an uncompensated partner or member of a collaborative effort
24that is awarded a demonstration project grant. A health facility
25that participates in a demonstration project that receives funds
26pursuant to this section may not claim the funding provided by the
27authority toward meeting its community benefit and charity care
28obligations.

29(4) Funds provided to a demonstration project pursuant to this
30subdivision may be used to supplement, but not to supplant,
31existing financial and resource commitments of the grantee or
32grantees or any other member of a collaborative effort that has
33been awarded a demonstration project grant.

34(c) (1) If a demonstration project that receives a grant pursuant
35to subdivision (b) is successful at developing a new method of
36delivering high-quality and cost-effective health care services in
37community settings that result in increased access to quality health
38care and preventive services or improved health care outcomes for
39vulnerable populations or communities, or both, then beginning
40as early as the second year after the initial allocation of moneys
P10   1provided pursuant to subdivision (b), the authority may implement
2a second grant program that awards not more than five million
3dollars ($5,000,000), in the aggregate, to eligible recipients as
4defined by the authority, to replicate in additional California
5communities the model developed by a demonstration project that
6received a grant pursuant to subdivision (b). Prior to the
7implementation of this second grant program, the authority shall
8prepare and provide a report to the Legislature and the Governor
9on the outcomes of the demonstration project. The report shall be
10made in accordance with Section 9795.

11(2) If the authority implements the second grant program, the
12authority shall also report annually, beginning with the first year
13of implementation of the second grant program, to the Legislature
14and the Governor regarding the program, including, but not limited
15to, the total amount of grants issued pursuant to this subdivision,
16the amount of each grant issued, and a description of each project
17awarded funding for replication of the model.

18(3) Grants under this subdivision may be utilized for eligible
19costs, as defined in subdivision (c) of Section 15432, including
20 equipment, information technology, and working capital, as defined
21in subdivision (h) of Section 15432.

22(4) The authority may adopt regulations relating to the grant
23program authorized pursuant to this subdivision, including
24regulations that define eligible recipients, eligible costs, and
25minimum and maximum grant amounts.

26(d) (1) The authority shall prepare and provide a report to the
27Legislature and the Governor every two years, commencing on
28January 1, 2017, on the grants awarded pursuant to subdivisions
29(b) and (g) that includes, but is not limited to, the following:

30(A) The total amount of grants issued.

31(B) The amount of each grant issued.

32(C) A description of other sources of funding for each project.

33(D) A description of each project awarded funding.

34(E) If available, a description of project outcomes that
35demonstrate cost-effective delivery of health care services in
36community settings, that result in improved access to quality health
37care or improved health care outcomes.

38(2) A report submitted pursuant to this subdivision shall be
39submitted in compliance with Section 9795.

P11   1(e) There is hereby created the California Health Access Model
2Program Account in the California Health Facilities Financing
3Authority Fund. All moneys in the account are hereby continuously
4appropriated to the authority for carrying out the purposes of this
5section. An amount of up to six million five hundred thousand
6dollars ($6,500,000) shall be transferred from funds in the
7California Health Facilities Financing Authority Fund that are not
8impressed with a trust for other purposes into the California Health
9Access Model Program Account for the purpose of issuing grants
10pursuant to this section. Any moneys remaining in the California
11Health Access Model Program Account on January 1, 2020, shall
12revert as of that date to the California Health Facilities Financing
13Authority Fund.

14(f) Any recipient of a grant provided pursuant to subdivisions
15(b) and (c) shall adhere to all applicable laws relating to scope of
16practice, licensure, staffing, and building codes.

17(g) There is hereby created the California Health Access Model
18Program Two Account within the California Health Facilities
19Financing Authority Fund for purposes of administering a second
20competitive grant selection process, in accordance with
21subdivisions (b) and (c), to fund one or more projects designed to
22demonstrate specified new or enhanced cost-effective methods of
23delivery quality health care services to improve access to quality
24health care for vulnerable populations or communities, or both.
25An amount of up to six million five hundred thousand dollars
26($6,500,000) shall be transferred from funds in the California
27Health Facilities Financing Authority Hospital Equipment Loan
28Program Fund that are not impressed with a trust for other purposes
29into the California Health Access Model Program Two Account
30for the purpose of administering a second competitive grant
31selection process pursuant to this subdivision. Any moneys
32remaining in the California Health Access Model Program Two
33Account on January 1, 2023, shall revert as of that date to the
34California Health Facilities Financing Authority Hospital
35Equipment Loan Program Fund.



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