Amended in Assembly August 31, 2015

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 amend Sections 15432 and 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.

Existing law, the California Health Facilities Financing Authority Act, 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 wouldbegin delete transfer up to $6,500,000end deletebegin insert authorize the authority to transfer moneys up to a total of $3,000,000end insert from the California Health Facilities Financing Authority Hospital Equipment Loan Program Fund to the account for the purposes of thebegin delete bill,end deletebegin insert bill if the authority decides to administer the 2nd competitive grant selection process,end insert and would require that any moneys remaining in the account as of January 1, 2023, revert tobegin insert theend insert 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.

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.

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

begin insert

This bill would become operative only if AB 648 is enacted and takes effect on or before January 1, 2016.

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    1

SECTION 1.  

Section 15432 of the Government Code is
2amended to read:

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.

P4    1(d) “Health facility” means a facility, place, or building that is
2licensed, accredited, or certified and organized, maintained, and
3operated for the diagnosis, care, prevention, and treatment of
4human illness, or physical, mental, or developmental disability,
5including convalescence and rehabilitation and including care
6during and after pregnancy, or for any one or more of these
7purposes, for one or more persons, and includes, but is not limited
8to, all of the following types:

9(1) A general acute care 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, including the following basic
13services: medical, nursing, surgical, anesthesia, laboratory,
14radiology, pharmacy, and dietary services.

15(2) An acute psychiatric hospital that is a health facility having
16a duly constituted governing body with overall administrative and
17professional responsibility and an organized medical staff that
18provides 24-hour inpatient care for mentally disordered,
19incompetent, or other patients referred to in Division 5
20(commencing with Section 5000) or Division 6 (commencing with
21Section 6000) of the Welfare and Institutions Code, including the
22following basic services: medical, nursing, rehabilitative,
23pharmacy, and dietary services.

24(3) A skilled nursing facility that is a health facility that provides
25the following basic services: skilled nursing care and supportive
26care to patients whose primary need is for availability or skilled
27nursing care on an extended basis.

28(4) An intermediate care facility that is a health facility that
29provides inpatient care to ambulatory or semiambulatory patients
30who have recurring need for skilled nursing supervision and need
31supportive care, but who do not require availability or continuous
32skilled nursing care.

33(5) A special health care facility that is a health facility having
34a duly constituted governing body with overall administrative and
35professional responsibility and an organized medical or dental staff
36that provides inpatient or outpatient, acute or nonacute care,
37including, but not limited to, medical, nursing, rehabilitation,
38dental, or maternity.

39(6) A clinic that is operated by a tax-exempt nonprofit
40corporation that is licensed pursuant to Section 1204 or 1204.1 of
P5    1the Health and Safety Code or a clinic exempt from licensure
2pursuant to subdivision (b) or (c) of Section 1206 of the Health
3and Safety Code.

4(7) An adult day health center that is a facility, as defined under
5subdivision (b) of Section 1570.7 of the Health and Safety Code,
6that provides adult day health care, as defined under subdivision
7(a) of Section 1570.7 of the Health and Safety Code.

8(8) A facility owned or operated by a local jurisdiction for the
9provision of county health services.

10(9) A multilevel facility that is an institutional arrangement
11where a residential facility for the elderly is operated as a part of,
12or in conjunction with, an intermediate care facility, a skilled
13nursing facility, or a general acute care hospital. “Elderly,” for the
14purposes of this paragraph, means a person 60 years of age or
15older.

16(10) A child day care facility operated in conjunction with a
17health facility. A child day care facility is a facility, as defined in
18Section 1596.750 of the Health and Safety Code. For purposes of
19this paragraph, “child” means a minor from birth to 18 years of
20age.

21(11) An intermediate care facility/developmentally disabled
22habilitative that is a health facility, as defined under subdivision
23(e) of Section 1250 of the Health and Safety Code.

24(12) An intermediate care facility/developmentally
25disabled-nursing that is a health facility, as defined under
26subdivision (h) of Section 1250 of the Health and Safety Code.

27(13) A community care facility that is a facility, as defined under
28subdivision (a) of Section 1502 of the Health and Safety Code,
29that provides care, habilitation, rehabilitation, or treatment services
30to developmentally disabled or mentally impaired persons.

31(14) A nonprofit community care facility, as defined in
32subdivision (a) of Section 1502 of the Health and Safety Code,
33other than a facility that, as defined in that subdivision, is a
34residential facility for the elderly, a foster family agency, a foster
35family home, a full service adoption agency, or a noncustodial
36adoption agency.

37(15) A nonprofit accredited community work activity program,
38as specified in subdivision (e) of Section 4851 and Section 4856
39of the Welfare and Institutions Code.

P6    1(16) A community mental health center, as defined in paragraph
2(3) of subdivision (b) of Section 5667 of the Welfare and
3Institutions Code.

4(17) A nonprofit speech and hearing center, as defined in Section
51201.5 of the Health and Safety Code.

6(18) A blood bank, as defined in Section 1600.2 of the Health
7and Safety Code, licensed pursuant to Section 1602.5 of the Health
8and Safety Code, and exempt from federal income taxation
9pursuant to Section 501(c)(3) of the Internal Revenue Code.

10(19) A residential facility for persons with developmental
11disabilities, as defined in Sections 4688.5 and 4688.6 of the
12Welfare and Institutions Code, which includes, but is not limited
13to, a community care facility licensed pursuant to Section 1502 of
14the Health and Safety Code and a family teaching home as defined
15in Section 4689.1 of the Welfare and Institutions Code.

16(20) A nonpublic school that provides educational services in
17conjunction with a health facility, as defined in paragraphs (1) to
18(19), inclusive, that otherwise qualifies for financing pursuant to
19this part, if the nonpublic school is certified pursuant to Sections
2056366 and 56366.1 of the Education Code as meeting standards
21relating to the required special education and specified related
22services and facilities for individuals with physical, mental, or
23developmental disabilities.

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

26“Health facility” includes information systems equipment and
27 the following facilities, if the equipment and facility is operated
28in conjunction with or to support the services provided in one or
29more of the facilities specified in paragraphs (1) to (20), inclusive,
30of this subdivision: a laboratory, laundry, a nurses or interns
31residence, housing for staff or employees and their families or
32patients or relatives of patients, a physicians’ facility, an
33administration building, a research facility, a maintenance, storage,
34or utility facility, an information systems facility, all structures or
35facilities related to any of the foregoing facilities or required or
36useful for the operation of a health facility and the necessary and
37usual attendant and related facilities and equipment, and parking
38and supportive service facilities or structures required or useful
39for the orderly conduct of the health facility.

P7    1“Health facility” does not include any institution, place, or
2building used or to be used primarily for sectarian instruction or
3study or as a place for devotional activities or religious worship.

4(e) “Participating health institution” means a city, city and
5county, or county, a district hospital, or a private nonprofit
6corporation or association, or a limited liability company whose
7sole member is a nonprofit corporation or association authorized
8by the laws of this state to provide or operate a health facility or
9a nonprofit corporation that controls or manages, is controlled or
10managed by, is under common control or management with, or is
11affiliated with any of the foregoing, and that, pursuant to this part,
12undertakes the financing or refinancing of the construction or
13acquisition of a project or of working capital as provided in this
14part. “Participating health institution” also includes, for purposes
15of the California Health Facilities Revenue Bonds (UCSF-Stanford
16Health Care) 1998 Series A, the Regents of the University of
17California.

18(f) “Project” means construction, expansion, remodeling,
19renovation, furnishing, or equipping, or funding, financing, or
20refinancing of a health facility or acquisition of a health facility
21to be financed or refinanced with funds provided in whole or in
22part pursuant to this part. “Project” may include reimbursement
23for the costs of construction, expansion, remodeling, renovation,
24furnishing, or equipping, or funding, financing, or refinancing of
25a health facility or acquisition of a health facility. “Project” may
26include any combination of one or more of the foregoing
27undertaken jointly by any participating health institution with one
28or more other participating health institutions.

29(g) “Revenue bond” or “bond” means a bond, warrant, note,
30lease, or installment sale obligation that is evidenced by a
31certificate of participation or other evidence of indebtedness issued
32by the authority.

33(h) “Working capital” means moneys to be used by, or on behalf
34of, a participating health institution to pay or prepay maintenance
35or operation expenses or any other costs that would be treated as
36an expense item, under generally accepted accounting principles,
37in connection with the ownership or operation of a health facility,
38including, but not limited to, reserves for maintenance or operation
39expenses, interest for not to exceed one year on any loan for
40working capital made pursuant to this part, and reserves for debt
P8    1service with respect to, and any costs necessary or incidental to,
2that financing.

3

SEC. 2.  

Section 15438.10 of the Government Code is amended
4to read:

5

15438.10.  

(a) The Legislature finds and declares the following:

6(1) Many Californians face serious obstacles in obtaining needed
7health care services, including, but not limited to, medical, mental
8health, dental, and preventive services. The obstacles faced by
9vulnerable populations and communities include the existence of
10complex medical, physical, or social conditions, disabilities,
11economic disadvantage, and living in remote or underserved areas
12that make it difficult to access services.

13(2) With the recent passage of national health care reform, there
14is an increased demand for innovative ways to deliver quality
15health care, including preventive services, to individuals in a
16cost-effective manner.

17(3) There is a need to develop new methods of delivering health
18services utilizing innovative models that can be demonstrated to
19be effective and then replicated throughout California and that
20bring community-based health care preventive services to
21individuals where they live or receive education, social, or general
22health services.

23(4) For more than 30 years, the California Health Facilities
24Financing Authority has provided financial assistance through
25tax-exempt bonds, low-interest loans, and grants to health facilities
26in California, assisting in the expansion of the availability of health
27services and health care facilities throughout the state.

28(b) (1) Following the completion of a competitive selection
29process, the authority may award one or more grants that, in the
30aggregate, do not exceed one million five hundred thousand dollars
31($1,500,000) to one or more projects designed to demonstrate
32specified new or enhanced cost-effective methods of delivering
33quality health care services to improve access to quality health
34care for vulnerable populations or communities, or both, that are
35effective at enhancing health outcomes and improving access to
36quality health care and preventive services. These health care
37services may include, but are not limited to, medical, mental health,
38or dental services for the diagnosis, care, prevention, and treatment
39of human illness, or individuals with physical, mental, or
40developmental disabilities. More than one demonstration project
P9    1may receive a grant pursuant to this section. It is the intent of the
2Legislature for a demonstration project that receives a grant to
3allow patients to receive screenings, diagnosis, or treatment in
4community settings, including, but not limited to, school-based
5health centers, adult day care centers, and residential care facilities
6 for the elderly, or for individuals with mental illness or
7developmental disabilities.

8(2) A grant awarded pursuant to this subdivision may be
9allocated in increments to a demonstration project over multiple
10years to ensure the demonstration project’s ability to complete its
11work, as determined by the authority. Prior to the initial allocation
12of funds pursuant to this subdivision, the administrators of the
13demonstration project shall provide evidence that the demonstration
14project has or will have additional funds sufficient to ensure
15completion of the demonstration project. If the authority allocates
16a grant in increments, each subsequent year’s allocation shall be
17provided to the demonstration project only upon submission of
18research that shows that the project is progressing toward the
19identification of a high-quality and cost-effective delivery model
20that improves health outcomes and access to quality health care
21and preventive services for vulnerable populations or communities,
22and can be replicated throughout the state in community settings.

23(3) Except for a health facility that qualifies as a “small and
24rural hospital” pursuant to Section 124840 of the Health and Safety
25Code, a health facility that has received tax-exempt bond financing
26from the authority shall not be eligible to receive funds awarded
27for a demonstration project. Such a health facility may participate
28as an uncompensated partner or member of a collaborative effort
29that is awarded a demonstration project grant. A health facility
30that participates in a demonstration project that receives funds
31pursuant to this section may not claim the funding provided by the
32authority toward meeting its community benefit and charity care
33obligations.

34(4) Funds provided to a demonstration project pursuant to this
35subdivision may be used to supplement, but not to supplant,
36existing financial and resource commitments of the grantee or
37grantees or any other member of a collaborative effort that has
38been awarded a demonstration project grant.

39(c) (1) If a demonstration project that receives a grant pursuant
40to subdivision (b) is successful at developing a new method of
P10   1delivering high-quality and cost-effective health care services in
2community settings that result in increased access to quality health
3care and preventive services or improved health care outcomes for
4vulnerable populations or communities, or both, then beginning
5as early as the second year after the initial allocation of moneys
6provided pursuant to subdivision (b), the authority may implement
7a second grant program that awards not more than five million
8dollars ($5,000,000), in the aggregate, to eligible recipients as
9defined by the authority, to replicate in additional California
10communities the model developed by a demonstration project that
11received a grant pursuant to subdivision (b). Prior to the
12implementation of this second grant program, the authority shall
13prepare and provide a report to the Legislature and the Governor
14on the outcomes of the demonstration project. The report shall be
15made in accordance with Section 9795.

16(2) If the authority implements the second grant program, the
17authority shall also report annually, beginning with the first year
18of implementation of the second grant program, to the Legislature
19and the Governor regarding the program, including, but not limited
20to, the total amount of grants issued pursuant to this subdivision,
21the amount of each grant issued, and a description of each project
22awarded funding for replication of the model.

23(3) Grants under this subdivision may be utilized for eligible
24costs, as defined in subdivision (c) of Section 15432, including
25 equipment, information technology, and working capital, as defined
26in subdivision (h) of Section 15432.

27(4) The authority may adopt regulations relating to the grant
28program authorized pursuant to this subdivision, including
29regulations that define eligible recipients, eligible costs, and
30minimum and maximum grant amounts.

31(d) (1) The authority shall prepare and provide a report to the
32Legislature and the Governor every two years, commencing on
33January 1, 2017, on the grants awarded pursuant to subdivisions
34(b) and (g) that includes, but is not limited to, the following:

35(A) The total amount of grants issued.

36(B) The amount of each grant issued.

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

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

39(E) If available, a description of project outcomes that
40demonstrate cost-effective delivery of health care services in
P11   1community settings, that result in improved access to quality health
2care or improved health care outcomes.

3(2) A report submitted pursuant to this subdivision shall be
4submitted in compliance with Section 9795.

5(e) There is hereby created the California Health Access Model
6Program Account in the California Health Facilities Financing
7Authority Fund. All moneys in the account are hereby continuously
8appropriated to the authority for carrying out the purposes of this
9section. An amount of up to six million five hundred thousand
10dollars ($6,500,000) shall be transferred from funds in the
11California Health Facilities Financing Authority Fund that are not
12impressed with a trust for other purposes into the California Health
13Access Model Program Account for the purpose of issuing grants
14pursuant to this section. Any moneys remaining in the California
15Health Access Model Program Account on January 1, 2020, shall
16revert as of that date to the California Health Facilities Financing
17Authority Fund.

18(f) Any recipient of a grant provided pursuant to subdivisions
19(b) and (c) shall adhere to all applicable laws relating to scope of
20practice, licensure, staffing, and building codes.

21(g) There is hereby created the California Health Access Model
22Program Two Account within the California Health Facilities
23Financing Authority Fund for purposes of administering a second
24competitive grant selection process, in accordance with
25subdivisions (b) and (c), to fund one or more projects designed to
26demonstrate specified new or enhanced cost-effective methods of
27delivery quality health care services to improve access to quality
28health care for vulnerable populations or communities, or both.
29begin delete An amount of up to six million five hundred thousand dollars
30($6,500,000) shall be transferredend delete
begin insert The authority may transfer
31moneys up to a total of three million dollars ($3,000,000)end insert
from
32funds in the California Health Facilities Financing Authority
33Hospital Equipment Loan Program Fund that are not impressed
34with a trust for other purposes into the California Health Access
35Model Program Two Account for the purpose of administering a
36second competitive grant selection process pursuant to this
37begin delete subdivision.end deletebegin insert subdivision if the authority decides to administer the
38second competitive grant selection process.end insert
Any moneys remaining
39in the California Health Access Model Program Two Account on
40January 1, 2023, shall revert as of that date to the California Health
P12   1Facilities Financing Authority Hospital Equipment Loan Program
2Fund.

3begin insert

begin insertSEC. 3.end insert  

end insert

begin insertThis act shall become operative only if Assembly Bill
4648 is enacted and takes effect on or before January 1, 2016.end insert



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