BILL ANALYSIS
AB 1409
Page 1
Date of Hearing: April 26, 2001
ASSEMBLY COMMITTEE ON HEALTH
Helen Thomson, Chair
AB 1409 (Chan) - As Amended: April 18, 2001
POLICY QUESTIONS :
1)Should the authority to license and regulate of nursing home
administrators be transferred from the Department of Consumer
Affairs (DCA) to the Department of Health Services (DHS)?
2)Should the state examination for nursing home administrators
be held at least four times a year?
3)Should applicants for a license to be a nursing home
administrator be required to undergo a criminal record
clearance by submitting to DHS two sets of completed
fingerprint cards?
4)Should the Nursing Home Administrator Program (NHAP) be
required to deny any application for any license, and to
suspend or revoke any existing license, if the applicant has
been convicted of specified crimes?
SUBJECT : Nursing home administrators.
SUMMARY : Transfers the authority to regulate the licensure and
regulation of nursing home administrators from DCA to DHS and
makes various technical and conforming amendments including
establishing a procedure for a provisional one-year license.
Specifically, this bill :
1)Establishes within the Department of Health Services (DHS) a
Nursing Home Administrator Program (NHAP) to license and
regulate nursing home administrators and repeals existing
statutes which provide for the licensure and regulation of
nursing home administrators by the Board of Nursing Home
Administrators (BNHA) of the Department of Consumer of Affairs
(DCA).
2)Applies existing statutes applicable to BNHA's licensure and
regulation of nursing home administrators to the NHAP.
Codifies existing regulations regarding the licensing of
nursing home administrators.
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3)Requires nothing in this bill to be construed to allow the
NHAP to have jurisdiction over an administrator of an
intermediate care facility/developmentally disabled-nursing or
an intermediate care facility/ developmentally disabled
habilitative, if the administrator of the facility is not
using licensure under this bill to qualify as an administrator
in accordance with current law.
4)Requires NHAP to adopt rules and regulations that are
reasonably necessary to carry out this bill. Requires
regulations governing the nursing home administrator program
that are in effect prior to January 1, 2002, and that are not
in conflict with this bill, to remain in effect until new
regulations are implemented for the purpose of this bill.
5)Requires a person who acts as an administrator without a
license for more than 10 days in situations when a licensed
administrator is not available, to have at least 20 hours per
week of direct supervision, as opposed to only part-time
supervision under current law, by a licensed nursing home
administrator.
6)Requires the state examination to be held at least four times
a year, at a time and place determined by NHAP. Requires the
applicant to schedule the computer-based national examination
after the applicant is notified by NHAP of his or her
eligibility to take the examination.
7)Requires an applicant who applies for the licensing
examination on the basis of work experience to submit a
declaration signed under penalty of perjury, verifying his or
her work experience.
8)Exempts minor traffic violations from the statement of whether
the applicant has been convicted of a crime.
9)Requires applicants for a nursing home administrator license
to submit evidence of electronic transmission of fingerprints
or fingerprint cards to NHAP.
10)Prohibits the withdrawal of an application for a license
after it has been filed with the department from depriving DHS
of its authority to institute or continue a proceeding against
the applicant for the denial of the license upon any ground
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provided by law or to enter an order denying the license upon
that ground, unless DHS consents in writing to the applicant's
withdrawal of the application.
11)Prohibits the suspension, expiration, or forfeiture by
operation of law of a license issued by DHS, the suspension,
forfeiture, or cancellation by order of DHS or a court of law
of a license, or the surrender without the written consent of
DHS of a license, from depriving DHS of its authority to
institute or continue a disciplinary proceeding against the
licensee upon any ground provided by law or to enter an order
suspending or revoking the license or otherwise taking
disciplinary action against the licensee on any grounds.
12)Requires the applicant to read and sign the Examination
Security Agreement and comply with its terms at the time of
the examination.
13)Requires applicants to undergo a criminal record clearance by
submitting to DHS two sets of completed fingerprint cards for
clearance through the Department of Justice and the Federal
Bureau of Investigation.
14)Requires NHAP to require applicants to provide his or her
federal employer identification number or social security
number at the time of application, issuance, or renewal of a
nursing home administrator license. Limits the use of this
information to the purpose of establishing the identification
of persons affected by state tax laws and compliance with
court orders for child support.
15)Requires NHAP to provide the Franchise Tax Board with
specified information relating to licensees upon request by
the Board.
16)Requires NHAP to require compliance with any judgment or
order for support prior to issuance or renewal of a license to
nursing home administrator.
17)Permits NHAP to deny, suspend, revoke, or otherwise restrict
the license of an applicant or licensee for specified acts of
misconduct relating to the examination required for nursing
home administrators. Specifies that it is a misdemeanor for
any person to engage in conduct that subverts or attempts to
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subvert any licensing examination or administration of an
examination.
18)Establishes a fee schedule for fees relating to the licensure
of nursing home administrators.
19)Limits the amount the fees can be adjusted by DHS, when the
revenue projected to be collected is less than the projected
costs for the budget year, to twice the increase in the
Consumer Price Index.
20)Permits provisional one-year licenses to be granted to
reciprocity applicants, as defined by this bill, who hold a
valid out of state license and who comply with criteria
established by this bill.
21) Requires licenses issued pursuant to this bill, that are not
provisional licenses, to expire within 24 months of the date
of issuance.
22)Establishes criteria for renewing licenses that have or have
not expired. Permits licensees, whose licenses expired while
serving in the armed services during a period of war, to
reinstate his or her license without examination or penalty if
specified conditions are met.
23)Permits a licensee, who does not intend to engage in activity
requiring nursing home administrator licensure, to file a
request to place his or her license in inactive status.
24)Requires an applicant to provide evidence of completion of
specified continuing education requirements, in order to renew
a license.
25)Requires an Administrator-in-Training Program (AIT) to be
developed by NHAP, in consultation with representatives from
the long-term care industry and advocacy groups. Requires the
AIT to include specified areas of instruction including
orientation, administration and business office, residents'
rights and abuse prevention, and staffing requirements and
work force retention.
26)Requires a preceptor, who is authorized to provide training
to persons seeking to qualify for the licensing examination
under this bill to provide a directly supervised training
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program. Defines directly supervised training program for the
purposes of this bill as supervision by a preceptor of an
administrator in training during the performance of duties
authorized by this bill.
27)Requires NHAP, in reviewing citation logs, to base the
determination of whether disciplinary action is warranted
against a nursing home administrator on the administrator's
involvement or culpability in the citations
28)Specifies that it is the responsibility of the nursing home
administrator to provide the highest level of care and safety
possible to the residents entrusted to the facility for care.
29)Prohibits a licensee from being cited for a violation caused
by any person licensed pursuant to the Medical Practice Act if
the person is independent of, and not connected with, the
facility and the licensee shows that he or she has exercised
reasonable care and diligence in notifying these persons of
their duties to the patients in the nursing facility.
30)Revises the factors NHAP is required to give due
consideration to in assessing a fine to licensee. Specifies
what may happen if a licensee, examinee or participant fails
to pay a fine.
31)Requires DHS to assess the licensee a civil penalty in the
amount of $50 for each day that the violation continues beyond
the date specified by the citation. Requires there to be a 7%
interest penalty on the unpaid balance of an administrative
fine.
32)Requires NHAP to deny any application for any license, and to
suspend or revoke any existing license, if the applicant has
been convicted of specified crimes including violent or
serious felonies as defined by law.
33)Permits NHAP to deny, suspend, or revoke, a nursing home
administrator license or participation in specific training
program areas under this bill upon specified grounds including
unprofessional conduct; misappropriation of funds or property
of the facility, the patients, or of others; physical, mental,
or verbal abuse of patients or residents; or procuring a
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nursing home license by fraud.
34)Permits NHAP to place a nursing home administrator license on
probation in lieu of formal action. Establishes criteria for
the probationary license.
35)Permits NHAP to temporarily suspend any license prior to any
hearing if the action is necessary to protect the public
welfare.
36)Permits certain superior courts to issue injunctions or other
appropriate orders, on application of NHAP, the Attorney
General, or the district attorney whenever a person has
engaged, or is about to engage, in any acts or practices that
constitute, or will constitute, a violation of this bill.
37)Makes various other technical and conforming changes relating
to the licensure of nursing home administrators.
EXISTING LAW :
1)Provides for the licensure and regulation of nursing home
administrators through DCA.
2)Specifies that it is a misdemeanor for any person to act or
serve in the capacity of a nursing home administrator, unless
he or she is the holder of a nursing home administrator's
license.
3)Establishes the Board of Examiners of Nursing Home
Administrators. Requires the Board to establish and carry out
procedures designed to ensure that individuals licensed as
nursing home administrators will comply with standards
established by the Board.
4)Requires the examination for nursing home administrators to be
held at least once a year.
5)Establishes an administrator-in-training program for nursing
home administrators.
6)Establishes criteria for the citation of nursing home
administrators.
FISCAL EFFECT : Unknown
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COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
sponsored by DHS and DCA. The author states that the Nursing
Home Administrator Program (Program) currently operates under
an Interagency Agreement between DHS and DCA that is due to
expire June 30, 2001. Federal law imposed the state licensure
requirements for nursing home administrators in 1970. At that
time the Board of Nursing Home Administrators (BNHA) had the
responsibility for licensing and regulating nursing home
administrators. BNHA was statutorily sunset on June 30, 1998,
and DCA renamed BNHA the Nursing Home Administrator Program
(NHAP). However, the sunset eliminated the Board members, not
the licensing and regulatory responsibility, and federal law
still requires states to license nursing home administrators.
The author argues that in order to strengthen the oversight
provisions of NHAP and to ensure clear state administrative
accountability for its operation, the designation of DHS as
the authority with responsibility for the program is
necessary.
The author adds that under the National Association of Boards of
Examiners of Long Term Care Administrators, every nursing home
administrator must successfully pass the national Nursing Home
Administrator Licensing Examination in order to be licensed.
The national examination is recognized as an official and
acceptable examination covering federal regulations for NHAP
overseeing or administering LTC facilities. Current law
limits California from charging the appropriate fee to
participate in the national examination, and California
residents must register to take the examination in other
states (Oregon and Nevada). California is the only state that
is unable to participate in this examination. The author
argues as one of the largest states with over 1,400
facilities, it is necessary to provide fee authority to allow
applicants to participate without going to other states.
The author states that there has been a 17% reduction in
licensed Nursing Home Administrators in California since the
1993/94 fiscal year. Adequate and qualified management is a
key component in determining the quality of care provided by
any nursing home. This bill includes a number of provisions
to enhance the ability of the industry to hire, train, and
develop quality nursing home administrators. This bill makes
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changes to improve the Administrator in Training Program to
better prepare participants for the licensure examination
(only 46% are passing) and the challenge of managing skilled
nursing facilities.
The author adds that this bill will also clarify the criminal
convictions that will preclude applicant's from licensure.
2)SUPPORT . According to the cosponsor of this bill, DCA, this
bill would follow through on recommendations made by the Joint
Legislative Sunset Review Committee. Transferring the program
to DHS will allow DHS to pursue alternative sources of
funding, including federal monies available through the Health
Care Financing Administration. In addition, DHS will be able
to incorporate regulation of administrators with its
enforcement of nursing home facilities to streamline and
strengthen enforcement efforts. DCA adds that by increasing
examination frequency and implementing a provisional license,
the number of qualified nursing home administrators in the
state should increase.
CAHF states that it appreciates the language of this bill that
addresses the frequency of testing, the examination fees,
reciprocity for out-of-state administrators, provisional
licenses, and changes to the preceptor qualifications and
training program.
3)RELATED LEGISLATION . SB 357 (Murray) contains provisions
similar this bill including requiring the state examination
for nursing home administrators to be administered at least
four times a year, and providing for provisional licenses for
administrators with out-of-state licenses.
4)PREVIOUS LEGISLATION . SB 1981 (Leslie) of 2000, contained
provisions similar to this bill and SB 357 including requiring
the state examination for nursing home administrators to be
administered at least four times a year, providing for
provisional licenses for administrators with out-of-state
licenses, and establishing the amount of the fees associated
with the licensure of nursing home administrators. SB 1981
passed both houses, but was placed on the inactive file by
request of the author.
REGISTERED SUPPORT / OPPOSITION :
AB 1409
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Support
Department of Consumer Affairs (sponsor)
Department of Health Services (sponsor)
California Association of Health Facilities
California Association of Homes and Services for the Aging
Mariner Post-Acute Network
The Office of the Governor
Opposition
None on file
Analysis Prepared by : David Gonzalez / HEALTH / (916) 319-2097