BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 215|
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THIRD READING
Bill No: AB 215
Author: Feuer (D) and Smyth (R) et al
Amended: 6/23/09 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 8-2, 6/17/09
AYES: Alquist, Strickland, Cedillo, DeSaulnier, Leno,
Maldonado, Pavley, Wolk
NOES: Aanestad, Cox
NO VOTE RECORDED: Negrete McLeod
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 65-11, 5/18/09 - See last page for vote
SUBJECT : Long-term health care facilities: ratings
SOURCE : Author
DIGEST : This bill requires a long-term health care
facility that provide skilled nursing care to post, in
accordance with specified requirements, the overall
facility rating information determined by the federal
Centers for Medicare and Medicaid Services.
ANALYSIS :
Existing law defines long-term health care facilities to
include skilled nursing facilities, intermediate care
facilities, congregate living facilities, nursing
CONTINUED
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facilities, and pediatric day health and respite
facilities.
Existing law requires the Department of Public Health (DPH)
to develop and establish a consumer information service
system to provide updated and accurate information to the
general public and consumers regarding long-term care
facilities in their communities that includes an on-line
inquiry system accessible through a toll-free phone number
and through the internet, that includes long-term care
facility profiles, and information regarding substantiated
complaints and state citations assessed.
Under existing law, the Long-Term Care, Health, Safety, and
Security Act of 1973, DPH can assess penalties for
violations of prescribed state and federal requirements.
Violations are classified based on the nature of the
violation, and class "B" citations are subject to a civil
penalty between $100 and $1,000, per citation.
Money collected as a result of state and federal civil
penalties imposed under the existing state Long-Term Care,
Health, Safety, and Security Act of 1973, or federal law,
must be deposited into the State Health Facilities Citation
Penalties Account (State Account), which contains money
collected from violations of state law, or the Federal
Account, which contains money collected from violations of
federal law.
This bill:
1. Requires, effective January 1, 2011, a LTC facility that
has been certified for purposes of Medicare or Medicaid
and provides skilled nursing care, to post the overall
facility rating information determined by CMS in
accordance with specified requirements.
2. Requires the information to be posted in at least an
area accessible and visible to members of the public, an
area used for employee breaks, and in an area used by
residents for communal functions, such as dining,
resident council meetings, or activities.
3. Requires the posted information to meet specified
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requirements relating to the size, font and paper size,
including requiring the information to include the full
name and address of the facility and the most recent
overall star rating given by CMS to that facility,
except that a facility is required to have seven
business days from the date when it receives a different
rating from the CMS to include the updated rating in the
posting.
4. Requires the star rating to be expressed as the number
that reflects the number of stars given to the facility
by CMS in a clear and easily readable font of at least
two inches. Directly below the number, the same number
of star symbols is required of a size of at least
one-half inch print with text in at least 28 point font
stating "The above number is out of five stars."
5. Requires the rating to be aligned in the center of the
page, to be in a clear and easily readable font, and to
include a specific written disclosure about the rating,
with information on where more information can be
obtained about the rating.
6. Requires a copy of the most recent CMS report on the
facility to be maintained at the facility, and to be
made available to residents or the public upon request.
7. Requires a violation of this bill to constitute a class
"B" violation, prohibits a violation from constituting a
crime, and requires fines from a violation of this bill
to be deposited into the State Health Facilities
Citation Penalties Account.
Background
The CMS "Five-Star Quality Rating System" is located on the
CMS Nursing Home Compare website. It was created to help
consumers, their families, and their caregivers compare
nursing homes more easily and help identify areas where
patients and their families and caregivers may want to ask
further questions. The nursing homes that are shown on
Nursing Home Compare are certified to participate in
Medicare and/or Medi-Cal. Nursing home ratings are taken
from the following three sources of data:
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1. Health Inspections . Measures based on outcomes from
state health inspections for federal standards:
Facility ratings for the health inspection domain are
based on the number, scope, and severity of deficiencies
identified during the three most recent annual
inspection surveys, as well as substantiated findings
from the most recent 36 months of complaint
investigations. Deficiency findings are weighted by
scope and severity, and take into account the number of
re-visits required to ensure that deficiencies
identified during the health inspection survey have been
corrected.
2. Staffing . Measures based on nursing home staffing
levels: Facility ratings on the staffing domain are
based on two measures: (a) registered nurse hours per
resident day; and (b) total staffing hours per resident
day derived from the CMS Online Survey and Certification
Reporting (OSCAR) system, and are case-mix adjusted.
3. Quality Measures . Facility ratings for the quality
measures are based on performance on 10 of the 19
quality measures currently posted on the Nursing Home
Compare website, and include seven long-stay measures
and three short-stay measures. Examples of the quality
measures include the percentage of long-term stay
residents who needed help with daily activities has
increased, whose ability to move about in and around
their room got worse, the percentage of long stay
residents given pneumonia and flu vaccines, the
percentage of residents with moderate to severe pain,
bed sores, who are physically restrained, who have
urinary tract infections, and who had a catheter
inserted and left in their bladder.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 6/29/09)
California Advocates for Nursing Home Reform
Contra Costa County Advisory Council on Aging
Los Angeles County Board of Supervisors
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AARP California
American Federation of State, County and Municipal
Employees, AFL-CIO
Bet Tzedek Legal Services
California Alliance for Retired Americans
California Senior Legislature
Congress of California Seniors
Consumer Attorneys of California
Los Angeles County Board of Supervisors
San Joaquin County Commission on Aging
National Union of Healthcare Workers
Professional Fiduciary Association of California
ARGUMENTS IN SUPPORT : Senior and nursing home advocacy
groups write in support that residents and family members
should have access to as much information about each
long-term care facility as possible, and posting the CMS
rating in a public area allows individuals to view one
piece of critical information needed to make determinations
about the home, and will help ensure individuals are aware
of the federal rating and have access to critical
information that is only available online. Additionally,
supporters argue the posting of the federal rating will
provide additional incentives to achieve the highest
possible grade thereby promoting high quality care for
patients.
ASSEMBLY FLOOR :
AYES: Ammiano, Arambula, Beall, Bill Berryhill, Tom
Berryhill, Blakeslee, Block, Blumenfield, Brownley,
Buchanan, Caballero, Charles Calderon, Carter, Chesbro,
Conway, Cook, Coto, Davis, De La Torre, De Leon, DeVore,
Emmerson, Evans, Feuer, Fletcher, Fong, Fuentes,
Furutani, Galgiani, Gilmore, Hall, Harkey, Hayashi,
Hernandez, Hill, Huber, Huffman, Jeffries, Jones, Knight,
Krekorian, Lieu, Bonnie Lowenthal, Ma, Mendoza, Monning,
Nava, Nestande, Nielsen, John A. Perez, V. Manuel Perez,
Portantino, Ruskin, Salas, Silva, Skinner, Smyth,
Solorio, Swanson, Torlakson, Torres, Torrico, Tran,
Yamada, Bass
NOES: Adams, Anderson, Fuller, Gaines, Garrick, Hagman,
Logue, Miller, Niello, Audra Strickland, Villines
NO VOTE RECORDED: Duvall, Eng, Price, Saldana
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CTW:do 6/30/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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