BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 2675
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AUTHOR: Chesbro
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AMENDED: As Introduced
HEARING DATE: June 9, 2010
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CONSULTANT:
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Bain
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SUBJECT
Health facilities: licensee orientation
SUMMARY
Increases the coursework hour requirement from 8 to 16
hours for an applicant for initial licensure as an
intermediate care facility/developmentally
disabled-habilitative (ICF/DD-H) and an intermediate care
facility/developmentally disabled-nursing (ICF-DD-N) by
requiring an additional 8 hours on the statutory and
regulatory requirements related to business management.
CHANGES TO EXISTING LAW
Existing law:
Existing law establishes the California Department of
Public Health (DPH), which is responsible for the licensing
and regulation of health facilities, including ICF/DD-H and
ICF-DD-N.
Existing law defines an ICF/DD-H as a facility with a
capacity of 4 to 15 beds that provides 24-hour personal
care, habilitation, developmental, and supportive health
services to 15 or fewer persons with developmental
disabilities who have intermittent, recurring needs for
Continued---
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nursing services, but have been certified by a physician as
not requiring the availability of continuous skilled
nursing care.
Existing law defines an ICF/DD-N in the same manner as an
ICF/DD-H, except that an ICF/DD-N does not have to provide
habilitation services. Additionally, an ICF/DD-N must
serve medically fragile persons with developmental
disabilities, or who demonstrate significant developmental
delay that may lead to a developmental disability if not
treated.
Existing law requires an applicant for initial licensure as
an ICF/DD-H or an ICF/DD-N to attend an eight-hour
orientation program containing prescribed components
approved by the Department of Developmental Services (DDS).
Existing law defines a "developmental disability" as a
disability that originates before an individual attains age
18, that continues (or can be expected to continue)
indefinitely, and constitutes a substantial disability for
that individual. A developmental disability includes
mental retardation, cerebral palsy, epilepsy, autism, and
includes disabling conditions found to be closely related
to mental retardation or to require treatment similar to
that required for individuals with mental retardation.
This bill:
Increases, from 8 hours to 16 hours, the course requirement
an applicant or his or her designee must take for initial
licensure as an ICF/DD-H or an ICF/DD-N. The additional
eight hours required by this bill are required to outline
the statutory and regulatory requirements related to
business management. The additional eight-hour program
must include, but need not be limited to, cost reporting
(required under current law), general accounting
principles, the Department of Health Care Services' audit
process, and the regional center vendorization process.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, no direct fiscal impact to DDS to approve and
monitor the ICF/DD orientation program. According to the
sponsors of this bill, fewer than 20 individuals complete
STAFF ANALYSIS OF ASSEMBLY BILL 2675 (Chesbro) Page
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the training annually and training fees are paid by
participants, not DDS or facilities.
BACKGROUND AND DISCUSSION
This bill is sponsored by the California Association of
Health Facilities (CAHF), which states the majority of
persons with developmental disabilities in California now
reside in the community. As one result, small homes for
persons with developmental disabilities (such as ICF/DD-N
and ICF/DD-H) continue to be developed throughout the
state. CAHF states those seeking to operate these
facilities typically do so as they wish to serve this
population because of personal interests, such as a family
member with a developmental disability, or a care-giving
background in nursing or a related field.
CAHF states that although most potential licensees have
knowledge and education related to consumer needs and the
"how-to" of delivering consumer-driven services, they often
have little or no practical business experience. CAHF
states this becomes problematic once these facilities begin
operating and the licensee struggles to implement effective
payroll, cost reporting and budgeting processes.
CAHF states that in 1997, the Legislature recognized the
need to educate licensees of small ICF/DD-H and ICF/DD-N
about the rules and regulations governing their operation.
As a result, these providers are required to complete a
statutorily mandated eight-hour orientation prior to
licensure. The eight-hour course focuses on California's
developmental disabilities system and facility programmatic
and regulatory requirements. Although there is a brief
overview of business-related regulatory requirements, a
practical discussion of business considerations is lacking.
CAHF states there is increasing feedback from new
operators and overseeing departments that new licensees are
struggling to manage the financial aspects of their
business. This can lead to poorly crafted business plans
that may ultimately place some of these small providers at
greater risk of financial insolvency. CAHF argues that
adding eight hours to the existing course requirement will
address this issue by allowing instructors with expertise
in accounting and business practices specific to ICFs/DD to
more thoroughly educate potential providers about key
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business operations.
Background on ICF/DD-H and ICF/DD-N
A state license is required to operate health facilities,
including the four types of intermediate care facilities
(ICF) that provide services to developmentally disabled
individuals. Intermediate care facilities differ in their
bed size, the level of nursing services provided, whether
habilitative services are provided, and the type of
developmental deficit of the individuals receiving services
in the facility.
For example, an ICF/DD-N are generally defined in the same
manner as an ICF/DD-H, except that an ICF/DD-N does not
have to provide habilitation services (habilitation
services are services to assist an individual with
behavioral skills, such as communication and social
skills). In addition, an ICF/DD-N must serve medically
fragile persons with developmental disabilities, or who
demonstrate significant developmental delay that may lead
to a developmental disability if not treated.
Applicants for licensing and/or certification (for Medi-Cal
reimbursement) as an ICF/DD-H and ICF/DD-N must submit an
application package to the Department of Public Health's
Licensing and Certification (L&C) Program that includes
specified information, including information on the owner
type, licensee name and address, whether the license wishes
to participate in Medicare and Medi-Cal, the person in
charge of the facility, individuals having five percent or
more ownership interest, financial resources, a program
plan, and property ownership. Applicants must also pay
licensing fees ($938.01 per bed for 2009-10 for ICF/DD-H
and ICF/DD-N). In addition, applicants for licensure as an
ICF/DD-H and ICF/DD-N must submit a program plan for
approval by DDS.
DPH indicates that there are 405 licensed ICF/DD-N with
2,481 beds, and 766 licensed ICF/DD-H with 4,715 beds. In
2009, DPH indicates it received 6 initial licensure
applications for an ICF/DD-N and 6 for an ICF/DD-H.
Existing law requires an applicant for initial licensure of
an ICF-DD-H or an ICF/DD-N to attend an eight-hour
orientation program containing prescribed components
STAFF ANALYSIS OF ASSEMBLY BILL 2675 (Chesbro) Page
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approved by DDS. The orientation must outline the role,
requirements, and regulations of each of the following:
The scope of responsibility for operation including
regulatory requirements and statutes governing the
facility type;
Cost reporting;
Local planning;
Regional center and other community support services;
All federal and state agencies responsible for licensing
and certification, and data collection; and,
Government and private agencies responsible for ensuring
the rights of the developmentally disabled.
Under existing law, the orientation must be conducted by
relevant community services and provider organizations.
Orientation instructors must have knowledge or experience
in the subject area to be taught, and must either possess a
four-year college degree relevant to the course or courses
to be taught, be a health professional with a valid and
current license to practice in California, or have at least
two years experience in California as an administrator of a
long-term health care facility that provides services to
persons with developmental disabilities within the last
eight years.
According to the DDS web site, there are four providers who
provide the mandatory eight-hour orientation program
approved by DDS, including one provided by the nonprofit
foundation of CAHF. The current cost of the training
program of three of the four providers is $189, $225 and
$359.
Prior legislation
AB 2488 (Alby), Chapter 471, Statutes of 1996, established
an eight-hour orientation program for licensure of
applicants of ICF/DD-H and ICF/DD-N that outlines the scope
of responsibility for facility operation, including
regulatory requirements and statutes governing the facility
type. AB 2488 was also sponsored by CAHF.
PRIOR ACTIONS
Assembly Health Committee 18-0
Assembly Appropriations Committee15-0
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Assembly Floor 74-0
POSITIONS
Support: California Association of Health Facilities
(sponsor)
Oppose: None received
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