BILL NUMBER: SJR 13	CHAPTERED
	BILL TEXT

	RESOLUTION CHAPTER  45
	FILED WITH SECRETARY OF STATE  JUNE 28, 2010
	APPROVED BY GOVERNOR  JUNE 28, 2010
	ADOPTED IN SENATE  JULY 16, 2009
	ADOPTED IN ASSEMBLY  JUNE 21, 2010

INTRODUCED BY   Senator Oropeza

                        JUNE 2, 2009

   Relative to new dialysis clinic licensure and certification.


	LEGISLATIVE COUNSEL'S DIGEST


   SJR 13, Oropeza. New dialysis clinic licensure and certification.
   This measure would urge the Centers for Medicare and Medicaid
Services to adopt regulations, and the Congress and the President of
the United States to enact legislation, to improve the system and
speed up the process for timely licensure and certification surveys
of new dialysis clinics.



   WHEREAS, There is a critical need for more end stage renal disease
(ESRD) dialysis clinics to serve the existing and growing population
of dialysis patients in California; and
   WHEREAS, It is critical to continue to expand the number of
dialysis clinics in California to keep pace with the growing
population of dialysis patients, driven by the growth in hypertension
and diabetes, which are the two primary diagnoses leading to chronic
kidney disease (CKD) and kidney failure; and
   WHEREAS, A new dialysis clinic must have a state licensure survey
and a separate Centers for Medicare and Medicaid Services (CMS)
certification survey before the clinic may be reimbursed for treating
Medicare patients; and
   WHEREAS, New dialysis clinics must wait months, and more than a
year in some instances, for state surveyors to perform the licensure
and certification surveys needed in order for these facilities to
open their doors to Medicare patients; and
   WHEREAS, The current state of the licensure and certification
process reduces the incentive for dialysis providers to consider
California locations for new dialysis clinics and increases the
potential for future access problems for California patients; and
   WHEREAS, Many patients must travel beyond conveniently located new
dialysis clinics for months because the new clinics lack licensure
and certification surveys, even though the new clinics are fully
outfitted, staffed, and ready to serve patients; and
   WHEREAS, In areas where all dialysis clinics are at maximum
capacity, some Medicaid and Medicare patients must be kept in acute
care hospitals, at much greater cost, while they wait for
availability at a dialysis clinic so that they may transfer to a
long-term care facility and obtain outpatient dialysis care at the
clinic; and
   WHEREAS, CMS requires state surveyors in the Licensing and
Certification Division of the State Department of Public Health to
perform surveys pursuant to a four tier survey process. New dialysis
clinic surveys are placed in Tier III; and
   WHEREAS, CMS requires the department to complete all functions
categorized as Tier I or Tier II prior to completing functions in
Tier III, but provides insufficient funding for the completion of the
Tier I and Tier II functions; and
   WHEREAS, CMS should either separate new dialysis clinic surveys
from other functions in the four tier process, move new dialysis
clinic surveys into Tier I or Tier II, or provide adequate funding to
ensure the completion of Tier I, II, and III functions on a timely
basis; and
   WHEREAS, The new CMS requirement for a "justification letter" for
new dialysis clinics further slows the process and should be
eliminated; and
   WHEREAS, CMS should permit the department surveyors to better
utilize their resources by allowing state licensure surveys to be
completed simultaneously with CMS certification surveys; now,
therefore, be it
   Resolved by the Senate and the Assembly of the State of
California, jointly, That the Legislature of the State of California
strongly urges CMS to adopt regulations, and the Congress and the
President of the United States to enact legislation, to improve the
system and speed up the process for timely licensure and
certification surveys of new dialysis clinics to provide patients
with access to these services as soon as possible and to eliminate
the chilling impact on new clinic construction in California; and be
it further
   Resolved, That the Secretary of the Senate transmit copies of this
resolution to the President and Vice President of the United States,
the Speaker of the House of Representatives, the Majority Leader of
the United States Senate, each Senator and Representative from
California in the Congress of the United States, the Administrator
for the Centers for Medicare and Medicaid Services, and to the author
for appropriate distribution.