BILL ANALYSIS
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|SENATE RULES COMMITTEE | SJR 13|
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THIRD READING
Bill No: SJR 13
Author: Oropeza (D)
Amended: As introduced
Vote: 21
SENATE HEALTH COMMITTEE : 11-0, 7/8/09
AYES: Alquist, Strickland, Aanestad, Cedillo, Cox,
DeSaulnier, Leno, Maldonado, Negrete McLeod, Pavley, Wolk
SUBJECT : New dialysis clinic licensure and certification
SOURCE : California Dialysis Council
DIGEST : This resolution urges the federal Centers for
Medicare and Medicaid Services to adopt regulations, and
the Congress and President to enact legislation, to improve
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.
ANALYSIS : Existing federal law establishes conditions
for participation that health care providers, including
specialty clinics, must meet to participate in the Medicare
and Medicaid programs.
Existing state law (1) provides for the regulation and
oversight by the Department of Public Health (DPH) of
primary care clinics and specialty clinics, and (2)
CONTINUED
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includes as a type of specialty clinic a "chronic dialysis
clinic," which is a clinic that provides less than 24-hour
care for the treatment of patients with end-stage renal
disease, including renal dialysis services.
This resolution:
1. Urges the federal Centers for Medicare and Medicaid
Services (CMS) to adopt regulations, and the Congress
and President to enact legislation, to improve 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.
2. Cites several factors demonstrating a need for more
timely licensure and certification of new dialysis
clinics, including:
A. The need 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 and kidney failure.
B. A new dialysis clinic must have a state
licensure survey and a separate CMS certification
survey before the clinic may be reimbursed for
treating Medicare patients, and new dialysis
clinics must wait months, and more than a year in
some instances, for state surveyors to perform the
licensure and certification surveys.
C. 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.
D. In areas where all dialysis clinics are at
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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.
E. CMS requires state surveyors in the Licensing
and Certification Division of the DPH to perform
surveys pursuant to a four tier survey process, in
which new dialysis clinic surveys are placed in
Tier III.
F. 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.
3. States that 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.
4. States that the new CMS requirement for a "justification
letter" for new dialysis clinics further slows the
process and should be eliminated and CMS should permit
the department surveyors to better utilize their
resources by allowing state licensure surveys to be
completed simultaneously with CMS certification surveys.
Background
Health care facilities in California are licensed,
regulated, inspected, and/or certified by a number of
public and private agencies at the state and federal
levels, including the DPH Licensing and Certification
Program (L&C) and the U.S. Department of Health and Human
Services' CMS. These agencies have separate, yet sometimes
overlapping jurisdictions. L&C is responsible for ensuring
health care facilities comply with state laws and
regulations. In addition, L&C cooperates with CMS to
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ensure that facilities accepting Medicare and Medi-Cal
(California's version of the federal Medicaid program)
payments meet federal requirements.
According to the DPH L&C Division, a facility that has
submitted a licensing application is first subject to a
licensing survey, which focuses on building standards,
policies and procedures, the credentialing of staff, and
equipment and supplies. A facility that wishes to receive
Medicare and Medicaid payments must submit a separate
application to CMS. Once that application is approved, L&C
conducts a federal certification survey. This survey is
designed to ensure that the facility can provide services
in accordance with federal regulations. The only way a
facility can demonstrate this is to begin admitting
patients/residents and providing services prior to billing
the federal programs.
According to DPH, it is unable to estimate the length of
time it takes to conduct the initial licensing and
certification surveys, but believes it has improved the
timeliness of the surveys. The timelines for the surveys
further varies among its field offices, depending on their
workload. DPH L&C does not receive federal funding for its
licensing survey work, which is funded through license
facility fees, but does receive federal funding for the
certification surveys. While CMS contends that the state
is receiving sufficient funding to conduct Tier 1 through 3
survey work, funding for Tier 4 facilities, including for
initial certification surveys, is generally acknowledged to
be inadequate. According to DPH, while additional federal
funding for surveyor positions would help reduce backlogs,
it would also need authorization through the budget for
additional surveyor positions in order to make use of the
new funds.
According to DPH, given the fact that a facility cannot
operate without first having a license and that the federal
certification survey evaluates how a facility is actually
delivering care to patients in accordance with federal
regulations, concurrent licensing and certification surveys
cannot currently be done simultaneously.
FISCAL EFFECT : Fiscal Com.: No
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SUPPORT : (Verified 7/13/09)
California Dialysis Council (source)
ARGUMENTS IN SUPPORT : The California Dialysis Council,
the sponsor of this resolution, states that given that the
population of dialysis patients in California continues to
grow, driven by the surge in diabetes and hypertension, and
given the delays in opening new facilities due to the
separate licensing and certification surveys that must be
conducted, it is essential that CMS and the Congress
address this problem, as requested by the resolution.
CTW:do 7/13/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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