BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 221|
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THIRD READING
Bill No: SB 221
Author: Walters (R)
Amended: 4/21/09
Vote: 21
SENATE HEALTH COMMITTEE : 11-0, 4/1/09
AYES: Alquist, Strickland, Aanestad, Cedillo, Cox,
DeSaulnier, Leno, Maldonado, Negrete McLeod, Pavley, Wolk
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SUBJECT : Home dialysis agencies
SOURCE : California Dialysis Council
DIGEST : This bill repeals existing law which provides
for the licensure and regulation of home dialysis agencies.
ANALYSIS :
Existing law:
1. Establishes "home dialysis agencies," which are defined
as specified entities that engage in providing home
dialysis services and other therapeutic services to
patients in their homes.
2. Defines "home dialysis services" as the treatment and
care given to patients of a home dialysis agency which
are administered by a physician, qualified registered or
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licensed nurse, or qualified hemodialysis technician
pursuant to a patient's care plan.
3. Requires home dialysis agencies to be licensed by the
Department of Public Health (DPH), and sets forth
various requirements a home dialysis agency must meet in
order to qualify for licensure, having specified
policies relating to patient care, personnel training
and qualifications, and recordkeeping. Home dialysis
agencies are required to provide specified services,
including nursing, nutritional counseling, medical, and
social services, perform assessments of a patient's home
to ensure a safe physical environment for the
performance of dialysis, and meet specified requirements
relating to dialysis equipment, supplies, and waste
disposal.
This bill repeals existing statute which provides for the
licensing and regulation of home dialysis agencies, and
makes findings and declarations that the statute has
created confusion and misunderstandings with respect to
dialysis services provided in skilled nursing facilities
(SNFs).
Background
Home dialysis agencies . The home dialysis agency model set
forth by existing law is one where a patient would receive
staff-assisted dialysis treatment in his or her own home.
The home dialysis agency law defines a "home" as a house,
apartment, SNF, intermediate care facility, congregate
living facility, or other setting where dialysis is
provided by at least one staff person per patient.
According to DPH, although existing statute allows for
licensure of home dialysis agencies, it has never been
implemented, and no provider has been licensed as a home
dialysis agency.
Dialysis services in SNFs . In June 2007, the then
Department of Health Services, now referred to as DPH,
issued an All Facilities Letter (AFL) stating that the
provision of dialysis services in a long-term care setting,
including SNFs, was not authorized. The department
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interpreted the home dialysis agency statutes as applicable
to SNF dialysis providers; since no provider was licensed
as a home dialysis agency, the department ordered the
delivery of dialysis services in SNFs to cease.
In August 2007, DPH issued a subsequent All Facilities
Letter which superseded and clarified the letter issued two
months prior. In this letter, DPH stated that, upon
further review, it had determined that dialysis services
may be provided in SNFs under existing regulations, which
allow for the provision of dialysis as an optional service.
DPH clarified that SNFs must meet specified federal
certification standards, and be authorized by DPH to
provide the dialysis services, and that the services must
be added to the facility's license. The letter provided
that these dialysis services may only be provided to
residents of the facility, and not to the general public,
and further provided that if the SNF does not employ
qualified persons to provide dialysis services, it may
contract with an outside service that meets all applicable
standards for providing dialysis services. SNFs are
required to have written policies and procedures for the
management of dialysis services.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 4/21/09)
California Dialysis Council (source)
California Association of Health Facilities
ARGUMENTS IN SUPPORT : The California Dialysis Council
(CDC) states that no entity has ever requested licensure
under the home dialysis agency law, and that the existing
of the law has created confusion among certain dialysis
providers. The CDC states that this bill will help avoid
such confusion by repealing the home dialysis agency law.
The California Association of Health Facilities (CAHF)
states that the home dialysis statute has caused confusion
among health care providers as to whether or not the
provision of dialysis services in SNFs is permitted. CAHF
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explains that in 2007, this confusion resulted in a small
group of providers meeting with DPH to ask for
clarification on the law. CAHF states that the meeting
prompted DPH's June 2007 AFL disallowing dialysis services
in SNFs, which as later retracted and replaced by the
August 2007 AFL clarifying that dialysis services may be
provided in SNFs as an optional service. CAHF states that
this statute is out-dated, and has never been applied, and
that by repealing the statute, facilities will have clear
authority to provide dialysis services to patients who are
often so ill, that they cannot be safely transported
between a dialysis clinic and their facility of residence.
CTW:do 4/21/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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