BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 641|
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THIRD READING
Bill No: AB 641
Author: Feuer (D), et al.
Amended: 8/23/11 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 6-3, 07/06/11
AYES: Hernandez, Alquist, De Le�n, DeSaulnier, Rubio, Wolk
NOES: Strickland, Anderson, Blakeslee
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SENATE HEALTH COMMITTEE : 6-3, 08/29/11 (pursuant to Senate
Rule 29.10)
AYES: Hernandez, Alquist, De Le�n, DeSaulnier, Rubio, Wolk
NOES: Strickland, Anderson, Blakeslee
SENATE APPROPRIATIONS COMMITTEE : 6-3, 08/31/11 (pursuant
to Senate Rule 29.10)
AYES: Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
NOES: Walters, Emmerson, Runner
ASSEMBLY FLOOR : 52-24, 05/23/11 - See last page for vote
SUBJECT : Long-term care: civil penalties
SOURCE : Author
DIGEST : This bill eliminates the citation review
conference (CRC) process from the citation appeals process
for long-term care (LTC) facilities, and allows fines to be
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levied from both state and federal agencies when an
incident violates both state and federal laws.
Senate Floor Amendments of 8/23/11 (1) impose specified
requirements pertaining to the transfer of specified assets
for same sex spouses and registered domestic partners, (2)
extend financial protections that are currently provided to
opposite-sex spouses to same-sex spouses and registered
domestic partners, and (3) implement federal Centers for
Medicare and Medicaid Services guidance on same sex spouse
and registered domestic partner spousal asset protections,
which was issued in June 2011.
ANALYSIS : Existing law:
1.Provides for the inspection and licensure of LTC
facilities by the California Department of Public Health
(DPH).
2.Establishes the Long-Term Care, Health, Safety, and
Security Act of 1973, which permits DPH to assess
penalties against LTC facilities for violation of
prescribed state statutes, regulations, and federal
standards pertaining to patient care.
3.Prohibits the issuance of both a citation pursuant to
state laws and the recommendation that a federal civil
monetary penalty be imposed for the same action.
4.Establishes a citation and appeals process that includes
a CRC.
This bill:
1.Revises state law to enable DPH to recommend that the
federal Centers for Medicare and Medicaid Services impose
a federal civil monetary penalty when DPH's Licensing and
Certification Division determines that a LTC facility is
out of compliance with both state and federal
requirements.
2.Eliminates the CRC appeals process for all levels of
state citations.
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3.Repeals existing law requesting DPH to develop
recommendations to address the findings published in the
June 2010 State Auditor report entitled, "Department of
Public Health: It Reported Inaccurate Financial
Information and Can Likely Increase Revenues for the
State and Federal Health Facilities Citation Penalties
Accounts."
4.Requires the Department of Health Care Services (DHCS) to
consider, at the initial application or upon
redetermination for the Medi-Cal long-term care benefit,
whether an undue hardship exists prior to finding a
person ineligible for medical assistance for home and
facility care.
5.Defines an undue hardship to exist under the following
conditions:
A. The applicant has transferred all or any portion of
ownership interest in the shared principal residence
to his or her same-sex spouse or registered domestic
partner.
B. The applicant has transferred interest in resources
other than the shared principal residence to his or
her same-sex spouse or registered domestic partner to
the extent the value of those resources do not exceed
the community spouse resource allowance that would be
available to that person if he or she was an
opposite-sex spouse.
C. The applicant has transferred his or her right to
receive income to his or her same-sex spouse or
registered domestic partner and the amount of that
income does not exceed the maximum monthly spousal
income allowance that would be available to that
person if he or she was an opposite-sex spouse.
1.Defines specified terms.
2.Requires DHCS to request federal approval and receive
federal financial participation prior to implementation.
3.Authorizes implementation by all-county letter or similar
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instructions, without regulatory action.
Background
At the request of the Joint Legislative Audit Committee,
the California State Auditor produced an audit report in
June of 2010, examining DPH. According to the State
Auditor report, state law specifies that LTC facilities are
not required to pay monetary penalties on contested
citations that have not been resolved. LTC facilities may
contest a monetary penalty by requesting an appeal through
the CRC process in which an independent hearing officer
from DPH's Office of Legal Services makes a determination
on whether to uphold, modify, or dismiss the citation.
Because of DPH's staffing issues and workload priorities,
more than 600 citations, with corresponding monetary
penalties amounting to nearly $5 million, were awaiting a
CRC as of February 2010. According to DPH, delays in the
CRC process may encourage LTC facilities to appeal
citations and request CRCs as a way to delay paying their
monetary penalties.
SB 853 (Budget and Fiscal Review Committee), Chapter 717,
Statutes of 2010, required DPH, in consultation with
stakeholders, to develop recommendations to address this
report, and provide recommendations to the Legislature no
later than March 1, 2011. In January 2011, DPH solicited
input from stakeholders and issued recommendations in April
2011. AB 641 reflects the revised recommendations of DPH.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/15/11)
Advocacy, Inc.
Alzheimer's Association, California Council
Bet Tzedek Legal Services
California Advocates of Nursing Home Reform
California Alliance of Retired Americans
California Long-Term Care Ombudsman Association
California Senior Legislature
Catholic Charities of California United
Congress of California Seniors
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Council on Aging, Orange County
Disability Rights California
Foundation Aiding the Elderly
National Senior Citizens Law Center
Ombudsman and HICAP Services of Northern California
ARGUMENTS IN SUPPORT : Supporters state that this bill
allows for both state and federal penalties to be levied
when both state and federal violations occur and gives DPH
the necessary discretion when finding serious and blatant
violations. Supporters argue the CRC process is
inefficient and redundant and by removing the CRC process,
nursing home oversight will be streamlined. Supporters
write AB 641 will strengthen the oversight protection for
the vulnerable residents in skilled nursing facilities.
ASSEMBLY FLOOR : 52-24, 05/23/11
AYES: Alejo, Allen, Ammiano, Atkins, Beall, Block,
Blumenfield, Bonilla, Bradford, Brownley, Buchanan,
Butler, Charles Calderon, Campos, Carter, Cedillo,
Chesbro, Davis, Dickinson, Eng, Feuer, Fong, Fuentes,
Furutani, Galgiani, Gatto, Gordon, Hall, Hayashi, Roger
Hern�ndez, Hill, Huber, Hueso, Huffman, Lara, Bonnie
Lowenthal, Ma, Mendoza, Mitchell, Monning, Pan, Perea, V.
Manuel P�rez, Portantino, Skinner, Solorio, Swanson,
Torres, Wieckowski, Williams, Yamada, John A. P�rez
NOES: Achadjian, Conway, Donnelly, Fletcher, Beth Gaines,
Garrick, Grove, Hagman, Halderman, Harkey, Jeffries,
Jones, Knight, Logue, Mansoor, Miller, Morrell, Nestande,
Nielsen, Olsen, Silva, Smyth, Valadao, Wagner
NO VOTE RECORDED: Bill Berryhill, Cook, Gorell, Norby
CTW:nl 8/31/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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