BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  AB 1394
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          Date of Hearing:   March 29, 2011

                            ASSEMBLY COMMITTEE ON HEALTH
                              William W. Monning, Chair
             AB 1394 (Committee on Health) - As Amended:  March 23, 2011
           
          SUBJECT  :  Health care facilities: financing.

           SUMMARY  :  Makes a variety of technical, clarifying, and 
          non-controversial changes to statutes affecting the California 
          Health Facilities Financing Authority (CHFFA).  Specifically, 
           this bill  : 

          1)Expands the categories of health facilities eligible for 
            financing under the Healthcare Expansion Loan Program (HELP) 
            to include entities that provide private educational services 
            to patients in health facilities, and facilities that provide 
            ancillary support services, such as information systems, 
            laundry services, or equipment.   

          2)Authorizes a participating health facility to undertake 
            directly, or through a related nonprofit corporation, the 
            financing and refinancing of a project.

          3)Allows CHFFA to enter into bond exchange agreements (BEAs). 

          4)Specifies when a default is likely to occur and what actually 
            constitutes a default.

          5)Clarifies that participating health institutions, rather than 
            the physical buildings of health facilities, are the legal 
            organizations or entities obligated to act, promise, or 
            demonstrate satisfaction with CHFFA's requirements.

          6)Authorizes CHFFA to pledge or grant security interests to 
            banks and other large institutions that act as letters of 
            credit providers and providers of liquidity support.  

          7)Permits CHFFA to re-finance a borrower's debt from other 
            conduit financing providers.

           EXISTING LAW  :

          1)Defines a "conduit financing provider" as any county, city, 
            city and county, public district, public authority, public 








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            corporation, nonprofit corporation, joint powers authority 
            (JPA), or other statutorily constituted public entity that 
            issues one or more conduit revenue bonds.

          2)Defines a "conduit revenue bond" as any municipal security, 
            the proceeds of which are loaned to any non-governmental 
            borrower, including, but not limited to, persons, for-profit 
            corporations, nonprofit 501(c)(3) corporations, partnerships, 
            and other legal entities, for purposes that are allowed for 
            qualified private activity bonds under federal law.

          3)Establishes CHFFA, consisting of nine members, including the 
            State Treasurer who serves as chairman, through the CHFFA Act.

          4)Expresses legislative intent in enacting the CHFFA Act to 
            provide financing to health facilities that can demonstrate 
            the financial feasibility of their projects, as specified.

          5)Authorizes CHFFA to make secured or unsecured loans to, or 
            purchase secured or unsecured loans of, any participating 
            health institution in connection with the financing of a 
            project or working capital in accordance with an agreement 
            between CHFFA and the participating health institution.  

          6)Specifies, for the purposes of CHFFA's loans, that a 
            non-profit health institution includes, but is not limited to: 
            a general acute care hospital; an acute psychiatric hospital; 
            a skilled nursing facility (SNF); an intermediate care 
            facility; a special health care facility that provides 
            medical, nursing, rehabilitation, dental, or maternity 
            services; a clinic; an adult day health center; a 
            county-operated health facility; a residential facility for 
            the elderly that is operated as a part of, or in conjunction 
            with, an intermediate care facility, a SNF, or a general acute 
            care hospital; a child day care facility operated in 
            conjunction with a health facility; an intermediate care 
            facility/developmentally disabled habilitative, that is a 
            health facility;  a community care facility; an accredited 
            community work-activity program; a community mental health 
            center; a speech and hearing center; or, a blood bank. 

           FISCAL EFFECT  :   This bill has not yet been analyzed by a fiscal 
          committee.

           COMMENTS  :   








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           1)PURPOSE OF THIS BILL  .  This bill is sponsored by the State 
            Treasurer's Office (STO) to modernize and update the statutes 
            affecting CHFFA.  According to the STO, new types of health 
            care facilities that are consistent with the legislative 
            intent of CHFFA's statute have begun to seek funding for 
            expansions in response to changes to the delivery of health 
            care services in California.  Additionally, a rapidly evolving 
            economic system has made various types of economic agreements 
            more widespread.  When CHFFA's statute was initially enacted 
            in 1979, BEAs were not prevalent but have since become more 
            widespread.  However, the omission of these types of 
            agreements and facilities in CHFFA's statute hinders its 
            ability to provide bond funds to a diversity of health care 
            institutions.  This bill makes technical or non-controversial 
            changes to CHFFA's statute to ensure that CHFFA is able to 
            provide financing efficiently to all eligible health entities.

           2)BACKGROUND  .  Certain types of non-governmental borrowers can 
            take advantage of tax-exempt financing through conduit revenue 
            bonds issued by many types of governmental entities, including 
            state financing authorities, such as CHFFA, chartered cities, 
            counties, JPAs, redevelopment agencies, and local housing and 
            industrial development authorities.  These bonds may be issued 
            for various purposes including health and educational 
            facilities, economic development, and multi-family housing.  
            The issuing agency loans the funds obtained from the financing 
            to a non-governmental borrower who builds and operates the 
            project.  A conduit revenue bond is payable solely from the 
            loan payments received from the non-governmental party, so the 
            governmental issuer normally has no liability for debt service 
            on the bonds. 

           3)CHFFA  .  CHFFA was created to be the State's vehicle for 
            providing financial assistance to public and nonprofit health 
            care providers through loans funded by the issuance of 
            tax-exempt bonds.  By borrowing through CHFFA, health 
            facilities can likely obtain lower interest rates than they 
            would through conventional bonds issued by JPAs and other 
            conduit authorities.  

          Generally, nonprofit, licensed health facilities in the state, 
            including adult day health centers, community clinics, SNFs, 
            developmentally disabled centers, hospitals, and drug and 
            alcohol rehabilitation centers are eligible for CHFFA 








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            financing.  Proceeds from CHFFA bonds may be used for 
            project-related costs, including: construction, remodeling, 
            and renovation; land acquisition (as part of the proposed 
            project); acquisition of existing health facilities; purchase 
            or lease of equipment; refinancing or refunding of prior debt; 
            working capital for start-up facilities; costs of bond 
            issuance; feasibility studies; and, reimbursement of prior 
            expenses.  

          From 2005-10, the majority of CHFFA's conduit financing provided 
            to eligible entities on an annual basis has been conveyed 
            through tax-exempt revenue bonds.  Large multi-hospital 
            systems have been CHFFA's primary borrowers over the last five 
            years, with 10 hospital systems borrowing more than $3.3 
            billion of the total $8.7 billion in tax-exempt revenue bonds 
            issued. 

          CHFFA utilizes fees paid by borrowers of its tax-exempt bond 
            program to fund its HELP II financing program.  CHFFA 
            initiated this program in 1988 to provide low-interest and 
            low-cost loans of up to $750,000 to California's non-profit 
            small and rural health facilities that might not otherwise 
            have alternative financing options to address their capital 
            needs.  Since 2005, CHFFA has loaned nearly $35 million to 
            small and rural health clinics.

           4)BEAs  .  This bill would give CHFFA the authority to enter into 
            BEAs through a process that, according to the STO, is similar 
            to when a homeowner re-finances a home.  BEAs enable borrowers 
            to alter various terms and rates of their prior bonds in order 
            to make conditions more favorable for borrowers or acceptable 
            to investors without having to issue new bonds. The prior 
            bonds are then replaced or "exchanged" for bonds with the new 
            terms. The seller (underwriter) and purchaser (bondholder) 
            agree to "exchange" the bonds under these new terms.  BEAs did 
            not exist when CHFFA's statute was initially enacted in 1979 
            but are somewhat commonplace now.  The STO states that BEA 
            authority gives CHFFA the flexibility it needs to function in 
            the modern day health care finance arena and points to data 
            showing that, in 2010, CHFFA issued $712 million in bonds for 
            the purpose of health care facilities and hospitals while JPAs 
            issued $1.3 billion in bonds for similar purposes during this 
            time period.  According to the STO, the changes in this bill 
            to allow CHFFA to enter into BEAs, to pledge or grant security 
            interests, and to re-finance debt from other bond issuers are 








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            intended to make CHFFA more attractive to borrowers and allow 
            it to fairly compete with JPAs and other bond providers that 
            are already permitted to do these activities.  

           5)SUPPORT  .  State Treasurer Bill Lockyer writes in support that 
            California's health care scene and economic environment have 
            evolved dramatically since the enactment of CHFFA's statute in 
            1979.  This bill will modernize the statute to ensure that 
            CHFFA is better able to serve these rapidly changing needs and 
            enable it to continue to provide much needed alternative 
            financing options, through programs like HELP II, to small and 
            rural health facilities throughout the state.      

           REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          California State Treasurer Bill Lockyer

           Opposition 
           
          None on file.

           
          Analysis Prepared by  :    Cassie Royce / HEALTH / (916) 319-2097