BILL ANALYSIS �
AB 1710
Page 1
Date of Hearing: April 17, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1710 (Yamada) - As Amended: April 10, 2012
SUBJECT : Nursing home administrators: fees and fines.
SUMMARY : Authorizes the Department of Public Health (DPH) to
adjust the licensing fees for the Nursing Home Administrator
Program (NHAP) and removes the licensing fee adjustment
limitation in existing law relating to the California Consumer
Price Index (CCPI). Requires DPH to prepare certain reports
relating to nursing home administrator (NHA) licensing fees and
to submit these reports to the appropriate policy and fiscal
committees of the Legislature and post the reports on its
Internet Website. Specifically, this bill :
1)Authorizes DPH, if the revenue projected to be collected from
NHA licensing fees is less than the projected costs for the
budget year, to propose NHA licensing fees to be adjusted to
an amount sufficient to cover the reasonable regulatory costs
to DPH. Requires DPH, commencing February 1, 2013, and every
February 1 thereafter, to publish a list of proposed
adjustments to NHA licensing fees.
2)Requires DPH, within 30 days of the enactment of the annual
Budget each year, to publish a list of actual numerical fee
charges as adjusted. Requires the final NHA licensing fee
list, with an explanation of any adjustment, to be published
by all of the following means:
a) Issuing a letter to all licensed NHAs, all skilled
nursing facilities (SNFs) and intermediate care facilities
(ICFs), and all continuing education providers;
b) Posting the list of DPH's Internet Website; and,
c) Including the final fee list as part of the licensing
application package.
3)Prohibits the adjustment of NHA licensing fees and the
publication of the NHA licensing fee list from being subject
to regulation requirements in existing law.
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4)Requires DPH to prepare the following reports and make those
reports available to the public by submitting them to the
appropriate policy and fiscal committees of the Legislature,
and by posting them on DPH's Internet Website:
a) A report of all costs to implement NHAP licensing fee
activities. Requires DPH, as a part of this report, to
recommend adjustments to fees based on projected workload
and costs. Requires the cost estimates to be based on
appropriation amounts in the Governor's proposed budget for
the next fiscal year;
b) A staffing and systems analysis to ensure efficient and
effective utilization of fees collected and proper
allocation of DPH resources for the administration of NHAP
licensing fee activities. Requires this analysis to
include the following information for the current fiscal
year and each of the previous four fiscal years:
i) The number of persons applying for a NHA license,
the number of NHA licenses approved or denied, and the
number of NHA licenses renewed;
ii) The number of applicants taking the NHA exam and the
number of applicants who pass or fail the exam;
iii) The number of persons applying for, accepted into,
and completing the Administrator in Training (AIT)
Program;
iv) The number, source, and disposition of complaints
made against persons in the AIT Program and licensed
NHAs, including the length of time between receipt of the
complaint and completion of the investigation;
v) The number and type of final administrative,
remedial, or disciplinary actions taken against licensed
NHAs;
vi) A listing of the names and nature of violations for
individual licensed NHAs, including final administrative,
remedial, or disciplinary actions taken; and,
vii) The number of appeals, informal conferences, or
hearings filed by NHAs or held, the length of time
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between the request being filed and the final
determination of the appeal, and the number of
administrative, remedial, or disciplinary actions taken.
5)Requires, within 10 days after the beginning of every month,
all NHAP licensing fees collected by the program for the month
preceding to be paid in to the DPH Licensing and Certification
Program Fund.
6)Requires administrative fines collected by the NHAP to be
deposited in the DPH Licensing and Certification Program Fund.
EXISTING LAW :
1)Establishes the NHA Act which provides for the licensing of
NHAs by DPH.
2)Provides for the licensure of SNFs and ICFs by DPH.
3)Prescribes specified NHA's licensing fees, and requires that
the fees be adjusted annually, as directed by the Legislature
in the annual Budget Act, by an amount not to exceed the CCPI.
4)Requires that the NHA licensing fees be deposited in the NHA
State License Examining Fund, a continuously appropriated
fund.
FISCAL EFFECT : This bill has not yet been heard by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill
modernizes the way NHAP fees are calculated in order to
realistically reflect the workload and program needs. The
author maintains that the NHAP funding was inadvertently
omitted from the fee reform initiative for "right-sizing" or
adjusting licensing fees based on the workload and costs for
the Department of Health Services (DHS) Licensing and
Certification Program (now DPH Licensing and Certification
Program) as a part of the Fiscal Year (FY) 2006-07 Budget Act.
The author maintains this lack of integrated funding, public
accountability and resources, creates problems for the NHAP to
be able to fully implement its statutory responsibilities to
protect the health and safety of nursing home residents by
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ensuring that NHAs meet professional licensing standards.
According to the author, as a result of lack of resources, the
program hasn't been able to do the following: a) Revise the
state exam for NHAs; b) Investigate complaints in a timely
manner; c) Take disciplinary actions for violations of
professional standards; or, d) Conduct routine analysis to
determine any correlation between SNF violations and NHA
responsibilities.
2)NHAs . DPH currently licenses 2,600 NHAs. Only SNFs or ICFs
require licensed NHAs, however, according to DPH, there are
other types of facilities that may opt to utilize a licensed
NHA rather than another type of professional, which by law,
may oversee operations of a facility. In order to become a
NHA, an individual must be at least 18 years of age, be a
citizen of the United States or a legal resident, and have a
reputable and responsible character. An individual must also
have one of the following combinations of experience and
education:
a) A master's degree in nursing home administration or a
related health administration field. The master's program
must have included an internship/residency of at least 480
hours in a SNF or an ICF;
b) A baccalaureate degree and completion of a NHAP-approved
AIT program of 1,000 hours;
c) Ten years of recent full-time work experience, a current
license as a registered nurse and completion of a
NHAP-approved AIT program of 1,000 hours. At least five
years of the ten years of work experience must have been in
a supervisory or director of nursing position; or,
d) Ten years of full-time work experience, in any
department of a SNF, ICF, or an ICF
Developmentally/Disabled with 60 semester units (or 90
quarter units) of college or university courses, and
completion of a NHAP-approved AIT program of 1,000 hours.
At least five of the ten years of work experience must have
been in a position of department manager.
3)NHAP . According to an April 2011, NHAP Annual Fee Report
(2011 Fee Report), in June of 1998, the California State Board
of Examiners of NHAs within the Department of Consumer Affairs
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(DCA) was eliminated and, through an interagency agreement,
DCA delegated the legislative and regulatory authority for
NHAP administration to DPH's Licensing and Certification
Division. AB 1409 (Chan), Chapter 687, Statutes of 2001,
known as the NHA Act, permanently redirected NHAP to DPH and
created the NHA State License Examining Fund in the State
Treasury to be continuously appropriated to support the
functions of the NHAP. NHAP's role is to protect the public
by ensuring only qualified individuals are licensed and
appropriate standards of competency are established and
enforced. According to the 2011 Fee Report, redirecting NHAP
to DPH offered the opportunity to coordinate oversight of
facilities and NHAs who manage those facilities. The NHA Act
does the following: a) Provides the authority for NHAP and
specifies licensing requirements; b) Addresses fees including
those for state and national examinations; c) Provides
procedures for out-of-state NHA licensees to obtain a one-year
provisional license; d) Develops an AIT program in
consultation with representatives from the long-term care
industry and advocacy groups; and, e) Establishes a designated
citation and administrative fine assessment system.
The Program Staff resources dedicated to carrying out the NHAP
consist of the following full-time positions: a) One Staff
Services Manager I; b) Three Associate Governmental Program
Analysts; and, One Staff Services Analyst.
4)NHAP LICENSING FEES . Current California law requires that the
NHAP generate revenue from the collection of licensing fees
and specifies methods to follow for adjusting those fees.
Current law limits the adjustment of licensing fees to no more
than the increase in the CCPI, unless the NHAP operates at a
deficit for the budget year. In that case, under existing
law, DPH is authorized to propose the fees be adjusted by not
more than twice the increase of the CCPI. Since 1998, NHAP
fees have remained constant. Following are a list of the fees
collected by NHAP:
-------------------------------------------------------------
|Fee Categories |Fees FY |
| |2010-11 |
|-------------------------------------------------+-----------|
|Reviewing an Applicant's Eligibility to take the | $25 |
|Examination Application Fee | |
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|-------------------------------------------------+-----------|
|Persons Applying for Reciprocity Consideration | $50 |
|Licensure Application Fee | |
|-------------------------------------------------+-----------|
|Persons Applying for the AIT Program Application | $100 |
|Fee | |
|-------------------------------------------------+-----------|
|Written State Examination Fee | $140 |
|-------------------------------------------------+-----------|
|Initial License Fee | $190 |
|-------------------------------------------------+-----------|
|Active License Renewal Fee | $190 |
|-------------------------------------------------+-----------|
|Inactive License (Biennial) Fee | $190 |
|-------------------------------------------------+-----------|
|Delinquency Fee | $50 |
|-------------------------------------------------+-----------|
|Duplicate License Fee | $25 |
|-------------------------------------------------+-----------|
|Provisional License Fee | $250 |
|-------------------------------------------------+-----------|
|Endorsement of Credentials to the Licensing | $25 |
|Authority of Another State | |
|-------------------------------------------------+-----------|
|Preceptor Certification Fee (Triennial) | $50 |
|-------------------------------------------------+-----------|
|Approval of a Continuing Education Provider | $150 |
|Biennial Fee | |
|-------------------------------------------------+-----------|
|Approval of a Continuing Education Course | $15 |
|Biennial Fee | |
|-------------------------------------------------+-----------|
|Reciprocity State Examination Fee | $140 |
|-------------------------------------------------+-----------|
|Fingerprinting Process Fee | $51 |
|-------------------------------------------------+-----------|
|Administrative Fines | Varied |
|-------------------------------------------------+-----------|
|Miscellaneous |Varied |
-------------------------------------------------------------
DPH reports beginning FY 2003-04 through FY 2007-08, NHAP
costs exceeded revenues. However, in FY 2007-08, the
Governor's Budget included an additional 2.5 NHAP positions
and increased budget authority to enable the NHAP to
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accomplish the mandated workload. Consequently, according to
DPH, the NHAP's operating expenses increased that year to
$579,000 while the revenues collected were only $334,373, thus
reducing the program's contingency reserve. In response, DPH
analyzed NHAP staff duties and responsibilities and concluded
that some more general functions were consistent with other
DPH Licensing and Certification Program activities and were
more appropriately charged to the DPH Licensing and
Certification Special Fund. As a result, beginning in FY
2008-09, NHAP's appropriation was reduced in order to rebuild
the program's contingency reserve without program impact. The
author argues that, by "right-sizing" the NHAP fees, this bill
will allow all of the NHAP's expenses to be covered by NHAP
fees.
5)SUPPORT . The California Advocates for Nursing Home Reform
(CANHR) write in support that this bill creates a more
effective way of reporting what is done with administrator
fees and makes the program more transparent. CANHR maintains
that this bill would have a positive fiscal impact on DPH,
while having no cost to the state.
6)PREVIOUS LEGISLATION :
a) AB 1807 (Committee on Budget), Chapter 74, Statutes of
2006, changed the fee setting methodology and "right sized"
licensing for health facilities and agencies licensed by
DPH's Licensing and Certification.
b) AB 1490 (Chan), Chapter 687, Statutes of 2001,
permanently transfers the functions of licensing
professional nursing home administrators from the DCA to
the DHS (now DPH). Transferred funds and program position
authority from the Business and Professions Code to the
Health and Safety Code.
7)POLICY CONCERNS . A fiscal analysis regarding the initial
licensing fee increase as a result of this bill has not been
conducted. Considering the fees for the NHAP have not
increased since 1998, there is the potential for "sticker
shock" to the industry. The author might wish, moving
forward, to consider a fee increase phase-in mechanism to
ensure that a significant increase to the fees does not incur
unintended consequences.
REGISTERED SUPPORT / OPPOSITION :
AB 1710
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Support
California Advocates for Nursing Home Reform
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097