BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1710
AUTHOR: Yamada
AMENDED: April 26, 2012
HEARING DATE: June 20, 2012
CONSULTANT: Marchand
SUBJECT : Nursing home administrators: fees and fines.
SUMMARY : Revises how nursing home administrator licensing fees
are to be adjusted so that fee revenue is sufficient to cover
the regulatory costs to the Department of Public Health (DPH),
and revises and increases DPH reporting requirements regarding
the Nursing Home Administrator Program (NHAP).
Existing law:
1.Establishes the NHAP to license and regulate nursing home
administrators.
2.Requires the administrators of skilled nursing facilities,
intermediate care facilities, and intermediate care
facilities/developmentally disabled to be licensed under NHAP.
3.Requires applicants for licensure as a nursing home
administrator to be at least 18 years old, and meet one of
several pathway requirements, including the following:
a. A master's degree in nursing home administration or
related health administration field, which included an
internship or residency of at least 480 hours in a skilled
nursing or intermediate care facility;
b. A baccalaureate degree and the completion of a
NHAP-approved Administrator-in-Training (AIT) program of at
least 1,000 hours;
c. Ten years of recent full-time work experience, a current
license as a registered nurse, and the completion of a
NHAP-approved AIT program of at least 1,000 hours;
d. Ten years of full-time work experience in any department
of a skilled nursing facility or an intermediate care
facility with at least 60 semester units of college
courses, and the completion of a NHAP-approved AIT program
of at least 1,000 hours; or
e. Ten years of full-time hospital administration
experience in an acute care hospital with at least 60
semester units of college courses, and the completion of a
Continued---
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NHAP-approved AIT program of at least 1,000 hours.
4.Establishes a list of fees for purpose of NHAP, such as
application, examination, and license fees, and requires these
fees be adjusted annually, as directed by the Legislature in
the annual Budget Act. The fees include $190 for the initial
license and the biennial license renewal.
5.Prohibits the adjustment in the NHAP examination fees from
exceeding the increase in the California Consumer Price Index
(CPI), unless the revenue projected to be collected is less
than the projected costs for the budget year, in which case
the fees cannot exceed twice the increase in the CPI.
6.Requires DPH to provide an annual NHAP fee report to the
Legislature each April 1.
This bill:
1.Deletes the existing provisions of law governing how NHAP fees
are to be adjusted, which limit fee increases to no more than
the increase in the CPI or to no more than twice the CPI if
revenue is projected to be less than costs.
2.Requires DPH to propose that NHAP fees be adjusted, if the
revenue projected to be collected is less than the projected
costs for the budget year, to an amount sufficient to cover
the reasonable regulatory costs to the DPH. Requires DPH to
publish a list of proposed adjustments to these fees on
February 1, 2013, and every February thereafter.
3.Revises the requirement that DPH publish a list of actual
numerical fee charges for NHAP by July 30 each year and
instead requires DPH to publish this list within 30 days of
the enactment of the annual Budget Act.
4.Requires DPH to publish the final fee list by all of the
following means:
a. Issuing a letter to all licensed nursing home
administrators, all skilled nursing facilities and
intermediate care facilities, and all continuing education
providers;
b. Posting the list on DPH's website; and
c. Including the final fee list as part of the licensing
application package.
5.Requires DPH to conduct a staffing and systems analysis for
purposes of ensuring efficient and effective utilization of
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fees and the proper allocation of departmental resources for
the administration of activities required by NHAP. Requires
DPH to make a report of this analysis to the Legislature by
March 31, 2013, and to post it on its website.
6.Deletes a requirement that DPH provide an annual fiscal year
NHAP fee report to the Legislature each April 1, and instead
requires DPH to prepare a report, by January 15 each year,
containing the following information:
a. Estimates of costs to implement activities required by
NHAP and estimated fee revenue;
b. Recommended adjustments to fees based on projected
workload and costs; and
c. An analysis containing the following information for the
current fiscal year and each of the previous four fiscal
years:
i. The number of persons applying for a nursing home
administrator's license, the number of licenses approved
or denied, and the number renewed;
ii. The number of applicants taking the licensing
exam and the number who pass or fail;
iii. The number of persons applying for, accepted
into, and completing the AIT Program;
iv. The number, source, and disposition of complaints
made against persons in the AIT Program and licensees,
including the 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
nursing home administrators;
vi. A listing of the names and nature of violations
for individual licensed nursing home administrators,
including final administrative, remedial, or
disciplinary actions taken; and
vii. The number of appeals, informal conferences, or
hearings filed by nursing home administrators or held,
the length of time between the request being filed and
the final determination of the appeal, and the number of
administrative, remedial, or disciplinary actions taken.
7.Requires all fees collected pursuant to NHAP, as well as
administrative fines against licensees, to be paid into the
Nursing Home Administrator Licensing Account in DPH's
Licensing and Certification Program Fund, rather than the
Nursing Home Administrator's State License Examining Fund
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8.States the intent of the Legislature that activities of the
NHAP related to licensure of nursing home administrators be
supported by fee revenue that is sufficient to fund these
activities.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1.Potential increased fee revenue of up to $400,000 annually
could be assessed if DPH supported all NHAP activities by
NHAP-related fee revenue as envisioned in this bill. For
example, if all fees related to NHAP were increased
proportionately, fees for nursing home administrators could
approximately double from the current biennial fee of $190 to
$380.
2.Costs associated with new reporting requirements are expected
to be minor and absorbable.
PRIOR VOTES :
Assembly Health: 13- 6
Assembly Appropriations:12- 4
Assembly Floor: 47- 25
COMMENTS :
1.Author's statement. According to the author, this bill will
end the practice of charging the costs of some NHAP functions
to other programs, federal funds, or the General Fund. This
bill makes the NHAP within DPH self-sustaining by revising
accounting procedures, eliminating the cap on fee increases,
and conforming the report date.
This bill enacts the same licensing fee adjustment mechanism
for NHAP that DPH uses for certified nurse assistants, home
health aides, and all categories of health facilities,
agencies and clinics. This will assure full resources
necessary for the entire licensing and certification program
to perform efficiently and effectively, while placing no
burden upon federal funds, the General Fund, or other
licensing programs. This bill assures the proper allocation of
DPH resources for administering NHAP. The staffing and systems
analysis called for in this bill ensures that the Legislature
will be informed of the ongoing activities, challenges, and
necessary fee adjustments in time for budget hearings.
2.Background on NHAP. The fees established in statute for the
NHAP program have not changed since the licensing and
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regulation of nursing home administrators was shifted to DPH
from the State Board of Nursing Home Administrators in the
Department of Consumer Affairs, which was initially
accomplished through an interagency agreement on July 1, 1998,
and then by statute effective January 1, 2002.
According to DPH's NHAP Annual Fee Report (Fee Report) for the
2011-12 fiscal year (FY), released in April of 2011, NHAP fees
have remained constant since 1998. Beginning in FY 2003-04
through FY 2007-08, NHAP cost exceeded revenues. In FY
2006-07, NHAP's operating expenses increased to $507,000 while
the revenues remained constant at $392,000. In FY 2007-08, the
Governor's Budget included an additional 2.5 NHAP positions
and increased budget authority to enable the NHAP to
accomplish the mandated workload. NHAP's operating expenses
thus continued to increase to $579,000, while the revenues
decreased to $334,373, which reduced the contingency reserve
significantly. The Fee Report states that an analysis of the
duties and responsibilities of NHAP staff was conducted that
revealed some functions were more general in nature and
consistent with Licensing and Certification (L&C) activities
and that these costs would more appropriately be charged to
the L&C Special Fund.
The Fee Report projects that in 2011-12, there will be
$387,000 in NHAP fee revenue, while expenditures from the
Nursing Home Administrator's State License Examining Fund (NHA
Fund) will total $366,000. DPH notes that if revenue is
projected to be less than the projected costs for the budget
year, DPH is authorized by statute to propose that fees be
adjusted by up to twice the increase in the CPI. However, with
the reduction in appropriation from the NHA Fund as a result
of shifting some expenses to the L&C Special Fund, revenues
have exceeded actual and projected costs during FY 2008-09
through FY 2011-12, and therefore, DPH proposes no fee
increases.
3.Prior legislation. AB 1807 (Committee on Budget), Chapter 74,
Statutes of 2006, among other provisions, provided DPH new
authority for restructuring fees that are collected from
health facilities and other entities licensed by DPH so that
the L&C Division of DPH would be entirely supported by federal
funds and special funds beginning in the 2009-10 FY.
AB 1409 (Chan), Chapter 687, Statutes of 2001, established
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with DPH the authority to license and regulate nursing home
administrators and made additional changes to NHAP regarding
the examination and licensing of nursing home administrators.
4.Support. This bill is supported by the California Advocates
for Nursing Home Reform (CANHR), which states that this bill
will have a positive fiscal impact on DPH, while having no
cost to the state. More importantly, CANHR argues this bill
will create a more effective way of reporting what is done
with administrator fees. CANHR states that requiring DPH to
report projected costs annually to the Legislature would make
the use of the money transparent.
SUPPORT AND OPPOSITION :
Support: California Advocates for Nursing Home Reform
Oppose: None received.
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