BILL NUMBER: SB 91 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JULY 12, 2011
INTRODUCED BY Committee on Budget and Fiscal Review
JANUARY 10, 2011
An act relating to the Budget Act of 2011.
An act to amend Sections 1570.7, 1574.5, 1576.2, and 1578.1 of, and
to repeal Sections 1575.5 and 1590.3 of, the Health and Safety Code,
and to amend Section 14574 of the Welfare and Institutions Code,
relating to adult day health care, and making an appropriation
therefor, to take effect immediately, bill related to the budget.
LEGISLATIVE COUNSEL'S DIGEST
SB 91, as amended, Committee on Budget and Fiscal Review.
Budget Act of 2011. Adult day health care centers.
Existing law, the California Adult Day Health Care Act, provides
for the licensure and regulation of adult day health care centers,
with administrative responsibility shared between the State
Department of Public Health, the State Department of Health Care
Services, and the California Department of Aging pursuant to an
interagency agreement. Existing law provides that a negligent,
repeated, or willful violation of a provision of the California Adult
Day Health Care Act is a misdemeanor.
Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which health care
services are provided to qualified, low-income persons. The Medi-Cal
program is, in part, governed and funded by federal Medicaid Program
provisions. Existing law provides, to the extent permitted by federal
law, that adult day health care be excluded from coverage under the
Medi-Cal program.
Existing law requires, concurrently with the submission of an
application for initial licensure as an adult day health care center,
an applicant to apply for eligibility certification as a provider of
adult day health care services reimbursable under the Medi-Cal
program. Existing law also prohibits a license from being issued or
renewed for an adult day health care center that is not approved as a
Medi-Cal provider of adult day health care services.
This bill would remove the requirement that an applicant for
initial licensure as an adult day health care center apply for
Medi-Cal certification. This bill would also remove the prohibition
against issuing or renewing a license for an adult day health care
center that is not approved as a Medi-Cal provider of adult day
health care services, and would make conforming changes.
Existing law provides that if an adult day health care center
licensee provides adult day program services, the adult day health
care license is the only license required to provide these additional
services.
This bill would require a provider choosing to add an adult day
program within the adult day health care facility to submit a notice
to the department. By changing the definition of a crime, this bill
would impose a state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
This bill would appropriate the sum of $1,000 from the General
Fund to the State Department of Public Health for administrative
costs.
This bill would declare that it is to take effect immediately as a
bill providing for appropriations related to the Budget Bill.
This bill would express the intent of the Legislature to enact
statutory changes relating to the Budget Act of 2011.
Vote: majority. Appropriation: no yes
. Fiscal committee: no yes .
State-mandated local program: no yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1570.7 of the Health
and Safety Code is amended to read:
1570.7. As used in this chapter and in any regulations
promulgated thereunder:
(a) "Adult day health care" means an organized day program of
therapeutic, social, and skilled nursing health activities and
services provided pursuant to this chapter to elderly persons or
adults with disabilities with functional impairments, either physical
or mental, for the purpose of restoring or maintaining optimal
capacity for self-care. Provided on a short-term basis, adult day
health care serves as a transition from a health facility or home
health program to personal independence. Provided on a long-term
basis, it serves as an alternative to institutionalization in a
long-term health care facility when 24-hour skilled nursing care is
not medically necessary or viewed as desirable by the recipient or
his or her family.
(b) "Adult day health center" or "adult day health care center"
means a licensed and certified facility that
provides adult day health care.
(c) "Core staff" includes the positions of program director,
registered nurse, social worker, activity director, and program aide.
(d) "Department" or "state department" means the State Department
of Public Health.
(e) "Director" means the State Public Health Officer.
(f) "Elderly" or "older person" means a person 55 years of age or
older, but also includes other adults who are chronically ill or
impaired and who would benefit from adult day health care.
(g) "Extended hours" means those hours of operation prior to or
following the adult day health care program hours of service, as
designated by the adult day health care center in its plan of
operation, during which the adult day health care center may operate
an adult day program, or an Alzheimer's day care resource center, or
both.
(h) "Hours of service" means the program hours defined and posted
by the adult day health care center for the provision of adult day
health care services, pursuant to Section 14550 of the Welfare and
Institutions Code, which shall be no less than four hours, excluding
transportation.
(i) "Individual plan of care" means a plan designed to provide
recipients of adult day health care with appropriate treatment in
accordance with the assessed needs of each individual.
(j) "License" means a basic permit to operate an adult day health
care center. With respect to a health facility licensed pursuant to
Chapter 2 (commencing with Section 1250), "license" means a special
permit, as defined by Section 1251.5, empowering the health facility
to provide adult day health care services.
(k) "Long-term absence" or "long-term vacancy" means an absence or
vacancy lasting, or likely to last, more than one month. An adult
day health care center's policies and procedures shall be specific
regarding coverage in the situation for long-term absences or
vacancies.
(l) "Maintenance program" means procedures and exercises that are
provided to a participant, pursuant to Section 1580, in order to
generally maintain existing function. These procedures and exercises
are planned by a licensed or certified therapist and are provided by
a person who has been trained by a licensed or certified therapist
and who is directly supervised by a nurse or by a licensed or
certified therapist.
(m) "Program director" shall be a person with both of the
following:
(1) One of the following backgrounds:
(A) A person with a bachelor's degree and a minimum of two years
of experience in a management, supervisory, or administrative
position.
(B) A person with a master's degree and a minimum of one year of
experience in a management, supervisory, or administrative position.
(C) A registered nurse with a minimum of two years experience in a
management, supervisory, or administrative position.
(2) Appropriate skills, knowledge, and abilities related to the
health, and mental, cognitive, and social needs of the participant
group being served by the adult day health center.
(n) "Restorative therapy" means physical, occupational, and speech
therapy, and psychiatric and psychological services that are planned
and provided by a licensed or certified therapist. The therapy and
services may also be provided by an assistant or aide under the
appropriate supervision of a licensed therapist, as determined by the
licensed therapist. The therapy and services are provided to restore
function, when there is an expectation that the condition will
improve significantly in a reasonable period of time, as determined
by the multidisciplinary assessment team.
(o) "Short-term absence" or "short-term vacancy" means an absence
or vacancy lasting one month or less, and includes sick leave and
vacations. An adult day health care center shall ensure that
appropriate staff is designated to serve in these positions during
the short-term absence or vacancy and that the center's policies and
procedures are specific regarding coverage of short-term absences or
vacancies.
(p) "Social worker" shall be a person who meets one of the
following:
(1) The person holds a master's degree in social work from an
accredited school of social work.
(2) The person holds a master's degree in psychology, gerontology,
or counseling from an accredited school and has one year of
experience providing social services in one or more of the fields of
aging, health, or long-term care services.
(3) The person is licensed by the California Board of Behavioral
sciences.
(4) The person holds a bachelor's degree in social work from an
accredited school with two years of experience providing social
services in one or more of the fields of aging, health, or long-term
care services.
SEC. 2. Section 1574.5 of the Health and
Safety Code is amended to read:
1574.5. (a) All adult day health care centers shall maintain
compliance with licensing and certification
requirements. These requirements shall not prohibit program
flexibility for the use of alternate concepts, methods, procedures,
techniques, equipment, number and qualifications of personnel, or the
conducting of pilot projects, if these alternatives or pilot
projects are carried out with provisions for safe and adequate care
and with the prior written approval of the state department. This
approval shall provide for the terms and conditions under which
permission to use an alternative or pilot program is granted.
Particular attention shall be given to encourage the development of
models appropriate to rural areas. The department may allow the
substitution of work experience for academic requirements for the
position of program director, administrator, or activity coordinator.
(b) The applicant or licensee may submit a written request to the
department for program flexibility, and shall submit with the
request substantiating evidence supporting the request.
(c) Any approval by the department granted under this section, or
a true copy thereof, shall be posted immediately adjacent to the
center's license.
SEC. 3. Section 1575.5 of the Health
and Safety Code is repealed.
1575.5. (a) Concurrently with the submission of any application
under Section 1575.2, the applicant shall apply to the department for
eligibility certification as a provider of adult day health care
services reimbursable under the Medi-Cal Act (Chapter 7 (commencing
with Section 14000) of Part 3 of Division 9 of the Welfare and
Institutions Code). No license shall be issued or renewed for an
adult day health care center that is not approved as a Medi-Cal
provider of adult day health care services.
(b) (1) This section shall not apply to centers licensed during
a moratorium imposed in accordance with Section 14043.46 of the
Welfare and Institutions Code. The moratorium shall not prohibit the
department from approving a change in ownership, relocation, or
increase in capacity for an adult day health care center that meets
the conditions in subdivision (c) of Section 14043.46 of the Welfare
and Institutions Code.
(2) This section shall not apply upon the implementation of the
adult day health care waiver in accordance with the Welfare and
Institutions Code.
SEC. 4. Section 1576.2 of the Health
and Safety Code is amended to read:
1576.2. (a) Each license
issued or renewed pursuant to this chapter shall not be transferable
and the initial license shall expire 12 months from the date of its
issuance. The director shall be given the discretion to approve
applications for relicensure for a period of up to 24 months.
Application for annual renewal of a license, accompanied by the
required fee, shall be filed with the department not less than 30
days prior to the expiration date. Failure to submit a renewal
application prior to that date shall result in expiration of the
license.
(b) A license shall be rescinded for an applicant that has had
its Medi-Cal certification for adult day health care revoked.
SEC. 5. Section 1578.1 of the Health
and Safety Code is amended to read:
1578.1. (a) Notwithstanding subdivisions (b) and (c) of Section
1570.7 or any other provision of law, if an adult day health care
center licensee also provides adult day program services, the adult
day health care license shall be the only license required to provide
these additional services. Costs shall be allocated among the
programs in accordance with generally accepted accounting practices.
(b) The department, unless otherwise specified by the interagency
agreement entered into pursuant to Section 1572 shall evaluate the
program services provided for in subdivision (a) for quality of care
and compliance with program requirements, concurrent with inspections
of the adult day health care facility, using a single survey
process.
(c) The department and the California Department of Aging shall
jointly develop and adopt regulations pursuant to Section 1580 for
the provision of different levels of care under the single adult day
health care license.
(b) A provider choosing to add an adult day program within the
adult day health care facility shall submit a notice to the
department on such forms as may be required.
(c) Review and approval of the application to provide a dual
program shall not require an on-site inspection.
(d) The maximum licensed capacity shall be determined by the local
fire authority and shall include limits for ambulatory and
nonambulatory participants.
SEC. 6. Section 1590.3 of the Health
and Safety Code is repealed.
1590.3. (a) The denial, suspension, or revocation of a center's
license shall be considered immediate grounds for the denial,
suspension, or termination of the center's certification.
(b) Proceedings to deny an application for licensure or
certification, suspend a license or certification, or revoke a
license or terminate certification shall be consolidated whenever
possible.
SEC. 7. Section 14574 of the Welfare
and Institutions Code is amended to read:
14574. (a) The director shall terminate the Medi-Cal
certification of any adult day health care provider at any time if he
or she finds the provider is not in compliance with standards
prescribed by this chapter or Chapter 7 (commencing with Section
14000) or regulations adopted pursuant to these chapters. The
director shall give reasonable notice of his or her intention to
terminate the certification to the provider and participants in the
center. The notice shall state the effective date of, and the reason
for, the termination.
(b) The denial, suspension, or termination of certification shall
be considered grounds for denial, suspension, or revocation of the
license.
(c)
(b) The California Department of Aging and the
department shall coordinate proceedings to deny an application for
certification, to terminate or suspend certification, or to revoke or
suspend licensure to the extent appropriate to ensure consistency
and uniformity.
(d)
(c) The provider shall have the right to appeal the
department's decision made pursuant to Section 14123.
(e)
(d) This section is not applicable to denials of
initial certification made pursuant to a moratorium imposed in
accordance with Section 14043.46 of the Welfare and Institutions
Code.
SEC. 8. No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.
SEC. 9. The sum of one thousand dollars ($1,000)
is hereby appropriated from the General Fund to the State Department
of Public Health for administrative costs.
SEC. 10. This act is a bill providing for
appropriations related to the Budget Bill within the meaning of
subdivision (e) of Section 12 of Article IV of the California
Constitution, has been identified as related to the budget in the
Budget Bill, and shall take effect immediately.
SECTION 1. It is the intent of the Legislature
to enact statutory changes relating to the Budget Act of 2011.