BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
SB 799 (Negrete McLeod)
Hearing Date: 5/26/2011 Amended: 3/30/2011
Consultant: Katie Johnson Policy Vote: Health 8-0
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BILL SUMMARY: SB 799 would require the California Department of
Public Health (CDPH) to complete long-term care facility
complaint investigations within a 90-working day period. The
bill would also extend the time period from 5 business days to
15-working days in which a complainant could notify CDPH of his
or her request for an informal conference to discuss the
investigation's determination and would require additional
mini-exit interview requirements.
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Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
Increased staff workload $1,750 - $3,500 $2,750 - $5,500
$2,750 - $5,500 Special*
for 90 day requirement
*State Department of Public Health Licensing and Certification
Program Fund
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STAFF COMMENTS: SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
This bill would require CDPH to complete long-term care facility
complaint investigations within a 90-working day period.
Although there is no statutory requirement on CDPH to complete
investigations within a specified time frame, the department's
internal policy until June 2009 was to complete investigations
within 40 days, based on federal guidance that was rescinded.
Long-term care facilities include skilled-nursing facilities,
intermediate care facilities, congregate living health
facilities, nursing facilities, and pediatric day health and
respite facilities. CDPH currently completes about 45 percent of
complaint investigations within 45 working days and 71 percent
within 90 working days. The department completes about 65
percent of entity reported incidents (ERIs) within 90 working
days. In FY 2009-2010, there were 5,696 complaints and 11,864
entity reported incidents (ERIs) that required an onsite
investigation; average complaint and ERI investigations require
about 9 hours of a Health Facility Evaluator Nurse to complete.
If CDPH were to estimate that it 10 percent of the complaints
and ERIs would never be completed within 90 days due to
unforeseen circumstances, the department would need staff to
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process 1,081 and 2,966 additional complaints and ERIs,
respectively, within 90 working days, assuming current
investigation completion rates and assuming that the numbers of
complaints and ERIs are the same as those in FY 2009-2010. At 9
hours per complaint and ERI, the workload would be 9,794 hours
and 26,964 hours, respectively. If 1250 hours of a HFEN's time
is spent on these complaints, it would take 30 HFENs to absorb
this workload. Additionally, CDPH's accepted ratio for
supervisors is 1 supervisor to 6 HFENs and support staff ratio
is 1 support staff : 6 supervisors/HFENs. Thus, CDPH would need
an additional 30 HFENs, 5 HFE supervisors, and 6 support staff
as well as additional administrative staff workload in the low
hundreds of thousands of dollars annually. The estimated cost
would be $3.5 million in FY 2011-2012 and $5.5 million in FY
2012-2013 and ongoing.
However, these investigations would not be new. It is presumable
that the investigations are in the middle of completion. If that
is the case, the number of hours per HFEN would be fewer. If the
workload per HFEN were estimated to be 4.5 hours-the
investigation would be half complete-the costs would be half of
the estimates above at approximately $1.75 million in FY
2011-2012 and $2.75 million in FY 2012-2013.
This bill would require CDPH to utilize the same timeframes
established by this bill for complaints for ERI investigations.
Staff notes that these timeframes for complaints may not be
appropriate to apply to ERIs because all complaint
investigations require an on-site visit whereas it is at the
department's discretion to decide whether an ERI necessitates an
on-site investigation.
If the department were to interpret this bill as meaning that
all ERIs would now require an on-site investigation, using the
same methodology as above, CDPH would need about 105 HFENs, 18
supervisors, and 21 support staff plus additional administrative
support at an estimated cost of $10 million in FY 2011-2012 and
$17 million annually thereafter. In FY 2009-2010, there were
25,920 ERIs, of which 14,056 did not require an on-site
investigation. Additionally, this bill would require the
department to conduct a mini-exit interview not only upon
exiting a facility, but also upon completion of the
investigation. This new requirement could potentially double the
number of exit interviews currently conducted and would
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potentially significantly increase the number conducted if CDPH
needed to conduct more on-site ERI visits. Costs would be in the
hundreds of thousands annually.
In order to cover these costs, the department would need to
significantly increase its licensing and certification fees in
order to cover this increased workload.
This bill would also extend the time period from 5 business days
to 15-working days in which a complainant could notify CDPH of
his or her request for an informal conference to discuss the
investigation's determination. This increase in time could
induce more complainants to request an informal conference call
and could thereby increase CDPH staff workload. However, since
"informal" is a loosely defined term and can mean a phone
conversation, the costs would be minor and absorbable.
The author's proposed amendments would permit CDPH to extend the
90 working day deadline on a case by case basis to accommodate
the workload of investigative staff. This would ease some of the
cost pressure on CDPH, but the department would have a workload
increase to meet the 90 working day completion requirement on a
regular basis and the costs would continue to be approximately
$2,750,000 - $5,500,000 annually. The amendments would also
permit rather than mandate that CDPH apply the timeframes for
investigation or inspection established by these provisions for
an ERI. This would eliminate the cost of on-site ERI inspections
that are not currently conducted. The amendments would require
CDPH to include recommendations for increasing facility
licensing fees due to an increase in workload related to this
bill in its annual system and staffing analysis.