BILL ANALYSIS �
SB 1228
Page 1
SENATE THIRD READING
SB 1228 (Alquist)
As Amended August 24, 2012
Majority vote
SENATE VOTE :36-0
HEALTH 12-0 APPROPRIATIONS 16-0
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|Ayes:|Monning, Atkins, Eng, |Ayes:|Gatto, Harkey, |
| |Garrick, Gordon, Hayashi, | |Blumenfield, Bradford, |
| |Roger Hern�ndez, Bonnie | |Charles Calderon, Campos, |
| |Lowenthal, Mansoor, | |Davis, Fuentes, Hall, |
| |Mitchell, Nestande, Pan | |Hill, Cedillo, Mitchell, |
| | | |Nielsen, Norby, Solorio, |
| | | |Wagner |
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SUMMARY : Establishes, until January 1, 2020, within the
Department of Public Health (DPH) the Small House Skilled
Nursing Facilities (SHSNFs) Pilot Program to allow DPH to
authorize the development and operation of up to 10 SHSNFs.
Specifically, this bill :
1)Establishes within DPH the Small House Skilled Nursing
Facilities (SHSNFs) Pilot Program to allow DPH to authorize
the development and operation of up to 10 SHSNFs.
2)Defines SHSNFs as a health facility that provides skilled
nursing care and supportive care in a small, homelike,
residential setting in an apartment, cottage, house, or
similar residential unit, to patients whose primary need is
for the availability of skilled nursing care on an extended
basis. Permits a SHSNF to consist of a group or cluster of
such residential homes, or a distinct area within an existing
skilled nursing facility (SNF) that otherwise meets the
definition of a SHSNF, is physically separate and
distinguishable from the remainder of the SNFs, and has a
distinct entry with no traffic of staff, residents, or
visitors not affiliated with the SHSNF. Permits a SHSNF to
also be a distinct part of a general acute care hospital or an
acute psychiatric hospital.
3)Establishes characteristics for facilities that are eligible
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for the SHSNF pilot program.
4)Permits a facility to be licensed by DPH as a SHSNF pilot
facility if the facility meets both of the following
requirements:
a) The facility has been determined by DPH to comply with
all provisions necessary to be certified to participate as
a provider of care either as a SNF in the federal Medicare
Program or as a nursing facility in the federal Medicaid
Program; and,
b) The facility has been determined by DPH and the Office
of Statewide Health Planning and Development (OSHPD) to
fully comply with all pilot program requirements.
5)Requires each SHSNF pilot facility to be subject to the same
licensing enforcement provisions, in existing law, that apply
to other SNFs.
6)Requires each SHSNF pilot facility to be subject to DPH's
Licensing and Certification program fee for SNFs.
7)Requires each SHSNF pilot facility to receive a peer group
weighted average Medi-Cal reimbursement rate as calculated by
the State Department of Health Care Services.
8)Requires DPH to permit the formulation of new standards for
long-term care that may extend beyond, or vary from,
traditional long-term health care facility models, including
but not limited to, facility layout and design consistent with
newly adopted revisions to the California Building Standards
Code, nursing care levels, staffing levels, infection control,
sanitation, dietary services, and other personal care and
habilitation provisions that may be more flexible that those
currently required in California for skilled nursing
facilities (SNFs) and continuous nursing facilities.
9)Requires DPH, together with OSHPD of the State Long-Term Care
Ombudsman, in developing the standards for the SHSNF pilot
program to consult long-term care providers, health advocacy
organizations, health care employees organizations, consumer
advocates, elder care advocates, and others identified as
having a vested interest in long-term health care.
10)Requires DPH to issue, by July 1, 2013, one or more All
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Facilities Letters that provide the standards to be used by
providers accepted into the pilot program for the development
and operation of all pilot facilities.
11)Establishes several definitions , including defining: a)
"versatile worker" which means a certified nursing assistant
who provides personal care, socialization, activity aid
services, meal preparation services, and laundry and
housekeeping services; b) "supportive care" which includes the
provision of socialization, activity aide services, and
homemaker services; and, c) "homemaker services" which means
food preparation, housekeeping, laundry, and maintenance
services.
12)Requires each pilot facility to provide for consistent staff
assignments and self-managed work teams of direct care staff,
including staff working as versatile workers. Requires
licensed nursing staff to direct versatile workers in all
activities delegated under the licensed nurses' scope of
practice. Permits a versatile worker to be supervised by
nonclinical staff when performing nonclinical duties, at the
discretion of the facility.
13)Requires DPH to establish criteria to measure the benefits
and successes of SHSNFs, as a whole, and to compare the
results achieved by each model variant. Requires DPH to
evaluate and analyze the emerging concepts in long-term SNFs
developed pursuant to the pilot program for purposes of
considering future regulatory modification.
14)Requires DPH to prepare and submit a report to the
Legislature on the results of the SHSNF pilot program.
Requires the report to be submitted to the Legislature at
least 24 months prior to the termination of the pilot program,
and requires the report to include an evaluation of the pilot
program's cost, safety, and quality of care.
15)Sunsets the SHSNF pilot program on January 1, 2020.
16)Makes conforming changes to avoid chaptering out problems
with SB 135 (Ed Hernandez) of 2012 regarding free standing
hospice facility licensure.
17)Makes other technical and clarifying changes.
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EXISTING LAW :
1)Provides for the licensure of health facilities, including
SNFs, by DPH.
2)Defines "SNF" as a health facility that provides skilled
nursing care and supportive care to patients whose primary
need is for availability of skilled nursing care on an
extended basis.
3)Requires OSHPD, under the Alfred E. Alquist Hospital
Facilities Seismic Safety Act, to assume responsibility for
the enforcement of all building standards related to hospital
buildings, including SNFs.
EXISTING REGULATIONS :
1)Further define "SNF" as a facility providing 24-hour inpatient
care and, at a minimum, includes physician, skilled nursing,
dietary, and pharmaceutical services and an activity program.
2)Require each SNF licensed for 59 or fewer beds to have at
least one registered nurse or a licensed vocational nurse,
awake and on duty, in the facility at all times, day and
night.
3)Require each SNF to employ sufficient nursing staff to provide
a minimum of 3.2 nursing hours per patient day. Requires this
staffing ratio to only include direct caregivers, which is
defined to include registered nurses, licensed vocational
nurses, psychiatric technicians, or certified nurse
assistants, who are performing nursing services.
4)Specify that while all SNFs are required to maintain
compliance with licensing requirements, these requirements are
not to prohibit the use of alternate concepts, methods,
procedures, techniques, equipment, personnel qualifications,
or the conducting of pilot projects, as long as such
exceptions have prior written approval of DPH.
FISCAL EFFECT : Unknown
COMMENTS : According to the author, SHSNFs implementing the core
practices outlined in this bill are an important development in
long-term care options that many consumers, family, and staff
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prefer to traditional settings. The author states that they
also deliver better clinical outcomes, more direct-care time,
and greater resident engagement at the same operating cost as
traditional nursing homes. The author asserts that this deep
culture change model of SHSNFs is proliferating in many states
and meets all federal nursing home certification requirements.
Unfortunately, these homes are difficult to develop in
California under current state requirements, and California's
current statutory and regulatory framework did not anticipate
this significant innovation.
According to the author, SHSNFs following the practices outlined
in this bill currently require multiple agency interpretations
and waivers to move forward in California. These
interpretations and waivers add a great deal of time and expense
to implementation - both for the provider organizations and the
state agencies involved. This additional time and expense
discourages their development and deprives California residents
of this important option.
The author states that this bill would create a new health
facility licensing category to assist the development of SHSNFs
implementing the core practices that research has shown to
reliably deliver improved satisfaction, quality, and cost
outcomes.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
FN: 0005651