BILL ANALYSIS �
SB 1228
Page 1
SENATE THIRD READING
SB 1228 (Alquist)
As Amended August 27, 2012
Majority vote
SENATE VOTE :36-0
HEALTH 13-5
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|Ayes:|Pan, Ammiano, Atkins, |
| |Bonilla, Eng, Gordon, |
| |Hayashi, Roger Hern�ndez, |
| |Bonnie Lowenthal, |
| |Mitchell, Monning, V. |
| |Manuel P�rez, Williams |
| | |
|-----+--------------------------|
|Nays:|Logue, Garrick, Mansoor, |
| |Nestande, Silva |
| | |
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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 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, each home having 12 or fewer beds, 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 SNF, 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
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hospital or an acute psychiatric hospital.
3)Defines "home" as an apartment, home, or other similar unit
that serves 12 or fewer residents.
4)Establishes characteristics for facilities that are eligible
for the SHSNF pilot program.
5)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 skilled nursing facility
(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.
6)Requires each SHSNF pilot facility to be subject to the same
licensing enforcement provisions, in existing law, that apply
to other SNFs.
7)Requires each SHSNF pilot facility to be subject to DPH's
Licensing and Certification program fee for SNFs.
8)Requires each SHSNF pilot facility to receive a peer group
weighted average Medi-Cal reimbursement rate as calculated by
the Department of Health Care Services.
9)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 than those
currently required in California for SNFs and continuous
nursing facilities.
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10)Requires DPH, together with OSHPD and 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.
11)Requires DPH to issue, by July 1, 2013, one or more All
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.
12)Establishes several additional 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.
13)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.
14)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.
15)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
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program's cost, safety, and quality of care.
16)Sunsets the SHSNF pilot program on January 1, 2020.
17)Makes conforming changes to avoid chaptering out problems
with SB 135 (Ed Hernandez) of 2012 regarding free standing
hospice facility licensure.
18)Makes other technical and clarifying changes.
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)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. Require 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
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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 : This bill, as amended has not yet been heard by
a fiscal committee.
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
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 small house nursing homes 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 SHSNF pilot
program to assist the development of SHSNFs in California
implementing the core practices that research has shown to
reliably deliver improved satisfaction, quality, and cost
outcomes.
The August 24, 2012, floor amendments changed this bill from
establishing a new licensing category for SHSNFs to a pilot
program. The Assembly Health Committee is hearing these
substantive changes as well as the August 27, 2012, amendments
which do the following:
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1)Limit the SHSNF pilot facility license to 12 beds;
2)Establish a definition of "home" for purposes of this bill;
3)Clarify that a SHSNF pilot facility kitchen may be open, but
must allow for separation in accordance with building
standards; and,
4)Make various technical changes.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
FN: 0005744