BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  AB 1571
                                                                  Page  1

          Date of Hearing:   May 21, 2014

                        ASSEMBLY COMMITTEE ON APPROPRIATIONS
                                  Mike Gatto, Chair

                   AB 1571 (Eggman) - As Amended:  April 22, 2014 

          Policy Committee:                              Human  
          ServicesVote:6 - 0 

          Urgency:     No                   State Mandated Local Program:  
          Yes    Reimbursable:              No

           SUMMARY  

          This bill places additional requirements on residential care  
          facility for the elderly (RCFE) licensee applicants and requires  
          the Department of Social Services (DSS) to establish a RCFE  
          consumer information service system, including posting  
          information on its website. Specifically, this bill: 

          1)Requires the applicant to disclose whether they are a  
            for-profit or not-for-profit provider. 

          2)Clarifies that applicants must provide information regarding  
            prior involvement with a RCFE in California, including a  
            facility located in another state or another similarly  
            licensed facility.

          3)Requires DSS to cross check all applicant information with the  
            Department of Public Health (DPH) to determine if the  
            applicant has a prior history of operating health care  
            facilities.

          4)Requires DSS to deny an application for licensure and  
            subsequently revoke a license on the grounds that the  
            applicant knowingly made a false statement or withheld  
            enforcement actions against a previously held license.

          5)Requires DSS, by July 1, 2015 to post RCFE profiles on its  
            Internet Web site, and requires by July 1, 2017, to include on  
            each RCFE profile, information regarding complaints,  
            violations, appeals, Inspection reports and plans of  
            correction.









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          6)Requires that, by July 1, 2019, each RCFE submit a profile of  
            resident characteristics to DSS. 

          7)Requires DSS, by July 1, 2019, to develop and implement a RCFE  
            rating system and states that DSS work with stakeholder  
            groups, in the development of the system. 

          8)Permits DSS to deny an application for licensure on the  
            grounds that the applicant has a history of noncompliance with  
            the requirements of a health-related facility, or a similarly  
            licensed facility in another state, applicable state and  
            federal laws and regulations, and the requirements governing  
            the operators of those facilities.

           



          FISCAL EFFECT
           
          1)On-going costs, likely minor, to DSS to cross check all  
            applicant information with the Department of Public Health for  
            prior history of operating health care facilities. DSS  
            indicates they do this now for applicants who self-identify  
            with this type of prior history.

          2)One-time costs to DSS in the range of $1 million in 2014/15  
            and ongoing costs of approximately $700,000 for project  
            development, testing and maintenance and other related IT  
            contract work related to website improvement and the  
            development and implementation of a RCFE rating system.

          3)On-going costs, likely minor, to maintain and periodically  
            update the facility rating system.

          4)The Governor has proposed several budget initiatives to assist  
            DSS with its oversight activities, including centralized  
            application processing and establishing a statewide quality  
            assurance unit to track complaints and performance.  These  
            budget proposals could assist with some of the requirements  
            outlined in this bill.

           COMMENTS  

           1)Purpose  . The author notes that consumers do not have online  








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            access to public information that could help them make an  
            informed choice when choosing a RCFE.  If a consumer wants to  
            view a facility's record, the consumer must drive to a  
            regional office that may be far away and require hours of  
            driving.  This bill seeks to remedy this by requiring DSS to  
            establish an on-line Consumer Information System so that  
            consumers have important information readily accessible.  

            This bill will also require complete disclosure of ownership  
            and prior ownership of any type of facility, in any state,  
            including a history of compliance and will require DSS to  
            cross check applicant information with the Department of  
            Public Health.
           
          2)Background  . RCFEs, commonly referred to as assisted living  
            facilities, are licensed retirement  residential homes and  
            board and care homes that provide personal care and  
            supervision or health related services to persons who are 60  
            years of age and over, who voluntarily choose to reside in the  
            facility.  RCFEs enable older persons to live independently in  
            a home-like environment rather than in nursing home or other  
            institutionalized facility. Services include personal care and  
            protective supervision, including incidental medical services,  
            based upon the needs of the resident.   
           
            There are 7,589 licensed RCFEs in California with a capacity  
            to serve over 176,000 residents.  Licensed by DSS' Community  
            Care Licensing Division (CCL), RCFEs range in size from  
            residential homes with six or less beds to more formal  
            residential facilities with 100 beds or more.  DSS is required  
            to conduct unannounced licensing inspections of the more than  
            75,000 licensed community care facilities, including RCFEs, at  
            least once every five years, more often in some circumstances.  


           3)DSS Website  . DSS is required to operate an automated RCFE  
            license information system to provide information on licensees  
            and former licensees of RCFEs.  It currently has a searchable  
            database of RCFEs on its website, but information is limited  
            to the name, location, contact information, type of facility  
            and whether the facility's license is current or pending.  It  
            does not provide information such as a facility's licensing  
            history, staff, or its complaints history. Under current  
            practice, when a licensee undergoes a licensing inspection or  
            is subject to a complaint investigation, the information  








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            reported by CCLD is maintained in a paper-based format.  To  
            acquire information on the quality of a facility, a person  
            must travel to one of DSS' eight regional licensing offices  
            and request the information in person. 

            In response to recent incidences in RCFEs, DSS is working to  
            provide more robust information of licensed RCFEs on its  
            website. DSS anticipates having an online searchable database  
            with up to five years of historical information on RCFEs,  
            including:

             a)   the name of the facility and its licensee's name and  
               contact information;

             b)   the number of substantiated, unsubstantiated, and  
               inconclusive complaints filed against the facility,  
               including complaint severity and whether a complaint  
               resulted in a citation;

             c)   the number of inspections, complaint investigations, and  
               general visits to the facility. 

            DSS anticipates the database will be available in the next few  
            months. 

           1)Governor's Budget  . In response to recent health and safety  
            issues discovered at facilities licensed by the CCLD, the  
            2014-15 Governor's Budget proposes a comprehensive plan to  
            reform the CCLD program. This proposal includes an increase of  
            $7.5 million ($5.8 million General Fund) and 71.5 positions to  
            improve the timeliness of investigations, ensure the CCLD  
            inspects all facilities at least once every five years,  
            increase staff training, and establish clear fiscal, program,  
            and corporate accountability. The proposal also increases  
            civil penalties assessed for violations and increases  
            licensing and application fees by 10%. 

           2)Related Legislation  .  

             a)   AB 1436 (Waldron, 2014) requires the DSS to post  
               information on its website regarding Residential Care  
               Facilities for the Elderly (RCFE), including results of  
               licensing inspections reports, consultation reports,  
               violations, plans of correction, appeal requests, and the  
               number, nature and status of complaints filed against a  








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               facility. This bill is pending on this committee's Suspense  
               File.

             b)   AB 1899 (Brown, 2014) requires the Department of Social  
               Services (DSS) to establish and maintain a telephone  
               hotline and an internet-based website to accept public  
               complaints regarding RCFEs, and requires the website to  
               include final actions resulting in citation, suspension, or  
               revocation against each licensee, indexed by  name of the  
               licensee and by the name of the facility. This bill is  
               pending on this committee's Suspense File.

             c)   AB 2621 (Garcia, 2014) requires DSS to post similar  
               information on their website regarding child day care  
               facilities. This bill is before this committee today.

           1)RCFE Reform Package  . In response to a number of highly  
            publicized events at facilities licensed by CCL that have  
            raised questions regarding the state's ability to comply with  
            existing oversight and enforcement requirements, a number of  
            legislative measures are being pursued to strengthen, address  
            shortcomings, resolve legal liabilities and gaps in the  
            provision of services, and ultimately reform the RCFE  
            industry.  Several of these measures are pending on this  
            committee's Suspense File.

           Analysis Prepared by  :    Jennifer Swenson / APPR. / (916)  
          319-2081