BILL ANALYSIS �
AB 1816
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Date of Hearing: April 30, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 1816 (Yamada) - As Amended: April 7, 2014
Policy Committee: HealthVote:19-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires the Department of Public Health (DPH) to
complete investigations of complaints in long-term care
facilities within 40 working days from receipt of the complaint,
and allows extension of this time frame under specified
circumstances. It also requires DPH to:
1)Provide additional information about the investigation to the
complainant, if investigations take longer than 40 working
days.
2)Analyze and report on its compliance with these time frames.
3)Provide specific findings concerning each alleged violation,
and include in the findings a summary of the evidence upon
which the determination was made.
4)Apply the time frames established by the bill to facility
self-reports.
FISCAL EFFECT
1)Additional staff costs of up to $18.5 million annually to DPH
to meet the tighter time frames for completion of
investigations (Licensing and Certification (L&C) Fund, paid
for by facility licensing fees). Of this amount, up to $1.2
million is attributable to state-run facilities, whose
licensure fees are paid for with GF dollars. This additional
cost represents a 10% increase in total funding for the L&C
program.
2)Additional minor costs to DPH to expand notification pursuant
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to the bill's requirements.
COMMENTS
1)Purpose . According to the author, timely investigations are
critical to reduce risk by identifying and acting to protect
dependent adults from dangerous situations. The author
indicates DPH struggles to meet its workload demands and often
does not complete investigations of complaints in a timely
manner. This bill is intended to address this issue by
establishing a 40-day limit on the length of an investigation,
with allowable extensions for difficult conditions.
2)Background . Existing law requires DPH Licensing and
Certification (L&C) division to issue state licenses and to
certify a number of facility types meet federal requirements
for participation in Medicare and Medicaid. The department's
duties include inspecting facilities to verify compliance with
licensing and certification standards, citing and penalizing
facilities that fail to meet requirements, investigating
alleged complaints, certifying and investigating related
personnel, and conducting various quality improvement
programs. Although DPH L&C is responsible for a wide variety
of facility types and personnel, the majority of staff time is
devoted to inspections and complaint investigations of
long-term care facilities. DPH L&C is funded through facility
license fees, which are based on the staff time devoted to
different facility types.
Current law requires DPH to make an onsite inspection within
10 working days of the receipt of a written or oral complaint
(24 hours for serious complaints), but does not specify a time
frame for completion. It requires DPH to notify the
complainant of the name of the inspector, and provides for the
complainant to accompany the inspector to the site of the
alleged violation. It also requires DPH to notify the
complainant of their determination within 10 working days of
the completion of the complaint investigation, and allows an
appeal process. Finally, current law excludes, for the
purposes of these complaint investigation timelines, a
self-report of a potential violation from a facility itself.
This bill would extend the requirements to facility
self-reports.
3)Complaints . The timeliness of L&C complaint investigation has
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been a subject of criticism by advocates, as well as long-term
care facilities themselves, for several years. Information
provided by DPH indicates the department receives about 5,500
complaints per year. Over the last several years, about half
were resolved within 90 days. The department does appear to
be making progress in resolving more cases within a 90-day
time frame. Data indicates about 60% were resolved within 90
days in 2012-13. However, data also indicates there is a
growing backlog of complaint investigations, as more
complaints are received than closed each year. At the end of
fiscal year 2012-13, there were more than 1,000 cases in
queue.
4)Oversight . In 2007, the Bureau of State Audits published a
report that found the former Department of Health Services
struggled to initiate and close complaint investigations and
communicate with complainants in a timely manner. On Jan. 1,
2014, the Assembly Committee on Aging and Long-Term Care and
the Assembly Committee on Health held a joint oversight
hearing on DPH L&C, taking testimony from stakeholders on the
issue of complaint timeliness. On March 12, 2014, the Joint
Legislative Audit Committee approved Assemblymember Yamada's
request for an audit examining the effectiveness DPH L&C
complaint investigation processes.
5)Staff Comments. This bill establishes an expectation for DPH
to go from a status quo where over 40% of complaints take
longer than 90 days to complete, to a process where the vast
majority are completed within 40 days. Although this time
frame may be preferable from the perspective of reaching
speedy and fair resolutions for stakeholders, it appears
unlikely the department will meet this standard January 1,
2015, given significant process and staffing changes may be
required. Thus, DPH is likely to be out of compliance with
this standard immediately.
In addition, staff notes the L&C division has many competing
priorities, including timely licensing and certification
inspections of long-term care facilities and other facility
types, as well as personnel. Placing time and documentation
constraints on certain aspects of L&C duties may be desirable,
but any new mandate should be considered in context of the
universe of L&C priorities. The relative importance of speedy
complaint investigations could differ depending on L&C
performance in other areas. For example, placing greater
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emphasis on speedy resolution of new cases may conflict with
addressing a backlog of older cases or allocating staff to
meet federally mandated time frames for annual certification.
It is certainly possible to prioritize certain areas over
others, or set higher expectations for certain functions, but
trade-offs in terms of higher resource levels and/or the
possibility of deprioritizing other functions should be
considered.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081