BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 1816 (Yamada) - Long-term health care facilities.
Amended: June 17, 2014 Policy Vote: Health 8-0
Urgency: No Mandate: No
Hearing Date: August 4, 2014
Consultant: Brendan McCarthy
This bill meets the criteria for referral to the Suspense File.
Bill Summary: AB 1816 would require the Department of Public
Health to set a 60-day performance benchmark for the completion
of investigations into complaints against long-term health care
facilities.
Fiscal Impact:
Increased costs up to $15.3 million per year for additional
staff to complete investigations within the benchmark
(Licensing and Certification Fund). According to the
Department of Public Health, currently about 40% of
complaint investigations are completed within 60 days. In
order to complete all investigations within 60 days, the
Department projects that it will need 73 additional staff
positions to conduct the investigations as well as
associated administrative positions.
The Department has indicated that it would also need the
equivalent of 9 additional positions to prepare summaries
for all investigations in which the complaint was
unsubstantiated, in case the complainant requested that
information. Because the bill would only require that
information to be provided to a complainant upon request,
staff does not believe it would be necessary to prepare such
reports for each unsubstantiated complaint. Therefore, this
analysis does not include those staff costs.
Increased costs of $1.1 million per year to state-owned
facilities licensed by the Department due to fee increases
on all facility operators to pay for the increased costs of
the bill (General Fund).
Unknown potential impact to the Medi-Cal program and the
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General Fund due to potential impacts on the "quality
assurance fee" assessed on long-term care facilities. Under
current law, long-term health care facility operators are
assessed a quality assurance fee, which is used by the state
to draw down additional funding for the long-term care
services provided by the Medi-Cal program and to provide
General Fund savings related to Medi-Cal. Federal law limits
the amount of any quality assurance fee (including other
fees assessed by the states). The Department of Public
Health indicates that the fee increases necessary to pay for
the increased costs of this bill may limit the state's
ability to collect quality assurance fees (or limit the
Department's ability to raise fee revenue sufficient to pay
for the costs of this bill).
Background: The Department of Public Health licenses and
regulates long-term health care facilities - which include
skilled nursing facilities, intermediate care facilities,
congregate living health facilities, nursing facilities, and
pediatric day health and respite facilities. When the Department
receives a complaint against a long-term health care facility,
the Department is require to make an onsite inspection of the
complaint within ten working days or within 24 hours if the
complaint involves a threat of imminent danger. The Department
is required to notify the complainant and the facility of its
determinations within ten days of the completion of an
investigation. There is no deadline in statute under which the
Department is required to complete an investigation.
Proposed Law: AB 1816 would require the Department of Public
Health to set a 60-day performance benchmark for the completion
of investigations of complaints against long-term care
facilities.
Specific provisions of the bill would:
Require the Department of Public Health, by July 1, 2015,
to set a performance benchmark, not to exceed 60 days, for
the completion of investigations;
Allow the Department to extend an investigation beyond 60
days, but require the Department to notify the complainant;
Upon request of the complainant, require the Department to
provide written information to a complainant on the
investigation;
State legislative intent that the Department complete its
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investigations within the benchmark;
Require the Department to analyze its compliance with the
benchmark in its annual staffing analysis of the Licensing
and Certification Program.
Related Legislation: AB 1996 (Brown) would have increased the
frequency of inspections of long-term health care facilities to
every year and would have authorized an inspector to refer a
facility for the appointment of a temporary manager. That bill
was never heard in the Assembly Health Committee.
Staff Comments: As noted above, there is uncertainty about
whether the fee increases on long-term care providers that would
be necessary to pay for the costs of this bill can be assessed
on long-term care facilities without impacting the quality
assurance fee assessed on long-term care facilities.