BILL ANALYSIS �
AB 1974
Page 1
Date of Hearing: April 29, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 1974 (Quirk) - As Amended: April 1, 2014
SUBJECT : Health facilities: special services.
SUMMARY : Specifies that, for purposes of skilled nursing
facility (SNF) licensing applications "special service" does not
include a functional division, department, or unit of a nursing
facility that is organized, staffed, and equipped to provide
physical therapy services, occupational therapy services, or
speech pathology and audiology services to residents of the
facility.
EXISTING LAW :
1)Established the Department of Public Health (DPH), which,
among other things is responsible for licensing, regulating
and inspecting certain health facilities.
2)Specifies that "special service" means a functional division,
department, or unit of a health facility which is organized,
staffed, and equipped to provide a specific type or types of
patient care and which has been identified by DPH regulations
and for which DPH has established special standards for
quality of care.
3)Defines a nursing facility as a licensed health facility that
is 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.
4)Specifies that a "special permit" is a permit issued in
addition to a license, authorizing a health facility to offer
one or more special services when DPH has determined that the
health facility has met the standards for quality of care
established by DPH.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
AB 1974
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1)PURPOSE OF THIS BILL . According to the author, state law and
regulations require that SNFs receive approval from DPH to
provide "special" or "optional" services to their patients and
these services include physical therapy, occupational therapy,
and speech pathology. The author further states that to
receive a license a facility must fill out a detailed
application and state licensing officials must conduct a
thorough and specialized survey of the facility, however,
requiring SNFs that are licensed under Medi-Cal, through DHCS
and certified under Medicare to also obtain approval from DPH
to provide therapy services is duplicative and creates an
unnecessary burden for both the nursing facility and the
state.
2)BACKGROUND . Health care facilities in California are
licensed, regulated, inspected, and/or certified by a number
of public and private agencies at the state and federal
levels, including the DPH Licensing and Certification Program
and the U.S. Department of Health and Human Services' Centers
for Medicare and Medicaid Services (CMS). These agencies have
separate, yet sometimes overlapping, jurisdictions. DPH is
responsible for ensuring health care facilities comply with
state laws and regulations. In addition, DPH cooperates with
CMS to ensure that facilities accepting Medicare and Medi-Cal
(in California, Medicaid is referred to as Medi-Cal) payments
meet federal requirements.
In 1987 the federal Omnibus Budget Reconciliation Act was
implemented, under which to be federally certified and meet
Medicare and Medicaid requirements, a SNF must offer physical
therapy, occupational therapy, and speech pathology. Medicare
certification surveyors annually review facilities for
compliance with these requirements. California's Title 22
regulations relating to optional services have not been
updated by DPH since the federal changes were made, and
specify that physical therapy, occupational therapy, and
speech pathology are "special, or "optional services," and as
such must be listed on a facilities licensing application.
It's not your mother's nursing home. California's Title 22
regulations were drafted at a time when a SNF was much more
like the assisted living facilities of today. Physical
therapy, occupational therapy, and speech pathology were less
likely to be offered, and then more usually on an outpatient
basis, hence their classification as "special services," and
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the requirement that they be listed on a facilities licensure
application. Today the average stay in a SNF is about six
weeks, therapy services are the norm, and are required as a
condition of the facilities participation in Medicare. For
example a SNF patient might stay for a short time while
recovering from a broken hip, or after a hip replacement, and
would require daily physical therapy.
3)SUPPORT . The California Association of Health Facilities'
(CAHF) is the sponsor of this bill and states that because of
an outdated technicality licensed and certified nursing
facilities must submit duplicate forms and spend unnecessary
time in completing these requirements along with the state
wasting unnecessary funding and resources in duplicating a
survey. CAHF further states this bill will address the
redundant and obsolete Title 22 requirements by amending
statute to state that Medicare certified nursing facilities
will not be required to obtain duplicative approval by state
licensing to provide inpatient therapy services already
required under their certification.
The California Hospital Association supports this bill,
writing that outdated Medicaid requirements categorize therapy
services as optional under the Medi-Cal program, however, if a
SNF wants to participate in the Medicare program (which most
facilities do) they must comply with the mandatory requirement
that these same therapy services be provided to a patient that
has a care plan requiring such services.
4)TECHNICAL AMENDMENT . As currently drafted this bill exempts
all SNFs from including a list of the special services they
provide on their state licensing application. There are a
small number of SNFs who accept private pay patients and are
not federally certified. In order to clarify that those
facilities must continue to comply with state licensing
requirements regarding special services, the bill should be
amended as follows:
"Special service" does not include a functional division,
department, or unit of a nursing facility defined in Section
1250, paragraph (k) that is Medicare and Medi-Cal certified ,
and that is organized, staffed, and equipped to provide
physical therapy services, occupational therapy services, or
speech pathology and audiology services to residents of the
facility.
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REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Health Facilities (sponsor)
California Hospital Association
Opposition
None on file.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097