BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1974
AUTHOR: Quirk
AMENDED: June 10, 2014
HEARING DATE: June 25, 2014
CONSULTANT: Moreno
SUBJECT : Health facilities: special services.
SUMMARY : Specifies that a "special service" does not include a
functional division, department, or unit of a nursing facility
that is Medicare or Medi-Cal certified and that is organized,
staffed, and equipped to provide inpatient physical therapy
services, occupational therapy services, or speech pathology and
audiology services to residents of the facility.
Existing law:
1.Establishes the Department of Public Health (DPH), which,
among other things, is responsible for licensing, regulating
and inspecting certain health facilities.
2.Defines a "special service" as 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 regulations of
the state department and for which the state department has
established special standards for quality of care.
3.Permits acute care hospitals to be approved, in addition to
the basic services offered under their license, to offer
special services, including, but not limited to:
a. Radiation therapy department;
b. Burn center;
c. Emergency center;
d. Hemodialysis center (or unit);
e. Psychiatric;
f. Intensive care newborn nursery;
g. Cardiac surgery;
h. Cardiac catheterization laboratory;
i. Renal transplant; and,
j. Other special services as the department may prescribe
by regulation.
Continued---
AB 1974 | Page 2
1.Defines a "nursing facility" as a licensed health facility
that is 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.
This bill:
1.Specifies that a "special service" does not include a
functional division, department, or unit of a nursing facility
that is Medicare or Medi-Cal certified and that is organized,
staffed, and equipped to provide inpatient physical therapy
services, occupational therapy services, or speech pathology
and audiology services to residents of the facility.
2.Prohibits the provision in 1) above from limiting DPH's
ability to evaluate compliance with the therapy requirements
for nursing facilities and SNFs during investigations or
inspections, or to limit the department's ability to enforce
the therapy requirements.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, minor and absorbable costs to DPH to apply this
change to licensure practice, and minor commensurate reduced
workload.
PRIOR VOTES :
Assembly Health: 19- 0
Assembly Appropriations:17- 0
Assembly Floor: 73- 0
COMMENTS :
1.Author's statement. According to the author, state law and
regulations require that skilled nursing facilities receive
approval from DPH to provide "special" or "optional services"
to their patients. These services include physical therapy,
occupational therapy and speech pathology. To receive
approval a facility must fill out a detailed application and
state licensing officials must conduct a thorough and
specialized survey of the facility. Old Medicaid requirements
categorize these services as optional under the Medi-Cal
program. However, under more recent Medicare rules, therapy
services are no longer "optional." If a SNF chooses to
participate in the Medicare program they must provide these
therapy services. Medicare certification surveyors review
facilities for compliance with these requirements. Requiring
SNFs that are licensed under Medi-Cal and certified under
AB 1974 | Page
3
Medicare to obtain approval from DPH to provide inpatient
therapy services is duplicative. This 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.
3.Title 22 vs. today's world. 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.
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 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.
4.Support. The California Association of Health Facilities
AB 1974 | Page 4
(CAHF), the sponsor of this bill, 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 writes 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.
SUPPORT AND OPPOSITION :
Support: California Association of Health Facilities (sponsor)
California Hospital Association
Congress of California Seniors
Oppose: None received
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