BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 1974|
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CONSENT
Bill No: AB 1974
Author: Quirk (D)
Amended: 8/5/14 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 8-0, 6/25/14
AYES: Hernandez, Morrell, Beall, De Le�n, DeSaulnier, Evans,
Monning, Nielsen
NO VOTE RECORDED: Wolk
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 73-0, 5/23/14 (Consent) - See last page for
vote
SUBJECT : Health facilities: special services
SOURCE : California Association of Health Facilities
DIGEST : This bill specifies that a "special service" does not
include a functional division, department, or unit of a nursing
facility 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 if these services are provided solely
to meet the federal Centers for Medicare and Medicaid Services
certification requirements. The bill states that these
provisions do not limit the Department of Public Health's (DPH)
ability to enforce or evaluate compliance with specified therapy
requirements during investigations or inspections.
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2
ANALYSIS :
Existing law:
1.Establishes 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 DPH may prescribe by
regulation.
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 organized, staffed, and equipped to provide inpatient
physical therapy services, occupational therapy services, or
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3
speech pathology and audiology services to residents of the
facility if these services are provided solely to meet the
federal Centers for Medicare and Medicaid Services
certification requirements.
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 DPH's ability to enforce the therapy
requirements. Clarifies that "special service" includes
physical therapy services, occupational therapy services, or
speech pathology and audiology services provided by a nursing
facility, as defined.
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.
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
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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.
Comments
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
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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/6/14)
California Association of Health Facilities (source)
California Hospital Association
Congress of California Seniors
ARGUMENTS IN SUPPORT : The California Association of Health
Facilities (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
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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.
ASSEMBLY FLOOR : 73-0, 5/23/14
AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,
Bocanegra, Bonta, Bradford, Brown, Buchanan, Ian Calderon,
Campos, Chau, Ch�vez, Chesbro, Conway, Cooley, Dababneh,
Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox, Frazier,
Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell,
Gray, Grove, Hagman, Hall, Holden, Jones, Jones-Sawyer,
Levine, Linder, Logue, Lowenthal, Maienschein, Mansoor,
Medina, Mullin, Muratsuchi, Nazarian, Olsen, Pan, Patterson,
Perea, John A. P�rez, Quirk, Quirk-Silva, Rendon,
Ridley-Thomas, Rodriguez, Salas, Skinner, Stone, Ting, Wagner,
Waldron, Weber, Wieckowski, Wilk, Williams, Yamada, Atkins
NO VOTE RECORDED: Bonilla, Harkey, Roger Hern�ndez, Melendez,
Nestande, V. Manuel P�rez, Vacancy
JL:e 8/6/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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