California Assembly Bill AB784 Amended / Bill

 BILL NUMBER: AB 784AMENDED BILL TEXT AMENDED IN SENATE AUGUST 23, 2011 AMENDED IN ASSEMBLY MAY 9, 2011 INTRODUCED BY Assembly  Members   Yamada     and Knight   Member   Yamada  FEBRUARY 17, 2011  An act to add Section 14589.6 to the Welfare and Institutions Code, relating to care facilities.   An act to amend Sections 1570.2, 1570.7, 1578, and 1585.5 of, and to add Sections 1584.5, 1587, and 1587.5 to, the Health and Safety Code, relating to care facilities, and declaring the urgency thereof, to take effect immediately.  LEGISLATIVE COUNSEL'S DIGEST AB 784, as amended, Yamada. Adult day health care. Existing law, the California Adult Day Health Care Act, provides for the licensure and regulation of adult day health care centers, with administrative responsibility for the adult day health care program shared among the State Department of Public Health, the State Department of Health Care Services, and the California Department of Aging pursuant to an interagency agreement  . Existing law provides that a negligent, repeated, or willful violation of a provision of the California Adult Day Health Care Act is a misdemeanor  . Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.  Existing law, the Adult Day Health Medi-Cal Law, establishes adult day health care services as a Medi-Cal benefit and requires adult day health centers to offer, and provide directly on the premises, specified services.  Existing law,  with prescribed implementation,  to the extent permitted by federal law, excludes adult day health care from coverage under the Medi-Cal program  and provides that it is the intent of the Legislature to adopt legislation during the 2011-12 Regular Session creating a new program to provide a well-defined scope of services, as specified, to eligible beneficiaries in the absence of such community-based services  .  This bill would, to the extent that funds are available, require that equivalent services provided at 2 specified veterans homes of California be considered for inclusion in the new program. This bill would require that this provision be implemented in a manner that is equitable with regard to other enrollees of the new program.   This bill would require an adult day health care center to have a prescribed program plan, as defined. This bill would provide the minimum staffing requirements for an adult day health care center.   Existing law requires an adult day health care center to provide services to each participant pursuant to an individual plan of care, as defined, designed to maintain or restore each participant's optimal capacity for self-care.   This bill would require this plan to be designed by the multidisciplinary team, composed, at a minimum, as prescribed. This bill would require an adult day health care center to provide certain services, as needed, to implement participants' individual plans of care in accordance with the program plan.   By changing the definition of a crime, this bill would create a state-mandated local program.   The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.   This bill would provide that no reimbursement is required by this act for a specified reason.   This bill would declare that it is to take effect immediately as an urgency statute.  Vote:  majority   2/3  . Appropriation: no. Fiscal committee: yes. State-mandated local program:  no   yes  . THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:  SECTION 1.   Section 1570.2 of the   Health and Safety Code   is amended to read:  1570.2. The Legislature hereby finds and declares that there exists a pattern of overutilization of  long-term  institutional care for elderly  persons or   persons,  adults with disabilities,  and acutely or chronically ill adults  and that there is an urgent need to establish and to continue a community-based system of quality adult day health care which will enable elderly  persons or   persons,  adults with disabilities  , and acutely or chronically ill adults  to maintain maximum independence. While recognizing that there continues to be a substantial need for facilities providing  24-hour  custodial care, overreliance on this type of care has proven to be a costly panacea in both financial and human terms, often traumatic, and destructive of continuing family relationships and the capacity for independent living. It is, therefore, the intent of the Legislature in enacting this chapter and related provisions to provide for the development of policies and programs that will accomplish the following: (a) Ensure that elderly  persons and   persons,  adults with disabilities  , and acutely or chronically ill adults  are not institutionalized inappropriately or prematurely. (b) Provide a viable alternative to  institutionalization   the utilization of institutional services  for those elderly  persons and   persons,  adults with disabilities  , and acutely or chronically ill adults  who are capable of living at home with the aid of appropriate health care or rehabilitative and social services. (c) Establish adult day health centers in the community for this purpose, that will be easily accessible to all participants, including economically disadvantaged elderly  persons and   persons,  adults with disabilities,  and acutely or chronically ill adults  and that will provide  person-centered  outpatient health, rehabilitative, and social services necessary to permit the participants to  gain or  maintain personal independence and lead meaningful lives. (d) Include the services of adult day health centers as a benefit under the Medi-Cal Act, that shall be an initial and integral part in the development of an overall plan for a coordinated, comprehensive continuum of optional long-term care services based upon appropriate need. (e) Establish a rural alternative adult day health care program designed to meet the special needs and requirements of rural areas to enable the implementation of subdivisions (a) through (d), inclusive, for all Californians in need of those services. (f) Ensure that all laws, regulations, and procedures governing adult day health care be enforced equitably regardless of organizational sponsorship and that all program flexibility provisions be administered equitably.  SEC. 2.   Section 1570.7 of the   Health and Safety Code   , as amended by Chapter 119 of the Statutes of 2011, is amended to read:  1570.7. As used in this chapter and in any regulations promulgated thereunder: (a) "Adult day health care" means an organized  day program of therapeutic, social, and skilled nursing health activities and services provided pursuant to this chapter to elderly persons or adults with disabilities with functional impairments, either physical or mental,   outpatient program utilizing a patient-centered multi   disciplinary team approach to manage physical, cognitive, and behavioral   health conditions  for the purpose of restoring or maintaining  an individual's  optimal  capacity for self-care   health and functioning  . Provided on a short-term basis, adult day health care serves as a  transition   site for transitioning  from a health facility  or home health program to personal independence   to the community with the goal of preventing avoidable emergency department visits and inpatient readmissions and restoring optimal health  . Provided  on a long-term basis   over a longer term  , it serves  as an alternative  to  deter  institutionalization  in a long-term health care facility when 24-hour skilled nursing care is not medically necessary or viewed as desirable by the recipient or his or her family   and overuse of more costly medical resourc   es  . (b) "Adult day health center" or "adult day health care center" means a licensed facility that provides adult day health care.  (c) "Average daily attendance" means the average number of participants attending the adult day health care center daily, calculated over the past month.   (c)   (d)  "Core staff" includes the positions of program director, registered nurse, social worker, activity director, and program aide.  (d)   (e)  "Department" or "state department" means the State Department of Public Health.  (e)   (f)  "Director" means the State Public Health Officer.  (f)   (g)  "Elderly" or "older person" means a person 55 years of age or older  , but also includes other adults who are acutely or chronically ill or impaired disabled and who would benefit from adult day health care  .  (g)   (   h)  "Extended hours" means those hours of operation prior to or following the adult day health care program hours of service, as designated by the adult day health care center in its plan of operation, during which the adult day health care center may operate an adult day program, or an Alzheimer's day care resource center, or both.  (i) "Full-time" means the total program hours of service per week.   (j) "Half-time" means 50 percent of full-time.   (k) "Hours of operation" means the regular hours during which the adult day health care center is open and any staff are on the premises, including, but not limited to, hours during which no participants are scheduled to attend but the doors are open to conduct business operations.   (h)   (   l   )  "Hours of service" means the program hours defined and posted by the adult day health care center  during which core staff and participants are present  for the provision of adult day health care services  , pursuant to Section 14550 of the Welfare and Institutions Code, which shall be no less than four hours, excluding transportation  .  (i)   (m)  "Individual plan of care" means a plan designed to provide recipients of adult day health care with appropriate treatment in accordance with the assessed needs of each individual  participant within the facility's scope of services, as defined in the program plan  .  (n) "Institutional services" includes any 24-hour health facility and a hospital emergency department.   (j)   (   o)  "License" means a basic permit to operate an adult day health care center. With respect to a health facility licensed pursuant to Chapter 2 (commencing with Section 1250), "license" means a special permit, as defined by Section 1251.5, empowering the health facility to provide adult day health care services.  (k)   (   p)  "Long-term absence" or "long-term vacancy" means  an   a staff  absence or vacancy lasting, or  likely   expected  to last,  more   longer  than one month.  An adult day health care center's policies and procedures shall be specific regarding coverage in the situation for long-term absences or vacancies.   (l)   (   q)  "Maintenance program" means procedures and exercises that are  provided to a participant, pursuant to Section 1580, in order to generally maintain existing function   performed repetitively to maintain a level of functioning when a patient's restoration potential is insignificant in relation to the therapy required to achieve that potential, when it has been determined that the treatment goals will not materialize, or when the therapy performed is considered to be a general exercise program  . These procedures and exercises are planned by a licensed or certified therapist and are provided by a person who has been trained by a licensed or certified therapist and who is directly supervised by a nurse  or by a licensed or certified therapist  .  (r) "Personal health care provider" means the participant's personal physician, physician's assistant, or nurse practitioner, operating within his or her scope of practice.   (s) "Program aide" means a person, supervised by the program director or other members of the multidisciplinary team, whose job duties include, but are not limited to, provision of personal care, assistance with activities, transportation, or other services, as assigned.   (m)   (   t)  "Program director" shall be a person with both of the following: (1) One of the following backgrounds: (A) A person with a bachelor's degree and a minimum of two years of experience in a management, supervisory, or administrative position. (B) A person with a master's degree and a minimum of one year of experience in a management, supervisory, or administrative position. (C) A registered nurse with a minimum of two years experience in a management, supervisory, or administrative position. (2) Appropriate skills, knowledge, and abilities related to the health, and mental, cognitive, and social needs of the participant group being served by the adult day health center.  (u) "Program plan" means a written description of the adult day health care center's philosophy, objectives, and processes for providing required services to the participant populations.   (n)   (   v)  "Restorative therapy" means physical, occupational, and speech therapy, and psychiatric and psychological services that are planned and provided by a licensed or certified therapist. The therapy and services may also be provided by an assistant or aide under the appropriate supervision of a licensed therapist, as determined by the licensed therapist. The therapy and services are provided to restore function, when there is an expectation that the condition will improve significantly  in   within a reasonable period of time, as determined by the multidisciplinary assessment team.  (o)   (   w)  "Short-term absence" or "short-term vacancy" means an   a staff  absence or vacancy lasting  , or expected to last,  one month or less, and includes sick leave and  vacations. An adult day health care center shall ensure that appropriate staff is designated to serve in these positions during the short-term absence or vacancy and that the center's policies and procedures are specific regarding coverage of short-term absences or vacancies   vacations, but does not include periods during which staff are absent from the facility performing program-related duties  .  (p)   (   x)  "Social worker" shall be a person who meets one of the following: (1) The person holds a master's degree in social work from an accredited school of social work. (2) The person holds a master's degree in psychology, gerontology, or counseling from an accredited school and has one year of experience providing social services in one or more of the fields of aging, health, or long-term care services. (3) The person is licensed by the California Board of Behavioral Sciences. (4) The person holds a bachelor's degree in social work from an accredited school with two years of experience providing social services in one or more of the fields of aging, health, or long-term care services.  SEC. 3.   Section 1578 of the   Health and Safety Code   is amended to read:  1578.  (a)    A provider may share space with another licensed health facility, community care facility, senior center, or other appropriate structure, upon the approval of the department, based upon a determination of all of the following:  (a)   (   1)  The use of the shared space does not jeopardize the welfare of the participant or other clients.  (b)   (   2)  The shared use does not exceed occupancy capacity established for fire safety.  (c)   (   3)  The space used by the adult day health care center is not essential to meet the other program's licensing requirements.  (d)   (4)  Each entity schedules services and activities at separate times. This subdivision shall not apply to space used for meals or for space used by another licensed adult day services program.  For   (b)     For  purposes of this section, "shared space" means the mutual use of exits and entrances, offices, hallways, bathrooms, treatment rooms, and dining rooms by an adult day health care center and another program  pursuant to Section 1578.1  .  SEC. 4.   Section 1584.5 is added to the   Health and Safety Code   , to read:   1584.5. An adult day health care center shall have a program plan that shall contain all of the following: (a) The total number of participants the center proposes to serve, or currently serves, daily. (b) A profile of the participant population the center proposes to serve, or currently serves, that includes a description of the specific medical, social, and other needs of each population. (c) A description of the specific services provided to address the medical, social, and other needs of each participant population that the center proposes to serve, or currently serves, as specified in subdivision (b). (d) A description of the specialized professional and program staff that will provide, or currently provides, the adult day health care center's program services, as specified in subdivision (c), and that staff's responsibilities. The plan shall demonstrate that the adult day health care center is organized and staffed to carry out the requirements as specified in the regulations adopted pursuant to Section 1580. (e) An in-service training plan for each center staff member to commence within the first six months of employment. The training plan shall address, at a minimum, the specific medical, social, and other needs of each participant population the center proposes to serve, as specified in subdivision (b). (f) An example of a one-week schedule of daily program services. (g) A plan for a behavior modification program if such a program will be used as a basic intervention for meeting the needs of a special population, such as persons with developmental disabilities or persons with mental disabilities. The plan, as applied to persons with developmental disabilities, shall be consistent with Section 4503 of the Welfare and Institutions Code.   SEC. 5.   Section 1585.5 of the   Health and Safety Code   is amended to read:  1585.5.  (a)    Adult day health care centers shall provide services to each participant pursuant to an individual plan of care designed  by the multidisciplinary team  to maintain or restore each participant's optimal capacity for self-care.  (b) The multidisciplinary team shall be composed of, at a minimum, the staff physician or the participant's personal health care provider, the registered nurse, the social worker, the program director, and, as needed, an occupational therapist, physical therapist, or speech and language pathologist. The multidisciplinary team shall assess the needs of the participant and develop the participant's individual plan of care.   SEC. 6.   Section 1587 is added to the   Health and Safety Code   , to read:   1587. (a) The minimum staffing requirements for an adult day health care center shall be as follows: (1) A full-time program director shall be employed to implement the program plan, and supervise and coordinate staff. (2) Program aides shall be employed in a sufficient number to meet the personal care and supervision needs of the participants during program hours of service or extended program hours, but in no event shall the program aides employed be fewer than a ratio of one-half aide for every increment of eight participants being cared for during program hours of service. Program aides shall be qualified by education, training, and experience to perform the duties assigned and meet the needs of the program. (3) A full-time registered nurse shall be employed to oversee the provision of nursing services. A half-time vocational nurse shall be provided for each increment of 10 in average daily attendance exceeding 40, calculated monthly, and which has been sustained over each of the prior three calendar months. (4) A full-time social worker shall be employed to provide direct skilled social work services and to oversee the provision of social services. A half-time social work assistant shall be provided for each increment of 10 in average daily attendance exceeding 40, calculated monthly, and which has been sustained over each of the prior three calendar months. (5) A full-time activity director shall be employed to direct the activity program. The activity director may be counted in the ratio for calculating the necessary direct care staff defined in subdivision (b). (6) A licensed nurse shall be on duty during the defined program hours of service. (b) The adult day health care center's policies and procedures shall be specific regarding the provision of adequate staffing for coverage with qualified personnel for long-term and short-term absences or vacancies. Regardless of the reason for the staff absence or vacancy, the adult day health care center shall provide sufficient staffing to ensure participant safety and shall designate appropriate substitute staff as needed.   SEC. 7.   Section 1587.5 is added to the   Health and Safety Code   , to read:   1587.5. The minimum services that shall be provided by an adult day health care center, as needed, to implement participants' individual plans of care, in accordance with the program plan, are as follows: (a) Occupational therapy services. (b) Pharmacist consulting services to assist with implementation of the center's medication policies and procedures and to consult on individual participant drug regimens. (c) Physical therapy services. (d) Psychiatric or psychological consulting services provided by a qualified licensed practitioner. (e) Skilled dietary consulting services. (f) Speech and language pathology services.   SEC. 8.   No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.   SEC. 9.   This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:   In order to ensure that adult day health care centers may remain open, providing services to elderly persons, adults with disabilities, and acutely or chronically ill adults with the elimination of adult day health care as a Medi-Cal benefit, it is necessary that this act take effect immediately.   SECTION 1.   Section 14589.6 is added to the Welfare and Institutions Code, to read: 14589.6. (a) If exclusion of adult day health care from coverage under the Medi-Cal program is implemented pursuant to Section 14589.5, and a new program is enacted to provide a well-defined scope of services to eligible beneficiaries who meet a high medical acuity standard and are at a significant risk of institutionalization in the absence of such community-based services, then equivalent services provided at the William J. "Pete" Knight Veterans Home of California, Lancaster, and the Veterans Home of California, Ventura, shall be considered for inclusion in the new program. (b) This section shall be implemented only to the extent that funds are available and in a manner that is equitable with regard to other potential enrollees of the new program.