Existing law provides for the licensure and regulation of specialty clinics, including rehabilitation clinics. Existing law defines a rehabilitation clinic as a clinic that, in addition to providing medical services directly, also provides physical rehabilitation services for patients who remain less than 24 hours. Existing law requires a rehabilitation clinic to provide at least 2 of certain specified rehabilitation services, including, among others, physical therapy and occupational therapy.

This bill would define a rehabilitation innovation center as a not-for-profit or government-owned rehabilitation facility that meets specified criteria.

Existing law provides for the licensure and regulation of specialty clinics, including rehabilitation clinics. Existing law defines a rehabilitation clinic as a clinic that, in addition to providing medical services directly, also provides physical rehabilitation services for patients who remain less than 24 hours. Existing law requires a rehabilitation clinic to provide at least 2 of certain specified rehabilitation services, including, among others, physical therapy and occupational therapy.

This bill would define a rehabilitation innovation center as a not-for-profit or government-owned rehabilitation facility that meets specified criteria.

Existing law provides for the licensure and regulation of specialty clinics, including rehabilitation clinics. Existing law defines a rehabilitation clinic as a clinic that, in addition to providing medical services directly, also provides physical rehabilitation services for patients who remain less than 24 hours. Existing law requires a rehabilitation clinic to provide at least 2 of certain specified rehabilitation services, including, among others, physical therapy and occupational therapy.

This bill would define a rehabilitation innovation center as a not-for-profit or government-owned rehabilitation facility. facility that meets specified criteria.

Existing law provides for the licensure and regulation of specialty clinics, including rehabilitation clinics. Existing law defines a rehabilitation clinic as a clinic that, in addition to providing medical services directly, also provides physical rehabilitation services for patients who remain less than 24 hours. Existing law requires a rehabilitation clinic to provide at least 2 of certain specified rehabilitation services, including, among others, physical therapy and occupational therapy.

This bill would define a rehabilitation innovation center as a not-for-profit or government-owned rehabilitation facility.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1411

Author:(Cristina Garcia)

As Amended Ver:August 21, 2017

Majority vote

Original Committee Reference: HEALTH

SUMMARY: Establishes the Preserving Rehabilitation Innovation Centers Act of 2017 which defines a "rehabilitation innovation center" as a not-for-profit or government-owned rehabilitation facility that meets specified requirements, and makes various findings and declarations regarding the importance of supporting these institutions so they can continue to lead the nation's efforts to provide cutting-edge medical care to the most complex rehabilitation patients.

The Senate amendments make technical and clarifying changes to reflect the correct name of the federal agency that provides the facility designations specified in this bill.

FISCAL EFFECT: None

COMMENTS: According to the author, Rancho Los Amigos National Rehabilitation Center (Rancho) was founded in 1888 to serve farming families who could not afford medical services. The author notes that in the 1950s, a polio epidemic struck Southern California and clinical teams at the time reorganized to provide comprehensive rehabilitative services. The author states that this reorganization transitioned Rancho into the internationally recognized hospital it is today, and that this bill would designate Rancho as a rehabilitation innovation center in California in recognition of Rancho's particular expertise in treating patients with complex rehabilitation needs.

Rancho. Rancho is the only rehabilitation hospital in Los Angeles County's Department of Health Services. The hospital specializes in brain, neurology, orthopedic, pediatric, spine injury, and stroke rehabilitation. Each year, the hospital provides care to approximately 4,000 inpatients and 71,000 outpatients, making it one of the largest rehabilitation centers in the nation. The hospital serves as a branch campus of the University of Southern California Schools of Medicine, Dentistry, and Allied Health professions, and is affiliated with universities throughout the nation. Rancho is accredited by the Joint Commission and the Commission on Accreditation of Rehabilitation Facilities.

Preserving Rehabilitation Innovation Centers Act of 2015. Senate Bill 1168 and House Resolution 2292 would have designated five rehabilitation centers throughout the United States, including Rancho, as rehabilitation innovation centers, which could have qualified for higher Medicare payments to cover their additional costs for the complex Medicare patient care, research and training that they provide. The bills would have required the U.S. Secretary of Health and Human Services to conduct a study to assess the costs incurred by rehabilitation innovation centers that are beyond the prospective rates for furnishing items and services to individuals under Medicare, conducting research, and providing medical training.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0001366

 THIRD READING  

Bill No: AB 1411

Author:

Amended: 8/21/17 in Senate

Vote:

SENATE HEALTH COMMITTEE: 8-0, 7/19/17

AYES: Hernandez, Nguyen, Atkins, Leyva, Mitchell, Monning, Newman, Roth

NO VOTE RECORDED: Nielsen

ASSEMBLY FLOOR: 77-2, 5/15/17 - See last page for vote

SUBJECT:

SOURCE: Author

DIGEST:

This bill defines a “rehabilitation innovation center” as a nonprofit or government-owned facility that holds at least one federal rehabilitation research and training designation, as specified.

ANALYSIS:

Existing law:

1. Licenses and regulates various types of health facilities, including general acute care hospitals, by the Department of Public Health.
2. Permits a general acute care hospital that exclusively provides acute medical rehabilitation center services, including at least physical therapy, occupational therapy, and speech therapy, to provide for the required surgical and anesthesia services through a contract with another acute care hospital.
3. Defines a “rehabilitation center,” in the California Code of Regulations, as a functional unit of a hospital for the provision of those rehabilitation services that restore an ill or injured person to the highest level of self-sufficiency or gainful employment of which he is capable in the shortest possible time.
4. Establishes, in the California Code of Regulations, minimum requirements for rehabilitation centers, including that rehabilitation beds be in a designated area of the hospital and be included in the licensed bed capacity of the hospital.

This bill:

1. Defines a “rehabilitation innovation center,” for purposes of this bill, as a not-for-profit or government-owned rehabilitation facility that meets all of the following requirements:
   1. Is classified as a not-for-profit entity under the Centers for Medicare and Medicaid Services Provider of Services file;
   2. Holds at least one federal rehabilitation research and training designation for research projects on traumatic brain injury, spinal cord injury, or stroke rehabilitation research from the Rehabilitation Research and Training Centers, the Rehabilitation Engineering Research Center, or the Model Spinal Cord Injury Systems at the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) at the federal Department of Health and Human Services; and,
   3. Has at least 200 Medi-Cal discharges per year.
2. Makes various legislative findings and declarations, including that there are an estimated 1,181 inpatient rehabilitation facilities in the United States, among which there is a small group of inpatient rehabilitation institutions that are contributing to the future of rehabilitation care medicine; that these leading inpatient rehabilitation institutions are all not-for-profit or government-owned and serve a high volume of Medicare or Medicaid beneficiaries; and, it is vital that these leading inpatient rehabilitation institutions are supported so they can continue to lead the nation’s efforts to advance integrated, multidisciplinary rehabilitation research.

Comments

1. Author’s statement. According to the author, Rancho Los Amigos National Rehabilitation Center (Rancho) was first founded in 1888 to serve farming families who could not afford medical services. In the 1950s, a polio epidemic struck Southern California, and clinical teams at the time reorganized to provide more comprehensive rehabilitative services. Through this reorganization, Rancho transitioned into the internationally recognized hospital it is today. This bill designates Rancho as a “rehabilitation innovation center” in California. The rehabilitation innovation center designation is a recognition of the inpatient rehabilitation research center that has particular expertise in treating patients with the most complex rehabilitation needs.
2. Rancho Los Amigos. Rancho is owned and operated by Los Angeles County’s Department of Health Services, and located in Downey. It is licensed as a general acute care hospital, with 289 total licensed beds, of which 150 are rehabilitation beds. According to its Web site, the hospital specializes in brain, neurology, orthopedic, pediatric, spine injury, and stroke rehabilitation, and provides care to approximately 4,000 inpatients and 71,000 outpatients each year, which makes it one of the largest rehabilitation centers in the nation. Rancho also serves as a branch campus of the University of Southern California medical school.
3. Based on prior federal legislation. The definition in this bill was lifted from a United States Senate bill (S.1168, authored by Senator Kirk of Illinois) that was introduced in 2015, but did not ultimately pass Congress. The federal bill, titled the “Preserving Rehabilitation Innovation Centers Act of 2016,” would have required a study and report relating to the costs incurred by, and the Medicare payments made to, rehabilitation innovation centers. This report was also required to include recommendations for legislation and administrative action as determined appropriate. The definition of “rehabilitation innovation center” included in this federal legislation is very similar to the one used in this bill, although this bill only contains the definition and does not include a required study or report. In support of the federal legislation, the Rehabilitation Innovations Centers Coalition prepared a “Frequently Asked Questions” (FAQ) document. According to the FAQ, only the following five rehabilitation innovation centers in the country would meet the proposed definition:
   1. MedStar National Rehabilitation Hospital, Washington, DC;
   2. Rancho Los Amigos National Rehabilitation Center in Downey, CA;
   3. Rehabilitation Institute of Chicago, Chicago, IL;
   4. TIRR Memorial Hermann, Houston, TX; and,
   5. University of Pittsburgh Medical Center Rehabilitation Institute, Pittsburgh, PA.
4. National Institute on Disability, Independent Living, and Rehabilitation Research. NIDILRR is the federal government’s primary disability research agency. Its mission is to generate new knowledge and to promote its effective use to improve the abilities of individuals with disabilities to perform activities of their choice in the community, and to expand society’s capacity to provide full opportunities and accommodations for its citizens with disabilities. NIDILRR achieves this mission by providing for research, demonstration, training, technical assistance and related activities; promoting the transfer of, use and adoption of rehabilitation technology; and, ensuring the widespread distribution, in usable formats, of practical scientific and technological information.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 8/22/17)

None received

OPPOSITION: (Verified 8/22/17)

None received

ASSEMBLY FLOOR: 77-2, 5/15/17

AYES: Acosta, Aguiar-Curry, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dababneh, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NOES: Travis Allen, Harper

NO VOTE RECORDED: Holden

Prepared by:

8/23/17 11:07:30

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: AB 1411

SUBJECT: Health care facilities: rehabilitation innovation centers

SUMMARY:

Defines a “rehabilitation innovation center” as a nonprofit or government-owned facility that holds at least one federal rehabilitation research and training designation, as specified.

Existing law:

1. Licenses and regulates various types of health facilities, including general acute care hospitals, by the Department of Public Health (DPH).
2. Permits a general acute care hospital that exclusively provides acute medical rehabilitation center services, including at least physical therapy, occupational therapy, and speech therapy, to provide for the required surgical and anesthesia services through a contract with another acute care hospital.
3. Defines a “rehabilitation center,” in the California Code of Regulations, as a functional unit of a hospital for the provision of those rehabilitation services that restore an ill or injured person to the highest level of self-sufficiency or gainful employment of which he is capable in the shortest possible time.
4. Establishes, in the California Code of Regulations, minimum requirements for rehabilitation centers, including that rehabilitation beds be in a designated area of the hospital and be included in the licensed bed capacity of the hospital.

This bill:

1. Defines a “rehabilitation innovation center,” for purposes of this bill, as a not-for-profit or government-owned rehabilitation facility, as each of these are defined in the bill.
2. Defines a “not-for-profit rehabilitation facility,” for purposes of this bill, as a facility that meets all of the following:
   1. Is classified as a not-for-profit entity under the Centers for Medicare and Medicaid Services Provider of Services file;
   2. Holds at least one federal rehabilitation research and training designation for research projects on traumatic brain injury, spinal cord injury, or stroke rehabilitation research from the Rehabilitation Research and Training Centers or the Rehabilitation Engineering Research Center at the National Institute on Disability and Rehabilitation Research (NIDRR) at the federal Department of Education; and,
   3. Has at least 200 Medi-Cal discharges per year.
3. Defines a “government-owned rehabilitation facility,” for purposes of this bill, as a facility that meets both of the following:
   1. Is classified as a government-owned institution under the Centers for Medicare and Medicaid Services Provider of Services file; and,
   2. Holds at least one federal rehabilitation research and training designation for research projects on traumatic brain injury, spinal cord injury, or stroke rehabilitation research from the Rehabilitation Research and Training Centers, the Rehabilitation Engineering Research Center, or the Model Spinal Cord Injury Systems at the NIDRR at the federal Department of Education.
4. Makes various legislative findings and declarations, including that there are an estimated 1,181 inpatient rehabilitation facilities in the United States, among which there is a small group of inpatient rehabilitation institutions that are contributing to the future of rehabilitation care medicine; that these leading inpatient rehabilitation institutions are all not-for-profit or government-owned and serve a high volume of Medicare or Medicaid beneficiaries; and, it is vital that these leading inpatient rehabilitation institutions are supported so they can continue to lead the nation’s efforts to advance integrated, multidisciplinary rehabilitation research.

FISCAL EFFECT:

This bill is keyed non-fiscal.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, Rancho Los Amigos National Rehabilitation Center (Rancho) was first founded in 1888 to serve farming families who could not afford medical services. In the 1950s, a polio epidemic struck Southern California, and clinical teams at the time reorganized to provide more comprehensive rehabilitative services. Through this reorganization, Rancho transitioned into the internationally recognized hospital it is today. This bill would designate Rancho as a “rehabilitation innovation center” in California. The rehabilitation innovation center designation is a recognition of the inpatient rehabilitation research center that has particular expertise in treating patients with the most complex rehabilitation needs.
   
2. Rancho Los Amigos. Rancho is owned and operated by Los Angeles County’s Department of Health Services, and located in Downey. It is licensed as a general acute care hospital, with 289 total licensed beds, of which 150 are rehabilitation beds. According to its website, the hospital specializes in brain, neurology, orthopedic, pediatric, spine injury, and stroke rehabilitation, and provides care to approximately 4,000 inpatients and 71,000 outpatients each year, which makes it one of the largest rehabilitation centers in the nation. Rancho also serves as a branch campus of the University of Southern California medical school.
3. Based on prior federal legislation. The definition in this bill was lifted from a United States Senate bill (S.1168, authored by Senator Kirk of Illinois) that was introduced in 2015, but did not ultimately pass Congress. The federal bill, titled the “Preserving Rehabilitation Innovation Centers Act of 2016,” would have required a study and report relating to the costs incurred by, and the Medicare payments made to, rehabilitation innovation centers. This report was also required to include recommendations for legislation and administrative action as determined appropriate. The definition of “rehabilitation innovation center” included in this federal legislation is very similar to the one used in this bill, although this bill only contains the definition and does not include a required study or report.
   
   In support of the federal legislation, the Rehabilitation Innovations Centers Coalition prepared a “Frequently Asked Questions” (FAQ) document. According to the FAQ, only the following five rehabilitation innovation centers in the country would meet the proposed definition:
   1. MedStar National Rehabilitation Hospital, Washington, DC;
   2. Rancho Los Amigos National Rehabilitation Center in Downey, CA;
   3. Rehabilitation Institute of Chicago, Chicago, IL;
   4. TIRR Memorial Hermann, Houston, TX; and,
   5. University of Pittsburgh Medical Center Rehabilitation Institute, Pittsburgh, PA.
4. National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). In 2015, as part of the federal Workforce Innovation and Opportunity Act, NIDRR changed its name to the NIDILRR. Further, it moved from the federal Department of Education to the Administration for Community Living, which is within the Department of Health and Human Services (HHS). NIDILRR is the federal government’s primary disability research agency. Its mission is to generate new knowledge and to promote its effective use to improve the abilities of individuals with disabilities to perform activities of their choice in the community, and to expand society’s capacity to provide full opportunities and accommodations for its citizens with disabilities. NIDILRR achieves this mission by providing for research, demonstration, training, technical assistance and related activities; promoting the transfer of, use and adoption of rehabilitation technology; and, ensuring the widespread distribution, in usable formats, of practical scientific and technological information.
5. Policy and drafting comments.
   1. What is the purpose of this designation? As noted above, this bill is based on a similar federal bill. However, the federal bill required a study and a report on the costs of operating an innovation center, and the Medicare payment rates. This bill simply contains a definition. It is not clear what purpose it serves to simply designate a facility as an innovation center. For example, it does not appear that having this designation entitles a facility to greater reimbursement rates from insurers. Is it appropriate for the state to confer official designations on facilities when there is not a clearly defined purpose for having the designation?
   2. Unclear what facilities will qualify. According to information provided by the author, Rancho meets the qualifications of this bill, but to the author’s knowledge, no other facility in California would meet the definition. Committee staff attempted to find information on the designations described in this bill on the website of the Administration for Community Living and as well as other entities referenced by this bill, and while there is information on grants awarded by the NIDILRR and some other information, there does not appear to be a list of institutions that have received training designations as described in this bill.
   3. Why different requirements for government-owned vs. nonprofit facilities? While similar, there are different criteria for designation as a “rehabilitation innovation center” depending on whether the facility is government-owned or a nonprofit. For example, a nonprofit is required to have at least 200 Medi-Cal discharges per year, but there is no such requirement for government-owned facilities. Also, in addition to the types of designations that nonprofit facilities can get in order to meet the definition of an innovation center, government-owned facilities can also meet the definition with a training designation for research projects from the “Model Spinal Cord Injury Systems” at the NIDRR. It is not clear why there should be different standards for nonprofit vs. government-owned facilities.
   4. NIDRR has changed its name and department. As noted above, NIDRR changed its name to NIDILRR, and moved from the federal Department of Education to the Administration for Community Living within the HHS. This bill should be amended to reflect the correct name of the federal agency that provides the designations specified in this bill.

SUPPORT AND OPPOSITION:

Support: None received

Oppose: None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 1411

Author:(Cristina Garcia)

As Introduced Ver:February 17, 2017

Majority vote

SUMMARY: Establishes the Preserving Rehabilitation Innovation Centers Act of 2017 which defines a "rehabilitation innovation center" as a not-for-profit or government-owned rehabilitation facility, and makes various findings and declarations regarding the importance of supporting these institutions so they can continue to lead the nation's efforts to provide cutting-edge medical care to the most complex rehabilitation patients. Specifically, this bill:

1. Defines a not-for-profit rehabilitation facility as a facility that meets all of the following requirements:
   1. Is classified as a not-for-profit entity under the Centers for Medicare and Medicaid Services (CMS) Provider of Services file;
   2. Holds at least one federal rehabilitation research and training designation for research projects on traumatic brain injury, spinal cord injury, or stroke rehabilitation research from the National Institute on Disability and Rehabilitation Research (NIDRR), at the federal Department of Education; and,
   3. Has at least 200 Medi-Cal discharges per year.
2. Defines a government-owned rehabilitation facility as a facility that meets both of the following requirements:
   1. Is classified as a government-owned institution under the CMS Provider of Services file; and,
   2. Holds at least one federal rehabilitation research and training designation for research projects on traumatic brain injury, spinal cord injury, or stroke rehabilitation research from the NIDRR.

FISCAL EFFECT: None

COMMENTS: According to the author, Rancho Los Amigos National Rehabilitation Center (Rancho) was first founded in 1888 to serve farming families who could not afford medical services. The author notes that in the 1950s, a polio epidemic struck Southern California and clinical teams at the time reorganized to provide more comprehensive rehabilitative services. The author states that through this reorganization Rancho transitioned into the internationally recognized hospital it is today, and that this bill would designate Rancho as a rehabilitation innovation center in California in recognition of Rancho's particular expertise in treating patients with the most complex rehabilitation needs.

1. Rancho. As the only rehabilitation hospital in Los Angeles County's Department of Health Services, Rancho serves a unique and vital role in patient recovery, rehabilitation and reintegration. The hospital specializes in brain, neurology, orthopedic, pediatric, spine injury, and stroke rehabilitation. Each year, the hospital provides care to approximately 4,000 inpatients and 71,000 outpatients, making it one of the largest rehabilitation centers in the nation. The hospital serves as a branch campus of the University of Southern California Schools of Medicine, Dentistry, and Allied Health professions, and is affiliated with universities throughout the nation. Rancho is accredited by the Joint Commission and the Commission on Accreditation of Rehabilitation Facilities.
2. NIDRR. NIDRR, through its many programs, projects and research, provides an array of grants and other funding opportunities to serve individuals with disabilities and their families. NIDRR's mission is to generate new knowledge and to promote its effective use to improve the abilities of individuals with disabilities to perform activities of their choice in the community, and to expand society's capacity to provide full opportunities and accommodations for its citizens with disabilities.
3. Preserving Rehabilitation Innovation Centers Act of 2015. Senate Bill 1168 (United States Senator Kirk) and House Resolution 2292 (United States Representative Olson) would have designated five rehabilitation centers throughout the United States, including Rancho, as rehabilitation innovation centers, which could have qualified for higher Medicare payments to cover their additional costs for the complex Medicare patient care, research and training that they provided. The bills would have required the United States Secretary of Health and Human Services to conduct a study to assess the costs incurred by rehabilitation innovation centers that are beyond the prospective rates for each of the following activities: a) furnishing items and services to individuals under Medicare; b) conducting research; and, c) providing medical training.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0000319

Date of Hearing: May 9, 2017

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 1411

Author:(Cristina Garcia) – As Introduced Ver:February 17, 2017

SUBJECT: Health care facilities: rehabilitation innovation centers.

SUMMARY: Establishes the Preserving Rehabilitation Innovation Centers Act of 2017 which defines a "rehabilitation innovation center" as a not-for-profit or government-owned rehabilitation facility, and makes various findings and declarations regarding the importance of supporting these institutions so they can continue to lead the nation's efforts to provide cutting-edge medical care to the most complex rehabilitation patients. Specifically, this bill:

1. Defines a not-for-profit rehabilitation facility as a facility that meets all of the following requirements:
   1. Is classified as a not-for-profit entity under the Centers for Medicare and Medicaid Services (CMS) Provider of Services file;
   2. Holds at least one federal rehabilitation research and training designation for research projects on traumatic brain injury, spinal cord injury, or stroke rehabilitation research from the National Institute on Disability and Rehabilitation Research (NIDRR), at the federal Department of Education; and,
   3. Has at least 200 Medi-Cal discharges per year.
2. Defines a government-owned rehabilitation facility as a facility that meets both of the following requirements:
   1. Is classified as a government-owned institution under the CMS Provider of Services file; and,
   2. Holds at least one federal rehabilitation research and training designation for research projects on traumatic brain injury, spinal cord injury, or stroke rehabilitation research from the NIDRR.

EXISTING LAW:

1. Establishes the Medi-Cal program, administered by the Department of Health Care Services, under which qualified low-income individuals receive health care services.
2. Licenses and regulates clinics, including primary care clinics and specialty clinics, by the Department of Public Health (DPH), and exempts various types of clinics from licensure and regulation by DPH, including clinics operated by the United States, by this state or by any of its political subdivisions, by a nonprofit corporation, or by a federally recognized Indian tribe on tribal land.

FISCAL EFFECT: None

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, Rancho Los Amigos National Rehabilitation Center (Rancho) was first founded in 1888 to serve farming families who could not afford medical services. The author notes that in the 1950s, a polio epidemic struck Southern California and clinical teams at the time reorganized to provide more comprehensive rehabilitative services. The author states that through this reorganization Rancho transitioned into the internationally recognized hospital it is today, and that this bill would designate Rancho as a rehabilitation innovation center in California in recognition of Rancho's particular expertise in treating patients with the most complex rehabilitation needs.
2. BACKGROUND.
   1. Rancho. As the only rehabilitation hospital in Los Angeles County’s Department of Health Services, Rancho serves a unique and vital role in patient recovery, rehabilitation and reintegration. The hospital specializes in brain, neurology, orthopedic, pediatric, spine injury, and stroke rehabilitation. Each year, the hospital provides care to approximately 4,000 inpatients and 71,000 outpatients, making it one of the largest rehabilitation centers in the nation. The hospital serves as a branch campus of the University of Southern California Schools of Medicine, Dentistry, and Allied Health professions, and is affiliated with universities throughout the nation. Rancho is accredited by the Joint Commission and the Commission on Accreditation of Rehabilitation Facilities.
   2. NIDRR. NIDRR, through its many programs, projects and research, provides an array of grants and other funding opportunities to serve individuals with disabilities and their families. NIDRR's mission is to generate new knowledge and to promote its effective use to improve the abilities of individuals with disabilities to perform activities of their choice in the community, and to expand society's capacity to provide full opportunities and accommodations for its citizens with disabilities.
   3. Preserving Rehabilitation Innovation Centers Act of 2015. Senate Bill 1168 and House Resolution 2292 would have designated five rehabilitation centers throughout the United States, including Rancho, as rehabilitation innovation centers, which could have qualified for higher Medicare payments to cover their additional costs for the complex Medicare patient care, research and training that they provided. The bills would have required the U.S. Secretary of Health and Human Services to conduct a study to assess the costs incurred by rehabilitation innovation centers that are beyond the prospective rates for each of the following activities: i) furnishing items and services to individuals under Medicare; ii) conducting research; and, iii) providing medical training.
   4. Medicare payments. For institutional care, such as hospital or rehabilitation center care, Medicare uses prospective payment systems (PPS). In a PPS, the health care institution receives a set amount of money for each episode of care provided to a patient, regardless of the actual amount of care. The actual allotment of funds is based on a list of diagnosis-related groups (DRG). The actual amount depends on the primary diagnosis that is made at the facility. There are some issues surrounding Medicare's use of DRGs because if the patient uses less care, the hospital gets to keep the remainder. This, in theory, should balance the costs for the facility. However, if the patient uses more care, then the facility has to cover its own losses.
3. POLICY COMMENT. As currently drafted, this bill simply designates Rancho as a rehabilitation innovation center. Should this bill move forward, the author may want to consider adding language similar to previous federal bills that require a study to determine whether or not the state should provide additional reimbursements to these types of facilities.

REGISTERED SUPPORT / OPPOSITION:

Support

None on file.

Opposition

None on file.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097