Existing law provides for the establishment and operation of veterans homes at various sites, and provides for an administrator of each home, as specified. Existing law establishes the duties of the Department of Veterans Affairs with regard to the establishment and regulation of veterans homes.

This bill would revise and recast those provisions. Among other things, the bill would provide that the administrator is the senior executive appointed to oversee the operations of a veterans home. The bill would specify which veterans homes are administered by the Department of Veterans Affairs. bill would specify that the administrator of each home is responsible for ensuring compliance with State and Federal law, as specified. The bill would require the Secretary of Veterans Affairs to adopt uniform statewide policies and procedures, by regulation, for the operation of those veterans homes, as specified. relating to, among other things, the admission of residents and quality of care standards. The bill would make findings and declarations and state the intent of the Legislature to monitor the departments efforts to implement a statewide electronic health record for its system of veterans homes.

Existing law provides for the establishment and operation of veterans homes at various sites, and provides for an administrator of each home, as specified. Existing law establishes the duties of the Department of Veterans Affairs with regard to the establishment and regulation of veterans homes.

This bill would revise and recast those provisions. Among other things, the bill would provide that the administrator is the senior executive appointed to oversee the operations of a veterans home. The bill would specify which veterans homes are administered by the Department of Veterans Affairs. The bill would require the Secretary of Veterans Affairs to adopt uniform statewide policies and procedures, by regulation, for the operation of those veterans homes, as specified. The bill would make findings and declarations and state the intent of the Legislature to monitor the departments efforts to implement a statewide electronic health record for its system of veterans homes.

Existing law establishes the criteria for admission to a veterans home, as specified. Existing law establishes the fees and charges for residency, as established by each administrator of a home, and requires each administrator to adopt rules and regulations for the administration of the homes.

This bill would instead require that the fees and charges be established by the secretary, rather than by each administrator, and that the secretary adopt rules and regulations that apply to the homes and the criteria for admission. The bill would authorize the secretary to establish needs-based criteria for admission to veterans homes and to prioritize admission for veterans with service-related disabilities, as specified.

Existing law authorizes a resident spouse to continue his or her residency after a veteran spouses death.

This bill would require a resident spouse who continues residency after a veteran spouses death to continue to pay all applicable fees and to comply with all department regulations, and would expand those provisions to include domestic partners.

Existing law authorizes the department to investigate a veterans financial status for admission purposes.

This bill would further authorize the department to determine a residents or applicants income or suitability for residence at a veterans home and would provide that providing false information or failure to pay fees is grounds for financial penalties or discharge from a veterans home.

Existing law requires 100% of the moneys received by a veterans home from veterans receiving federal aid to be placed to the credit of the home to augment the current appropriation for the support of the home.

This bill would delete that provision.

Existing law requires members of a veterans home to pay fees and charges as determined by the department, subject to a specified fee schedule.

This bill would provide that failure to pay fees is cause for the administrator to refer the resident to collections or dismiss the resident from the home.

Existing law, upon the death of a veteran in a home, requires any moneys not in excess of $3,000 held by the home for the veteran to be paid to the homes Morale, Welfare, and Recreation Fund, a continuously appropriated special fund, if no will or heir or other family member is discovered within a specified number of years after his or her death.

This bill would increase the amount that may be transferred to $15,000, thereby making an appropriation.

Existing law, upon the departure of a veteran from a home, requires any moneys not in excess of $3,000 held by the home for the veteran to be paid to the homes Morale, Welfare, and Recreation Fund, a continuously appropriated special fund, if the money is not requested by the veteran within a specified number of years after his or her departure.

This bill would increase the amount that may be transferred to $5,000, thereby making an appropriation.

This bill would make other conforming changes and would delete obsolete provisions and references, as specified.

Existing law provides for the establishment and operation of veterans homes at various sites, and provides for an administrator of each home, as specified. Existing law establishes the duties of the Department of Veterans Affairs with regard to the establishment and regulation of veterans homes.

This bill would revise and recast those provisions. Among other things, the bill would provide that the administrator is the senior executive appointed to oversee the operations of a veterans home. The bill would specify which veterans homes are administered by the Department of Veterans Affairs. The bill would require the Secretary of Veterans Affairs to adopt uniform statewide policies and procedures, by regulation, for the operation of those veterans homes, as specified. The bill would make findings and declarations and state the intent of the Legislature to monitor the departments efforts to implement a statewide electronic health record for its system of veterans homes.

Existing law establishes the criteria for admission to a veterans home, as specified. Existing law establishes the fees and charges for residency, as established by each administrator of a home, and requires each administrator to adopt rules and regulations for the administration of the homes.

This bill would instead require that the fees and charges be established by the secretary, rather than by each administrator, and that the secretary adopt rules and regulations that apply to the homes and the criteria for admission. The bill would authorize the secretary to establish needs-based criteria for admission to veterans homes and to prioritize admission for veterans with service-related disabilities, as specified.

Existing law authorizes a resident spouse to continue his or her residency after a veteran spouses death.

This bill would require a resident spouse who continues residency after a veteran spouses death to continue to pay all applicable fees and to comply with all department regulations, and would expand those provisions to include domestic partners.

Existing law authorizes the department to investigate a veterans financial status for admission purposes.

This bill would further authorize the department to determine a residents or applicants income or suitability for residence at a veterans home and would provide that providing false information or failure to pay fees is grounds for financial penalties or discharge from a veterans home.

Existing law requires 100% of the moneys received by a veterans home from veterans receiving federal aid to be placed to the credit of the home to augment the current appropriation for the support of the home.

This bill would delete that provision.

Existing law requires members of a veterans home to pay fees and charges as determined by the department, subject to a specified fee schedule.

This bill would provide that failure to pay fees is cause for the administrator to refer the resident to collections or dismiss the resident from the home.

Existing law, upon the death of a veteran in a home, requires any moneys not in excess of $3,000 held by the home for the veteran to be paid to the homes Morale, Welfare, and Recreation Fund, a continuously appropriated special fund, if no will or heir or other family member is discovered within a specified number of years after his or her death.

This bill would increase the amount that may be transferred to $15,000, thereby making an appropriation.

Existing law, upon the departure of a veteran from a home, requires any moneys not in excess of $3,000 held by the home for the veteran to be paid to the homes Morale, Welfare, and Recreation Fund, a continuously appropriated special fund, if the money is not requested by the veteran within a specified number of years after his or her departure.

This bill would increase the amount that may be transferred to $5,000, thereby making an appropriation.

This bill would make other conforming changes and would delete obsolete provisions and references, as specified.

Date of Hearing: August 8, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

SBPCA Bill Id:SB 485

Author:(Nielsen) – As Amended Ver:July 5, 2017

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the California Department of Veterans Affairs (CalVet) to adopt statewide policies and procedures, by regulation, for operation of the state veterans’ home system. This bill also requires the administrator or each home to be responsible for ensuring compliance with all state and federal statutes and regulations, as specified, and states legislative intent to closely monitor and encourage CalVet’s efforts to implement a statewide electronic health records (EHR) system for its veterans’ homes, as specified.

FISCAL EFFECT:

Significant ongoing costs of $1.9 million (GF) annually for several additional staff positions for CalVet to implement the provisions of the bill, especially to create quality-of-care standards and a quality-of-care review process.

COMMENTS:

1. Purpose. According to the author:

SB 485 is a long-overdue piece of legislation that guarantees the policies and procedures governing our state’s veterans’ homes are transparent, are consistent across the state, and ensure the highest possible quality of care for our veterans.

In stating that the administrator of each home is responsible for ensuring compliance with applicable statutes and regulations, SB 485 ensures that administrators will not be able to deflect responsibility for the safe operation of the homes.

1. Background. CalVet operates eight veterans’ homes throughout the state. These homes provide rehabilitative, residential, and medical care and services to the state’s aged or disabled veterans (and eligible spouses). The homes range in size from 60 residents on a 20-acre site to over 1,000 residents on a 500-acre site. At full capacity, the homes can house and care for approximately 3,000 veterans. As of April 2017, approximately 2,200 individuals reside in the homes.

Through this bill, CalVet’s current policies and procedures will be adopted by regulation and in accordance with the Administrative Procedure Act, allowing for public input and stakeholder review and requiring that the department justify the rationale for each of their policies. SB 96 (Committee on Budget and Fiscal Review, Chapter 28, Statutes of 2017) among other items, removed antiquated references in the Military and Veterans Code and updated the statues to reflect the existence of eight homes. However, the current regulations governing the homes remain largely unchanged since 1992 when there existed only a single veterans’ home (Yountville).

1. Prior Legislation.

SB 980 (Neilson), of the 2015-16 Legislative Session, would have required CalVet to adopt statewide policies and procedures, by regulation, for operation of the state veterans’ home system, implement a stateside EHR system, and correct and update outdated terminology and references in the Military and Veterans Code. That bill was held on this committee’s Suspense File.

Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081

Date of Hearing: June 26, 2018

ASSEMBLY COMMITTEE ON VETERANS AFFAIRS

Jacqui Irwin, Chair

SBPCA Bill Id:SB 485

Author:(Nielsen) – As Amended Ver:July 5, 2017

SENATE VOTE: 40-0

SUBJECT: Veterans’ homes

SUMMARY: Requires the California Department of Veterans Affairs (CalVet) to:

1. Adopt statewide policies and procedures, by regulation, for operation of the state veterans home system;
2. Implement a statewide electronic health records (EHR) system; and
3. Correct and update outdated terminology and references within the portion of the Military and Veterans Code (MVC) that governs state veterans’ homes.

EXISTING LAW:

1. Authorizes establishment and operation of the Veterans’ Home of California (VHC) system.
2. Establishes CalVet’s authority and responsibilities in administering the system.
3. Requires each on-site home administrator to adopt rules and regulations for the administration of each home.
4. Defines criteria for admission to a veterans’ home.
5. Requires that home members (residents) pay fees and charges as determined by CalVet, subject to a specified fee schedule.
6. Authorizes CalVet to investigate a veteran’s financial status for admission purposes.
7. Requires that − upon the death of a veteran in a home – any monies not in excess of $3,000 held by the home for the veteran to be paid to the home’s Morale, Welfare, and Recreation Fund, if no will or heir or other family member is discovered.
8. Authorizes:
   1. Married veteran home members to have their non-veteran spouses domicile with them.
   2. A resident spouse to continue residency after a veteran spouse’s death.
9. Requires 100% of the moneys received by a veterans’ home from veterans receiving federal aid to be placed to the credit of the home to augment the current appropriation for the support of the home.

FISCAL EFFECT: According to the Senate Appropriations Committee:

1. Significant ongoing costs of $1.7 million annually for several additional staff positions for CalVet to implement the provisions of the bill, especially to create quality of care standards and a quality of care review process. (GF)
2. Potential revenue to CalVet for receiving a higher per diem for residents who have a service-connected disability rating from the U.S. Department of Veterans Affairs of 70% or higher. (GF)
3. Potential revenue to CalVet for the authority to levy a financial penalty for members who provide false financial information or are delinquent in monthly member fees. (GF)

COMMENTS:

According to the author:

SB 485 is a long-overdue piece of legislation that guarantees the policies and procedures governing our state’s veterans’ homes are transparent, are consistent across the state, and ensure the highest possible quality of care for our veterans.

Through this bill, CalVet’s current policies and procedures will be adopted by regulation and in accordance with the Administrative Procedure Act, allowing for public input and stakeholder review and requiring that the department justify the rationale for each of their policies. While the recent enactment of SB 96 (Chapter 28, Statutes of 2017) – which borrowed significantly from SB 485’s predecessor, SB 980 (2016) – removed antiquated references in the Military and Veterans Code and updated the statues to reflect the existence of eight homes, the current regulations governing the homes remain largely unchanged since 1992 when there existed only a single veterans’ home (Yountville). The system has rapidly expanded in recent years, yet there has been no attempt to update the regulations.  

In stating that the administrator of each home is responsible for ensuring compliance with applicable statutes and regulations, SB 485 ensures that administrators will not be able to deflect responsibility for the safe operation of the homes. This has been an issue historically, with past administrators trying to avoid responsibility for various problems: for instance, the Chula Vista home suffered from deferred maintenance and plant operations problems, yet the administrator had not submitted the necessary budget change requests to identify needed funding. SB 485 clearly states the responsibilities of the administrator and avoids future misunderstandings.

Finally, implementing an electronic health record (EHR) system is imperative in ensuring California veterans receive high quality health care. EHR adoption gives health care providers instant access to complete information about their patient, and the ability to better coordinate care and more easily share information. The U.S. Department of Veterans Affairs was one of the early adopters of EHR, and a study by the Center for IT Leadership (2010) estimated that their system prevented $4.64 billion in adverse drug events. Adopting an EHR in our state’s veterans’ homes will give health care providers the tools they need to make better decisions for the care of their patients.

This Committee heard SB 980 (2016) which was substantially similar to the trailer bill language in SB 96 (2017) and this bill until the most recent amendments. Much of the Committee’s analysis of SB 980 remains applicable to SB 485. SB 96 enacted many long overdue changes, however, substantial portions of the Military and Veterans Code still need modernization and cleanup. The department undertook a project to address code cleanup globally but it has been postponed indefinitely and its status is unknown.

The language in SB 980 and SB 485 as introduced was the result of collaborative efforts including input by the Author, stakeholder involvement, and technical assistance from CalVet. Committee Staff noted in the analysis of SB 980 that, “…the architecture of the veteran sections of the Military and Veterans Code reasonably should flow from the leadership and vision of the department and be the subject of an officially sponsored proposal.” Staff’s understanding is that the trailer bill language pertaining to the Military and Veterans Code which then became part of SB 96 was offered by the Administration. In summary, the author and CalVet accomplished much through the collective leadership of SB 980 and SB 96.

Home Administrator Responsibilities

SB 485 now contains Author-selected remaining provisions of SB 485 that were not included in SB 96. The language pertaining to the Administrator of each Home, without more context, could be restate duties which are implicit in such a position or already included in the duty statement for Homes Administrator positions (the language below is from the CalVet recruiting materials for the Fresno Home Administrator position) which state in pertinent part:

Under the general direction of the California Department of Veterans Affairs--Undersecretary of Veterans Homes and with the support of a centralized administrative staff at CalVet Headquarters, the Fresno Veteran’s Home Administrator has overall responsibility for opening the Home, hiring staff, ensuring quality long-term care for veterans, and management of the facility and staff.

1. Ensure that the Home meets all licensing and certification standards through planning, training, physical facility improvement, policies, and procedures. Develop ongoing contacts with regulatory agencies such as the Department of Health Services, California Medical Association, USDVA, the Department of Social Services, and the Veterans Administration.

2. Supervise all personnel and monitor staffing levels for efficiencies and long term planning. Oversee facility and equipment maintenance program.

3. Establish priorities and implement strategies to maintain high quality of care to Veteran residents while closely monitoring all revenue and costs. …

7. Successful candidate must also have the ability to understand and comply with a complex system of laws and regulations to include: Health and Safety Code-Division 2 Chapter 3.3, Welfare and Institutions Code-Division 9 Chapter 8.7, Title 22-Division 1.8 Chapter 1.5 (Department of Aging Regulations). Title 22-Division 3 Chapter 5 (Medical Certification Regulations), Title 22-Division 5 Chapter 10 (Licensing Regulations), and Title 22-Division 6 Chapter 8 (Residential Care for the Elderly).

As noted by the Author, however, there has been more than one State Audit Report specifically and strongly criticizing the performance of certain Home Administrators, and there has been more turnover in those jobs than expected, systemwide. As noted above, CalVet has taken and continues to take steps to move the Homes toward an integrated and more centrally managed system.

Electronic Health Record

The language regarding an electronic health record system arises out of a troubled CalVet contract to create and implement such a system, now standard in the United States and the resulting Audit. This Committee conducted a hearing on the serious conclusions detailed in the Audit which could be summarized as extremely poor contract management and expenditure of millions in state funds without receiving a functional product.

Regulatory Development Language

Similar comments as above concerning the statement of duties for the Home Administrators apply to the language in the bill concerning regulatory development. Many of the listed priorities in the bill for regulatory development are there because the way those processes function is or has been a black box, or there has not been a standard practice across the Homes. Staff is aware that several regulatory packages are already in development for the Homes and this year’s budget funds additional CalVet staff for the specific purpose of staffing regulatory development and maintenance.

REGISTERED SUPPORT / OPPOSITION:

Support

American G.I Forum of California

American Legion – Department of California

AMVETS-Department of California

California Association of County Veterans Service Officers

California Long-Term Care Ombudsman Association

California State Commanders Veterans Council

Military Officers Association of America, California Council of Chapters

Vietnam Veterans of America-California State Council

Opposition

None on File.

Analysis Prepared by: Jenny Callison / V.A. / (916) 319-3550

Date of Hearing: July 11, 2017

ASSEMBLY COMMITTEE ON VETERANS AFFAIRS

Jacqui Irwin, Chair

SBPCA Bill Id:SB 485

Author:(Nielsen) – As Amended Ver:July 5, 2017

SENATE VOTE: 40-0

SUBJECT: Veterans’ homes

SUMMARY: Requires the California Department of Veterans Affairs (CalVet) to:

1. Adopt statewide policies and procedures, by regulation, for operation of the state veterans home system;
2. Implement a statewide electronic health records (EHR) system; and
3. Correct and update outdated terminology and references within the portion of the Military and Veterans Code (MVC) that governs state veterans’ homes.

EXISTING LAW:

1. Authorizes establishment and operation of the Veterans’ Home of California (VHC) system.
2. Establishes CalVet’s authority and responsibilities in administering the system.
3. Requires each on-site home administrator to adopt rules and regulations for the administration of each home.
4. Defines criteria for admission to a veterans’ home.
5. Requires that home members (residents) pay fees and charges as determined by CalVet, subject to a specified fee schedule.
6. Authorizes CalVet to investigate a veteran’s financial status for admission purposes.
7. Requires that − upon the death of a veteran in a home – any monies not in excess of $3,000 held by the home for the veteran to be paid to the home’s Morale, Welfare, and Recreation Fund, if no will or heir or other family member is discovered.
8. Authorizes:
   1. Married veteran home members to have their non-veteran spouses domicile with them.
   2. A resident spouse to continue residency after a veteran spouse’s death.
9. Requires 100% of the moneys received by a veterans’ home from veterans receiving federal aid to be placed to the credit of the home to augment the current appropriation for the support of the home.

FISCAL EFFECT: According to the Senate Appropriations Committee:

1. Significant ongoing costs of $1.7 million annually for several additional staff positions for CalVet to implement the provisions of the bill, especially to create quality of care standards and a quality of care review process. (GF)
2. Potential revenue to CalVet for receiving a higher per diem for residents who have a service-connected disability rating from the U.S. Department of Veterans Affairs of 70% or higher. (GF)
3. Potential revenue to CalVet for the authority to levy a financial penalty for members who provide false financial information or are delinquent in monthly member fees. (GF)

COMMENTS:

According to the author:

SB 485 is a long-overdue piece of legislation that guarantees the policies and procedures governing our state’s veterans’ homes are transparent, are consistent across the state, and ensure the highest possible quality of care for our veterans.

Through this bill, CalVet’s current policies and procedures will be adopted by regulation and in accordance with the Administrative Procedure Act, allowing for public input and stakeholder review and requiring that the department justify the rationale for each of their policies. While the recent enactment of SB 96 (Chapter 28, Statutes of 2017) – which borrowed significantly from SB 485’s predecessor, SB 980 (2016) – removed antiquated references in the Military and Veterans Code and updated the statues to reflect the existence of eight homes, the current regulations governing the homes remain largely unchanged since 1992 when there existed only a single veterans’ home (Yountville). The system has rapidly expanded in recent years, yet there has been no attempt to update the regulations.  

In stating that the administrator of each home is responsible for ensuring compliance with applicable statutes and regulations, SB 485 ensures that administrators will not be able to deflect responsibility for the safe operation of the homes. This has been an issue historically, with past administrators trying to avoid responsibility for various problems: for instance, the Chula Vista home suffered from deferred maintenance and plant operations problems, yet the administrator had not submitted the necessary budget change requests to identify needed funding. SB 485 clearly states the responsibilities of the administrator and avoids future misunderstandings.

Finally, implementing an electronic health record (EHR) system is imperative in ensuring California veterans receive high quality health care. EHR adoption gives health care providers instant access to complete information about their patient, and the ability to better coordinate care and more easily share information. The U.S. Department of Veterans Affairs was one of the early adopters of EHR, and a study by the Center for IT Leadership (2010) estimated that their system prevented $4.64 billion in adverse drug events. Adopting an EHR in our state’s veterans’ homes will give health care providers the tools they need to make better decisions for the care of their patients.

This Committee heard SB 980 (2016) which was substantially similar to the trailer bill language in SB 96 (2017) and this bill until the most recent amendments. Much of the Committee’s analysis of SB 980 remains applicable to SB 485. SB 96 enacted many long overdue changes, however, substantial portions of the Military and Veterans Code still need modernization and cleanup. The department undertook a project to address code cleanup globally but it has been postponed indefinitely and its status is unknown.

The language in SB 980 and SB 485 as introduced was the result of collaborative efforts including input by the Author, stakeholder involvement, and technical assistance from CalVet. Committee Staff noted in the analysis of SB 980 that, “…the architecture of the veteran sections of the Military and Veterans Code reasonably should flow from the leadership and vision of the department and be the subject of an officially sponsored proposal.” Staff’s understanding is that the trailer bill language pertaining to the Military and Veterans Code which then became part of SB 96 was offered by the Administration. In summary, the author and CalVet accomplished much through the collective leadership of SB 980 and SB 96.

Home Administrator Responsibilities

SB 485 now contains Author-selected remaining provisions of SB 485 that were not included in SB 96. The language pertaining to the Administrator of each Home, without more context, could be restate duties which are implicit in such a position or already included in the duty statement for Homes Adminstrator positions (the language below is from the CalVet recruiting materials for the Fresno Home Administrator position) which state in pertinent part:

Under the general direction of the California Department of Veterans Affairs--Undersecretary of Veterans Homes and with the support of a centralized administrative staff at CalVet Headquarters, the Fresno Veteran’s Home Administrator has overall responsibility for opening the Home, hiring staff, ensuring quality long-term care for veterans, and management of the facility and staff.

1. Ensure that the Home meets all licensing and certification standards through planning, training, physical facility improvement, policies, and procedures. Develop ongoing contacts with regulatory agencies such as the Department of Health Services, California Medical Association, USDVA, the Department of Social Services, and the Veterans Administration.

2. Supervise all personnel and monitor staffing levels for efficiencies and long term planning. Oversee facility and equipment maintenance program.

3. Establish priorities and implement strategies to maintain high quality of care to Veteran residents while closely monitoring all revenue and costs. …

7. Successful candidate must also have the ability to understand and comply with a complex system of laws and regulations to include: Health and Safety Code-Division 2 Chapter 3.3, Welfare and Institutions Code-Division 9 Chapter 8.7, Title 22-Division 1.8 Chapter 1.5 (Department of Aging Regulations). Title 22-Division 3 Chapter 5 (Medical Certification Regulations), Title 22-Division 5 Chapter 10 (Licensing Regulations), and Title 22-Division 6 Chapter 8 (Residential Care for the Elderly).

As noted by the Author, however, there has been more than one State Audit Report specifically and strongly criticizing the performance of certain Home Administrators, and there has been more turnover in those jobs than expected, systemwide. As noted above, CalVet has taken and continues to take steps to move the Homes toward an integrated and more centrally managed system.

Electronic Health Record

The language regarding an electronic health record system arises out of a troubled CalVet contract to create and implement such a system, now standard in the United States and the resulting Audit. This Committee conducted a hearing on the serious conclusions detailed in the Audit which could be summarized as extremely poor contract management and expenditure of millions in state funds without receiving a functional product.

Regulatory Development Language

Similar comments as above concerning the statement of duties for the Home Administrators apply to the language in the bill concerning regulatory development. Many of the listed priorities in the bill for regulatory development are there because the way those processes function is or has been a black box, or there has not been a standard practice across the Homes. Staff is aware that several regulatory packages are already in development for the Homes and this year’s budget funds additional CalVet staff for the specific purpose of staffing regulatory development and maintenance.

REGISTERED SUPPORT / OPPOSITION:

Support

American G.I Forum of California

American Legion – Department of California

AMVETS-Department of California

California Association of County Veterans Service Officers

California Long-Term Care Ombudsman Association

California State Commanders Veterans Council

Military Officers Association of America, California Council of Chapters

Vietnam Veterans of America-California State Council

Opposition

None on File.

Analysis Prepared by: John Spangler / V.A. / (916) 319-3550

 THIRD READING  

Bill No: SB 485

Author:

:

Vote:

SENATE VETERANS AFFAIRS COMMITTEE: 7-0, 3/28/17

AYES: Newman, Nielsen, Dodd, Hueso, Nguyen, Roth, Wilk

SENATE JUDICIARY COMMITTEE: 7-0, 4/18/17

AYES: Jackson, Moorlach, Anderson, Hertzberg, Monning, Stern, Wieckowski

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/25/17

AYES: Lara, Bates, Beall, Bradford, Hill, Nielsen, Wiener

SUBJECT:

SOURCE: Author

DIGEST:

This bill requires the California Department of Veterans Affairs (CalVet) to (1) adopt statewide policies and procedures, by regulation, for operation of the state veterans home system; (2) implement a statewide electronic health records (EHR) system; and (3) correct and update outdated terminology and references within the portion of the Military and Veterans Code (MVC) that governs state veterans’ homes.

ANALYSIS:

Existing law:

1. Authorizes establishment and operation of the Veterans’ Home of California (VHC) system.
2. Establishes CalVet’s authority and responsibilities in administering the system.
3. Requires each on-site home administrator to adopt rules and regulations for the administration of each home.
4. Defines criteria for admission to a veterans’ home.
5. Requires that home members (residents) pay fees and charges as determined by CalVet, subject to a specified fee schedule.
6. Authorizes CalVet to investigate a veteran’s financial status for admission purposes.
7. Requires that − upon the death of a veteran in a home – any monies not in excess of $3,000 held by the home for the veteran to be paid to the home’s Morale, Welfare, and Recreation Fund, if no will or heir or other family member is discovered.
8. Authorizes:
   1. Married veteran home members to have their non-veteran spouses domicile with them.
   2. A resident spouse to continue residency after a veteran spouse’s death.
9. Requires 100% of the moneys received by a veterans’ home from veterans receiving federal aid to be placed to the credit of the home to augment the current appropriation for the support of the home.

This bill:

1. Clarifies CalVet authority to adopt, amend, or repeal regulations concerning the administration and operation of the VHC system, and that, except as otherwise provided, these regulations shall be adopted pursuant to the Administrative Practices Act.
2. Permits CalVet to adopt, amend, and repeal emergency regulations concerning the VHC. Requires the regulations to be in compliance with Section 11346.1 of the Government Code, except for exemption when the CalVet Secretary states in writing the following special circumstances:
   1. The possible loss or delay in the receipt of federal, state, or local funding.
   2. The need to maintain licensing or certification by any state or federal agency for any VHC facility or program.
   3. The need to protect against a serious and immediate threat to the health or safety of residents or staff in one or more of the facilities of the VHC.
   4. The urgent need to comply immediately with recommendations of the Department of Finance or the State Auditor.
3. Requires CalVet to do the following concerning administration and operation:
   1. Ensure that all medical or other facilities under its jurisdiction satisfy all applicable federal and state licensing, certification, and other approval requirements, including, but not limited to, the requirements of the United States Department of Veterans Affairs, the federal Centers for Medicare and Medicaid Services, the State Department of Public Health, the State Department of Social Services, and the California State Board of Pharmacy, including preparation of plans of correction as required.
   2. Develop and maintain clinical policies and procedures, including both of the following:
   3. Community standards for best clinical practices, including, but not limited to, practices recommended by the federal Centers for Disease Control and Prevention and the federal Centers for Medicare and Medicaid Services.
   4. The appropriate clinical standard of practice.
   5. Adopt fire and life safety policies and procedures consistent with the requirements of the State Fire Marshal and other applicable regulatory and licensing agencies.
   6. Adopt earthquake and environmental protection policies and procedures.
4. Requires the Secretary of CalVet to adopt, by regulation, uniform statewide policies and procedures, for the operation of the homes:
   1. That are in conformity, as nearly as possible, with all relevant licensing and certification agencies, including, but not limited to, the United States Department of Veterans Affairs, the federal Centers for Medicare and Medicaid Services, the State Department of Social Services, and the State Department of Public Health, to ensure that adequate care and a homelike environment is provided in a cost-effective manner for members of the homes.
   2. That implement the requirements to obtain and maintain necessary licenses and accreditations, as well as to ensure members in all homes throughout the state, to the extent possible, receive equitable treatment, benefits, and services, and to ensure that high-quality care is provided.
   3. That include, but are not limited to, all of the following:
      1. The admission of applicants.
      2. The conditions upon which members may enter and remain in the home.
      3. Resident disciplinary procedures.
      4. Quality of care standards.
      5. An internal quality of care review process.
      6. Delineating which services will be provided to members by the state.
      7. Setting staffing standards.
      8. Staff training requirements.
      9. Clarifying the relationship between the department and allied councils.
      10. Any other policies and procedures to ensure the safe and effective operation of the homes.
5. Makes findings and declarations that the health care industry has been moving toward adoption of EHR as the accepted industry standard, and that specifies the outcome-based evidence supporting that trend.
6. Makes findings and declarations that CalVet has initiated the administrative processes necessary to implement a statewide EHR for the VHC system.
7. States the Legislature’s intent to monitor closely the department’s efforts and to encourage it to meet the goal of implementing a statewide EHR for VHC as quickly as possible with a system that reflects best practices and helps ensure a high quality of care.
8. Adjusts admission criteria so that veterans who have service-connected disabilities rated by USDVA have priority over veterans without such disabilities.
9. Authorizes, generally, the Secretary to establish needs-based criteria for admission to veterans’ homes and to prioritize admission for veterans with service-related disabilities, as specified.
10. Requires a resident spouse or domestic partner who continues residency after a veteran spouse’s death to continue to pay all applicable fees and to comply with all department regulations, and would expand those provisions to include domestic partners.
11. Authorizes CalVet to determine a resident’s or applicant’s income or suitability for residence at a veterans’ home and would provide that providing false information or failure to pay fees is grounds for financial penalties or discharge from a veterans’ home. Permits the department to contract with any other state or federal agency or private entity to conduct the investigation.
12. Provides that the provision of false financial and other information by an applicant or member or nonpayment of fees may be grounds for financial penalties or denial of admission to, or discharge from, a veterans’ home.
13. Provides that failure to pay fees is cause for the administrator to refer the resident to collections or dismiss the resident from the home.
14. Provides that CalVet may calculate as part of the existing means-based member fees any retroactive benefit payments a home member may receive from the USDVA and may bill the appropriately additional amount of fees.
15. Authorizes CalVet to arrange by contract or any other form of agreement with the USDVA to leverage federal contracts for the procurement of goods and services.
16. Requires that the fees and charges be established by the Secretary, rather than by each administrator, and that the Secretary adopt rules and regulations that apply to the homes and the criteria for admission.
17. Increases the amount that may be transferred to the MWR fund upon the death of a veteran in a home if no will or heir or other family member is discovered within a specified number of years after his or her death to $15,000.
18. Increases the amount that may be transferred to the home’s MWR Fund upon the departure of a veteran from a home if the money is not requested by the veteran within a specified number of years after his or her departure to $5,000.
19. Makes other conforming changes and would delete obsolete provisions and references, as specified.

Background

State Veterans Homes. The Veterans Homes Division provides rehabilitative, residential medical care and services in a homelike environment for aged and disabled veterans (and eligible veteran spouses) residing in the State's eight veterans homes, which are located in Barstow, Chula Vista, Fresno, Lancaster. Redding, Ventura, West Los Angeles, and Yountville. As of mid-March 2017, more than 2,200 members in total resided in the homes.

The eight campuses offer different combinations of the following levels of care that generate increasing levels of cost:

1. Independent living/domiciliary care: Barstow, Chula Vista, Yountville.
2. Residential care/assisted living: All homes except Barstow.
3. Intermediate care: Barstow, Yountville.
4. Skilled nursing care: Barstow, Chula Vista, Fresno, Redding, West LA, Yountville.
5. Memory care (within skilled nursing facilities): Fresno, Redding, West LA, Yountville.
6. Outpatient clinic: All homes.

FISCAL EFFECT: Appropriation: Yes Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee:

• Significant ongoing costs of $1.7 million annually for several additional staff positions for CalVet to implement the provisions of the bill, especially to create quality of care standards and a quality of care review process. (GF)
• Potential revenue to CalVet for receiving a higher per diem for residents who have a service-connected disability rating from the U.S. Department of Veterans Affairs of 70% or higher. (GF)
• Potential revenue to CalVet for the authority to levy a financial penalty for members who provide false financial information or are delinquent in monthly member fees. (GF)

SUPPORT: (Verified 5/26/17)

American G.I. Forum of California

American Legion - Department of California

AMVETS - Department of California

California Association of County Veterans Service Officers

California Long-Term Care Ombudsman Association

California State Commanders Veteran Council

Military Officers Association of America - California Council of Chapters

Vietnam Veterans of American - California State Council

OPPOSITION: (Verified 5/26/17)

None received

Prepared by:

5/27/17 16:28:32

**** END ****

SENATE COMMITTEE ON

Senator Ricardo Lara, Chair

2017 - 2018 Regular Session

SB 485 (Nielsen) - Veterans’ homes

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

SB 485 would require the California Department of Veterans Affairs (CalVet) to adopt statewide policies and procedures, by regulation, for operation of the state veterans home system.

Fiscal Impact:

• Significant ongoing costs of $1.7 million annually for several additional staff positions for CalVet to implement the provisions of the bill, especially to create quality of care standards and a quality of care review process. (GF)
• Potential revenue to CalVet for receiving a higher per diem for residents who have a service-connected disability rating from the U.S. Department of Veterans Affairs of 70% or higher. (GF)
• Potential revenue to CalVet for the authority to levy a financial penalty for members who provide false financial information or are delinquent in monthly member fees. (GF)

Background:

CalVet operates eight veterans homes throughout the State. These homes provide rehabilitative, residential, and medical care and services to the state's aged or disabled veterans (and eligible veteran spouses). The homes range in size from 60 residents on a 20 acre site to over 1,000 residents on 500 acres. At full capacity, the homes can house and care for approximately 3,000 veterans. As of April 2017, approximately 2,200 members reside in the homes.

Proposed Law:

This bill would:

• Clarify CalVet authority to adopt, amend, or repeal regulations concerning the administration and operation of the Veterans’ Home of California (VHC) system, and that except as otherwise provided, these regulations shall be adopted pursuant to the Administrative Practices Act;
• Authorize CalVet to adopt, amend, or repeal regulations concerning the administration and operation of the VHC system in compliance with Section 11346.1 of the Government Code, except when the CalVet secretary states in writing the following special circumstances:
  • Possible loss or delay in the receipt of federal, state, or local funding;
  • The need to maintain licensing or certification by any state or federal agency for any VHC facility or program;
  • The need to protect against a serious and immediate threat to the health or safety of residents or staff in one or more of the facilities of the VHC;
  • The urgent need to comply immediately with recommendations of the Department of Finance or the State Auditor;
• Require CalVet to take the necessary steps to ensure that all medical or other facilities under its jurisdiction satisfy all applicable federal and state licensing, certification, and other approval requirements, develop and maintain clinical policies and procedures, as specified, adopt fire and life safety policies and procedures and earthquake and environmental protection policies and procedures;
• Require the Secretary of Veterans Affairs to adopt uniform statewide policies and procedures, by regulation, in accordance with the Administrative Procedure Act that are in conformity, as nearly as possible, with all relevant licensing and certification agencies to ensure that adequate care and a homelike environment is provided in a cost-effective manner for members of the homes;
• Require the policies and procedures to implement the requirements to obtain and maintain required licenses and accreditations, as well as to ensure members in all homes throughout the state, to the extent possible, receive equitable treatment, benefits, and services, and to ensure that high-quality care is provided;
• Require each home to have an administrator who is recommended by the Secretary of Veterans Affairs, appointed by the Governor, and located at that home. The administrator must be responsible for ensuring compliance with all state and federal statutes and regulations related to the operation of the home and for implementation of all statewide policies and procedures;
• Recast existing legislation on the following:
  • Adjust admission criteria so that veterans who have service-connected disabilities rated by the United States Department of Veterans Affairs have priority over veterans without such disabilities;
  • Authorize the Secretary to establish needs-based criteria for admission;
  • Require a resident spouse who continues residency after a veteran spouse’s death to continue to pay all applicable fees and to comply with all department regulations, and would expand those provisions to include domestic partners;
  • Authorize CalVet to determine a resident’s or applicant’s income or suitability for residence at a veterans’ home and would provide that providing false information or failure to pay fees is grounds for financial penalties or discharge from a veterans’ home, and permits the department to contract with any other state or federal agency or private entity to conduct the investigation;
  • Provide that the provision of false financial and other information by an applicant or member or nonpayment of fees may be grounds for financial penalties or denial of admission to, or discharge from, a veterans’ home;
  • Provide that failure to pay fees is cause for the administrator to refer the resident to collections or dismiss the resident from the home;
  • Provide that CalVet may calculate as part of the existing means-based member fees any retroactive benefit payments a home member may receive from the USDVA and may bill the appropriate additional amount of fees;
  • Authorize CalVet to arrange by contract or any other form of agreement with the USDVA to leverage federal contracts for the procurement of goods and services;

Require that the fees and charges be established by the Secretary, rather than by each administrator, and that the Secretary adopt rules and regulations that apply to the homes and the criteria for admission;

• • Increase the amount that may be transferred to the Morale, Recreation, and Relief (MWR) fund upon the death of a veteran in a home if no will or heir or other family member is discovered within a specified number of years after his or her death to $15,000;
  • Increase the amount that may be transferred to the home’s MWR Fund upon the departure of a veteran from a home, if the money is not requested by the veteran within a specified number of years after his or her departure, to $5,000;
  • Make other conforming changes and delete obsolete provisions and references, as specified;
• Make legislative findings and declarations stating that CalVet has initiated the process necessary to implement a statewide Electronic Health Records (EHR) system and state the Legislature’s intent to monitor closely CalVet’s efforts in rolling out their EHR system for the VHC system.

Related Legislation:

SB 980 (Nielsen, 2016), similar to this bill, would have required CalVet to adopt statewide policies and procedures, by regulation, for operation of the state veterans’ home system, implement a statewide EHR system, and correct and update outdated terminology and references in the Military and Veterans Code. This bill died in the Assembly Appropriations committee.

Staff Comments:

Many portions of the Military and Veterans Code are outdated and include obsolete terms and references. This bill would update and standardize the policies and procedures governing the veterans’ homes.

This bill requires the Secretary to develop policies and procedures through regulations for the operations of the homes and, to the extent possible, are required to be in conformity to federal regulations. This requirement would drive additional limited-term costs to CalVet in the low millions but could be more depending upon the complexity of developing these policies and procedures.

-- END --

SENATE JUDICIARY COMMITTEE

Senator Hannah-Beth Jackson, Chair

2017-2018 Regular Session

Bill No: SB 485 (Author:Nielsen)

Version: February 16, 2017

Hearing Date: April 18, 2017

Fiscal: Yes

Urgency: No

Consultant: MS

SUBJECT

Veterans’ homes

DESCRIPTION

Existing law provides for the establishment and operation of veterans’ homes at various sites, and provides for the administration of these homes. This bill would revise and recast those provisions. This bill would specify which veterans’ homes are administered by the Department of Veterans Affairs, CalVet, and would require the Secretary of Veterans Affairs to adopt uniform statewide policies and procedures by regulation. Additionally, this bill would clarify the Secretary of Veteran Affairs authority to adopt, amend, or repeal regulations concerning the administration and operation of the veterans’ homes system. In clarifying this authority, this bill would provide some limitations on the Administrative Procedure Act’s applicability to CalVet’s regulatory process.

This bill also makes legislative findings regarding the Department of Veterans Affairs implementation of a statewide electronic health record (EHR) system and the Legislature’s intention to monitor this effort.

BACKGROUND

The State of California, acknowledging the service and sacrifices California veterans have made, established veterans’ homes to help provide for the state’s aged or disabled veterans. The Veterans Homes Division provides rehabilitative, residential medical care, and other services in a homelike environment for eligible veterans and their spouses. Eight homes in California currently serve over 2,000 veterans.

Many of the homes were built in the last 10 years and the state’s laws and regulations governing the homes are not standardized. Also, some policies and procedures are outdated and need to be updated to reflect the level of care provided at the homes. This bill would clarify CalVet’s authority to adopt, amend, or repeal regulations concerning the administration and operation of the veterans’ homes system, while also updating and standardizing the existing policies that govern these homes. This bill also makes findings and declarations related to CalVet’s implementation of a statewide EHR system and encourages CalVet to meet their goal of implementing the statewide EHR as quickly as possible with a system that reflects best practices and helps ensure a high quality of care.

This bill is similar to SB 980 (Nielsen, 2016) in the revision and recasting of existing law providing for the establishment and operation of veterans’ homes. SB 980 included provisions that would have required the Secretary of Veterans Affairs to implement a statewide EHR for veterans’ homes. Since SB 980 was held in Assembly Appropriations, it seems the Secretary of Veterans Affairs has begun implementing such a system on their own accord. Thus, this bill differs from SB 980 in that it focuses on the Secretary of Veterans Affairs ability to adopt, amend, or repeal regulations concerning the administration and operation of the veterans’ homes system, and makes declarations and findings related to the implementation of CalVet’s statewide EHR system.

CHANGES TO EXISTING LAW

Existing law authorizes the establishment and operation of the Veterans’ Home of California (VHC) system. (Mil. & Vet. Code Sec. 1011.)

Existing law establishes CalVet’s authority and responsibilities in administering the VHC system. (Mil. & Vet. Code Sec. 1011 et seq.)

Existing law defines the criteria for admission to a veteran’s home, requires that home members pay fees and charges as determined by CalVet, and authorizes CalVet to investigate a veteran's financial status for admission purposes. (Mil. & Vet. Code Secs. 1012, 1012.1, 1012.2, 1012.3.)

Existing law authorizes married veteran home members to have their non-veteran spouses live with them, and allows a resident spouse to continue residency after a veteran spouse’s death. (Mil. & Vet. Code Sec. 1012.3.)

Existing law provides for the management of funds received by the VHC system and requires 100 percent of the moneys received by a veterans’ home from veterans receiving federal aid to be placed to the credit of the home to augment the current appropriation for the support of the home. (Mil. & Vet. Code Secs. 1034-1049.)

Existing law provides for veterans’ homes to take up to $3,000 from a deceased resident’s estate if no will or heir is discovered within a set time frame, with any additional funds being distributed to the Morale, Welfare, and Recreation fund if no spouse, child, grandchild, or parent is discovered within five years of the death of the veteran. (Mil. & Vet. Code Sec. 1034.)

Existing law established procedural requirements for the adoption, amendment, or repeal of administrative regulations, including standards to enable public participation in the adoption, amendment, or repeal of an emergency regulation. (Gov. Code Sec. 11346 et seq.)

This bill clarifies CalVet authority to adopt, amend, or repeal regulations concerning the administration and operation of the VHC system, and that, except as otherwise provided, these regulations shall be adopted pursuant to the Administrative Practices Act.

This bill permits CalVet to adopt, amend, and repeal emergency regulations concerning the administration and operation of the VHC. These regulations shall comply with Section 111346.1 of the Government Code, except for when the CalVet Secretary states in writing the following special circumstances:

• the possible loss or delay in the receipt of federal, state, or local funding;
• the need to maintain licensing or certification by any state or federal agency for any Veterans’ Home of California facility or program;
• the need to protect against a serious and immediate threat to the health or safety of residents or staff in one or more of the facilities of the Veterans’ Home of California; or
• the urgent need to comply immediately with recommendations of the Department of Finance or the State Auditor.

This bill requires CalVet to do the following concerning the administration and operation of VHCs:

• ensure that all medical or other facilities under its jurisdiction satisfy all applicable federal and state licensing, certification, and other approval requirements, including, but not limited to, the requirements of the United States Department of Veterans Affairs (USDVA), the federal Centers for Medicare and Medicaid Services, the State Department of Public Health, the State Department of Social Services, and the California State Board of Pharmacy, including preparation of plans of correction as required;
• develop and maintain clinical policies and procedures, including those on community standards for clinical best practices and the appropriate clinical standard of practice, including, but not limited to, practices recommended by the federal Centers for Disease Control and Prevention and the federal Centers for Medicare and Medicaid Services;
• adopt fire and life safety policies and procedures consistent with the requirements of the State Fire Marshal and other applicable regulatory and licensing agencies; and
• adopt earthquake and environmental protection policies and procedures.

This bill requires the Secretary to adopt, by regulation, uniform statewide policies and procedures for the operation of the VHCs that:

• are in conformity, as nearly as possible, with all relevant licensing and certification agencies, including, but not limited to, the United States Department of Veterans Affairs, the federal Centers for Medicare and Medicaid Services, the State Department of Social Services, and the State Department of Public Health, to ensure that adequate care and a homelike environment are provided in a cost-effective manner for members of the homes;
• implement the requirements to obtain and maintain necessary licenses and accreditations, as well as to ensure members in all homes throughout the state, to the extent possible, receive equitable treatment, benefits, and services, and to ensure that high-quality care is provided; and
• include, but are not limited to all of the following:
  • the admission of applicants;
  • the conditions upon which members may enter and remain in the home;
  • resident disciplinary procedures;
  • quality of care standards;
  • an internal quality of care review process;
  • delineating which services will be provided to members by the state;
  • setting staffing standards;
  • staff training requirements;
  • clarifying the relationship between the department and allied councils; and
  • any other policies and procedures to ensure the safe and effective operation of the homes.

This bill would recast existing legislation on the following:

• adjusts admission criteria so that veterans who have service-connected disabilities rated by the United States Department of Veterans Affairs have priority over veterans without such disabilities;
• authorizes the Secretary to establish needs-based criteria for admission;
• requires a resident spouse who continues residency after a veteran spouse’s death to continue to pay all applicable fees and to comply with all department regulations, and would expand those provisions to include domestic partners;
• authorizes CalVet to determine a resident’s or applicant’s income or suitability for residence at a veterans’ home and would provide that providing false information or failure to pay fees is grounds for financial penalties or discharge from a veterans’ home, and permits the department to contract with any other state or federal agency or private entity to conduct the investigation;
• provides that the provision of false financial and other information by an applicant or member or nonpayment of fees may be grounds for financial penalties or denial of admission to, or discharge from, a veterans’ home;
• provides that failure to pay fees is cause for the administrator to refer the resident to collections or dismiss the resident from the home;
• provides that CalVet may calculate as part of the existing means-based member fees any retroactive benefit payments a home member may receive from the USDVA and may bill the appropriate additional amount of fees;
• authorizes CalVet to arrange by contract or any other form of agreement with the USDVA to leverage federal contracts for the procurement of goods and services;
• requires that the fees and charges be established by the Secretary, rather than by each administrator, and that the Secretary adopt rules and regulations that apply to the homes and the criteria for admission;
• increases the amount that may be transferred to the Morale, Recreation, and Relief (MWR) fund upon the death of a veteran in a home if no will or heir or other family member is discovered within a specified number of years after his or her death to $15,000;
• increases the amount that may be transferred to the home’s MWR Fund upon the departure of a veteran from a home, if the money is not requested by the veteran within a specified number of years after his or her departure, to $5,000;
• makes other conforming changes and deletes obsolete provisions and references, as specified.

This bill makes findings and declarations that CalVet has initiated the administrative processes necessary to implement a statewide EHR for the VHC system, as well as that the health care industry has been moving toward the adoption of EHR as the accepted industry standard and specifies the outcome-based evidence supporting that trend.

This bill states the Legislature’s intent to monitor closely the CalVet’s efforts in rolling out their EHR and to encourage the department to meet the goal of implementing a statewide EHR for VHC as quickly as possible with a system that reflects best practices and helps ensure a high quality of care.

COMMENT

1. Stated need for this bill

According to the author:

The veterans’ home system has exploded from three homes to eight homes in the last several years and has become more challenging in terms of guaranteeing quality of care. In general, CalVet has lagged behind other state departments in promulgating regulations that codify its policies and procedures. Major portions of the Military and Veterans Code are outdated and still include archaic and irrelevant terms and references, including numerous provisions within the areas of the [Military and Veterans Code] that govern state veterans’ homes.

SB 485 updates and standardizes the policies and procedures governing California’s eight veterans’ homes to create efficiencies and fairness, and provides proper oversight.

In support, the California Long-Term Care Ombudsman Association (CLTCOA) writes:

Quality care for seniors and a respect for resident’s rights does not happen by accident. SB 485 puts in law the policy and procedures necessary to ensure Veterans receive a standard of care adopted through uniform statewide policies and procedures for the operation of veteran’s homes. The bill has a number of provisions designed to update and standardize the policies and procedures which govern California’s Veterans’ homes. These updates are long overdue and are necessary to ensure administrative consistency for the elderly and dependent Veterans who live in these facilities.

1. Clarifying CalVet’s authority to adopt, amend, or repeal regulations

Much of the focus of this bill relates to added sections to the Military and Veterans Code that confirm and clarify CalVet’s authority to adopt, amend, or repeal regulations relating to the administration and operation of the VHC system. These sections appear to set parameters and provide guidance for where CalVet should be looking when adopting or amending regulations that set standards for the California’s veteran homes, particularly in terms of their medical or clinical policies and procedures. These new sections speak to the applicability of the Administrative Procedure Act (APA), and thus the ability for public participation in the adoption of these standards and policies through regulation.

1. Applicability of the APA

The Administrative Procedure Act (APA) establishes rulemaking procedures and standards for state agencies in California. The requirements set forth in the APA are designed to provide the public with a meaningful opportunity to participate in the adoption of state regulations and to ensure that regulations are clear, necessary, and legally valid. In emergency situations, where the adoption (or repeal) of a regulation is necessary for the immediate preservation of the public peace, health, or safety, an agency is not required to comply with all of the public participation requirements of the APA. (See Gov. Code Sec. 11346.1.) In those situations, the agency is required to take additional action to ensure transparency and subsequent participation by the public.

The APA is particularly important because many state agencies effectively hold legislative, executive, and judicial power over the industries they regulate. Thus, the APA represents the basic level of protection that individuals and entities can expect with respect to rulemaking by state agencies, and agencies should not be able to exempt themselves from its requirements without good justification.

The APA prohibits state agencies from issuing, utilizing, enforcing, or attempting to enforce any guideline, criterion, bulletin, manual, instruction, order, standard of general application, or other rule, which is a regulation, unless that document has been adopted as a regulation and filed with the Secretary of State. (Gov. Code Sec. 11340.5(a).) Further, pursuant to the requirements of the APA and the Insurance Code, an emergency regulation adopted by the Commissioner is subject to the following:

• at least five working days prior to submission of the emergency regulation to the Office of Administrative Law, the Commissioner shall mail a notice of proposed emergency action to every person, group, or association who had previously filed a request for notice of regulatory actions with the commissioner; and
• the notice of proposed emergency action shall include the following:
  • a description of the problem and the necessity for the regulation;
  • a description of the justification for adoption of the regulation as an emergency regulation; and
  • a copy of the text of the proposed emergency regulation. (Gov. Code Sec. 11346.1; Ins. Code Sec. 12921.7.)

In keeping with state policy preference to apply the APA to agencies’ rulemaking processes, proposed section 79.3(a) states, “notwithstanding any other law, the department may adopt, amend, or repeal regulations concerning the administration and operation of the Veterans’ Homes of California. Except as otherwise provided, these regulations shall be adopted pursuant to the Administrative Procedure Act.” This proposed section goes on to say that in certain situations dealing with the adoption, amendment, or repeal of emergency regulations, CalVet procedure may differ from the APA’s provisions for emergency regulations, as set forth in Section 11346.1 of the Government Code. Should the APA provisions for emergency regulation not apply, the Secretary of Veterans Affairs must state in writing, that the adoption, amendment, or repeal is necessary for at least one of the following reasons:

• the possible loss or delay in the receipt of federal, state, or local funding;
• the need to maintain licensing or certification by any state or federal funding for any Veterans’ Home of California facility or program;
• the need to protect against a serious and immediate threat to the health or safety or residents or staff; and/or
• the urgent need to comply immediately with recommendations of the Department of Finance or State Auditor.

These above exceptions do not seem controversial in their avoidance of the APA’s emergency regulation requirements, because they apply only to a narrow set of circumstances related to emergency regulation. Additionally, they require the Secretary to provide reasoning for this circumvention in writing, enabling the public to have notice of the decision and understand the reasoning for this process change.

1. Waiver of the APA

What may be concerning is the exemption from all provisions of the APA for proposed Section 79.4. This proposed section would clarify CalVets’ ability to: take the necessary steps to ensure that all medical or other facilities under its jurisdiction satisfy all applicable federal and state licensing, certification, and other approval requirements; and develop and maintain clinical policies and procedures. This bill goes on to specify that these policies and procedures may look to community standards for best clinical practices and work to develop the appropriate standard of practice. The bill then states that the department may adopt regulations to implement this section, but that such regulations are exempted from the rulemaking provisions of the APA.

When SB 980 (Nielsen, 2016) was considered by this Committee last year, the issue of concern was patient privacy if CalVet implemented an EHR for California’s veterans’ homes. Amendments were added prior to being heard by this Committee to ensure existing privacy protections would be met even with an EHR in place. This was considered necessary because the unique needs of the veteran population, and how information held in a medical record may affect anything from medical treatment, to mental health treatment, to employment prospects, privacy, and accuracy, with regard to veteran patient information, are of the utmost importance.

Additionally, it is well documented that the veteran population has unique needs. Dr. Stephen Hunt, national director of the U.S. Department of Veterans Affairs Post Deployment Integrative Care Initiative, said, “folks returning from combat have a constellation of health concerns, including physical issues, psychological issues and psychosocial issues concerning things like work and family.” Clearly, the wounds of war can go far beyond what meets the eye. From mental health issues to pain and illness that persist long after they have left the battlefield, veterans face a multitude of health troubles more frequent among them than the general population. (Salamon, After the Battle: 7 Health Problems Facing Veterans, Live Science (2010) <http://www.livescience. com/8916-battle-7-health-problems-facing-veterans.html> [as of 4/12/2016].)

These needs suggest that when rulemaking decisions are made regarding clinical practices and medical treatment, those affected may be interested in having the opportunity to weigh in. By exempting these decisions from the APA, this bill may lessen the ability of veterans’ groups and other stakeholders to impact CalVet’s decision process and ensure the highest standards of care are being provided for our elderly and dependent veterans.

To address these concerns the Author suggests the following amendment:

Suggested Amendments:

On page 4, strike out lines 35 through 40 and insert:

(b) The department may adopt regulations to implement this section. The adoption, amendment, or repeal of a regulation authorized by this section shall be adopted pursuant to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).

1. Findings and declarations regarding CalVet’s implementation of EHR

This bill makes legislative findings and declarations as to the health care industry’s use of EHR and how this improves patient care and more efficient health care. A legislative finding and declaration is then made regarding CalVet’s implementation of a statewide EHR for its system of veterans’ homes. The bill then states it is the Legislature’s intent to closely monitor the CalVet’s efforts on this implementation and encourage it meet its goal of implementing a statewide EHR as quickly as possible.

This differs from SB 980 (Nielsen, 2016), which would have required the CalVet implement an EHR system for its veterans’ homes by 2018. By instead providing legislative intent language regarding CalVet’s existing administrative procedures to implement such a system, this bill seems to be avoiding the privacy and costs concerns faced by SB 980.

It should be noted that a 2012 State Auditor Report, highlighted that CalVet’s chief financial auditor spoke to CalVet’s implementation of such a system in 2012 and stated then that they hoped the system would be in all eight veterans’ homes by the end of 2014. (California State Auditor, California Department of Veterans Affairs May 2013 Audit Report,< https://www.bsa.ca.gov/pdfs/reports/2012-119.pdf> [as of March 31, 2017].) This legislative intent language will likely not impact the speed with which CalVet implements an EHR system.

Support: American G.I. Forum of California; American Legion – Department of California; AMVETS – Department of California (Sponsor); California Association of County Veterans Service Officers (Sponsor); California Long-Term Care Ombudsman Association; California State Commanders Veterans Council; Military Officers Association of America, California Council of Chapters; Vietnam Veterans of America-California State Council

Opposition: None Known

HISTORY

Source: AMVETS—Department of California; California Association of County Veterans Service Officers

Related Pending Legislation: None Known

Prior Legislation:

SB 980 (Nielsen, 2016) would have specified which veterans’ homes are administered by the Department of Veterans Affairs and would have required the Secretary of Veterans Affairs to implement a statewide electronic medical record system for veterans’ homes by January 1, 2018. This bill would have recast and updated existing provisions on California’s veterans’ homes, similar to SB 485 (Nielsen, 2017). SB 980 was held in the Assembly Appropriations Committee.

SB 543 (Wolk, Ch. 424, Stat. 2016), with regard to the Veterans Home of California system, creates a single system-wide Morale, Welfare, and Recreation Fund (MWR Fund) that consolidates existing and future MWR moneys generated by individual veterans home campuses, and establishes procedures and restrictions on the budgeting and spending of moneys in the Fund.

SB 1410 (Wolk, Ch. 659, Stat. 2014) requires non-veteran spouses to pay the same fees and charges as paid by veteran members of a veterans’ home, as determined by CalVet, and subjects them to the same prohibitions.

AB 1580 (Yamada, 2014) would have consolidated the separate MWR Funds at each veterans home into a newly created fund in the State Treasury. AB 1580 was held on the Senate floor.

SB 10 (Evans, Chapter 265, Statutes of 2011) provides for the establishment of a Veteran’s Home Allied Council for each veterans home, and additionally permits each council to represent veterans who reside in that same home in matters before the Legislature if each council, in the course of providing that representation, complies with specified requirements.

Prior Vote: Senate Veterans Affairs Committee (Ayes 7, Noes 0)

**************

SENATE COMMITTEE ON VETERANS AFFAIRS

Senator Josh Newman, Chair

2017 - 2018 Regular

Bill No: SB 485 Hearing Date: 3/28/17

Subject: Veterans’ homes

DESCRIPTION

Summary:

This bill requires the California Department of Veterans Affairs (CalVet) to (1) adopt statewide policies and procedures, by regulation, for operation of the state veterans home system; (2) implement a statewide electronic health records (EHR) system; and (3) correct and update outdated terminology and references within the portion of the Military and Veterans Code (MVC) that governs state veterans’ homes.

Existing law:

1. Authorizes establishment and operation of the Veterans’ Home of California (VHC) system.
2. Establishes CalVet’s authority and responsibilities in administering the system.
3. Requires each on-site home administrator to adopt rules and regulations for the administration of each home.
4. Defines criteria for admission to a veterans’ home.
5. Requires that home members (residents) pay fees and charges as determined by CalVet, subject to a specified fee schedule.
6. Authorizes CalVet to investigate a veteran’s financial status for admission purposes.
7. Requires that − upon the death of a veteran in a home – any monies not in excess of $3,000 held by the home for the veteran to be paid to the home’s Morale, Welfare, and Recreation Fund, if no will or heir or other family member is discovered.
8. Authorizes:
   1. Married veteran home members to have their non-veteran spouses domicile with them.
   2. A resident spouse to continue residency after a veteran spouse’s death.
9. Requires 100% of the moneys received by a veterans’ home from veterans receiving federal aid to be placed to the credit of the home to augment the current appropriation for the support of the home.

This bill:

1. Clarifies CalVet authority to adopt, amend, or repeal regulations concerning the administration and operation of the VHC system, and that, except as otherwise provided, these regulations shall be adopted pursuant to the Administrative Practices Act.
2. Permits CalVet to adopt, amend, and repeal emergency regulations concerning the administration and operation of the VHC. These regulations shall be in compliance with Section 11346.1 of the Government Code, except for exemption when the CalVet Secretary states in writing the following special circumstances:
   1. The possible loss or delay in the receipt of federal, state, or local funding.
   2. The need to maintain licensing or certification by any state or federal agency for any Veterans’ Home of California facility or program.
   3. The need to protect against a serious and immediate threat to the health or safety of residents or staff in one or more of the facilities of the Veterans’ Home of California.
   4. The urgent need to comply immediately with recommendations of the Department of Finance or the State Auditor.
3. Requires CalVet to do the following concerning administration and operation:
   1. Ensure that all medical or other facilities under its jurisdiction satisfy all applicable federal and state licensing, certification, and other approval requirements, including, but not limited to, the requirements of the United States Department of Veterans Affairs, the federal Centers for Medicare and Medicaid Services, the State Department of Public Health, the State Department of Social Services, and the California State Board of Pharmacy, including preparation of plans of correction as required.
   2. Develop and maintain clinical policies and procedures, including both of the following:
   3. Community standards for best clinical practices, including, but not limited to, practices recommended by the federal Centers for Disease Control and Prevention and the federal Centers for Medicare and Medicaid Services.
   4. The appropriate clinical standard of practice.
   5. Adopt fire and life safety policies and procedures consistent with the requirements of the State Fire Marshal and other applicable regulatory and licensing agencies.
   6. Adopt earthquake and environmental protection policies and procedures.
4. Requires the Secretary to adopt, by regulation, uniform statewide policies and procedures, for the operation of the homes:
   1. That are in conformity, as nearly as possible, with all relevant licensing and certification agencies, including, but not limited to, the United States Department of Veterans Affairs, the federal Centers for Medicare and Medicaid Services, the State Department of Social Services, and the State Department of Public Health, to ensure that adequate care and a homelike environment is provided in a cost-effective manner for members of the homes.
   2. That implement the requirements to obtain and maintain necessary licenses and accreditations, as well as to ensure members in all homes throughout the state, to the extent possible, receive equitable treatment, benefits, and services, and to ensure that high-quality care is provided.
   3. That include, but are not limited to, all of the following:
5. The admission of applicants.
6. The conditions upon which members may enter and remain in the home.
7. Resident disciplinary procedures.
8. Quality of care standards.
9. An internal quality of care review process.
10. Delineating which services will be provided to members by the state.
11. Setting staffing standards.
12. Staff training requirements.
13. Clarifying the relationship between the department and allied councils.
14. Any other policies and procedures to ensure the safe and effective operation of the homes.
15. Makes findings and declarations that the health care industry has been moving toward adoption of EHR as the accepted industry standard, and that specifies the outcome-based evidence supporting that trend.
16. Makes findings and declarations that CalVet has initiated the administrative processes necessary to implement a statewide EHR for the VHC system.
17. States the Legislature’s intent to monitor closely the department’s efforts and to encourage it to meet the goal of implementing a statewide EHR for VHC as quickly as possible with a system that reflects best practices and helps ensure a high quality of care.
18. Adjusts admission criteria so that veterans who have service-connected disabilities rated by USDVA have priority over veterans without such disabilities.
19. Generally authorizes the Secretary to establish needs-based criteria for admission to veterans’ homes and to prioritize admission for veterans with service-related disabilities, as specified.
20. Requires a resident spouse or domestic partner who continues residency after a veteran spouse’s death to continue to pay all applicable fees and to comply with all department regulations, and would expand those provisions to include domestic partners.
21. Authorizes CalVet to determine a resident’s or applicant’s income or suitability for residence at a veterans’ home and would provide that providing false information or failure to pay fees is grounds for financial penalties or discharge from a veterans’ home. Permits the department to contract with any other state or federal agency or private entity to conduct the investigation.
22. Provides that the provision of false financial and other information by an applicant or member or nonpayment of fees may be grounds for financial penalties or denial of admission to, or discharge from, a veterans’ home.
23. Provides that failure to pay fees is cause for the administrator to refer the resident to collections or dismiss the resident from the home.
24. Provides that CalVet may calculate as part of the existing means-based member fees any retroactive benefit payments a home member may receive from the USDVA and may bill the appropriately additional amount of fees.
25. Authorizes CalVet to arrange by contract or any other form of agreement with the USDVA to leverage federal contracts for the procurement of goods and services.
26. Requires that the fees and charges be established by the Secretary, rather than by each administrator, and that the Secretary adopt rules and regulations that apply to the homes and the criteria for admission.
27. Increases the amount that may be transferred to the MWR fund upon the death of a veteran in a home if no will or heir or other family member is discovered within a specified number of years after his or her death to $15,000.
28. Increases the amount that may be transferred to the home’s MWR Fund upon the departure of a veteran from a home if the money is not requested by the veteran within a specified number of years after his or her departure to $5,000.
29. Makes other conforming changes and would delete obsolete provisions and references, as specified.

BACKGROUND

State Veterans Homes. The State of California provides veterans’ homes to help provide for the state's aged or disabled veterans to acknowledge the service and tremendous sacrifices California veterans have made on behalf of our nation.

CalVet's Veterans Homes Division provides rehabilitative, residential medical care and services in a homelike environment for aged and disabled veterans (and eligible veteran spouses) residing in the State's eight veterans homes, which are located in Barstow, Chula Vista, Fresno, Lancaster. Redding, Ventura, West Los Angeles, and Yountville. As of mid-March 2016, a total of 2,158 members resided in the homes.

Many of the homes were built in the last 10 years and the state’s laws and regulations governing the homes are not standardized. Also, some policies and procedures are outdated and need to be updated to reflect the level of care provided at the homes.

Levels of Care. The eight campuses offer different combinations of the following levels of care that generate increasing levels of cost:

1. Independent living/domiciliary care (Barstow, Chula Vista, Yountville):

This level of care is for residents able to perform activities of daily living with, at most, minimal assistance. Non-nursing employees provide limited supervision. Residents have access to all of the Home's services, activities, and medical care. Individuals can transfer to higher levels of care as needed. Independent living is also referred to as Domiciliary by CalVet and the USDVA.

1. Residential care/assisted living (All homes except Barstow):

Residential Care Facilities for the Elderly (RCFE) are available for residents who require minimal assistance and supervision with some activities of daily living. RCFE services may include care by licensed nurses. In the future, memory care programs may be established within the RCFEs.

1. Intermediate care (Barstow, Yountville):

This level is for residents who often require licensed nursing assistance with medications and treatments, and generally require unlicensed nursing assistance with several daily living activities.

1. Skilled nursing care (Barstow, Chula Vista, Fresno, Redding, West LA, Yountville)

This level of care provides 24-hour services of licensed nurses and certified nursing assistants, and is more comprehensive than intermediate care. Skilled nursing residents have greater access to rehabilitation therapies, nursing care, pharmacy management, structured activities and clinical dietary services.

1. Memory care:

The Fresno, Redding, West LA and Yountville homes provide memory care programs within their skilled nursing facilities.

1. Outpatient clinic:

In addition to the above levels of care, each home provides an outpatient clinic to serve its members. The clinics provide comprehensive multidisciplinary assessments as well as ongoing primary care. The clinics address the veteran's routine care needs and also will arrange visits with outside medical specialists as necessary.​

Electronic Health Records. New technologies and financial incentives have resulted in health care providers increasingly and actively using EHRs. An EHR is an electronic version of a patient‘s medical history, which is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports The EHR automates access to the information and has the potential to streamline clinician workflow. The EHR also has the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.

In 2009, the President signed the American Recovery and Reinvestment Act which included the establishment of the Office of the National Coordinator for Health Information Technology to facilitate and expand the use of health information technology pursuant to national standards. Using EHR systems is intended to reduce medical errors and increase patient accessibility to personal medical information. However, according to Privacy Rights Clearing House, 1263 data breaches involving medical and healthcare providers have been made public since 2005. Those breaches involved over 45 million records. Accordingly, both the state and federal governments continue to enact measures to ensure the protection of patient medical information, and closely monitor legislation involving EHRs.

The Department of Defense and USDVA Information Exchange allows a service member’s EHR to follow the member from inception into the Military Health System through retirement and into care with the USDVA. A majority of VHC home members qualify for USDVA care and would benefit from a state home system that is interoperable with the USDVA system.

COMMENT

Committee Comments:

1. The VHC system consumes nearly 80% of CalVet’s departmental budget and provides direct care for several thousand elderly and disabled veterans and their spouses or domestic partners. The State of California licenses and inspects private nursing homes and the ones that it owns and operates should be the gold standard.
2. This bill is a somewhat scaled-down version of SB 980 (Nielsen), which stalled in Assembly Appropriations in the waning days of the 2016 session year. For example, this bill does not contain SB 980’s mandate that on or before January 1, 2019, the Secretary must implement an EHR system that is standardized across all VHC campus homes. The current bill merely finds and declares that CalVet has initiated the administrative processes necessary to implement a statewide EHR for the VHC system, and states the Legislature’s intent to monitor closely the department’s efforts and to encourage it to meet the goal.

However, according to State Auditor Report 2012-119:

According to CalVet’s chief financial officer, “since 2012 CalVet has been in the process of implementing an electronic health record system at all the veterans homes that will streamline its medical billing process and reduce the chance of human error when preparing electronic claims, enabling it to maintain accurate records of the number of veterans enrolled in federal, state, or private insurance plans, including the Medicare and Medi-Cal programs. The chief financial officer anticipates that the new electronic health record system will be fully operating in all eight veterans homes by the end of 2014.”

Related/Prior Legislation

SB 980 (Nielsen, died Assembly Appropriations Suspense, 2016) bill requires CalVet to (1) adopt statewide policies and procedures, by regulation, for operation of the state veterans home system; (2) implement a statewide EHR system; and (3) correct and update outdated terminology and references within the portion of the MVC that governs state veterans’ homes.

SB 543 (Wolk, pending Assembly, 2016), with regard to the Veterans Home of California system, creates a single system-wide Morale, Welfare, and Recreation Fund (MWR Fund) that consolidates existing and future MWR moneys generated by individual veterans home campuses, and establishes procedures and restrictions on the budgeting and spending of moneys in the Fund.

SB 1410 (Wolk, Chapter 659, Statutes of 2014) requires non-veteran spouses to pay the same fees and charges as paid by veteran members of a veterans’ home, as determined by CalVet, and subjects them to the same prohibitions.

AB 1580 (Yamada, died Senate 3rd Reading, 2014) consolidates the separate MWR Funds at each veterans home into a newly created fund in the State Treasury.

SB 10 (Evans, Chapter 265, Statutes of 2011) provides for the establishment of a Veteran’s Home Allied Council for each veterans home, and would additionally permit each council to represent veterans who reside in that same home in matters before the Legislature if each council, in the course of providing that representation, complies with specified requirements, as prescribed.

POSITIONS

Sponsor: Author.

Support:

American G.I. Forum of California

American Legion - Department of California

AMVETS - Department of California

California Association of County Veterans Service Officers

California Long-Term Care Ombudsman Association

California State Commanders Veteran Council

Military Officers Association of America - California Council of Chapters

Vietnam Veterans of American - California State Council

Oppose: None on file.

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