AB 839: Residential care facilities for the elderly: financing.
- Session Year: 2023-2024
- House: Assembly
- Latest Version Date: 2023-10-10
Current Status:
Passed
(2023-10-10: Chaptered by Secretary of State - Chapter 667, Statutes of 2023.)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Enacted
What does this bill do?
This bill lets the California Health Facilities Financing Authority use state loans, bonds, and grants to finance or refinance residential care facilities for the elderly (RCFEs) — senior care homes that provide housing plus care and supervision — for buying, building, remodeling, furnishing, and related costs. It also lowers the age used to define “elderly” in multilevel facilities from 62 to 60 and authorizes the authority’s fund to be used for RCFE projects, including an appropriation from that fund.
The summary is provided by generative AI which can make mistakes. For original language, please view the details in the table below.
Existing law provides for the licensure and regulation of residential care facilities for the elderly (RCFEs) by the State Department of Social Services.
Under existing law, the California Health Facilities Financing Authority Act, the California Health Facilities Financing Authority is authorized to make and fund loans through the issuance of revenue bonds, and award grants, to finance or refinance projects by participating health institutions, as defined. Under the act, projects include construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility, as defined, or acquisition of a health facility to be financed or refinanced with funds provided in whole or in part pursuant to the act. Under the act, the California Health Facilities Financing Authority Fund is created, with moneys in the fund continuously appropriated to the authority for carrying out the purposes of the act.
This bill would expand the above-described program to include RCFEs by adding an RCFE to the definition of health facility under the program. The bill would make conforming changes to related provisions. The bill would clarify that other provisions under existing law relating to health facilities would not be affected by the expanded definition, as specified.
Under existing law, an RCFE is defined as a housing arrangement chosen voluntarily by persons 60 years of age or over, or their authorized representative, where varying levels and intensities of care, supervision, and certain services are provided, and whereby persons under 60 years of age with compatible needs may be allowed to be admitted or retained in an RCFE, as specified.
Under the California Health Facilities Financing Authority Act, one of the types of health facilities is a multilevel facility, which is an institutional arrangement where an RCFE is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Under that provision, elderly means a person 62 years of age or older.
This bill would modify that definition of elderly to mean a person 60 years of age or older.
By expanding the purpose for which the above-described continuously appropriated fund may be used, with regard to RCFE projects, the bill would make an appropriation from that fund. The bill would make legislative findings relating to the purpose of the bill.
Existing law provides for the licensure and regulation of residential care facilities for the elderly (RCFEs) by the State Department of Social Services.
Under existing law, the California Health Facilities Financing Authority Act, the California Health Facilities Financing Authority is authorized to make and fund loans through the issuance of revenue bonds, and award grants, to finance or refinance projects by participating health institutions, as defined. Under the act, projects include construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility, as defined, or acquisition of a health facility to be financed or refinanced with funds provided in whole or in part pursuant to the act. Under the act, the California Health Facilities Financing Authority Fund is created, with moneys in the fund continuously appropriated to the authority for carrying out the purposes of the act.
This bill would expand the above-described program to include RCFEs by adding an RCFE to the definition of health facility under the program. The bill would make conforming changes to related provisions. The bill would clarify that other provisions under existing law relating to health facilities would not be affected by the expanded definition, as specified.
Under existing law, an RCFE is defined as a housing arrangement chosen voluntarily by persons 60 years of age or over, or their authorized representative, where varying levels and intensities of care, supervision, and certain services are provided, and whereby persons under 60 years of age with compatible needs may be allowed to be admitted or retained in an RCFE, as specified.
Under the California Health Facilities Financing Authority Act, one of the types of health facilities is a multilevel facility, which is an institutional arrangement where an RCFE is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Under that provision, elderly means a person 62 years of age or older.
This bill would modify that definition of elderly to mean a person 60 years of age or older.
By expanding the purpose for which the above-described continuously appropriated fund may be used, with regard to RCFE projects, the bill would make an appropriation from that fund. The bill would make legislative findings relating to the purpose of the bill.
Existing law provides for the licensure and regulation of residential care facilities for the elderly (RCFEs) by the State Department of Social Services.
Existing law, the California Health Facilities Financing Authority Act, authorizes the California Health Facilities Financing Authority to, among other things, make loans from the continuously appropriated California Health Facilities Financing Authority Fund to participating health institutions, as defined, for financing or refinancing the acquisition, construction, or remodeling of health facilities, as defined.Under existing law, the California Health Facilities Financing Authority Act, the California Health Facilities Financing Authority is authorized to make and fund loans through the issuance of revenue bonds, and award grants, to finance or refinance projects by participating health institutions, as defined. Under the act, projects include construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility, as defined, or acquisition of a health facility to be financed or refinanced with funds provided in whole or in part pursuant to the act. Under the act, the California Health Facilities Financing Authority Fund is created, with moneys in the fund continuously appropriated to the authority for carrying out the purposes of the act.
This bill would expand the above-described loan program to include RCFEs by adding an RCFE to the definition of health facility under the program. The bill would make conforming changes to related provisions. The bill would clarify that other provisions under existing law relating to health facilities would not be affected by the expanded definition, as specified.
Under existing law, an RCFE is defined as a housing arrangement chosen voluntarily by persons 60 years of age or over, or their authorized representative, where varying levels and intensities of care, supervision, and certain services are provided, and whereby persons under 60 years of age with compatible needs may be allowed to be admitted or retained in an RCFE, as specified.
Under the California Health Facilities Financing Authority Act, one of the types of health facilities is a multilevel facility, which is an institutional arrangement where an RCFE is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Under that provision, elderly means a person 62 years of age or older.
This bill would modify that definition of elderly to mean a person 60 years of age or older.
By expanding the purpose for which the above-described continuously appropriated fund may be used, with regard to RCFE projects, the bill would make an appropriation from that fund. The bill would make legislative findings relating to the purpose of the bill.
Existing law provides for the licensure and regulation of residential care facilities for the elderly (RCFEs) by the State Department of Social Services.
Existing law, the California Health Facilities Financing Authority Act, authorizes the California Health Facilities Financing Authority to, among other things, make loans from the continuously appropriated California Health Facilities Financing Authority Fund to participating health institutions, as defined, for financing or refinancing the acquisition, construction, or remodeling of health facilities, as defined.
Existing law, the California Health Facility Construction Loan Insurance Law, establishes, without cost to the state, an insurance program for health facility construction, improvement, and expansion loans in order to stimulate the flow of private capital into health facilities construction, improvement, and expansion and in order to rationally meet the need for new, expanded, and modernized public and nonprofit health facilities necessary to protect the health of all the people of this state. Existing law establishes the Health Facility Construction Loan Insurance Fund, to be continuously appropriated to carry out the provisions and administrative costs of the insurance program.This bill would expand the above-described loan and insurance programs program to include RCFEs by adding an RCFE to the definition of health facility under those programs. the program. The bill would make conforming changes to related provisions. The bill would clarify that other provisions under existing law relating to health facilities would not be affected by the expanded definition, as specified.
Under existing law, an RCFE is defined as a housing arrangement chosen voluntarily by persons 60 years of age or over, or their authorized representative, where varying levels and intensities of care, supervision, and certain services are provided, and whereby persons under 60 years of age with compatible needs may be allowed to be admitted or retained in an RCFE, as specified.
Under the California Health Facilities Financing Authority Act, one of the types of health facilities is a multilevel facility, which is an institutional arrangement where an RCFE is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Under that provision, elderly means a person 62 years of age or older.
This bill would modify that definition of elderly to mean a person 60 years of age or older.
By expanding the purpose for which the two above-described continuously appropriated funds fund may be used, with regard to RCFE projects, the bill would make an appropriation from each of those funds. that fund. The bill would make legislative findings relating to the purpose of the bill.
Existing law provides for the licensure and regulation of residential care facilities for the elderly (RCFEs) by the State Department of Social Services.
Existing law, the California Health Facilities Financing Authority Act, authorizes the California Health Facilities Financing Authority to, among other things, make loans from the continuously appropriated California Health Facilities Financing Authority Fund to participating health institutions, as defined, for financing or refinancing the acquisition, construction, or remodeling of health facilities, as defined.
Existing law, the California Health Facility Construction Loan Insurance Law, establishes, without cost to the state, an insurance program for health facility construction, improvement, and expansion loans in order to stimulate the flow of private capital into health facilities construction, improvement, and expansion and in order to rationally meet the need for new, expanded, and modernized public and nonprofit health facilities necessary to protect the health of all the people of this state. Existing law establishes the Health Facility Construction Loan Insurance Fund, to be continuously appropriated to carry out the provisions and administrative costs of the insurance program.
This bill would expand the above-described loan and insurance programs to include RCFEs by adding an RCFE to the definition of health facility under those programs. The bill would make conforming changes to related provisions. By The bill would clarify that other provisions under existing law relating to health facilities would not be affected by the expanded definition, as specified.
Under existing law, an RCFE is defined as a housing arrangement chosen voluntarily by persons 60 years of age or over, or their authorized representative, where varying levels and intensities of care, supervision, and certain services are provided, and whereby persons under 60 years of age with compatible needs may be allowed to be admitted or retained in an RCFE, as specified.
Under the California Health Facilities Financing Authority Act, one of the types of health facilities is a multilevel facility, which is an institutional arrangement where an RCFE is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Under that provision, elderly means a person 62 years of age or older.
This bill would modify that definition of elderly to mean a person 60 years of age or older.
By expanding the purpose for which the two above-described continuously appropriated funds may be used, with regard to RCFE projects, the bill would make an appropriation from each of those funds. The bill would make legislative findings relating to the purpose of the bill.
Existing law provides for the licensure and regulation of residential care facilities for the elderly (RCFEs) by the State Department of Social Services.
Existing law, the California Health Facilities Financing Authority Act, authorizes the California Health Facilities Financing Authority to, among other things, make loans from the continuously appropriated California Health Facilities Financing Authority Fund to participating health institutions, as defined, for financing or refinancing the acquisition, construction, or remodeling of health facilities, as defined.
Existing law, the California Health Facility Construction Loan Insurance Law, establishes, without cost to the state, an insurance program for health facility construction, improvement, and expansion loans in order to stimulate the flow of private capital into health facilities construction, improvement, and expansion and in order to rationally meet the need for new, expanded, and modernized public and nonprofit health facilities necessary to protect the health of all the people of this state. Existing law establishes the Health Facility Construction Loan Insurance Fund, to be continuously appropriated to carry out the provisions and administrative costs of the insurance program.
This bill would expand the above-described loan and insurance programs to include RCFEs by adding an RCFE to the definition of health facility under those programs. The bill would make conforming changes to related provisions. By expanding the purpose for which the two continuously appropriated funds may be used, with regard to RCFE projects, the bill would make an appropriation from each of those funds. The bill would make legislative findings relating to the purpose of the bill.
The Legislature finds and declares that the purpose of this act is to promote the financing or refinancing of the acquisition, construction, and remodeling of residential care facilities for the elderly.
SEC. 2.Section 15432 of the Government Code is amended to read:15432.As used in this part, the following words and terms shall have the following meanings, unless the context clearly indicates or requires another or different meaning or intent:
(a)Act means the California Health Facilities Financing Authority Act.
(b)Authority means the California Health Facilities Financing Authority created by this part or any board, body, commission, department, or officer succeeding to the principal functions thereof or to which the powers conferred upon the authority by this part shall be given by law.
(c)Cost, as applied to a project or portion of a project financed under this part, means and includes all or any part of the cost of construction and acquisition of all lands, structures, real or personal property, rights, rights-of-way, franchises, easements, and interests acquired or used for a project, the cost of demolishing or removing any buildings or structures on land so acquired, including the cost of acquiring any lands to which those buildings or structures may be moved, the cost of all machinery and equipment, financing charges, interest prior to, during, and for a period not to exceed the later of one year or one year following completion of construction, as determined by the authority, the cost of insurance during construction, the cost of funding or financing noncapital expenses, reserves for principal and interest and for extensions, enlargements, additions, replacements, renovations and improvements, the cost of engineering, service contracts, reasonable financial and legal services, plans, specifications, studies, surveys, estimates, administrative expenses, and other expenses of funding or financing, that are necessary or incident to determining the feasibility of constructing any project, or that are incident to the construction, acquisition, or financing of any project.
(d)Health facility means a facility, place, or building that is licensed, accredited, or certified and organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, or physical, mental, or developmental disability, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons, and includes, but is not limited to, all of the following types:
(1)A general acute care hospital that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.
(2)An acute psychiatric hospital that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care for mentally disordered, incompetent, or other patients referred to in Division 5 (commencing with Section 5000) or Division 6 (commencing with Section 6000) of the Welfare and Institutions Code, including the following basic services: medical, nursing, rehabilitative, pharmacy, and dietary services.
(3)A skilled nursing facility that is a health facility that provides the following basic services: skilled nursing care and supportive care to patients whose primary need is for availability or skilled nursing care on an extended basis.
(4)An intermediate care facility that is a health facility that provides the following basic services: inpatient care to ambulatory or semiambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require availability or continuous skilled nursing care.
(5)A special health care facility that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical or dental staff that provides inpatient or outpatient, acute or nonacute care, including, but not limited to, medical, nursing, rehabilitation, dental, or maternity.
(6)A clinic that is operated by a tax-exempt nonprofit corporation that is licensed pursuant to Section 1204 or 1204.1 of the Health and Safety Code or a clinic exempt from licensure pursuant to subdivision (b) or (c) of Section 1206 of the Health and Safety Code.
(7)An adult day health center that is a facility, as defined under subdivision (b) of Section 1570.7 of the Health and Safety Code, that provides adult day health care, as defined under subdivision (a) of Section 1570.7 of the Health and Safety Code.
(8)A facility owned or operated by a local jurisdiction for the provision of county health services.
(9)A multilevel facility is an institutional arrangement where a residential care facility for the elderly is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Elderly, for the purposes of this paragraph, means a person 60 years of age or older.
(10)A child daycare facility operated in conjunction with a health facility. A child daycare facility is a facility, as defined in Section 1596.750 of the Health and Safety Code. For purposes of this paragraph, child means a minor from birth to 18 years of age.
(11)An intermediate care facility/developmentally disabled habilitative that is a health facility, as defined under subdivision (e) of Section 1250 of the Health and Safety Code.
(12)An intermediate care facility/developmentally disabled-nursing that is a health facility, as defined under subdivision (h) of Section 1250 of the Health and Safety Code.
(13)A community care facility that is a facility, as defined under subdivision (a) of Section 1502 of the Health and Safety Code, that provides care, habilitation, rehabilitation, or treatment services to developmentally disabled or mentally impaired persons.
(14)A nonprofit community care facility, as defined in subdivision (a) of Section 1502 of the Health and Safety Code, other than a facility that, as defined in that subdivision, is a foster family agency, a foster family home, a full service adoption agency, or a noncustodial adoption agency.
(15)A nonprofit accredited community work activity program, as specified in subdivision (e) of Section 4851 and Section 4856 of the Welfare and Institutions Code.
(16)A community mental health center, as defined in paragraph (3) of subdivision (b) of Section 5667 of the Welfare and Institutions Code.
(17)A nonprofit speech and hearing center, as defined in Section 1201.5 of the Health and Safety Code.
(18)A blood bank, as defined in Section 1600.2 of the Health and Safety Code, licensed pursuant to Section 1602.5 of the Health and Safety Code, and exempt from federal income taxation pursuant to Section 501(c)(3) of the Internal Revenue Code.
(19)A residential facility for persons with developmental disabilities, as defined in Sections 4688.5 and 4688.6 of the Welfare and Institutions Code, which includes, but is not limited to, a community care facility licensed pursuant to Section 1502 of the Health and Safety Code and a family teaching home as defined in Section 4689.1 of the Welfare and Institutions Code.
(20)(A)A residential care facility for the elderly, as defined in Section 1569.2 of the Health and Safety Code.
(B)This paragraph shall not be construed as affecting the licensing of health facilities under Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code, or any other provisions relating to health facilities, except as the term health facility is interpreted for purposes of the California Health Facilities Financing Authority Act under this part. The designation of a residential care facility for the elderly as a health facility, as made pursuant to this paragraph, shall apply to this part only.
(21)A nonpublic school that provides educational services in conjunction with a health facility, as defined in paragraphs (1) to (20), inclusive, that otherwise qualifies for financing pursuant to this part, if the nonpublic school is certified pursuant to Sections 56366 and 56366.1 of the Education Code as meeting standards relating to the required special education and specified related services and facilities for individuals with physical, mental, or developmental disabilities.
Health facility includes a clinic that is described in subdivision (l) of Section 1206 of the Health and Safety Code.
Health facility includes information systems equipment and the following facilities, if the equipment and facility is operated in conjunction with or to support the services provided in one or more of the facilities specified in paragraphs (1) to (21), inclusive, of this subdivision: a laboratory, laundry, a nurses or interns residence, housing for staff or employees and their families or patients or relatives of patients, a physicians facility, an administration building, a research facility, a maintenance, storage, or utility facility, an information systems facility, all structures or facilities related to any of the foregoing facilities or required or useful for the operation of a health facility and the necessary and usual attendant and related facilities and equipment, and parking and supportive service facilities or structures required or useful for the orderly conduct of the health facility.
Health facility does not include any institution, place, or building used or to be used primarily for sectarian instruction or study or as a place for devotional activities or religious worship.
(e)Participating health institution means a city, city and county, or county, a district hospital, or a private nonprofit corporation or association, or a limited liability company whose sole member is a nonprofit corporation or association authorized by the laws of this state to provide or operate a health facility or a nonprofit corporation that controls or manages, is controlled or managed by, is under common control or management with, or is affiliated with any of the foregoing, and that, pursuant to this part, undertakes the financing or refinancing of the construction or acquisition of a project or of working capital as provided in this part. Participating health institution also includes, for purposes of the California Health Facilities Revenue Bonds (UCSF-Stanford Health Care) 1998 Series A, the Regents of the University of California.
(f)Project means construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility or acquisition of a health facility to be financed or refinanced with funds provided in whole or in part pursuant to this part. Project may include reimbursement for the costs of construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility or acquisition of a health facility. Project may include any combination of one or more of the foregoing undertaken jointly by any participating health institution with one or more other participating health institutions.
(g)Revenue bond or bond means a bond, warrant, note, lease, or installment sale obligation that is evidenced by a certificate of participation or other evidence of indebtedness issued by the authority.
(h)Working capital means moneys to be used by, or on behalf of, a participating health institution to pay or prepay maintenance or operation expenses or any other costs that would be treated as an expense item, under generally accepted accounting principles, in connection with the ownership or operation of a health facility, including, but not limited to, reserves for maintenance or operation expenses, interest for not to exceed two years on any loan for working capital made pursuant to this part, and reserves for debt service with respect to, and any costs necessary or incidental to, that financing.
The Legislature finds and declares that the purpose of this act is to promote the financing or refinancing of the acquisition, construction, and remodeling of residential care facilities for the elderly.
SEC. 2.Section 15432 of the Government Code is amended to read:15432.As used in this part, the following words and terms shall have the following meanings, unless the context clearly indicates or requires another or different meaning or intent:
(a)Act means the California Health Facilities Financing Authority Act.
(b)Authority means the California Health Facilities Financing Authority created by this part or any board, body, commission, department, or officer succeeding to the principal functions thereof or to which the powers conferred upon the authority by this part shall be given by law.
(c)Cost, as applied to a project or portion of a project financed under this part, means and includes all or any part of the cost of construction and acquisition of all lands, structures, real or personal property, rights, rights-of-way, franchises, easements, and interests acquired or used for a project, the cost of demolishing or removing any buildings or structures on land so acquired, including the cost of acquiring any lands to which those buildings or structures may be moved, the cost of all machinery and equipment, financing charges, interest prior to, during, and for a period not to exceed the later of one year or one year following completion of construction, as determined by the authority, the cost of insurance during construction, the cost of funding or financing noncapital expenses, reserves for principal and interest and for extensions, enlargements, additions, replacements, renovations and improvements, the cost of engineering, service contracts, reasonable financial and legal services, plans, specifications, studies, surveys, estimates, administrative expenses, and other expenses of funding or financing, that are necessary or incident to determining the feasibility of constructing any project, or that are incident to the construction, acquisition, or financing of any project.
(d)Health facility means a facility, place, or building that is licensed, accredited, or certified and organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, or physical, mental, or developmental disability, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons, and includes, but is not limited to, all of the following types:
(1)A general acute care hospital that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.
(2)An acute psychiatric hospital that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care for mentally disordered, incompetent, or other patients referred to in Division 5 (commencing with Section 5000) or Division 6 (commencing with Section 6000) of the Welfare and Institutions Code, including the following basic services: medical, nursing, rehabilitative, pharmacy, and dietary services.
(3)A skilled nursing facility that is a health facility that provides the following basic services: skilled nursing care and supportive care to patients whose primary need is for availability or skilled nursing care on an extended basis.
(4)An intermediate care facility that is a health facility that provides the following basic services: inpatient care to ambulatory or semiambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require availability or continuous skilled nursing care.
(5)A special health care facility that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical or dental staff that provides inpatient or outpatient, acute or nonacute care, including, but not limited to, medical, nursing, rehabilitation, dental, or maternity.
(6)A clinic that is operated by a tax-exempt nonprofit corporation that is licensed pursuant to Section 1204 or 1204.1 of the Health and Safety Code or a clinic exempt from licensure pursuant to subdivision (b) or (c) of Section 1206 of the Health and Safety Code.
(7)An adult day health center that is a facility, as defined under subdivision (b) of Section 1570.7 of the Health and Safety Code, that provides adult day health care, as defined under subdivision (a) of Section 1570.7 of the Health and Safety Code.
(8)A facility owned or operated by a local jurisdiction for the provision of county health services.
(9)A multilevel facility is an institutional arrangement where a residential care facility for the elderly is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Elderly, for the purposes of this paragraph, means a person 60 years of age or older.
(10)A child daycare facility operated in conjunction with a health facility. A child daycare facility is a facility, as defined in Section 1596.750 of the Health and Safety Code. For purposes of this paragraph, child means a minor from birth to 18 years of age.
(11)An intermediate care facility/developmentally disabled habilitative that is a health facility, as defined under subdivision (e) of Section 1250 of the Health and Safety Code.
(12)An intermediate care facility/developmentally disabled-nursing that is a health facility, as defined under subdivision (h) of Section 1250 of the Health and Safety Code.
(13)A community care facility that is a facility, as defined under subdivision (a) of Section 1502 of the Health and Safety Code, that provides care, habilitation, rehabilitation, or treatment services to developmentally disabled or mentally impaired persons.
(14)A nonprofit community care facility, as defined in subdivision (a) of Section 1502 of the Health and Safety Code, other than a facility that, as defined in that subdivision, is a foster family agency, a foster family home, a full service adoption agency, or a noncustodial adoption agency.
(15)A nonprofit accredited community work activity program, as specified in subdivision (e) of Section 4851 and Section 4856 of the Welfare and Institutions Code.
(16)A community mental health center, as defined in paragraph (3) of subdivision (b) of Section 5667 of the Welfare and Institutions Code.
(17)A nonprofit speech and hearing center, as defined in Section 1201.5 of the Health and Safety Code.
(18)A blood bank, as defined in Section 1600.2 of the Health and Safety Code, licensed pursuant to Section 1602.5 of the Health and Safety Code, and exempt from federal income taxation pursuant to Section 501(c)(3) of the Internal Revenue Code.
(19)A residential facility for persons with developmental disabilities, as defined in Sections 4688.5 and 4688.6 of the Welfare and Institutions Code, which includes, but is not limited to, a community care facility licensed pursuant to Section 1502 of the Health and Safety Code and a family teaching home as defined in Section 4689.1 of the Welfare and Institutions Code.
(20)(A)A residential care facility for the elderly, as defined in Section 1569.2 of the Health and Safety Code.
(B)This paragraph shall not be construed as affecting the licensing of health facilities under Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code, or any other provisions relating to health facilities, except as the term health facility is interpreted for purposes of the California Health Facilities Financing Authority Act under this part. The designation of a residential care facility for the elderly as a health facility, as made pursuant to this paragraph, shall apply to this part only.
(21)A nonpublic school that provides educational services in conjunction with a health facility, as defined in paragraphs (1) to (20), inclusive, that otherwise qualifies for financing pursuant to this part, if the nonpublic school is certified pursuant to Sections 56366 and 56366.1 of the Education Code as meeting standards relating to the required special education and specified related services and facilities for individuals with physical, mental, or developmental disabilities.
Health facility includes a clinic that is described in subdivision (l) of Section 1206 of the Health and Safety Code.
Health facility includes information systems equipment and the following facilities, if the equipment and facility is operated in conjunction with or to support the services provided in one or more of the facilities specified in paragraphs (1) to (21), inclusive, of this subdivision: a laboratory, laundry, a nurses or interns residence, housing for staff or employees and their families or patients or relatives of patients, a physicians facility, an administration building, a research facility, a maintenance, storage, or utility facility, an information systems facility, all structures or facilities related to any of the foregoing facilities or required or useful for the operation of a health facility and the necessary and usual attendant and related facilities and equipment, and parking and supportive service facilities or structures required or useful for the orderly conduct of the health facility.
Health facility does not include any institution, place, or building used or to be used primarily for sectarian instruction or study or as a place for devotional activities or religious worship.
(e)Participating health institution means a city, city and county, or county, a district hospital, or a private nonprofit corporation or association, or a limited liability company whose sole member is a nonprofit corporation or association authorized by the laws of this state to provide or operate a health facility or a nonprofit corporation that controls or manages, is controlled or managed by, is under common control or management with, or is affiliated with any of the foregoing, and that, pursuant to this part, undertakes the financing or refinancing of the construction or acquisition of a project or of working capital as provided in this part. Participating health institution also includes, for purposes of the California Health Facilities Revenue Bonds (UCSF-Stanford Health Care) 1998 Series A, the Regents of the University of California.
(f)Project means construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility or acquisition of a health facility to be financed or refinanced with funds provided in whole or in part pursuant to this part. Project may include reimbursement for the costs of construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility or acquisition of a health facility. Project may include any combination of one or more of the foregoing undertaken jointly by any participating health institution with one or more other participating health institutions.
(g)Revenue bond or bond means a bond, warrant, note, lease, or installment sale obligation that is evidenced by a certificate of participation or other evidence of indebtedness issued by the authority.
(h)Working capital means moneys to be used by, or on behalf of, a participating health institution to pay or prepay maintenance or operation expenses or any other costs that would be treated as an expense item, under generally accepted accounting principles, in connection with the ownership or operation of a health facility, including, but not limited to, reserves for maintenance or operation expenses, interest for not to exceed two years on any loan for working capital made pursuant to this part, and reserves for debt service with respect to, and any costs necessary or incidental to, that financing.
The Legislature finds and declares that the purpose of this act is to promote the financing or refinancing of the acquisition, construction, and remodeling of residential care facilities for the elderly.
SEC. 2.Section 15432 of the Government Code is amended to read:15432.As used in this part, the following words and terms shall have the following meanings, unless the context clearly indicates or requires another or different meaning or intent:
(a)Act means the California Health Facilities Financing Authority Act.
(b)Authority means the California Health Facilities Financing Authority created by this part or any board, body, commission, department, or officer succeeding to the principal functions thereof or to which the powers conferred upon the authority by this part shall be given by law.
(c)Cost, as applied to a project or portion of a project financed under this part, means and includes all or any part of the cost of construction and acquisition of all lands, structures, real or personal property, rights, rights-of-way, franchises, easements, and interests acquired or used for a project, the cost of demolishing or removing any buildings or structures on land so acquired, including the cost of acquiring any lands to which those buildings or structures may be moved, the cost of all machinery and equipment, financing charges, interest prior to, during, and for a period not to exceed the later of one year or one year following completion of construction, as determined by the authority, the cost of insurance during construction, the cost of funding or financing noncapital expenses, reserves for principal and interest and for extensions, enlargements, additions, replacements, renovations and improvements, the cost of engineering, service contracts, reasonable financial and legal services, plans, specifications, studies, surveys, estimates, administrative expenses, and other expenses of funding or financing, that are necessary or incident to determining the feasibility of constructing any project, or that are incident to the construction, acquisition, or financing of any project.
(d)Health facility means a facility, place, or building that is licensed, accredited, or certified and organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, or physical, mental, or developmental disability, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons, and includes, but is not limited to, all of the following types:
(1)A general acute care hospital that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.
(2)An acute psychiatric hospital that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care for mentally disordered, incompetent, or other patients referred to in Division 5 (commencing with Section 5000) or Division 6 (commencing with Section 6000) of the Welfare and Institutions Code, including the following basic services: medical, nursing, rehabilitative, pharmacy, and dietary services.
(3)A skilled nursing facility that is a health facility that provides the following basic services: skilled nursing care and supportive care to patients whose primary need is for availability or skilled nursing care on an extended basis.
(4)An intermediate care facility that is a health facility that provides the following basic services: inpatient care to ambulatory or semiambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require availability or continuous skilled nursing care.
(5)A special health care facility that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical or dental staff that provides inpatient or outpatient, acute or nonacute care, including, but not limited to, medical, nursing, rehabilitation, dental, or maternity.
(6)A clinic that is operated by a tax-exempt nonprofit corporation that is licensed pursuant to Section 1204 or 1204.1 of the Health and Safety Code or a clinic exempt from licensure pursuant to subdivision (b) or (c) of Section 1206 of the Health and Safety Code.
(7)An adult day health center that is a facility, as defined under subdivision (b) of Section 1570.7 of the Health and Safety Code, that provides adult day health care, as defined under subdivision (a) of Section 1570.7 of the Health and Safety Code.
(8)A facility owned or operated by a local jurisdiction for the provision of county health services.
(9)A multilevel facility is an institutional arrangement where a residential care facility for the elderly is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Elderly, for the purposes of this paragraph, means a person 60 years of age or older.
(10)A child daycare facility operated in conjunction with a health facility. A child daycare facility is a facility, as defined in Section 1596.750 of the Health and Safety Code. For purposes of this paragraph, child means a minor from birth to 18 years of age.
(11)An intermediate care facility/developmentally disabled habilitative that is a health facility, as defined under subdivision (e) of Section 1250 of the Health and Safety Code.
(12)An intermediate care facility/developmentally disabled-nursing that is a health facility, as defined under subdivision (h) of Section 1250 of the Health and Safety Code.
(13)A community care facility that is a facility, as defined under subdivision (a) of Section 1502 of the Health and Safety Code, that provides care, habilitation, rehabilitation, or treatment services to developmentally disabled or mentally impaired persons.
(14)A nonprofit community care facility, as defined in subdivision (a) of Section 1502 of the Health and Safety Code, other than a facility that, as defined in that subdivision, is a foster family agency, a foster family home, a full service adoption agency, or a noncustodial adoption agency.
(15)A nonprofit accredited community work activity program, as specified in subdivision (e) of Section 4851 and Section 4856 of the Welfare and Institutions Code.
(16)A community mental health center, as defined in paragraph (3) of subdivision (b) of Section 5667 of the Welfare and Institutions Code.
(17)A nonprofit speech and hearing center, as defined in Section 1201.5 of the Health and Safety Code.
(18)A blood bank, as defined in Section 1600.2 of the Health and Safety Code, licensed pursuant to Section 1602.5 of the Health and Safety Code, and exempt from federal income taxation pursuant to Section 501(c)(3) of the Internal Revenue Code.
(19)A residential facility for persons with developmental disabilities, as defined in Sections 4688.5 and 4688.6 of the Welfare and Institutions Code, which includes, but is not limited to, a community care facility licensed pursuant to Section 1502 of the Health and Safety Code and a family teaching home as defined in Section 4689.1 of the Welfare and Institutions Code.
(20)(A)A residential care facility for the elderly, as defined in Section 1569.2 of the Health and Safety Code, through the use of special funds in accordance with this part. Code.
(B)This paragraph shall not be construed as affecting the licensing of health facilities under Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code, or any other provisions relating to health facilities, except as the term health facility is interpreted for purposes of the California Health Facilities Financing Authority Act under this part. The designation of a residential care facility for the elderly as a health facility, as made pursuant to this paragraph, shall apply to this part only.
(21)A nonpublic school that provides educational services in conjunction with a health facility, as defined in paragraphs (1) to (20), inclusive, that otherwise qualifies for financing pursuant to this part, if the nonpublic school is certified pursuant to Sections 56366 and 56366.1 of the Education Code as meeting standards relating to the required special education and specified related services and facilities for individuals with physical, mental, or developmental disabilities.
Health facility includes a clinic that is described in subdivision (l) of Section 1206 of the Health and Safety Code.
Health facility includes information systems equipment and the following facilities, if the equipment and facility is operated in conjunction with or to support the services provided in one or more of the facilities specified in paragraphs (1) to (21), inclusive, of this subdivision: a laboratory, laundry, a nurses or interns residence, housing for staff or employees and their families or patients or relatives of patients, a physicians facility, an administration building, a research facility, a maintenance, storage, or utility facility, an information systems facility, all structures or facilities related to any of the foregoing facilities or required or useful for the operation of a health facility and the necessary and usual attendant and related facilities and equipment, and parking and supportive service facilities or structures required or useful for the orderly conduct of the health facility.
Health facility does not include any institution, place, or building used or to be used primarily for sectarian instruction or study or as a place for devotional activities or religious worship.
(e)Participating health institution means a city, city and county, or county, a district hospital, or a private nonprofit corporation or association, or a limited liability company whose sole member is a nonprofit corporation or association authorized by the laws of this state to provide or operate a health facility or a nonprofit corporation that controls or manages, is controlled or managed by, is under common control or management with, or is affiliated with any of the foregoing, and that, pursuant to this part, undertakes the financing or refinancing of the construction or acquisition of a project or of working capital as provided in this part. Participating health institution also includes, for purposes of the California Health Facilities Revenue Bonds (UCSF-Stanford Health Care) 1998 Series A, the Regents of the University of California.
(f)Project means construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility or acquisition of a health facility to be financed or refinanced with funds provided in whole or in part pursuant to this part. Project may include reimbursement for the costs of construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility or acquisition of a health facility. Project may include any combination of one or more of the foregoing undertaken jointly by any participating health institution with one or more other participating health institutions.
(g)Revenue bond or bond means a bond, warrant, note, lease, or installment sale obligation that is evidenced by a certificate of participation or other evidence of indebtedness issued by the authority.
(h)Working capital means moneys to be used by, or on behalf of, a participating health institution to pay or prepay maintenance or operation expenses or any other costs that would be treated as an expense item, under generally accepted accounting principles, in connection with the ownership or operation of a health facility, including, but not limited to, reserves for maintenance or operation expenses, interest for not to exceed two years on any loan for working capital made pursuant to this part, and reserves for debt service with respect to, and any costs necessary or incidental to, that financing.
The Legislature finds and declares that the purpose of this act is to promote the financing or refinancing of the acquisition, construction, remodeling, improvement, or expansion and remodeling of residential care facilities for the elderly.
SEC. 2.Section 15432 of the Government Code is amended to read:15432.As used in this part, the following words and terms shall have the following meanings, unless the context clearly indicates or requires another or different meaning or intent:
(a)Act means the California Health Facilities Financing Authority Act.
(b)Authority means the California Health Facilities Financing Authority created by this part or any board, body, commission, department, or officer succeeding to the principal functions thereof or to which the powers conferred upon the authority by this part shall be given by law.
(c)Cost, as applied to a project or portion of a project financed under this part, means and includes all or any part of the cost of construction and acquisition of all lands, structures, real or personal property, rights, rights-of-way, franchises, easements, and interests acquired or used for a project, the cost of demolishing or removing any buildings or structures on land so acquired, including the cost of acquiring any lands to which those buildings or structures may be moved, the cost of all machinery and equipment, financing charges, interest prior to, during, and for a period not to exceed the later of one year or one year following completion of construction, as determined by the authority, the cost of insurance during construction, the cost of funding or financing noncapital expenses, reserves for principal and interest and for extensions, enlargements, additions, replacements, renovations and improvements, the cost of engineering, service contracts, reasonable financial and legal services, plans, specifications, studies, surveys, estimates, administrative expenses, and other expenses of funding or financing, that are necessary or incident to determining the feasibility of constructing any project, or that are incident to the construction, acquisition, or financing of any project.
(d)Health facility means a facility, place, or building that is licensed, accredited, or certified and organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, or physical, mental, or developmental disability, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons, and includes, but is not limited to, all of the following types:
(1)A general acute care hospital that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.
(2)An acute psychiatric hospital that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care for mentally disordered, incompetent, or other patients referred to in Division 5 (commencing with Section 5000) or Division 6 (commencing with Section 6000) of the Welfare and Institutions Code, including the following basic services: medical, nursing, rehabilitative, pharmacy, and dietary services.
(3)A skilled nursing facility that is a health facility that provides the following basic services: skilled nursing care and supportive care to patients whose primary need is for availability or skilled nursing care on an extended basis.
(4)An intermediate care facility that is a health facility that provides the following basic services: inpatient care to ambulatory or semiambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require availability or continuous skilled nursing care.
(5)A special health care facility that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical or dental staff that provides inpatient or outpatient, acute or nonacute care, including, but not limited to, medical, nursing, rehabilitation, dental, or maternity.
(6)A clinic that is operated by a tax-exempt nonprofit corporation that is licensed pursuant to Section 1204 or 1204.1 of the Health and Safety Code or a clinic exempt from licensure pursuant to subdivision (b) or (c) of Section 1206 of the Health and Safety Code.
(7)An adult day health center that is a facility, as defined under subdivision (b) of Section 1570.7 of the Health and Safety Code, that provides adult day health care, as defined under subdivision (a) of Section 1570.7 of the Health and Safety Code.
(8)A facility owned or operated by a local jurisdiction for the provision of county health services.
(9)A multilevel facility is an institutional arrangement where a residential care facility for the elderly is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Elderly, for the purposes of this paragraph, means a person 60 years of age or older.
(10)A child daycare facility operated in conjunction with a health facility. A child daycare facility is a facility, as defined in Section 1596.750 of the Health and Safety Code. For purposes of this paragraph, child means a minor from birth to 18 years of age.
(11)An intermediate care facility/developmentally disabled habilitative that is a health facility, as defined under subdivision (e) of Section 1250 of the Health and Safety Code.
(12)An intermediate care facility/developmentally disabled-nursing that is a health facility, as defined under subdivision (h) of Section 1250 of the Health and Safety Code.
(13)A community care facility that is a facility, as defined under subdivision (a) of Section 1502 of the Health and Safety Code, that provides care, habilitation, rehabilitation, or treatment services to developmentally disabled or mentally impaired persons.
(14)A nonprofit community care facility, as defined in subdivision (a) of Section 1502 of the Health and Safety Code, other than a facility that, as defined in that subdivision, is a foster family agency, a foster family home, a full service adoption agency, or a noncustodial adoption agency.
(15)A nonprofit accredited community work activity program, as specified in subdivision (e) of Section 4851 and Section 4856 of the Welfare and Institutions Code.
(16)A community mental health center, as defined in paragraph (3) of subdivision (b) of Section 5667 of the Welfare and Institutions Code.
(17)A nonprofit speech and hearing center, as defined in Section 1201.5 of the Health and Safety Code.
(18)A blood bank, as defined in Section 1600.2 of the Health and Safety Code, licensed pursuant to Section 1602.5 of the Health and Safety Code, and exempt from federal income taxation pursuant to Section 501(c)(3) of the Internal Revenue Code.
(19)A residential facility for persons with developmental disabilities, as defined in Sections 4688.5 and 4688.6 of the Welfare and Institutions Code, which includes, but is not limited to, a community care facility licensed pursuant to Section 1502 of the Health and Safety Code and a family teaching home as defined in Section 4689.1 of the Welfare and Institutions Code.
(20)(A)A residential care facility for the elderly, as defined in Section 1569.2 of the Health and Safety Code, through the use of special funds in accordance with this part.
(B)This paragraph shall not be construed as affecting the licensing of health facilities under Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code, or any other provisions relating to health facilities, except as the term health facility is interpreted for purposes of the California Health Facilities Financing Authority Act under this part and any incidental purposes of the Health Facility Construction Loan Insurance Law under Chapter 1 (commencing with Section 129000) of Part 6 of Division 107 of the Health and Safety Code. part.
(21)A nonpublic school that provides educational services in conjunction with a health facility, as defined in paragraphs (1) to (20), inclusive, that otherwise qualifies for financing pursuant to this part, if the nonpublic school is certified pursuant to Sections 56366 and 56366.1 of the Education Code as meeting standards relating to the required special education and specified related services and facilities for individuals with physical, mental, or developmental disabilities.
Health facility includes a clinic that is described in subdivision (l) of Section 1206 of the Health and Safety Code.
Health facility includes information systems equipment and the following facilities, if the equipment and facility is operated in conjunction with or to support the services provided in one or more of the facilities specified in paragraphs (1) to (21), inclusive, of this subdivision: a laboratory, laundry, a nurses or interns residence, housing for staff or employees and their families or patients or relatives of patients, a physicians facility, an administration building, a research facility, a maintenance, storage, or utility facility, an information systems facility, all structures or facilities related to any of the foregoing facilities or required or useful for the operation of a health facility and the necessary and usual attendant and related facilities and equipment, and parking and supportive service facilities or structures required or useful for the orderly conduct of the health facility.
Health facility does not include any institution, place, or building used or to be used primarily for sectarian instruction or study or as a place for devotional activities or religious worship.
(e)Participating health institution means a city, city and county, or county, a district hospital, or a private nonprofit corporation or association, or a limited liability company whose sole member is a nonprofit corporation or association authorized by the laws of this state to provide or operate a health facility or a nonprofit corporation that controls or manages, is controlled or managed by, is under common control or management with, or is affiliated with any of the foregoing, and that, pursuant to this part, undertakes the financing or refinancing of the construction or acquisition of a project or of working capital as provided in this part. Participating health institution also includes, for purposes of the California Health Facilities Revenue Bonds (UCSF-Stanford Health Care) 1998 Series A, the Regents of the University of California.
(f)Project means construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility or acquisition of a health facility to be financed or refinanced with funds provided in whole or in part pursuant to this part. Project may include reimbursement for the costs of construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility or acquisition of a health facility. Project may include any combination of one or more of the foregoing undertaken jointly by any participating health institution with one or more other participating health institutions.
(g)Revenue bond or bond means a bond, warrant, note, lease, or installment sale obligation that is evidenced by a certificate of participation or other evidence of indebtedness issued by the authority.
(h)Working capital means moneys to be used by, or on behalf of, a participating health institution to pay or prepay maintenance or operation expenses or any other costs that would be treated as an expense item, under generally accepted accounting principles, in connection with the ownership or operation of a health facility, including, but not limited to, reserves for maintenance or operation expenses, interest for not to exceed two years on any loan for working capital made pursuant to this part, and reserves for debt service with respect to, and any costs necessary or incidental to, that financing.
SEC. 3.Section 129010 of the Health and Safety Code is amended to read:129010.Unless the context otherwise requires, the definitions in this section govern the construction of this chapter and of Section 32127.2.(a)Bondholder means the legal owner of a bond or other evidence of indebtedness issued by a political subdivision or a nonprofit corporation.(b)Borrower means a political subdivision or nonprofit corporation that has secured or intends to secure a loan for the construction of a health facility.(c)Construction, improvement, or expansion or construction, improvement, and expansion includes construction of new buildings, expansion, modernization, renovation, remodeling and alteration of existing buildings, acquisition of existing buildings or health facilities, and initial or additional equipping of any of these buildings.In connection therewith, construction, improvement, or expansion or construction, improvement, and expansion includes the cost of construction or acquisition of all structures, including parking facilities, real or personal property, rights, rights-of-way, the cost of demolishing or removing any buildings or structures on land so acquired, including the cost of acquiring any land where the buildings or structures may be moved, the cost of all machinery and equipment, financing charges, interest (prior to, during and for a period after completion of the construction), provisions for working capital, reserves for principal and interest and for extensions, enlargements, additions, replacements, renovations and improvements, cost of engineering, financial and legal services, plans, specifications, studies, surveys, estimates of cost and of revenues, administrative expenses, expenses necessary or incident to determining the feasibility or practicability of constructing or incident to the construction; or the financing of the construction or acquisition.(d)Committee means the Advisory Loan Insurance Committee.(e)Debenture means any form of written evidence of indebtedness issued by the State Treasurer pursuant to this chapter, as authorized by Section 4 of Article XVI of the California Constitution.(f)Fund means the Health Facility Construction Loan Insurance Fund.(g)Health facility means any facility providing or designed to provide services for the acute, convalescent, and chronically ill and impaired, including, but not limited to, public health centers, community mental health centers, facilities for the developmentally disabled, nonprofit community care facilities that provide care, habilitation, rehabilitation or treatment to developmentally disabled persons, facilities for the treatment of chemical dependency, including a community care facility, licensed pursuant to Chapter 3 (commencing with Section 1500) of Division 2, a clinic, as defined pursuant to Chapter 1 (commencing with Section 1200) of Division 2, an alcoholism recovery facility, defined pursuant to former Section 11834.11, and a structure located adjacent or attached to another type of health facility and that is used for storage of materials used in the treatment of chemical dependency, and general tuberculosis, mental, and other types of hospitals and related facilities, such as laboratories, outpatient departments, extended care, nurses home and training facilities, offices and central service facilities operated in connection with hospitals, diagnostic or treatment centers, extended care facilities, nursing homes, and rehabilitation facilities. Health facility also means an adult day health center, a multilevel facility, and a residential care facility for the elderly. Except for facilities for the developmentally disabled, facilities for the treatment of chemical dependency, a multilevel facility, or a residential care facility for the elderly, or as otherwise provided in this subdivision, health facility does not include any institution furnishing primarily domiciliary care.Health facility also means accredited nonprofit work activity programs as defined in subdivision (e) of Section 4851 and Section 4856 of the Welfare and Institutions Code, and nonprofit community care facilities as defined in Section 1502, excluding foster family homes, foster family agencies, and adoption agencies.Unless the context dictates otherwise, health facility includes a political subdivision of the state or nonprofit corporation that operates a facility included within the definition set forth in this subdivision.(h)Department means the Department of Health Care Access and Information.(i)Lender means the provider of a loan and its successors and assigns.(j)Loan means money or credit advanced for the costs of construction or expansion of the health facility, and includes both initial loans and loans secured upon refinancing and may include both interim, or short-term loans, and long-term loans. A duly authorized bond or bond issue, or an installment sale agreement, may constitute a loan.(k)Maturity date means the date that the loan indebtedness would be extinguished if paid in accordance with periodic payments provided for by the terms of the loan.(l)Mortgage means a first mortgage on real estate. Mortgage includes a first deed of trust.(m)Mortgagee includes a lender whose loan is secured by a mortgage. Mortgagee includes a beneficiary of a deed of trust.(n)Mortgagor includes a borrower, a loan to whom is secured by a mortgage, and the trustor of a deed of trust.(o)Nonprofit corporation means any corporation formed under or subject to the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 1 of the Corporations Code) that is organized for the purpose of owning and operating a health facility and that also meets the requirements of Section 501(c)(3) of the Internal Revenue Code.(p)Political subdivision means any city, county, joint powers entity, local hospital district, or the California Health Facilities Authority.(q)Project property means the real property where the health facility is, or is to be, constructed, improved, or expanded, and also means the health facility and the initial equipment in that health facility.(r)Public health facility means any health facility that is or will be constructed for and operated and maintained by any city, county, or local hospital district.(s)Adult day health center means a facility defined under subdivision (b) of Section 1570.7, that provides adult day health care, as defined under subdivision (a) of Section 1570.7.(t)Multilevel facility means an institutional arrangement where a residential care facility for the elderly is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Elderly, for the purposes of this subdivision, means a person 60 years of age or older.(u)State plan means the plan described in Section 129020.(v)(1)Residential care facility for the elderly has the same meaning as set forth in Section 1569.2.(2)This subdivision, and the reference to residential care facilities for the elderly in subdivision (g), shall not be construed as affecting the licensing of health facilities under Chapter 2 (commencing with Section 1250) of Division 2, or any other provisions relating to health facilities, except as the term health facility is interpreted for purposes of the Health Facility Construction Loan Insurance Law under this chapter and any incidental purposes of the California Health Facilities Financing Authority Act under Part 7.2 (commencing with Section 15430) of Division 3 of Title 2 of the Government Code.The Legislature finds and declares that the purpose of this act is to promote the financing or refinancing of the acquisition, construction, remodeling, improvement, or expansion of residential care facilities for the elderly.
SEC. 2.Section 15432 of the Government Code is amended to read:15432.As used in this part, the following words and terms shall have the following meanings, unless the context clearly indicates or requires another or different meaning or intent:
(a)Act means the California Health Facilities Financing Authority Act.
(b)Authority means the California Health Facilities Financing Authority created by this part or any board, body, commission, department, or officer succeeding to the principal functions thereof or to which the powers conferred upon the authority by this part shall be given by law.
(c)Cost, as applied to a project or portion of a project financed under this part, means and includes all or any part of the cost of construction and acquisition of all lands, structures, real or personal property, rights, rights-of-way, franchises, easements, and interests acquired or used for a project, the cost of demolishing or removing any buildings or structures on land so acquired, including the cost of acquiring any lands to which those buildings or structures may be moved, the cost of all machinery and equipment, financing charges, interest prior to, during, and for a period not to exceed the later of one year or one year following completion of construction, as determined by the authority, the cost of insurance during construction, the cost of funding or financing noncapital expenses, reserves for principal and interest and for extensions, enlargements, additions, replacements, renovations and improvements, the cost of engineering, service contracts, reasonable financial and legal services, plans, specifications, studies, surveys, estimates, administrative expenses, and other expenses of funding or financing, that are necessary or incident to determining the feasibility of constructing any project, or that are incident to the construction, acquisition, or financing of any project.
(d)Health facility means a facility, place, or building that is licensed, accredited, or certified and organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, or physical, mental, or developmental disability, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons, and includes, but is not limited to, all of the following types:
(1)A general acute care hospital that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.
(2)An acute psychiatric hospital that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care for mentally disordered, incompetent, or other patients referred to in Division 5 (commencing with Section 5000) or Division 6 (commencing with Section 6000) of the Welfare and Institutions Code, including the following basic services: medical, nursing, rehabilitative, pharmacy, and dietary services.
(3)A skilled nursing facility that is a health facility that provides the following basic services: skilled nursing care and supportive care to patients whose primary need is for availability or skilled nursing care on an extended basis.
(4)An intermediate care facility that is a health facility that provides the following basic services: inpatient care to ambulatory or semiambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require availability or continuous skilled nursing care.
(5)A special health care facility that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical or dental staff that provides inpatient or outpatient, acute or nonacute care, including, but not limited to, medical, nursing, rehabilitation, dental, or maternity.
(6)A clinic that is operated by a tax-exempt nonprofit corporation that is licensed pursuant to Section 1204 or 1204.1 of the Health and Safety Code or a clinic exempt from licensure pursuant to subdivision (b) or (c) of Section 1206 of the Health and Safety Code.
(7)An adult day health center that is a facility, as defined under subdivision (b) of Section 1570.7 of the Health and Safety Code, that provides adult day health care, as defined under subdivision (a) of Section 1570.7 of the Health and Safety Code.
(8)A facility owned or operated by a local jurisdiction for the provision of county health services.
(9)A multilevel facility is an institutional arrangement where a residential care facility for the elderly is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Elderly, for the purposes of this paragraph, means a person 62 60 years of age or older.
(10)A child day care daycare facility operated in conjunction with a health facility. A child day care daycare facility is a facility, as defined in Section 1596.750 of the Health and Safety Code. For purposes of this paragraph, child means a minor from birth to 18 years of age.
(11)An intermediate care facility/developmentally disabled habilitative that is a health facility, as defined under subdivision (e) of Section 1250 of the Health and Safety Code.
(12)An intermediate care facility/developmentally disabled-nursing that is a health facility, as defined under subdivision (h) of Section 1250 of the Health and Safety Code.
(13)A community care facility that is a facility, as defined under subdivision (a) of Section 1502 of the Health and Safety Code, that provides care, habilitation, rehabilitation, or treatment services to developmentally disabled or mentally impaired persons.
(14)A nonprofit community care facility, as defined in subdivision (a) of Section 1502 of the Health and Safety Code, other than a facility that, as defined in that subdivision, is a foster family agency, a foster family home, a full service adoption agency, or a noncustodial adoption agency.
(15)A nonprofit accredited community work activity program, as specified in subdivision (e) of Section 4851 and Section 4856 of the Welfare and Institutions Code.
(16)A community mental health center, as defined in paragraph (3) of subdivision (b) of Section 5667 of the Welfare and Institutions Code.
(17)A nonprofit speech and hearing center, as defined in Section 1201.5 of the Health and Safety Code.
(18)A blood bank, as defined in Section 1600.2 of the Health and Safety Code, licensed pursuant to Section 1602.5 of the Health and Safety Code, and exempt from federal income taxation pursuant to Section 501(c)(3) of the Internal Revenue Code.
(19)A residential facility for persons with developmental disabilities, as defined in Sections 4688.5 and 4688.6 of the Welfare and Institutions Code, which includes, but is not limited to, a community care facility licensed pursuant to Section 1502 of the Health and Safety Code and a family teaching home as defined in Section 4689.1 of the Welfare and Institutions Code.
(20)(A)A residential care facility for the elderly, as defined in Section 1569.2 of the Health and Safety Code, through the use of special funds in accordance with this part.
(B)This paragraph shall not be construed as affecting the licensing of health facilities under Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code, or any other provisions relating to health facilities, except as the term health facility is interpreted for purposes of the California Health Facilities Financing Authority Act under this part and any incidental purposes of the Health Facility Construction Loan Insurance Law under Chapter 1 (commencing with Section 129000) of Part 6 of Division 107 of the Health and Safety Code.
(21)A nonpublic school that provides educational services in conjunction with a health facility, as defined in paragraphs (1) to (20), inclusive, that otherwise qualifies for financing pursuant to this part, if the nonpublic school is certified pursuant to Sections 56366 and 56366.1 of the Education Code as meeting standards relating to the required special education and specified related services and facilities for individuals with physical, mental, or developmental disabilities.
Health facility includes a clinic that is described in subdivision (l) of Section 1206 of the Health and Safety Code.
Health facility includes information systems equipment and the following facilities, if the equipment and facility is operated in conjunction with or to support the services provided in one or more of the facilities specified in paragraphs (1) to (21), inclusive, of this subdivision: a laboratory, laundry, a nurses or interns residence, housing for staff or employees and their families or patients or relatives of patients, a physicians facility, an administration building, a research facility, a maintenance, storage, or utility facility, an information systems facility, all structures or facilities related to any of the foregoing facilities or required or useful for the operation of a health facility and the necessary and usual attendant and related facilities and equipment, and parking and supportive service facilities or structures required or useful for the orderly conduct of the health facility.
Health facility does not include any institution, place, or building used or to be used primarily for sectarian instruction or study or as a place for devotional activities or religious worship.
(e)Participating health institution means a city, city and county, or county, a district hospital, or a private nonprofit corporation or association, or a limited liability company whose sole member is a nonprofit corporation or association authorized by the laws of this state to provide or operate a health facility or a nonprofit corporation that controls or manages, is controlled or managed by, is under common control or management with, or is affiliated with any of the foregoing, and that, pursuant to this part, undertakes the financing or refinancing of the construction or acquisition of a project or of working capital as provided in this part. Participating health institution also includes, for purposes of the California Health Facilities Revenue Bonds (UCSF-Stanford Health Care) 1998 Series A, the Regents of the University of California.
(f)Project means construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility or acquisition of a health facility to be financed or refinanced with funds provided in whole or in part pursuant to this part. Project may include reimbursement for the costs of construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility or acquisition of a health facility. Project may include any combination of one or more of the foregoing undertaken jointly by any participating health institution with one or more other participating health institutions.
(g)Revenue bond or bond means a bond, warrant, note, lease, or installment sale obligation that is evidenced by a certificate of participation or other evidence of indebtedness issued by the authority.
(h)Working capital means moneys to be used by, or on behalf of, a participating health institution to pay or prepay maintenance or operation expenses or any other costs that would be treated as an expense item, under generally accepted accounting principles, in connection with the ownership or operation of a health facility, including, but not limited to, reserves for maintenance or operation expenses, interest for not to exceed two years on any loan for working capital made pursuant to this part, and reserves for debt service with respect to, and any costs necessary or incidental to, that financing.
SEC. 3.Section 129010 of the Health and Safety Code is amended to read:129010.Unless the context otherwise requires, the definitions in this section govern the construction of this chapter and of Section 32127.2.
(a)Bondholder means the legal owner of a bond or other evidence of indebtedness issued by a political subdivision or a nonprofit corporation.
(b)Borrower means a political subdivision or nonprofit corporation that has secured or intends to secure a loan for the construction of a health facility.
(c)Construction, improvement, or expansion or construction, improvement, and expansion includes construction of new buildings, expansion, modernization, renovation, remodeling and alteration of existing buildings, acquisition of existing buildings or health facilities, and initial or additional equipping of any of these buildings.
In connection therewith, construction, improvement, or expansion or construction, improvement, and expansion includes the cost of construction or acquisition of all structures, including parking facilities, real or personal property, rights, rights-of-way, the cost of demolishing or removing any buildings or structures on land so acquired, including the cost of acquiring any land where the buildings or structures may be moved, the cost of all machinery and equipment, financing charges, interest (prior to, during and for a period after completion of the construction), provisions for working capital, reserves for principal and interest and for extensions, enlargements, additions, replacements, renovations and improvements, cost of engineering, financial and legal services, plans, specifications, studies, surveys, estimates of cost and of revenues, administrative expenses, expenses necessary or incident to determining the feasibility or practicability of constructing or incident to the construction; or the financing of the construction or acquisition.
(d)Committee means the Advisory Loan Insurance Committee.
(e)Debenture means any form of written evidence of indebtedness issued by the State Treasurer pursuant to this chapter, as authorized by Section 4 of Article XVI of the California Constitution.
(f)Fund means the Health Facility Construction Loan Insurance Fund.
(g)Health facility means any facility providing or designed to provide services for the acute, convalescent, and chronically ill and impaired, including, but not limited to, public health centers, community mental health centers, facilities for the developmentally disabled, nonprofit community care facilities that provide care, habilitation, rehabilitation or treatment to developmentally disabled persons, facilities for the treatment of chemical dependency, including a community care facility, licensed pursuant to Chapter 3 (commencing with Section 1500) of Division 2, a clinic, as defined pursuant to Chapter 1 (commencing with Section 1200) of Division 2, an alcoholism recovery facility, defined pursuant to former Section 11834.11, and a structure located adjacent or attached to another type of health facility and that is used for storage of materials used in the treatment of chemical dependency, and general tuberculosis, mental, and other types of hospitals and related facilities, such as laboratories, outpatient departments, extended care, nurses home and training facilities, offices and central service facilities operated in connection with hospitals, diagnostic or treatment centers, extended care facilities, nursing homes, and rehabilitation facilities. Health facility also means an adult day health center, a multilevel facility, and a residential care facility for the elderly. Except for facilities for the developmentally disabled, facilities for the treatment of chemical dependency, a multilevel facility, or a residential care facility for the elderly, or as otherwise provided in this subdivision, health facility does not include any institution furnishing primarily domiciliary care.
Health facility also means accredited nonprofit work activity programs as defined in subdivision (e) of Section 4851 and Section 4856 of the Welfare and Institutions Code, and nonprofit community care facilities as defined in Section 1502, excluding foster family homes, foster family agencies, and adoption agencies.
Unless the context dictates otherwise, health facility includes a political subdivision of the state or nonprofit corporation that operates a facility included within the definition set forth in this subdivision.
(h)Department means the Department of Health Care Access and Information.
(i)Lender means the provider of a loan and its successors and assigns.
(j)Loan means money or credit advanced for the costs of construction or expansion of the health facility, and includes both initial loans and loans secured upon refinancing and may include both interim, or short-term loans, and long-term loans. A duly authorized bond or bond issue, or an installment sale agreement, may constitute a loan.
(k)Maturity date means the date that the loan indebtedness would be extinguished if paid in accordance with periodic payments provided for by the terms of the loan.
(l)Mortgage means a first mortgage on real estate. Mortgage includes a first deed of trust.
(m)Mortgagee includes a lender whose loan is secured by a mortgage. Mortgagee includes a beneficiary of a deed of trust.
(n)Mortgagor includes a borrower, a loan to whom is secured by a mortgage, and the trustor of a deed of trust.
(o)Nonprofit corporation means any corporation formed under or subject to the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 1 of the Corporations Code) that is organized for the purpose of owning and operating a health facility and that also meets the requirements of Section 501(c)(3) of the Internal Revenue Code.
(p)Political subdivision means any city, county, joint powers entity, local hospital district, or the California Health Facilities Authority.
(q)Project property means the real property where the health facility is, or is to be, constructed, improved, or expanded, and also means the health facility and the initial equipment in that health facility.
(r)Public health facility means any health facility that is or will be constructed for and operated and maintained by any city, county, or local hospital district.
(s)Adult day health center means a facility defined under subdivision (b) of Section 1570.7, that provides adult day health care, as defined under subdivision (a) of Section 1570.7.
(t)Multilevel facility means an institutional arrangement where a residential care facility for the elderly is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Elderly, for the purposes of this subdivision, means a person 60 years of age or older.
(u)State plan means the plan described in Section 129020.
(v)(1)Residential care facility for the elderly has the same meaning as set forth in Section 1569.2.
(2)This subdivision, and the reference to residential care facilities for the elderly in subdivision (g), shall not be construed as affecting the licensing of health facilities under Chapter 2 (commencing with Section 1250) of Division 2, or any other provisions relating to health facilities, except as the term health facility is interpreted for purposes of the Health Facility Construction Loan Insurance Law under this chapter and any incidental purposes of the California Health Facilities Financing Authority Act under Part 7.2 (commencing with Section 15430) of Division 3 of Title 2 of the Government Code.
The Legislature finds and declares that the purpose of this act is to promote the financing or refinancing of the acquisition, construction, remodeling, improvement, or expansion of residential care facilities for the elderly.
SEC. 2.Section 15432 of the Government Code is amended to read:15432.As used in this part, the following words and terms shall have the following meanings, unless the context clearly indicates or requires another or different meaning or intent:
(a)Act means the California Health Facilities Financing Authority Act.
(b)Authority means the California Health Facilities Financing Authority created by this part or any board, body, commission, department, or officer succeeding to the principal functions thereof or to which the powers conferred upon the authority by this part shall be given by law.
(c)Cost, as applied to a project or portion of a project financed under this part, means and includes all or any part of the cost of construction and acquisition of all lands, structures, real or personal property, rights, rights-of-way, franchises, easements, and interests acquired or used for a project, the cost of demolishing or removing any buildings or structures on land so acquired, including the cost of acquiring any lands to which those buildings or structures may be moved, the cost of all machinery and equipment, financing charges, interest prior to, during, and for a period not to exceed the later of one year or one year following completion of construction, as determined by the authority, the cost of insurance during construction, the cost of funding or financing noncapital expenses, reserves for principal and interest and for extensions, enlargements, additions, replacements, renovations and improvements, the cost of engineering, service contracts, reasonable financial and legal services, plans, specifications, studies, surveys, estimates, administrative expenses, and other expenses of funding or financing, that are necessary or incident to determining the feasibility of constructing any project, or that are incident to the construction, acquisition, or financing of any project.
(d)Health facility means a facility, place, or building that is licensed, accredited, or certified and organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, or physical, mental, or developmental disability, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons, and includes, but is not limited to, all of the following types:
(1)A general acute care hospital that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.
(2)An acute psychiatric hospital that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care for mentally disordered, incompetent, or other patients referred to in Division 5 (commencing with Section 5000) or Division 6 (commencing with Section 6000) of the Welfare and Institutions Code, including the following basic services: medical, nursing, rehabilitative, pharmacy, and dietary services.
(3)A skilled nursing facility that is a health facility that provides the following basic services: skilled nursing care and supportive care to patients whose primary need is for availability or skilled nursing care on an extended basis.
(4)An intermediate care facility that is a health facility that provides the following basic services: inpatient care to ambulatory or semiambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require availability or continuous skilled nursing care.
(5)A special health care facility that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical or dental staff that provides inpatient or outpatient, acute or nonacute care, including, but not limited to, medical, nursing, rehabilitation, dental, or maternity.
(6)A clinic that is operated by a tax-exempt nonprofit corporation that is licensed pursuant to Section 1204 or 1204.1 of the Health and Safety Code or a clinic exempt from licensure pursuant to subdivision (b) or (c) of Section 1206 of the Health and Safety Code.
(7)An adult day health center that is a facility, as defined under subdivision (b) of Section 1570.7 of the Health and Safety Code, that provides adult day health care, as defined under subdivision (a) of Section 1570.7 of the Health and Safety Code.
(8)A facility owned or operated by a local jurisdiction for the provision of county health services.
(9)A multilevel facility is an institutional arrangement where a residential facility for the elderly is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Elderly, for the purposes of this paragraph, means a person 62 years of age or older.
(10)A child day care facility operated in conjunction with a health facility. A child day care facility is a facility, as defined in Section 1596.750 of the Health and Safety Code. For purposes of this paragraph, child means a minor from birth to 18 years of age.
(11)An intermediate care facility/developmentally disabled habilitative that is a health facility, as defined under subdivision (e) of Section 1250 of the Health and Safety Code.
(12)An intermediate care facility/developmentally disabled-nursing that is a health facility, as defined under subdivision (h) of Section 1250 of the Health and Safety Code.
(13)A community care facility that is a facility, as defined under subdivision (a) of Section 1502 of the Health and Safety Code, that provides care, habilitation, rehabilitation, or treatment services to developmentally disabled or mentally impaired persons.
(14)A nonprofit community care facility, as defined in subdivision (a) of Section 1502 of the Health and Safety Code, other than a facility that, as defined in that subdivision, is a residential facility for the elderly, a foster family agency, a foster family home, a full service adoption agency, or a noncustodial adoption agency.
(15)A nonprofit accredited community work activity program, as specified in subdivision (e) of Section 4851 and Section 4856 of the Welfare and Institutions Code.
(16)A community mental health center, as defined in paragraph (3) of subdivision (b) of Section 5667 of the Welfare and Institutions Code.
(17)A nonprofit speech and hearing center, as defined in Section 1201.5 of the Health and Safety Code.
(18)A blood bank, as defined in Section 1600.2 of the Health and Safety Code, licensed pursuant to Section 1602.5 of the Health and Safety Code, and exempt from federal income taxation pursuant to Section 501(c)(3) of the Internal Revenue Code.
(19)A residential facility for persons with developmental disabilities, as defined in Sections 4688.5 and 4688.6 of the Welfare and Institutions Code, which includes, but is not limited to, a community care facility licensed pursuant to Section 1502 of the Health and Safety Code and a family teaching home as defined in Section 4689.1 of the Welfare and Institutions Code.
(20)A residential care facility for the elderly, as defined in Section 1569.2 of the Health and Safety Code, through the use of special funds in accordance with this part.
(20)(21)A nonpublic school that provides educational services in conjunction with a health facility, as defined in paragraphs (1) to (19), (20), inclusive, that otherwise qualifies for financing pursuant to this part, if the nonpublic school is certified pursuant to Sections 56366 and 56366.1 of the Education Code as meeting standards relating to the required special education and specified related services and facilities for individuals with physical, mental, or developmental disabilities.
Health facility includes a clinic that is described in subdivision (l) of Section 1206 of the Health and Safety Code.
Health facility includes information systems equipment and the following facilities, if the equipment and facility is operated in conjunction with or to support the services provided in one or more of the facilities specified in paragraphs (1) to (20), (21), inclusive, of this subdivision: a laboratory, laundry, a nurses or interns residence, housing for staff or employees and their families or patients or relatives of patients, a physicians facility, an administration building, a research facility, a maintenance, storage, or utility facility, an information systems facility, all structures or facilities related to any of the foregoing facilities or required or useful for the operation of a health facility and the necessary and usual attendant and related facilities and equipment, and parking and supportive service facilities or structures required or useful for the orderly conduct of the health facility.
Health facility does not include any institution, place, or building used or to be used primarily for sectarian instruction or study or as a place for devotional activities or religious worship.
(e)Participating health institution means a city, city and county, or county, a district hospital, or a private nonprofit corporation or association, or a limited liability company whose sole member is a nonprofit corporation or association authorized by the laws of this state to provide or operate a health facility or a nonprofit corporation that controls or manages, is controlled or managed by, is under common control or management with, or is affiliated with any of the foregoing, and that, pursuant to this part, undertakes the financing or refinancing of the construction or acquisition of a project or of working capital as provided in this part. Participating health institution also includes, for purposes of the California Health Facilities Revenue Bonds (UCSF-Stanford Health Care) 1998 Series A, the Regents of the University of California.
(f)Project means construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility or acquisition of a health facility to be financed or refinanced with funds provided in whole or in part pursuant to this part. Project may include reimbursement for the costs of construction, expansion, remodeling, renovation, furnishing, or equipping, or funding, financing, or refinancing of a health facility or acquisition of a health facility. Project may include any combination of one or more of the foregoing undertaken jointly by any participating health institution with one or more other participating health institutions.
(g)Revenue bond or bond means a bond, warrant, note, lease, or installment sale obligation that is evidenced by a certificate of participation or other evidence of indebtedness issued by the authority.
(h)Working capital means moneys to be used by, or on behalf of, a participating health institution to pay or prepay maintenance or operation expenses or any other costs that would be treated as an expense item, under generally accepted accounting principles, in connection with the ownership or operation of a health facility, including, but not limited to, reserves for maintenance or operation expenses, interest for not to exceed two years on any loan for working capital made pursuant to this part, and reserves for debt service with respect to, and any costs necessary or incidental to, that financing.
SEC. 3.Section 129010 of the Health and Safety Code is amended to read:129010.Unless the context otherwise requires, the definitions in this section govern the construction of this chapter and of Section 32127.2.
(a)Bondholder means the legal owner of a bond or other evidence of indebtedness issued by a political subdivision or a nonprofit corporation.
(b)Borrower means a political subdivision or nonprofit corporation that has secured or intends to secure a loan for the construction of a health facility.
(c)Construction, improvement, or expansion or construction, improvement, and expansion includes construction of new buildings, expansion, modernization, renovation, remodeling and alteration of existing buildings, acquisition of existing buildings or health facilities, and initial or additional equipping of any of these buildings.
In connection therewith, construction, improvement, or expansion or construction, improvement, and expansion includes the cost of construction or acquisition of all structures, including parking facilities, real or personal property, rights, rights-of-way, the cost of demolishing or removing any buildings or structures on land so acquired, including the cost of acquiring any land where the buildings or structures may be moved, the cost of all machinery and equipment, financing charges, interest (prior to, during and for a period after completion of the construction), provisions for working capital, reserves for principal and interest and for extensions, enlargements, additions, replacements, renovations and improvements, cost of engineering, financial and legal services, plans, specifications, studies, surveys, estimates of cost and of revenues, administrative expenses, expenses necessary or incident to determining the feasibility or practicability of constructing or incident to the construction; or the financing of the construction or acquisition.
(d)Committee means the Advisory Loan Insurance Committee.
(e)Debenture means any form of written evidence of indebtedness issued by the State Treasurer pursuant to this chapter, as authorized by Section 4 of Article XVI of the California Constitution.
(f)Fund means the Health Facility Construction Loan Insurance Fund.
(g)Health facility means any facility providing or designed to provide services for the acute, convalescent, and chronically ill and impaired, including, but not limited to, public health centers, community mental health centers, facilities for the developmentally disabled, nonprofit community care facilities that provide care, habilitation, rehabilitation or treatment to developmentally disabled persons, facilities for the treatment of chemical dependency, including a community care facility, licensed pursuant to Chapter 3 (commencing with Section 1500) of Division 2, a clinic, as defined pursuant to Chapter 1 (commencing with Section 1200) of Division 2, an alcoholism recovery facility, defined pursuant to former Section 11834.11, and a structure located adjacent or attached to another type of health facility and that is used for storage of materials used in the treatment of chemical dependency, and general tuberculosis, mental, and other types of hospitals and related facilities, such as laboratories, outpatient departments, extended care, nurses home and training facilities, offices and central service facilities operated in connection with hospitals, diagnostic or treatment centers, extended care facilities, nursing homes, and rehabilitation facilities. Health facility also means an adult day health center and a multilevel facility. center, a multilevel facility, and a residential care facility for the elderly. Except for facilities for the developmentally disabled, facilities for the treatment of chemical dependency, or a multilevel facility, or a residential care facility for the elderly, or as otherwise provided in this subdivision, health facility does not include any institution furnishing primarily domiciliary care.
Health facility also means accredited nonprofit work activity programs as defined in subdivision (e) of Section 19352 and Section 19355 4851 and Section 4856 of the Welfare and Institutions Code, and nonprofit community care facilities as defined in Section 1502, excluding foster family homes, foster family agencies, adoption agencies, and residential care facilities for the elderly. and adoption agencies.
Unless the context dictates otherwise, health facility includes a political subdivision of the state or nonprofit corporation that operates a facility included within the definition set forth in this subdivision.
(h)Department means the Department of Health Care Access and Information.
(i)Lender means the provider of a loan and its successors and assigns.
(j)Loan means money or credit advanced for the costs of construction or expansion of the health facility, and includes both initial loans and loans secured upon refinancing and may include both interim, or short-term loans, and long-term loans. A duly authorized bond or bond issue, or an installment sale agreement, may constitute a loan.
(k)Maturity date means the date that the loan indebtedness would be extinguished if paid in accordance with periodic payments provided for by the terms of the loan.
(l)Mortgage means a first mortgage on real estate. Mortgage includes a first deed of trust.
(m)Mortgagee includes a lender whose loan is secured by a mortgage. Mortgagee includes a beneficiary of a deed of trust.
(n)Mortgagor includes a borrower, a loan to whom is secured by a mortgage, and the trustor of a deed of trust.
(o)Nonprofit corporation means any corporation formed under or subject to the Nonprofit Public Benefit Corporation Law (Part 2 (commencing with Section 5110) of Division 2 of Title 1 of the Corporations Code) that is organized for the purpose of owning and operating a health facility and that also meets the requirements of Section 501(c)(3) of the Internal Revenue Code.
(p)Political subdivision means any city, county, joint powers entity, local hospital district, or the California Health Facilities Authority.
(q)Project property means the real property where the health facility is, or is to be, constructed, improved, or expanded, and also means the health facility and the initial equipment in that health facility.
(r)Public health facility means any health facility that is or will be constructed for and operated and maintained by any city, county, or local hospital district.
(s)Adult day health center means a facility defined under subdivision (b) of Section 1570.7, that provides adult day health care, as defined under subdivision (a) of Section 1570.7.
(t)Multilevel facility means an institutional arrangement where a residential facility for the elderly is operated as a part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Elderly, for the purposes of this subdivision, means a person 60 years of age or older.
(u)State plan means the plan described in Section 129020.
(v)Residential care facility for the elderly has the same meaning as set forth in Section 1569.2.
|
Date
|
Status
|
|---|---|
| Oct 10, 2023 | Chaptered by Secretary of State - Chapter 667, Statutes of 2023. |
| Oct 10, 2023 | Approved by the Governor. |
| Sep 14, 2023 | Enrolled and presented to the Governor at 4:30 p.m. |
| Sep 7, 2023 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 79. Noes 0. Page 3024.). |
| Sep 5, 2023 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after September 7 pursuant to Assembly Rule 77. |
| Sep 5, 2023 | Read third time. Passed. Ordered to the Assembly. (Ayes 39. Noes 0. Page 2358.). |
| Aug 15, 2023 | Read second time. Ordered to third reading. |
| Aug 14, 2023 | From committee: Be ordered to second reading pursuant to Senate Rule 28.8. |
| Jul 5, 2023 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 5. Noes 0.) (July 3). Re-referred to Com. on APPR. |
| Jun 20, 2023 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HUMAN S. |
| Jun 7, 2023 | From committee: Do pass and re-refer to Com. on HUMAN S. (Ayes 12. Noes 0.) (June 7). Re-referred to Com. on HUMAN S. |
| May 10, 2023 | Referred to Coms. on HEALTH and HUMAN S. |
| Apr 27, 2023 | In Senate. Read first time. To Com. on RLS. for assignment. |
| Apr 27, 2023 | Read third time. Passed. Ordered to the Senate. (Ayes 79. Noes 0. Page 1365.) |
| Apr 20, 2023 | Read second time. Ordered to Consent Calendar. |
| Apr 19, 2023 | From committee: Do pass. To Consent Calendar. (Ayes 14. Noes 0.) (April 19). |
| Apr 3, 2023 | Re-referred to Com. on APPR. |
| Mar 30, 2023 | Read second time and amended. |
| Mar 29, 2023 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 14. Noes 0.) (March 28). |
| Mar 21, 2023 | Re-referred to Com. on HEALTH. |
| Mar 20, 2023 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Feb 23, 2023 | Referred to Com. on HEALTH. |
| Feb 15, 2023 | From printer. May be heard in committee March 17. |
| Feb 14, 2023 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 7, 2023 | AB 839 Addis Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Sep 5, 2023 | Assembly 3rd Reading AB839 Addis By Alvarado-Gil | Senate Floor |
Passed |
|
| Jul 3, 2023 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Human Services |
Passed |
|
| Jun 7, 2023 | Do pass, but first be re-referred to the Committee on [Human Services] | Senate Standing Committee on Health |
Passed |
|
| Apr 27, 2023 | AB 839 Addis Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| Apr 19, 2023 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Mar 28, 2023 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| California Advocates for Nursing Home Reform | ** Against | |
| California Assisted Living Association | * Support | Jul 3, 2023 |
| California Commission on Aging | ** Support | |
| California Senior Legislature | ** Support | |
| Canhr | ** Against | |
| LeadingAge | ** Support | |
| LeadingAge California | ** Support | |
| Orrick, Herrington & Sutcliffe | * Support | Jun 7, 2023 |
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 839
Author:(Addis)
As Amended Ver:June 20, 2023
Majority vote
SUMMARY
Adds residential care facilities for the elderly (RCFEs) to the list of facilities eligible to participate in financing and funding programs offered by the California Health Facilities Financing Authority (CHFFA).
Senate Amendments
Clarify that the designation of an RCFE as a health facility applies only for the purposes of this bill.
COMMENTS
According to the California Master Plan for Aging, California's over-60 population is projected to diversify and grow faster than any other age group. By 2030, 10.8 million Californians will be an older adult, making up one-quarter of the state's population.
- RCFEs. RCFEs, commonly referred to as Care Homes or Residential Care, include Assisted Living, Continuing Care Retirement Communities (CCRCs), and Memory Care to seniors who are age 60 and over. Aside from housing, RCFEs deliver care to senior residents along with assistance with daily living, activities, and general supervision as needed.
CCRCs, also called life care communities, offer different levels of service in one location. Many of them offer independent housing (houses or apartments), assisted living, and skilled nursing care all on one campus. Healthcare services and recreation programs are also provided. In a CCRC, where an individual lives depends on the level of service they need. People who can no longer live independently move to the assisted living facility or sometimes receive home care in their independent living unit. If necessary, they can enter the CCRC's nursing home. Assisted living is for people who need help with daily care, but not as much help as a nursing home provides. Assisted living facilities range in size from as few as 25 residents to 120 or more. Typically, a few "levels of care" are offered, with residents paying more for higher levels of care.
Assisted living residents usually live in their own apartments or rooms and share common areas. They have access to many services, including up to three meals a day; assistance with personal care; help with medications, housekeeping, and laundry; 24-hour supervision, security, and on-site staff; and, social and recreational activities. Exact arrangements vary from state to state.
Nursing homes, also called SNFs, provide a wide range of health and personal care services. Their services focus on medical care more than most assisted living facilities. These services typically include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. Rehabilitation services, such as physical, occupational, and speech therapy, are also available.
According to the Department of Social Services, there are 7,469 RCFE's operating in the state, 239 of which are non-profit RCFEs that would be subject to the provisions of this bill.
- California Health Facility Financing Authority Construction Loan Insurance Law. In order to meet the requirements for CHFFA financing, an institution must be a public hospital, a private non-profit corporation, or an association authorized by the laws of California to provide or operate a health facility and undertake the financing or refinancing of a project. Generally, non-profit, licensed health facilities in the State of California including adult day health centers, community clinics, developmentally disabled centers, and drug and alcohol rehabilitation centers are eligible for financing. Applicants must be approved by a resolution of the CHFFA Members at a regularly scheduled public meeting. In addition to initial eligibility, CHFFA requires borrowers to comply with its Bond Issuance Guidelines per bond rating category and provide loan security provisions and bond covenants that correspond with its rating. Savings resulting from issuance of tax-exempt bonds for borrowers must be transferred to the consuming public via lower or contained costs for delivery of health services.
According to the Author
Non-profit RCFEs should not be an outlier when it comes to eligibility for CHFFA and Cal-Mortgage programs. These facilities are incredibly important to the communities they serve and deserve access to interest-free funding and other benefits provided by these programs.
Arguments in Support
LeadingAge is the sponsor of this bill and states that the demographics of older adults in the state is rapidly changing. California is expected to have over 10.8 million individuals over the age of 60 by 2030 and by 2060 adults 60 and over will make up 30% of California's population. Since CHFFA was created in 1979, the delivery of health care and the aging process has evolved. Licensed assisted living and memory care now offer supportive personal care services in more residential type buildings and programs. Independence and dignity are key consumer values. There is a clear shift from licensed nursing care to licensed assisted living and memory care. LeadingAge also states that this bill furthers Goal 1: Housing for All Ages and Stages of the Master Plan for Aging, which aims to allow older adults to live where they chose as they age, "in communities that are age-, disability- and dementia-friendly." LeadingAge concludes that expanding the CHFFA programs to all RCFEs will reduce borrowing costs to create more nonprofit assisted living and memory care to meet the needs of our growing older adult population.
Arguments in Opposition
California Advocates for Nursing Home Reform are opposed to this bill, stating, CHFFA was created to be the state's vehicle for providing financial assistance to public and non-profit health care providers in our State. The mission of CHFFA is to help eligible and credit worthy providers reduce their cost of capital, and promote important California health access, health care improvement and cost containment objectives. CCRCs are not health care providers. While CCRCs are required to include some licensed skilled nursing beds on the premises, the overwhelming majority of CCRC residents are in independent living units. Most CCRCs do not accept Medi-Cal even in their skilled nursing units. Expanding the program of the California Health Facilities Financing Authority to include CCRCs will do nothing to promote the mission of CHFFA. It will not promote health access, health care improvement or cost containment. It will surely, however, expand the profits of these already profitable companies – regardless of for-profit or non-profit status. It would also be a betrayal of the mission of the CHFFA program.
FISCAL COMMENTS
According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.
VOTES:
ASM HEALTH: 14-0-1
YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner Horvath, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber
ABS, ABST OR NV: Wendy Carrillo
ASM APPROPRIATIONS: 14-0-2
YES: Holden, Megan Dahle, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Robert Rivas, Sanchez, Weber, Wilson
ABS, ABST OR NV: Bryan, Pellerin
ASSEMBLY FLOOR: 79-0-1
YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones‑Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon
ABS, ABST OR NV: Jim Patterson
SENATE FLOOR: 39-0-1
YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
ABS, ABST OR NV: Padilla
UPDATED
VERSION: June 20, 2023
CONSULTANT: Lara Flynn / HEALTH / (916) 319-2097 FN: 0001434
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB 839 |
THIRD READING
Bill No: AB 839
Author: Addis (D)
Amended: 6/20/23 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 12-0, 6/7/23
AYES: Eggman, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Roth, Rubio, Wahab, Wiener
SENATE HUMAN SERVICES COMMITTEE: 5-0, 7/3/23
AYES: Alvarado-Gil, Ochoa Bogh, Hurtado, Menjivar, Wahab
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 79-0, 4/27/23 (Consent) - See last page for vote
SUBJECT: Residential care facilities for the elderly: financing
DIGEST:
This bill adds residential care facilities for the elderly to the list of facilities eligible to participate in financing and funding programs offered by the California Health Facilities Financing Authority (CHFFA).
ANALYSIS:
Existing law:
- Establishes the CHFFA, consisting of nine members, led by the State Treasurer who serves as the chair, and the executive director, who is appointed by the State Treasurer. States the intent of the Legislature to provide financing, through tax-exempt revenue bond funding, to health institutions that can demonstrate the financial feasibility of their projects, and that any savings experienced by the health institution be passed on to the consuming public through lower charges or containment of the rate of increase in hospital rates. [GOV §15430, et seq.]
- Defines “health facility,” for purposes of obtaining financing through CHFFA, as a facility, place, or building that is licensed, accredited, or certified and organized, maintained, and operated or the diagnosis, care, prevention, and treatment of human illness, or physical, mental, or developmental disability, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes. Lists a number of types of facilities, including hospitals and clinics, skilled nursing facilities, adult day health centers, and multilevel facilities where a residential facility for the elderly is operated as part of, or in conjunction with, a nursing home or a general acute care hospital, among other types of facilities. [GOV §15432]
- Requires health facilities participating in CHFFA funding to either be a non-profit corporation, or operated by a government entity. [GOV §15432 (e)]
- Establishes the California Community Care Facilities Act (CCF Act) to establish a coordinated and comprehensive system of community care for mentally ill, developmentally and physically disabled, and children and adults who require care or services by a facility or organization issued a license or special permit under the CCF Act. Pursuant to the CCF Act, the Department of Social Services (DSS) licenses and regulates CCFs of various types, including those that provide nonmedical residential care, day treatment, adult daycare, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children. Includes adult residential facilities, among other facility types. [HSC §1500 et seq., §1502]
- Licenses and regulates residential care facilities for the elderly (RCFEs) by DSS, and defines RCFEs as a housing arrangement chosen voluntarily by persons 60 years of age or over, where varying levels and intensities of care and supervision, protection supervision, or personal care, or health-related services are provided, based upon their varying needs, as determined in order to be admitted and to remain in the facility. Defines “health-related services,” for purposes of RCFEs, as services that are required to be directly provided by an appropriate skilled professional, including a registered nurse, licensed vocational nurse, physical therapist, or occupational therapist. [HSC §1569 et seq., §1569.2]
This bill:
- Adds RCFEs to the list of health facilities eligible to participate in financing and funding programs offered by CHFFA.
- Prohibits the inclusion of RCFEs from being construed to affect the licensing of health facilities, or any other provisions of law relating to health facilities, except as the term “health facility” is interpreted for purposes of CHFFA. Specifies that the designation of an RCFE as a health facility by this bill only applies to provisions of law governing CHFFA financing.
- Makes minor technical and conforming changes, including revising the definition of a multilevel facility to reflect that RCFEs serve residents 60 years of age or older, rather than 62 years of age or older.
Comments
- Author’s statement. According to the author, currently, a non-profit RCFE that is not attached to a skilled nursing facility is not eligible for lower interest rate tax-exempt financing through CHFFA. Many non-profit RCFE’s are unable to access this program, making borrowing costs prohibitive when compared to RCFE’s with skilled nursing facilities attached. Affordability is a major concern for many non-profit RCFE’s, especially those that are not connected to a skilled nursing facility because of their current inability to access this program. By allowing these RCFE’s to utilize these tools they will be able to borrow at much lower costs overall.
- Background on existing CHFFA programs. CHFFA was created to be the state's vehicle for providing financial assistance to public and non-profit health care providers primarily through loans funded by the issuance of tax-exempt bonds. To this end, CHFFA administers the Bond Financing Program and the Tax-Exempt Equipment Financing Program. CHFFA also provides direct loans to small and rural health facilities through the Healthcare Expansion Loan Program (HELP) II Financing Program. In September of 2021, the Governor signed into law the Nondesignated Public Hospital Bridge Loan Program to enable CHFFA to issue up to $40 million in working capital loans at zero interest rate to certain hospitals that are affected by financial delays associated with the transition to the Quality Incentive Program. These Nondesignated Public Hospital Bridge Loans are required to be paid back in two years, and are secured by Medi-Cal reimbursements. Additionally, CHFFA administers several grant programs, including the Children's Hospital Programs, the Community Services Infrastructure Grant Program, and the Investment in Mental Health Wellness Grant Program. Under the Mental Health Wellness grant program, counties can apply for funding to develop a continuum of crisis services to children and youth up to 21 years of age in four categories: crisis residential treatment, crisis stabilization, mobile crisis support teams, and family respite care.
By borrowing through CHFFA’s tax-exempt bond financing program, health facilities can likely obtain rates that are 20% lower than they would through taxable financing options. Generally, non-profit, licensed health facilities in California, including adult day health centers, community clinics, skilled nursing facilities, developmentally disabled centers, hospitals, and drug and alcohol rehabilitation centers are eligible for CHFFA financing. Proceeds from CHFFA financings may be used for project-related costs, including: construction; remodeling and renovation; land acquisition (as part of the proposed project); acquisition of existing health facilities; purchase or lease of equipment; refinancing or refunding of prior debt; working capital for start-up facilities; costs of bond issuance; feasibility studies; and, reimbursement of prior expenses. Under statute, savings resulting from issuance of tax-exempt bonds for borrowers must be transferred to the consuming public through lower or contained costs for delivery of health services. CHFFA states that to enforce this requirement, applicants are required to complete a pass-through savings certification as part of its loan application that demonstrates significant community service.
Since its first bond issuance in 1981, CHFFA’s bond financing program has issued 646 bonds for an aggregate total of approximately $47.5 billion, with 275 health facilities availing themselves of this financing. - Background on RCFEs and other facilities licensed by DSS. RCFEs are designed to provide a living space where seniors 60 or older can get assistance with activities of daily living, as needed. They are not health facilities, but the facilities typically bring licensed health care practitioners into the facility to provide care as necessary. Some RCFEs include memory care units for seniors with dementia. RCFEs can also be part of a continuing care retirement community (CCRC), which offers different levels of service in one location, often (but not always) including a skilled nursing facility (licensed by the California Department of Public Health) where a resident can be moved if they start requiring continuous nursing care. Under existing law, CHFFA financing is available to a “multilevel facility” where an RCFE is operated as a part of, or in conjunction with, an intermediate care facility, skilled nursing facility, or hospital. Under this provision of law, a CCRC that includes both an RCFE and a skilled nursing facility, for example, is eligible for CHFFA financing. However, RCFEs that do not operate in conjunction with a health facility are not eligible under existing law. According to DSS, there are a total of 7,469 RCFEs operating in California. However, because CHFFA financing is limited to only facilities operated by non-profits (or those operated by governmental entities), only the 239 non-profit RCFEs would be eligible for CHFFA financing under this bill (and some of these are likely already eligible as part of a multilevel facility where a skilled nursing facility is operated alongside the RCFE).
DSS also licenses a type of community care facility known as an adult residential facility. This is distinguished from an RCFE as being part of the system of community care to provide nonmedical residential care, day treatment, and other services for children and/or adults that need personal services, supervision, or assistance essential for sustaining the activities of daily living, including but not limited to the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children. Adult residential facilities, as opposed to RCFEs, are not specific to the aging population over 60. Under existing law, most non-profit community care facilities, including adult residential facilities, are already eligible to participating in CHFFA financing. RCFEs are specifically excluded.
FISCAL EFFECT: Appropriation: Yes Fiscal Com.: Yes Local: No
SUPPORT: (Verified 8/16/23)
LeadingAge California (source)
California Commission on Aging
California Senior Legislature
OPPOSITION: (Verified 8/16/23)
California Advocates for Nursing Home Reform
ARGUMENTS IN SUPPORT: This bill is sponsored by LeadingAge California, which states that this bill modernizes and updates the CHFFA statute to allow non-profit RCFEs, regardless of their connection to a skilled nursing facility, to utilize the program. LeadingAge states that since CHFFA was created in 1979, the delivery of health care and the aging process has evolved, and that licensed assisted living and memory care no offer supportive personal care services in more residential type buildings and programs. Independence and dignity are key consumer values, and there is a clear shift from licensed nursing care to licensed assisted living and memory care. LeadingAge also states that this bill furthers one of the goals of the Master Plan for Aging, which aims to allow older adults to live where they choose as they age, “in communities that are age-, disability-, and dementia-friendly.” Expanding the CHFFA program to all RCFEs will reduce borrowing costs to create more nonprofit assisted living and memory care to meet the needs of our growing older adult population.
The California Commission on Aging supports this bill, stating that RCFEs are residential non-medical facilities for adults over the age of 60 who are unable to live by themselves but who do not require 24-hour nursing care. Sometimes referred to as assisted living or board and care facilities, RCFEs allow older adults to remain in a residential setting while receiving necessary assistance in daily tasks. The California Commission on Aging states that these facilities are critical toward providing housing for older adults who require a higher level of care, but demand for this type of housing has drastically outpaced its availability. California’s rising housing costs have caused many small residential facility operators to close and decelerated construction of new facilities. This bill helps stop the flow of older adults into homelessness by providing funding of critical housing and services for RCFEs.
The California Senior Legislature also supports this bill, stating it will be beneficial to many as the senior population increases.
ARGUMENTS IN OPPOSITION: California Advocates for Nursing Home Reform (CANHR) opposes this bill because it would allow access to CHFFA funding by continuing care retirement communities. CANHR cites data from DSS that there are currently 79 non-profit CCRCs, which require a substantial entrance fee and substantial monthly care fees, in addition to a contract. According to CANHR, many of these “nonprofits” have increased their annual monthly care fees 8% to 10% over the past few years, which have imposed significant hardships on the residents, many of whom have invested their life savings into these CCRCs in order to live out their lives there. CANHR states that these residents did not expect that they would be investing in real estate development corporations that would impose liabilities on them and divert resources from their communities to other properties, while the reserve funds of these facilities hold millions of dollars in “profits.” CANHR states that a number of these nonprofit CCRC are planning to eliminate their skilled nursing units to save even more money, and this bill will only assist them in this venture. CANHR states that CHFFA was created to be the state’s vehicle for providing financial assistance to public and nonprofit health care providers, and CCRCs are not health care providers. While CCRCs include some licensed skilled nursing beds on the premises, the overwhelming majority of CCRC residents are in independent living units. CANHR argues that expanding CHFFA to include CCRC does nothing to promote the mission of CHFFA, but will expand the profits of these already profitable companies, regardless of for-profit or nonprofit status.
ASSEMBLY FLOOR: 79-0, 4/27/23
AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon
NO VOTE RECORDED: Jim Patterson
Prepared by: Vincent D. Marchand / HEALTH / (916) 651-4111
8/16/23 14:16:49
**** END ****
SENATE COMMITTEE ON HUMAN SERVICES
Senator Alvarado-Gil, Chair
2023 - 2024 Regular
Bill No: | AB 839 | ||
Author: | Addis | ||
Version: | June 20, 2023 | Hearing Date: | July 3, 2023 |
Urgency: | No | Fiscal: | Yes |
Consultant: | Diana Dominguez | ||
Subject: Residential care facilities for the elderly: financing
SUMMARY
This bill adds residential care facilities for the elderly (RCFEs) to the list of facilities eligible to participate in financing and funding programs offered by the California Health Facilities Financing Authority (CHFFA).
ABSTRACT
Existing law:
- Establishes the CHFFA, consisting of nine members, led by the State Treasurer who serves as the chair, and the executive director, who is appointed by the State Treasurer. States the intent of the Legislature to provide financing, through tax-exempt revenue bond funding, to health institutions that can demonstrate the financial feasibility of their projects, and that any savings experienced by the health institution be passed on to the consuming public through lower charges or containment of the rate of increase in hospital rates. (GOV 15430 et seq.)
- Defines “health facility” to mean a facility, place, or building that is licensed, accredited, or certified and organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, or physical, mental, or developmental disability, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons. Lists a number of types of facilities, including hospitals and clinics, skilled nursing facilities, adult day health centers, and multilevel facilities where a residential facility for the elderly is operated as part of, or in conjunction with, a nursing home or a general acute care hospital, among other types of facilities. (GOV 15432)
- Defines “multilevel facility” as an institutional arrangement where an RCFE is operated as part of, or in conjunction with, an intermediate care facility, a skilled nursing facility, or a general acute care hospital. Further, defines “elderly,” for purposes of this act, to mean a person 62 years of age or older. (GOV 15432(d)(9))
- Defines “nonprofit community care facility” as a facility other than as defined in HSC 1502(a), an RCFE, a foster family agency, a foster family home, a full service adoption agency, or a noncustodial adoption agency. (GOV 15432(d)(14))
- Establishes the California Community Care Facilities Act to establish a coordinated and comprehensive system of community care for mentally ill, developmentally and physically disabled, and children and adults who require care or services by a facility or organization issued a license or special permit pursuant to the Act. Requires the California Department of Social Services (CDSS) to license and regulate community care facilities of various types, including those that provide nonmedical residential care, day treatment, adult daycare, or foster family agency services for children, adults, or children and adults, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children. Includes adult residential facilities, among other facility types. (HSC 1500 et seq.)
- Establishes the California Residential Care Facilities for the Elderly Act to require RCFEs be licensed as a separate category within the existing structure of CDSS. Defines “RCFEs” as a housing arrangement chosen voluntarily by persons 60 years of age or over, or their authorized representative, where varying levels and intensities of care and supervision, protective supervision, personal care, or health-related services are provided, based upon their varying needs, as determined in order to be admitted and to remain in the facility. Defines “health-related services” as services that shall be directly provided by an appropriate skilled professional, including a registered nurse, licensed vocational nurse, physical therapist, or occupational therapist. (HSC 1569 et seq.)
This bill:
- Finds and declares that the purpose of this act is to promote the financing or refinancing of the acquisition, construction, and remodeling of RCFEs.
- Changes the definition of “elderly” for the purposes of this act to mean a person 60 years of age or older, rather than 62 years of age or older.
- Adds RCFEs to the list of health facilities eligible to participate in financing and funding programs offered by CHFFA.
- Specifies that the inclusion of RCFEs should not be construed to affect the licensing of health facilities, or any other provisions of law relating to health facilities, except as the term “health facility” is interpreted for purposes of the CHFFA Act.
FISCAL IMPACT
The Assembly Appropriations Committee estimates that, because CHFFA charges a fee to the borrower to access the financing, no state costs.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, “Non-profit residential care facilities for the elderly should not be an outlier when it comes to eligibility for the California Health Facility Financing Authority funding. These facilities are incredibly important to the communities they serve and deserve access to interest-free funding and other benefits provided by this program.”
California Health Facilities Financing Authority (CHFFA)
CHFFA was created to be the state’s vehicle for providing financial assistance to public and nonprofit health care providers primarily through loans funded by the issuance of tax-exempt bonds. CHFFA administers financing programs, grant programs, and provides direct loans to health facilities. By borrowing through CHFFA’s tax-exempt bond financing program, health facilities can likely obtain rates that are 20% lower than they would through taxable financing options. Generally, non-profit, licensed health facilities in California, including adult day health centers, community clinics, skilled nursing facilities, developmentally disabled centers, hospitals, and drug and alcohol rehabilitation centers are eligible for CHFFA financing. Proceeds from CHFFA financings may be used for project-related costs, including: construction; remodeling and renovation; land acquisition (as part of the proposed project); acquisition of existing health facilities; purchase or lease of equipment; refinancing or refunding of prior debt; working capital for start-up facilities; costs of bond issuance; feasibility studies; and, reimbursement of prior expenses. Under statute, savings resulting from issuance of tax-exempt bonds for borrowers must be transferred to the consuming public through lower or contained costs for delivery of health services. CHFFA states that to enforce this requirement, applicants are required to complete a pass-through savings certification as part of its loan application that demonstrates significant community service.
Since its first bond issuance in 1981, CHFFA’s bond financing program has issued 646 bonds for an aggregate total of approximately $47.5 billion, with 275 health facilities availing themselves of this financing.
Residential Care Facilities for the Elderly (RCFEs)
Sometimes referred to as assisted living facilities, RCFEs are responsible for providing housing, housekeeping, supervision, and personal care assistance with activities of daily living, such as hygiene, dressing, eating, and walking, to individuals ages 60 and older. California’s network of RCFEs ranges from small homes serving a handful of residents to larger RCFEs that can house over 100 residents in communities across the state. RCFEs provide a special combination of housing, personalized supportive services, and 24-hour staffing designated to respond to the individual needs of those who require supervision and help with activities of daily living. This level of care and supervision is for people who are unable to live by themselves but who do not need 24-hour nursing care. RCFEs are considered non-medical facilities and are not required to have nurses, certified nursing assistances, or doctors on staff, but typically bring licensed health care practitioners into the facility to provide care as necessary. Some RCFEs include memory care units for seniors with dementia.
RCFEs are licensed and overseen by CDSS. RCFEs can also be part of a continuing care retirement community (CCRC), which offers different levels of service in one location, often including a skilled nursing facility, licensed by the California Department of Public Health (CDPH), where a resident can be moved if they start requiring continuous nursing care. Under existing law, CHFFA financing is available to a “multilevel facility” where an RCFE is operated as a part of, or in conjunction with, an intermediate care facility, skilled nursing facility, or hospital. Under this provision of law, a CCRC that includes both an RCFE and a skilled nursing facility, for example, is eligible for CHFFA financing. However, RCFEs that do not operate in conjunction with a health facility are not eligible under existing law. According to CDSS, there are a total of 7,469 RCFEs operating in California. Since CHFFA financing is limited to only facilities operated by nonprofits (or those operated by governmental entities), only the 239 non-profit RCFEs would be eligible for CHFFA financing under this bill. Some of these are likely already eligible as part of a multilevel facility where a skilled nursing facility is operated alongside the RCFE.
CDSS also licenses a type of community care facility known as an adult residential facility. This is distinguished from an RCFE as being part of the system of community care to provide nonmedical residential care, day treatment, and other services for children and/or adults that need personal services, supervision, or assistance essential for sustaining the activities of daily living, including but not limited to the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children. Adult residential facilities, as opposed to RCFEs, are not specific to the aging population over 60. Under existing law, most nonprofit community care facilities, including adult residential facilities, are already eligible to participating in CHFFA financing. RCFEs are specifically excluded.
SUPPORT/OPPOSITION
Arguments in support
According to LeadingAge California, “The demographics of older adults in the state is rapidly changing. California is expected to have over 10.8 million individuals over the age of 60 by 2030 and by 2060 adults 60 and over will make up 30% of California’s population. Since CHFFA was created in 1979, the delivery of health care and the aging process has evolved. Licensed assisted living and memory care now offer supportive personal care services in more residential type buildings and programs. Independence and dignity are key consumer values. There is a clear shift from licensed nursing care to licensed assisted living and memory care. Additionally, AB 839 furthers Goal 1: Housing for All Ages and Stages of the Master Plan for Aging, which aims to allow older adults to live where they chose as they age, ‘in communities that are age-, disability- and dementia-friendly’. Expanding the CHFFA program to all RCFEs will reduce borrowing costs to create more nonprofit assisted living and memory care to meet the needs of our growing older adult population.”
Arguments in opposition
According to California Advocates for Nursing Home Reform (CANHR), Continuing Care Retirement Communities (CCRCs) require a substantial entrance fee and monthly care fees, which can constitute a large portion of residents’ savings. Additionally, many nonprofit CCRCs have increased their care fees between 8 and 10 percent over the past few years. CANHR is concerned that CCRCs will eliminate their skilled nursing facilities, reducing down to RCFEs, as a cost saving measure: “Now, a number of these non-profit CCRCs are planning to eliminate their skilled nursing units to save even more money. AB 839 will only assist them in this venture. […] The mission of CHFFA is to help eligible and credit worthy providers reduce their cost of capital, and promote important California health access, health care improvement and cost containment objectives. CCRCs are not health care providers. While CCRCs are required to include some licensed skilled nursing beds on the premises, the overwhelming majority of CCRC residents are in independent living units. Most CCRCs do not accept Medi-Cal even in their skilled nursing units.”
Related legislation:
SB 45 (Roth) establishes the California Acute Care Psychiatric Hospital Loan Fund to provide loans to qualifying county applicants for the purpose of constructing or renovating acute care psychiatric hospitals or psychiatric health facilities, or renovating or expanding general acute care hospitals in order to add or expand an inpatient psychiatric unit. SB 45 is pending in the Assembly Health Committee.
COMMENTS
This bill seeks to add RCFEs as a facility type eligible for financing and funding under the CHFFA. By providing additional resources to RCFEs, whose savings must be passed along to consumers, this bill may help prevent the flow of older adults into homelessness by providing funding of critical housing and services. In addition, most nonprofit community care facilities, including adult residential facilities, are already eligible under existing law.
PRIOR VOTES
Senate Health Committee: | 12 - 0 |
Assembly Floor: | 79 - 0 |
Assembly Appropriations Committee: | 14 - 0 |
Assembly Health Committee: | 14 - 0 |
POSITIONS
Support:
LeadingAge California (Sponsor)
California Assisted Living Association
California Commission on Aging
Oppose:
California Advocates for Nursing Home Reform
Canhr
-- END --
SENATE COMMITTEE ON HEALTH
Senator Dr. Susan Talamantes Eggman, Chair
BILL NO: AB 839
AUTHOR: | Addis | ||
VERSION: | March 30, 2023 | ||
HEARING DATE: | June 7, 2023 | ||
CONSULTANT: | Vincent D. Marchand | ||
SUBJECT: Residential care facilities for the elderly: financing
SUMMARY:
- Adds residential care facilities for the elderly to the list of facilities eligible to participate in financing and funding programs offered by the California Health Facilities Financing Authority.
Existing law:
- Establishes the California Health Facilities Financing Authority (CHFFA), consisting of nine members, led by the State Treasurer who serves as the chair, and the executive director, who is appointed by the State Treasurer. States the intent of the Legislature to provide financing, through tax-exempt revenue bond funding, to health institutions that can demonstrate the financial feasibility of their projects, and that any savings experienced by the health institution be passed on to the consuming public through lower charges or containment of the rate of increase in hospital rates. [GOV §15430, et seq.]
- Defines “health facility,” for purposes of obtaining financing through CHFFA, as a facility, place, or building that is licensed, accredited, or certified and organized, maintained, and operated or the diagnosis, care, prevention, and treatment of human illness, or physical, mental, or developmental disability, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes. Lists a number of types of facilities, including hospitals and clinics, skilled nursing facilities, adult day health centers, and multilevel facilities where a residential facility for the elderly is operated as part of, or in conjunction with, a nursing home or a general acute care hospital, among other types of facilities. [GOV §15432]
- Requires health facilities participating in CHFFA funding to either be a nonprofit corporation, or operated by a government entity. [GOV §15432 (e)]
- Establishes the California Community Care Facilities Act (CCF Act) to establish a coordinated and comprehensive system of community care for mentally ill, developmentally and physically disabled, and children and adults who require care or services by a facility or organization issued a license or special permit under the CCF Act. Pursuant to the CCF Act, the Department of Social Services (DSS) licenses and regulates CCFs of various types, including those that provide nonmedical residential care, day treatment, adult daycare, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children. Includes adult residential facilities, among other facility types. [HSC §1500 et seq., §1502]
- Licenses and regulates residential care facilities for the elderly (RCFEs) by DSS, and defines RCFEs as a housing arrangement chosen voluntarily by persons 60 years of age or over, where varying levels and intensities of care and supervision, protection supervision, or personal care, or health-related services are provided, based upon their varying needs, as determined in order to be admitted and to remain in the facility. Defines “health-related services,” for purposes of RCFEs, as services that are required to be directly provided by an appropriate skilled professional, including a registered nurse, licensed vocational nurse, physical therapist, or occupational therapist. [HSC §1569 et seq., §1569.2]
This bill:
- Adds RCFEs to the list of health facilities eligible to participate in financing and funding programs offered by CHFFA.
- Prohibits the inclusion of RCFEs from being construed to affect the licensing of health facilities, or any other provisions of law relating to health facilities, except as the term “health facility” is interpreted for purposes of CHFFA.
- Makes minor technical and conforming changes, including revising the definition of a multilevel facility to reflect that RCFEs serve residents 60 years of age or older, rather than 62 years of age or older.
FISCAL EFFECT:
According to the Assembly Appropriations Committee, because CHFFA charges a fee to the borrower to access the financing, no state costs.
COMMENTS:
- Author’s statement. According to the author, currently, a non-profit RCFE that is not attached to a skilled nursing facility is not eligible for lower interest rate tax-exempt financing through CHFFA. Many non-profit RCFE’s are unable to access this program, making borrowing costs prohibitive when compared to RCFE’s with skilled nursing facilities attached. Affordability is a major concern for many non-profit RCFE’s, especially those that are not connected to a skilled nursing facility because of their current inability to access this program. By allowing these RCFE’s to utilize these tools they will be able to borrow at much lower costs overall.
- Background on existing CHFFA programs. CHFFA was created to be the state's vehicle for providing financial assistance to public and nonprofit health care providers primarily through loans funded by the issuance of tax-exempt bonds. To this end, CHFFA administers the Bond Financing Program and the Tax-Exempt Equipment Financing Program. CHFFA also provides direct loans to small and rural health facilities through the Healthcare Expansion Loan Program (HELP) II Financing Program. In September of 2021, the Governor signed into law the Nondesignated Public Hospital Bridge Loan Program to enable CHFFA to issue up to $40 million in working capital loans at zero interest rate to certain hospitals that are affected by financial delays associated with the transition to the Quality Incentive Program. These Nondesignated Public Hospital Bridge Loans are required to be paid back in two years, and are secured by Medi-Cal reimbursements. Additionally, CHFFA administers several grant programs, including the Children's Hospital Programs, the Community Services Infrastructure Grant Program, and the Investment in Mental Health Wellness Grant Program. Under the Mental Health Wellness grant program, counties can apply for funding to develop a continuum of crisis services to children and youth up to 21 years of age in four categories: crisis residential treatment, crisis stabilization, mobile crisis support teams, and family respite care.
By borrowing through CHFFA’s tax-exempt bond financing program, health facilities can likely obtain rates that are 20% lower than they would through taxable financing options. Generally, non-profit, licensed health facilities in California, including adult day health centers, community clinics, skilled nursing facilities, developmentally disabled centers, hospitals, and drug and alcohol rehabilitation centers are eligible for CHFFA financing. Proceeds from CHFFA financings may be used for project-related costs, including: construction; remodeling and renovation; land acquisition (as part of the proposed project); acquisition of existing health facilities; purchase or lease of equipment; refinancing or refunding of prior debt; working capital for start-up facilities; costs of bond issuance; feasibility studies; and, reimbursement of prior expenses. Under statute, savings resulting from issuance of tax-exempt bonds for borrowers must be transferred to the consuming public through lower or contained costs for delivery of health services. CHFFA states that to enforce this requirement, applicants are required to complete a pass-through savings certification as part of its loan application that demonstrates significant community service.
Since its first bond issuance in 1981, CHFFA’s bond financing program has issued 646 bonds for an aggregate total of approximately $47.5 billion, with 275 health facilities availing themselves of this financing. - Background on RCFEs and other facilities licensed by DSS. RCFEs are designed to provide a living space where seniors 60 or older can get assistance with activities of daily living, as needed. They are not health facilities, but the facilities typically bring licensed health care practitioners into the facility to provide care as necessary. Some RCFEs include memory care units for seniors with dementia. RCFEs can also be part of a continuing care retirement community (CCRC), which offers different levels of service in one location, often (but not always) including a skilled nursing facility (licensed by the California Department of Public Health) where a resident can be moved if they start requiring continuous nursing care. Under existing law, CHFFA financing is available to a “multilevel facility” where an RCFE is operated as a part of, or in conjunction with, an intermediate care facility, skilled nursing facility, or hospital. Under this provision of law, a CCRC that includes both an RCFE and a skilled nursing facility, for example, is eligible for CHFFA financing. However, RCFEs that do not operate in conjunction with a health facility are not eligible under existing law. According to DSS, there are a total of 7,469 RCFEs operating in California. However, because CHFFA financing is limited to only facilities operated by nonprofits (or those operated by governmental entities), only the 239 non-profit RCFEs would be eligible for CHFFA financing under this bill (and some of these are likely already eligible as part of a multilevel facility where a skilled nursing facility is operated alongside the RCFE).
DSS also licenses a type of community care facility known as an adult residential facility. This is distinguished from an RCFE as being part of the system of community care to provide nonmedical residential care, day treatment, and other services for children and/or adults that need personal services, supervision, or assistance essential for sustaining the activities of daily living, including but not limited to the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children. Adult residential facilities, as opposed to RCFEs, are not specific to the aging population over 60. Under existing law, most nonprofit community care facilities, including adult residential facilities, are already eligible to participating in CHFFA financing. RCFEs are specifically excluded.
- Double referral. This bill is double referred. Should it pass out of this committee, it will be referred to the Senate Committee on Human Services.
- Related legislation. SB 45 (Roth) establishes the California Acute Care Psychiatric Hospital Loan Fund to provide loans to qualifying county applicants for the purpose of constructing or renovating acute care psychiatric hospitals or psychiatric health facilities, or renovating or expanding general acute care hospitals in order to add or expand an inpatient psychiatric unit. SB 45 is pending in the Assembly.
- Support. This bill is sponsored by LeadingAge California, which states that this bill would modernize and update the CHFFA statute to allow nonprofit RCFEs, regardless of their connection to a skilled nursing facility, to utilize the program. LeadingAge states that since CHFFA was created in 1979, the delivery of health care and the aging process has evolved, and that licensed assisted living and memory care no offer supportive personal care services in more residential type buildings and programs. Independence and dignity are key consumer values, and there is a clear shift from licensed nursing care to licensed assisted living and memory care. LeadingAge also states that this bill furthers one of the goals of the Master Plan for Aging, which aims to allow older adults to live where they choose as they age, “in communities that are age-, disability-, and dementia-friendly.” Expanding the CHFFA program to all RCFEs will reduce borrowing costs to create more nonprofit assisted living and memory care to meet the needs of our growing older adult population. The California Commission on Aging supports this bill, stating that RCFEs are residential non-medical facilities for adults over the age of 60 who are unable to live by themselves but who do not require 24-hour nursing care. Sometimes referred to as assisted living or board and care facilities, RCFEs allow older adults to remain in a residential setting while receiving necessary assistance in daily tasks. The California Commission on Aging states that these facilities are critical toward providing housing for older adults who require a higher level of care, but demand for this type of housing has drastically outpaced its availability. California’s rising housing costs have caused many small residential facility operators to close and decelerated construction of new facilities. This bill would help stop the flow of older adults into homelessness by providing funding of critical housing and services for RCFEs. The California Senior Legislature also supports this bill, stating it will be beneficial to many as the senior population increases.
- Support if amended. The California Association of Local Behavioral Health Boards and Commissions (CALBHB/C) supports this bill if amended to include “adult residential facilities” (ARFs) for adults with serious mental illness that are owned by nonprofits and governmental entities. According to CALBHB/C, ARFs and RCFEs are both licensed by DSS’ Community Care Licensing Division, and are essential components of California’s housing continuum for individuals with serious mental illness who need 24/7 care and housing. CALBHB/C states there is a critical shortage of ARFs and RCFEs in California, and appreciates efforts to boost this critical part of the care and housing continuum.
However, most nonprofit community care facilities, including ARFs, are already eligible under existing law. - Opposition. California Advocates for Nursing Home Reform (CANHR) opposes this bill because it would allow access to CHFFA funding by continuing care retirement communities. CANHR cites data from DSS that there are currently 79 non-profit CCRCs, which require a substantial entrance fee and substantial monthly care fees, in addition to a contract. According to CANHR, many of these “nonprofits” have increased their annual monthly care fees 8% to 10% over the past few years, which have imposed significant hardships on the residents, many of whom have invested their life savings into these CCRCs in order to live out their lives there. CANHR states that these residents did not expect that they would be investing in real estate development corporations that would impose liabilities on them and divert resources from their communities to other properties, while the reserve funds of these facilities hold millions of dollars in “profits.” CANHR states that a number of these nonprofit CCRC are planning to eliminate their skilled nursing units to save even more money, and this bill will only assist them in this venture. CANHR states that CHFFA was created to be the state’s vehicle for providing financial assistance to public and nonprofit health care providers, and CCRCs are not health care providers. While CCRCs include some licensed skilled nursing beds on the premises, the overwhelming majority of CCRC residents are in independent living units. CANHR argues that expanding CHFFA to include CCRC does nothing to promote the mission of CHFFA, but will expand the profits of these already profitable companies, regardless of for-profit or nonprofit status.
SUPPORT AND OPPOSITION:
Support: LeadingAge California (sponsor)
California Commission on Aging
California Senior Legislature
Oppose: California Advocates for Nursing Home Reform
-- END --
Date of Hearing: April 19, 2023
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Chris Holden, Chair
ABPCA Bill Id:AB 839
Author:(Addis) – As Amended Ver:March 30, 2023
Policy Committee: | Health | Vote: | 14 - 0 |
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Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill makes residential care facilities for the elderly (RCFEs) eligible for loans from the continuously appropriated California Health Facilities Financing Authority (CHFFA) Fund for financing or refinancing the acquisition, construction, or remodeling of health facilities, as defined. This bill also redefines “elderly,” for the purposes of the definition of an RCFE, as age 60 years or older, instead of 62 years or older.
FISCAL EFFECT:
Because CHFFA charges a fee to the borrower to access the financing, no state costs.
COMMENTS:
- Purpose. According to the author:
Currently, a non-profit [RCFE] that is not attached to a skilled nursing facility is not eligible for…lower interest rate tax-exempt financing through [CHFFA]...Many non-profit RCFE’s are unable to access these programs, making borrowing costs prohibitive when compared to RCFE’s with skilled nursing facilities attached…Non-profit [RCFEs] should not be an outlier when it comes to eligibility for [CHFFA]...These facilities are incredibly important to the communities they serve and deserve access to interest-free funding and other benefits provided by these programs.
- CHFFA Financing. CHFFA, within the Office of the State Treasurer, is the state's vehicle for providing financial assistance to public and non-profit health care providers through loans, grants, and tax-exempt bonds. To qualify for CHFFA financing, an institution must be a public hospital, a private non-profit corporation, or an association authorized by California law to provide or operate a health facility and undertake the financing or refinancing of a project. Generally, non-profit, licensed health facilities in the state, including adult day health centers, community clinics, developmentally disabled centers, and drug and alcohol rehabilitation centers, are eligible for financing. Applicants must be approved by a resolution of the CHFFA members at a regularly scheduled public meeting. In addition to initial eligibility, CHFFA requires borrowers to comply with its Bond Issuance Guidelines per bond rating category and provide loan security provisions and bond covenants that correspond with its rating. A health facility must transfer savings resulting from issuance of tax-exempt bonds to the consuming public via lower or contained costs for delivery of health services.
- RCFEs. According to the Department of Social Services, there are 7,469 RCFEs operating in the state, 239 of which are non-profit RCFEs that would be subject to the provisions of this bill. RCFEs, commonly referred to as Care Homes or Residential Care, include assisted living, continuing care retirement communities (CCRCs, also called life care communities), and memory care to seniors who are age 60 and over. Aside from housing, RCFEs provide care, assistance with daily living, activities, and general supervision to senior residents.
CCRCs offer different levels of service in one location. Many of them offer independent housing (houses or apartments), assisted living, skilled nursing care, health care services, and recreation programs, all on one campus. Where an individual lives within a CCRC depends on the level of service they need. For example, people who can no longer live independently move to the assisted living facility or sometimes receive home care in their independent living unit. If necessary, they can enter the CCRC's nursing home.
Assisted living is for people who need help with daily care, but not as much help as a nursing home provides. Assisted living facilities typically offer a few levels of care, with residents paying more for higher levels of care. Assisted living residents usually live in their own apartments or rooms and share common areas, and have access to many services, including meals; assistance with personal care; help with medications and housekeeping; 24-hour supervision, security, and on-site staff; and social and recreational activities.
Nursing homes, also called skilled nursing facilities (SNFs), provide a wide range of health and personal care services, but focus on medical care more than most assisted living facilities. SNFs typically provide nursing care, 24-hour supervision, three meals a day, assistance with everyday activities, and rehabilitation services if needed.
Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081
Date of Hearing: March 28, 2023
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 839
Author:(Addis) – As Amended Ver:March 20, 2023
SUBJECT: Residential care facilities for the elderly: financing.
SUMMARY: Expands two existing health facility loan programs to include Residential Care Facilities for the Elderly (RCFEs) by including an RCFE in the definition of “health facility” under those programs. Specifically, this bill:
- Changes the definition of a “health facility” for purposes of the California Health Facility Financing Authority (CHFFA) and the California Health Facility Construction Loan Insurance Law (LIL), to include an RCFE.
- Expands the definition of “elderly” for purposes of LIL from an individual that is 62 years of age or older, to instead mean a person 60 years of age or older.
- Prohibits the definition of an RCFE as a “health facility” for purposes of this bill from being construed to affect the licensing of specified health facilities, except as the term “health facility” is interpreted for purposes of CHFFA and the LIL.
- Finds and declares that the purpose of this bill is to promote the financing or refinancing of the acquisition, construction, remodeling, improvement, or expansion of RCFEs.
EXISTING LAW:
- Establishes the CHFFA Act within the office of the State Treasurer to be the State's vehicle for providing financial assistance to public and non-profit health care providers through loans, grants, and tax-exempt bonds. [Government Code (GOV) §15430 et seq.]
- Defines “health facility,” for purposes of CHFFA eligibility, to mean a facility, place, or building that is licensed, accredited, or certified and organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, or physical, mental, or developmental disability, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons, and includes, but is not limited to, all of the following types:
- A general acute care hospital (GACH) that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services;
- An acute psychiatric hospital (APH) that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care for mentally disordered, incompetent, or other patients, as specified, including the following basic services: medical, nursing, rehabilitative, pharmacy, and dietary services;
- A skilled nursing facility (SNF) that is a health facility that provides the following basic services: skilled nursing care and supportive care to patients whose primary need is for availability or skilled nursing care on an extended basis;
- An intermediate care facility (ICF) that is a health facility that provides the following basic services: inpatient care to ambulatory or semiambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require availability or continuous skilled nursing care;
- A special health care facility that is a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical or dental staff that provides inpatient or outpatient, acute or nonacute care, including, but not limited to, medical, nursing, rehabilitation, dental, or maternity;
- A clinic that is operated by a tax-exempt nonprofit corporation;
- An adult day health center that is a facility that provides adult day health care;
- A facility owned or operated by a local jurisdiction for the provision of county health services;
- A multilevel facility that is an institutional arrangement where a RCFE is operated as a part of, or in conjunction with, an ICF, a SNF, or a GACH. Defines “elderly,” for the purposes of this provision, to mean a person 62 years of age or older;
- A child day care facility operated in conjunction with a health facility;
- An ICF/developmentally disabled (DD) habilitative that is a health facility;
- An ICF/DD-nursing that is a health facility;
- A community care facility that is a facility that provides care, habilitation, rehabilitation, or treatment services to developmentally disabled or mentally impaired persons;
- A nonprofit community care facility, other than a facility that, is a residential facility for the elderly, a foster family agency, a foster family home, a full service adoption agency, or a noncustodial adoption agency;
- A nonprofit accredited community work activity program;
- A community mental health center;
- A nonprofit speech and hearing center;
- A non-profit blood bank;
- A residential facility for persons with developmental disabilities;
- A nonpublic school that provides educational services in conjunction with a health facility; and,
- Community clinics. [Government Code §15432]
- Establishes the Department of Health Care Access and Information (HCAI) in the California Health and Human Services Agency to expand equitable access to quality, affordable health care for all Californians through resilient facilities, actionable information, and the health workforce each community needs. [Health and Safety Code (HSC) §127000, et seq.]
- Establishes the LIL within HCAI, to provide, without cost to the state, an insurance program for health facility construction, improvement, and expansion loans in order to stimulate the flow of private capital into health facilities construction, improvement, and expansion and in order to rationally meet the need for new, expanded and modernized public and nonprofit health facilities necessary to protect the health of all the people of this state. [HSC§ 129005]
- Defines, for purposes of 4) above, “health facility” to mean any facility providing or designed to provide services for the acute, convalescent, and chronically ill and impaired, including, but not limited to, public health centers, community mental health centers, facilities for the DD, nonprofit community care facilities that provide care, habilitation, rehabilitation or treatment to developmentally disabled persons, facilities for the treatment of chemical dependency, including a community care facility, a clinic, an alcoholism recovery facility, and a structure located adjacent or attached to another type of health facility and that is used for storage of materials used in the treatment of chemical dependency, and general tuberculosis, mental, and other types of hospitals and related facilities, such as laboratories, outpatient departments, extended care, nurses’ home and training facilities, offices and central service facilities operated in connection with hospitals, diagnostic or treatment centers, extended care facilities, nursing homes, and rehabilitation facilities. States that “health facility” also means an adult day health center and a multilevel facility. Specifies that, except for facilities for the DD, facilities for the treatment of chemical dependency, or a multilevel facility, or as otherwise provided in this subdivision, “health facility” does not include any institution furnishing primarily domiciliary care. [HSC §129010 (g)]
- Requires a facility receiving a loan pursuant to 4) above, to post a notice in appropriate areas within the facility, including but not limited to, admissions offices, emergency rooms, and business offices that states: “This facility has agreed to make its services available to all persons residing or employed in this area. This facility is prohibited by law from discriminating against Medi-Cal and Medicare patients. Should you believe you may be eligible for Medi-Cal or Medicare, you should contact our business office (or designated person or office) for assistance in applying. You should also contact our business office (or designated person or office) if you are in need of a physician to provide you with services at this facility. If you believe that you have been refused services at this facility in violation of the community service obligation you should inform (designated person or office) and the Department of Health Care Access and Information.” [HSC §129065]
- Defines an RCFE as a housing arrangement chosen voluntarily by persons 60 years of age or over, or their authorized representative, where varying levels and intensities of care and supervision, protective supervision, personal care, or health-related services are provided, based upon their varying needs, as determined in order to be admitted and to remain in the facility. [HSC §1569.2 (p)]
FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, non-profit RCFEs should not be an outlier when it comes to eligibility for CHFFA and Cal-Mortgage programs. These facilities are incredibly important to the communities they serve and deserve access to interest-free funding and other benefits provided by these programs.
- BACKGROUND. According to the California Master Plan for Aging, California’s over-60 population is projected to diversify and grow faster than any other age group. By 2030, 10.8 million Californians will be an older adult, making up one-quarter of the state’s population.
- RCFEs. RCFEs, commonly referred to as Care Homes or Residential Care, include Assisted Living, Continuing Care Retirement Communities (CCRCs), and Memory Care to seniors who are age 60 and over. Aside from housing, RCFEs deliver care to senior residents along with assistance with daily living, activities, and general supervision as needed.
CCRCs, also called life care communities, offer different levels of service in one location. Many of them offer independent housing (houses or apartments), assisted living, and skilled nursing care all on one campus. Healthcare services and recreation programs are also provided. In a CCRC, where an individual lives depends on the level of service they need. People who can no longer live independently move to the assisted living facility or sometimes receive home care in their independent living unit. If necessary, they can enter the CCRC's nursing home. Assisted living is for people who need help with daily care, but not as much help as a nursing home provides. Assisted living facilities range in size from as few as 25 residents to 120 or more. Typically, a few "levels of care" are offered, with residents paying more for higher levels of care.
Assisted living residents usually live in their own apartments or rooms and share common areas. They have access to many services, including up to three meals a day; assistance with personal care; help with medications, housekeeping, and laundry; 24-hour supervision, security, and on-site staff; and, social and recreational activities. Exact arrangements vary from state to state.
Nursing homes, also called SNFs, provide a wide range of health and personal care services. Their services focus on medical care more than most assisted living facilities. These services typically include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. Rehabilitation services, such as physical, occupational, and speech therapy, are also available.
According to the Department of Social Services, there are 7,469 RCFE’s operating in the state, 239 of which are non-profit RCFEs that would be subject to the provisions of this bill.
- CHFFA financing. In order to meet the requirements for CHFFA financing, an institution must be a public hospital, a private non-profit corporation, or an association authorized by the laws of California to provide or operate a health facility and undertake the financing or refinancing of a project. Generally, non-profit, licensed health facilities in the State of California including adult day health centers, community clinics, developmentally disabled centers, and drug and alcohol rehabilitation centers are eligible for financing. Applicants must be approved by a resolution of the CHFFA Members at a regularly scheduled public meeting. In addition to initial eligibility, CHFFA requires borrowers to comply with its Bond Issuance Guidelines per bond rating category and provide loan security provisions and bond covenants that correspond with its rating. Savings resulting from issuance of tax-exempt bonds for borrowers must be transferred to the consuming public via lower or contained costs for delivery of health services.
- HCAI LIL Program. To be eligible for loan insurance, the borrower must be either a California nonprofit public benefit corporation or a political subdivision. In addition, it must be organized to own and operate a health facility and assure that its services are, or will be, available to all persons residing in the facility’s service area. Loans may be insured to finance or refinance the construction of new facilities; to acquire existing buildings; to expand, modernize, or renovate existing buildings; or, to finance fixed or movable equipment needed to operate the facility.
- CHFFA financing. In order to meet the requirements for CHFFA financing, an institution must be a public hospital, a private non-profit corporation, or an association authorized by the laws of California to provide or operate a health facility and undertake the financing or refinancing of a project. Generally, non-profit, licensed health facilities in the State of California including adult day health centers, community clinics, developmentally disabled centers, and drug and alcohol rehabilitation centers are eligible for financing. Applicants must be approved by a resolution of the CHFFA Members at a regularly scheduled public meeting. In addition to initial eligibility, CHFFA requires borrowers to comply with its Bond Issuance Guidelines per bond rating category and provide loan security provisions and bond covenants that correspond with its rating. Savings resulting from issuance of tax-exempt bonds for borrowers must be transferred to the consuming public via lower or contained costs for delivery of health services.
- SUPPORT. LeadingAge is the sponsor of this bill and states that the demographics of older adults in the state is rapidly changing. California is expected to have over 10.8 million individuals over the age of 60 by 2030 and by 2060 adults 60 and over will make up 30% of California’s population. Since CHFFA was created in 1979, the delivery of health care and the aging process has evolved. Licensed assisted living and memory care now offer supportive personal care services in more residential type buildings and programs. Independence and dignity are key consumer values. There is a clear shift from licensed nursing care to licensed assisted living and memory care. LeadingAge also states that this bill furthers Goal 1: Housing for All Ages and Stages of the Master Plan for Aging, which aims to allow older adults to live where they chose as they age, “in communities that are age-, disability- and dementia-friendly.” LeadingAge concludes that expanding the CHFFA and Cal-Mortgage programs to all RCFEs will reduce borrowing costs to create more nonprofit assisted living and memory care to meet the needs of our growing older adult population.
- RELATED LEGISLATION. SB 45 (Roth) establishes the California Acute Care Psychiatric Hospital Loan Fund to provide zero-interest loans to qualifying county applicants for the purpose of constructing or renovating APHs or psychiatric health facilities, or renovating or expanding GACHs in order to add or expand an inpatient psychiatric unit. SB 45 is pending a hearing in the Senate Health Committee.
- SUGGESTED AMENDMENT. As noted in existing law and the background, the definition of health facilities eligible for the HCAI LIL program, “does not include any institution furnishing primarily domiciliary care,” which includes RCFEs as currently defined. The HCAI program also requires a facility to, “…assure that its services are, or will be, available to all persons residing in the facility’s service area.” However, Medi-Cal does not cover Assisted Living Care, those patients end up living in SNFs long-term. Therefore, individuals living in a RCFEs’ service area that are covered by Medi-Cal would not benefit from the RCFE, despite the RCFE benefiting from no-cost mortgage insurance. The Committee may wish to amend this bill to remove the provisions of the bill allowing RCFEs to participate in the HCAI LIL program.
REGISTERED SUPPORT / OPPOSITION:
Support
LeadingAge (sponsor)
California Commission on Aging
Opposition
None on file.
Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097
Bill Author
Bill Co-Author(s):