Bill Text: CA AB784 | 2011-2012 | Regular Session | Amended
Bill Title: Long-term health care facilities: bed holds: appeals.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2012-06-06 - From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH. [AB784 Detail]
Download: California-2011-AB784-Amended.html
BILL NUMBER: AB 784 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 6, 2012
AMENDED IN SENATE AUGUST 23, 2011
AMENDED IN ASSEMBLY MAY 9, 2011
INTRODUCED BY Assembly Member Yamada
FEBRUARY 17, 2011
An act to amend Sections 1570.2, 1570.7, 1578, and 1585.5
of, and to add Sections 1584.5, 1587, and 1587.5 to,
Section 1599.1 of the Health and Safety Code, relating to
health care facilities , and declaring the urgency
thereof, to take effect immediately .
LEGISLATIVE COUNSEL'S DIGEST
AB 784, as amended, Yamada. Adult day health care.
Long-term health care facilities: bed holds: appeals.
Under existing law, residents of long-term health care facilities
have certain rights, including the right to be readmitted to a
facility following a hospital stay, as specified, and the right, if
denied readmission by the facility, to appeal this decision.
Existing law establishes the State Health Facilities Citation
Penalties Account within the Special Deposit Fund, available upon
appropriation by the Legislature, for the protection of health or
property of residents of long-term health care facilities.
This bill would require the State Department of Health Care
Services to conduct the appeal hearings. This bill would require that
the State Department of Public Health be bound by a decision
rendered by the State Department of Health Care Services. If
readmission is ordered on appeal and the facility refuses to readmit
the resident, the bill would require the State Department of Health
Care Services to refer the matter to the State Department of Public
Health, and require the State Department of Public Health to assess a
specified civil penalty against the facility each day, until the
resident is readmitted or a maximum penalty amount is reached. This
bill would increase these penalty amounts if the facility has
previously refused after being ordered on appeal to readmit a
resident. The bill would require that these penalties be deposited
into the State Health Facilities Citation Penalties Account. The bill
would authorize the State Department of Health Care Services and the
State Department of Public Health to request that the Attorney
General seek injunctive relief and damages pursuant to specified
provisions of law. The bill would authorize the departments to
implement these provisions by means of letters, provider bulletins,
or other similar instructions.
Existing law, the California Adult Day Health Care Act, provides
for the licensure and regulation of adult day health care centers,
with administrative responsibility for the adult day health care
program shared among the State Department of Public Health, the State
Department of Health Care Services, and the California Department of
Aging pursuant to an interagency agreement. Existing law provides
that a negligent, repeated, or willful violation of a provision of
the California Adult Day Health Care Act is a misdemeanor.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions. Existing law, the Adult Day Health
Medi-Cal Law, establishes adult day health care services as a
Medi-Cal benefit and requires adult day health centers to offer, and
provide directly on the premises, specified services. Existing law,
with prescribed implementation, to the extent permitted by federal
law, excludes adult day health care from coverage under the Medi-Cal
program.
This bill would require an adult day health care center to have a
prescribed program plan, as defined. This bill would provide the
minimum staffing requirements for an adult day health care center.
Existing law requires an adult day health care center to provide
services to each participant pursuant to an individual plan of care,
as defined, designed to maintain or restore each participant's
optimal capacity for self-care.
This bill would require this plan to be designed by the
multidisciplinary team, composed, at a minimum, as prescribed. This
bill would require an adult day health care center to provide certain
services, as needed, to implement participants' individual plans of
care in accordance with the program plan.
By changing the definition of a crime, this bill would create a
state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
This bill would declare that it is to take effect immediately as
an urgency statute.
Vote: 2/3 majority . Appropriation:
no. Fiscal committee: yes. State-mandated local program: yes
no .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. This act shall be known, and may be
cited, as the Nursing Facility Bed Hold Protection Act of 2012.
SEC. 2. The Legislature finds and declares all of
the following:
(a) The protection of residents in California's nursing facilities
is of paramount importance to the citizens of California.
(b) Sixty-four percent of California nursing facility residents
have all or part of their care paid for by Medi-Cal.
(c) Nearly 40 percent of nursing home residents are hospitalized
at least once during their residency.
(d) State and federal law guarantee that a hospitalized resident's
bed will be held for at least seven days if the resident so elects.
The bed hold protects a resident's continuity of placement, ensures
that a decision to go to a hospital is unaffected by the risk of
losing his or her home, and protects residents from transfer trauma.
(e) Despite the bed hold requirements, nursing facilities often
refuse to hold a resident's bed, resulting in substantial costs to
the state in reimbursing acute care hospitals for administrative days
under Medi-Cal.
(f) A resident whose bed is not held may file a complaint with the
State Department of Public Health and request an appeal with the
State Department of Health Care Services.
(g) Even when a resident's appeal is granted and the nursing
facility is ordered to readmit the resident, many facilities refuse
to comply and do not suffer any adverse consequences.
(h) It is, therefore, the intent of the Legislature to enact
legislation that would do all of the following:
(1) Penalize nursing facilities that do not honor state and
federally required resident bed holds.
(2) Engage the licensed nursing staff at the State Department of
Public Health in a clinical review of a preliminary decision of the
State Department of Health Care Services to order the readmission of
a resident to determine if readmission is appropriate.
(3) Engage the Attorney General to consider an action to defend
the bed hold rights of nursing facility residents.
SEC. 3. Section 1599.1 of the Health
and Safety Code is amended to read:
1599.1. Written policies regarding the rights of patients shall
be established and shall be made available to the patient,
to any guardian, next of kin, sponsoring agency or
representative payee, and to the public. Those
policies and procedures shall ensure that each patient admitted to
the facility has the following rights and is notified of the
following facility obligations, in addition to those specified by
regulation:
(a) The facility shall employ an adequate number of qualified
personnel to carry out all of the functions of the facility.
(b) Each patient shall show evidence of good personal hygiene and
be given care to prevent bedsores, and measures shall be used to
prevent and reduce incontinence for each patient.
(c) The facility shall provide food of the quality and quantity to
meet the patients' needs in accordance with physicians' orders.
(d) The facility shall provide an activity program staffed and
equipped to meet the needs and interests of each patient and to
encourage self-care and resumption of normal activities. Patients
shall be encouraged to participate in activities suited to their
individual needs.
(e) The facility shall be clean, sanitary, and in good repair at
all times.
(f) A nurses' call system shall be maintained in operating order
in all nursing units and provide visible and audible signal
communication between nursing personnel and patients. Extension cords
to each patient's bed shall be readily accessible to patients at all
times.
(g) (1) If a facility has a significant beneficial interest in an
ancillary health service provider or if a facility knows that an
ancillary health service provider has a significant beneficial
interest in the facility, as provided by subdivision (a) of Section
1323, or if the facility has a significant beneficial interest in
another facility, as provided by subdivision (c) of Section 1323, the
facility shall disclose that interest in writing to the patient, or
his or her representative, and advise the patient, or his or her
representative, that the patient may choose to have another ancillary
health service provider, or facility, as the case may be, provide
any supplies or services ordered by a member of the medical staff of
the facility.
(2) A facility is not required to make any disclosures required by
this subdivision to any patient, or his or her representative, if
the patient is enrolled in an organization or entity that provides or
arranges for the provision of health care services in exchange for a
prepaid capitation payment or premium.
(h) (1) If a resident of a long-term health care facility has been
hospitalized in an acute care hospital and asserts his or her rights
to readmission pursuant to bed hold provisions, or readmission
rights of either state or federal law, and the facility refuses to
readmit him or her, the resident may appeal the facility's refusal.
Appeal hearings shall be conducted by the State Department of
Health Care Services. The State Department of Public
Health shall be bound by the decision rendered by the State
Department of Health Care Services.
(2) The refusal of the facility as described in this subdivision
shall be treated as if it were an involuntary transfer under federal
law, and the rights and procedures that apply to appeals of transfers
and discharges of nursing facility residents shall apply to the
resident's appeal under this subdivision.
(3) If the resident appeals pursuant to this subdivision, and the
resident is eligible under the Medi-Cal program, the resident shall
remain in the hospital and the hospital may be reimbursed at the
administrative day rate, pending the final determination of the
hearing officer, unless the resident agrees to placement in another
facility.
(4) If the resident appeals pursuant to this subdivision, and the
resident is not eligible under the Medi-Cal program, the resident
shall remain in the hospital if other payment is available, pending
the final determination of the hearing officer, unless the resident
agrees to placement in another facility.
(5) If the resident is not eligible for participation in the
Medi-Cal program and has no other source of payment, the hearing and
final determination shall be made within 48 hours.
(6) (A) (i) If readmission is ordered on appeal and the facility
refuses to readmit the resident after it receives the decision, the
State Department of Health Care Services shall refer the matter to
the State Department of Public Health. The State Department of Public
Health shall assess a civil penalty of one hundred dollars ($100)
per day, and the amount of the penalty shall increase by one hundred
dollars ($100) each subsequent day that the resident is not
readmitted until it reaches five hundred dollars ($500) on the fifth
day. Thereafter, the penalty amount shall be five hundred dollars
($500) per day against the facility until the resident is readmitted,
up to a total of one hundred thousand dollars ($100,000).
(ii) Notwithstanding clause (i), if the facility has previously
refused to readmit a resident after receiving an order following an
appeal hearing to readmit a resident pursuant to clause (i), the
State Department of Public Health shall assess a civil penalty of one
thousand dollars ($1,000) per day against the facility until the
resident is readmitted, up to a total of one hundred fifty thousand
dollars ($150,000).
(iii) Upon receiving the referral from the State Department of
Health Care Services pursuant to this subparagraph, the State
Department of Public Health shall issue a notice within 10 days to
the facility of the civil penalty assessment, informing the facility
of its current penalty amount, the amount that is immediately due and
payable, and an explanation of how the penalty shall accrue until
the resident is readmitted.
(iv) Penalties collected pursuant to this paragraph shall be
deposited into the State Health Facilities Citation Penalties Account
created pursuant to Section 1417.2. The State Department of Health
Care Services and the State Department of Public Health may request
that the Attorney General seek injunctive relief to enforce the
appeal decision and damages in the same manner as provided for in
Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of
the Business and Professions Code. If the Attorney General prevails,
the facility shall be liable for costs and attorney's fees.
(B) The State Department of Health Care Services may withhold or
deduct any Medi-Cal reimbursement payments to the facility to collect
the civil penalties assessed pursuant to this paragraph. If any
penalty assessed under this paragraph remains unpaid 60 days after
payment is due, the State Department of Health Care Services or the
State Department of Public Health may assess a penalty equal to 50
percent of the unpaid penalty amount and may seek to delay the
renewal of the facility's license.
(C) Civil penalties collected pursuant to this section shall be
immediately due and payable, notwithstanding any appeals, and shall
not be eligible for any reductions pursuant to subdivision (b) of
Section 1424.5, Section 1428.1, or any other law or rule.
(D) Notwithstanding the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code), or
any other provision of law, the State Department of Health Care
Services and the State Department of Public Health may implement this
paragraph, in whole or in part, by means of letters, provider
bulletins, or other similar instructions without taking regulatory
action.
(E) If the facility is granted a writ of mandate pursuant to
Section 1094.5 of the Code of Civil Procedure, the facility shall
receive a refund of the civil penalties paid pursuant to this
paragraph.
(i) Effective July 1, 2007, Sections 483.10, 483.12, 483.13, and
483.15 of Title 42 of the Code of Federal Regulations in effect on
July 1, 2006, shall apply to each skilled nursing facility and
intermediate care facility, regardless of a resident's payment source
or the Medi-Cal or Medicare certification status of the skilled
nursing facility or intermediate care facility in which the resident
resides, except that a noncertified facility is not obligated to
provide notice of Medicaid or Medicare benefits, covered services, or
eligibility procedures.
SECTION 1. Section 1570.2 of the Health and
Safety Code is amended to read:
1570.2. The Legislature hereby finds and declares that there
exists a pattern of overutilization of institutional care for elderly
persons, adults with disabilities, and acutely or chronically ill
adults and that there is an urgent need to establish and to continue
a community-based system of quality adult day health care which will
enable elderly persons, adults with disabilities, and acutely or
chronically ill adults to maintain maximum independence. While
recognizing that there continues to be a substantial need for
facilities providing 24-hour custodial care, overreliance on this
type of care has proven to be a costly panacea in both financial and
human terms, often traumatic, and destructive of continuing family
relationships and the capacity for independent living.
It is, therefore, the intent of the Legislature in enacting this
chapter and related provisions to provide for the development of
policies and programs that will accomplish the following:
(a) Ensure that elderly persons, adults with disabilities, and
acutely or chronically ill adults are not institutionalized
inappropriately or prematurely.
(b) Provide a viable alternative to the utilization of
institutional services for those elderly persons, adults with
disabilities, and acutely or chronically ill adults who are capable
of living at home with the aid of appropriate health care or
rehabilitative and social services.
(c) Establish adult day health centers in the community for this
purpose, that will be easily accessible to all participants,
including economically disadvantaged elderly persons, adults with
disabilities, and acutely or chronically ill adults and that will
provide person-centered outpatient health, rehabilitative, and social
services necessary to permit the participants to gain or maintain
personal independence and lead meaningful lives.
(d) Include the services of adult day health centers as a benefit
under the Medi-Cal Act, that shall be an initial and integral part
in the development of an overall plan for a coordinated,
comprehensive continuum of optional long-term care services based
upon appropriate need.
(e) Establish a rural alternative adult day health care program
designed to meet the special needs and requirements of rural areas to
enable the implementation of subdivisions (a) through (d),
inclusive, for all Californians in need of those services.
(f) Ensure that all laws, regulations, and procedures governing
adult day health care be enforced equitably regardless of
organizational sponsorship and that all program flexibility
provisions be administered equitably.
SEC. 2. Section 1570.7 of the Health and Safety
Code, as amended by Chapter 119 of the Statutes of 2011, is amended
to read:
1570.7. As used in this chapter and in any regulations
promulgated thereunder:
(a) "Adult day health care" means an organized outpatient program
utilizing a patient-centered multidisciplinary team approach to
manage physical, cognitive, and behavioral health conditions for the
purpose of restoring or maintaining an individual's optimal health
and functioning. Provided on a short-term basis, adult day health
care serves as a site for transitioning from a health facility to the
community with the goal of preventing avoidable emergency department
visits and inpatient readmissions and restoring optimal health.
Provided over a longer term, it serves to deter institutionalization
and overuse of more costly medical resources.
(b) "Adult day health center" or "adult day health care center"
means a licensed facility that provides adult day health care.
(c) "Average daily attendance" means the average number of
participants attending the adult day health care center daily,
calculated over the past month.
(d) "Core staff" includes the positions of program director,
registered nurse, social worker, activity director, and program aide.
(e) "Department" or "state department" means the State Department
of Public Health.
(f) "Director" means the State Public Health Officer.
(g) "Elderly" or "older person" means a person 55 years of age or
older.
(h) "Extended hours" means those hours of operation prior to or
following the adult day health care program hours of service, as
designated by the adult day health care center in its plan of
operation, during which the adult day health care center may operate
an adult day program, or an Alzheimer's day care resource center, or
both.
(i) "Full-time" means the total program hours of service per week.
(j) "Half-time" means 50 percent of full-time.
(k) "Hours of operation" means the regular hours during which the
adult day health care center is open and any staff are on the
premises, including, but not limited to, hours during which no
participants are scheduled to attend but the doors are open to
conduct business operations.
( l ) "Hours of service" means the program
hours defined and posted by the adult day health care center during
which core staff and participants are present for the provision of
adult day health care services.
(m) "Individual plan of care" means a plan designed to provide
recipients of adult day health care with appropriate treatment in
accordance with the assessed needs of each individual participant
within the facility's scope of services, as defined in the program
plan.
(n) "Institutional services" includes any 24-hour health facility
and a hospital emergency department.
(o) "License" means a basic permit to operate an adult day health
care center. With respect to a health facility licensed pursuant to
Chapter 2 (commencing with Section 1250), "license" means a special
permit, as defined by Section 1251.5, empowering the health facility
to provide adult day health care services.
(p) "Long-term absence" or "long-term vacancy" means a staff
absence or vacancy lasting, or expected to last, longer than one
month.
(q) "Maintenance program" means procedures and exercises that are
performed repetitively to maintain a level of functioning when a
patient's restoration potential is insignificant in relation to the
therapy required to achieve that potential, when it has been
determined that the treatment goals will not materialize, or when the
therapy performed is considered to be a general exercise program.
These procedures and exercises are planned by a licensed or certified
therapist and are provided by a person who has been trained by a
licensed or certified therapist and who is directly supervised by a
nurse.
(r) "Personal health care provider" means the participant's
personal physician, physician's assistant, or nurse practitioner,
operating within his or her scope of practice.
(s) "Program aide" means a person, supervised by the program
director or other members of the multidisciplinary team, whose job
duties include, but are not limited to, provision of personal care,
assistance with activities, transportation, or other services, as
assigned.
(t) "Program director" shall be a person with both of the
following:
(1) One of the following backgrounds:
(A) A person with a bachelor's degree and a minimum of two years
of experience in a management, supervisory, or administrative
position.
(B) A person with a master's degree and a minimum of one year of
experience in a management, supervisory, or administrative position.
(C) A registered nurse with a minimum of two years experience in a
management, supervisory, or administrative position.
(2) Appropriate skills, knowledge, and abilities related to the
health, and mental, cognitive, and social needs of the participant
group being served by the adult day health center.
(u) "Program plan" means a written description of the adult day
health care center's philosophy, objectives, and processes for
providing required services to the participant populations.
(v) "Restorative therapy" means physical, occupational, and speech
therapy, and psychiatric and psychological services that are planned
and provided by a licensed or certified therapist. The therapy and
services may also be provided by an assistant or aide under the
appropriate supervision of a licensed therapist, as determined by the
licensed therapist. The therapy and services are provided to restore
function, when there is an expectation that the condition will
improve significantly within a reasonable period of time, as
determined by the multidisciplinary assessment team.
(w) "Short-term absence" or "short-term vacancy" means a staff
absence or vacancy lasting, or expected to last, one month or less,
and includes sick leave and vacations, but does not include periods
during which staff are absent from the facility performing
program-related duties.
(x) "Social worker" shall be a person who meets one of the
following:
(1) The person holds a master's degree in social work from an
accredited school of social work.
(2) The person holds a master's degree in psychology, gerontology,
or counseling from an accredited school and has one year of
experience providing social services in one or more of the fields of
aging, health, or long-term care services.
(3) The person is licensed by the California Board of Behavioral
Sciences.
(4) The person holds a bachelor's degree in social work from an
accredited school with two years of experience providing social
services in one or more of the fields of aging, health, or long-term
care services.
SEC. 3. Section 1578 of the Health and Safety
Code is amended to read:
1578. (a) A provider may share space with another licensed health
facility, community care facility, senior center, or other
appropriate structure, upon the approval of the department, based
upon a determination of all of the following:
(1) The use of the shared space does not jeopardize the welfare of
the participant or other clients.
(2) The shared use does not exceed occupancy capacity established
for fire safety.
(3) The space used by the adult day health care center is not
essential to meet the other program's licensing requirements.
(4) Each entity schedules services and activities at separate
times. This subdivision shall not apply to space used for meals or
for space used by another licensed adult day services program.
(b) For purposes of this section, "shared space" means the mutual
use of exits and entrances, offices, hallways, bathrooms, treatment
rooms, and dining rooms by an adult day health care center and
another program pursuant to Section 1578.1.
SEC. 4. Section 1584.5 is added to the Health
and Safety Code, to read:
1584.5. An adult day health care center shall have a program plan
that shall contain all of the following:
(a) The total number of participants the center proposes to serve,
or currently serves, daily.
(b) A profile of the participant population the center proposes to
serve, or currently serves, that includes a description of the
specific medical, social, and other needs of each population.
(c) A description of the specific services provided to address the
medical, social, and other needs of each participant population that
the center proposes to serve, or currently serves, as specified in
subdivision (b).
(d) A description of the specialized professional and program
staff that will provide, or currently provides, the adult day health
care center's program services, as specified in subdivision (c), and
that staff's responsibilities. The plan shall demonstrate that the
adult day health care center is organized and staffed to carry out
the requirements as specified in the regulations adopted pursuant to
Section 1580.
(e) An in-service training plan for each center staff member to
commence within the first six months of employment. The training plan
shall address, at a minimum, the specific medical, social, and other
needs of each participant population the center proposes to serve,
as specified in subdivision (b).
(f) An example of a one-week schedule of daily program services.
(g) A plan for a behavior modification program if such a program
will be used as a basic intervention for meeting the needs of a
special population, such as persons with developmental disabilities
or persons with mental disabilities. The plan, as applied to persons
with developmental disabilities, shall be consistent with Section
4503 of the Welfare and Institutions Code.
SEC. 5. Section 1585.5 of the Health and Safety
Code is amended to read:
1585.5. (a) Adult day health care centers shall provide services
to each participant pursuant to an individual plan of care designed
by the multidisciplinary team to maintain or restore each participant'
s optimal capacity for self-care.
(b) The multidisciplinary team shall be composed of, at a minimum,
the staff physician or the participant's personal health care
provider, the registered nurse, the social worker, the program
director, and, as needed, an occupational therapist, physical
therapist, or speech and language pathologist. The multidisciplinary
team shall assess the needs of the participant and develop the
participant's individual plan of care.
SEC. 6. Section 1587 is added to the Health and
Safety Code, to read:
1587. (a) The minimum staffing requirements for an adult day
health care center shall be as follows:
(1) A full-time program director shall be employed to implement
the program plan, and supervise and coordinate staff.
(2) Program aides shall be employed in a sufficient number to meet
the personal care and supervision needs of the participants during
program hours of service or extended program hours, but in no event
shall the program aides employed be fewer than a ratio of one-half
aide for every increment of eight participants being cared for during
program hours of
service. Program aides shall be qualified by education, training, and
experience to perform the duties assigned and meet the needs of the
program.
(3) A full-time registered nurse shall be employed to oversee the
provision of nursing services. A half-time vocational nurse shall be
provided for each increment of 10 in average daily attendance
exceeding 40, calculated monthly, and which has been sustained over
each of the prior three calendar months.
(4) A full-time social worker shall be employed to provide direct
skilled social work services and to oversee the provision of social
services. A half-time social work assistant shall be provided for
each increment of 10 in average daily attendance exceeding 40,
calculated monthly, and which has been sustained over each of the
prior three calendar months.
(5) A full-time activity director shall be employed to direct the
activity program. The activity director may be counted in the ratio
for calculating the necessary direct care staff defined in
subdivision (b).
(6) A licensed nurse shall be on duty during the defined program
hours of service.
(b) The adult day health care center's policies and procedures
shall be specific regarding the provision of adequate staffing for
coverage with qualified personnel for long-term and short-term
absences or vacancies. Regardless of the reason for the staff absence
or vacancy, the adult day health care center shall provide
sufficient staffing to ensure participant safety and shall designate
appropriate substitute staff as needed.
SEC. 7. Section 1587.5 is added to the Health
and Safety Code, to read:
1587.5. The minimum services that shall be provided by an adult
day health care center, as needed, to implement participants'
individual plans of care, in accordance with the program plan, are as
follows:
(a) Occupational therapy services.
(b) Pharmacist consulting services to assist with implementation
of the center's medication policies and procedures and to consult on
individual participant drug regimens.
(c) Physical therapy services.
(d) Psychiatric or psychological consulting services provided by a
qualified licensed practitioner.
(e) Skilled dietary consulting services.
(f) Speech and language pathology services.
SEC. 8. No reimbursement is required by this
act pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.
SEC. 9. This act is an urgency statute
necessary for the immediate preservation of the public peace, health,
or safety within the meaning of Article IV of the Constitution and
shall go into immediate effect. The facts constituting the necessity
are:
In order to ensure that adult day health care centers may remain
open, providing services to elderly persons, adults with
disabilities, and acutely or chronically ill adults with the
elimination of adult day health care as a Medi-Cal benefit, it is
necessary that this act take effect immediately.
