Assembly Budget Subcommittee Chairman Dave Jones, D-Sacramento, put the brakes on a nursing home reform proposal by the Schwarzenegger administration during a hearing yesterday.
Jones, who is a candidate for insurance commissioner, asked a conference committee to consider one-year changes to a 2004 law that has since increased funding to nursing homes by nearly $1 billion.
The governor’s office had put forward a set of changes lauded by patient advocates who say the 2004 law did not meet its promise in improving the quality of nursing home care.
The governor’s two-year proposal would have extended raises to the nursing home industry both years without tapping into the state's general fund.
In exchange, the state would have taken money from nursing homes and returned it to those that meet quality and accountability measures. Those measures would have been determined this year by patient advocates and nursing home industry leaders.
A nursing home industry lobbyist testified yesterday that the changes were too significant to make without considerably more deliberation.
Patient advocates made the same argument in 2004 when the Nursing Home Quality Care Act was proposed. Still, it passed over their objections, changing the way nearly $4 billion per year in federal and state money is spent to fund nursing home care for the needy.
One patient advocacy group, California Advocates for Nursing Home Reform, applauded general outline of the governor's changes but said they do not go far enough. They wrote:
Accountability is urgently needed. California nursing home residents continue to suffer from routine neglect and abuse despite multi-billion dollar payment increases under Medi-Cal since 2004 when the Legislature adopted AB 1629, an industry-written rate plan. The blank-check system rewards operators with increased payments no matter how poor their care.
Acknowledging this grim reality, the DHCS proposal states it “has no tangible or direct
mechanism for financially incentivizing, rewarding, or penalizing SNFs for the overall quality of care rendered to their residents.”
During a budget subcommittee meeting yesterday, Jones said he was “conceptually supportive” of quality and performance, but was not willing to make so many changes so quickly. He said he was disappointed that the Department of Health Care Services did not seek an author for a bill proposing the changes. (The department proposed the changes as a budget trailer bill.)
In making only the one-year change and pulling back on the proposed quality and accountability fund, Jones aligned with the nursing home industry's lobbying group, the California Association of Health Facilities. That group’s fact sheet to lawmakers calls for only near-term changes, including a special fund (far smaller than what the Governor sought) to pay for stepped-up staffing inspections of nursing homes.
The governor's proposal sailed through a Senate budget committee Wednesday. Lawmakers approved the changes in concept, assuming additional details could be ironed out in a conference committee.
Now that group will attempt to bring both budget committee decisions in line with a final set of changes.
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