6Beds, Inc. is an advocacy organization committed to ensuring state and federal law does not create unfair and over-burdensome regulations that will prevent senior citizens from choosing small, home-like settings like six-bed facilities.

Advocacy, Issues, Survey

Emergency Call to Action: Don’t Lose Your Rate Increase!

WHO: Community Care Facilities (CCF) serving individuals with developmental disabilities (DD)

RE: ABX2-1 Rate Increase Survey

WHEN: September 7, 2017 (Thur)
TIME: 10 AM – 11 AM

LOCATION: Phone Conference

  • Call: 515-739-1548
  • Enter Code: 2947#

If you do not complete this survey you will lose your rate increase as of October 1, 2017.

With Assembly Bill (ABX2-1) many service providers received a rate increase through the ABX2-1 funds effective July 1, 2016.

The rate increase was for the purpose of increasing wages and/or benefits for staff.

This mandated survey that must be completed no later than Sunday, October 1, 2017 and on or before Friday, September 15, 2017 to be on time.

AGENDA:

  • Who are required to take survey?
  • Who are exempt from taking survey?
  • Where to take survey?
  • Simplest way to take survey?
  • Questions and Answers

Click here to learn more about the ABX2-1 Rate Increase Survey.

To join the call-to-action conference, please RSVP:

CLICK to RSVP

Advocacy, All Posts, ARF, Issues, RCFE

IN CASE YOU MISSED IT: DSS ANNOUNCED 2017 SSI/SSP NON-MEDICAL OUT-OF-HOME CARE (NMOHC) PAYMENT STANDARD

by George Kutnerian
The SSI/SSP non-medical out-of-home care (NMOHC) payment that SSI/SSP recipients who live in residential care facilities receive, has increased to $1,158.37 as follows:

Supplemental Security Income (SSI) $   735.00
State Supplementary Payment (SSP) $   423.37
$1,158.37

Of the $1,158.37, the SSI/SSP recipient is entitled to a personal and incidental needs allowance of $132.  This leaves $1,026.37 as the amount payable to the facility for basic services.

Please note that recipients who have income in addition to their SSI/SSP check (for example, a pension, Social Security Retirement, or disability benefits) can be charged the $1,026.37 amount for basic services plus an additional $20.  Because federal rules do not count the first $20 of a recipient’s income against his or her SSI/SSP grant, an SSI/SSP recipient with other income has an extra $20 that people who receive only an SSI/SSP check do not have.  Neither federal nor state law restricts the recipient in how this additional $20 amount is spent.  Therefore, if the recipient agrees in the admission agreement to pay the additional $20 for basic services, the facility may charge the additional amount resulting in a total monthly basic services charge of $1,046.37.

DSS’ Provider Information Notice regarding this topic can be found here (click to download).

Sincerely,

George K. Kutnerian
Senior Vice President of Public Policy & Legislation

Advocacy, All Posts, ARF, Issues, RCFE

Assisted Living Waiver Program – DHCS Announces Increased Provider Rates Effective 2017

by George Kutnerian
In a previous post, we let our readers know that California’s new budget would provide for an increase in funding for the Home and Community Based Services waiver programs, which includes the Assisted Living Waiver Program. At that time, the specific rates to take effect on January 1, 2017 had not yet been announced.

DHCS recently announced the specific provider rates that are to take effect on January 1, 2017.  The new provider rates are as follows:

 

Effective 2017                      Current

Tier 1         $55/day              $52/day

Tier 2         $66/day              $62/day

Tier 3         $75/day              $71/day

Tier 4         $87/day              $82/day

 

This marks the first rate increase the Assisted Living Waiver Program has received since its inception as a pilot program in 2006 when it began serving Los Angeles, Sacramento and San Joaquin counties.

The primary goal of the Assisted Living Waiver Program is to enable low-income, Medi-Cal eligible seniors and persons with disabilities, who would otherwise require nursing facility services, to remain in or relocate to the community.  The program was approved by the Centers for Medicaid and Medicare and is currently in the midst of its second five-year waiver that will run into 2019.  The Assisted Living Waiver Program currently operates in 14 counties throughout the State.

6-bed RCFEs play an important role in the Assisted Living Waiver Program.  The Assisted Living Waiver Program provider rate increase is yet another signal of the effectiveness of 6Beds’ advocacy in Sacramento, where 6Beds has persistently been advocating for provider rate increases for programs that impact 6-bed facilities as well as new funding sources for 6-bed facilities to cope with the rising costs of doing business in California.

Best Regards,

George Kutnerian, M.S., MBA
Senior Vice President – Public Policy & Legislation

Advocacy, All Posts, ARF, Issues, RCFE

First Increase in a Decade to State SSP Portion of the SSI/SSP Grant

by George Kutnerian
Effective January 1, 2017, the state SSP portion of the SSI/SSP grant will receive a cost-of-living increase equivalent to the increase in the California Necessities Index, which is 2.76 percent.  This increase would mark the first State SSP increase in more than a decade.

California, home to almost 20% of the nation’s SSI population, has long relied on 6-bed residential care facilities to provide housing and care for SSI/SSP recipients, among which are primarily the elderly and adults with disabilities, including those with developmental disabilities and mental illnesses.

The disparity between the capped SSI/SSP rate and the median market rate has grown to become a gaping chasm over the years, with the SSI/SSP board and care rate failing to keep up with the rapidly rising housing and operating costs that California’s small 6-bed residential care facilities face.

The 2.76% increase to the State SSP portion of the SSI/SSP grant, the first such increase in more than a decade, has been long overdue and is a step, albeit a very modest one, in the right direction.  6Beds recognizes that much more will have to be done to sustain the small 6-bed residential care facilities that care for SSI/SSP recipients and will continue to advocate on their behalf.

Best Regards,

George Kutnerian, M.S., MBA
Senior Vice President of Public Policy & Legislation

Advocacy, All Posts, ARF, Issues, RCFE

First Ever Rate Increase for Assisted Living Waiver Program

by George Kutnerian
California’s new budget will provide for an increase in funding for the Home and Community Based Services waiver programs, which includes the Assisted Living Waiver Program.

The budget will provide for an estimated $7.1 million from the State’s General Fund and an estimated $5.1 million in federal funds, reflecting increased costs in Home and Community Based Services waiver programs and long-term care facilities rate add-ons.

The specific provider rate increase for the Assisted Living Waiver Program has not yet been determined, but increased rates should take effect on January 1, 2017 and we expect the new rates to be announced sometime in the 4th quarter of this year.

The much needed and long overdue provider rate increase would be the first rate increase the Assisted Living Waiver Program has received since its inception as a pilot program in 2006 when it began serving Los Angeles, Sacramento and San Joaquin counties.

The primary goal of the Assisted Living Waiver Program is to enable low-income, Medi-Cal eligible seniors and persons with disabilities, who would otherwise require nursing facility services, to remain in or relocate to the community.  The program was approved by the Centers for Medicaid and Medicare and is currently in the midst of its second five-year waiver that will run until February 28, 2019, by which time we expect that another five year waiver renewal will be approved.  The Assisted Living Waiver Program currently operates in 14 counties throughout the State.

6-bed RCFEs and ARFs play an important role in the Assisted Living Waiver Program and 6Beds will continue to keep its members and followers apprised of new information pertaining to the provider rate increase.

Best Regards,

George Kutnerian, M.S., MBA
Senior Vice President of Public Policy & Legislation

Advocacy, All Posts, Issues, RCFE

$5/Bed Tax on RCFEs Proposed – 6Beds Opposes

On April 28, 2016, the California Long-Term Care Ombudsman Association (CLTCOA) proposed a $5/bed tax on all RCFEs to provide additional funding to the State’s Long-Term Care Ombudsman Program (LTCOP).

Watch footage from the April 28, 2016 Senate Budget & Fiscal Review Subcommittee #3 on Health and Human Services to hear the CLTCOA’s $5/bed RCFE tax proposal and 6Beds’ opposition testimony by 6Beds lobbyist, Robert Naylor.

While 6Beds supports the CLTCOA’s request for more funding from the State’s General Fund, 6Beds does not believe that additional funding for the LTCOP should come at the direct expense of small-home RCFE operators that, in just the last two years, have been heavily burdened by costly regulations, including:

  • 30% increase in licensing fees to help fund Community Care Licensing functions, including a return to annual inspections
  • Liability insurance mandate, costing thousands of dollars a year in insurance premiums
  • Significant increase in civil penalties
  • Quadrupling caregiver training hours
  • Doubling administrator certification hours
  • Increasing Medication Training
  • Expanding dementia care training

6Beds understands that the State has made changes with the goal of improving California’s residential care system, but these changes come with a cost that impact both small-home RCFE’s and their residents.  There is now data that shows there are more RCFE closures than openings, resulting in a net loss of facilities at a time when California’s older adult population is expanding rapidly.  Most of these closures are voluntary closures, which suggest that the primary reason for closures is lack of economic viability.

Some argue that the proposed tax does not represent a significant dollar amount. However, 6Beds is opposed to all taxes that target residential care operators, regardless of the size of the tax.  Any RCFE tax, regardless of amount, sets a bad precedent that can open the floodgates for future taxes on RCFEs and other residential care operators.

6Beds members strive to provide safe, quality, and affordable residential care.  6Beds understands the purpose of the LTCOP and the positive role that it can play in the residential care system, which is why 6Beds supports the CLTCOA’s General Fund request and, potentially, alternative funding sources that do not rely on taxing RCFE operators.

Regards,

George Kutnerian

Advocacy, All Posts, ARF, Issues, RCFE

6Beds Lobby Day: Dozens and Dozens of 6Beds Members Flood the State Capitol for Testimony in Opposition to the Civil Penalties Bill (AB 2231)

Dozens and dozens of 6Beds members and supporters flooded the State Capitol on April 12, 2016 for 6Beds’ Lobby Day with 6Beds’ testimony before the Assembly Human Services Committee in opposition to the civil penalties bill, AB 2231, one of the focal points of the day.

AB 2231 addresses violations, including repeat violations and serious/zero tolerance violations, as well as the civil penalties associated with these types of violations.  6Beds’ official comment letter on the bill can also be found here as well as the Assembly Human Services Committee’s bill analysis, which incorporated 6Beds’ comments.  Similar to the complainant appeal process that was proposed in 2015, 6Beds was once again the only provider organization to formally take an opposition position.

Although AB 2231 did not propose to change the highest civil penalty amounts of $15,000 and $10,000, which took effect with the passage of AB 2236 two years ago, 6Beds advocated that AB 2231 be amended to include the scaling down of these penalty amounts for RCFEs and ARFs serving six or fewer persons given the disproportionate economic impact and risk of closure these penalties expose small facilities to.  6Beds also advocated for an amendment that would tighten up the definition of a repeat violation to prevent situations where violations with different facts and circumstances could unfairly be labeled as repeat violations, subjecting licensees to costly civil penalties.  Finally, in light of Community Care Licensing’s (CCL) move towards collecting civil penalties upfront even if the deficiency is under appeal, 6Beds advocated for an amendment that would codify historic practice of having to pay a civil penalty only after the conclusion of an unsuccessful appeal.  It is fundamentally unfair for licensees to be asked to pay civil penalties while their appeals are pending.

The audience in the room that held the Assembly Human Services Committee hearing resembled a sea of blue, dominated by a large number of 6Beds members wearing blue 6Beds shirts. 6Beds’ testimony and the dozens of 6Beds members that formed a long line to individually express their opposition following the testimony made a powerful statement to both legislators and CCL that licensees of small residential care facilities are not to be ignored.  In response to 6Beds’ message and presence, the Chair of the Assembly Human Services Committee, Susan Bonilla (D – Concord), and the author of AB 2231, Ian Calderon (D – Whittier) both recognized the treatment of licensees with respect to sometimes inconsistent and subjective enforcement by CCL.  In the longer term, 6Beds believes that this recognition may help pave the way for future reforms of the Community Care Licensing system with the aim of improving the treatment and rights of licensees.  In the immediate term, 6Beds’ advocacy has caused Mr. Calderon to commit to working with 6Beds, particularly on amendments related to the definition of a repeat violation as well as the timing of civil penalty payments.

6Beds’ leadership would like to convey a heartfelt thank you to all of its members and supporters for their participation on April 12, 2016.  Everyone did a tremendous job of representing 6Beds, which has only increased 6Beds’ efficacy and will help 6Beds build upon the following positive changes relative to previous proposals for the bill that were already made prior to April 12, 2016:

Civil Penalty Amounts

The bill proposes to increase civil penalty amounts for serious/zero tolerance violations (e.g. fire clearance violations, overcapacity, ambulatory status, inoperable smoke alarms, absence of supervision, accessible bodies of water, accessible firearms/ammunition, refused entry to a facility, etc.).  Currently, the civil penalty amount for these types of violations is $150.  Prior to the introduction of AB 2231, it was proposed that the civil penalty amount for serious/zero tolerance violations be $1,000.  6Beds’ advocacy helped reduce this amount to the $500 that is currently proposed in AB 2231.

AB 2231 also proposes to increase civil penalty amounts for repeat violations of serious/zero tolerance violations, as well as other violation types.  Prior to AB 2231, it was proposed that the civil penalty amount for repeat violations of serious/zero tolerance violations be $2,000 plus $1,500 for each day the violation is not corrected.  6Beds’ advocacy helped reduce this amount to the current $1,000 plus $100 for each day the violation is not corrected that is proposed in AB 2231.

Prior to AB 2231, it was proposed that the civil penalty amount for repeat violations that were not of the serious/zero tolerance type be $500 plus $100 for each day the violation is not corrected.  6Beds’ advocacy helped reduce this amount to the current $250 plus $100 for each day the violation is not corrected that is proposed in AB 2231.

Imposition of Separate Civil Penalty for Underlying Violations

Prior to AB 2231, it was proposed that there could be imposed a separate civil penalty for an underlying violation that resulted in the imposition of a larger civil penalty.  For example, if absence of supervision resulted in the death of a resident, the previous proposal would have allowed for the imposition of a civil penalty for the death of the resident as well as a civil penalty for absence of supervision.  As a result of 6Beds’ advocacy, AB 2231 would only allow for the imposition of the higher civil penalty amount.  No double dipping.

Thanks again to everyone for their support and stay tuned for more updates on this bill as 6Beds works diligently to improve upon the bill.

Regards,

George Kutnerian

Advocacy, All Posts, Issues, RCFE

Resident Refund After Only a 5-Day Notice: 6Beds Submits Public Comments In Opposition To Proposed Title 22 Regulation

The Department of Social Services’ (DSS) Office of Regulation Development has proposed a number of regulations pertaining to admission agreements, most notably the following related to refunds:

87507(g)(5)(C)

Proposed Regulation: A refund of any prepaid monthly fees shall be given if the resident provides notice five days before the resident leaves the facility.  The refund shall be a proportional daily amount of any prepaid monthly fee(s), and shall be refunded at the time the resident leaves the facility and the unit is vacated.

 

DSS opened up its proposed regulations to public comment and 6Beds took the opportunity to address the proposed regulations with these comments, which were submitted on February 2, 2016.  Notably, 6Beds provided the following comment in response to the above proposed regulation that would allow for a refund after only providing a five day notice before the resident leaves the facility:

6Beds Comment: The proposed regulation misapplies Health & Safety Section 1569.682, which references a resident receiving a refund upon the resident’s leaving the facility after a five day notice only in the context of a forfeiture of license or change of use of the facility.  Instead, the proposed regulation would allow a resident to provide a five day notice and obtain a refund of any prepaid fees beyond the five days under any and all circumstances.  However, under circumstances outside of forfeiture of license or change of use of the facility, residents must provide a 30 day notice.

6Beds Recommendation: 6Beds recommends that the proposed regulation be modified to reflect that the five day notice and corresponding refund applies only in the event of forfeiture of license or change of use of the facility.

 

6Beds will provide an update after DSS’ Office of Regulation Development has responded to its comments.

Advocacy, All Posts, Issues, RCFE

WATCH: 6Beds’ Senate Human Services Committee Testimony In Opposition to Complainant Appeal Process

Hopefully, as a licensee you’ve never had to deal with a complaint against your facility, but if you have been a licensee long enough the odds are that at some point you’ve had a complaint made against your facility.  When a Licensing Program Analyst (LPA) comes to your facility to inform you that a complaint has been made against your facility, you probably get that feeling of a pit in your stomach.  When you work hard and do your best to please your residents and their families while maintaining compliance only to learn that a complaint has been filed against your facility, it can be a very deflating experience.
Blog - Complainant Appeal Process - Photo

Dealing with complaints can take up valuable time, cost you money, and be emotionally draining.  When you’re in the midst of a complaint investigation, what you’re probably looking forward to most is getting it behind you as fast as possible and, most importantly, with a favorable result.  If you get to the end of a complaint investigation with an “Inconclusive” or, better yet, an “Unfounded” result, you probably get that feeling that you can finally breathe a deep sigh of relief.  Well, what if I told you that as licensees we had to live in a world where a complainant, which is the party that made the complaint, could file an appeal if they were dissatisfied with Community Care Licensing’s (CCL) investigation findings?  Imagine getting that “Inconclusive” or “Unfounded” result and just as you’re in the midst of breathing that deep sigh of relief, you learn that the complainant has appealed your favorable investigation finding and that feeling of being able to breathe a deep sigh of relief has just reverted back to that feeling of having a pit in your stomach.  Well, that was almost our reality as of January 1, 2016 had 6Beds not intervened to have AB 1387 amended prior to its passage.

The June 25, 2015 version of AB 1387 included a two-level complainant appeal process that could potentially extend the complaint investigation process by 120 business days.  Keep in mind that I’m referring to 120 business days, which translates to a complainant appeal process that could last between five and six calendar months.

6Beds took decisive action when it learned of the proposed complainant appeal process in AB 1387.  In addition to writing a comment letter to the office of AB 1387’s author, Assembly Member Kansen Chu, I testified on behalf of 6Beds before the Senate Human Services Committee on July 14, 2015 in order to voice 6Beds’ concerns regarding the proposed complainant appeal process.  6Beds’ part of the testimony begins at the 4:52 mark and the entire AB 1387 hearing is 11:31 long.  However, I encourage you to watch the entire video in order to get full context.

California Advocates for Nursing Home Reform (CANHR) was the primary supporter of the complainant appeal process.  CANHR is the same group that sponsored the RCFE Reform Act of 2014.  6Beds’ position on the version of AB 1387 that included the complainant appeal process was “oppose unless amended”.  Not even the California Assisted Living Association (CALA), which represents many of the largest assisted living companies, opposed the version of the bill that included the complainant appeal process.

6Beds’ comment letter, testimony before the Senate Human Services Committee, and the aggressive advocacy of 6Beds’ lobbyists before and after the Senate Human Services Committee hearing played a significant role in the complainant appeal process being removed from the final version of AB 1387.  Read AB 1387 – Complainant Appeal Process for the portion of the final version of AB 1387 compared to the June 25, 2015 version that shows in red strikethrough the removal of the complainant appeal process from the bill.

The entirety of the June 25, 2015 version of AB 1387 was not detrimental to RCFE licensees.  In fact, the bill did contain important licensee appeal process reforms, which 6Beds strongly supported and even made improvements to that were incorporated into the final version of the bill.  However, where others took the easy position of compromising to accept the complainant appeal process in exchange for a reformed licensee appeal process, 6Beds took the more aggressive, but calculated approach of advocating for a bill that contained licensee appeal reforms without introducing a new and cumbersome complainant appeal process.

In a future blog post, I’ll address the new licensee appeal process that the final version of AB 1387 gave effect to on January 1, 2016.

Advocacy, All Posts, ARF, Issues, RCFE

Newly Sworn in Assembly Speaker Anthony Rendon Announces Assembly Floor Leadership Team

New Assembly Speaker Anthony Rendon (D-Paramount) announced his floor leadership team effective March 10, 2016.

The Assembly Democratic leadership appointments are as follows:

 

Speaker pro Tempore – Assemblymember Kevin Mullin (D-South San Francisco)

Assistant Speaker pro Tempore – Assemblymember Autumn R. Burke (D-Inglewood)

Majority Floor Leader – Assemblymember Ian C. Calderon (D-Whittier)

Assistant Majority Floor Leader – Assemblymember Jim Cooper (D-Elk Grove)

Majority Whip – Assemblymember Miguel Santiago (D-Los Angeles)

Democratic Whip – Assemblymember Nora Campos (D-San Jose)

Assistant Majority Whip – Assemblymember Evan Low (D-Silicon Valley)

Democratic Caucus Chair – Assemblymember Mike A. Gipson (D-Carson)

 

6Beds will continue to provide updates on new developments as it pertains to legislative leadership in Sacramento.