Amended  IN  Assembly  April 11, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill No. 1709

Introduced by Assembly Member Jones-Sawyer

February 22, 2019

An act to amend Sections 1337.3, 1337.6, 1416.20, 1416.22, 1416.42, 1416.50, and 1416.57 of the Health and Safety Code, relating to nursing homes.


LEGISLATIVE COUNSEL'S DIGEST


AB 1709, as amended, Jones-Sawyer. Nursing homes: staff.
(1) Existing law provides for the certification of nurse assistants by the State Department of Public Health. Existing law requires the department, among other duties, to prepare and maintain a list of approved training programs for nurse assistant certification, to review, on or before January 1, 2004, requires, the department to perform specified duties, including reviewing the current examination for approved training programs for certified nurse assistants and to develop developing a plan concerning career opportunities, as specified. Existing law requires certificate holders to complete 48 hours of inservice training every 2 years. opportunities.
This bill would require the department to complete complete, by January 1, 2022, and every 10 years thereafter, the review of the current examination for certified nurse assistants and the development of a plan by January 1, 2022, and every 10 years thereafter. The bill would instead require certificate holders to complete 30 hours of inservice training every 2 years, and would make conforming changes. to develop a plan promoting career opportunities.
(2) Existing law, the Nursing Home Administrators’ Act (Act), provides for the licensure and regulation of nursing home administrators, including application procedures, qualifications for and content of licensing examinations, and application and examination fee requirements, by the Nursing Home Administrator Program (program). Existing law requires an applicant to renew their license every 2 years, and to complete continuing education courses, as specified.
This bill would require the program, by January 1, 2022, and every 10 years thereafter, to perform a review of the nursing home administrator licensing examination, and to revise the examination, as described. The bill would authorize an applicant who has a current valid license as a nursing home administrator in another state to apply for licensure in this state if the applicant holds certification from the American College of Health Care Administrators. The bill would, for purposes of an initial license renewal, exempt an applicant from continuing education course requirements, and would make conforming changes. The bill would authorize an applicant to complete courses pertaining to nursing home administrators that have been approved by the National Association of Long Term Care Administrator Boards for purposes of completing continuing education requirements, as specified. requirements.
(3) Existing law requires the program to develop an Administrator-in-Training Program (AIT Program). Under existing law, the AIT Program, among other duties, Program is responsible for approving an individual to be a preceptor who is responsible for whose duties include coordinating, supervising, and teaching persons seeking to meet specified requirements to qualify for the nursing home administrator licensing examination. Existing law requires a preceptor to be the designated administrator of the facility where the training is conducted. Existing law conducted, and prohibits a preceptor from supervising more than 2 AIT trainees during the same time period.
This bill would exempt a preceptor from a training course requirement if the preceptor has been actively involved in supervising at least one AIT, as specified. AIT. The bill would clarify that a preceptor directly supervised training program includes both onsite and offsite training, and would authorize a preceptor to be available by email, as specified. email. The bill would additionally authorize the preceptor to be a nursing home administrator with central responsibility for the education and training of AITs. The bill would delete the prohibition related to the number of AITs that a preceptor may supervise. The bill would authorize the program to implement, interpret, or make specific provisions related to the AIT Program by means of letters, bulletins, or similar instructions, without taking regulatory action.
(4) The bill would additionally make technical, nonsubstantive changes to each provision.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1337.3 of the Health and Safety Code is amended to read:

1337.3.
 (a) The department shall prepare and maintain a list of approved training programs for nurse assistant certification. The list shall include training programs conducted by skilled nursing facilities or intermediate care facilities, as well as local agencies and education programs. In addition, the list shall include information on whether a training center is currently training nurse assistants, their competency test pass rates, and the number of nurse assistants they have trained. Clinical portions of the training programs may be obtained as on-the-job training, supervised by a qualified director of staff development or licensed nurse.
(b) The department shall inspect a representative sample of training programs. The department shall protect consumers and students in any training program against fraud, misrepresentation, or other practices that may result in improper or excessive payment of funds paid for training programs. In evaluating a training center’s training program, the department shall examine each training center’s trainees’ competency test passage rate, and require each program to maintain an average 60 percent test score passage rate to maintain its participation in the program. The average test score passage rate shall be calculated over a two-year period. If the department determines that a training program is either not complying with regulations or is not meeting the competency passage rate requirements, notice thereof in writing shall be immediately given to the program. If the program has not been brought into compliance within a reasonable time, the program may be removed from the approved list and notice thereof in writing given to it. Programs removed under this article shall be afforded an opportunity to request reinstatement of program approval at any time. The department’s district offices shall inspect facility-based centers as part of their annual survey.
(c) Notwithstanding Section 1337.1, the approved training program shall consist of at least the following:
(1) A 16-hour orientation program to be given to newly employed nurse assistants prior to providing direct patient care, and consistent with federal training requirements for facilities participating in the Medicare or Medicaid programs.
(2) (A) A precertification training program consisting of at least 60 classroom hours of training on basic nursing skills, patient safety and rights, the social and psychological problems of patients, and elder abuse recognition and reporting pursuant to subdivision (e) of Section 1337.1. The 60 classroom hours of training may be conducted within a skilled nursing facility, an intermediate care facility, or an educational institution or agency. A health facility, educational institution, or local agency may conduct the 60 classroom hours of training in an online or distance learning course format, as approved by the department.
(B) In addition to the 60 classroom hours of training required under subparagraph (A), the precertification program shall also consist of 100 hours of supervised and on-the-job training clinical practice. The 100 hours may consist of normal employment as a nurse assistant under the supervision of either the director of staff development or a licensed nurse qualified to provide nurse assistant training who has no other assigned duties while providing the training.
(3) At least two hours of the 60 hours of classroom training and at least four hours of the 100 hours of the supervised clinical training shall address the special needs of persons with developmental and mental disorders, including intellectual disability, Alzheimer’s disease, cerebral palsy, epilepsy, dementia, Parkinson’s disease, and mental illness.
(d) The department, in consultation with the State Department of Education and other appropriate organizations, shall develop criteria for approving training programs, that includes program content for orientation, training, inservice and the examination for testing knowledge and skills related to basic patient care services and shall develop a plan that identifies and encourages career ladder opportunities for certified nurse assistants. This group shall also recommend, and the department shall adopt, regulation changes necessary to provide for patient care when facilities utilize noncertified nurse assistants who are performing direct patient care. The requirements of this subdivision shall be established by January 1, 1989.
(e) By January 1, 2022, and every 10 years thereafter, the department, in consultation with the State Department of Education, the American Red Cross, and other appropriate organizations, shall do the following:
(1) Review the current examination for approved training programs for certified nurse assistants to ensure the accurate assessment of whether a nurse assistant has obtained the required knowledge and skills related to basic patient care services.
(2) Develop a plan that identifies and encourages career ladder opportunities for certified nurse assistants, including the application of on-the-job postcertification hours to educational credits.
(f) A skilled nursing facility or intermediate care facility shall determine the number of specific clinical hours within each module identified by the department required to meet the requirements of subdivision (d), subject to subdivisions (b) and (c). The facility shall consider the specific hours recommended by the state department when adopting the precertification training program required by this chapter.
(g) This article shall not apply to a program conducted by any church or denomination for the purpose of training the adherents of the church or denomination in the care of the sick in accordance with its religious tenets.
(h) The Chancellor of the California Community Colleges shall provide to the department a standard process for approval of college credit. The department shall make this information available to all training programs in the state.
(i) An online or distance learning nurse assistant training program shall meet the same standards as a traditional, classroom-based program.
(j) An online nurse assistant training program shall contract with a licensed skilled nursing facility or intermediate care facility for the purpose of coordinating and completing the clinical portion of the nurse assistant training program.

SEC. 2.Section 1337.6 of the Health and Safety Code is amended to read:
1337.6.

(a)Certificates issued under this article shall be renewed every two years and renewal shall be conditional upon the occurrence of all of the following:

(1)The certificate holder submitting documentation of completion of 30 hours of in-service training every two years obtained through an approved training program or taught by a director of staff development for a licensed skilled nursing or intermediate care facility that has been approved by the department, or by individuals or programs approved by the department. At least 12 of the 30 hours of in-service training shall be completed in each of the two years. The in-service training may be obtained through an online computer training program approved by the Licensing and Certification Division of the department.

(2)(A)A vendor of online programs for continuing education shall ensure that each online course contains all of the following:

(i)An interactive portion where the participants receive feedback, through online communication, based on input from the participant.

(ii)Required use of a personal identification number or personal identification information to confirm the identity of the participant.

(iii)A final screen displaying a printable statement, to be signed by the participant, certifying that the identified participant completed the course. The vendor shall obtain a copy of the final screen statement with the original signature of the participant prior to the issuance of a certificate of completion. The signed statement of completion shall be maintained by the vendor for a period of three years and shall be made available to the department upon demand.

(B)The department may approve online programs for continuing education that do not meet the requirements of subparagraph (A) if the vendor demonstrates to the department’s satisfaction that, through advanced technology, the course and the course delivery meet the other requirements of this section.

(3)The certificate holder obtaining a criminal record clearance.

(b)Certificates issued under this article shall expire on the certificate holder’s birthday.

(c)To renew an unexpired certificate, the certificate holder shall, on or before the certificate expiration date, apply for renewal on a form provided by the department and submit documentation of the required in-service training.

(d)The department shall give written notice to a certificate holder 90 days in advance of the renewal date and, 90 days in advance of the expiration of the fourth year that a renewal application has not been submitted, and shall give written notice informing the certificate holder, in general terms, of the provisions of this article. Nonreceipt of the renewal notice does not relieve the certificate holder of the obligation to make a timely renewal. Failure to make a timely renewal shall result in expiration of the certificate.

(e)Except as otherwise provided in this article, an expired certificate may be renewed at any time within two years after its expiration on the filing of an application for renewal on a form prescribed by the department and documentation of the required in-service education.

Renewal under this article shall be effective on the date on which the application is filed. If so renewed, the certificate shall continue in effect until the date provided for in this article, when it shall expire if it is not again renewed.

(f)If a certified nurse assistant applies for renewal more than two years after the expiration, the certified nurse assistant shall complete an approved 75-hour competency evaluation training program and competency evaluation program. A suspended certificate is subject to expiration and shall be renewed as provided in this article, but this renewal does not entitle the certificate holder, while the certificate remains suspended, and, until it is reinstated, to engage in the certified activity, or in any other activity or conduct in violation of the order or judgment by which the certificate was suspended.

(g)A revoked certificate is subject to expiration as provided in this article, but it cannot be renewed.

(h)Except as provided in subdivision (i), a certificate that is not renewed within four years after its expiration cannot be renewed, restored, reissued, or reinstated except upon completion of a certification program unless deemed otherwise by the department if both of the following conditions are met:

(1)No fact, circumstance, or condition exists that, if the certificate was issued, would justify its revocation or suspension.

(2)The person takes and passes any examination that may be required of an applicant for a new certificate at that time, that shall be given by an approved provider of a certification training program.

(i)A certified nurse assistant whose certificate has expired after two years may have their certificate renewed if they complete 75 hours in an approved competency evaluation training program, passes a competency test, and obtains a criminal background clearance prior to the renewal. The department shall develop a training program for these previously certified individuals.

(j)Certificate holders shall notify the department within 60 days of any change of address. Any notice sent by the department shall be effective if mailed to the current address filed with the department.

(k)Certificate holders that have been certified as both nurse assistants pursuant to this article and home health aides pursuant to Chapter 8 (commencing with Section 1725) of Division 2 shall renew their certificates at the same time on one application.

SEC. 3.SEC. 2.

 Section 1416.20 of the Health and Safety Code is amended to read:

1416.20.
 (a) The nursing home administrator licensing examination shall cover the broad aspects of nursing home administration.
(b) Unless otherwise provided in this article, every applicant for an initial license as a nursing home administrator shall pass a nursing home administrator licensing examination, which shall consist of a state and national examination. The state examination shall be held at least four times a year, at a time and place determined by the program. The national examination is computer-based and shall be scheduled by the applicant after the applicant is notified by the program of their eligibility to take the examination.
(c) If an applicant for licensure under this article, submits an endorsement certificate from another state indicating that the applicant scored at least 75 percent on the national examination, the applicant shall be required to take only the California state part of the licensing examination. If the applicant scored less than 75 percent on the national examination, the applicant shall take both the state and national examination.
(d) By January 1, 2022, and every 10 years thereafter, the program shall perform a review of the nursing home administrator licensing examination, and shall revise the examination, as necessary, to ensure its conformity with federal and state law and regulations.

SEC. 4.SEC. 3.

 Section 1416.22 of the Health and Safety Code is amended to read:

1416.22.
 (a) To qualify for the licensing examination, an applicant shall be at least 18 years of age, be a citizen of the United States or a legal resident, be of reputable and responsible character, demonstrate an ability to comply with this chapter, and comply with at least one of the following requirements:
(1) Have a master’s degree in nursing home administration or a related health administration field. The master’s program in which the degree was obtained must have included an internship or residency of at least 480 hours in a skilled nursing facility or intermediate care facility.
(2) (A) An applicant who has a current valid license as a nursing home administrator in another state and applies for licensure in this state the applicant shall either hold certification from the American College of Health Care Administrators as a nursing home administrator or meet the minimum education requirements that existed in this state at the time the applicant was originally licensed in the other state.
(B) The minimum education requirements that have existed in California are as follows:
Prior to 7/1/73
None
From 7/1/73 to 6/30/74
30 semester units
From 7/1/74 to 6/30/75
45 semester units
From 7/1/75 to 6/30/80
60 semester units
From 7/1/80 to present
Baccalaureate degree
(3) A doctorate degree in medicine, a current valid license as a physician and surgeon, and the completion of a program-approved AIT Program of at least 1,000 hours.
(4) A baccalaureate degree, and the completion of a program-approved AIT Program of at least 1,000 hours.
(5) Ten years of recent full-time work experience, and a current license, as a licensed registered nurse, and the completion of a program-approved AIT Program of at least 1,000 hours. At least the most recent five years of the 10 years of work experience shall be in a supervisory or director of nursing position.
(6) Ten years of full-time work experience in any department of a skilled nursing facility, an intermediate care facility, or an intermediate care facility developmentally/disabled with at least 60 semester units (or 90 quarter units) of college or university courses, and the completion of a program-approved AIT Program of at least 1,000 hours. At least the most recent five years of the 10 years of work experience shall be in a position as a department manager.
(7) Ten years of full-time hospital administration experience in an acute care hospital with at least 60 semester units (or 90 quarter units) of college or university courses, and the completion of a program-approved AIT Program of at least 1,000 hours. At least the most recent five years of the 10 years of work experience shall be in a supervisory position.
(b) An applicant for the licensing examination may obtain from the department a waiver of the education requirements in subdivision (a) if they meet the requirements of Section 1416.23.
(c) If the applicant and the preceptor provide compelling evidence that previous work experience of the applicant directly relates to nursing home administrator duties, the program may accept a waiver exception to a portion of the AIT Program that requires 1,000 hours. An applicant seeking a waiver of the educational requirements pursuant to Section 1416.23 shall not be eligible for a waiver under this subdivision.
(d) The applicant shall submit an official transcript that evidences the completion of required college and university courses, degrees, or both. An applicant who applies for the licensing examination on the basis of work experience shall submit a declaration signed under penalty of perjury, verifying the applicant’s work experience. This declaration shall be signed by a licensed nursing home administrator, physician and surgeon, chief of staff, director of nurses, or registered nurse who can attest to the applicant’s work experience.

SEC. 5.SEC. 4.

 Section 1416.42 of the Health and Safety Code is amended to read:

1416.42.
 (a) Except for provisional licenses issued pursuant to Section 1416.40, each license issued pursuant to this chapter shall expire 24 months from the date of issuance.
(b) (1) To renew an unexpired license the licensee shall, at least 30 days prior to the expiration of the license, submit an application for renewal on a form provided by the program, accompanied by the renewal fee. An applicant may request either an active license or an inactive license. If an applicant requests an active license, they shall submit proof of completion of the required hours of program-approved continuing education.
(2) For purposes of the initial license renewal, an applicant is exempt from the continuing education requirements specified in Section 1416.50. An applicant who, but for the completion of continuing education requirements, otherwise qualifies for license renewal is eligible for license renewal under this chapter.
(c) A delinquency fee is payable for license renewals not received by the program one day after the license expires.
(d) A license which has expired may be reinstated within three years following the date of expiration. The licensee shall apply for reinstatement on a form provided by the program and submit the completed form together with the current fee for license renewal. If the licensee requests an active license, the licensee shall furnish proof of completion of the required hours of continuing education. The reinstatement shall be effective on the date that the completed application, including required fees, is submitted and approved.

SEC. 6.SEC. 5.

 Section 1416.50 of the Health and Safety Code is amended to read:

1416.50.
 (a) For purposes of this chapter, “continuing education” means any course of study offered by an educational institution, association, professional society, or organization for the purpose of providing continuing education for nursing home administrators.
(b) This section shall govern the continuing education requirements needed by a nursing home administrator to renew their nursing home administrator license.
(c) (1) In order to renew a license, the applicant shall provide evidence satisfactory to the program that they have completed 40 hours of program-approved continuing education courses, of which at least 10 total hours shall be specifically in the area of aging or patient care.
(2) (A) For a period of two years from the date of initial licensure, an applicant shall be exempt from the continuing education requirements specified in this section.
(B) Pursuant to paragraph (2) of subdivision (b) of Section 1416.42, for purposes of the initial nursing home administrator license renewal, an applicant who, but for the completion of continuing education requirements, otherwise qualifies for license renewal is eligible for license renewal under this chapter.
(d) (1) The continuing education courses to be approved for credit toward the continuing education requirements include the following subject areas offered by accredited colleges, universities, community colleges, or a training entity approved by the department.
(A) Resident care.
(B) Personnel management.
(C) Financial management.
(D) Environmental management.
(E) Regulatory management.
(F) Organizational management.
(G) Patient care and aging.
(2) Any courses, including courses that are unavailable to the public or are offered through corporations, related to nursing home administration that are approved by the National Association of Long Term Care Administrator Boards may be approved for credit towards the continuing education requirements.
(e) No continuing education credit shall be allowed for courses failed according to the institution’s grading determination.
(f) If the program finds that programs of training and instruction conducted within the state are not sufficient in number or content to enable nursing home administrators to meet requirements established by law and this chapter, the program may approve courses conducted within and without this state as sufficient to meet educational requirements established by law and this chapter. For the purposes of this subdivision, the program shall have the authority to receive funds in a manner consistent with the requirements of the federal government.

SEC. 7.SEC. 6.

 Section 1416.57 of the Health and Safety Code is amended to read:

1416.57.
 (a) (1) An individual may, upon compliance with the requirements of this section, be approved by the program to be a preceptor who is authorized to provide a training program in which the preceptor coordinates, supervises, and teaches persons seeking to meet specified requirements to qualify for the licensing examination under this chapter. The approval obtained under this section shall be effective for a period of two years, after which the preceptor shall renew their preceptor status and attend a preceptor training course provided by the program.
(2) A preceptor is exempt from the preceptor training course requirement specified in this subdivision if the preceptor has been actively involved in supervising at least one AIT during the prior two-year period.
(b) In order to qualify to be a preceptor, a person shall meet all of the following conditions:
(1) Be a current active California licensed nursing home administrator.
(2) Have no pending disciplinary actions.
(3) Have served for at least two years as the designated administrator of a California licensed nursing home or for at least four years as the designated assistant administrator of a California licensed nursing home.
(4) Have gained experience in all administrative functions of a nursing home.
(c) The applicant seeking approval to be a preceptor shall submit an application form provided by the program that requires the applicant’s name, address, birth date, the states and dates of issuance of all professional licenses, including those as a nursing home administrator, and any other information required by the program.
(d) At the time of application, for purposes of substantiating that the conditions specified in subdivision (b) have been met, the applicant shall provide satisfactory evidence of their education, experience, and knowledge that qualifies them to supervise the training of an AIT Program participant and verification that the facilities at which the applicant has had direct management control as an administrator had a continuous operating history, free from major deficiencies, during the period of the applicant’s administration.
(e) An applicant shall not be approved as a preceptor until the applicant attends a preceptor’s training seminar provided or approved by the program.
(f) (1) For purposes of this section, “AIT” means Administrator-in-Training.
(2) The following requirements shall apply to a preceptor approved pursuant to this section:
(A) The preceptor shall provide a directly supervised training program, including onsite and offsite training, which shall include a minimum of 20 hours per week and a maximum of 60 hours per week. The preceptor shall be available either by telephone or email at all other times. There shall be regular personal contact between the preceptor and the AIT during the training program. For purposes of this subparagraph, “a directly supervised training program” means supervision by a preceptor of an AIT during the performance of duties authorized by this section. The preceptor shall be available during the AIT’s performance of those duties.
(B) The preceptor shall be one of the following:
(i) The designated administrator of the facility where the training is conducted.
(ii) A nursing home administrator with central responsibility for the education and training of AITs.
(C) The preceptor shall inform the NHAP of any significant training program changes dealing with their specific AIT.
(D) The preceptor shall rate the AIT’s training performance and complete an AIT evaluation report at the end of the AIT’s training.
(E) The preceptor shall be evaluated by the program based on the examination success and failure history of their AIT trainees and the program may revoke or suspend preceptor certificates as appropriate.
(g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the program may implement, interpret, or make specific this section by means of letters, bulletins, or similar instructions, without taking regulatory action.