BILL ANALYSIS
------------------------------------------------------------
|SENATE RULES COMMITTEE | AB 2645|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
------------------------------------------------------------
THIRD READING
Bill No: AB 2645
Author: Chesbro (D)
Amended: 6/21/10 in Senate
Vote: 27 - Urgency
SENATE HEALTH COMMITTEE : 7-0, 6/23/10
AYES: Alquist, Aanestad, Cedillo, Leno, Negrete McLeod,
Pavley, Romero
NO VOTE RECORDED: Strickland, Cox
SENATE APPROPRIATIONS COMMITTEE : 10-0, 8/2/10
AYES: Kehoe, Alquist, Ashburn, Corbett, Emmerson, Leno,
Price, Wolk, Wyland, Yee
NO VOTE RECORDED: Walters
ASSEMBLY FLOOR : 75-0, 6/2/10 - See last page for vote
SUBJECT : Mental health: skilled nursing facilities:
reimbursement rate
SOURCE : California Mental Health Directors Association
DIGEST : This bill expands, from July 1, 2010 to June 30,
2012, current law which imposes a reimbursement rate freeze
on specified skilled nursing facilities (SNFs) to include
institutions for mental disease licensed as SNFs.
ANALYSIS :
Existing federal law:
CONTINUED
AB 2645
Page
2
1. Defines an institution for mental disease (IMD) as a
hospital, nursing facility, or other institution of 17
or more beds that is primarily engaged in providing
diagnosis, treatment, or care of persons with mental
diseases, including medical attention, nursing care, and
related services.
2. Establishes the IMD exclusion, which prohibits federal
financial participation through Medicaid (Medi-Cal in
California) for individuals in an IMD between the ages
of 22 and 65. These individuals may still be eligible
for state-only Medi-Cal.
Existing state law:
1. Requires the Department of Health Care Services (DHCS)
to contract with SNFs that have been designated by the
Department of Mental Health as IMDs to provide services
to residents.
2. Establishes the Bronzan-McCorquodale Act, also known as
"Realignment," which shifted responsibility for the
provision of mental health services from the state to
counties. Provides funding for local programs with
revenues from increased vehicle licensing fees and sales
taxes.
3. Imposes a rate freeze on the following long-term care
facilities: SNFs, intermediate care facilities, rural
swing-bed facilities, subacute and pediatric subacute
care units that are distinct parts of general acute care
hospitals, and adult day health centers.
4. Requires IMDs licensed as SNFs to be reimbursed for
services at the rate established by DHCS. Mandates,
effective July 1, 2008, an annual 4.7 percent increase
in the reimbursement rate for IMDs.
This bill applies an SNF rate freeze established by AB 5 X4
(Evans), Chapter 5, Statutes of 2009-10, Fourth
Extraordinary Session, to county-supported IMDs. Under
current law, IMDs receive a statutory 4.7 percent increase
to their annual rates, per requirements of AB 360
AB 2645
Page
3
(Frommer), Chapter 508, Statutes of 2005.
Background
IMDs are a type of SNF with 17 or more beds that provide
24-hour nursing care and supervision to mentally ill
persons in need of continuous psychiatric and nursing care.
Federal law excludes these facilities from eligibility for
federal Medicaid funds when serving Medicaid clients. This
federal IMD exclusion applies only to adult Medicaid
beneficiaries between the ages of 21 and 65. Any one of
the following criteria defines an IMD: the facility is
licensed as a psychiatric facility; the facility is
accredited as a psychiatric facility; the facility is under
the jurisdiction of DMH; the facility specializes in
providing psychiatric-psychological care and treatment; or
more than 50 percent of all the patients-residents in the
facility require care because of mental illness. In
California, IMDs include facilities in the following
licensing categories, if the facility has 17 beds or more:
acute psychiatric hospitals, psychiatric health facilities,
SNFs with a certified special treatment program, and mental
health rehabilitation centers. There may be exceptions for
individual facilities. For example, a large SNF with a
small special treatment program unit (less than 50 percent
of total SNF beds) is not considered an IMD.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12
2012-13 Fund
IMD-SNFs ($3,000 to $6,000), annually, for two
yearsLocal
SUPPORT : (Verified 7/1/10)
California Mental Health Directors Association (source)
California State Association of Counties
AB 2645
Page
4
Disability Rights California
Humboldt County Department of Health and Human Services
Regional Council of Rural Counties
San Bernardino County Board of Supervisors
ARGUMENTS IN SUPPORT : Supporters, representing consumer
advocates and counties, state that this bill will bring
conformity to nursing home rates that were frozen in the
Budget Act of 2009 by setting the reimbursement rate for
services in IMDs at the same rate as was in effect on July
1, 2009. Disability Rights California writes in support
that this bill makes good fiscal sense in that it keeps
rates consistent for better financial planning in this
difficult economic time yet maintains services for people
needing to reside in an IMD. The California State
Association of Counties and the Regional Council of Rural
Counties note in support that, during difficult fiscal
times for counties, this bill will remove the mandatory 4.7
percent cost-of-living increase that is enjoyed by IMDS,
and not any other part of the public mental health system.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Bass, Beall,
Bill Berryhill, Blakeslee, Block, Blumenfield, Bradford,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,
DeVore, Emmerson, Eng, Evans, Feuer, Fletcher, Fong,
Fuentes, Fuller, Furutani, Gaines, Galgiani, Garrick,
Gilmore, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,
Huber, Huffman, Jeffries, Jones, Knight, Logue, Bonnie
Lowenthal, Ma, Mendoza, Miller, Monning, Nava, Nestande,
Niello, Nielsen, V. Manuel Perez, Portantino, Ruskin,
Salas, Saldana, Silva, Skinner, Smyth, Solorio, Swanson,
Torlakson, Torres, Torrico, Tran, Villines, Yamada, John
A. Perez
NO VOTE RECORDED: Tom Berryhill, Lieu, Norby, Audra
Strickland, Vacancy
CTW:mw 8/3/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
AB 2645
Page
5
**** END ****