BILL ANALYSIS Ó
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 784
A
AUTHOR: Yamada and Knight
B
AMENDED: May 9, 2011
HEARING DATE: June 29, 2011
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CONSULTANT:
8
Trueworthy
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SUBJECT
Adult day health care
SUMMARY
Requires specified veterans homes in Lancaster and Ventura
to be considered for inclusion as providers in the event of
the elimination of Adult Day Health Care (ADHC) services as
an optional Medi-Cal benefit and the enactment of a new
program to provide similar services.
CHANGES TO EXISTING LAW
Existing law:
Establishes the Medi-Cal program, under the Department of
Health Care Services (DHCS), to provide comprehensive
health benefits to low-income children, their parents or
caretaker relatives, pregnant women, elderly, blind or
disabled persons, nursing home residents, and refugees who
meet specified eligibility criteria.
Eliminates ADHC services as a Medi-Cal optional benefit
under AB 97 (Committee on Budget) signed into law in March
2011.
Prior to the elimination of ADHC as an optional benefit,
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 784 (Yamada and Knight)
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established the California ADHC Act which requires
licensure and regulation of ADHCs with administrative
responsibility shared between the state Department of
Public Health (DPH), the California Department of Aging
(CDA), and the Department of Health Care Services (DHCS)
pursuant to an interagency agreement.
Prior to the elimination of ADHC as an optional benefit,
required ADHC facilities to be licensed by DPH as health
care facilities and to be certified for Medi-Cal payments
by CDA.
Prior to the elimination of ADHC as an optional benefit,
established DHCS as the principal agency to oversee
Medi-Cal policy, rates, audits, investigations,
eligibility, and utilization.
This bill:
Requires specified veterans homes in Lancaster and Ventura
to be considered for inclusion as service providers in the
event of the elimination of ADHC services as an optional
Medi-Cal benefit and the enactment of a new program to
provide similar services.
Provides that the bill's provisions shall be implemented
only to the extent that funds are available and in a manner
that is equitable with regard to other potential enrollees
in the new ADHC-like program.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, AB 784 potentially has the following fiscal
implications:
1)Unknown fiscal effect on the Medi-Cal program. ADHC has
been eliminated as a Medi-Cal optional benefit. The
design and funding of a new program through which
ADHC-like services would potentially be provided is
currently being discussed.
2)If the proposed new program will be operated through a
federal waiver, as is being discussed, it will likely
have a capped enrollment and the addition of new
STAFF ANALYSIS OF ASSEMBLY BILL 784 (Yamada and Knight)
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facilities will likely not affect the overall number of
beneficiaries. However, if ADHC is maintained as a
Medi-Cal benefit, the cost could be up to $1 million (50
percent General Fund) annually based on the initial
expected number of enrollees.
3)Minor state costs to DPH to license and certify two new
facilities, paid for through licensure fees.
BACKGROUND AND DISCUSSION
According to the author, AB 784 will ensure that veterans
living at the William J. "Pete" Knight Veterans Home of
California, Lancaster and the Veterans Home of California,
Ventura remain able to receive the care that these home
were originally designed to provide through the existence
of ADHC centers on their campuses.
The author further states that while understanding the
magnitude of the elimination of ADHC funding in the 2011-12
Budget, the author's intent is to pursue the prioritization
of veteran's enrollment into the newly created Keeping
Adults Free From Institutions (KAFI) program, specifically
in the William J. "Pete" Knight Veterans Home of
California, Lancaster; and, the Veterans Home of
California, Ventura. These state veterans homes are
unlikely to close and have structured adult day health
facilities co-located on the veterans home campuses.
Including veterans in the forthcoming KAFI program will
provide opportunities to leverage federal veterans'
benefits with shrinking state GF support for adult
supportive services.
ADHC
ADHC is an organized day program of therapeutic, social and
health activities and services provided to elderly persons
or other persons with physical or mental impairments for
the purpose of restoring or maintaining optimal capacity
for self-care. Under federal law, ADHC services are an
"optional benefit" for states to provide. Specifically,
ADHC services are provided to Medi-Cal beneficiaries who
have medical or psychiatric impairments who have a written
request for ADHC services from a physician, a
multi-disciplinary team assessment, a signed participation
STAFF ANALYSIS OF ASSEMBLY BILL 784 (Yamada and Knight)
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agreement, and approval from DHCS. ADHC centers must
provide rehabilitation services (physical, occupational and
speech therapy services), medical services supervised by
the participant's personal physician or staff physician,
nursing services, psychiatric and psychological services,
medical social services, planned recreational and social
activities, and non-medical transportation (if necessary)
to and from participants' homes.
2011 Budget
Governor Brown proposed a budget that assumed elimination
of ADHC services, effective June 1, 2011, for a reduction
of $3.4 million ($1.7 million GF) in the current-year, and
$353.2 million ($176.6 million GF) in 2011-12. The
following compromise was adopted and signed into law in AB
97 (Budget Committee):
1)Eliminate the ADHC Benefit as a Medi-Cal Optional
Benefit.
2)Proceed with legislation in the 2011-12 Session to
develop a federal waiver to provide a more narrow scope
of services, and to specify level of medical acuity for
enrollment into this waiver program. AB 96 (Budget
Committee) establishes the KAFI program, and requires
DHCS to submit an application to the federal Centers for
Medicare and Medicaid Services to implement the program.
3)Appropriate $170 million ($85 million GF) in the budget
bill to provide for the transition for existing ADHC
enrollees to other Medi-Cal appropriate services, and to
facilitate, when applicable, the transition to newly
developed waiver services.
Motion for preliminary injunction
On June 9, 2011, a motion for preliminary injunction was
issued seeking an order that would prevent DHCS from:
"implementing or enforcing AB 97 or engaging in the
following actions until this Court rules on a permanent
injunction:
"Reducing, terminating or modifying Medi-Cal Adult Day
Health Care (ADHC) program benefits to Plaintiffs and
STAFF ANALYSIS OF ASSEMBLY BILL 784 (Yamada and Knight)
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Class Members pursuant to AB 97, unless and until
adequate, appropriate, and uninterrupted services are
provided to replace the care prescribed in their ADHC
plans of care, including through reasonable
modifications to Defendants' programs, to prevent
inappropriate institutionalization in violation of their
rights under the Americans with Disabilities Act ("ADA")
and Section 504 of the Rehabilitation Act of 1973
("Section 504"); and
"Reducing, terminating or modifying Medi-Cal Adult Day
Health Care (ADHC) program benefits to the Plaintiffs
and Class Members pursuant to AB 97, unless and until
Plaintiffs and Class Members are afforded notice and a
right to a hearing regarding adequate, appropriate, and
uninterrupted services which meet their medical needs as
currently prescribed by their ADHC plans of care in
compliance with their rights under the Due Process
clause of the Constitution, and the Medicaid Act."
DHCS will have an opportunity to respond to the motion, and
the court will rule on or after July 26, 2011.
Veterans homes of California
The mission of the California Department of Veterans
Affairs (CalVet) includes "providing the state's aged or
disabled veterans with rehabilitative, residential, and
medical care and services in a homelike environment at the
Veterans Homes of California." CalVet currently operates
the Veterans Home of California with campuses at Yountville
(Napa County), Barstow (San Bernardino County), Chula Vista
(San Diego County), Lancaster (Los Angeles County), Ventura
(Ventura County) and West Los Angeles (Los Angeles County).
In 2002, according to the CalVet web site, planning for
three large veteran's facilities, one in Ventura County,
one in Lancaster, and one in West Los Angeles, was
initiated following passage of AB 2559 (Wesson), Chapter
216, Statutes of 2002, the Veterans Home Bond Act of
2000,. The construction of the three facilities is
financed with federal veteran's homes grants and state bond
funding totaling $229 million, of which 60% is from federal
sources. All three sites are intended to provide
multi-level housing and medical services for eligible
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veterans. The two sites nearest completion, Ventura and
Lancaster, incorporate ADHC services as well as assisted
living and nursing care units within their
continuum-of-care design. Both projects had sought
approval for up to 100 licensed ADHC slots, but anticipate
only 20 enrollees at each facility for the first few years
of operation.
Related bills
AB 96 (Budget Committee) establishes the KAFI program, a
revised ADHC program, and requires DHCS to submit an
application to the federal Centers for Medicare and
Medicaid Services to implement the program. AB 96 is
pending in Engrossing and Enrolling.
AB 97 (Budget Committee) Chapter 3, Statutes of 2011, is
the Omnibus Health Trailer Bill for 2011-12 which contains
necessary changes to enact modifications in the Budget Bill
for 2011-12. AB 97 eliminates the ADHC program as an
optional benefit in Medi-Cal, consistent with the budget
bill and specifies the Legislature's findings and
declarations
Prior legislation
AB 1593 (Yamada) of 2010 would have exempted two new
publicly financed ADHC centers serving California veterans
from the existing moratorium on new Medi-Cal certified
ADHCs. AB 1593 was vetoed by Governor Schwarzenegger.
AB 369 (Yamada) of 2009 would have exempted two new
publicly financed ADHC centers serving California veterans
from the existing moratorium on new Medi-Cal certified
ADHCs. AB 369 was vetoed by Governor Schwarzenegger.
Arguments in support
The National Association of Social Workers (NASW) writes AB
774 promotes the well-being of all veterans. NASW writes
ADHC- type services allow veterans to visit the center to
receive assistance with their daily health needs and return
home after receiving services. This allows participants to
live independently while receiving the care they need.
PRIOR ACTIONS
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Assembly Health: 17- 0
Assembly Appropriations:17- 0
Assembly Floor: 77- 0
COMMENTS
1. Priority. The budget eliminated ADHC services as a
Medi-Cal optional benefit; and provided approximately half
of the funding previously allocated for ADHC services.
This money is to be used to transition existing ADHC
enrollees to other Medi-Cal services and to facilitate
transition to a newly developed federal waiver services
once implemented. Pending legislation, AB 96 (Budget
Committee), would establish a revised ADHC program, KAFI
program, and would require DHCS to submit an application to
the federal Centers for Medicare and Medicaid Services to
implement the program.
Does the committee wish to prioritize specific facilities
prior to the creation of the new ADHC program, KAFI
program?
POSITIONS
Support: National Association of Social Workers,
California Chapter
Oppose:None on file.
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