BILL ANALYSIS Ó
AB 518
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Date of Hearing: May 8, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 518 (Yamada and Blumenfield) - As Amended: April 11, 2013
Policy Committee: HealthVote:19-0
Aging and Long Term Care 7-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill codifies various terms of the Darling v. Douglas
settlement agreement (Case No. C-09-03798 SBA, United States
District Court, Northern District of California) to establish
Community-Based Adult Services (CBAS) as a Medi-Cal benefit.
FISCAL EFFECT
Unknown, but likely minor costs. No additional state costs
until at least August 2014, when the court directive from
Darling v. Douglas expires. In addition, the federal waiver
under which CBAS services are being provided continues until
November 2015. Beyond that date, costs are uncertain but given
the state's new Coordinated Care Initiative (CCI), transitioning
seniors and people with disabilities (SPDs) into managed care
plans, and the role CBAS plays in the CCI, it seems unlikely
significant changes will occur.
COMMENTS
1)Rationale . CBAS is an outpatient, facility-based program that
delivers skilled nursing care, skilled social services,
skilled therapies, personal care, meals, transportation, and
caregiver training and support. The majority of CBAS
beneficiaries are dually eligible for Medi-Cal and Medicare.
Darling v. Douglas was initiated in response to budget cuts
intended to eliminate Adult Day Health Center (ADHC) services.
Until 2011, ADHC was provided to low-income frail,
nursing-home eligible senior and people with disabilities
(SPDs) for over 30 years as a Medi-Cal benefit. These
services were provided at licensed ADHC centers and included
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medical services, nursing care, meals, social and therapeutic
activities, and transportation. Eligibility was based on an
individual's functional limitations, severity of chronic or
post-acute health conditions, and risk for nursing home
placement.
2)Settlement Agreement . Under the terms of the settlement, most
beneficiaries must enroll in a Medi-Cal managed care plan
(MCP) to receive the CBAS benefit. CBAS will provide services
roughly equivalent to those offered at ADHC centers, and
funded at the same rate, for patients who qualify.
Eligibility is based on medical need for those who are at risk
for institutionalization. The difference between CBAS and
ADHC is that CBAS will provide enhanced case management at
home for those who are not in imminent danger of
institutionalization.
As part of the settlement, the ADHC program transitioned from
a Medi-Cal state plan optional benefit to the new CBAS program
and services are being provided through a federal Medicaid
waiver, as of April 1, 2012. The waiver expires in November
2015. In approving the waiver amendment, the Centers for
Medicare and Medicaid Services (CMS) stated its understanding
the CBAS program would provide benefits consistent with the
settlement agreement.
According to CMS, this would ensure continuation of the
services being received by current ADHC recipients until such
time as they receive a face-to-face assessment to determine
whether they meet the needs-based criteria for CBAS benefits.
With the exception of this transition, ADHC would be
eliminated as a Medi-Cal optional benefit.
3)Alternatives to institutionalization . Supporters, including
the Community Clinic Association of Los Angeles, County
Welfare Directors Association, and National Association of
Social Workers, all recognize the importance of programs
providing alternatives to institutionalization for seniors and
people with disabilities. There is no opposition.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081
AB 518
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