BILL ANALYSIS Ó
AB 518
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ASSEMBLY THIRD READING
AB 518 (Yamada and Blumenfield)
As Amended April 11, 2013
Majority vote
HEALTH 19-0 AGING 7-0
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|Ayes:|Pan, Logue, Ammiano, |Ayes:|Yamada, Wagner, Brown, |
| |Atkins, Bonilla, Bonta, | |Daly, Gray, Grove, Levine |
| |Chesbro, Gomez, Roger | | |
| |Hernández, Rendon, | | |
| |Maienschein, Mansoor, | | |
| |Mitchell, Nazarian, | | |
| |Nestande, | | |
| |V. Manuel Pérez, Wagner, | | |
| |Wieckowski, Wilk | | |
| | | | |
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APPROPRIATIONS 17-0
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|Ayes:|Gatto, Harkey, Bigelow, |
| |Bocanegra, Bradford, Ian |
| |Calderon, Campos, |
| |Donnelly, Eggman, Gomez, |
| |Hall, Ammiano, Linder, |
| |Pan, Quirk, Wagner, Weber |
| | |
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SUMMARY : Establishes Community-Based Adult Services (CBAS) as a
benefit in the Medi-Cal program. Specifies the criteria for
eligibility, requires that CBAS be provided at licensed Adult Day
Health Centers (ADHC) certified by the Department of Health Care
Services (DHCS) as CBAS providers as specified. Requires CBAS
providers to meet specified standards and, beginning July 1, 2015,
have non-profit status. Requires the delivery of CBAS through
Medi-Cal managed care (MCMC), if available, unless the individual is
exempt from mandatory enrollment. Requires submission of a quality
assurance proposal to the Legislature and specifies legislative
findings, declarations, and intent.
FISCAL EFFECT : According to the Assembly Appropriations Committee,
unknown, but likely minor costs. No additional state costs until at
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least August 2014, when the court directive from Esther Darling, et
al. v. Toby Douglas, et al., (No.C-09-03798) 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 : According to the author, this bill is necessary to place
the terms of the settlement agreement reached in the case known as
"Darling v. Douglas," into state statute. The author states that
until 2011, ADHC was provided to low-income frail, nursing-home
eligible SPDs for over 30 years as a Medi-Cal benefit. These
services were provided at licensed ADHC centers and include 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. The author points
out that ADHC is an optional benefit, meaning that states are not
required to provide it as one of their Medicaid benefits. According
to the author, the Governor's January 2011 Budget Plan proposed to
eliminate ADHC as a Medi-Cal benefit in order to achieve General
Fund savings. The author states that the Legislature agreed to the
elimination because of the ongoing fiscal crisis. However, the
author points out, the Legislature proposed as an alternative a
smaller program that would replace ADHC. This time, elimination was
adopted by the Legislature in a budget trailer bill (AB 97 (Budget
Committee), Chapter 3, Statutes of 2011). In an attempt to offer an
alternative to the Administration's proposed elimination, the
Legislature passed AB 96 (Blumenfield) of 2011 to enact the Keeping
Adults Free from Institutions (KAFI) program and provide a framework
for a "capped" program (limited to roughly one-half the enrollment
of the ADHC program). AB 96 was vetoed. The author argues that now
that ADHC has been eliminated, and KAFI vetoed, there is no
statutorily authorized benefit. In June 2011 Darling v. Douglas was
filed as a class action law suit to preserve ADHC as a benefit. The
author points out that the benefit now only exists as a product of a
settlement agreement from that lawsuit and only until July 2014.
The benefit is also reflected in the Bridge to Reform waiver, but
the author states that the waiver could be changed through
administrative action with no input from the Legislature.
ADHC is a licensed community-based day care program providing
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participants with daily registered nursing care, physical,
occupational and speech language pathology therapies, therapeutic
activities and social services in one setting. ADHC helps adults
manage chronic disabling health conditions while living in their
home and community. Each ADHC center has a multidisciplinary team
of health professionals who conduct a comprehensive assessment of
each participant in order to determine and plan the ADHC services
needed to meet an individual's specific health and social needs,
pursuant to an individual plan of care. A set of "core services"
must be provided to each participant including professional nursing
services, personal care and/or social services, therapeutic
activities, and at least one meal per day. In addition to core
services, ADHC centers offer other specialty services such as
physical therapy, occupational therapy, speech and language
pathology, dietetics, and mental health services and must provide
transportation for participants to and from the center
Like ADHC, 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. Under the terms of the
settlement, most beneficiaries must enroll into a Medi-Cal managed
care plan 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. There is no cap on the number of
individuals who can be served, and services will be provided at no
cost to recipients.
Supporters, including the Jewish Public Affairs Committee of
California, the National Association of Social Workers and
LeadingAge California, state that CBAS currently operates under
authority of a court order scheduled to expire and the future of the
program is uncertain without legislative action. Supporters also
argue in support that placing the CBAS program into statute assures
medically fragile Californians and their families certainty and
access to a range of social and health support delivered in a
clinical setting that avoids costlier institutional placements.
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Analysis Prepared by : Marjorie Swartz / HEALTH / (916) 319-2097
FN:
0000630