BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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                                    THIRD READING


          Bill No:  AB 614
          Author:   Chávez (R)
          Amended:  8/4/14 in Senate
          Vote:     21

           
           SENATE VETERANS AFFAIRS COMMITTEE  :  6-0, 6/24/14
          AYES:  Hueso, Knight, Correa, Lieu, Nielsen, Roth
          NO VOTE RECORDED:  Block
           
          SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8
           
          ASSEMBLY FLOOR  :  76-0, 4/25/13 (Consent) - See last page for  
            vote


           SUBJECT  :    Veterans homes of California:  reimbursement 

           SOURCE  :     Author


           DIGEST  :    This bill provides that a veteran member of a  
          Veterans Home of California and who is in intermediate care or  
          skilled nursing care is not subject to charges and fees if  
          he/she meets specified criteria for disability status and  
          payments by the federal Department of Veterans Affairs (USDVA)  
          under specified federal regulations.

           ANALYSIS  :    

          Existing law:

          1.Provides for the establishment and operation of the Veterans  
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            Home of California, within the California Department of  
            Veterans Affairs (CalVet), at various sites for aged and  
            disabled veterans and their nonveteran spouses, who meet  
            certain eligibility requirements.

          2.Requires members (residents) of the homes to pay fees and  
            charges, as determined by CalVet.

          3.Provides for veterans homes to receive federal per diem  
            payments from USDVA, which help compensate the state veterans  
            homes for the costs of care.

          4.Provides for veterans homes to receive federal "aid and  
            attendance" payments from USDVA on behalf of eligible  
            veterans, who need levels of care exceeding provision of basic  
            domiciliary services.

          This bill conforms state law to federal regulations which:

          1.Eliminates USDVA aid and attendance payments for veterans, who  
            are USDVA -rated at 70% or higher disabled due to a  
            service-connected condition.

          2.Requires a state home, when receiving the super per diem rate  
            for veteran, USDVA -rated as 70% or higher service-connected,  
            not to charge a member fee to that veteran.

           Background
           
           California state veterans homes  .  CalVet's Veterans Homes  
          Division provides rehabilitative, residential medical care and  
          services in a homelike environment for all veterans (and  
          eligible veteran spouses) residing in the state's eight veterans  
          homes, which are located in Barstow, Chula Vista, Fresno,  
          Lancaster, Redding, Ventura, West Los Angeles, and Yountville.   
          As of early 2013, more than 1,700 members resided in these  
          veterans homes.

           Levels of Care.   The eight campuses offer different combinations  
          of the following levels of care that generate increasing levels  
          of cost:

           Independent living/domiciliary care (Barstow, Chula Vista,  
            Yountville):  This level of care is for residents able to  

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            perform activities of daily living with, at most, minimal  
            assistance.  Non-nursing employees provide limited  
            supervision.  Residents have access to all of the home's  
            services, activities, and medical care.  Individuals can  
            transfer to higher levels of care as needed.  Independent  
            living is also referred to as Domiciliary by CalVet and the  
            USDVA.

           Residential care/assisted living (All homes except Barstow):   
            Residential Care Facilities for the Elderly (RCFE) are  
            available for residents who require minimal assistance and  
            supervision with some activities of daily living.  RCFE  
            services may include care by licensed nurses. In the future,  
            memory care programs may be established within the RCFEs.

           Intermediate care (Barstow, Yountville):  This level is for  
            residents who often require licensed nursing assistance with  
            medications and treatments, and generally require unlicensed  
            nursing assistance with several daily living activities.

           Skilled nursing care (Barstow, Chula Vista, Fresno, Redding,  
            West Los Angeles, Yountville):  This level provides 24-hour  
            services of licensed nurses and certified nursing assistants,  
            and is more comprehensive than intermediate care.  Skilled  
            nursing residents have greater access to rehabilitation  
            therapies, nursing care, pharmacy management, structured  
            activities and clinical dietary services, and may provide a  
            memory care program.

           Home funding and member fees  .  Funding for the annual operating  
          expenses of the veterans homes comes from the state's General  
          Fund, and any additional revenues that the Veterans Homes  
          Division receives are subsequently remitted to the General Fund.  
           These additional sources of revenue primarily consist of  
          reimbursements from five sources:

          1.Medicare, a federally funded program which pays hospital  
            inpatient and outpatient care, and some skilled nursing care;

          2.Medi-Cal, funded by the federal and state governments, which  
            pays skilled nursing facility daily rates and various  
            healthcare costs;

          3.Member fees, which veterans' home residents pay in accordance  

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            with their income and level of care;

          4.So-called "aid and attendance," which are federal payments for  
            veterans who need personal care assistance; and 

          5.USDVA, which pays a per diem rate for each veteran in the  
            homes.

          Member fee amounts are determined by CalVet, and that  
          determination takes into account those times when the costs of a  
          resident's care (e.g. dental care, acute medical care, etc.)  
          exceed the basic fee.

          Under existing law, the total of the individual member's fees  
          and charges for any fiscal year shall not be greater than:

           47.5% of the member's annual income for domiciliary care.

           55% of the member's annual income for residential care for the  
            elderly or assisted living.

           65% of the member's annual income for intermediate care.

           70% of the member's annual income for skilled nursing care.

          Most veteran members are eligible to have the USDVA make per  
          diem payments to the state that help reduce costs to state  
          taxpayers.  The USDVA manages the "State Veterans Home Program,"  
          a grant program that provides federal assistance to states by  
          (1) participating in a percentage of the cost of construction of  
          state veterans homes and (2) paying per diem for ongoing  
          provision of care to eligible veterans residing in federally  
          recognized state veterans homes.  The per diem is the approved  
          daily rate established by the USDVA to reimburse state homes for  
          providing specified levels of care to eligible veterans.

          The federal "Basic State Home Per Diem Rates" for fiscal year  
          2014 are as follow:

           Adult Day Health Care:  $79.96 per day
           Domiciliary:  $43.32 per day
           Nursing Homes:  $100.37 per resident per day

          Veterans who are USDVA -rated as 70% or more disabled are  

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          eligible for enhanced per diem rates, based upon the location of  
          their state veterans home.  For example, Yountville receives a  
          $536.58 enhanced per diem and Barstow receives a $431.24  
          enhanced per diem.

          Aid and attendance payments are additional monetary allowances  
          paid by the USDVA to veterans, who require the aid and  
          attendance of another person.  The intent is to assist a  
          veteran, who has a physical or mental impairment, loss of  
          coordination, or conditions affecting the ability to dress and  
          undress, to feed oneself, to attend to sanitary needs, and to  
          keep oneself ordinarily clean and presentable.  The payments are  
          in addition to any other veterans pension the individual may  
          have earned.

          Under federal regulations, if a 70% plus veteran is eligible for  
          the super per diem, the USDVA will pay either aid and attendance  
          or the enhanced per diem, whichever is higher.  Right now the  
          super per diem for Yountville is $540.62 a day ($16,218.60 a  
          month).  The USDVA aid and attendance is $704 a month.  
          Therefore, the USDVA would pay only the per diem and not pay the  
          aid and attendance at all.

          In the 2009-10 Budget Act, the Legislature instituted a major  
          General Fund policy adjustment that affected home resident fees.  
           Specifically, it increased the amount of fees collected from  
          home residents from $17.2 million to $20 million - an increase  
          of $2.8 million.

          Previously, residents paid fees based on a percentage of their  
          income, up to a dollar cap, with the percentage and cap  
          increasing as the level of care increases.  The 2009 Budget  
          proposal increased resident fees by:

           Removing the dollar caps;

           Increasing the percentage for the RCFE; and

           Revising the fee structure for nonveteran spouses to more  
            accurately reflect their share of costs because they are  
            ineligible for the federal per diem payments. 

           USDVA disability ratings.   The USDVA administers claims and  
          provides compensation for injuries or diseases that happened  

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          while on active duty, or were made worse by active military  
          service.  The amount of basic benefit paid varies depending on  
          the severity of the condition.  Additional amounts may be paid  
          if the veteran has:  very severe disabilities or loss of  
          limb(s); a spouse, children, or dependent parents; or seriously  
          disabled spouse.  The USDVA makes a determination about the  
          severity of a disability based on the evidence the veteran  
          submits as part of a claim, or that USDVA obtains from the  
          veteran's official military records.

          The USDVA rates disability from 0% to 100% in 10% increments.   
          The 10-percent rating is the lowest rating for which compensable  
          income is awarded.  A veteran with a 100% rating will have one  
          or more disabilities that significantly interfere with normal  
          life functions.  A veteran with a 0% rating may have a  
          service-connected condition, but it doesn't interfere with  
          normal life functions.  The majority of disabled veterans rated  
          at 10%, 20%, or 30%. Over many years, a veteran's disability  
          claim may require re-ratings.  The re-ratings can be caused by  
          changes in law, advances in medical knowledge, or fluctuations  
          in the veteran's physical or mental condition.  An individual's  
          percentage rating may go up or down.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  No

           SUPPORT  :   (Verified  8/8/14)

          American Legion - Department of California
          AMVETS - Department of California
          California Association of County Veterans Service Officers
          California State Commanders Veterans Council
          Military Officers Association of America - California Council of  
          Chapters
          Veterans of Foreign Wars - Department of California
          Vietnam Veterans of America - California State Council

           ASSEMBLY FLOOR  :  76-0, 4/25/13
          AYES:  Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,  
            Blumenfield, Bocanegra, Bonilla, Bonta, Bradford, Brown,  
            Buchanan, Ian Calderon, Campos, Chau, Chávez, Chesbro, Conway,  
            Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox, Frazier,  
            Beth Gaines, Garcia, Gatto, Gomez, Gordon, Gorell, Gray,  
            Grove, Hagman, Hall, Harkey, Roger Hernández, Holden, Jones,  

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            Jones-Sawyer, Levine, Linder, Logue, Maienschein, Mansoor,  
            Medina, Melendez, Mitchell, Morrell, Mullin, Muratsuchi,  
            Nestande, Olsen, Pan, Patterson, Perea, V. Manuel Pérez,  
            Quirk, Quirk-Silva, Rendon, Salas, Skinner, Stone, Ting,  
            Torres, Wagner, Waldron, Weber, Wieckowski, Wilk, Williams,  
            Yamada, John A. Pérez
          NO VOTE RECORDED:  Cooley, Lowenthal, Nazarian, Vacancy


          AL:k  8/12/14   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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