BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 614| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 614 Author: Chávez (R) Amended: 8/21/14 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. Senate Floor Amendments of 8/21/14 add double-jointing language to prevent chaptering out issues with SB 1440 (Wolk). ANALYSIS : CONTINUED AB 614 Page 2 Existing law: 1.Provides for the establishment and operation of the Veterans 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. 3.Contains double-jointing language to prevent chaptering out issues with SB 1440 (Wolk). 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. CONTINUED AB 614 Page 3 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 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; CONTINUED AB 614 Page 4 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 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: CONTINUED AB 614 Page 5 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 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 CONTINUED AB 614 Page 6 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 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 8/21/14) 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 CONTINUED AB 614 Page 7 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, 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 8/21/14 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED