BILL ANALYSIS �
AB 1310
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Date of Hearing: May 8, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 1310 (Brown) - As Introduced: February 22, 2013
Policy Committee: HealthVote:19-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill revises the Medi-Cal pediatric subacute care program
by raising the eligibility age from 21 to 22, changing the
definition of pediatric subacute to include a person who
requires treatment for one or more active complex medical
conditions, or requires the administration of one or more
technically complex treatments, and adding specified conditions
to the ways in which medical necessity for pediatric subacute
services may be substantiated.
FISCAL EFFECT
Unknown, potentially significant costs in excess of $200,000.
Variables include the extent to which the increase in the
eligibility age results in an increase in the number of people
occupying more pediatric subacute care beds.
COMMENTS
1)Rationale . This bill seeks to address an unintended
consequence of the medical necessity definition that keeps
some children in acute care hospitals unnecessarily. The
author also argues the age range for pediatric subacute care
should correspond with state law for children receiving school
services, since the integration and continuity of these
services is beneficial. In addition, the current law is
interpreted in such a restrictive way that children, who could
benefit from subacute services outside of the acute care
hospital setting, must remain in the hospital at a cost much
higher than the cost of a subacute pediatric care facility.
2)Background . AB 667 (Mitchell), Chapter 294, Statutes of 2011,
AB 1310
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codified and updated the criteria used to evaluate and
authorize admission into Medi-Cal pediatric subacute
facilities. Until then, the criteria were in regulations
adopted in 1989 and included a limited number of specific
qualifying conditions. According to DHCS, these regulations
had never been updated to reflect enhanced and improved
technology. Devices now commonly used as an alternative to a
tracheotomy require careful supervision by skilled clinical
staff - particularly for young children with serious
respiratory issues.
Established on July 1, 1983 by DHCS, the Medi-Cal subacute care
program makes provisions for patients in facilities who meet
subacute care criteria. Specific reimbursement rates have
been developed for providers of subacute care who have been
licensed and certified. Pediatric subacute care is a level of
care needed by a person less than 21 years of age who uses a
medical technology that compensates for the loss of a vital
bodily function.
Pediatric subacute care units must employ sufficient subacute
staff, as required by subacute regulation. Staff-to-patient
ratios are a minimum daily average of 5.0 unduplicated
licensed nursing hours per patient day, and 4.0 certified
nurse assistant hours per patient day.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081