BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 1310 (Brown) - Medi-Cal: pediatric subacute care.
Amended: May 24, 2013 Policy Vote: Health 9-0
Urgency: No Mandate: No
Hearing Date: August 12, 2013
Consultant: Brendan McCarthy
This bill meets the criteria for referral to the Suspense File.
Bill Summary: AB 1310 would revise the eligibility criteria for
access to pediatric subacute care services in the Medi-Cal
program.
Fiscal Impact:
Likely one-time administrative costs in the hundreds of
thousands to revise regulations and review any applications
by new providers to participate in the Medi-Cal program (50%
General Fund, 50% federal funds).
Unknown costs for additional acute care services in the
Medi-Cal program (50% General Fund, 50% federal funds). By
broadening the eligibility criteria for access to subacute
care, the bill is likely to increase the demand for subacute
care. As explained below, the overall impact of increasing
demand is likely to be increased costs to the Medi-Cal
program. The size of this effect is unknown.
Since the bill broadens eligibility for pediatric subacute
care, it is possible that there could be some shift of
pediatric patients from more expensive acute care hospitals
to subacute care facilities. However, the supply of
pediatric subacute beds in the state is essentially fully
utilized. Thus, expanding eligibility is likely to increase
demand for these services beyond the supply of beds. (It is
possible that new providers will enter the market, although
this will depend on whether the rates that Medi-Cal pays for
those services are sufficient to encourage providers to
increase the number of available beds.)
Given the limited supply of pediatric subacute beds, over
time it is likely that increased demand by newly eligible
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patients with less severe conditions will displace patients
with more severe conditions from subacute care facilities to
acute care hospitals, which are significantly more costly.
For example, a patient that under current law would be
discharged from an acute care hospital to the community, to
receive outpatient or in-home services may be discharged to
a pediatric subacute care facility, occupying a bed that
would otherwise have been used by a patient whose only other
option is to receive care in an acute care hospital.
Background: The state's Medi-Cal program provides health care
services to seniors, the disabled, and certain low income
children and their parents. About 5.2 million Medi-Cal
beneficiaries (about 70% of the total Medi-Cal population)
receive their health care through Medi-Cal managed care. In
addition, the state is in the process of shifting certain
populations (seniors and persons with disabilities, rural
Medi-Cal beneficiaries, and individuals eligible for both
Medi-Cal and Medicare) from fee-for-service to managed care. In
total, these initiatives are likely to shift about two million
Medi-Cal beneficiaries to managed care.
Under current law, Medi-Cal beneficiaries are entitled to
pediatric subacute care services if they meet certain, detailed
criteria. (Subacute care is inpatient care with a lower level of
care that is typically provided in an acute care hospital.) In
order to be eligible for pediatric subacute care, a patient must
need a medical technology that compensates for the loss of a
vital bodily function (for example a patient needing a
ventilator to breathe).
There are 362 pediatric subacute care beds in the state and
those beds are essentially fully utilized. The state currently
pays $706 - $895 per day for pediatric subacute care, whereas
the state pays $1,425 per day for pediatric acute hospital care.
Proposed Law: AB 1310 would revise the eligibility criteria for
access to pediatric subacute care services in the Medi-Cal
program.
The bill would broaden the eligibility for pediatric subacute
care by adding the following eligibility criteria:
Dependence on complex wound care management;
Having a complex medical condition for which care needs can
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be met in a pediatric subacute care facility, if the only
other appropriate level of care to meet those needs is an
acute care hospital bed.
In addition, the bill would broaden the eligibility for access
based on a patient's need for total parenteral nutrition or
other intravenous support, by deleting some additional criteria
that must be met in current law. (In current law, a patient who
needs total parenteral nutrition must also have another
specified medical need, such as dialysis or positive airway
pressure. This bill would eliminate those additional criteria,
broadening eligibility.)
The bill would also make a variety of technical and
organizational changes to existing law.