BILL NUMBER: AB 1552 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Lowenthal
JANUARY 27, 2014
An act to add Article 7 (commencing with Section 14590.10) to
Chapter 8.7 of Part 3 of Division 9 of the Welfare and Institutions
Code, relating to adult day health care, and declaring the urgency
thereof, to take effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
AB 1552, as introduced, Lowenthal. Community-based adult services:
adult day health care centers.
Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which health care
services are provided to qualified, low-income persons. The Medi-Cal
program is, in part, governed and funded by federal Medicaid Program
provisions. Existing law provides, to the extent permitted by federal
law, that adult day health care (ADHC) be excluded from coverage
under the Medi-Cal program.
This bill would establish the Community-Based Adult Services
(CBAS) program, as a Medi-Cal benefit. The bill would require that
CBAS be provided and available at licensed ADHC centers that are
certified by the California Department of Aging as CBAS providers.
The bill would require CBAS providers to meet specified licensing
requirements and to provide care in accordance with specified
regulations.
This bill would declare that it is to take effect immediately as
an urgency statute.
Vote: 2/3. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) California supports the dignity, independence, and choice of
seniors and persons with disabilities to live in the most integrated
setting appropriate, in their own home or a community-based setting,
and to be free from unnecessary institutionalization.
(b) The American population is swiftly aging. According to the
Centers for Disease Control, in 2007, individuals 65 years of age and
over represented 12.6% of the American population; by 2030 it is
estimated the older adult population will reach 20% of the whole,
with 70 million adults over 65 years of age. Many of these adults
will experience disability and chronic conditions. The Alzheimer's
Association reports that over five million Americans are living with
Alzheimer's disease and that number will grow to 16 million by 2050,
with the cost of caring for those individuals growing from $203
billion in 2013 to $1.2 trillion by mid-century.
(c) According to the United States Census, California's older
adult population is the country's largest, with over four million
seniors currently residing in the state. The California Department of
Aging reports that one in every five Californians is now age 60 or
older and 40% of those individuals have a disability. The state's
population is also diverse: just under one-half million older adults
in the state identify as Latino or Hispanic, 354,000 identify as
Asian, over 182,000 as African American, and over 100,000 people as
Native American, Pacific Islander, or multiracial.
(d) Adult Day Health Care (ADHC) was established in California in
1974 as a service designed to meet the needs of older adults and
adults with disabilities in community settings rather than in
institutional care. ADHC centers are licensed daytime health
facilities that provide integrated services from a multidisciplinary
team including nurses, social workers, occupational therapists, and
other professionals.
(e) ADHC centers serve frail elders and other adults with
disabilities, chronic conditions, and complex care needs, such as
Alzheimer's disease or other dementia, diabetes, high blood pressure,
mental health diagnoses, traumatic brain injury, and people who have
had a stroke or breathing problems or who cannot take medications
properly.
(f) ADHC centers also offer caregiver support, addressing research
findings that identify caregiver stress as a leading cause of
placement in a nursing facility, as well as putting the aging or
disabled adult at increased risk for abuse or neglect.
(g) ADHC services include health, therapeutic, and social services
including transportation; skilled nursing care; physical,
occupational, and speech therapy; medical social work services;
therapeutic exercise activities; protective supervision; activities
of daily living, brain-stimulating activities, and a nutritionally
balanced hot meal. Services are provided in accordance with a
person-centered care plan designed after a three-day
interdisciplinary team assessment that includes a home visit and
communication with the participant's primary care physician.
(h) ADHC participants, who are at-risk of institutionalization,
receive services in the center and return to their own homes at
night. According to a recent study by the California Medicaid
Research Institute, the statewide weighted average annual per person
nursing home cost for Medi-Cal/Medicare recipients in California is
$83,364, while the average annual expenditure per person for ADHC for
this population is $9,312.
(i) ADHC centers are licensed by the State Department of Public
Health and overseen by the California Department of Aging and the
State Department of Health Care Services.
(j) In 1977, Senator Henry Mello issued a report that identified
the need for 600 ADHC centers statewide to meet the needs of
California's elder population. At its peak in 2004, approximately 360
ADHC centers provided care to over 40,000 medically fragile
Californians. In December 2013, there were a total of 270 open ADHC
centers in California, including 245 serving the Medi-Cal population,
two centers serving private-pay clients, and 23 centers associated
with Programs of All-Inclusive Care for the Elderly. Medi-Cal
recipients receiving services at ADHC centers totaled 24,800 persons.
(k) In 2014, 32 California counties do not have an adult day
health center.
(l) For many years, ADHC was a state plan optional benefit of the
Medi-Cal program, offering an integrated medical and social services
model of care that helped individuals continue to live outside of
nursing homes or other institutions.
(m) California's adult day services have experienced significant
instability in recent years due to California's fiscal crisis and
subsequent budget reductions. The Budget Act of 2011 and the related
trailer bill, Chapter 3 of the Statutes of 2011, eliminated ADHC as a
Medi-Cal optional State Plan benefit.
(n) A class action lawsuit, Esther Darling, et al. v. Toby
Douglas, et al., challenged the elimination of ADHC as a violation of
the Supreme Court decision in Olmstead v. L.C. The state settled the
lawsuit, agreeing to replace ADHC services with a new program called
Community-Based Adult Services (CBAS), effective April 1, 2012, to
provide necessary medical and social services to individuals with
intensive health care needs. CBAS is a managed care benefit,
administered through California's Medi-Cal Managed Care
Organizations. For CBAS-eligible individuals who do not qualify for
managed care enrollment and who have an approved medical exemption or
who reside in Shasta, Humboldt, Butte, or Imperial counties, where
managed care is currently not available, CBAS services are provided
as a Medi-Cal fee-for-service benefit.
(o) The State Department of Health Care Services amended the
"California Bridge to Reform" 1115 Waiver to include the new CBAS
program, which was approved by the Centers for Medicare and Medicaid
Services on March 30, 2012. CBAS is operational under the 1115 Bridge
to Reform waiver through August 31, 2014. There is no cap on
enrollment for this waiver service.
(p) Adult day services and CBAS programs remain a source of
necessary skilled nursing, therapeutic services, personal care,
supervision, health monitoring, and caregiver support. The state's
demographic forecast projects the continued growth of the aging
population at least through the year 2050, thereby increasing the
need and demand for integrated, community-based services.
(q) Continuation of a well-defined and well-regulated system of
CBAS programs is essential in order to meet the rapidly changing
needs of California's diverse and aging population and the state's
goals for the Coordinated Care Initiative.
(r) Ensuring that the CBAS program is codified beyond August 31,
2014, will enable thousands of disabled and frail Californians who
rely upon adult day health programs today, and those who will need
this service in the future, to be able to remain independent and free
of institutionalization for as long as possible.
SEC. 2. Article 7 (commencing with Section 14590.10) is added to
Chapter 8.7 of Part 3 of Division 9 of the Welfare and Institutions
Code, to read:
Article 7. Community-Based Adult Services
14590.10. (a) Notwithstanding the operational period of CBAS as
specified in the Special Terms and Conditions of California's Bridge
to Reform Section 1115(a) Medicaid Demonstration (11-W-00192/9), and
notwithstanding the duration of the CBAS settlement agreement, Case
No. C-09-03798 SBA, CBAS shall be a Medi-Cal benefit, and shall be
included as a covered service in contracts with all managed health
care plans, with standards, eligibility criteria, and provisions that
are at least equal to those contained in the Special Terms and
Conditions of the demonstration on the date the act that added this
section is chaptered. Any modifications to the CBAS program that
differ from the Special Terms and Conditions of the demonstration
shall be permitted only if they offer more protections or permit
greater access to CBAS.
(b) (1) CBAS providers shall be enrolled as California's Bridge to
Reform Section 1115(a) Medicaid Demonstration (11-W-00192/9)
providers and shall meet the standards specified in this chapter and
Chapter 5 (commencing with Section 54001) of Division 3 of Title 22
of the California Code of Regulations.
(2) CBAS providers shall meet all applicable licensing, Medi-Cal,
and California's Bridge to Reform Section 1115(a) Medicaid
Demonstration (11-W-00192/9) standards, including, but not limited
to, licensing provisions in Division 2 (commencing with Section 1200)
of the Health and Safety Code, including Chapter 3.3 (commencing
with Section 1570) of Division 2 of the Health and Safety Code, and
shall provide services in accordance with Chapter 10 (commencing with
Section 78001) of Division 5 of Title 22 of the California Code of
Regulations.
(c) (1) CBAS shall be provided and available at licensed Adult Day
Health Care centers that are certified by the California Department
of Aging as CBAS providers and shall be provided pursuant to a
participant's individualized plan of care, as developed by the center'
s multidisciplinary team.
(2) In counties where the State Department of Health Care Services
has implemented Medi-Cal managed care, CBAS shall be available as a
Medi-Cal managed care benefit pursuant to Section 14186.3, except
that for individuals who qualify for CBAS, but who are not qualified
for, or who are exempt from, enrollment in Medi-Cal managed care,
CBAS shall be provided as a fee-for-service Medi-Cal benefit.
(3) In counties that have not implemented Medi-Cal managed care,
CBAS shall be provided as a fee-for-service Medi-Cal benefit to all
eligible Medi-Cal beneficiaries who qualify for CBAS.
(d) For purposes of this section, "Community-Based Adult Services"
or "CBAS" means an outpatient, facility-based program that delivers
nutrition services, professional nursing care, therapeutic
activities, facilitated participation in group or individual
activities, social services, personal care services, and, when
specified in the individual plan of care, physical therapy,
occupational therapy, speech therapy, behavioral health services,
registered dietician services, and transportation.
SEC. 3. This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
In order to allow sufficient time to implement these provisions
and to ensure the continuity of Community-Based Adult Services in
California and the health and safety of program participants, it is
necessary that this act take effect immediately.