BILL ANALYSIS Ó
AB 1261
Page 1
Date of Hearing: April 14, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB
1261 (Burke) - As Introduced February 27, 2015
SUBJECT: Community-based adult services: adult day health care
centers.
SUMMARY: Codifies the Community-Based Adult Services (CBAS)
program and its requirements as a Medi-Cal benefit to be
provided at licensed adult day health care (ADHC) centers.
Specifically, this bill:
1)Requires CBAS providers to meet all applicable licensing and
Medi-Cal standards.
2)Requires CBAS to be included as a covered service in contracts
with all Medi-Cal managed care (MCMC) plans, with standards,
eligibility criteria, and provisions that are at least equal
to those contained in the approved Section 1115(a) Medicaid
demonstration project in effect at the time of this bill's
enactment.
3)Requires rates for CBAS provided by MCMC plans to be at least
equal to fee-for-service (FFS) Medi-Cal rates.
4)Requires CBAS to be provided and available at licensed ADHC
centers that are certified by the California Department of
Aging (CDA) as CBAS providers pursuant to a participant's
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individualized plan of care, as developed by the center's
multidisciplinary team.
5)Requires CBAS providers to comply with the requirements in
California's Bridge to Reform Demonstration and any approved
Section 1115(a) Medicaid demonstration project in effect at
the time of this bill's enactment.
6)Requires CBAS to be available as a MCMC benefit in counties
where the California Department of Health Care Services (DHCS)
has implemented MCMC.
7)Requires CBAS to be provided as a FFS Medi-Cal benefit in
counties that have not implemented MCMC, and for individuals
who are exempt from or ineligible for managed care enrollment.
8)Establishes eligibility requirements for CBAS, as specified.
EXISTING LAW:
1)Establishes the Medicaid program (Medi-Cal in California) as a
joint federal-state program to provide health care services to
low-income people and seniors, and persons with disabilities
(SPDs).
2)Requires states, under federal law, to provide certain health
care benefits such as hospital inpatient and outpatient care
and allows states to provide certain optional benefits in
their Medicaid programs.
3)Authorizes DHCS to enter into contracts with managed care
plans to provide services to Medi-Cal enrollees.
4)Requires specified Medi-Cal recipients to enroll in a MCMC
plan in specified counties.
5)Under federal law, establishes the Medicare program to provide
health care coverage to eligible individuals who are disabled
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or over age 65.
6)Establishes the Coordinated Care Initiative (CCI), which
requires DHCS to seek federal approval to establish
demonstration sites in up to eight counties to provide
coordinated Medi-Cal and Medicare benefits to persons eligible
for Medi-Cal and Medicare (dual eligibles) and authorizes DHCS
to require SPDs who are eligible for Medi-Cal only (not
Medicare) to mandatorily enroll in managed care plans for
long-term services and support (LTSS), which includes nursing
facility care, in-home supportive services, Multipurpose
Senior Services Program, and CBAS.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. The author argues this bill will
preserve access to the ADHC services that thousands of frail
Californians and their families depend on through the CBAS
program and gives providers a reliable rate structure to
ensure program sustainability. This bill will align state law
with the federal requirements for the CBAS benefit, consistent
with the program specifications in the current waiver. This
bill also requires MCMC plans to reimburse contracted
providers at rates that are not less than Medi-Cal FFS. The
author argues this will allow for better program
sustainability as well as legislative input and oversight.
The author points to information provided by CDA showing that
53 ADHC facilities have closed in the last three years, about
20% of available facilities.
2)BACKGROUND. The CBAS Program is administered jointly by DHCS,
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CDA, and the California Department of Public Health (DPH).
DPH licenses ADHC centers and CDA certifies them for
participation in the Medi-Cal program. CBAS offers services
to eligible older adults and/or adults with disabilities to
restore or maintain their optimal capacity for self-care and
delay or prevent inappropriate or personally undesirable
institutionalization. CBAS services include: an individual
assessment; professional nursing services; physical,
occupational, and speech therapies; mental health services;
therapeutic activities; social services; personal care; meals;
nutritional counseling; and, transportation to and from the
participant's residence and the CBAS center.
CBAS services are provided at licensed ADHC centers. ADHC is
a licensed community-based day care program providing
participants with daily registered nursing care, physical,
occupational and speech language pathology therapies,
therapeutic activities and social services in one setting.
ADHC helps adults manage chronic disabling health conditions
while living in their home and community. Each ADHC center
has a multidisciplinary team of health professionals who
conduct a comprehensive assessment of each participant in
order to determine and plan the ADHC services needed to meet
an individual's specific health and social needs, pursuant to
an individual plan of care.
Over the past several years, the status of ADHC/CBAS as a
Medi-Cal benefit has been subject to numerous Legislative and
Administrative actions. Governor Schwarzenegger
unsuccessfully proposed the elimination of ADHC in 2009 and
again in 2010. In the 2011-12 budget, Governor Brown also
proposed the elimination of ADHC as a Medi-Cal benefit, and
this time, elimination was adopted by the Legislature. In an
attempt to offer an alternative to the Administration's
proposed elimination, the Legislature passed AB 96 (Committee
on Budget) of 2011 to enact the Keeping Adults Free from
Institutions (KAFI) program which replaced ADHC with a capped
program, with enrollment limited to roughly one-half the
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enrollment of the ADHC program. AB 96 was vetoed by the
Governor.
A subsequent class action lawsuit, Esther Darling, et al. v.
Toby Douglas, et al., (No.C-09-03798) led to a settlement
whereby the state agreed to replace ADHC services with a new
program called CBAS effective April 1, 2012. DHCS amended the
California Bridge to Reform Waiver to include the new CBAS
program, which was approved by the Centers for Medicare and
Medicaid Services.
3)SUPPORT. Supporters argue this bill will help frail people
continue to live in their own homes by effectively managing
their care and providing needed services. The supporters note
it also aligns state law with federal requirements for the
CBAS benefits, consistent with the program specifications in
the current Section 1115 waiver. The support argues that this
bill also is important because it requires MCMC plans to
reimburse contracted providers at rates that are not less than
Medi-Cal FFS rates, a provision that existed in the waiver
until November 2014 and is important to continue until CBAS is
fully integrated into managed care. They conclude that as
California implements health care reform and moves to managed,
outcome-driven care, it is essential that integrated
community-based programs such as CBAS are key partners in
these changing systems and that they expand to meet the
growing needs of California's aging population and the goals
of offering alternatives to institutional care.
4)PREVIOUS LEGISLATION.
a) AB 1552 (Yamada) of 2014 was similar to this bill. AB
1552 was vetoed by Governor Brown who cited that codifying
the program was premature since it was being offered
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subject to a federally approved waiver, which was subject
to change.
b) AB 518 (Yamada) of 2013, established CBAS as a Medi-Cal
benefit and a covered service in managed care plan
contracts, establishes eligibility criteria for CBAS and
staffing standards for ADHC centers, and requires new CBAS
providers, as a condition of participation, to be
nonprofit. AB 518 was held in the Senate Health Committee.
c) SB 1008 (Committee on Budget and Fiscal Review), Chapter
33, Statutes of 2012, and SB 1036 (Committee on Budget and
Fiscal Review), Chapter 45, Statutes of 2012, authorize the
CCI as an eight-county pilot project to: i) integrate
Medi-Cal and Medicare benefits under managed care for dual
eligibles; and, ii) integrate LTSS under managed care for
dual eligibles and Medi-Cal-only SPDs.
d) AB 96 (Committee on Budget) would have established the
KAFI program, and would have required DHCS to submit an
application to the federal Centers for Medicare and
Medicaid Services to implement the program. AB 96 was
vetoed by Governor Brown.
e) AB 97 (Committee on Budget), Chapter 3, Statutes of
2011, among other provisions eliminated ADHC as a Medi-Cal
benefit.
5)DOUBLE REFERRAL. This bill is double referred, upon passage
in this Committee, this bill will be referred to the Assembly
Committee on Aging and Long-Term Care.
REGISTERED SUPPORT / OPPOSITION:
Support
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AARP
Adult Day Health Care of Mad River
Alzheimer's Association
Avenidas
Bay Area Community Services
California Association for Adult Day Services
California Association of Public Authorities for IHSS
Congress of California Seniors
Disability Rights California
HIChoice Health Care, Inc.
J Gelt Corporation / Casa Pacifica Adult Day Health Care Center
Justice in Aging
Leading Age California
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Meals on Wheels
New Life Adult Day Care Center
Partners in Care Foundation
Primary Care Association
San Fernando Valley Adult Day Health Care, LLC
San Francisco Department of Aging and Adult Services
San Ysidro Health Center
Sunny Cal Adult Day Health Care Center, Inc.
SunnyDay Adult Community Based Adult Services
United Domestic Workers of America, AFSCME Local 3930, AFL-CIO
Western Adult Day Health Care
1 individual
Opposition
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None on file.
Analysis Prepared by:Roger Dunstan / HEALTH / (916) 319-2097