BILL ANALYSIS Ó
AB 1261
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Date of Hearing: April 29, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
1261 (Burke) - As Introduced February 27, 2015
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|Policy |Health |Vote:|16 - 0 |
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| |Aging and Long Term Care | |7 - 0 |
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill continues the Community-Based Adult Services (CBAS)
program as a Medi-Cal benefit, and codifies related requirements
for CBAS consistent with current practice.
AB 1261
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FISCAL EFFECT:
1)Assuming federal approval is granted, annual costs to DHCS for
continuation of CBAS as a Medi-Cal benefit of approximately
$300 million annually, and growing in future years (50% GF/50%
federal). Since CBAS is already provided pursuant to the terms
and conditions of a federal waiver until October 31, 2015,
2015-16 costs for 8 additional months of service are expected
to be approximately $200 million (50% GF/50% federal).
2)Minor administrative costs (50% GF/50% federal) to DHCS to
secure federal approval.
3)Costs to the Department of Public Health (DPH) associated with
the licensure of Adult Day Health Centers (ADHCs), and
California Department of Aging (CDA) associated with
certifying facilities, will continue to be incurred. If not
for the continuation of CBAS through this bill or another
mechanism, there would likely be a reduction in the number of
ADHC providers, reducing licensure workload for DPH and
certification workload for CDA.
COMMENTS:
1)Purpose. The author indicates this bill will ensure the CBAS
program continues beyond the current requirement that the
program operate through October 31, 2015. Numerous advocates
for seniors, in addition to CBAS providers, support this bill
2)Brief History of CBAS and ADHC. The provision of ADHC
services is an optional Medi-Cal benefit. It includes
medical, nursing care, meals, social and therapeutic
activities, and transportation services provided at licensed
ADHC centers to qualifying individuals. Along with other
optional benefits, it was contemplated for elimination during
the recent fiscal crisis, setting off a series of events as
follows:
AB 1261
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a) March 2011: A budget trailer bill eliminated ADHC as an
optional Medi-Cal benefit, subject to federal approval.
b) June 2011: A class action lawsuit, Darling et al. v
Douglas., was filed in U.S. District Court on behalf of
35,000 ADHC participants, seeking to block the elimination
of ADHC as an optional Medi-Cal benefit, on grounds that
eliminating ADHC without appropriate replacement services
would violate the Americans With Disabilities Act by
placing participants at risk of institutionalization,
hospitalization, injury or death.
c) November 2011: DHCS announced a settlement agreement
that created CBAS, a smaller, more targeted program to
serve former ADHC clients most in need of medical and
social services.
d) January 2012: The court granted final approval of the
settlement.
Currently, no legislative statute authorizes CBAS. The
program operated under authority of a court directive
scheduled until August 2014, and is now operated under the
state's "Section 1115" waiver of the Social Security Act,
until October 31, 2015. Without legislative action, the
future of the CBAS program is uncertain after the court
directive.
1)Prior Legislation.
a) AB 1552 (Bonnie Lowenthal) was very similar to this
bill, and was vetoed. In his veto message, the Governor
states, "Currently, this benefit is authorized under an
approved waiver by the federal government. The terms of the
waiver may change, pending federal review. This important
program will continue to help many thousands of frail
adults remain independent. Codifying it now is premature."
b) AB 518 (Yamada) established CBAS as a Medi-Cal benefit
and a covered service in managed care plan contracts,
established eligibility criteria for CBAS and staffing
standards for ADHC centers, and required new CBAS
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providers, as a condition of participation, to be
nonprofit. AB 518 was held in the Senate Health Committee,
where testimony was taken on June 12, 2013, but no vote was
taken.
c) AB 96 (Blumenfield) would have established the Keeping
Adults Free of Institutions (KAFI) program and required
DHCS to submit an application to CMS to implement the
program. AB 96 was vetoed by Governor Brown.
d) AB 97 (Committee on Budget), Chapter 3, Statutes of
2011, among other provisions, eliminated ADHC as a Medi-Cal
benefit.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081