BILL ANALYSIS Ó
AB 1261
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ASSEMBLY THIRD READING
AB
1261 (Burke)
As Introduced February 27, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+---------------------+---------------------|
|Health |16-0 |Bonta, Maienschein, | |
| | |Burke, Chávez, Chiu, | |
| | |Gomez, Gonzalez, | |
| | |Lackey, Nazarian, | |
| | |Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Thurmond, Waldron, | |
| | |Wood | |
| | | | |
|----------------+------+---------------------+---------------------|
|Aging |7-0 |Brown, Hadley, | |
| | |Gipson, Gray, | |
| | |Levine, Lopez, | |
| | |Mathis | |
| | | | |
|----------------+------+---------------------+---------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, Eggman, | |
| | |Gallagher, | |
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| | | | |
| | | | |
| | |Eduardo Garcia, | |
| | |Gordon, Holden, | |
| | |Jones, Quirk, | |
| | |Rendon, Wagner, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Codifies the Community-Based Adult Services (CBAS)
program and its requirements as the California Medical Assistance
Program (Medi-Cal) benefit to be provided at licensed adult day
health care (ADHC) centers. Specifically, this bill requires CBAS
providers to meet all applicable licensing and Medi-Cal standards
and 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 in the Medicaid demonstration
project approved under Section 1115(a) of the Social Security Act
in effect at the time of this bill's enactment. In addition, this
bill 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 individualized
plan of care, as developed by the center's multidisciplinary team.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)Assuming federal approval is granted, annual costs to the
Department of Health Care Services (DHCS) for continuation of
CBAS as a Medi-Cal benefit of approximately $300 million
annually, and growing in future years (50% General Fund (GF)/50%
federal funds). Since CBAS is already provided pursuant to the
terms and conditions of a federal waiver until October 31, 2015,
2015 to 2016 costs for eight additional months of service are
expected to be approximately $200 million (50% GF/50% federal
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funds).
2)Minor administrative costs (50% GF/50% federal funds) to DHCS to
secure federal approval.
3)Costs to the Department of Public Health (DPH) associated with
the licensure of ADHCs, and 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: The author argues this bill preserves 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
fee-for-service (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.
The CBAS Program is administered jointly by DHCS, CDA, and 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
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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.
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.
There is no opposition on file.
AB 1261
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Analysis Prepared by:
Roger Dunstan / HEALTH / (916) 319-2097 FN:
0000769