BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 1261 (Burke) - Community-based adult services: adult day
health care centers
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|Version: February 27, 2015 |Policy Vote: HEALTH 9 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 27, 2015 |Consultant: Brendan McCarthy |
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*********** ANALYSIS ADDENDUM - SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on August 27, 2015
Bill
Summary: AB 1261 would require Community-Based Adult Services
to be provided as a Medi-Cal benefit.
Fiscal
Impact:
Ongoing costs of about $330 million per year to continue to
provide Community-Based Adult Services in the counties in
which this program is currently operating (General Fund and
federal funds). Community-Based Adult Services is an optional
benefit that states are not required to offer under federal
law. In the absence of this bill, the state could elect to
discontinue the program after at the conclusion of the state's
next Section 1115 waiver in 2020 (or sooner by an amendment to
that waiver).
AB 1261 (Burke) Page 1 of
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Unknown cost savings if the Department authorizes managed care
plans to provide Community-Based Adult Services in counties
where services are currently unavailable (General Fund and
federal funds). Prior to March 2012, Community-Based Adult
Services were limited by the availability of providers. At
that time, 26 counties had an Adult Day Health Center provider
(the predecessor to Community-Based Adult Services). The
remaining 32 counties are generally rural counties with small
populations. Given the low population densities of those
counties, it is not clear whether the operation of an Adult
Day Health Center could be financially viable or whether there
would be significant demand for those services, given long
travel times to and from such a center. The amendments
authorize the Department to allow Community-Based Adult
Services in additional counties to the extent that it is cost
effective.
No additional costs are anticipated from the requirement that
Medi-Cal managed care plans pay providers at rates that are
not less than Medi-Cal fee-for service rates. Medi-Cal managed
care plans currently pay providers at or above the
fee-for-service rate for Community-Based Adult Services and
the Department of Health Care Services indicates that this
will continue to be the case.
Potential cost savings due to reduced institutionalization and
improved clinical outcomes for participating Medi-Cal
beneficiaries (General Fund and federal funds). The intent of
offering Community-Based Adult Services is to allow Medi-Cal
beneficiaries who are at risk of being institutionalized (for
example, placement in a skilled nursing facility) due to
physical illness and cognitive impairment to remain in the
community. To the extent that Community-Based Adult Services
actually keeps a Medi-Cal beneficiary out of institutional
care, this benefit will almost certainly reduce state
spending. Whether or not the overall program reduces state
spending will depend, in part, on whether the benefit is
provided to beneficiaries who are likely to be
institutionalized and the clinical success of the benefit in
preventing institutionalization.
Unknown costs to the Department of Public Health for licensing
of additional Adult Day Health Centers (Licensing and
Certification Fund). To the extent that new Adult Day Health
AB 1261 (Burke) Page 2 of
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Centers open to provide Community-Based Adult Services, those
facilities would be licensed by the Department. All licensing
and enforcement costs would be reimbursed by fees.
Ongoing costs of about $3.3 million per year to certify that
Community-Based Adult Services providers are meeting Medi-Cal
program criteria and requirements by the Department of Aging
(General Fund and federal funds). Under an interagency
agreement with the Department of Health Care Service, the
Department of Aging is responsible for certifying that
providers meet all the applicable Medi-Cal program
requirements.
Author
Amendments: Limit the requirement to provide Community-Based
Adult Services to counties in which it was offered on April 1,
2012. The bill authorizes those services to be provided in
additional counties if the Department finds that doing so would
be cost-effective.
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