BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1261|
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THIRD READING
Bill No: AB 1261
Author: Burke (D), et al.
Introduced:8/31/15 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 6/17/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
ASSEMBLY FLOOR: 79-0, 6/2/15 - See last page for vote
SUBJECT: Community-based adult services: adult day health
care centers.
SOURCE: California Association for Adult Day Services
DIGEST: This bill requires Community-Based Adult Services to
be a Medi-Cal benefit, and to be included as a covered service
in contracts with all Medi-Cal 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 state's "Bridge to Reform" Section 1115
Medicaid Demonstration Waiver.
ANALYSIS:
Existing law:
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1) Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which health
care services are provided to qualified, low-income persons.
2) Excludes, to the extent permitted by federal law, adult day
health care (ADHC) from coverage under the Medi-Cal program.
3) Requires DHCS, to the extent that federal financial
participation is available, and pursuant to a demonstration
project or waiver of federal law, to establish specified
Medi-Cal pilot projects in up to eight counties, and requires
long-term services and supports (LTSS) to be available to
beneficiaries residing in counties participating in those
pilot projects. Includes Community Based Adult Services
(CBAS) within the definition of LTSS. This demonstration
project is known as the Coordinated Care Initiative (CCI).
4) Requires, as part of the CCI, all Medi-Cal LTSS to be
services covered under Medi-Cal managed care health plan
contracts and available only through plans to beneficiaries
residing in counties participating in the demonstration, with
specified exemptions.
This bill:
1) Requires, notwithstanding the operational period of CBAS as
specified in the Special Terms and Conditions (STCs) of
California's Bridge to Reform Section 1115 Medicaid Waiver,
and notwithstanding the duration of the CBAS settlement
agreement, CBAS to be a Medi-Cal benefit in counties where
CBAS existed on April 1, 2012.
2) Permits, to the extent provision of CBAS is determined by
DHCS to be both cost effective and necessary to prevent
avoidable institutionalization of plan enrollees within a
plan's service area in which CBAS was not available as of
April 1, 2012, CBAS to be a Medi-Cal managed care benefit
pursuant to the STCs at the discretion of the plan when it
contracts with a CBAS provider that has been certified as
such by DHCS.
3) Requires CBAS to have standards, eligibility criteria, and
provisions that are equivalent to those contained in the STCs
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of the demonstration waiver on the date this bill is signed
into law.
4) Defines "CBAS" as an outpatient, facility-based program,
provided pursuant to a participant's individualized plan of
care, as developed by the center's multidisciplinary team,
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.
5) Defines the eligibility criteria for CBAS services as a
Medi-Cal beneficiary who is age 18 or older, who is Medi-Cal
eligible based on being aged, blind or disabled or eligible
for both Medicare and Medi-Cal, who is enrolled in a Medi-Cal
managed care plan or is exempt from enrollment and has one of
five of the following:
a) Meet "Nursing Facility Level of Care A" (NF-A)
criteria as set forth in regulation, or above NF-A Level
of Care;
b) Have a diagnosed organic, acquired or traumatic brain
injury, and the enrollee must need assistance or
supervision with either:
i) Two of the following: bathing, dressing,
self-feeding, toileting, ambulation, transferring,
medication management, or hygiene; or,
ii) One need from the above list and one of the
following: money management, accessing community and
health resources, meal preparation, or transportation.
c) Have a moderate to severe cognitive disorder such as
dementia, including dementia characterized by the
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descriptors of, or equivalent to, Stages 5, 6, or 7 of the
Alzheimer's type;
d) Have a mild cognitive disorder such as dementia,
including dementia of the Alzheimer's Type, and needs
assistance or supervision with two of the following:
bathing, dressing, self-feeding, toileting, ambulation,
transferring, medication management, or hygiene; or,
e) Have a developmental disability.
6) Requires CBAS providers to be licensed as ADHCs and
certified by the California Department of Aging (CDA) as CBAS
providers, and to meet the standards specified in existing
law and regulation.
7) Requires CBAS providers to meet all applicable licensing and
Medi-Cal standards, and to provide services in accordance
with existing regulations.
8) Requires CBAS providers to comply with the provisions of
California's 2010 Bridge to Reform Section 1115 Medicaid
Waiver and any successor demonstration.
9) Requires, in counties where DHCS has implemented Medi-Cal
managed care, CBAS to be available as a Medi-Cal managed care
benefit, except for individuals who are not qualified for, or
who are exempt from, enrollment in Medi-Cal managed care. For
these individuals, CBAS is required to be provided as a
fee-for-service benefit.
10)Requires CBAS to be provided as a fee-for-service (FFS)
Medi-Cal benefit to all eligible Medi-Cal beneficiaries who
qualify for CBAS in counties that have not implemented
Medi-Cal managed care.
11)Requires Medi-Cal managed care plans to reimburse contracted
providers at rates that are not less than Medi-Cal FFS rates,
as published and revised by the DHCS, including retroactive
payment of any rate increment based on DHCS retroactive rate
adjustments, for equivalent services on the date the services
were provided.
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12)Implements this bill only to the extent that federal
financial participation is available.
Comments
1)Author's statement. According to the author, over 30,000
frail Californians and their families depend upon the ADHC
services provided through the CBAS program. While the current
federal waiver ensures that the program will continue for the
next few years, the waiver did not include language to ensure
that providers will be reimbursed at levels that are not less
than current Medi-Cal FFS rates, and state law has not been
updated to reflect the program requirements under the waiver
and guarantee legislative oversight. This bill preserves
access to the ADHC services and gives providers a reliable
rate structure to ensure program sustainability.
2)Background on CBAS. The Governor's May 2015-16 Budget
estimated CBAS expenditures in 2015-16 of $194.4 million GF.
Expenditures in CBAS have declined significantly from the
prior ADHC program, which had expenditures of $212 million GF
in 2009-10. CBAS providers are subject to the 10 percent
Medi-Cal rate reduction, which was implemented for CBAS
providers in December 2011, retroactive to June 2011.
According to data from the CDA, the number of ADHC centers and
ADHC/CBAS program Medi-Cal participants have declined since
2009-10. In 2009-10, there were 313 centers and 37,277
Medi-Cal participants. In March 2015, the number of ADHC
centers was estimated to be 241, with 31,182 Medi-Cal
participants. CBAS was added to the state's current Section
1115 waiver in 2014, which expires on October 31, 2015, and
the state is proposing to continue the program after that
date.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
1)Ongoing costs of about $330 million per year to continue to
provide CBAS in the counties in which this program is
currently operating (General Fund and federal funds). CBAS is
an optional benefit that states are not required to offer
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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).
2)Unknown cost savings if DHCS authorizes managed care plans to
provide CBAS in counties where services are currently
unavailable (General Fund and federal funds). Prior to March
2012, CBAS were limited by the availability of providers. At
that time, 26 counties had an ADHC provider (the predecessor
to CBAS). 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 ADHC 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 DHCS to allow CBAS in additional counties to the
extent that it is cost effective.
3)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 FFS rate
for CBAS and DHCS indicates that this will continue to be the
case.
4)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 CBAS 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 CBAS 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.
5)Unknown costs to the Department of Public Health for licensing
of additional ADHC (Licensing and Certification Fund). To the
extent that new ADHC open to provide CBAS, those facilities
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would be licensed by DHCS. All licensing and enforcement costs
would be reimbursed by fees.
6)Ongoing costs of about $3.3 million per year to certify that
CBAS providers are meeting Medi-Cal program criteria and
requirements by the CDA (General Fund and federal funds).
Under an interagency agreement with the DHCS, the CDA is
responsible for certifying that providers meet all the
applicable Medi-Cal program requirements.
SUPPORT: (Verified8/28/15)
California Association for Adult Day Services (source)
AARP
Acacia Adult Day Services
Adult Day Health Care of Mad River
Alzheimer's Association California Council
Ararat Adult Day Health Care Center
Association of California Healthcare Districts
Avenidas
Bay Area Community Services
California Association of Public Authorities for IHSS
California Chapter of the National Association of Social Workers
California PACE Association
California State Council on Developmental Disabilities
Casa Pacifica Adult Day Health Care Center
Congress of California Seniors
Disability Rights California
Eskaton Adult Day Health Center
Friends of Adult Day Health Care Centers
Get Together Adult Day Health Care Center
Guardian Adult Health Centers of California
J GELT Corporation
Justice in Aging
LeadingAge California
Meals-on-Wheels Greater San Diego, Inc.
Napa Valley Hospice Adult Day Services
New Life Adult Day Health Care
On Lok Senior Health Services
Partners in Care Foundation
Rehabilitation Services of Northern California: Bedford Center
San Fernando Valley Adult Day Health Care, LLC.
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San Francisco Department of Aging and Adult Services
San Ysidro Health Center
Sunny Cal Adult Day Health Care Center, Inc.
Sunny Day Adult Community Based Adult Services
Tender Heart Adult Day Health Care Center
United Domestic Workers/AFSCME Local 3930
United Way of Santa Barbara County
OPPOSITION: (Verified8/28/15)
Department of Finance
ARGUMENTS IN SUPPORT: The California Association for Adult
Day Services (CAADS) writes in support of this bill to extend
the CBAS program beyond the expiration of its current waiver
coverage, thus ensuring continuity of care to this vulnerable
population. CAADS states CBAS serves over 28,000 low-income
California seniors and persons 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, people who have had a stroke
or breathing problems or who cannot take medications properly.
This bill will ensure that these vulnerable Medi-Cal eligible
participants continue to have access to high-quality clinical,
therapeutic, and support services that enable them to live in
their own homes with dignity and independence despite having
multiple chronic health conditions that put them at risk of
high-cost institutional placement. CAADS concludes 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 the
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.
ARGUMENTS IN OPPOSITION: The Department of Finance (DOF)
writes in opposition to the previous version of this bill,
arguing it is unnecessary and results in potentially significant
General Fund costs by expanding the program to all 58 counties
and requiring managed care plans to reimburse providers at the
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FFS equivalent rate. DOF states that DHCS is currently applying
to renew the Section 1115 waiver, which includes the extension
of CBAS services as they currently exist, making this bill
unnecessary and inconsistent with the Administration's pending
waiver renewal application.
ASSEMBLY FLOOR: 79-0, 6/2/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd,
Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia,
Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,
Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Chávez
Prepared by:Scott Bain / HEALTH /
8/31/15 11:43:29
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