BILL ANALYSIS Ó
AB 1261
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GOVERNOR'S VETO
AB
1261 (Burke)
As Enrolled September 16, 2015
2/3 vote
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|ASSEMBLY: |79-0 |(June 2, 2015) |SENATE: |40-0 |(September 10, |
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|ASSEMBLY: |79-0 |(September 11, | | | |
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Original Committee Reference: HEALTH
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 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
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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. 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.
The Senate amendments limit the requirement to provide CBAS to
counties in which it was offered on April 1, 2012, clarify
beneficiary eligibility requirements, and requires CBAS to be a
covered service in Medi-Cal managed care plans.
FISCAL EFFECT: According to the Senate Appropriations
Committee, ongoing costs of about $330 million per year to
continue to provide CBAS in the counties in which this program
is currently operating; unknown cost savings if the Department
of Health Care Services (DHCS) authorizes managed care plans to
provide CBAS in counties where services are currently
unavailable; and, ongoing costs of about $3.3 million per year
to certify that CBAS providers are meeting Medi-Cal program
criteria and requirements by the Department of Aging.
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
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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 the
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.
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
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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.
This bill has no known opposition.
GOVERNOR'S VETO MESSAGE:
I am returning the following six bills without my signature;
Assembly Bill 50
Assembly Bill 858
Assembly Bill 1162
Assembly Bill 1231
Assembly Bill 1261
Senate Bill 610
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These bills unnecessarily codify certain existing health care
benefits or require the expansion or development of new benefits
and procedures in the Medi-Cal program.
Taken together, these bills would require new spending at a time
when there is considerable uncertainty in the funding of this
program. Until the fiscal outlook for Medi-Cal is stabilized, I
cannot support any of these measures.
Analysis Prepared by:
Patty Rodgers / HEALTH / (916) 319-2097 FN:
0002497