Amended in Assembly March 26, 2015

California Legislature—2015–16 Regular Session

Assembly BillNo. 1518


Introduced by Committee on Aging and Long-Term Care (Assembly Members Brown (Chair), Gipson, Levine, and Lopez)

March 10, 2015


An act to amendbegin insert and renumberend insert Section 14132.99 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 1518, as amended, Committee on Aging and Long-Term Care. Medi-Cal: nursing facilities.

Existing law provides for the Medi-Cal program,begin delete which isend delete administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing federal law authorizes the state to obtain waivers forbegin delete homeend deletebegin insert home-end insert and community-based services. Existing law authorizes the department to seek an increase in the scope of these waivers, in order to enable additional nursing facility residents to transition into the community, subject to implementation of these amended waivers upon obtaining federal financial participation, and to the extent it can demonstrate fiscal neutrality within the overall department budget.

This bill wouldbegin delete make a technical, nonsubstantive change to those provisions.end deletebegin insert authorize the department to seek additional increases in the scope of the home- and community-based Nursing Facility/Acute Hospital Waiver. The bill would require, by July 1, 2016, an additional 5,000 slots beyond those currently authorized for the waiver to be added . The bill would require that the department consider specified factors, consult with stakeholders, calculate the need for additional slots, and seek federal approval to add those slots to the waiver each year beginning January 1, 2016. Prior to submitting the annual request for additional waiver slots and the waiver renewal request, the bill would require the department to notify the appropriate fiscal and policy committees of the Legislature of the number of waiver slots included in the waiver renewal request along with data supporting that number of slots.end insert

begin insert

The bill would require the department to make an eligibility and level of care determination, and inform the individual about available waiver services, within three business days of receipt of the individual’s application for those patients who are in acute care hospitals and who are pending placement in a nursing facility and for those individuals who are more likely than not to be placed in a hospital or nursing facility within 30 days. The bill would require an individual residing in an institutional setting at a level of care included in the waiver to be determined to qualify for a waiver level of care that is no lower than the level of care he or she receives in the institution in which he or she resides, and would prohibit the department from using more stringent eligibility criteria for a waiver level of care than for the corresponding institutional level of care.

end insert
begin insert

The bill would require the department, by July 1, 2016, to take all necessary steps so that individuals who are clients of a regional center for individuals with developmental disabilities and who receive private duty nursing through the Early Periodic Screening, Diagnosis, and Treatment Program (EPSDT) seamlessly transition from receipt of private duty in-home nursing provided through EPSDT to medically necessary in-home nursing provided through adult Medi-Cal or a regional center when the individual reaches 21 years of age.

end insert
begin insert

The bill would require the department to adjust the cost limitation category of the waiver to use an aggregate cost limit formula, as specified. The bill would require the department to implement its provisions only if the department has obtained the necessary approvals and receives federal financial participation.

end insert

Vote: majority. Appropriation: no. Fiscal committee: begin deleteno end deletebegin insertyesend insert. State-mandated local program: no.

The people of the State of California do enact as follows:

P3    1begin insert

begin insertSECTION 1.end insert  

end insert

begin insertSection 14132.99 of the end insertbegin insertWelfare and Institutions
2Code
end insert
begin insert, as added by Section 3 of Chapter 551 of the Statutes of 2005,
3is amended and renumbered to read:end insert

4

begin delete14132.99.end delete
5begin insert14132.991.end insert  

(a) For the purposes of this section, “facility
6residents” means individuals who are currently residing in a nursing
7facility and whose care is paid for by Medi-Cal either with or
8without a share of cost. The term “facility residents” also includes
9individuals who are hospitalized and who are or will be waiting
10for transfer to a nursing facility.

11(b) begin deleteAn end deletebegin insertBy July 1, 2016, an end insertadditionalbegin delete 500end deletebegin insert 5,000end insert slots beyond
12those currently authorized for the home- and community-based
13begin delete Level A/B nursing facility waiver shall be added and 250 of these
14slots shall be reserved for residents residing in facilities and
15transitioning out of facilities.end delete
begin insert Nursing Facility/Acute Hospital
16Waiver shall be added to ensure that individuals residing in, or
17at risk of, out-of-home placements, including nursing facilities,
18can be considered for, and, if eligible, receive services from the
19waiver without delay.end insert

begin insert

20(c) (1) Each year, the department shall consider the factors
21listed in paragraph (2), consult with stakeholders, calculate the
22need for additional slots, and seek federal approval to add those
23slots to the Nursing Facility/Acute Hospital Waiver.

end insert
begin insert

24(2) The factors considered by the department pursuant to
25paragraph (1) shall include, but not be limited to, all of the
26following:

end insert
begin insert

27(A) Any waiting list for Nursing Facility/Acute Hospital Waiver
28services, including, but not limited to, waiting lists for a particular
29level of care.

end insert
begin insert

30(B) The needs identified by programs that assist people to leave
31nursing homes.

end insert
begin insert

32(C) The results of surveys of nursing home residents, including,
33but not limited to, the Minimum Data Sets (MDS), which identify
34residents who want to leave nursing homes.

end insert
begin insert

35(3) Prior to submitting the annual request for additional waiver
36slots and the waiver renewal request, the department shall notify
37the appropriate fiscal and policy committees of the Legislature of
P4    1the number of waiver slots included in the waiver renewal request
2along with data supporting that number of slots.

end insert
begin delete

3(c)

end delete

4begin insert(d)end insert For those patients who are in acute care hospitals and who
5are pending placement in a nursing facility,begin insert and for those
6individuals who are at imminent risk of placement in a hospital
7or nursing facility,end insert
the department shall expedite the processing
8of waiver applications in order tobegin delete divertend deletebegin insert facilitate remaining in a
9community setting andend insert
hospital dischargesbegin delete fromend deletebegin insert into the community
10rather than toend insert
nursingbegin delete facilities into the community.end deletebegin insert facilities. For
11purposes of this section, both of the following definitions apply:end insert

begin insert

12(1) “Imminent risk” means more likely than not to occur within
1330 days.

end insert
begin insert

14(2) “Expedite the processing of waiver applications” means
15that the department shall make an eligibility and level of care
16determination, and inform the individual about available waiver
17services, within three business days of receipt of the application.

end insert
begin insert

18(e) An individual residing in an institutional setting at a level
19of care included in the Nursing Facility/Acute Hospital Waiver
20shall be determined to qualify for a waiver level of care that is no
21lower than the level of care he or she receives in the institution in
22which he or she resides. The department shall not use more
23stringent eligibility criteria for a waiver level of care than for the
24corresponding institutional level of care.

end insert
begin insert

25(f) (1) By July 1, 2016, the department shall take all necessary
26steps so that individuals who are clients of a regional center for
27individuals with developmental disabilities pursuant to the
28Lanterman Developmental Disabilities Services Act (Division 4.5
29(commencing with Section 4500)) and who receive private duty
30nursing through the Early Periodic Screening, Diagnosis, and
31Treatment Program (EPSDT), as described in Section 1396d of
32Title 42 of United State Code, seamlessly transition from receipt
33of private duty in-home nursing provided through EPSDT to
34medically necessary in-home nursing provided through adult
35Medi-Cal or a regional center when the individual reaches 21
36years of age.

end insert
begin insert

37(2) The individuals described in paragraph (1) shall be eligible
38for at least the same level of services received through the EPSDT
39program unless the individual, and his or her authorized
P5    1representative, as appropriate, agree that the individual’s needs
2have decreased and less service is needed.

end insert
begin insert

3(3) The department shall maximize federal financial
4participation to meet the identified level of need for in-home
5nursing to ensure that a consumer does not experience a reduction
6in in-home nursing when he or she reaches 21 years of age.

end insert
begin delete

7(d)

end delete

8begin insert(g)end insert Thebegin delete nursing facility Level A/B waiversend deletebegin insert Nursing
9Facility/Acute Hospital Waiverend insert
shall be amended to add the
10following services:

11(1) One-time community transition services as defined and
12allowed by the federal Centers for Medicare and Medicaid Services,
13including, but not limited to, security deposits that are required to
14obtain a lease on an apartment or home, essential furnishings, and
15moving expenses required to occupy and use a community
16domicile, set-up fees, or deposits for utility or service access,
17including, but not limited to, telephone, electricity, and heating,
18and health and safety assurances, including, but not limited to, pest
19eradication, allergen control, or one-time cleaning prior to
20occupancy. These costs shall not exceed five thousand dollars
21($5,000).

22(2) Habilitation services, as defined in Section 1915(c)(5) of
23the federal Social Security Act (42 U.S.C. Sec. 1396n(c)(5)), and
24in attachment 3-d to the July 25, 2003, State Medicaid Directors
25Letter re Olmstead Update No. 3, to mean services designed to
26assist individuals in acquiring, retaining, and improving the
27self-help, socialization, and adaptive skills necessary to reside
28successfully in home- and community-based settings.

begin delete

29(e) When requesting the renewal of the waiver, the department
30shall consider expanding the number of waiver slots. Prior to
31submission of the waiver renewal request, the department shall
32notify the appropriate fiscal and policy committees of the
33Legislature of the number of waiver slots included in the waiver
34renewal request along with supportive data for those slots.

end delete
begin insert

35(h) By July 1, 2016, the department shall adjust the cost
36limitation category of the Nursing Facility/Acute Hospital Waiver
37to use an aggregate cost limit formula.

end insert
begin insert

38(i) By July 1, 2016, the aggregate cost limit formula described
39in subdivision (h) shall be based on 100 percent of the actual
40current rates for the corresponding institutional levels of care
P6    1specified in the Nursing Facility/Acute Hospital Waiver. Any cost
2increase in an institutional level of care shall be matched by an
3increase in the cost limitation of the corresponding Nursing
4Facility/Acute Hospital Waiver level of care.

end insert
begin delete

5(f)

end delete

6begin insert(j)end insertbegin insert(1)end insertbegin insertend insertThe department shall implement this section only to the
7extent it can demonstrate fiscal neutrality within the overall
8department budget, and federal fiscal neutrality as required under
9the terms of the federal waiver, and only if the department has
10obtained the necessary approvals and receives federal financial
11participation from the federal Centers for Medicare and Medicaid
12Services. Contingent upon federal approval of the waiver
13expansion, implementation shall commence within six months of
14the department receiving authorization for the necessary resources
15to provide the services to additional waiver participants.

begin insert

16(2) The department shall implement the amendments made to
17this section by the act that added this paragraph only to the extent
18it can demonstrate fiscal neutrality within the overall department
19budget, and federal fiscal neutrality as required under the terms
20of the federal waiver, and only if the department has obtained the
21necessary approvals and receives federal financial participation
22from the federal Centers for Medicare and Medicaid Services.
23Contingent upon federal approval of the waiver expansion,
24implementation shall commence within six months of the
25department receiving authorization for the necessary resources
26to provide the services to additional waiver participants.

end insert
begin delete
27

SECTION 1.  

Section 14132.99 of the Welfare and Institutions
28Code
, as added by Section 3 of Chapter 551 of the Statutes of
292005, is amended to read:

30

14132.99.  

(a) For the purposes of this section, “facility
31residents” means individuals who are currently residing in a nursing
32facility and whose care is paid for by Medi-Cal either with or
33without a share of cost. The term “facility residents” also includes
34individuals who are hospitalized and who are or will be waiting
35for transfer to a nursing facility.

36(b) An additional 500 slots beyond those currently authorized
37for the home- and community-based Level A/B nursing facility
38waiver shall be added and 250 of these slots shall be reserved for
39residents residing in facilities and transitioning out of facilities.

P7    1(c) For those patients who are in acute care hospitals and who
2are pending placement in a nursing facility, the department shall
3expedite the processing of waiver applications so that upon
4discharge those patients are diverted into the community rather
5than into nursing facilities.

6(d) The nursing facility Level A/B waivers shall be amended
7to add the following services:

8(1) One-time community transition services as defined and
9allowed by the federal Centers for Medicare and Medicaid Services,
10including, but not limited to, security deposits that are required to
11obtain a lease on an apartment or home, essential furnishings, and
12moving expenses required to occupy and use a community
13domicile, set-up fees or deposits for utility or service access,
14including, but not limited to, telephone, electricity, and heating,
15and health and safety assurances, including, but not limited to, pest
16eradication, allergen control, or one-time cleaning prior to
17occupancy. These costs shall not exceed five thousand dollars
18($5,000).

19(2) Habilitation services, as defined in Section 1915(c)(5) of
20the federal Social Security Act (42 U.S.C. Sec. 1396n(c)(5)), and
21in attachment 3-d to the July 25, 2003, State Medicaid Directors
22Letter re Olmstead Update No. 3, to mean services designed to
23assist individuals in acquiring, retaining, and improving the
24self-help, socialization, and adaptive skills necessary to reside
25successfully in home- and community-based settings.

26(e) When requesting the renewal of the waiver, the department
27shall consider expanding the number of waiver slots. Prior to
28submission of the waiver renewal request, the department shall
29notify the appropriate fiscal and policy committees of the
30Legislature of the number of waiver slots included in the waiver
31renewal request along with supportive data for those slots.

32(f) The department shall implement this section only to the
33extent it can demonstrate fiscal neutrality within the overall
34department budget, and federal fiscal neutrality as required under
35the terms of the federal waiver, and only if the department has
36obtained the necessary approvals and receives federal financial
37participation from the federal Centers for Medicare and Medicaid
38Services. Contingent upon federal approval of the waiver
39expansion, implementation shall commence within six months of
P8    1the department receiving authorization for the necessary resources
2to provide the services to additional waiver participants.

end delete


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