BILL NUMBER: AB 1518 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 25, 2015
AMENDED IN ASSEMBLY APRIL 27, 2015
AMENDED IN ASSEMBLY MARCH 26, 2015
INTRODUCED BY Committee on Aging and Long-Term Care (Assembly
Members Brown (Chair), Gipson, Levine, and Lopez)
MARCH 10, 2015
An act to amend and renumber 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, 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 for home- 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 would 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 the department
to, by February 1, 2016, apply for an additional 5,000
slots slots, to be added in the 2016- 17
fiscal year, beyond those currently authorized for the waiver.
The bill would , for each fiscal year after the 2016-
17 fiscal year, 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.
waiver. 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.
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.
The bill would provide that an individual who enrolls in the
waiver upon attaining 21 years of age who is no longer eligible to
receive services through the Early and Periodic Screening, Diagnosis,
and Treatment Program (EPSDT) shall receive the same level of
services under the waiver that he or she received through the EPSDT
program.
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. participation, and only to the extent
that it can demonstrate that its actual total expenditures for
services provided under the waiver will not exceed a specified
threshold.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14132.99 of the Welfare and Institutions Code,
as added by Section 3 of Chapter 551 of the Statutes of 2005, is
amended and renumbered to read:
14132.991. (a) For the purposes of this section, "facility
residents" means individuals who are currently residing in a nursing
facility and whose care is paid for by Medi-Cal either with or
without a share of cost. The term "facility residents" also includes
individuals who are hospitalized and who are or will be waiting for
transfer to a nursing facility.
(b) By February 1, 2016, the department shall apply for an
additional 5,000 slots slots, to be added in
the 2016- 17 fiscal year, beyond those
currently authorized for the home- and community-based Nursing
Facility/Acute Hospital Waiver, to ensure that individuals residing
in, or at risk of, out-of-home placements, including nursing
facilities, can be considered for, and, if eligible, receive services
from the waiver without delay.
(c) (1) Each year, For each fiscal year
after the 2016- 17 fiscal year, the department shall
consider calculate the need for
additional slots, and seek federal approval to add those slots to the
Nursing Facility/Acute Hospital Waiver, based on a consideration of
the factors listed in paragraph (2),
(2). In calculating the need for additional slots, the department
shall also consult with stakeholders, including, but not
limited to, individuals who use or would like to use waiver services,
programs with state contracts to divert people from or help people
leave nursing homes, the designated protection and advocacy
organization, independent living centers, area agencies on aging,
staff county staff providing for the delivery
of in-home supportive services authorized under Section 12301.6,
individuals providing services available under Article 7
(commencing with Section 12300) of Chapter 3, known as the In-Home
Supportive Services program, and managed care plans providing
Medi-Cal long-term services and support, calculate the need
for additional slots, and seek federal approval to add those slots to
the Nursing Facility/Acute Hospital Waiver. supports.
(2) The factors considered by the department pursuant to paragraph
(1) shall include, but not be limited to, all of the following:
(A) Any waiting list for Nursing Facility/Acute Hospital Waiver
services, including, but not limited to, waiting lists for a
particular level of care.
(B) The results of surveys of nursing home residents, including,
but not limited to, the Minimum Data Sets (MDS), which identify
residents who want to leave nursing homes.
(3) Prior to submitting the annual request for additional waiver
slots and the waiver renewal request, the department shall 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.
(d) (1) For those patients who are in acute care hospitals and who
are pending placement in a nursing facility, and for those
individuals who are at imminent risk of placement in a hospital or
nursing facility, the department shall expedite the processing of
waiver applications in order to facilitate remaining in a community
setting and hospital discharges into the community rather than to
nursing facilities.
(2) For purposes of this section, both of the following
definitions apply:
(A) "Imminent risk" means more likely than not to occur within 60
days, as determined by a treating professional, including, but not
limited to, a physician, a licensed clinical social worker, or a
nurse.
(B) "Expedite the processing of waiver applications" means that
the department shall make an eligibility and level of care
determination, and inform the individual about available waiver
services, within three business days of receipt of the application.
(e) An individual residing in an institutional setting at a level
of care included in the Nursing Facility/Acute Hospital Waiver shall
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. The department shall not use more stringent
eligibility criteria for a waiver level of care than for the
corresponding institutional level of care.
(f) (1) An individual who enrolls in the Nursing Facility/Acute
Hospital Waiver upon attaining 21 years of age who is no longer
eligible to receive services under the Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT) program shall be eligible for at
least the same level of services under the Nursing Facility/Acute
Hospital Waiver that he or she received through the EPSDT program
unless the individual, and his or her authorized representative, as
applicable, agree that the individual's needs have decreased and a
lower level of service is needed.
(2) The department shall maximize federal financial participation
to meet the identified level of need for in-home nursing to ensure
that a consumer does not experience a reduction in in-home nursing
when he or she reaches 21 years of age.
(g) The Nursing Facility/Acute Hospital Waiver shall be amended to
add the following services:
(1) One-time community transition services as defined and allowed
by the federal Centers for Medicare and Medicaid Services, including,
but not limited to, security deposits that are required to obtain a
lease on an apartment or home, essential furnishings, and moving
expenses required to occupy and use a community domicile, set-up
fees, or deposits for utility or service access, including, but not
limited to, telephone, electricity, and heating, and health and
safety assurances, including, but not limited to, pest eradication,
allergen control, or one-time cleaning prior to occupancy. These
costs shall not exceed five thousand dollars ($5,000).
(2) Habilitation services, as defined in Section 1915(c)(5) of the
federal Social Security Act (42 U.S.C. Sec. 1396n(c)(5)), and in
attachment 3-d to the July 25, 2003, State Medicaid Directors Letter
re Olmstead Update No. 3, to mean services designed to assist
individuals in acquiring, retaining, and improving the self-help,
socialization, and adaptive skills necessary to reside successfully
in home- and community-based settings.
(h) By July 1, 2016, the department shall adjust the cost
limitation category of the Nursing Facility/Acute Hospital Waiver to
use an aggregate cost limit formula.
(i) By July 1, 2016, the aggregate cost limit formula described in
subdivision (h) shall be based on 100 percent of the actual current
rates for the corresponding institutional levels of care specified in
the Nursing Facility/Acute Hospital Waiver. Any cost increase in an
institutional level of care shall be matched by an increase in the
cost limitation of the corresponding Nursing Facility/Acute Hospital
Waiver level of care.
(j) (1) The department shall implement this section only to the
extent it can demonstrate fiscal neutrality within the overall
department budget, and federal fiscal neutrality as required under
the terms of the federal waiver, and only if the department has
obtained the necessary approvals and receives federal financial
participation from the federal Centers for Medicare and Medicaid
Services. Contingent upon federal approval of the waiver expansion,
implementation shall commence within six months of the department
receiving authorization for the necessary resources to provide the
services to additional waiver participants.
(2) The department shall implement the amendments made to this
section by the act that added this paragraph only to the extent it
can demonstrate fiscal neutrality within the overall
department budget, that the department's actual total
expenditures for home, community-based, and other services under the
Nursing Facility/Acute Hospital Waiver will not, in any year of the
waiver period, exceed 100 percent of the amount that would be
incurred by the Medi-Cal program for these individuals, absent the
waive r, in institutions for which the individuals
qualify, and federal fiscal neutrality as required under
the terms of the federal waiver, and only if the department has
obtained the necessary approvals and receives federal financial
participation from the federal Centers for Medicare and Medicaid
Services. Contingent upon federal approval of the waiver expansion,
implementation shall commence within six months of the department
receiving authorization for the necessary resources to provide the
services to additional waiver participants.