BILL ANALYSIS Ó
AB 1518
Page 1
Date of Hearing: May 13, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
1518 (Committee on Aging and Long-Term Care) - As Amended April
27, 2015
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| |Aging and Long Term Care | |6 - 0 |
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill stipulates new requirements for the state's Medi-Cal
Nursing Facility/Acute Hospital Waiver (NF/AH waiver).
Specifically, this bill requires Department of Health Care
Services (DHCS) to:
AB 1518
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1)Increase the allowable number of slots in the NF/AH waiver
program by 5,000, and to seek additional slots based on an
annual assessment of need.
2)Expedite eligibility processing for individuals at imminent
risk of placement in institutional settings.
3)Qualify a participating enrollee for the same level of care in
a community setting as they would have received in an
institution.
4)Provide enrollees who age out of eligibility for Early
Periodic Screening, Diagnosis, and Treatment (EPSDT) services
at age 21, and who enroll in the waiver, the same level of
services provided through EPSDT despite their age. Prohibits a
reduction in in-home nursing for enrollees in this situation.
5)Use an aggregate, instead of individual, cost cap to establish
budget neutrality, and requires a rebasing of the cost cap to
the actual current costs for institutional care on an ongoing
basis.
6)Implement this bill, only to the extent the department can
demonstrate budget neutrality on a state level and on a
federal level, as well as gain federal approval and financial
participation, and requires implementation 6 months after the
department receives authorization for necessary resources.
FISCAL EFFECT:
1)One-time administrative costs in the range of $100,000
AB 1518
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(GF/federal) DHCS to apply for a waiver amendment and seek
federal approval, and to establish new policies and procedures
related to the bill's requirements, such as assessment of
imminent risk and determinations of level of care.
2)Though a comprehensive budget neutrality analysis and
assessment of unmet need for waiver services is not available,
it is assumed total costs for Medi-Cal benefits will be
cost-neutral, as the bill specifies. The cost neutrality
would have to be monitored on a continuous basis. Costs or
cost savings as compared to the status quo could vary
depending on how robustly the expansion is implemented, how
many individuals enroll, and how many are actually able to
avoid institutionalization, who would otherwise be
institutionalized. However, using aggregate, instead of
individual cost caps, will make it more difficult to prove,
and to attain, budget neutrality. This poses a higher level
of fiscal risk to the state than the current waiver design, in
which costs for waiver services are capped on an individual
basis. Additionally, this bill raises the cost cap per
individual for home and community-based services to the level
for institutional care. This could increase costs, as
compared to the status quo, by an unknown amount because it
would likely result in some individuals receiving a higher
level of service in their home than they otherwise would,
because individuals who actually would qualify for a nursing
level of care but choose to remain in their homes anyway do
not currently incur institutional-level costs.
Within the overall budget neutrality, it is expected the state
will incur unknown annual costs, likely in the hundreds of
thousands of dollars (GF/federal), for additional state staff
to conduct assessments for waiver eligibility on an expedited
basis, as well as significant cost savings to the extent
individuals are cared for at home instead of in a facility.
COMMENTS:
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1)Purpose. The author argues California's NF/AH waiver program
does not currently meet the needs of seniors and youth with
disabilities who wish to receive services at home, and avoid
nursing homes and other institutions. The author states that
home-based services are typically less expensive, more
desirable to the clients and their families, and consistent
with state and federal priorities; however, current state
policies and limited funding and flexibility prevent
individuals from being moved from institutions to home-based
care.
2)Background. The NF/AH waiver is a 1915(c) Home and
Community-Based Services Waiver that provides community-based
alternatives to Medi-Cal eligible individuals who would
otherwise be receiving care in either an acute hospital, adult
or pediatric subacute facility, nursing facility, or
distinct-part nursing facility. The Waiver is available to
individuals who are currently residing in an institution but
wish to transition to his/her home and community, as well as
to individuals who reside in the community, but are at-risk
for being institutionalized within the next 30 days. The
current NH/AF Waiver has an enrollment cap of 3,792 persons in
2015 and 3,964 in 2016.
3)Cost Structure of NH/AF Waiver. A state may limit
participation in a waiver based on the expected cost of the
home and community-based services that would be furnished to a
person. A waiver's design may include reasonable methods to
control overall spending, including the specification of an
individual cost limit. California currently imposes a cost
limit lower that is generally lower than the institutional
level, that applies to each individual enrolled. The state
does not provide a waiver slot to any otherwise qualified
individual, when the state reasonably expects that the cost of
home and community-based services (HCBS) furnished to that
individual would exceed an amount specified by the state that
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is less than the cost of a level of care specified for the
waiver. The costs for HCBS are set at 51% to 107% of
institutional rates, depending on the facility type.
4)Related Legislation. AB 664 (Dodd), pending on the Suspense
File of this committee, requires an evaluation of a universal
assessment tool pilot program, currently being piloted by
DHCS. A UAT is designed to assess an individual's LTC needs
in a comprehensive way.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081