BILL ANALYSIS Ó AB 1518 Page 1 ASSEMBLY THIRD READING AB 1518 (Committee on Aging and Long-Term Care) As Amended April 27, 2015 Majority vote ------------------------------------------------------------------- |Committee |Votes |Ayes |Noes | | | | | | | | | | | |----------------+------+---------------------+---------------------| |Health |19-0 |Bonta, Maienschein, | | | | |Bonilla, Burke, | | | | |Chávez, Chiu, Gomez, | | | | |Gonzalez, Roger | | | | |Hernández, Lackey, | | | | |Nazarian, Patterson, | | | | |Ridley-Thomas, | | | | |Rodriguez, Santiago, | | | | |Steinorth, Thurmond, | | | | |Waldron, Wood | | | | | | | |----------------+------+---------------------+---------------------| |Aging |6-0 |Brown, Gipson, Gray, | | | | |Levine, Lopez, | | | | |Mathis | | | | | | | |----------------+------+---------------------+---------------------| |Appropriations |17-0 |Gomez, Bigelow, | | | | |Bonta, Calderon, | | | | |Chang, Daly, Eggman, | | | | |Gallagher, | | AB 1518 Page 2 | | | | | | | | | | | | |Eduardo Garcia, | | | | |Gordon, Holden, | | | | |Jones, Quirk, | | | | |Rendon, Wagner, | | | | |Weber, Wood | | | | | | | | | | | | ------------------------------------------------------------------- SUMMARY: Requires the Department of Health Care Services (DHCS) to authorize an additional 5,000 slots beyond current standards for home and community-based patients, and updates requirements to the Nursing Facility/Acute Hospital (NF/AH) Waiver, as specified. Provides this bill only be implemented to the extent that DHCS can demonstrate fiscal neutrality within the DHCS budget and implementation is contingent on federal approval. Specifically, this bill: 1)Requires, by January 1, 2016, nursing home facilities to authorize an additional 5,000 slots beyond those currently authorized for home and community-based NF/AH Waiver. Requires DHCS to consider specified factors to calculate the need for, and seek federal approval of, additional slots to the waiver. 2)Updates requirements regarding the NF/AH Waiver to expedite the Waiver application process and clarify level of care for patients, as specified. 3)Requires DHCS to ensure a seamless transition for patients receiving private duty in-home nursing provided through the Early Periodic Screening, Diagnosis and Treatment program to medically necessary in-home nursing once a patient turns 21 years of age. 4)Adds new services to the NF/AH Waiver and adjusts the cost limitation category of the Waiver to use an aggregate cost limit AB 1518 Page 3 formula, as specified. FISCAL EFFECT: According to the Assembly Appropriations Committee: 1)One-time administrative costs in the range of $100,000 (General Fund (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. 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: According to the author, 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. In addition, the author asserts that upon turning 21, many individuals, who received home care prior to their 21st birthday, are forced into institutions because they become ineligible due to age restrictions for specified services. AB 1518 Page 4 Disability Rights California, the sponsor of this bill, states the current NF/AH waiver offers much less money for home-based care than the state pays for care in comparable institutions. The sponsor points to the individual cost limit structure, outdated cost limits, a lengthy waiver approval process, and a risk of discontinued services for individuals who qualify for Early and Periodic Screening, Diagnostic, and Treatment services, as evidence for the need for this bill. Supporters assert this bill provides people with disabilities, including young people and seniors, more opportunities to receive long-term services and supports in their own homes and communities rather than forcing them into less desirable, unneeded and more expensive institutional settings. They also state this bill will reflect in state budget savings, as home-based services are less expensive than comparable institutional services. There is no opposition to this bill. Analysis Prepared by: An-Chi Tsou / HEALTH / (916) 319-2097 FN: 0000766