BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1518|
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THIRD READING
Bill No: AB 1518
Author: Committee on Aging and Long-Term Care
VersionAmended:9/1/15 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 7/1/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth
NO VOTE RECORDED: Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
ASSEMBLY FLOOR: 80-0, 6/1/15 - See last page for vote
SUBJECT: Medi-Cal: nursing facilities
SOURCE: Disability Rights California
DIGEST: This bill requires the Department of Health Care
Services (DHCS), by February 1, 2016, to apply for an additional
5,000 slots beyond those currently authorized for the home- and
community-based Nursing Facility/Acute Hospital Waiver in
2016-17.
ANALYSIS:
Existing law:
1)Establishes the Medi-Cal program, administered by DHCS, under
which qualified low-income individuals receive health care
services.
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Page 2
2)Authorizes, under federal Medicaid law, the federal Secretary
of Health and Human Services to allow a state to include as
"medical assistance" under its Medicaid program payment for
part or all of the cost of HCBS (other than room and board)
approved by the Secretary which are provided pursuant to a
written plan of care to individuals who would require the
level of care provided in a hospital or a nursing facility or
intermediate care facility which could be reimbursed under the
state's Medicaid program. This provision of federal law is
referred to as a Medicaid 1915(c) Home and Community-Based
Services Waiver, and it enables the state to received federal
Medicaid matching funds for HCBS.
3)Requires an additional 500 slots beyond those currently
authorized for the home- and community-based Level A/B nursing
facility waiver to be added, and 250 of these slots to be
reserved for residents residing in facilities and
transitioning out of facilities. Defines "facility residents"
as 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 and individuals who are hospitalized
and who are or will be waiting for transfer to a nursing
facility.
4)Requires DHCS to implement the provisions of 3 and 4) above
only to the extent it can demonstrate fiscal neutrality within
the overall DHCS budget, and federal fiscal neutrality as
required under the terms of the federal waiver, and only if
DHCS has obtained the necessary approvals and receives federal
financial participation from the federal Centers for Medicare
and Medicaid Services (CMS).
This bill:
1)Requires DHCS, for the 2016-17 fiscal year, to apply for an
additional 5,000 slots beyond those currently authorized for
the home- and community-based Nursing Facility/Acute Hospital
Waiver (NF/AH Waiver), to ensure that individuals residing in,
or at risk of, out-of-home placements, including nursing
facilities, can be considered for and receive services from
the waiver without delay.
2)Repeals an existing law provision requiring an additional 500
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slots beyond those currently authorized for the home-and
community-based Level A/B nursing facility waiver to be added
and 250 of these slots to be reserved for residents residing
in facilities and transitioning out of faciliites.
Comments
1)Author's statement. According to the author, as the wife and
caregiver of a proud American and proud Californian, bound to
a wheelchair for the remainder of his life, the author wishes
to remind members that 2015 marks the 25th anniversary of the
Americans with Disabilities Act (ADA), which says that people
with disabilities have a right to receive services in the most
integrated setting. The 1999 Supreme Court Olmstead decision
upheld that right. In this bill, the Assembly Committee on
Aging and Long-Term Care is asking the legislature to
modernize the NF/AH waiver to reflect the ADA and the 1999
Olmstead decision, and the wishes of vast numbers of
Californians who want to stay at home to receive services.
Additionally, the state budget savings that will be realized
because home-based services are generally less expensive than
comparable institutional services should offer tremendous
confidence that this is the correct direction to move as the
state faces the unknown implications of 1,000 people a day
turning 65 and aging into a period of their lives when
disability is more common than not. Currently, access to the
NF/AH waiver is restricted to a fixed number of participants,
thus creating an irrational barrier to a community-based
option for care, while encouraging unfettered access to less
desirable, more expensive institutional care. This bill
revises our state policies to assure access to waiver services
for more people.
2)Nursing Facility/Acute Hospital Waiver. The NF/AH Waiver is a
federal 1915(c) Home and Community-Based Services Waiver in
effect through December 31, 2016. Section 1915(c) waivers
allow states to receive Medicaid funding to provide long-term
care services in home and community settings, rather than in
institutional settings. The goals of the waiver are to:
a) Facilitate a safe and timely transition of Medi-Cal
eligible persons from a medical facility to his/her home or
community setting utilizing NF/AH Waiver services;
b) Offer Medi-Cal eligible persons who reside in the
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community but are at risk of being institutionalized within
the next 30 days, the option of utilizing NF/AH Waiver
services to develop a home or community setting program
that will safely meet his/her medical care needs; and,
c) Maintain overall cost neutrality so that the costs of
the participant's selected NF/AH Waiver and Medi-Cal state
plan services do not exceed the Medi-Cal institutional cost
at the participant's assessed level of care (LOC) and
necessary facility type.
DHCS' Long-Term Care Division In-Home Operations Branch is
responsible for the implementation and monitoring of the NF/AH
waiver. To be eligible for the waiver, an individual must:
a) Have full scope Medi-Cal eligibility;
b) Be physically disabled (of any age);
c) Meet the acute hospital, adult or pediatric subacute,
nursing facility, distinct-part nursing facility, adult, or
pediatric Level B (skilled) nursing facility, or Level A
(intermediate) nursing facility (NF) Level of Care with the
option of returning to and/or remaining in his/her home or
home-like setting in the community in lieu of
institutionalization; and,
d) Meet other criteria and requirements listed in the
waiver
Waiver services are delivered through Medi-Cal HCBS Waiver
providers such as home health agencies, durable medical
equipment companies, individual nurse providers, licensed
clinical social workers, marriage and family therapists,
personal care agencies, non-profit organizations, professional
corporations, individual personal care providers, and certain
community residential facilities. Examples of the service
provided under the waiver include private duty nursing, home
health aide services, case management, environmental
accessibility adaptations, medical equipment operating
expenses, waiver personal care services and respite care.
Enrollment in the waiver is capped (referred to as "slots" by
calendar year). For 2015, the enrollment cap is 3,792,
increasing to 3,964 in 2016. DHCS indicates current enrollment
waiver enrollment is 3,328 individuals. As of March 2015, DHCS
indicates there are 1,473 people on the NF/AH nursing facility
A/B levels of care wait list, and over 99 percent of these
individuals reside in their homes and less than 1 percent
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reside in an institutional setting. DHCS indicates there is
priority enrollment for persons residing in hospitals, skilled
nursing facilities, and children aging out of EPSDT. DHCS
policy if there is a waitlist is that available waiver slots
are assigned to NF/AH eligible individuals in the following
order: (a) individuals who have been residing in a health care
facility for at least 90 days at the time of submission of the
waiver application; and (b) individuals residing in the
community at the time of submission of the waiver application.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee, annual
administrative costs of about $5.5 million per year ($2.0
million General Fund) for DHCS to enroll participants in the
waiver program, provide case management, and program management.
SUPPORT: (Verified8/31/15)
American Federation of State, County and Municipal Employees
California Advocates for Nursing Home Reform
California Alliance for Retired Americans
California Association for Health Services at Home
California Association of Public Authorities for IHSS
California Commission on Aging
California Hospital Association
California In-Home Supportive Services Consumer Alliance
Congress of California Seniors
United Domestic Workers of America (UDW)/AFSCME Local 3930
Westside Center for Independent Living
OPPOSITION: (Verified8/31/15)
Department of Finance
ARGUMENTS IN SUPPORT: This bill is sponsored by Disability
Rights California (DRC), which writes that this bill came its
clients who want to stay out of or return home from
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institutional long term care settings and are unable to do so
because of the outdated design and implementation of the NF/AH
waiver. DRC states this bill increases the number of waiver
slots as the current number is inadequate to meet the need.
ARGUMENTS IN OPPOSITION:The Department of Finance writes in
opposition to the prior version that this bill it imposes
significant additional costs on the state's General Fund that
are not included in the 2015 Budget Act.
ASSEMBLY FLOOR: 80-0, 6/1/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,
Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,
Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,
Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins
Prepared by:Scott Bain / HEALTH /
9/1/15 9:39:40
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