BILL NUMBER: SB 1401 INTRODUCED
BILL TEXT
INTRODUCED BY Senator McGuire
FEBRUARY 19, 2016
An act to add and repeal Section 14132.78 of the Welfare and
Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 1401, as introduced, McGuire. Home health care pilot projects.
Existing law provides for the licensure and regulation of home
health agencies by the State Department of Public Health. Existing
law requires all private or public organizations that provide or
arrange for skilled nursing services to patients in the home to
obtain a home health agency license. Existing law also provides for
the Medi-Cal program, which is administered by the State Department
of Health Care Services, under which qualified low-income individuals
receive health care services. Existing law provides that home health
care services are covered Medi-Cal benefits, subject to utilization
controls.
This bill would require the department, on or before January 1,
2017, to develop at least 3 regional pilot projects in counties
located in designated areas of the state. The pilot projects would be
targeted to increase access to in-home, private duty nursing care
for children receiving Medi-Cal benefits who are eligible for
in-home, shift nursing care services. The bill would require, for a
period of at least 2 years, an increased reimbursement rate for
participating licensed home health agencies that are currently
providing private duty nursing. The bill would require that the pilot
project be implemented only to the extent that federal financial
participation is available, and would require the department to
submit any state plan amendment, waiver, or waiver amendment
application necessary for federal approval.
This bill would authorize the department to establish reasonable
provider eligibility standards and participation requirements and
also would require the department, or an entity contracting with the
department, to report to specified committees of the Legislature an
evaluation of the effectiveness of the pilot projects, with input
from specified stakeholders. The bill's provisions would become
inoperative on July 1, 2019, and would be repealed as of January 1,
2020.
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. The Legislature finds and declares all of the
following:
(a) Home care services provide a critical role in the care
continuum. Home health agencies work with patients who have medically
complex conditions, are often permanently disabled, and require
extended or continuous care, including ventilation, tracheostomy, and
enteral feedings.
(b) These services allow patients to receive care in their homes
and allow parents of disabled children to continue to work in their
communities. Studies have shown that home care is cost-effective
compared to care in an acute care or long-term care setting.
(c) The state has a responsibility under Section 1902(a)(30)(A) of
the federal Social Security Act (42 U.S.C. Sec. 1396a(a)(30)(A)) to
ensure that Medicaid payments are consistent with efficiency,
economy, and quality of care, and are sufficient to enlist enough
providers so that care and services are available under the state
plan at least to the extent that care and services are available to
the general population in the geographic area.
(d) Hundreds of pediatric Medi-Cal patients in need of home health
services may face significant barriers in accessing care. According
to a 2015 study by Leavitt Partners, Medi-Cal patients have fewer
options than patients with alternative payment sources for the
services of home health agencies. Nearly 20 percent of Medi-Cal
certified agencies reported having to cease to provide services to an
area they previously served. In addition, only 28 percent of the
agencies surveyed reported the ability to provide more than 75
percent of the skilled nursing hours that the state approved for the
patient and almost 60 percent of the agencies reported that they are
able to cover less than 25 percent of the approved hours for their
Medi-Cal patients.
(e) Overwhelming evidence suggests that many home health agencies
are shifting resources away from Medi-Cal patients, thereby creating
barriers to providing care to Medi-Cal's most medically fragile
children. Factors that create these barriers include, but are not
limited to, out-of-date reimbursement methodologies, difficulty
recruiting nurses into the home health care sector because of low pay
rates, competition for nursing staff from long-term care facilities,
and market exits by many certified agencies. These factors appear to
have resulted in home health agencies receiving declining referrals
from hospitals, using informal waiting lists or caps to manage
patient caseload, and missed nursing shifts for the families of
qualified patients.
(f) In order to address access to in-home nursing care for
children, the State Department of Health Care Services shall conduct
pilot projects targeted to home care providers in counties in at
least three regions of the state: the San Francisco Bay area
counties, the Central Valley region, and the San Diego area. The
pilot projects will require the department to adopt an
incentive-based value payment for children who are receiving skilled
nursing care in the home and who are enrolled in the state's Medi-Cal
EPSDT/IHO waiver programs. The value-based payment model will reward
providers that improve quality and lower costs, through better
outcomes.
SEC. 2. Section 14132.78 is added to the Welfare and Institutions
Code, to read:
14132.78. (a) (1) On or before January 1, 2017, the department
shall establish at least three regional pilot projects, located in
counties in the San Francisco Bay area, the Central Valley, and the
San Diego area, applicable to home health agencies that treat
children who receive skilled nursing services through the Medi-Cal
program.
(2) The pilot projects established pursuant to paragraph (1) shall
be targeted to increase access to in-home, private duty nursing care
for children receiving Medi-Cal benefits who are eligible for
in-home, shift nursing care services. The applicable reimbursement
rate for licensed home health agencies that are currently providing
private duty nursing care shall be 20 percent above the Medi-Cal rate
schedule as of July 1, 2015. The increased reimbursement rate shall
remain in effect for at least two years.
(3) This section shall be implemented only to the extent that
federal financial participation is available. The department shall
submit any necessary application to the federal Centers for Medicare
and Medicaid Services for a state plan amendment, waiver, or
amendment to a waiver to implement the pilot project described in
this section.
(b) The department may establish reasonable provider eligibility
standards and participation requirements for the pilot projects.
(c) No later than April 1, 2019, the department, or a qualified
academic institution or other entity with which the department
contracts, shall submit a report evaluating the effectiveness of the
pilot projects to the Senate Committee on Health, the Assembly
Committee on Health, the Senate Committee on Budget and Fiscal
Review, and the Assembly Committee on Budget.
(1) In order to compare access to necessary and approved services
before and after the establishment of the pilot projects, the
department may request participating home health agencies to report
on key access to care indicators identified by the department, the
participating agencies, and referring hospitals. The key access to
care indicators shall include, but need not be limited to:
(A) The increase or decrease in hospital discharges to home health
agencies.
(B) The number of nursing hours filled, as compared to the number
of hours that have been approved.
(C) The number of available licensed home health agencies that
accept pediatric patients.
(2) In evaluating the effectiveness of the pilot projects, the
department shall cooperate with, and consider input from, home health
agencies, consumer groups, hospitals, and other provider
associations.
(3) A report submitted pursuant to subdivision shall be submitted
in compliance with Section 9795 of the Government Code.
(d) This section shall become inoperative on July 1, 2019, and as
of January 1, 2020, is repealed.