BILL ANALYSIS
AB 369
Page 1
ASSEMBLY THIRD READING
AB 369 (Yamada)
As Amended April 13, 2009
Majority vote
HEALTH 18-0 APPROPRIATIONS 14-3
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|Ayes:|Jones, Fletcher, Adams, |Ayes:|De Leon, Ammiano, Charles |
| |Ammiano, Block, Carter, | |Calderon, Davis, Duvall, |
| |Conway, De La Torre, De | |Fuentes, Hall, |
| |Leon, Emmerson, Hall, | |John A. Perez, Price, |
| |Hayashi, Hernandez, | |Skinner, Solorio, Audra |
| |Bonnie Lowenthal, Nava, | |Strickland, Torlakson, |
| |V. Manuel Perez, Salas, | |Krekorian |
| | Audra | | |
| |Strickland | | |
| | | | |
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| | |Nays:|Nielsen, Harkey, Miller |
| | | | |
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SUMMARY : Creates an exemption to the existing Medi-Cal
certification moratorium for Adult Day Health Centers (ADHCs)
which will allow the opening of two new, publicly financed
ADHCs. Specifically, this bill exempts from the current
moratorium a state-owned and operated property, for which
planning began before 2002, that is funded by state bonds and
federal grants to serve California veterans.
EXISTING LAW :
1)Establishes the California ADHC Act which requires licensure
and regulation of ADHC centers with administrative
responsibility shared between the State Department of Public
Health (DPH), the California Department of Aging, and the
Department of Health Care Services (DHCS) pursuant to an
interagency agreement.
2)Authorizes DPH to implement one year moratoriums on
certification and enrollment in the Medi-Cal Program of new
adult day health care centers on a statewide or regional basis
with certain statutory exceptions.
AB 369
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FISCAL EFFECT : According to the Assembly Appropriations
Committee, one-time costs during ramp up of $114,000 (50%
General Fund (GF)) and annual costs $450,000 (50% GF) to provide
ADHC services to 40 Medi-Cal eligible individuals eventually
enrolled over fiscal years 2010-11 and 2011-12 at the ADHC
programs at two veterans' medical campuses that will be opening
at the end of calendar year 2010. Annual costs per ADHC
participant are $11,000.
COMMENTS : This bill, according to the sponsor, the California
Association for Adult Day Services (CAADS), creates an exemption
to the ADHC moratorium on Medi-Cal certification to permit two
ADHCs operated by the California Department of Veterans Affairs
(CDVA) to become eligible for Medi-Cal reimbursement. CDVA is
constructing two large veteran's campuses, one in Ventura County
and another in Lancaster, which will include multi-level housing
and medical services intended to incorporate ADHC within their
planned care continuum. The availability of ADHC, notes the
sponsor, is a key component of these publicly funded operations,
and the Medi-Cal moratorium has had the unintended effect of
preventing ADHC services within the new facilities.
ADHC is an organized day program of therapeutic, social, and
health activities and services provided to elderly persons with
functional impairments, either physical or mental, at risk of
institutional placement. The sponsor notes that ADHCs employ a
multidisciplinary team approach providing multiple services
under one roof. These services include skilled nursing care,
physical therapy, social services, meals, speech therapy, and
socialization in order to reduce the risk factors which could
lead to placement into more expensive care settings. California
offers ADHC as an optional Medi-Cal benefit to reduce
utilization of nursing homes, emergency rooms, and hospitals.
According to CAADS, roughly 42,000 Medi-Cal beneficiaries are
now served by 350 ADHCs in this state.
The 2004-05 California State Budget authorized the DHCS to
impose a moratorium on the certification of new ADHCs after
August 2004. The moratorium was implemented in response to the
very rapid growth in ADHCs in certain regions of the state. The
moratorium has been renewed every year since 2004. However, the
Legislature has, over the last five years, authorized several
exemptions to allow expansion of specific ADHC operations.
AB 369
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ADHCs were initially required to be nonprofit, charitable
facilities until 1994, when legislation (SB 1492 (Mello),
Chapter 1121, Statutes of 1994) authorized for-profit companies
to develop ADHCs. In recent years the number of centers has
grown from 72 to nearly 350 stand alone operations. This rapid
growth brought higher state costs, according to this committee's
analysis of prior legislation, and DHCS became increasingly
concerned that some centers provided only minimal services and
failed to comply with state requirements. In 2004, the federal
Centers for Medicare and Medicaid Services directed California
to shift ADHC from an optional Medi-Cal benefit to a home and
community based waiver program. The rapid growth, compliance
concerns, and change in structure led the Legislature to impose
the moratorium.
In 2002, according to the CDVA Web site, planning for three
large veteran's facilities, one in Ventura County, one in
Lancaster, and one in West Los Angeles, was initiated following
passage of the Veterans Home Bond Act of 2000 (AB 2559
(Wesson), Chapter 216, Statutes of 2002). The three facilities
are financed with federal veteran's home grants and state bond
funding totaling $229 million, of which 60% is from federal
sources. All three sites are intended to provide multilevel
housing and medical services for eligible veterans. The two
sites nearest completion, Ventura and Lancaster, incorporate
ADHC services as well as assisted living and nursing care units
within their continuum of care design. CAADS indicates that
both projects had sought approval for up to 100 licensed ADHC
slots, but anticipate only 20 enrollees at each facility for the
first few years of operation. Absent this legislation,
residents of the two facilities will, according to the sponsor,
be placed in the campus Medi-Cal nursing home with higher state
costs and less personal independence for the beneficiary.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
FN: 0001203