BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 117|
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UNFINISHED BUSINESS
Bill No: SB 117
Author: Corbett (D), et al
Amended: 9/4/09
Vote: 21
SENATE HEALTH COMMITTEE : 10-1, 4/1/09
AYES: Alquist, Strickland, Cedillo, Cox, DeSaulnier, Leno,
Maldonado, Negrete McLeod, Pavley, Wolk
NOES: Aanestad
SENATE APPROPRIATIONS COMMITTEE : 10-1, 5/28/09
AYES: Kehoe, Cox, Corbett, Denham, DeSaulnier, Hancock,
Leno, Oropeza, Wyland, Yee
NOES: Walters
NO VOTE RECORDED: Runner, Wolk
SENATE FLOOR : 33-6, 6/3/09
AYES: Alquist, Calderon, Cedillo, Cogdill, Corbett, Correa,
Cox, Denham, DeSaulnier, Ducheny, Florez, Hancock,
Harman, Hollingsworth, Kehoe, Leno, Liu, Lowenthal,
Maldonado, Negrete McLeod, Oropeza, Padilla, Pavley,
Romero, Runner, Simitian, Steinberg, Strickland, Wiggins,
Wolk, Wright, Wyland, Yee
NOES: Aanestad, Ashburn, Benoit, Dutton, Huff, Walters
NO VOTE RECORDED: Vacancy
ASSEMBLY FLOOR : 51-26, 09/08/09 - See last page for vote
SUBJECT : Adult day health care services
SOURCE : California Association for Adult Day Services
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DIGEST : This bill extends the deadline by which the
Department of Health Care Services is required to establish
a new Medi-Cal rate reimbursement methodology for adult day
health care services (ADHC), from August 1, 2010 to August
1, 2012.
Assembly Amendments (1) deleted provisions amending Section
1570.7 of the Health and Safety Code defining "Core staff"
to include social workers; (2) specifies beneficiaries be
eligible for adult day care health services; (3) make
technical/clarifying changes; (4) extend the deadline for
the Department of Health Care Services to establish the
reimbursement methodology to 2012 instead of 2011.
ANALYSIS :
Existing law:
1. Defines adult day health care services (ADHC) as an
organized day program of therapeutic, social, and health
activities and services provided to elderly persons with
either physical or mental impairments, for the purpose
of restoring an individual's ability to provide
self-care, maintain independence, and avoid
institutionalization in a long-term health care
facility. ADHC is provided at ADHC centers, which are
licensed by the Department of Public Health (DPH), and
certified for the Medi-Cal program by the California
Department of Aging (CDA).
2. Establishes the Medi-Cal program administered by DHCS,
to provide comprehensive health care coverage to certain
categories of low-income eligible individuals and
families, including children, the aged, the blind, the
disabled, nursing home residents, refugees, and pregnant
women. ADHC centers may qualify for Medi-Cal
reimbursement for specified services provided to certain
persons who are eligible for Medi-Cal
3. Requires DHCS, by August 1, 2010, and in consultation
with specified stakeholders, to establish a Medi-Cal
reimbursement methodology for ADHC services that is
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based on the cost of services provided to an ADHC
client.
4. Sets forth various timeframes associated with the
establishment and implementation of the new
reimbursement system, including timeframes for DHCS to
establish new ADHC cost reports, train ADHC providers on
the new methodology, and adopt regulations to implement
the new methodology.
This bill extends the deadline by which DHCS is required to
establish a new Medi-Cal rate reimbursement methodology for
ADHC services, from August 1, 2010 to August 1, 2012 and
makes conforming changes to other timeframes associated
with the establishment and implementation of the
reimbursement methodology. Specifically, this bill:
1. Requires DHCS to produce a cost report for a core rate,
a methodology and documentation necessary to estimate
the rates for separately billed services and for
transportation services by 2010 (was 2007).
2. Requires DHCS to establish facility peer groupings in
consultation with the California Association of Adult
Day Services (CAADS), by 2011 (was 2008).
3. Requires DHCS to facilitate training of providers in
collaboration with CAADS on the use of the new
methodologies and documentation by 2011 (was 2008).
4. Requires DHCS to establish a preliminary estimate of a
reimbursement limit, the rates for individual services
and the rates for separately billed services by 2012
(was 2010), including a comparison to the rate
methodology in effect in 2011-12.
5. Requires DHCS to adopt regulations by 2015 (was 2013).
6. Changes the title of social worker to social services
director in the list of ADHC core staff.
7. Makes technical amendments to AB 4x 5 (Evans), Chapter
5, Statutes of 2009, Fourth Extraordinary Session, the
Budget Health Trailer Bill related to ADHC.
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Background
ADHC is a licensed community-based day care program
providing a variety of health, therapeutic, and social
services to those at risk of being placed in a nursing
home. Each ADHC center has a multidisciplinary team of
health professionals who conduct a comprehensive assessment
of each participant in order to determine and plan the ADHC
services needed to meet an individual's specific health and
social needs, pursuant to an individual plan of care.
ADHC centers must provide a set of "core services" to each
participant which includes professional nursing services,
personal care and/or social services, therapeutic
activities, and at least one meal per day. In addition to
core services, ADHC centers often provide other specialty
services such as physical therapy, occupational therapy,
speech and language pathology, dietetics, and mental health
services.
ADHC centers also must provide transportation for
participants to and from the center.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12
Fund
DHCS staffing costs $0$144 - $393 $287 - $785
General
for development of $144 - $393 $287 - $78
Federal
methodology
Up to 3 Years higherunknown, but in the tens of millions
General
reimbursement due of dollars Federal
to delayed savings
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SUPPORT : (Verified 9/9/09)
California Association for Adult Day Services (source)
Aging Services of California
American Federation of State, County, and Municipal
Employees
California Association of Health Facilities
Commonwealth Adult Day Health Care
Graceful Senescence Adult Day Health Care, Inc.
Hope Adult Day Care Center
Sunny Day Adult Health Care
Yolo Adult Day Health Center
ARGUMENTS IN SUPPORT : The California Association of
Health Facilities (CAHF) states that the development of the
new reimbursement system has been complex and relies on the
collection of valid data. CAHF states that it is critical
that reliable and comparable data be collected from all
ADHCs in order to calculate new reimbursement rates, which
is why the revised implementation dates set forth in this
bill are necessary.
According to the author's office, DHCS has been unable to
meet the current timeframes required by existing law for
developing a new ADHC rate methodology. The author's
office further states that this bill provides additional
time for the establishment and implementation of the new
rate methodology to ensure that the methodology is
established through a collaborative process between DHCS
and ADHC stakeholders that preserve the integrity of the
program model.
The federal government has recently indicated substantial
compliance issues with respect to the current reimbursement
methodology for payment of ADHC in the Medi-Cal program.
SB 1755 (Chesbro), Chapter 691, Statutes of 2006, requires
the Department of Health Services, (now DHCS), to establish
a cost-based Medi-Cal reimbursement methodology for ADHC
services, establish new eligibility criteria for ADHC
services for the purposes of Medi-Cal reimbursement, and
establish daily core services to be provided by ADHC
centers to each participant. The requirements of SB 1755
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of 2006 addresses the federal compliance issues. According
to CAADS, sponsor of the bill, the dates for implementation
of the new ADHC reimbursement methodology were overly
ambitious for such a complex endeavor, and that DHCS has
not met the timeframes set forth by SB 1755.
The recently enacted 2009-10 ADHC budget was reduced by $28
million GF associated with reforms to ADHC administration
and funding including limiting services to no more than
three-days per week for a period of time, a rate freeze,
establishing a definition of medical acuity, on-site
treatment authorization requests and establishing a
stakeholder work group to assist with implementation. This
bill also corrects erroneous references in ABX4 5 (Evans)
of 2009, the Health Trailer Bill that implemented the
reforms.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Arambula, Beall, Block, Blumenfield,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Coto, Davis, De La Torre, De Leon, Eng, Evans,
Feuer, Fong, Fuentes, Galgiani, Hall, Hayashi, Hernandez,
Hill, Huber, Huffman, Jones, Krekorian, Lieu, Bonnie
Lowenthal, Ma, Mendoza, Monning, Nava, John A. Perez, V.
Manuel Perez, Portantino, Ruskin, Salas, Saldana,
Skinner, Solorio, Swanson, Torlakson, Torres, Torrico,
Tran, Yamada, Bass
NOES: Anderson, Tom Berryhill, Blakeslee, Conway, Cook,
DeVore, Duvall, Emmerson, Fletcher, Fuller, Gaines,
Garrick, Gilmore, Hagman, Harkey, Jeffries, Knight,
Logue, Miller, Nestande, Niello, Nielsen, Silva, Smyth,
Audra Strickland, Villines
NO VOTE RECORDED: Bill Berryhill, Furutani, Vacancy
RJG:do 9/9/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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