BILL NUMBER: SB 998 INTRODUCED
BILL TEXT
INTRODUCED BY Senator Liu
FEBRUARY 9, 2010
An act to add Division 13 (commencing with Section 22100) to the
Welfare and Institutions Code, relating to long-term care services.
LEGISLATIVE COUNSEL'S DIGEST
SB 998, as introduced, Liu. Long-term care: assessment and
planning.
Existing law provides for the licensure of various health
facilities, including general acute care facilities, skilled nursing
facilities, and intermediate care facilities, by the State Department
of Public Health.
Existing law establishes the California Partnership for Long-Term
Care Program and requires the State Department of Health Care
Services to adopt regulations to administer the program.
This bill would require the State Department of Health Care
Services to initiate a process to develop, by no later than July 1,
2012, a tool for the uniform long-term care services assessment of
individuals in order to assist consumers in finding long-term care
services of their choice, as specified. The department would be
required to submit a report on the use of these assessments to the
Legislature. The bill would, commencing July 1, 2012, require, with
certain exceptions, every long-term health care facility that
receives an application for admission of a Medi-Cal eligible or
Medicare/Medi-Cal eligible person to initiate the assessment prior to
admission or on the first day for which Medi-Cal reimbursement is
requested. It would also require, commencing July 1, 2012, with
certain exceptions, every general acute care hospital that identifies
a Medi-Cal eligible or Medicare/Medi-Cal eligible person for
referral to a long-term health facility to initiate a uniform
long-term care services assessment at the time of referral. It would
also prohibit, on and after January 1, 2013, any facility that admits
a Medi-Cal eligible or Medicare/Medi-Cal eligible person that has
not initiated a required uniform long-term care services assessment
within 48 hours of admission from receiving reimbursement until the
assessment has been initiated, and from being reimbursed for those
days during which assessment could have been initiated, but was not
initiated.
This bill would, among other things, require every county
department of social services or public health, when it establishes a
long-term care case management program, to assign case managers to
each acute care hospital, skilled nursing facility, and other
licensed long-term care facility located within the county department'
s jurisdiction. After these facilities are notified of the
appropriate case manager, each facility would be required to inform
the case manager when a new patient or resident is admitted and that
may need specified assistance.
The bill would also require these persons, upon a discharge from a
long-term care facility, to be provided with prescribed services by
the county, and would express intent pertaining to the funding of
these services. Because the bill would impose various duties on each
county, the bill would create a state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) California is home to the largest older adult
population in the nation. Currently, approximately 4.4 million older
adults will comprise almost 15 percent of the state's population. By
2030, projections suggest that 8.3 million older adults will account
for nearly 18 percent of the population.
(b) California's services for older adults and other adults with
long-term care needs currently exist in an uncoordinated patchwork of
programs overseen by multiple state agencies and organizations,
rather than a coordinated continuum of care focused on providing
services that are consumer-centered, least restrictive, and most cost
effective.
(c) All older adults and other adults with long-term care needs,
whether they are residing in a nursing facility or living in the
community, should have access to information about the services that
are available in order to avoid institutionalization and the services
of a counselor or case manager who can help navigate the multiple
health and social service programs that may provide benefits to that
individual.
(d) Given recent reports and recommendations, California needs a
strategic plan for long-term care services that will maximize the use
of finite resources and reduce the use of institutional care.
California's plan for the implementation of the federal Olmstead
decision is the beginning of the process of providing the statewide
service coordination and assessment necessary for a continuum of
services for those in need of long-term care, including older adults.
(e) The public interest would best be served by a broad array of
long-term care services that support persons who need these services
at home or in the community whenever practicable, and that promote
individual autonomy, dignity, and choice. In-home supportive services
and adult day health care are examples of services that the state
should prioritize with stable and adequate funding.
(f) Other states that have invested in a coordinated approach for
long-term care and home- and community-based services have improved
the effectiveness of the overall delivery system and reduced the rate
of growth of institutional care.
(g) In order for California to adequately meet the challenges of
an aging population and implement the Olmstead decision, it is the
intent of the Legislature to establish an integrated system of
long-term care that will enable older adults and other adults with
long-term care needs to remain at home whenever possible and live in
the least restrictive environment with autonomy, dignity, and choice
whenever possible.
SEC. 2. Division 13 (commencing with Section 22100) is added to
the Welfare and Institutions Code, to read:
DIVISION 13. LONG-TERM CARE ASSESSMENT AND PLANNING FOR
INDIVIDUALS
22100. It is the intent of the Legislature to establish a
long-term care services system that does all of the following:
(a) Provides a continuum of social and health services that foster
independence and self-reliance, maintain individual dignity, and
allow consumers of long-term care services to remain an integral part
of their family and community life. Essential features of this
continuum may include any or all of the following:
(1) Discharge planning in hospitals, skilled nursing facilities,
and other licensed care with the goal of returning an individual to
his or her home as soon as possible, with support services if
necessary. Discharge planning includes both diversion from hospital
to home and transition from skilled nursing facility or another
residential care setting to home. Discharge planning may begin before
a scheduled hospital visit.
(2) The ability to maintain or make modifications on homes
necessary for a person to remain or to return.
(3) Budget flexibility within a unified budget for long-term care.
This includes funds for nursing facility services, in-home
supportive services (IHSS), adult day health care, a multipurpose
senior services project (MSSP), waiver programs, and other home- and
community-based services.
(4) The integration and expansion of federal waiver programs to
realize maximum federal fund participation.
(5) Rental assistance vouchers for those who are able to transfer
from an institution, but who have no permanent home.
(6) A common database that is accessible and interoperable across
programs enabling the state and counties to combine and analyze data
from treatment authorization requests (TARs), in-home supportive
services, hospitals, nursing homes, and other facilities and
programs.
(b) Ensures that, if out-of-home placement is necessary, it is at
the appropriate level of care, and prevents unnecessary utilization
of acute care hospitals, skilled nursing facilities, and other
licensed residential care facilities.
(c) Delivers long-term care services in the least restrictive
environment appropriate for the consumer, based on the consumer's
individual needs and choices.
(d) Provides older adults with the information and supports needed
to exercise self-direction and to make choices, given those adults
capability and interest, and involves them and their family members
as partners in the development and implementation of long-term care
services.
22101. (a) The State Department of Health Care Services shall
initiate a process, in collaboration with stakeholders, to develop no
later than July 1, 2012, a tool for the uniform, long-term care
services assessment of individuals in order to assist consumers in
finding long-term care services of their choice. Stakeholders in this
process shall include consumer advocates, advocates for older
adults, disability rights advocates, public and private hospitals,
long-term care facilities, home health and hospice agencies,
long-term care program representatives, including in-home supportive
services and county representatives. The uniform long-term care
services assessment tool shall be developed to assist consumers make
informed choices about home and community options for individuals who
are hospitalized and likely to need long-term care, or individuals
in the community who are likely to need long-term care. In addition,
the department shall, in collaboration with the stakeholders,
establish training standards for the use of the uniform long-term
care services assessment tool for use by an individual pursuant to
Section 22102.
(b) Individuals eligible for the uniform long-term care services
assessment tool shall include all of the following:
(1) Medicaid enrollees and recipients, Medicaid applicants, or
individuals eligible for both Medicare and Medicaid.
(2) Individuals who apply or are likely to apply for admission to
a nursing facility.
(3) Individuals who are reasonably expected to become Medicaid
recipients within 180 days of admission to a nursing facility.
(c) In developing the uniform long-term care services assessment
tool, the department and stakeholders in the development process
shall consider all of the following:
(1) The long-term care programs for which the individual is or may
become eligible.
(2) The individual's strengths, limitations, and preferences.
(3) The individual's preferred living situation and environment.
(4) The individual's physical health, and functional and cognitive
abilities.
(5) The individual's available informal supports and other paid or
unpaid resources.
(6) The individual's need for intervention.
(7) The individual's need for case management activities.
(8) The individual's need for referrals.
(9) The individual's plan of care needs, including all of the
following:
(A) Personal care and household assistance needs.
(B) Treatments or therapies, or both.
(C) Medication management.
(D) Seizures.
(E) Skin care.
(F) Preventive care.
(G) Risk of falls.
(H) Pain management.
(I) Cognitive capacity.
(J) Depression.
(K) Problem behaviors.
(L) Suicide risk.
(M) Substance abuse.
(N) Communication.
(O) Family supports and other nonfamilial support systems.
(P) Consumer goals.
(d) The department shall, in collaboration with the stakeholder
groups identified in subdivision (a), develop a process by which
individuals who receive the uniform long-term care services
assessment and express a preference for living appropriately at home
or in another community-based setting, also receive all of the
following:
(1) A comprehensive community services plan, to be developed with
the individual and, as appropriate, the individual's representative.
(2) Information about the availability of services that could meet
the individual's needs, as set forth in the community services plan,
and an explanation of the cost to the individual of the available
in-home and community services in relation to nursing facility care.
(3) Information on retention of Supplemental Security Income/State
Supplementary Plan benefits, home modification allowances, or home
maintenance allowances, and any other financial supports that would
assist the individual in maintaining his or her home during a
hospital or nursing facility stay.
(4) Opportunity for discussion, evaluation, and ongoing
involvement with a case manager or counselor.
22102. Any individual employed by the state or by a county may
perform the long-term care services assessment if the individual
employee has attained a level of training that meets the training
standards established in subdivision (a) of Section 22101.
22103. (a) Except as provided in subdivision (c), commencing July
1, 2012, every long-term care facility that receives an application
for admission of a Medi-Cal eligible or Medicare/Medi-Cal eligible
person shall, using the assessment tool developed pursuant to Section
22101, initiate a uniform long-term care services assessment prior
to admission or on the first day for which Medi-Cal reimbursement is
requested.
(b) Except as provided in subdivision (c), commencing July 1,
2012, every general acute care hospital, as defined in Section 1250
of the Health and Safety Code, that identifies a Medi-Cal eligible or
Medicare/Medi-Cal eligible person for referral to a long-term
facility shall initiate a uniform long-term care services assessment
at the time of referral.
(c) A uniform long-term care services assessment shall not be
required for persons referred to programs for the mentally ill or
developmentally disabled administered by the State Department of
Mental Health or the State Department of Developmental Services where
an assessment is in place for mental health services, development
center services, or regional center services.
(d) On and after January 1, 2013, a long-term care facility that
admits a Medi-Cal eligible or Medicare/Medi-Cal eligible person and
that has not initiated a uniform long-term care services assessment
required pursuant to subdivisions (a) and (b) within 48 hours of
admission shall not receive reimbursement until the assessment has
been initiated, and shall not be reimbursed for those days during
which assessment could have been initiated, but was not initiated.
(e) A uniform long-term care services assessment shall be
considered initiated when a facility or provider has made a request
for the assessment to the county or the appropriate department.
(f) Individuals admitted to a long-term care facility who have
been residing in the independent living or residential care facility
portion of a multilevel facility that includes residents of
continuing care retirement communities shall be subject to the
uniform long-term care services assessment.
(g) By December 1, 2013, the State Department of Health Care
Services shall report to the Legislature the total number of
long-term care services assessments performed in the state, along
with all of the following:
(1) The total number of assessments of individuals from the
community.
(2) The total number of assessments of individuals from nursing
facilities.
(3) The total number of assessments of individuals from hospitals.
(4) The total number of individuals assessed who were placed in
community care.
(5) The total number of individuals assessed who were placed in
nursing homes.
(6) The total number of individuals assessed who were diverted
from nursing home placement.
(7) The total number of individuals assessed who were not able to
be diverted, and why, including, but not limited to, personal choice,
medical condition, unavailability of community-based services, such
as in-home supportive services, adult day health care, Alzheimer'
s-specific programs, independent living programs, housing assistance,
residential care facilities for the elderly, home-delivered meals,
home health care, protective services, respite care, social day care,
transportation services, or legal assistance.
(h) (1) The department shall pursue any additional necessary
waivers and state plan amendments to ensure federal financial
participation in funding increases to home- and community-based
services, including, but not limited to, in-home supportive services
and adult day health care, home maintenance and home modification
allowances, as well as training and employment of individuals who
will conduct the uniform long-term care assessments and case
management or counseling of individuals eligible or at-risk of
needing long-term care.
(2) On or before July 1, 2011, the department shall, in
collaboration with stakeholders identified in subdivision (a) of
Section 22101, submit to the Legislature a financing plan for
providing long-term care services pursuant to this division. By
December 1, 2011, the department shall, in collaboration with
stakeholders, submit to the Legislature a proposal for the temporary
or permanent restructuring of bed rates and reimbursements to nursing
facilities and the redirection of penalties and fines to fund its
plan for long-term care services, if necessary.
(3) Subdivisions (g) and (h) shall not be implemented unless the
director of the department certifies that the collection of federal
funds, other revenue from restructuring of reimbursements, penalties,
and fines, or private funds, is sufficient to fund the
implementation of long-term care services assessments, case
management or counseling, and services pursuant to this division.
(i) The department may, in collaboration with the stakeholders
identified in subdivision (a) of Section 22101, evaluate whether
existing state or county information systems and processes may be
developed to meet the purposes of this division.
(j) For purposes of this section, a long-term care facility
includes a skilled nursing facility, intermediate care facility,
intermediate care facility/developmentally disabled, intermediate
care facility/developmentally disabled habilitative, intermediate
care facility/developmentally disabled nursing, and congregate living
health facility, as these terms are defined in Section 1250 of the
Health and Safety Code.
22104. The Legislature finds and declares all of the following:
(a) A principal purpose of case management is to enable an
individual to return home from a hospital following an illness or
injury and to return home from a skilled nursing facility or other
long-term care facility.
(b) The purpose of case management in discharge planning is to
divert an individual who would otherwise enter a skilled nursing
facility from a general acute care hospital and to transfer an
individual out of a skilled nursing facility when he or she is able
to be home or in a less restrictive environment.
(c) If case management for long-term care is to be phased in, then
it is the intent of the Legislature for case management to be
established as early as possible for persons newly placed in a
skilled nursing facility, as defined in Section 1250 of the Health
and Safety Code, or other licensed facilities and for patients of a
general acute care hospital who may be discharged if certain home-
and community-based services are immediately available.
22105. (a) When a county department of social services or public
health establishes a long-term care case management program for
persons who are eligible for Medi-Cal or Medicare, the county
department shall assign case managers to each general acute care
hospital, skilled nursing facility, and other licensed long-term care
facility located within the department's jurisdiction. After these
health facilities are notified of the appropriate case manager, each
facility shall inform the case manager of when a new patient or
resident is admitted and that this person may need assistance in
identifying and securing home- and community-based services.
(b) The county shall provide those individuals eligible for
Medi-Cal and Medicare who may need support services in order to
return home upon discharge with those services to the extent that the
services are not provided by any other program. The county shall
also provide those who may need support services after a stay in a
skilled nursing facility or other licensed long-term care facility in
order to return home with those services to the extent that the
services are not provided by any other program.
(c) Services provided through case management may include
maintenance or renovations to a home to accommodate an individual's
disability or infirmity that brought on the hospitalization or stay
in the skilled nursing facility and may include rental vouchers if an
individual requires accommodation while renovations are completed or
arrangements are made for permanent housing in the event the
individual cannot return to their residence at the time of
hospitalization but can live in a less restrictive environment than a
skilled nursing facility or other licensed long-term facility.
22106. (a) Funds for case management, rental vouchers, and home
renovation to enable a person to return to or remain in his or her
residence shall be from both of the following sources:
(1) Federal funds for Medicare and Medicaid, including waivers.
(2) State savings realized from diverting individuals from
placement in skilled nursing facilities and other institutions and
transferring persons from those facilities to home or a less
restrictive environment.
(b) The Department of Finance, with the assistance of the
California Health and Human Services Agency and subject to review by
the Legislative Analyst, shall establish a baseline of expenditures
for skilled nursing facility care based on the average of state and
county expenditures for this care in the 2008-09, 2009-10, and
2010-11 fiscal years. This information may be used to determine the
amounts that are saved each subsequent year from implementation of
this division
(c) The expansion of case management services shall occur as
savings in other programs allow.
SEC. 3. If the Commission on State Mandates determines that this
act contains costs mandated by the state, reimbursement to local
agencies and school districts for those costs shall be made pursuant
to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of
the Government Code.