BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: SB 998
S
AUTHOR: Liu and Alquist
B
AMENDED: April 5, 2010
HEARING DATE: April 14, 2010
9
CONSULTANT:
9
Bain
8
SUBJECT
Long-term care: assessment and planning.
SUMMARY
Requires the Department of Health Care Services (DHCS), in
consultation with a stakeholder group, to develop or
identify a long-term care assessment tool for use in case
management. Additionally, requires each county to
establish a long-term care case management program for
persons who are Medi-Cal recipients or applicants or
individuals eligible for both Medicare and Medi-Cal and who
are residing in a long-term health care facility, who apply
for admission to a long-term health care facility or are at
imminent risk of being placed in a long-term health care
facility.
CHANGES TO EXISTING LAW
Existing federal law:
Authorizes the federal Secretary of the Department of
Health and Human Services to award, on a competitive basis,
grants to states for demonstration projects under the Money
Follows the Person demonstration program (MFP demonstration
program). The MFP demonstration program is designed to
achieve the following objectives with respect to
institutional and home and community-based long-term care
services under state Medicaid programs to:
Continued---
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 2
Increase the use of home- and community-based (HCB),
rather than institutional, long-term care services,
referred to as "rebalancing."
Eliminate barriers or mechanisms (whether in state law,
the state Medicaid plan, the state budget, or otherwise),
that prevent or restrict the flexible use of Medicaid
funds to enable Medicaid-eligible individuals to receive
support for appropriate and necessary long-term services
in the settings of their choice, referred to as "money
follows the person."
Increase the ability of the state Medicaid program to
assure continued provision of home- and community-based
long-term care services to eligible individuals who
choose to transition from an institutional to a community
setting, referred to as "continuity of service."
Ensure that procedures are in place (at least comparable
to those required under the qualified HCB program) to
provide quality assurance for eligible individuals
receiving Medicaid home- and community-based long-term
care services and to provide for continuous quality
improvement in such services, referred to as "quality
assurance and quality improvement."
Individuals eligible under an MFP demonstration project are
Medi-Cal beneficiaries who reside (and who have resided,
for a period of not less than 90 consecutive days) in an
inpatient facility and for who, but for the provision of
home- and community-based long-term care services, the
individual would continue to require the level of care
provided in an inpatient facility.
Existing state law:
Requires each hospital to have a written discharge planning
policy and process. This policy must require that
appropriate arrangements for post-hospital care (including,
but not limited to, care at home, in a skilled nursing or
intermediate care facility, or from a hospice), are made
prior to discharge for those patients who are likely to
suffer adverse health consequences upon discharge if there
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 3
is no adequate discharge planning.
Requires a hospital to provide every patient anticipated to
be in need of long-term care at the time of discharge with
contact information for at least one public or nonprofit
agency or organization dedicated to providing information
or referral services relating to community-based long-term
care options in the patient's county of residence and
appropriate to the needs and characteristics of the
patient. At a minimum, this information must include
contact information for the area agency on aging (AAA)
serving the patient's county of residence, local
independent living centers, or other information
appropriate to the needs and characteristics of the
patient.
Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
health care services are provided to qualified low-income
persons. Existing law establishes a schedule of benefits
under the Medi-Cal Program, which includes many types of
services, including skilled nursing facilities services,
adult day health care, and home- and community-based
services approved by the federal government, to the extent
that federal financial participation is available for those
services under federal waivers.
Authorizes DHCS to use utilization controls in Medi-Cal but
limits the utilization controls to specified activities.
One of the authorized utilization controls is prior
authorization (typically through a treatment authorization
request or "TAR"). Prior authorization is approval by DHCS
of a specified service in advance of the rendering of that
service based upon a determination of medical necessity.
Requires DHCS to establish a targeted case management
program, and authorizes DHCS to conduct a program of
aggressive case management of elective, non-emergency acute
care hospital admissions for the purpose of reducing both
the numbers and duration of acute care hospital stays by
Medi-Cal beneficiaries where it is expected to be
cost-effective. The latter program is known as the Medical
Case Management Program.
This bill:
This bill makes various legislative findings and
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 4
declarations regarding California's older adult population,
including that the services for older adults exist in an
uncoordinated patchwork of programs, the need for a state
strategic plan on long-term care services, that other
states have invested in a coordinated approach for
long-term care and home- and community-based services.
This bill would make several statements of legislative
intent, including intent to establish an integrated system
of long-term care that will enable older adults and 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.
Long-Term Care Assessment Tool
This bill would require DHCS to initiate a process, in
collaboration with specified stakeholders, to develop or
identify no later than July 1, 2012, a tool for the
uniform, long-term care services assessment of individuals
in order to assist eligible consumers in finding long-term
care services of their choice.
The uniform long-term care services assessment tool is
required to assist eligible consumers in making informed
choices about home and community options for individuals
who are hospitalized and likely to need long-term care,
individuals who reside in an institution, or individuals in
the community who are likely to need long-term care.
DHCS would be authorized to develop or identify the
uniform, long-term care services assessment without meeting
the rule-making requirements of the Administrative
Procedure Act, so long as at least one 30-day public
comment period is used.
DHCS would be required, in collaboration with the
stakeholders, to establish training standards for case
management and for the use of the uniform long-term care
services assessment tool as part of the long-term care case
management program established by this bill.
In developing the uniform long-term care services
assessment tool, DHCS and the stakeholders in the
development process must consider several factors for
inclusion in the assessment tool, including the long-term
care programs for which the individual is or may become
eligible. Examples of factors to be considered include the
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 5
individual's strengths, limitations, and preferences,
preferred living situation/environment, physical health,
functional and cognitive abilities, available informal
supports and other paid/unpaid resources, need for case
management and referrals to programs and services, barriers
that prevent the individual from living at home, in the
community, or in a less restrictive environment, and the
individual's plan of care needs, which can include an
enumerated list of conditions, needs, risks, goals and
behaviors.
DHCS and the stakeholders would be required to evaluate
whether existing federal, state, or county assessment tools
or information systems and processes can be used,
integrated, or further developed, taking into account
specified factors if DHCS decides not to develop its own
uniform, long-term care services assessment.
DHCS would be required, in collaboration with the
stakeholder groups, to develop recommended best practices
under which individuals who receive the uniform long-term
care services assessment and express a preference for
living at home or in another community-based setting, may
also receive all of the following:
A comprehensive community services plan, to be developed
with the individual and, as appropriate, the individual's
representative.
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 long-term health care facility
care.
Information on retention of Supplemental Security
Income-State Supplementary Plan benefits, rental
assistance vouchers, 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.
An opportunity for discussion, evaluation, and ongoing
involvement with a case manager or counselor.
Case Management
This bill would require each county, with assistance from
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 6
DHCS, to establish a long-term care case management program
for persons who are Medi-Cal recipients or applicants or
individuals eligible for both Medicare and Medi-Cal who are
residing in a long-term health care facility, or who apply
for admission to a long-term health care facility or are at
imminent risk of being placed in a long-term health care
facility.
Requires counties, in establishing the long-term care case
management program, to identify one or more county
departments or nonprofit organizations, or a combination of
the two, to provide case management. Counties can contract
with nonprofit organizations for this purpose, including
independent living centers, AAAs, providers of multipurpose
senior services, linkages, aging and disability resource
connections programs, and public authorities.
Requires DHCS to provide guidance to counties to promote
the provision of case management services in ways that
maximize federal financial participation. Additionally,
DHCS is authorized to contract directly with nonprofit
organizations, or a combination of departments and
nonprofit organizations, in lieu of a particular county or
counties, upon the request of a county or counties, to
satisfy the case management requirements.
Requires counties to identify eligible individuals who need
support services in order to live at home or in the
community, and to arrange for the provision of those
services to the extent that the services are not provided
by any other program, and to the extent that the provision
of these services would allow them to live safely at home
or in the community.
Of these eligible individuals, the county would be required
to give first priority to individuals who have been, or are
expected to be, residents of a long-term health care
facility for more than 21 days, but who can reasonably be
expected to return home or to the community if case
management services are provided. The next priority must
be given to individuals who are referred by a hospital who
may be diverted from care at a long-term health care
facility if case management services are provided, and for
individuals who request and are eligible for case
management services in order to avoid being placed in a
long-term health care facility, either from the community
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 7
or home setting.
Services that are required to be provided through the case
management program must include, but are not limited to, a
specified list of services. These services include
identifying (until the uniform, long-term care services
assessment is either developed or identified) any barriers
to the individual's return to or remainder at home or in
the community, enrolling/assisting in home- and
community-based programs, developing and executing a care
plan, ensuring the coordination of health and social
services that meet the individual's needs, coordinating
home maintenance or renovations to accommodate an
individual's disability or infirmity, arranging for the
payment of a home upkeep allowance for the individual,
applying for rental assistance vouchers or other retention
of income, follow-up services to ensure that an
individual's ongoing or changing needs are being met, and
community-reentry training or independent living training
for the individual, if necessary.
A copy of the assessment must be provided to the
individual, if requested.
The county or its designee would be required to assign case
managers to each long-term health care facility located
within the county, and to notify each of these long-term
health care facilities of any changes in personnel. Case
managers and those doing the assessment are prohibited from
being employees of a long-term health care facility or a
hospital, and are required to meet the training standards
established by the stakeholder group.
Individuals designated as a case manager would be required
to have access to any long-term health care facility in
order to provide case management services. Failure to
provide this access can result in the imposition of an
administrative penalty against the long-term health care
facility.
This bill allows a hospital to make a referral to the
designated case manager when it has a patient who will be
referred to a long-term health care facility and the
hospital anticipates that the placement will be needed for
more than 21 days. A hospital can also make a referral
when it has a patient it believes can return home upon
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 8
discharge, if certain services or modifications can be made
that the case manager can arrange, if the patient would
require a referral to a long-term care facility if those
modifications or services are not made.
Provisions Affecting Long-Term Care Facilities
Requires a long-term health care facility to inform the
designated case manager assigned to that facility when a
new patient or resident who is admitted and has been, or is
expected to be, a resident for 21 days or who has expressed
a preference for living at home or in the community and may
need assistance in identifying and securing home- and
community-based services. Eligible individuals are
individuals who meet the following: Individuals who are
Medi-Cal applicants or recipients, applicants or
individuals eligible for both Medicare and Medi-Cal who are
residing in a long-term health care facility or who apply
for admission to a long-term health care facility or are at
imminent risk of being placed in a long-term health care
facility.
Referrals may be made before a patient has been a resident
for 21 days if it is likely that without assistance from
the case manager, the patient will not be able to return
home in fewer than 21 days from admission. Referrals must
be made on or before the 21st day of a patient's residence.
This bill would require, commencing January 1, 2012, a
long-term health care facility, as defined, to display at
least one poster, in an area accessible to residents,
advertising the telephone number of the facility's
designated case manager. The poster must be developed in
consultation with the designated case manager and DHCS.
This bill would prohibit a long-term health care facility
that admits a new patient, or an individual eligible for
case management under this bill, that has not made a
referral to case management, from receiving reimbursement
until the referral has been made. This bill would prohibit
the facility from being reimbursed for those days during
which a referral should have been made, but was not made.
This requirement would take effect January 1, 2013.
Hospital Discharge Information
This bill would specify that the existing contact
information hospitals must provide to patients anticipated
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 9
to be in need of long-term care at the time of discharge on
public or nonprofit agency or organizations providing
referral services relating to community-based long-term
care options must be provided both orally and in writing.
Additionally, this bill would require this information to
be provided to the patient, and, if applicable, the
patient's authorized representative, at the earliest
possible opportunity prior to discharge.
Budget expenditure baseline for long-term care services
This bill would require the Department of Finance
(Finance), with the assistance of the California Health and
Human Services Agency and subject to review by the
Legislative Analyst's Office (LAO), to establish a baseline
of expenditures for long-term health care facility care
based on the average of state and county expenditures for
the services in the 2008-09, 2009-10, and 2010-11 fiscal
years. This information is to be used to determine the
amounts that are saved each subsequent year from
implementation of this bill. This bill would require
Finance, subject to review by the LAO, to provide an
estimate of the state savings realized from placing
individuals who would otherwise be placed in, or
transferred to, a long-term health care facility in a home
or to a less restrictive environment when the budget for
home- and community-based services is considered by the
appropriate budget committees of the Legislature.
Report to the Legislature
This bill requires DHCS, in consultation with the Office of
Statewide Health Planning and Development, to report to the
Legislature the total number of long-term care services
assessments performed in the state, along with all of the
following:
The total number of assessments of individuals from the
community.
The total number of assessments of individuals in nursing
facilities and hospitals.
The total number of individuals assessed who were placed
in community care.
The total number of individuals assessed who were
diverted from nursing home placement.
The total number of individuals assessed who were not
able to be diverted, and why.
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 10
This reporting requirement sunsets January 1, 2015.
Waiver and State Plan Amendments
This bill would require DHCS to pursue any additional
necessary Medicaid 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.
This bill would require DHCS, in collaboration with
stakeholders, to submit to the Legislature a financing plan
for providing long-term care services under this bill by
July 1, 2011.
Medi-Cal treatment authorization requests
This bill would authorize the stakeholder group to review
the Medi-Cal treatment authorization requests (TAR) process
and recommend to DHCS ways to improve the role of the TAR
process in assisting those who wish to return home from a
long-term health care facility. This bill requires DHCS,
in collaboration with the stakeholders, by December 1,
2011, to submit to the Legislature recommended changes, to
the TAR process to promote the more rapid movement of
residents of long-term health care facilities to the home
and community, the restructuring of long-term care
reimbursement to provide reimbursement for a coordinated
program of home and community-based services in lieu of
reimbursement for services provided in a skilled nursing
facility, when this program would allow an individual to
remain in or return to a community setting, and
reimbursement for hospital, skilled nursing, and
rehabilitation care, so that this care will be provided at
levels sufficient to ensure beneficiary access to optimal
medical and functional recovery and to provide patient and
caregiver education directed toward successful transition
to the community setting.
Definition of long-term health care facility
This bill would define for purposes of this bill, a
long-term health care facility to include the following:
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 11
A skilled nursing facility;
An intermediate care facility;
An intermediate care facility/developmentally disabled;
An intermediate care facility/developmentally disabled
habilitative;
An intermediate care facility/developmentally disabled
nursing; and,
A congregate living health facility.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
This bill prohibits the case management-related provisions,
the requirement that Finance establish a expenditure
baseline for long-term health care facility care, and the
DHCS report to the Legislature on long-term care services
assessments from being implemented unless the Director of
DHCS 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 under this bill.
BACKGROUND AND DISCUSSION
According to the author, persons in need of long-term care
in California often want to stay in their own home or
return to their home as soon as possible after surgery or
an incident such as a broken hip. There are many services
available to help them, including discharge planning at
acute care hospitals and skilled nursing facilities,
in-home supportive services (IHSS), the multi-services
senior services program, adult day programs, and others.
However, for the most part, the aged or disabled
individuals must navigate these sets of services alone.
Each service may require its own assessment, have its own
offices, or depend on the individual to know about the
service and make it work.
According to the author, this bill has several purposes but
its primary goal is to reduce the length of stay in skilled
nursing facilities of aged and disabled persons through the
provision of case management and transition services,
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 12
borrowing elements from long-term care services offered in
Oregon and Washington. The author states there is some
evidence from other states that case management and
transition services reduce usage of skilled nursing
facilities, and home and community based services tend to
be significantly less expensive, which the author believes
will result in cost savings. The author states a secondary
goal of this measure is to bring stakeholders together to
review assessments of persons in skilled nursing
facilities, or at risk of going to a skilled nursing
facility, to determine what home- and community-based
services those persons would need in order to avoid moving
to a skilled nursing facility or to reduce the time needed
for such a facility placement.
This bill is the result of a series of meetings, from
August 2009 through the winter of 2009, of various experts
and legislative staff, followed by joint hearings earlier
this year of the Senate Committee on Human Services and the
Senate Subcommittee on Aging and Long-Term Care and a
follow-up meeting in March of those who provided testimony
at the February hearing.
Background
California has more persons age 65 and older than other
states and the population of this age group is growing. In
2007, California was home to 4 million persons age 65 and
older or representing 11 percent of the state's population.
In 2010, the number of Californians age 65 and older is
projected to increase to 4.4 million or 14.7 percent, and
is projected to increase to 8.3 million or 17.8 percent of
all Californians in 2030.
Approximately 2.4 million persons in California report
having two or more disabilities and an estimated 400,000
plus have intellectual or developmental disabilities.
Long-term care services generally address an individual's
health, social, and personal needs, and are provided in
institutional care settings (for example, skilled nursing
facilities) and through community-based providers ranging
from nonmedical residential care facilities to services
such as transportation and meals to help individuals remain
in their homes instead of being placed in an facility.
Long-term care services are provided not only to the
elderly (age 65 and older), but also to younger persons
with developmental, mental, and/or physical disabilities.
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 13
Many of the persons eligible for long-term care services
use multiple services provided by a variety of programs
operated by many state departments. Within California, the
Departments of Aging (CDA), Health Care Services, Social
Services, Developmental Services, Mental Health,
Rehabilitation, and Veterans Affairs directly administer
long-term care programs.
A recent report found California's current long-term care
delivery system is organized by program rather than by
person. California's services for older adults and
individuals with disabilities are covered through programs
managed by multiple state agencies and organizations. Tens
of thousands of persons receive services from multiple
programs, while others shift between programs in complex
passages resulting in costs and consumer outcomes that are
rarely studied since no one department is responsible for
the entirety of a person's care and services.
Report on Home- and Community-Based Long-Term Care
In November 2009, a report entitled, "Home and
Community-Based Long-Term Care: Recommendations to Improve
Access for Californians" was released. That study was
commissioned under the California Community Choices Project
to improve the understanding of the financial and
structural barriers to increasing consumer access to home-
and community-based services and to provide recommendations
for improving the structure and management of funding for
long-term care services and supports in California. The
authors of the report (Mollica and Hendrickson) made
recommendations for improving the financing and delivery of
long-term care services in California based on interviews
with state officials, state staff and stakeholders, data
obtained from the state and other sources, as well as
reviews of statutes, regulations and previous related
reports.
The authors stated that California spends more than $10
billion annually on long-term care, and the majority of the
funds pay for services in the community. The programs that
cover the services for adults with physical disabilities
and older adults appear to function independently with
separate delivery systems and management structures.
Consumers must contact different organizations for each
program, and only persons with developmental disabilities
are able to contact a single entity, receive information
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 14
about their options, assess their service needs and access
the appropriate service.
The report recommends that California develop a strategic
plan that describes which populations, services and
programs will be addressed by the strategic plan, and
describes the mission, values and goals for its long-term
living services and supports programs. The report also
contains 28 specific recommendations requiring state
statutory change or administrative action.
In testimony before the Senate Human Services Committee and
the Senate Subcommittee on Aging and Long-Term Care, one of
the report authors (Hendrickson) testified that nursing
home transition work is a significant and cost-effective
way for states to reduce their long-term living
expenditures. Transition is the practice of sending persons
into nursing homes, identifying residents who want to
leave, and then helping them secure alternative housing and
services outside of the nursing home. Hendrickson noted
that, while there is a 25-year debate on whether or not
expanding Medicaid home and community-based services is
cost effective, there is agreement by most that helping
persons leave nursing homes is cost effective, especially
when the community costs are controlled.
Arguments in support
The California Association of Area Agencies on Aging (C4A),
representing the 33 AAAs throughout California, writes in
support that it believes that in order for California to
adequately meet the challenges of serving an aging
population, it is essential that we establish an integrated
system of long-term care that will enable older persons to
remain at home in the least restrictive environment, and
this bill is a major step in that direction.
The California Retired Teachers Association writes in
support that there is currently no assurance that placement
in long-term care is always the best or most appropriate
placement, or that the care facility in which the
individual is being placed is the most appropriate care
facility for that individual. CRTA argues the assessment
process and methodology required to be developed by this
bill would assist not only the individuals being placed in
long-term care, but also the institutions that are making
the placements.
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 15
Oppose unless amended
Aging Services of California is opposed to this bill unless
it is amended to: (a) clarify who pays for the resident's
assessment prior to admission to a SNFl (b) exempt
continuing care retirement communities (CCRCs) from being
required to assess CCRC residents going into a SNF; and,
(c) delete the provisions of this bill allowing the
Administrative Procedures Act (APA) regulatory process to
be bypassed. ASC argues that because CCRC residents will
go from a SNF to either independent or assisted living at
the CCRC, the purpose of the assessment is moot. Finally,
Aging Services argues the APA gives the public the right to
be fully involved in a statute's implementation, and it
does not support legislation that waives these important
procedures rights.
Support if amended
The California Hospital Association (CHA) writes that it
supports the intent of the bill as currently written, but
CHA believes the current language requires additional
amendments which it recommends. CHA's most significant
concern relates to the discussion of the development of a
tool for the assessment of individuals. CHA argues the
goals of this legislation would be served more effectively
by requiring the development of a process for the
identification of individuals that may benefit from
community case management services and the assessment of
individual barriers to that individual's transition to a
community setting. CHA argues it is concerned the current
language places too much emphasis on the clinical and
functional assessments of individuals, and not on community
resources and barriers to transition. CHA indicates it is
committed to continuing to work together, and with
continued discussion and agreement on its amendments, it
looks forward to being able to support this bill in its
final form.
The California Foundation for Independent Living Centers
(CFILC) writes that it supports the aims of this bill, it
appreciates the stakeholder process and the inclusion of
the stakeholder amendments in this measure. CFILC writes
that it would support this bill if it were amended, arguing
that CFILC feels the provisions allowed designated service
providers who are performing transition services to have
direct access to facility residents should be strengthened,
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 16
and the mechanism for connecting a resident who wishes to
leave a nursing home with a transition service provider
should be further specified.
Position pending
The California Association of Health Facilities (CAHF)
writes that it appreciates being part of the dialogue on
this bill, but CAHF has yet to take a formal position on
the bill because, as a work-in-progress, it is not sure
where some key elements will end up. CAHF supports
strengthening case management, and believes creating a
uniform assessment tool is also a step in the right
direction but expresses concern about the language allowing
DHCS to develop a single assessment tool without going
through the regulatory process. CAHF also argues the data
and report on expenditures required in the bill also
considers only savings when facility costs are compared to
community/home long term care services, and it is possible
that medical care of an individual in the community may be
more expensive than in a facility, and this should be taken
into consideration as part of the analysis. Finally, CAHF
has continuing concerns about the actual implementation of
this bill and the desire of other advocacy groups to fund
community-based care with resources diverted from
institutional services. CAHF argues the entire continuum
of long-term care - including nursing facility and home-
and community-based services - must be adequately funded.
Prior legislation
AB 3019 (Daucher) of 2006, which was sponsored by the
then-Department of Health Services and supported by the
Department of Aging as part of the Governor's 2006-07
long-term care budget proposals, would have required the
California Health and Human Services Agency, in
consultation with technical advisers and stakeholders, to
develop the Community Options and Assessment Protocol
(COAP), to minimize duplication and redundancy of multiple
assessments for home- and community-based services and
connect consumers with appropriate program services under
the protocol. AB 3019 defined COAP to mean an information
gathering tool and protocol that would facilitate
assessments and referrals across home- and community-based
services and programs and that would document basic
personal information, functional and supportive needs,
personal preferences for services, caregiver needs, and
that augments available medical assessment information.
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 17
AB 3019 would also have appropriated $593,000 from the
General Fund and $594,000 in federal funds to Agency for
the purpose of implementing COAP, to fund a staff position
for two years, and a technical expert contractor to develop
deliverables related to the requirements of AB 3019. AB
3019 was held on the Senate Appropriations Suspense file,
and the COAP has not subsequently been funded.
SB 633 (Alquist), Chapter 472, Statutes of 2007 requires a
hospital to provide every patient
anticipated to be in need of long-term care at the time of
discharge, with contact information
or at least one public or nonprofit agency or organization
dedicated to providing information
or referral services relating to community-based long-term
care options in the patient's
county of residence and appropriate to the needs and
characteristics of the patient.
At a minimum, this information must include contact
information for the AAA serving the
patient's county of residence, local independent living
centers, or other information
appropriate to the needs and characteristics of the patient.
COMMENTS
Clarifying drafting issues .
The requirements of this measure that are placed on
hospitals and long-term care facilities should be moved
from their placement in the Welfare and Institutions Code
to the Health and Safety Code to ensure that these
provisions are enforced by the California Department of
Public Health, which licenses and regulates these
facilities.
The provisions of this bill referring to Medi-Cal TARS
should also reference Section 14133 as that section is the
main utilization control section.
The provisions of this measure prohibiting reimbursement to
a long-term care facility that has not made a referral to
the case manager are intended to be aimed at Medi-Cal
STAFF ANALYSIS OF SENATE BILL 998 (Liu) Page 18
reimbursement, but the bill as drafted, prohibits payment
from other payer sources. An amendment is needed to limit
the nonpayment provision to Medi-Cal reimbursement and not
other payer sources.
The provisions of this bill establishing the eligibility
for the long-term care management program will be clarified
to be individuals who are Medi-Cal recipients or
applicants, or are individuals eligible for both Medicare
and Medi-Cal, and who meet at least one of the following:
Are residing in a long-term health care facility;
Are individuals who apply for admission to a long-term
health care facility; or,
Are individuals who are at imminent risk of being placed
in a long-term health care facility.
POSITIONS
Support: California Association of Area Agencies on Aging
California Retired Teachers Association
Oppose: Aging Services of California (unless amended)
-- END --