BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
998 (Liu/Alquist)
Hearing Date: 5/27/2010 Amended: 4/20/2010
Consultant: Katie Johnson Policy Vote: Health 6-3
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BILL SUMMARY: SB 998 would require the Department of Health
Care Services (DHCS) to work with stakeholders to develop or
identify a long-term care assessment tool that would identify an
individual's long-term care needs. It would also require
counties to establish a long-term care case management program
for persons who are Medi-Cal recipients or enrolled in both
Medi-Cal and Medicare and residing in, applying for admission
to, or at imminent risk of being placed in a long-term health
care facility.
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Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
Stakeholder process to likely hundreds of thousands
annuallyGeneral/*
develop or select long-term Federal
care assessment tool; ongoing
program oversight
Development and likely hundreds of
thousandsGeneral/**
procurement of long-term one-time Federal
care assessment tool
Implementation of county likely hundreds of
General/***
case management program millions of dollars annually
Federal
Increased reimbursement and unknown, but likely in the
General/*
utilization of home and millions of dollars annually
Federal
community based services
Potential long-term likely in the millions of
dollars General/*
cost avoidance to the extent that cost is
containedFederal
and avoided by treating people in
a more cost-effective setting
*In general, costs would be shared 50 percent General Fund and
50 percent federal funds for all staff work
**If system procurement is necessary, costs could be shared 10
percent General Fund and 90 percent federal funds
***Costs could be shared 25 percent General Fund and 75 percent
federal funds
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STAFF COMMENTS: SUSPENSE FILE.
Long-Term Care Assessment Tool
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SB 998 (Liu/Alquist)
This bill would require the Department of Health Care Services
(DHCS) to develop a uniform long-term care services assessment
in collaboration with stakeholders no later than July 1, 2012.
To develop the tool, the department would likely need additional
personnel to staff the stakeholder workgroup and technical
expertise in developing the assessment tool software at a cost
likely in the hundreds of thousands of dollars annually through
July 1, 2012.
County Case Management Program
This bill would create a county-based, comprehensive long-term
care program that would provide an assessment of an individual's
long-term care services needs and
ongoing case management to ensure that the individual would have
every opportunity to reside at home or in another
community-based setting instead of in a long-term care facility.
Individuals who are Medi-Cal recipients or enrolled in both
Medi-Cal and Medicare, also known as dual eligibles, and
residing in, applying for admission to, or at imminent risk of
being placed in a long-term health care facility would be
eligible for the program. California has approximately 1.1
million dual eligibles and about 380,000 seniors and persons
with disabilities (SPDs) who are Medi-Cal enrollees.
Although it is unknown how many people could be eligible for
these transition and case management services, if 1 percent of
these individuals, approximately 150,000 people, were eligible
for this program, it could cost approximately $150 million -
$350 million annually for case management services, assuming
salaries of $100,000 and caseloads of 40 - 80 consumers. If the
case managers were licensed health care professionals, their
salaries could be eligible to receive an enhanced federal funds
matching rate of 75 percent federal funds and 25 percent General
Fund. Otherwise, costs would likely be shared 50 percent federal
funds and 50 percent General Fund.
This bill could also cause a minor increase in costs to the
Office of Statewide Health Planning and Development (OSHPD) for
data collection and storage and to the Department of Finance
(DOF) to develop program baseline and savings estimates.
Potential Future Program Cost Avoidance
This bill specifically directs DOF to estimate savings realized
from placing individuals who would otherwise be placed in or
transferred to a licensed long-term health care facility in a
home or in a less restrictive environment. To the extent that
projected costs of serving beneficiaries in long-term care
facilities is shown to be more than the program costs of
maintaining an individual in a community placement, there could
be significant cost avoidance.
Existing State Home and Community-Based Programs
Within California, the Departments of Aging (CDA), Health Care
Services (DHCS), Developmental Services (DDS), Mental Health
(DMH), Rehabilitation (DOR), Social Services (DSS), and Veterans
Affairs (DVA) each directly administer long-term care programs
such as Money Follows the Person (MFP), Program of All-Inclusive
Care for
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SB 998 (Liu/Alquist)
the Elderly (PACE), In-Home Supportive Services (IHSS), and a
DDS Home and Community Based Services waiver. Many of these
programs conduct their own separate assessments and have
different eligibility requirements, limits on caseload, and
different streams of federal, state, and local funding. Although
it could be possible that DHCS and counties, in implementing
this bill, could utilize and build upon current programs,
streams of funding, and service delivery systems, it is unknown
both operationally and fiscally how existing programs would
interface with this bill's required long-term care assessment
tool and case management program.
Additionally, federal health care reform provides states
opportunities to expand their offerings of home and
community-based services, including an option that permits state
Medicaid agencies to apply to the federal government for a
Section 1915(k) state plan amendment (SPA) commencing October 1,
2010, also known as the Community First Choice Option.
Participating states could receive a 6 percent augmentation in
the federal matching rate.
One example of an existing system of a consumer-centered
assessment, plan, case management system, and service
procurement is the regional center system that serves
Californians diagnosed with developmental disabilities as
administered by DDS. The regional center system is made up of 21
nonprofit regional centers that contract with DDS to initially
assess an individual's needs, develop an individual plan that
outlines the local services that an individual may need to live
in his/her community, purchase those necessary services, and
provide ongoing case management to the individual.
DDS and DHCS jointly administer a Section 1915(c) Home and
Community Based Services (HCBS) waiver which provides consumers
who are eligible for both Medi-Cal and DDS an array of home and
community based services, such as home health, respite, skilled
nursing, and transportation, in order to enable them to live in
a placement outside of a long-term care facility. Waiver
enrollment is capped at 90,000 consumers for October 1, 2009, to
September 31, 2010, and is capped at 95,000 for October 1, 2010,
through September 31, 2011. The DDS November 2009 Estimate
estimates that the department will spend approximately $1.9
billion total funds in FY 2010-2011 for staff and purchase of
services for the HCBS waiver. Costs per consumer under this bill
would vary depending on his or her individual needs.