BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 667|
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CONSENT
Bill No: AB 667
Author: Mitchell (D), et al.
Amended: 6/9/11 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 8-0, 6/22/11
AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee,
De Le�n, DeSaulnier, Wolk
NO VOTE RECORDED: Rubio
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 70-0, 5/12/11 - See last page for vote
SUBJECT : Medi-Cal: subacute care program
SOURCE : Subacute Saratoga Hospital and the Childrens
Recovery Center
DIGEST : This bill establishes medical necessity
standards for the Medi-Cal subacute care program.
ANALYSIS :
Existing law:
1. Establishes the Medi-Cal program, under the Department
of Health Care Services (DHCS), to provide comprehensive
health benefits to low-income children, their parents or
caretaker relatives, pregnant women, elderly, blind or
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disabled persons, nursing home residents, and refugees
who meet specified eligibility criteria.
2. Establishes the Medi-Cal subacute care program in order
to more effectively use Medi-Cal dollars while ensuring
needed services for patients who meet subacute care
criteria.
3. Establishes level of care, reimbursement, scope and
duration of benefits, staff-to-patient ratios, and
standards for participation in the Medi-Cal subacute
care program.
This bill:
1. Makes various legislative findings and declarations
relating to subacute care hospitals, including, that
California has 400 children under the age of 21 who rely
on life-sustaining technology in 10 pediatric subacute
care hospitals.
2. Declares that the regulatory criteria related to the
subacute care program have not been updated since the
program's inception 16 years ago.
3. Defines "pediatric subacute services" in the Medi-Cal
program as health care services needed by a person under
the age of 21 who uses medical technology that
compensates for the loss of vital bodily functions.
4. Requires that medical necessity for pediatric subacute
care must be substantiated by one of the following:
A. Tracheostomy with dependence on mechanical
ventilation for a minimum of six hours each day;
B. Dependence on tracheostomy care requiring
suctioning at least every six hours, and room air
mist or oxygen as needed and dependence on one of the
following six treatment procedures:
(1) Dependence on tracheostomy care requiring
suctioning at least every six hours and room air
mist or oxygen;
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(2) Continuous intravenous therapy, as
specified;
(3) Peritoneal dialysis;
(4) Tube feeding;
(5) Other medical technologies that require the
services of a professional nurse; or
(6) Biphasic Positive Airway Pressure (BiPAP) as
specified and lacking cognitive or physical
ability to protect the airway.
C. Dependence on tracheostomy care requiring
suctioning at least every six hours and room air mist
or oxygen and one of the conditions in (B) (2)
through (4) above;
D. Dependence on skilled-nursing care in the
administration of any three of (B) above; or,
E. Dependence on BiPAP and Continuous Positive Airway
Pressure (CPAP), as specified, and one of the
conditions in (B) (1) through (6) above.
5. Establishes that the medical necessity in this bill is
intended solely for the evaluation of a potential
eligible patient for pediatric subacute care who would
otherwise be receiving an acute level of care.
6. Deletes the requirement that subacute patient care be
defined by DHCS based on a study established in 1980,
and makes other technical and clarifying changes.
Background
Medi-Cal subacute care program . Established in July of
1983, the Medi-Cal subacute care program serves patients in
licensed health facilities who meet subacute care criteria.
Pediatric subacute care is a level of care needed by a
person under the age of 21 who uses a medical technology
that compensates for the loss of a vital bodily function.
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Specific reimbursement rates have been developed for
providers of subacute care, and daily reimbursement rates
for subacute facilities vary depending on the type of the
facility and whether the patient is ventilator dependent or
non-ventilator dependent.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 7/11/11)
Subacute Saratoga Hospital and the Children's Recovery
Center (source)
California Hospital Association
ARGUMENTS IN SUPPORT : The Subacute Saratoga Hospital and
the Children's Recovery Center, the sponsor of this bill,
writes that pediatric subacute patients are medically
fragile; these patients require 24-hour nursing and special
services such as inhalation therapy, tracheostomy care,
intravenous feeding tubes, and complex wound care. Prior
to the creation of the subacute program, patients were
treated in high-cost intensive care units of children's
hospitals or state developmental centers. According to the
sponsor, current admission criteria are contained in
regulations and include a limited number of qualifying
conditions. These regulations have not been updated to
reflect enhanced and improved technology such as BiPAP or
CPAP, which did not exist at the time regulations were
developed. The sponsor argues these devices are now
commonly used as an alternative to a tracheostomy.
The California Hospital Association (CHA) writes that
pediatric subacute care is a cost-effective alternative to
hospital-based care for critically ill children. CHA
argues the clarification to medical necessity criteria in
this bill will support the appropriate and timely discharge
of children from the hospital setting to subacute care.
Supporters contend that since pediatric subacute rates are
approximately one-fifth of those paid for care in a
pediatric intensive care unit of an acute hospital or a
state developmental center, substantial Medi-Cal savings
will also accrue every time a child is successfully placed
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in one of these facilities. Children would also benefit
greatly from the specialty care, the
rehabilitation/developmental services, and the more
family-friendly environment offered in this setting.
ASSEMBLY FLOOR : 70-0, 5/12/11
AYES: Achadjian, Allen, Ammiano, Atkins, Beall, Bill
Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Charles Calderon, Campos,
Carter, Chesbro, Cook, Davis, Dickinson, Donnelly, Eng,
Feuer, Fletcher, Fong, Fuentes, Furutani, Beth Gaines,
Galgiani, Gatto, Gordon, Grove, Hagman, Halderman, Hall,
Harkey, Hayashi, Hill, Huber, Hueso, Huffman, Jeffries,
Jones, Knight, Lara, Logue, Ma, Mansoor, Mendoza, Miller,
Monning, Morrell, Nestande, Nielsen, Norby, Olsen, Pan,
Perea, V. Manuel P�rez, Silva, Skinner, Smyth, Solorio,
Swanson, Valadao, Wagner, Wieckowski, Williams, Yamada,
John A. P�rez
NO VOTE RECORDED: Alejo, Cedillo, Conway, Garrick, Gorell,
Roger Hern�ndez, Bonnie Lowenthal, Mitchell, Portantino,
Torres
CTW:kc 7/11/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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