BILL ANALYSIS �
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 21
S
AUTHOR: Liu and Alquist
B
AMENDED: March 9, 2011
HEARING DATE: March 23, 2011
2
CONSULTANT:
1
Trueworthy
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. Requires long-term care facilities to make
referrals to the designated case manager and would stop
Medi-Cal reimbursement for those days where a referral
should have been made but was not.
CHANGES TO EXISTING LAW
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).
Individuals eligible under an MFP demonstration project are
Medi-Cal beneficiaries who reside (and who have resided,
Continued---
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
2
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. 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:
� Increase the use of home- and community-based (HCB),
rather than institutional, long-term care services.
� 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 care
services in the settings of their choice.
� 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.
� 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.
Through the Federal Affordable Care Act (ACA), federal
funds have been made available to help states establish and
expand home- and community-based long-term care services
and supports for older adults and people with disabilities.
The new funds will support states Money Follows the Person
Programs (MFP), which the Affordable Care Act (ACA)
extended for an additional five years through 2016, and the
Community First Choice Option, which the ACA created.
State Medicaid
Establishes the Medi-Cal program, administered by the
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
3
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.
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.
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.
Beginning in June 2011, California will begin to
mandatorily enroll Seniors and Persons with Disabilities
(SPDs) into Medi-Cal managed care plans in fourteen
counties that currently have Medi-Cal managed care.
Hospital discharge
Requires each hospital to have a written discharge planning
policy and process that requires appropriate arrangements
for post-hospital care and a process to inform each
patient, orally or in writing, of the continuing care
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
4
requirements following discharge from the hospital.
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.
This bill:
This bill makes various legislative findings and
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, such as Washington, Oregon, and Pennsylvania, have
invested in a coordinated approach for long-term care and
home- and community-based services. This bill would
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
Requires 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
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
5
the community who are likely to need long-term care.
Authorizes DHCS 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.
Requires DHCS, 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 barriers that prevent an
individual from living at home, in the community, or in a
less restrictive environment.
Requires DHCS and the stakeholders 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 tool.
Requires DHCS, 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
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
6
assistance vouchers, home modification allowances, or
home maintenance allowances, and any other financial
support 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
Requires each county, with assistance from 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
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
7
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.
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 tool 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
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
8
administrative penalty against the long-term health care
facility.
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 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.
Requires, commencing January 1, 2013, 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.
Prohibits a long-term health care facility that admits a
new patient, or an individual eligible for case management
under this bill, which has not made a referral to case
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
9
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, 2014.
Hospital discharge information
This bill would specify that the existing contact
information hospitals must provide to patients anticipated
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 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
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
10
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; and
� The total number of individuals assessed who were not
able to be diverted, and why.
These reporting requirement sunsets January 1, 2016.
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 are 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, 2012.
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,
2012, 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
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
11
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:
� 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
SB 21 is identical to SB 998 (Liu and Alquist) of 2010
which was held in the Senate Appropriations Committee.
Below is a summary of fiscal analysis for SB 998 (Liu and
Alquist).
---------------------------------------------------------------
|Provisions |2010-11, 2011-12, |Fund |
| |2012-13 | |
|------------------------------+--------------------+-----------|
|Stakeholder process to |likely hundreds of |General/Fed|
|develop or select long-term |thousands of |eral |
|care assessment tool; ongoing |dollars annually | |
|program oversight | | |
| | | |
|------------------------------+--------------------+-----------|
|Development and procurement |likely hundreds of |General/Fed|
|of long-term care assessment |thousands to |eral |
|tool |millions of dollars | |
| | | |
|------------------------------+--------------------+-----------|
|Implementation of county case |likely millions of |General/Fed|
|management program |dollars of |eral |
| |case managers | |
|------------------------------+--------------------+-----------|
|Increased long-term care |likely millions of |General/Fed|
|General/*** |dollars annually |eral |
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
12
|facility staff reimbursement | | |
|------------------------------+--------------------+-----------|
|Increased reimbursement and |unknown but likely |General/Fed|
|utilization of home and |millions to |eral |
|community based services |billions of dollars | |
|------------------------------+--------------------+-----------|
|Potential long-term cost |unknown, to the |General/Fed|
|avoidance |extent that program |eral |
| |cost-avoidance is | |
| |contained and | |
| |avoided by treating | |
| |people in a more | |
| |cost-effective | |
| |setting cost | |
| |is contained and | |
| |avoided by | |
| |Federal | |
| |treating people in | |
| |a more cost- | |
---------------------------------------------------------------
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 assist aged and disabled individuals
return to their homes following a hospitalization or a stay
in a skilled nursing facility through the provision of case
coordination, borrowing elements from long-term care
services provided in Oregon and Washington. The author
states there is some evidence from other states that case
management and transition services reduce usage of skilled
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
13
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 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 2010 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, representing 11 percent of the state's
population. In 2010, the number of Californians age 65 and
older was 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 a 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.
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
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
14
Departments of Aging (CDA), Health Care Services, Social
Services, Developmental Services, Mental Health,
Rehabilitation, and Veterans Affairs directly administer
long-term care programs.
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
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
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
15
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.
Prior legislation
SB 998 (Liu and Alquist) of 2010 is identical to SB 21. SB
998 was held in the Senate Appropriations Committee.
SB 208 (Steinberg, Alquist and Speaker Perez), Chapter 714,
Statutes of 2010 enacted statutory changes necessary for
the Department of Health Care Services (DHCS) and counties
to implement a new proposed Comprehensive Demonstration
Project Waiver (Section 1115 Waiver) in the Medi-Cal
Program and Authorizes DHCS to require the mandatory
enrollment of seniors and people with disabilities (SPDs)
in a Medi-Cal managed care plan
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 (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
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
16
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
would augment available medical assessment information.
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.
Arguments in support
The California Association of Area Agencies on Aging writes
that in order for California to adequately meet the
challenges of serving an aging population, it is essential
that an integrated system of long-term care be established
that will enable older persons to remain at home in the
least restrictive environment. The Congress of California
Seniors writes in support, arguing SB 21 will assure that
seniors face only a single assessment and single point of
entry for the services for which they may qualify.
Support if amended
The California Association of Health Facilities (CAHF)
writes that it supports the intent of the bill as written,
but is concerned about some of the language in the measure
which appears to try to alter or reduce current spending on
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
17
long-term care and nursing facilities in order to re-direct
it to case management services. CAHF argues that in order
to cope with future demands, the entire continuum of long
term care, including nursing facilities, must be adequately
resourced. CAHF also argues the assessment tool should be
developed through the use of emergency regulations. SB 21
currently allows the DHCS to develop the assessment tool
without going through the regulatory process.
COMMENTS
1. Author Amendments. Staff understands the author
will be requesting the following amendments in
committee:
a. Page 6, lines 30 - 34: Amend the
penalties for nursing homes failing to refer a
patient to case manager. SB 21 originally
prohibited the facility from receiving
reimbursement for the days a referral should have
been made but was not. The amendment would
treat a non-referral as an infraction within the
current citation process.
b. Page 9, line 8: Require DHCS to respond
to public comments submitted using the
Administrative Procedure Act to develop the
assessment tool.
c. Page 14, line 29: Add data items to be
used in data analysis required in the evaluation.
POSITIONS
Support: AARP (Support if Amended)
California Association of Area Agencies on Aging
California Association of Health Facilities
(Support if Amended)
California Association of Public Authorities
(Support in Concept)
California Hospital Association
Catholic Charities of California United
Congress of California Seniors
Disability Rights California (Support in Concept)
Oppose: None received.
STAFF ANALYSIS OF SENATE BILL 21 (Liu and Alquist) Page
18
-- END --