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---



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          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 




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          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 




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          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 




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          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 




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            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 




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          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 




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          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 




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          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 




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            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 




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          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       |




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          |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 




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          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 




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          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 




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          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 




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          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 




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          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.




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