BILL ANALYSIS Ó
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THIRD READING
Bill No: AB 614
Author: Chávez (R)
Amended: 8/21/14 in Senate
Vote: 21
SENATE VETERANS AFFAIRS COMMITTEE : 6-0, 6/24/14
AYES: Hueso, Knight, Correa, Lieu, Nielsen, Roth
NO VOTE RECORDED: Block
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 76-0, 4/25/13 (Consent) - See last page for
vote
SUBJECT : Veterans homes of California: reimbursement
SOURCE : Author
DIGEST : This bill provides that a veteran member of a
Veterans Home of California and who is in intermediate care or
skilled nursing care is not subject to charges and fees if
he/she meets specified criteria for disability status and
payments by the federal Department of Veterans Affairs (USDVA)
under specified federal regulations.
Senate Floor Amendments of 8/21/14 add double-jointing language
to prevent chaptering out issues with SB 1440 (Wolk).
ANALYSIS :
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Existing law:
1.Provides for the establishment and operation of the Veterans
Home of California, within the California Department of
Veterans Affairs (CalVet), at various sites for aged and
disabled veterans and their nonveteran spouses, who meet
certain eligibility requirements.
2.Requires members (residents) of the homes to pay fees and
charges, as determined by CalVet.
3.Provides for veterans homes to receive federal per diem
payments from USDVA, which help compensate the state veterans
homes for the costs of care.
4.Provides for veterans homes to receive federal "aid and
attendance" payments from USDVA on behalf of eligible
veterans, who need levels of care exceeding provision of basic
domiciliary services.
This bill conforms state law to federal regulations which:
1.Eliminates USDVA aid and attendance payments for veterans, who
are USDVA -rated at 70% or higher disabled due to a
service-connected condition.
2.Requires a state home, when receiving the super per diem rate
for veteran, USDVA -rated as 70% or higher service-connected,
not to charge a member fee to that veteran.
3.Contains double-jointing language to prevent chaptering out
issues with SB 1440 (Wolk).
Background
California state veterans homes . CalVet's Veterans Homes
Division provides rehabilitative, residential medical care and
services in a homelike environment for all veterans (and
eligible veteran spouses) residing in the state's eight veterans
homes, which are located in Barstow, Chula Vista, Fresno,
Lancaster, Redding, Ventura, West Los Angeles, and Yountville.
As of early 2013, more than 1,700 members resided in these
veterans homes.
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Levels of Care. The eight campuses offer different combinations
of the following levels of care that generate increasing levels
of cost:
Independent living/domiciliary care (Barstow, Chula Vista,
Yountville): This level of care is for residents able to
perform activities of daily living with, at most, minimal
assistance. Non-nursing employees provide limited
supervision. Residents have access to all of the home's
services, activities, and medical care. Individuals can
transfer to higher levels of care as needed. Independent
living is also referred to as Domiciliary by CalVet and the
USDVA.
Residential care/assisted living (All homes except Barstow):
Residential Care Facilities for the Elderly (RCFE) are
available for residents who require minimal assistance and
supervision with some activities of daily living. RCFE
services may include care by licensed nurses. In the future,
memory care programs may be established within the RCFEs.
Intermediate care (Barstow, Yountville): This level is for
residents who often require licensed nursing assistance with
medications and treatments, and generally require unlicensed
nursing assistance with several daily living activities.
Skilled nursing care (Barstow, Chula Vista, Fresno, Redding,
West Los Angeles, Yountville): This level provides 24-hour
services of licensed nurses and certified nursing assistants,
and is more comprehensive than intermediate care. Skilled
nursing residents have greater access to rehabilitation
therapies, nursing care, pharmacy management, structured
activities and clinical dietary services, and may provide a
memory care program.
Home funding and member fees . Funding for the annual operating
expenses of the veterans homes comes from the state's General
Fund, and any additional revenues that the Veterans Homes
Division receives are subsequently remitted to the General Fund.
These additional sources of revenue primarily consist of
reimbursements from five sources:
1.Medicare, a federally funded program which pays hospital
inpatient and outpatient care, and some skilled nursing care;
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2.Medi-Cal, funded by the federal and state governments, which
pays skilled nursing facility daily rates and various
healthcare costs;
3.Member fees, which veterans' home residents pay in accordance
with their income and level of care;
4.So-called "aid and attendance," which are federal payments for
veterans who need personal care assistance; and
5.USDVA, which pays a per diem rate for each veteran in the
homes.
Member fee amounts are determined by CalVet, and that
determination takes into account those times when the costs of a
resident's care (e.g. dental care, acute medical care, etc.)
exceed the basic fee.
Under existing law, the total of the individual member's fees
and charges for any fiscal year shall not be greater than:
47.5% of the member's annual income for domiciliary care.
55% of the member's annual income for residential care for the
elderly or assisted living.
65% of the member's annual income for intermediate care.
70% of the member's annual income for skilled nursing care.
Most veteran members are eligible to have the USDVA make per
diem payments to the state that help reduce costs to state
taxpayers. The USDVA manages the "State Veterans Home Program,"
a grant program that provides federal assistance to states by
(1) participating in a percentage of the cost of construction of
state veterans homes and (2) paying per diem for ongoing
provision of care to eligible veterans residing in federally
recognized state veterans homes. The per diem is the approved
daily rate established by the USDVA to reimburse state homes for
providing specified levels of care to eligible veterans.
The federal "Basic State Home Per Diem Rates" for fiscal year
2014 are as follow:
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Adult Day Health Care: $79.96 per day
Domiciliary: $43.32 per day
Nursing Homes: $100.37 per resident per day
Veterans who are USDVA -rated as 70% or more disabled are
eligible for enhanced per diem rates, based upon the location of
their state veterans home. For example, Yountville receives a
$536.58 enhanced per diem and Barstow receives a $431.24
enhanced per diem.
Aid and attendance payments are additional monetary allowances
paid by the USDVA to veterans, who require the aid and
attendance of another person. The intent is to assist a
veteran, who has a physical or mental impairment, loss of
coordination, or conditions affecting the ability to dress and
undress, to feed oneself, to attend to sanitary needs, and to
keep oneself ordinarily clean and presentable. The payments are
in addition to any other veterans pension the individual may
have earned.
Under federal regulations, if a 70% plus veteran is eligible for
the super per diem, the USDVA will pay either aid and attendance
or the enhanced per diem, whichever is higher. Right now the
super per diem for Yountville is $540.62 a day ($16,218.60 a
month). The USDVA aid and attendance is $704 a month.
Therefore, the USDVA would pay only the per diem and not pay the
aid and attendance at all.
In the 2009-10 Budget Act, the Legislature instituted a major
General Fund policy adjustment that affected home resident fees.
Specifically, it increased the amount of fees collected from
home residents from $17.2 million to $20 million - an increase
of $2.8 million.
Previously, residents paid fees based on a percentage of their
income, up to a dollar cap, with the percentage and cap
increasing as the level of care increases. The 2009 Budget
proposal increased resident fees by:
Removing the dollar caps;
Increasing the percentage for the RCFE; and
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Revising the fee structure for nonveteran spouses to more
accurately reflect their share of costs because they are
ineligible for the federal per diem payments.
USDVA disability ratings. The USDVA administers claims and
provides compensation for injuries or diseases that happened
while on active duty, or were made worse by active military
service. The amount of basic benefit paid varies depending on
the severity of the condition. Additional amounts may be paid
if the veteran has: very severe disabilities or loss of
limb(s); a spouse, children, or dependent parents; or seriously
disabled spouse. The USDVA makes a determination about the
severity of a disability based on the evidence the veteran
submits as part of a claim, or that USDVA obtains from the
veteran's official military records.
The USDVA rates disability from 0% to 100% in 10% increments.
The 10-percent rating is the lowest rating for which compensable
income is awarded. A veteran with a 100% rating will have one
or more disabilities that significantly interfere with normal
life functions. A veteran with a 0% rating may have a
service-connected condition, but it doesn't interfere with
normal life functions. The majority of disabled veterans rated
at 10%, 20%, or 30%. Over many years, a veteran's disability
claim may require re-ratings. The re-ratings can be caused by
changes in law, advances in medical knowledge, or fluctuations
in the veteran's physical or mental condition. An individual's
percentage rating may go up or down.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/21/14)
American Legion - Department of California
AMVETS - Department of California
California Association of County Veterans Service Officers
California State Commanders Veterans Council
Military Officers Association of America - California Council of
Chapters
Veterans of Foreign Wars - Department of California
Vietnam Veterans of America - California State Council
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ASSEMBLY FLOOR : 76-0, 4/25/13
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,
Blumenfield, Bocanegra, Bonilla, Bonta, Bradford, Brown,
Buchanan, Ian Calderon, Campos, Chau, Chávez, Chesbro, Conway,
Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox, Frazier,
Beth Gaines, Garcia, Gatto, Gomez, Gordon, Gorell, Gray,
Grove, Hagman, Hall, Harkey, Roger Hernández, Holden, Jones,
Jones-Sawyer, Levine, Linder, Logue, Maienschein, Mansoor,
Medina, Melendez, Mitchell, Morrell, Mullin, Muratsuchi,
Nestande, Olsen, Pan, Patterson, Perea, V. Manuel Pérez,
Quirk, Quirk-Silva, Rendon, Salas, Skinner, Stone, Ting,
Torres, Wagner, Waldron, Weber, Wieckowski, Wilk, Williams,
Yamada, John A. Pérez
NO VOTE RECORDED: Cooley, Lowenthal, Nazarian, Vacancy
AL:k 8/21/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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