BILL ANALYSIS �
AB 1552
Page 1
Date of Hearing: April 8, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 1552 (Lowenthal) - As Introduced: January 27, 2014
SUBJECT : Community-based adult services: adult day health care
centers.
SUMMARY : Establishes the Community-Based Adult Services (CBAS)
program as a Medi-Cal benefit to be provided at licensed adult
day health care (ADHC) centers. Specifically, this bill :
1)Requires CBAS to be included as a covered service in contracts
with all Medi-Cal managed care (MCMC) plans, with standards,
eligibility criteria, and provisions that are at least equal
to those contained in the current Bridge to Reform Waiver.
2)Requires CBAS providers to be enrolled as providers in
California's Bridge to Reform Demonstration, to meet the
licensing and other standards specified in state regulations
for ADHC providers.
3)Requires CBAS to be provided and available at licensed ADHC
centers that are certified by the California Department of
Aging (CDA) as CBAS providers pursuant to a participant's
individualized plan of care, as developed by the center's
multidisciplinary team.
4)Requires CBAS to be available as a MCMC benefit in counties
where the California Department of Health Care Services (DHCS)
has implemented MCMC.
5)Requires CBAS to be provided as a fee-for-service Medi-Cal
benefit in counties that have not implemented MCMC, and for
individuals who are exempt from or ineligible for managed care
enrollment.
6)Contains an urgency clause to ensure that the provisions of
this bill go into immediate effect upon enactment.
7)Makes numerous legislative findings and declarations.
EXISTING LAW :
AB 1552
Page 2
1)Establishes the Medicaid program (Medi-Cal in California) as a
joint federal-state program to provide health care services to
low-income people and seniors, and persons with disabilities
(SPDs).
2)Requires states, under federal law, to provide certain health
care benefits such as hospital inpatient and outpatient care
and allows states to provide certain optional benefits in
their Medicaid programs.
3)Authorizes DHCS to enter into contracts with managed care
plans to provide services to Medi-Cal enrollees.
4)Requires specified Medi-Cal recipients to enroll in a MCMC
plan in specified counties.
5)Under federal law, establishes the Medicare program to provide
health care coverage to eligible individuals who are disabled
or over age 65.
6)Establishes the Coordinated Care Initiative (CCI), which
requires DHCS to seek federal approval to establish
demonstration sites in up to eight counties to provide
coordinated Medi-Cal and Medicare benefits to persons eligible
for Medi-Cal and Medicare (dual eligible) and authorizes DHCS
to require SPDs who are eligible for Medi-Cal only (not
Medicare) to mandatorily enroll in managed care plans for
long-term services and support (LTSS), which includes nursing
facility care, in-home supportive services (IHSS),
Multipurpose Senior Services Program, and CBAS.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . For many years, ADHC was a state plan
optional benefit of the Medi-Cal program. The program was
eliminated in 2011 as a result of the state budget crisis. A
subsequent class action lawsuit, Esther Darling, et al. v.
Toby Douglas , et al., (No.C-09-03798) led to a settlement
whereby the state agreed to replace ADHC services with a new
program called CBAS effective April 1, 2012. DHCS amended the
California Bridge to Reform Waiver to include the new CBAS
program, which was approved by the Centers for Medicare and
Medicaid Services (CMS) on March 30, 2012, for the period
AB 1552
Page 3
through August 31, 2014.
The author writes that, while the ADHC program has never had the
capacity to meet statewide need, the elimination of Medi-Cal
funding during the budget crisis set the program back even
further. According to the author, in 1977, an estimated 600
centers were needed in California; at its peak in 2004, only
360 centers were in operation; and today, California has 270
centers. The author writes that, without the statutory
extension provided in this bill, CBAS will no longer be
offered through Medi-Cal beyond August 31, 2014, and nearly
25,000 frail Californians will lose the community-based
services that keep them in their own homes and communities.
2)BACKGROUND . The CBAS Program is administered jointly by DHCS,
the California Department of Public Health (DPH), and CDA.
DPH licenses ADHC centers and CDA certifies them for
participation in the Medi-Cal program. CBAS offers services
to eligible older adults and/or adults with disabilities to
restore or maintain their optimal capacity for self-care and
delay or prevent inappropriate or personally undesirable
institutionalization. CBAS services include: an individual
assessment; professional nursing services; physical,
occupational, and speech therapies; mental health services;
therapeutic activities; social services; personal care; meals;
nutritional counseling; and transportation to and from the
participant's residence and the CBAS center.
CBAS services are provided at licensed ADHC centers. ADHC is
a licensed community-based day care program providing
participants with daily registered nursing care, physical,
occupational and speech language pathology therapies,
therapeutic activities and social services in one setting.
ADHC helps adults manage chronic disabling health conditions
while living in their home and community. Each ADHC center
has a multidisciplinary team of health professionals who
conduct a comprehensive assessment of each participant in
order to determine and plan the ADHC services needed to meet
an individual's specific health and social needs, pursuant to
an individual plan of care.
Over the past several years, the status of ADHC/CBAS as a
Medi-Cal benefit has been subject to numerous Legislative and
Administrative actions. Governor Schwarzenegger
unsuccessfully proposed the elimination of ADHC in 2009 and
AB 1552
Page 4
again in 2010. In the 2011-12 Budget, Governor Brown also
proposed the elimination of ADHC as a Medi-Cal benefit, and
this time, elimination was adopted by the Legislature. In an
attempt to offer an alternative to the Administration's
proposed elimination, the Legislature passed AB 96 (Committee
on Budget) of 2011 to enact the Keeping Adults Free from
Institutions (KAFI) program which replaced ADHC with a capped
program, with enrollment limited to roughly one-half the
enrollment of the ADHC program. AB 96 was vetoed.
After DHCS filed a state-plan amendment to seek federal
approval to eliminate ADHC, seven ADHC clients filed suit
against DHCS in Darling v. Douglas , seeking relief for
violation of, among other laws, due process guaranteed by the
U.S. Constitution, the Americans with Disabilities Act, and
federal rights to Medicaid services. In November of 2011, the
state reached a settlement agreement with the plaintiffs that
created CBAS as an alternative to ADHC. The court approved
the settlement agreement in January 2012; the settlement
expires August 31, 2014.
Currently, DHCS and CDA are conducting a stakeholder process,
consisting of a series of webinars and meetings, to obtain
input from interested parties regarding the future direction
of the CBAS program and the amending and renewing of the CBAS
section of the Bridge to Reform Waiver. The stakeholder
workgroup includes representatives for managed care plans,
consumers/advocates, CBAS providers, Legislative staff, and
the Administration. The stakeholder workgroup is scheduled to
have its final webinar to summarize the outcomes of the
process on April 10, 2014, and, according to DHCS and CDA, an
amendment to the waiver will be submitted to CMS by May 31,
2014.
3)SUPPORT . Numerous ADHC providers have submitted letters in
support of this bill. These providers write that CBAS
services help frail people continue to live in their own homes
by effectively managing their care and providing needed
services. These providers write that, without the daily
supervision and support CBAS provides, many CBAS participants'
needs would go unmet and undetected. AARP, in support, writes
that CBAS helps Californians with disabilities or chronic
illnesses to continue to live in their own homes with dignity
and independence, and that the program also helps family
caregivers balance their other responsibilities with the care
AB 1552
Page 5
they provide for loved. The Congress of California Seniors,
in support, writes that without this bill, the lives of many
frail elderly people will be disrupted as they are forced into
nursing homes and the State of California will incur much
greater expense for their institutionalized care.
4)RELATED LEGISLATION . AB 518 (Yamada) establishes CBAS as a
Medi-Cal benefit and a covered service in managed care plan
contracts, establishes eligibility criteria for CBAS and
staffing standards for ADHC centers, and requires new CBAS
providers, as a condition of participation, to be nonprofit.
AB 518 is in the Senate Health Committee, where testimony was
taken on June 12, 2013, but no vote has been held.
5)PREVIOUS LEGISLATION .
a) SB 1008 (Committee on Budget and Fiscal Review), Chapter
33, Statutes of 2012, and SB 1036 (Committee on Budget and
Fiscal Review), Chapter 45, Statutes of 2012, authorize the
CCI as an eight-county pilot project to: i) integrate
Medi-Cal and Medicare benefits under managed care for dual
eligibles; and, ii) integrate LTSS under managed care for
dual eligibles and Medi-Cal-only SPDs.
b) AB 96 would have established the KAFI program and
required DHCS to submit an application to CMS to implement
the program. AB 96 was vetoed by Governor Brown.
c) AB 97 (Committee on Budget), Chapter 3, Statutes of
2011, among other provisions eliminates ADHC as a Medi-Cal
benefit.
d) SB 208 (Steinberg), Chapter 714, Statutes of 2010,
contains the provisions implementing Section 1115(b)
Medicaid Demonstration Waiver from CMS entitled "A Bridge
to Reform Waiver." Among the provisions, this waiver
authorized mandatory enrollment into managed care plans of
over 600,000 low-income SPDs who are eligible for Medi-Cal
only (not Medicare) in 16 counties.
e) SB 117 (Corbett), Chapter 165, Statutes of 2009, extends
the deadline by which DHCS was required to establish a new
Medi-Cal rate reimbursement methodology for ADHCs, from
August 1, 2010, to August 1, 2012.
AB 1552
Page 6
f) AB 572 (Berg), Chapter 648, Statutes of 2008, clarifies
requirements pertaining to ADHC hours of service, core
staff, and staff absences, transportation services, and
meal requirements.
g) SB 1755 (Chesbro), Chapter 691, Statutes of 2006, enacts
numerous reforms in the ADHC program, and Medi-Cal coverage
for ADHC, including narrowing the program eligibility and
medical necessity criteria; revising the service
requirements and roles and responsibilities of ADHC
providers; and requiring the Department of Health Services
(now DHCS) to establish a new prospective, cost-based
reimbursement methodology and to perform field audits of
ADHC providers, as specified.
6)DOUBLE REFERRAL . This bill is double referred, upon passage
in this Committee, this bill will be referred to the Assembly
Committee on Aging and long-Term Care.
7)TECHNICAL AMENDMENT . This bill references California's Bridge
to Reform Section 1115(a) Medicaid Demonstration
(11-W-00192/9). This should be corrected to reflect the
correct number for this Demonstration, which is 11-W-00193/9.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association for Adult Day Services (sponsor)
AARP
Acacia Adult Day Services
Adult Day Services Network of Contra Costa
American Federation of State, County and Municipal Employees,
AFL-CIO
Bedford Center
California Commission on Aging
California Medical Association
Congress of California Seniors
Eskaton Adult Day Health Center Carmichael
Evermost Health Management, Inc.
Get Together Adult Day Health Care Center
Guardian Adult Day Health Center
Horizon Elder Law and Estate Planning, Inc.
Humboldt Senior Resource Center Adult Day Health and Alzheimer's
Services
AB 1552
Page 7
Irvine Adult Day Health Services, Inc.
Mills Peninsula Senior Focus
Multipurpose Senior Services Program Site Association
National Association of Social Workers, California Chapter
National Health Law Program
New Life Adult Day Health Care
Open Arms Adult Day Health Care
San Ysidro Health Center
Sunny Cal Adult Day Health Care Center, Inc.
Woodland Healthcare
Yolo Adult Day Health Center
Numerous individuals
Opposition
None on file.
Analysis Prepared by : Ben Russell / HEALTH / (916) 319-2097