BILL ANALYSIS �
AB 1552
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Date of Hearing: April 22, 2014
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Mariko Yamada, Chair
AB 1552 (Lowenthal) - As Amended: April 10, 2014
SUBJECT : Medi-Cal: Community Based Adult Services: Urgency
SUMMARY : Establishes the Community Based Adult Services (CBAS)
program services and a benefit in the Medi-Cal program, and
calls for immediate implementation. Specifically, this bill :
1)Establishes CBAS program services as a benefit to eligible and
qualified low-income beneficiaries of the Medi-Cal program.
2)Requires that those services be provided at licensed adult day
health care (ADHC) centers which are certified as providers by
the California Department of Aging (CDA), and must follow the
provisions of California's Bridge to Reform Waiver.
3)Declares the act as an urgency measure in order to ensure
sufficient time to implement these provisions, to ensure
continuity of care, and to ensure that the health and safety
of participants are protected.
4)Makes legislative findings and declarations.
EXISTING LAW :
1)In partnership with the federal government, establishes the
Medi-Cal program, to provide various health and long-term
services to low-income women and children, seniors, and people
with disabilities.
2)Authorizes the Department of Health Care Services (DHCS) to
enter into contracts with Managed Care Plans (MCPs) to provide
services to Medi-Cal enrollees.
3)Requires eligible families, children, seniors, and people with
disabilities to enroll in a Medi-Cal MCP for health care
services in specified counties.
4)Establishes the Coordinated Care Initiative (CCI) that
required DHCS to seek federal approval to establish
demonstration sites in up to eight counties to better serve
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the state's eligible seniors and persons with disabilities by
integrating delivery of medical, behavioral, and long-term
care services, and to identify strategies to integrate
Medicare and Medi-Cal for people in both programs.
1)Authorizes DHCS to require seniors and people with
disabilities (SPDs) who are eligible for Medi-Cal only to
enroll in Medi-Cal Managed Care plans for Long-Term Services
and Supports.
2)As a condition of a settlement agreement, (Case No. C-09-03798
SBA), requires the state to provide CBAS to eligible
participants through the end of August of this year.
FISCAL EFFECT : Unknown
COMMENTS :
Author's Statement : "AB 1552 ensures that thousands of frail
Californians who rely upon adult day health programs today, and
those who will need this service in the future, will be able to
remain independent and free of institutionalization for as long
as possible."
Background : As stated in the findings and declarations of AB
1552: The American population is swiftly aging. According to
the Centers for Disease Control, in 2007, individuals 65 years
of age and over represented 12.6% of the American population; by
2030 it is estimated the older adult population will reach 20%
of the whole, with 70 million adults over 65 years of age. Many
of these adults will experience disability and chronic
conditions. The Alzheimer's Association reports that over five
million Americans are living with Alzheimer's disease and that
number will grow to 16 million by 2050, with the cost of caring
for those individuals growing from $203 billion in 2013 to $1.2
trillion by mid-century.
According to the California Department of Finance Demographic
Unit, California's 65+ population will reach 5 million this
year. The California Department of Aging reports that one in
every five Californians is now age 60 or older and 40% of those
individuals have a disability.
Community Based Adult Services : CBAS is a Medi-Cal Managed Care
benefit available to eligible Medi-Cal beneficiaries enrolled in
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Medi-Cal Managed Care. Eligibility to participate in CBAS is
determined by the beneficiary's Medi-Cal Managed Care Plan.
Other Medi-Cal beneficiaries ineligible to enroll in Medi-Cal
Managed Care may receive CBAS. CBAS services include an
individual assessment, professional nursing services, physical,
occupational and speech therapies, mental health services,
therapeutic activities, social services, personal care, a meal,
nutritional counseling, and transportation to and from the
participant's residence and the CBAS center. CBAS replaced
Adult Day Health Care (ADHC) services which were an optional
benefit under the Medi-Cal Program through February 29, 2012.
Purpose of the Bill : AB 1552 extends the Community-Based Adult
Services (CBAS) program beyond the August 31, 2014 waiver
expiration. In counties that have implemented Medi-Cal managed
care, CBAS will be available as a managed care benefit. In
counties that have not implemented Medi-Cal managed care, or for
individuals that are exempt from enrollment in Medi-Cal managed
care, CBAS will be provided as a fee-for-service Medi-Cal
benefit.
Currently, no legislative statute authorizes CBAS. The program
operates under authority of a court directive scheduled to
expire in August 2014, along with an administrative request
granted by the federal government through an existing "Section
1115" waiver of the Social Security Act. An 1115 waiver allows
states to experiment, pilot or demonstrate projects which are
likely to assist in promoting the objectives of the Medicaid
program. The 1115 waivers are flexible, so states have room to
develop Medicaid Plans that suit their state's health care
goals.
Without legislative action, the future of the CBAS program is
uncertain after the court directive issued in December of 2011,
expires in August of 2014. At that time, program participants
risk losing the vital health and social services provided by
CBAS, and the state risks further costly court battles and more
expensive institutional placements for CBAS participants.
Placing the court-ordered CBAS program into statute assures
medically fragile Californians and their families' certainty and
access to a range of social and health supports delivered in a
clinical setting that avoids costlier institutional placements.
Like daycare for children in working families, this daytime care
model for frail, elder or functionally impaired adults is
essential in order to meet the moral, ethical, and legal duties
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of caregiving families.
History : For many years, Adult Day Health Care (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., challenged the elimination of ADHC
as a violation of the Supreme Court decision Olmstead v. L.C.
The state settled the lawsuit, agreeing to replace ADHC services
with a new program called CBAS effective April 1, 2012, to
provide necessary medical and social services to individuals
with intensive health care needs. The Department of Health Care
Services amended the "California Bridge to Reform" 1115 Waiver
to include the new CBAS program, which was approved by the
Centers for Medicare and Medicaid Services on March 30, 2012.
CBAS is operational under the 1115 Bridge to Reform waiver
through August 31, 2014.
The California Department of Aging and the Department of Health
Services facilitated a stakeholder process since October of 2013
to develop recommendations for future CBAS efforts. Six work
group meetings attended by managed care plan representatives,
providers, advocates, legislative staff, and administrative
staff, which developed recommendations to delete obsolete
provisions related to ADHC-to-CBAS transition, continue access
monitoring, create new special terms and conditions (STC) and
standards of participation (SOP) clarifying relationships
between managed care plans and providers, conditions for
grievances and appeals, administrative issues related to care
planning, and allowances for growth of new centers. Draft
language for these changes is being reviewed by the
administration, and may be available to work group participants
and others for review and comment shortly.
Support : Supporters argue that as the state implements health
care reform and becomes reliant upon managed, outcome-driven
care, it is essential that integrated community-based programs
remain key partners in the changing system. The Multipurpose
Senior Services Program Site Association argues that CBAS
services are essential for their clientele who are frail elders
eligible for skilled nursing care, but choose to live in less
costly settings.
Previous Hearing : AB 1552 passed Assembly Committee on Health
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April 8, 2014 by a vote of 18-0.
Previous and 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.
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: a) integrate Medi-Cal and
Medicare benefits under managed care for dual eligibles; and, b)
integrate Long Term Services and Support (LTSS) under managed
care for dual eligibles and Medi-Cal-only SPDs.
AB 96 (Blumenfield) would have established the Keeping Adults
Free of Institutions (KAFI) program and required DHCS to submit
an application to CMS to implement the program. AB 96 was
vetoed by Governor Brown.
AB 97 (Committee on Budget), Chapter 3, Statutes of 2011, among
other provisions eliminates ADHC as a Medi-Cal benefit.
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.
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.
REGISTERED SUPPORT / OPPOSITION :
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Support
Adult Day Services Network of Contra Costa
Alzheimer's Association
American Association of Retired Persons (AARP)
American Federation of State, County and Municipal Employees
(AFSCME), AFL-CIO
California Alliance for Retire Americans
California Association for Adult Day Services (CAADS)
California Commission on Aging
California Communities United Institute
California Medical Association
California Primary Care Association (CPCA)
Camelot Adult Day Health Care Center
Congress of California Seniors
County Welfare Directors Association of California (CWDA)
ESKATON Adult Day Health Center Carmichael
Evermost Health Management, Inc.
GetTogether Adult Day Health Care Center
Humboldt Senior Resource Center
LMS Health Partners
Los Angeles Aging Advocacy Coalition
MountainView ADHC, Inc.
Multipurpose Senior Services Program Site Association
National Association of Social Workers-California Chapter
(NASW-CA)
National Health law Program (NHeLP)
Poway Adult Day Health Care Center
St. Barnabas Senior Services
San Ysidro Health Center (SYHC)
Senior Services Coalition
State Independent Living Council (SILC)
Sunny Cal Adult Day Health Care Center, Inc.
United Domestic Workers of America (UDW)-AFSCME Local
3930/AFL-CIO
Numerous individuals (about 100).
Opposition
None on file.
Analysis Prepared by : Robert MacLaughlin / AGING & L.T.C. /
(916) 319-3990
AB 1552
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