BILL ANALYSIS �
AB 1552
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Date of Hearing: May 7, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 1552 (Lowenthal) - As Amended: April 10, 2014
Policy Committee: Health Vote:18-0
Aging and Long-Term Care Vote: 6-0
Urgency: Yes State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill continues the Community-Based Adult Services (CBAS)
program as a Medi-Cal benefit, and codifies related requirements
for CBAS consistent with current practice.
FISCAL EFFECT
1)Assuming federal approval is granted, annual costs to DHCS for
continuation of CBAS as a Medi-Cal benefit of approximately
$300 million total annually, and growing in future years (50%
GF/50% federal). Since the special terms and conditions of a
related federal waiver specifies CBAS must be operational
through August 31, 2014, 2014-15 costs for 10 additional
months of service are expected to be approximately $250
million (50% GF/50% federal).
2)Minor administrative costs (50% GF/50% federal) to DHCS to
secure federal approval.
3)Currently incurred costs to the Department of Public Health
(DPH) associated with the licensure of Adult Day Health
Centers (ADHCs), and California Department of Aging (CDA)
associated with certifying facilities, would continue to be
incurred. If not for the continuation of CBAS through this
bill or another mechanism, there would likely be a reduction
in the number of ADHC providers, reducing licensure workload
for DPH and certification workload for CDA.
COMMENTS
1)Purpose . The author indicates this bill will ensure the CBAS
AB 1552
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program continues beyond the current requirement that the
program operate through August 31, 2014.
2)Brief History of CBAS and ADHC . The provision of ADHC
services is an optional Medi-Cal benefit. It includes
medical, nursing care, meals, social and therapeutic
activities, and transportation services provided at licensed
ADHC centers to qualifying individuals. Along with other
optional benefits, it was contemplated for elimination during
the recent fiscal crisis, setting off a series of events as
follows:
a) March 2011: A budget trailer bill eliminated ADHC as an
optional Medi-Cal benefit, subject to federal approval.
b) June 201: A class action lawsuit, Darling et al. v
Douglas., was filed in U.S. District Court on behalf of
35,000 ADHC participants, seeking to block the elimination
of ADHC as an optional Medi-Cal benefit, on grounds that
eliminating ADHC without appropriate replacement services
would violate the Americans With Disabilities Act by
placing participants at risk of institutionalization,
hospitalization, injury or death.
c) November 2011: DHCS announced a settlement agreement
that created CBAS, a smaller, more targeted program to
serve former ADHC clients most in need of medical and
social services.
d) January 2012: The court granted final approval of the
settlement.
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. 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. However, DHCS
indicates it is pursuing an extension to the federal waiver
amendment to extend the state's authority to provide CBAS.
CBAS costs are included in the DHCS 2014-15 proposed budget,
reflected in managed care rates.
1)Support . Numerous advocates for seniors, in addition to CBAS
providers, support this bill.
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2)Prior Legislation.
a) 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.
b) 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.
c) AB 97 (Committee on Budget), Chapter 3, Statutes of
2011, among other provisions, eliminates ADHC as a Medi-Cal
benefit.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081