BILL ANALYSIS �
AB 1552
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CONCURRENCE IN SENATE AMENDMENTS
AB 1552 (Lowenthal)
As Amended August 4, 2014
2/3 vote. Urgency
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|ASSEMBLY: |77-0 |(May 28, 2014) |SENATE: |24-11|(August 21, |
| | | | | |2014) |
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Original Committee Reference: HEALTH
SUMMARY : Establishes the Community-Based Adult Services (CBAS)
program as a Medi-Cal benefit, in both Medi-Cal fee-for-service
and managed care, and specifies requirements for CBAS program
eligibility, and provider licensure and certification.
The Senate amendments establish CBAS program eligibility
criteria. Specifically, the Senate amendments require CBAS
benefit to be available to all CBAS beneficiaries who meet or
exceed specified medical necessity criteria and who qualify
based on one of the following criteria:
1)Meeting or exceeding Nursing Facility Level of Care A.
2)Having a diagnosed traumatic brain injury or chronic mental
disorder, as defined, and needing assistance or supervision
with activities of daily living (such as bathing, dressing,
and feeding one's self), and instrumental activities of daily
living (such as money management, and meal preparation).
3)Having moderate to severe cognitive disorder, such as
dementia.
4)Having a mild cognitive disorder, and needing assistance or
supervision with at least two instrumental activities of daily
living.
5)Having a developmental disability, as defined.
FISCAL EFFECT : According to the Senate Appropriations
Committee:
1)Ongoing costs of about $380 million per year to continue to
provide Community-Based Adult Services in the counties in
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which this program is currently operating (General Fund and
federal funds). As noted below, the state is currently
offering Community-Based Adult Services under a court order
that is set to expire in August of 2014. Community-Based
Adult Services is an optional benefit that states are not
required to offer under federal law. In the absence of this
bill, the state could elect to discontinue the program after
August 2014 (although the state may be subject to further
legal action if it did so).
2)Potential cost savings due to reduced institutionalization and
improved clinical outcomes for participating Medi-Cal
beneficiaries (General Fund and federal funds). The intent of
offering Community-Based Adult Services is to allow Medi-Cal
beneficiaries who are at risk of being institutionalized (for
example, placement in a skilled nursing facility) due to
physical illness and cognitive impairment to remain in the
community. To the extent that Community-Based Adult Services
actually keeps a Medi-Cal beneficiary out of institutional
care, this benefit will almost certainly reduce state
spending. Whether or not the overall program reduces state
spending will depend, in part, on whether the benefit is
provided to beneficiaries who are likely to be
institutionalized and the clinical success of the benefit in
preventing institutionalization.
3)Unknown costs to expand Community-Based Adult Services
statewide (General Fund and federal funds). Prior to March
2012, Community-Based Adult Services were limited by the
availability of providers. At that time, 26 counties had an
Adult Day Health Center provider (the predecessor to
Community-Based Adult Services). Current law places a
one-year moratorium on new Community-Based Adult Services
providers, which can be extended by the Department of Health
Care Services. This bill does not extend the moratorium on
providers. If the Department relaxes the moratorium on new
providers, the Community-Based Adult Services could become
available in the 32 counties that do not currently have a
provider. However, the remaining 32 counties are generally
rural counties with small populations. Given the low
population densities of those counties, it is not clear
whether the operation of an Adult Day Health Center could be
financially viable or whether there would be significant
demand for those services, given long travel times to and from
such a center.
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4)Unknown costs to the Department of Public Health for licensing
of additional Adult Day Health Centers (Licensing and
Certification Fund). To the extent that new Adult Day Health
Centers open to provide Community-Based Adult Services, those
facilities would be licensed by the Department. All licensing
and enforcement costs would be reimbursed by fees.
5)Ongoing costs of about $3.3 million per year to certify that
Community-Based Adult Services providers are meeting Medi-Cal
program criteria and requirements by the Department of Aging
(General Fund and federal funds). Under an interagency
agreement with the Department of Health Care Service, the
Department of Aging is responsible for certifying that
providers meet all the applicable Medi-Cal program
requirements.
COMMENTS : According to the author, this bill 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. The author states
that without this bill, CBAS will not be offered in Medi-Cal
beyond August 31, 2014, meaning that many frail elderly and
disabled adults will be without these community-based services.
The Department of Health Care Services (DHCS), the California
Department of Public Health, and the California Department of
Aging (CDA) jointly administer CBAS, which offers services to
eligible older adults and/or adults with disabilities to restore
or maintain their capacity for self-care and delay or prevent
inappropriate 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 replaced ADHC as a Medi-Cal benefit. ADHC was an optional
community-based day program that provided eligible participants
at risk of nursing home placement with a variety of services
including physical, occupational and speech language pathology
therapies, therapeutic activities and social services. ADHC was
eliminated as a Medi-Cal benefit in order to achieve General
Fund savings. Subsequently, a lawsuit, Esther Darling, et al.
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v. Toby Douglas, et al., (No.C-09-03798) contested the
elimination, and in November of 2011, the state reached a
settlement agreement with the plaintiffs that created CBAS as a
Medi-Cal benefit. Following the settlement, the state's "Bridge
to Reform" Section 1115 Waiver was amended to include the new
CBAS program, and Special Terms and Conditions (STC) were
established outlining standards for the program.
Under the STCs, CBAS is operational through August 31, 2014.
DHCS has requested permission from the federal government to
continue to offer CBAS for at least one more year. In June
2014, DHCS issued draft STCs upon which the eligibility criteria
added to this bill by the Senate amendments are based, and
submitted a draft CBAS Waiver Amendment to the Centers for
Medicare and Medicaid Services (CMS) for approval. On August 1,
2014, CMS granted a temporary extension of CBAS through October
31, 2014. According to CDA, this temporary extension will allow
the state to continue to provide CBAS as described in the
current Waiver STCs while giving CMS additional time to review
the draft CBAS Waiver amendment.
CBAS providers support this bill explaining that CBAS services
help frail people live in their own homes by managing their care
and providing necessary services. AARP argues 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 they provide for loved.
The Congress of California Seniors states 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.
DHCS opposes the bill stating that it is unnecessary because the
department has submitted a CBAS Waiver Amendment to continue
CBAS benefits beyond the existing sunset date. DHCS states that
the Waiver Amendment was submitted after an extensive six-month
stakeholder engagement process which included providers,
Medi-Cal managed care plans, consumers, advocates, legislative
staff, and others, and given the action already taken by DHCS to
continue CBAS, this bill is not necessary.
Analysis Prepared by : Kelly Green / HEALTH / (916) 319-2097
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