Bill Text: CA AB1518 | 2015-2016 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Medi-Cal: nursing facilities.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Engrossed - Dead) 2016-11-30 - Died on Senate inactive file. [AB1518 Detail]
Download: California-2015-AB1518-Amended.html
Bill Title: Medi-Cal: nursing facilities.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Engrossed - Dead) 2016-11-30 - Died on Senate inactive file. [AB1518 Detail]
Download: California-2015-AB1518-Amended.html
BILL NUMBER: AB 1518 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 26, 2015
INTRODUCED BY Committee on Aging and Long-Term Care (Assembly
Members Brown (Chair), Gipson, Levine, and Lopez)
MARCH 10, 2015
An act to amend and renumber Section 14132.99 of the
Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1518, as amended, Committee on Aging and Long-Term Care.
Medi-Cal: nursing facilities.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care
Services, under which qualified low-income individuals receive health
care services. The Medi-Cal program is, in part, governed and funded
by federal Medicaid Program provisions. Existing federal law
authorizes the state to obtain waivers for home
home- and community-based services. Existing law
authorizes the department to seek an increase in the scope of these
waivers, in order to enable additional nursing facility residents to
transition into the community, subject to implementation of these
amended waivers upon obtaining federal financial participation, and
to the extent it can demonstrate fiscal neutrality within the overall
department budget.
This bill would make a technical, nonsubstantive change
to those provisions. authorize the department to seek
additional increases in the scope of the home- and community-based
Nursing Facility/Acute Hospital Waiver. The bill would require, by
July 1, 2016, an additional 5,000 slots beyond those currently
authorized for the waiver to be added . The bill would require that
the department consider specified factors, consult with stakeholders,
calculate the need for additional slots, and seek federal approval
to add those slots to the waiver each year beginning January 1, 2016.
Prior to submitting the annual request for additional waiver slots
and the waiver renewal request, the bill would require the department
to notify the appropriate f iscal and policy committees
of the Legislature of the number of waiver slots included in the
waiver renewal request along with data supporting that number of
slots.
The bill would require the department to make an eligibility and
level of care determination, and inform the individual about
available waiver services, within three business days of receipt of
the individual's application for those patients who are in acute care
hospitals and who are pending placement in a nursing facility and
for those individuals who are more likely than not to be placed in a
hospital or nursing facility within 30 days. The bill would require
an individual residing in an institutional setting at a level of care
included in the waiver to be determined to qualify for a waiver
level of care that is no lower than the level of care he or she
receives in the institution in which he or she resides, and would
prohibit the department from using more stringent eligibility
criteria for a waiver level of care than for the corresponding
institutional level of care.
The bill would require the department, by July 1, 2016, to take
all necessary steps so that individuals who are clients of a regional
center for individuals with developmental disabilities and who
receive private duty nursing through the Early Periodic Screening,
Diagnosis, and Treatment Program (EPSDT) seamlessly transition from
receipt of private duty in-home nursing provided through EPSDT to
medically necessary in-home nursing provided through adult Medi-Cal
or a regional center when the individual reaches 21 years of age.
The bill would require the department to adjust the cost
limitation category of the waiver to use an aggregate cost limit
formula, as specified. The bill would require the department to
implement its provisions only if the department has obtained the
necessary approvals and receives federal financial participation.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14132.99 of the
Welfare and Institutions Code , as added by Section 3 of
Chapter 551 of the Statutes of 2005, is amended and
renumbered to read:
14132.99. 14132.991. (a) For the
purposes of this section, "facility residents" means individuals who
are currently residing in a nursing facility and whose care is paid
for by Medi-Cal either with or without a share of cost. The term
"facility residents" also includes individuals who are hospitalized
and who are or will be waiting for transfer to a nursing facility.
(b) An By July 1, 2016, an
additional 500 5,000 slots beyond
those currently authorized for the home- and community-based
Level A/B nursing facility waiver shall be added and 250 of
these slots shall be reserved for residents residing in facilities
and transitioning out of facilities. Nursing
Facility/Acute Hospital Waiver shall be added to ensure that
individuals residing in, or at risk of, out-of-home placements,
including nursing facilities, can be considered for, and, if
eligible, receive services from the waiver without delay.
(c) (1) Each year, the department shall consider the factors
listed in paragraph (2), consult with stakeholders, calculate the
need for additional slots, and seek federal approval to add those
slots to the Nursing Facility/Acute Hospital Waiver.
(2) The factors considered by the department pursuant to paragraph
(1) shall include, but not be limited to, all of the following:
(A) Any waiting list for Nursing Facility/Acute Hospital Waiver
services, including, but not limited to, waiting lists for a
particular level of care.
(B) The needs identified by programs that assist people to leave
nursing homes.
(C) The results of surveys of nursing home residents, including,
but not limited to, the Minimum Data Sets (MDS), which identify
residents who want to leave nursing homes.
(3) Prior to submitting the annual request for additional waiver
slots and the waiver renewal request, the department shall notify the
appropriate fiscal and policy committees of the Legislature of the
number of waiver slots included in the waiver renewal request along
with data supporting that number of slots.
(c)
(d) For those patients who are in acute care hospitals
and who are pending placement in a nursing facility, and for
those individuals who are at imminent risk of placement in a hospital
or nursing facility, the department shall expedite the
processing of waiver applications in order to divert
facilitate remaining in a community setting and
hospital discharges from into the community
rather than to nursing facilities into the community.
facilities. For purposes of this section, both of the
following definitions apply:
(1) "Imminent risk" means more likely than not to occur within 30
days.
(2) "Expedite the processing of waiver applications" means that
the department shall make an eligibility and level of care
determination, and inform the individual about available waiver
services, within three business days of receipt of the application.
(e) An individual residing in an institutional setting at a level
of care included in the Nursing Facility/Acute Hospital Waiver shall
be determined to qualify for a waiver level of care that is no lower
than the level of care he or she receives in the institution in which
he or she resides. The department shall not use more stringent
eligibility criteria for a waiver level of care than for the
corresponding institutional level of care.
(f) (1) By July 1, 2016, the department shall take all necessary
steps so that individuals who are clients of a regional center for
individuals with developmental disabilities pursuant to the Lanterman
Developmental Disabilities Services Act (Division 4.5 (commencing
with Section 4500)) and who receive private duty nursing through the
Early Periodic Screening, Diagnosis, and Treatment Program (EPSDT),
as described in Section 1396d of Title 42 of United State Code,
seamlessly transition from receipt of private duty in-home nursing
provided through EPSDT to medically necessary in-home nursing
provided through adult Medi-Cal or a regional center when the
individual reaches 21 years of age.
(2) The individuals described in paragraph (1) shall be eligible
for at least the same level of services received through the EPSDT
program unless the individual, and his or her authorized
representative, as appropriate, agree that the individual's needs
have decreased and less service is needed.
(3) The department shall maximize federal financial participation
to meet the identified level of need for in-home nursing to ensure
that a consumer does not experience a reduction in in-home nursing
when he or she reaches 21 years of age.
(d)
(g) The nursing facility Level A/B waivers
Nursing Facility/Acute Hospital Waiver shall be
amended to add the following services:
(1) One-time community transition services as defined and allowed
by the federal Centers for Medicare and Medicaid Services, including,
but not limited to, security deposits that are required to obtain a
lease on an apartment or home, essential furnishings, and moving
expenses required to occupy and use a community domicile, set-up
fees, or deposits for utility or service access, including, but not
limited to, telephone, electricity, and heating, and health and
safety assurances, including, but not limited to, pest eradication,
allergen control, or one-time cleaning prior to occupancy. These
costs shall not exceed five thousand dollars ($5,000).
(2) Habilitation services, as defined in Section 1915(c)(5) of the
federal Social Security Act (42 U.S.C. Sec. 1396n(c)(5)), and in
attachment 3-d to the July 25, 2003, State Medicaid Directors Letter
re Olmstead Update No. 3, to mean services designed to assist
individuals in acquiring, retaining, and improving the self-help,
socialization, and adaptive skills necessary to reside successfully
in home- and community-based settings.
(e) When requesting the renewal of the waiver, the department
shall consider expanding the number of waiver slots. Prior to
submission of the waiver renewal request, the department shall notify
the appropriate fiscal and policy committees of the Legislature of
the number of waiver slots included in the waiver renewal request
along with supportive data for those slots.
(h) By July 1, 2016, the department shall adjust the cost
limitation category of the Nursing Facility/Acute Hospital Waiver to
use an aggregate cost limit formula.
(i) By July 1, 2016, the aggregate cost limit formula described in
subdivision (h) shall be based on 100 percent of the actual current
rates for the corresponding institutional levels of care specified in
the Nursing Facility/Acute Hospital Waiver. Any cost increase in an
institutional level of care shall be matched by an increase in the
cost limitation of the corresponding Nursing Facility/Acute Hospital
Waiver level of care.
(f)
(j) (1) The department shall
implement this section only to the extent it can demonstrate fiscal
neutrality within the overall department budget, and federal fiscal
neutrality as required under the terms of the federal waiver, and
only if the department has obtained the necessary approvals and
receives federal financial participation from the federal Centers for
Medicare and Medicaid Services. Contingent upon federal approval of
the waiver expansion, implementation shall commence within six months
of the department receiving authorization for the necessary
resources to provide the services to additional waiver participants.
(2) The department shall implement the amendments made to this
section by the act that added this paragraph only to the extent it
can demonstrate fiscal neutrality within the overall department
budget, and federal fiscal neutrality as required under the terms of
the federal waiver, and only if the department has obtained the
necessary approvals and receives federal financial participation from
the federal Centers for Medicare and Medicaid Services. Contingent
upon federal approval of the waiver expansion, implementation shall
commence within six months of the department receiving authorization
for the necessary resources to provide the services to additional
waiver participants.
SECTION 1. Section 14132.99 of the Welfare and
Institutions Code, as added by Section 3 of Chapter 551 of the
Statutes of 2005, is amended to read:
14132.99. (a) For the purposes of this section, "facility
residents" means individuals who are currently residing in a nursing
facility and whose care is paid for by Medi-Cal either with or
without a share of cost. The term "facility residents" also includes
individuals who are hospitalized and who are or will be waiting for
transfer to a nursing facility.
(b) An additional 500 slots beyond those currently authorized for
the home- and community-based Level A/B nursing facility waiver shall
be added and 250 of these slots shall be reserved for residents
residing in facilities and transitioning out of facilities.
(c) For those patients who are in acute care hospitals and who are
pending placement in a nursing facility, the department shall
expedite the processing of waiver applications so that upon discharge
those patients are diverted into the community rather than into
nursing facilities.
(d) The nursing facility Level A/B waivers shall be amended to add
the following services:
(1) One-time community transition services as defined and allowed
by the federal Centers for Medicare and Medicaid Services, including,
but not limited to, security deposits that are required to obtain a
lease on an apartment or home, essential furnishings, and moving
expenses required to occupy and use a community domicile, set-up fees
or deposits for utility or service access, including, but not
limited to, telephone, electricity, and heating, and health and
safety assurances, including, but not limited to, pest eradication,
allergen control, or one-time cleaning prior to occupancy. These
costs shall not exceed five thousand dollars ($5,000).
(2) Habilitation services, as defined in Section 1915(c)(5) of the
federal Social Security Act (42 U.S.C. Sec. 1396n(c)(5)), and in
attachment 3-d to the July 25, 2003, State Medicaid Directors Letter
re Olmstead Update No. 3, to mean services designed to assist
individuals in acquiring, retaining, and improving the self-help,
socialization, and adaptive skills necessary to reside successfully
in home- and community-based settings.
(e) When requesting the renewal of the waiver, the department
shall consider expanding the number of waiver slots. Prior to
submission of the waiver renewal request, the department shall notify
the appropriate fiscal and policy committees of the Legislature of
the number of waiver slots included in the waiver renewal request
along with supportive data for those slots.
(f) The department shall implement this section only to the extent
it can demonstrate fiscal neutrality within the overall department
budget, and federal fiscal neutrality as required under the terms of
the federal waiver, and only if the department has obtained the
necessary approvals and receives federal financial participation from
the federal Centers for Medicare and Medicaid Services. Contingent
upon federal approval of the waiver expansion, implementation shall
commence within six months of the department receiving authorization
for the necessary resources to provide the services to additional
waiver participants.
