Bill Text: CA AB1518 | 2015-2016 | Regular Session | Amended

California Assembly Bill 1518 (Prior Session Legislation)

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 NUMBER: AB 1518	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 27, 2015
	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, 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- 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 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,
  require the department to,  by  July 1,
  February 1,  2016,  apply for  an
additional 5,000 slots beyond those currently authorized for the
 waiver to be added .   waiver.  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 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.
   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.   provide that an individual who 
 enrolls in the waiver upon attaining 21 years of age who is no
longer eligible to receive services through the Early and Periodic
Screening, Diagnosis, and Treatment Program (EPSDT) shall receive the
same level of services under the waiver that he or she received
through the EPSDT program. 
   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: 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:
   14132.991.  (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) By  July 1,   February 1,  2016,
 the department shall apply   for  an additional
5,000 slots beyond those currently authorized for the home- and
community-based Nursing Facility/Acute Hospital  Waiver shall
be added   Waiver,  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,  including,
but not limited to, individuals who use or would like to use waiver
services,   programs with state contracts to divert people
from or help people leave nursing homes, the designated protection
and advocacy organization, independent living centers, area agencies
on aging, staff providing services available under Article 7
(commencing with Section 12300) of   Chapter 3, known as the
In-Home Supportive Services program, and managed care plans
providing Medi-Cal long-   term services and support, 
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) 
    (B)  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.
   (d)  (1)    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 facilitate remaining in
a community setting and hospital discharges into the community
rather than to nursing facilities.  For 
    (2)     For  purposes of this section,
both of the following definitions apply: 
   (1) 
    (A)  "Imminent risk" means more likely than not to occur
within  30 days.   60 days, as determined by a
treating professional, including, but not limited to, a physician, a
licensed clinical social worker, or a nurse.  
   (2) 
    (B)  "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.   An individual
who enrolls in the Nursing Facility/Acute Hospital Waiver upon
attaining 21 years of age who is no longer eligible to receive
services under the Early and Periodic Screening, Diagnosis, and
Treatment (EPSDT) program shall be eligible for at least the same
level of services under the Nursing Facility/Acute Hospital Waiver
that he or she received through the EPSDT program unless the
individual, and his or her authorized repr   esentative, as
applicable, agree that the individual's needs have decreased and a
lower level of service is needed.  
   (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) 
    (2)  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.
   (g) The 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.
   (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.
   (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.