CDCAN Report #154-2011 – JULY 25, 2011 – Monday

Says Administration Will Work To Transition Over 34,000 Seniors and People with Disabilities in the Program to Other Medi-Cal Community-Based Services - News Disappoint and Angers Disability and Senior Advocates Including Over 300 Community-Based Providers and 7,000 Workers

SACRAMENTO, CALIF (CDCAN)  [Last updated 07/25/2011 03L45 PM] - Governor Brown vetoed today AB 96, the budget trailer bill that calls for the creation of a new model of Adult Day Health Care saying the such a new “…look-alike program at this juncture is unnecessary and untimely,” in an action that is sure to disappoint and anger tens of thousands of people with disabilities and seniors, their families, hundreds of community-based providers and thousands of workers who provide those services. The Governor as expected, signed a less controversial budget trailer bill also dealing with adult day health centers – SB 91, that would allow those centers to continue to operate as licensed facilities without the requirement of being certified as a Medi-Cal provider.

The current version of Adult Day Health Care as a Medi-Cal “optional benefit” is scheduled for elimination as of December 1, 2011 (the original date was September 1, 2011, but the Department of Health Care Services requested that the effective date be delayed 90 days from that date to help with transition efforts.  The federal government approved the request last week). . 

[CDCAN Note:  A copy of the 2 page veto message is attached to this CDCAN Report titled "2011072-AB 96_Veto_Message.pdf"  . It was sent out by the Governor's office as a pdf "image" rather than a document, which means that persons who are blind or sight impaired will not be able to read it using a screen reading device.  I reproduced the full text of the veto message below in this report however - Marty Omoto]

 The news of the Governor’s veto will impact over 34,000 people with disabilities and seniors in the Adult Day Health Care program, and the over 300 community organizations and over 7,000 people who, as employees who provide those services – all who faced imminent elimination of the Medi-Cal service, and likely closure of hundreds of community-based providers and the loss of thousands of jobs across the State by December 1, 2011.

The Governor in his veto message added that the bill, authored by Assemblymember Bob Blumenfield (Democrat – Van Nuys), “…does not address the immediate need to transition ADHC [Adult Day Health Care] beneficiaries to other home and community-based services that can meet their needs, and would cause confusion for both consumers and providers about when an ill-defined” new model of Adult Day Health Care would be available.   

Regarding the existing over 300 community based providers who provide Adult Day Health Care services and their over 7,000 workers – all who face the prospect of loss of jobs or outright closure, the Governor in his veto message said that “…to the extent that adult day health care-type services can become part of an integrated continuum of care, my Administration will work to bring such providers into the conversation on how these services can be efficiently and effectively delivered for the benefit of consumers,” adding that “…for this reason, I am signing Senate Bill 91, which will allow adult day health centers to continue to operate after the fee-for-service payments under Medi-Cal expire.  This will allow adult day health centers tobe considered a care option as part of an integrated delivery system, or for consumers who may wish to access services apart from Medi-Cal.”

The elimination of the entire Adult Day Health Care program as a Medi-Cal “optional benefit”  was proposed by Governor Brown last January and approved by the Legislature in March as part of the larger package of spending cuts to close the enormous budget deficit.  The elimination of Adult Day Health Care as a Medi-Cal “optional benefit” was the largest single sweeping reduction in health and human services in at least the last 15 years with the combined direct impact of tens of thousands of recipients, workers and hundreds of community-based providers – nearly all who face imminent closure, and for individual workersthe  loss of jobs and income for their own families in a matter of months.  

It is called a Medi-Cal “optional benefit” because it is a benefit or service that the federal government does not require the states to provide as part of their approved Medicaid program (called “Medi-Cal” in California). 

WHAT THIS NEWS MEANS

* Adult  Day Health Care will remain a Medi-Cal benefit at least until December 1, 2011 (instead of September 1, 2011). 

* With the veto by the Governor today,  the Brown Administration – as represented by the Department of Health Care Services – will notofficially move forward in any planning, development or submission of a proposal for a new model of Adult Day Health Care under a new federal Medicaid waiver or other proposal under the Medicaid program . 

*  The State however will proceed officially with a plan to only move people currently in the Adult Day Health Care program into other similar Medi-Cal services – with no official plans regarding the transition of existing Adult Day Health Care centers and their employees, and no plans regarding development and submission of a proposal for a new model of the program under a federal Medicaid waiver or other Medicaid program. 

* The Legislature in March and again in June, restored $85 million in State general funds for the 2011-2012 State budget year to help in transition of the eliminated Medi-Cal benefit into a new model of Adult Day Health Care. 

*  However that amount is only half the State general funding that the Adult Day Health Care program received in the 2010-2011 State budget year that ended June 30th. It is not clear how many of the over 300 centers, 7,000 employees and over 34,000 recipients will be able to continue in a new model of Adult Day Health Care with State general funding cut by 50%. 

* A federal lawsuit to block the elimination from proceeding was filed in federal district court in June on behalf of the recipients of Adult Day Health Care.  A hearing was originally set for July 26th, but reportedly was postponed until November because of the delay in the effective date of the elimination of the Medi-Cal benefit until December 1, 2011.

WHO THIS IMPACTS

* Over 34, 000 seniors and people with disabilities – including thousands of persons with developmental disabilities, who are in the Adult Day Health Care program either through Medi-Cal or referred there through one of the 21 non-profit regional centers under the State’s Lanterman Developmental Disabilities Services Act  (the nation’s only civil rights act for persons with developmental disabilities).  It is not clear how the elimination of the Medi-Cal optional benefit impacts those persons since they were placed in those programs through regional centers – not through the Medi-Cal program.

* Over 7,000 people who work in the over 300 community-based organizations that provide Adult Day Health Care services – probably nearly all facing either outright closure and elimination of thousands of jobs in a matter of months, the time frame is not clear.   Advocates say that many of those people and organizations could be helped by the enactment of AB 96. 

*  Other agencies and community organizations, including the 21 non-profit regional centers, county health and human services agencies, including those involved with Medi-Cal, In-Home Supportive Services, housing and other supports and services. 

COMPLETE TEXT OF GOVERNOR’S VETO MESSAGE:

OFFICE OF THE GOVERNOR

July 25, 2011

To the Members of the California State Assembly:

I am returning Assembly Bill 96 without my signature.

The bill would recreate, under a different name, the same Adult Day Health Care

(ADHC) program that was eliminated as a Medi-Cal optional benefit through the 2011-12

Budget Act. While my Administration deeply shares the goal of “Keeping Adults Free

from Institutions,” creating a new ADHC look-alike program at this juncture is

unnecessary and untimely. It does not address the immediate need to transition ADHC

beneficiaries to other home and community-based services that can meet their needs, and

would cause confusion for both consumers and providers about when an ill-defined

“KAFI” program would be available.

In order to ensure that ADHC benefciaries do not face the risk of unnecessary

institutionalization when the benefit expires, my Administration is currently working

with adult day health centers, managed care plans, and local community-based

organizations to ensure that need medical services and home and community-based

services are available.  Additionally, in order to ensure that ther eis enough time for

transition to such services, the Department of Health Care Services recently extended the

ADHC benfit through administrative action untuil December 1, 2011, with federal

funding approval.

Given the importance if these transition efforts, I am directing the Department of Health

Care Services to work with the Legislature, stakeholders, managed care plans, and home

and community-based services providers to ensure that ADHC beneficiaries will have a

smooth transition to appropriate servies, and those who are most at risk of

institutionalization have access to services that will help them remain in the community.

Care in an integrated setting will be part of my Administration’s plan to improve long-

term care.  To the extent that adult day health care-type services can become part of an

integrated continuum of care, my Administration will work to bring such providers into

the conversation on how these services can be efficiently and effectively delivered for the

benefit of consumers.

For this reason, I am signing Senate Bill 91, which will allow adult day health centers to

continue to operate after the fee-for-service payments under Medi-Cal expire.  This will

allow adult day health centers to be considered a care option as part of an integrated

delivery system, or for consumers who may wish to access services apart from Medi-Cal.

Sincerely,

[SIGNED]

Edmund G. Brown Jr.

CDCAN SUMMARY OF ADULT DAY HEALTH CARE RELATED BUDGET TRAILER BILLS

This is the latest information and status (Monday, July 25, 2011) on the three budget related bills that impact Adult Day Health Care (or the people in the program as in the case of SB 93):

SB 91 – BUDGET TRAILER BILL: ADULT DAY HEALTH CARE: CENTERS: MEDI-CAL CERTIFICATION

AUTHOR: Senate Budget and Fiscal Review Committee

CDCAN SUMMARY:

Contains necessary technical corrections as a result of the elimination of Adult Day Health Care as a Medi-Cal “optional benefit” the budget trailer bill, AB 97 (Chapter 3, Statutes of 2011 as follows: 

*  Delinks licensure from Medi-Cal certification for Adult Day Health Care centers,  Current State law requires Adult Day Health Care Centers to be certified Medi-Cal providers as a condition of State licensure. This bill delinks certification and licensure.
*  Permits Adult Day Health Care centers  to operate “adult day programs,” for individuals  who do not require on-site medical care, without obtaining an  additional social services license and specifies that:

(a) The Adult Day Health Care center is to provide notice to the State
(b)  An on-site inspection will not be required; and
(c) The local fire authority shall determine capacity limits.
* Adds an appropriation allowing this bill to take effect immediately upon enactment.
PREVIOUS ACTION 07/14/2011: PASSED Assembly by vote of 51 to 8. In State Senate. Heard in Senate Budget and Fiscal Review Committee and referred to Senate floor.  PASSED State Senate by vote of  24 to 14. 

PREVIOUS ACTION 07/19/2011: Sent to the Governor at 1:00 PM.

LATEST ACTION 07/25/2011: SIGNED by the Governor.

EFFECTIVE DATE:  Effective upon approval of the Governor (or as provided for in the bill)

CDCAN COMMENT:  This 8 page bill does not address or resolve the current problems of transitioning the existing Adult Day Health Care program into a new model under a yet to be developed (and submitted) federal Medicaid waiver.

LATEST VERSION OF BILL – HTML: http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0051-0100/sb_91_bill_20110715_enrolled.html

LATEST VERSION OF BILL – PDF:  http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0051-0100/sb_91_bill_20110715_enrolled.pdf

PRIORITY: VERY HIGH 

SB 93 – BUDGET TRAILER BILL: HEALTH & HUMAN SERVICES: IHSS TRIGGER CUT  (“CLEAN-UP” BILL TO SB 73)  

AUTHOR: Senate Budget and Fiscal Review Committee

CDCAN SUMMARY

Makes technical change or correction to SB 73 provisions dealing with In-Home Supportive Services (IHSS) “trigger cuts”.  The bill would make a technical correction to correctly  identify the component, subdivision (b), of Control Section 3.94 of the Budget Act of 2011 that would cause the reduction in In-Home Supportive Services to be implemented under the triggers included in the budget package, and adds an appropriation allowing this bill to take effect immediately upon enactment.

PREVIOUS ACTION 07/14/2011:  In State Senate. Heard in Senate Budget and Fiscal Review Committee and referred to Senate floor.  PASSED State Senate by vote of 24 to 14. (PASSED Assembly by vote of 48 to 27 on 07/11/2011). 

LATEST ACTION 07/19/2011: Sent to the Governor at 1:00 PM. (no reported action as of 7/25/2011)

NEXT STEPS: Governor has 12 calendar days to sign or veto the bill (or allow it to become law without his signature.

CDCAN COMMENT:  This bill makes only a technical change to the provisions related to the previously approved “trigger cuts” to IHSS.  Clarifies that the IHSS “trigger cuts” are “tier 1″ trigger cuts. While this bill does not focus on Adult Day Health Care, In-Home Supportive Services does impact many of the over 34,000 people in the Adult Day Health Care program who also are in the IHSS program.     

LINK TO LATEST VERSION OF BILL – HTML   http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0051-0100/sb_93_bill_20110715_enrolled.html

LINK TO LATEST VERSION OF BILL – PDF:  http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0051-0100/sb_93_bill_20110715_enrolled.pdf

PRIORITY:  HIGH
AB 96 – ADULT DAY HEALTH CARE: KEEPING ADULTS FREE FROM INSTITUTIONS (“KAFI”)

AUTHOR: Assemblymember Bob Blumenfield (Democrat – Van Nuys)

CDCAN SUMMARY:

Would authorize the creation of a new model of Adult Day Health Care (ADHC) program, under a federal Medicaid Waiver, as follows:

* States legislative intent  to create the “Keeping Adults Free from Institutions” (KAFI) program, to provide community services that prevent institutionalization; that  the KAFI program allow recipients of Adult Day Health Care  be given  priority in transitioning; and, 

that the new program be established as quickly as possible. 

* Require the Department of Health Care Services to submit an application for a federal waiver, to implement the KAFI program, by September 1, 2011;
* Require the KAFI program to utilize licensed adult day health centers to provide medical, behavioral health, and social services to Medi-Cal recipients who are at high risk of institutionalization;
* Authorize the Department of Health Care Services to implement the KAFI program by way of a state plan amendment to the State’s Medicaid State Plan, federal waiver, or both; and,
* Require federal approval, federal financial  participation (federal matching funds) and an appropriation in the Annual Budget Act for implementation of KAFI.  

PREVIOUS ACTION 06/15/2011: PASSED Assembly by vote of 54 to 24.  (PASSED State Senate by vote of 24 to 15 on 06/10/2011)

PREVIOUS ACTION 07/14/2011: Sent to Governor at 3:15 PM. 

LATEST ACTION 07/25/2011: VETOED by Governor 

NEXT STEPS:  Legislature could attempt to over-ride the Governor’s veto – which requires 2/3rds vote in both houses – a highly unlikely event.     

CDCAN COMMENT:  This veto of AB 96 signals – as some advocates feared – a position by the Brown Administration not to continue Adult Day Health Care in any form.  See below for full text of this bill – and also attached as a pdf file)

LATEST VERSION OF BILL – HTML: http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_0051-0100/ab_96_bill_20110714_enrolled.html

LATEST VERSION OF BILL – PDF:  http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_0051-0100/ab_96_bill_20110714_enrolled.pdf

PRIORITY: VERY HIGH

TEXT OF AB 96 – “KEEPING ADULTS FREE FROM INSTITUTIONALIZATION”

This is the version of AB 96 that was passed by the Assembly and State Senate in mid-June and then sent to the Governor on July 14th, which he vetoed July 25, 2011.  

 The appropriation of $1,000 in State general fund in this budget trailer bill (and all others) is to make it officially a budget related bill that falls under the requirements of Proposition 25 (allowing for passage by a majority vote – and because it is a budget trailer bill connected to the main budget bill, to take effect immediately): 

BILL NUMBER: AB 96 ENROLLED

INTRODUCED BY   Committee on Budget