Bill Text: CA SB281 | 2021-2022 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Medi-Cal: Short-Term Community Transitions program.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2022-09-30 - Chaptered by Secretary of State. Chapter 898, Statutes of 2022. [SB281 Detail]

Download: California-2021-SB281-Amended.html

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Amended  IN  Senate  March 03, 2021

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Senate Bill

No. 281

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Introduced by Senator Dodd

February 01, 2021

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An act to amend Sections 14196.2, 14196.4, and 14196.5 of, to amend the heading of Article 6.2 (commencing with Section 14196.2) of Chapter 7 of Part 3 of Division 9 of, to add Section 14196.7 to, and to add and repeal to add Article 6.25 (commencing with Section 14196.71) of to Chapter 7 of Part 3 of Division 9 of, and to repeal and add Section 14196.6 of, the Welfare and Institutions Code, relating to Medi-Cal, and declaring the urgency thereof, to take effect immediately.

LEGISLATIVE COUNSEL'S DIGEST

SB 281, as amended, Dodd. Medi-Cal: California Community Transitions program.

Existing law establishes 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 establishes the Money Follows the Person Rebalancing Demonstration, which is designed to achieve various objectives with respect to institutional and home- and community-based long-term care services provided under state Medicaid programs. Under the Money Follows the Person Rebalancing Demonstration, an eligible individual is required to meet prescribed qualifications, including that they have resided in an inpatient facility for at least 90 consecutive days.

Existing law requires the department to provide services consistent with the Money Follows the Person Rebalancing Demonstration for transitioning eligible individuals out of an inpatient facility who have not resided in the facility for at least 90 days, and to cease providing those services on January 1, 2024. Existing law repeals these provisions on January 1, 2025.

This bill would instead require the department to provide those services for individuals who have not resided in the facility for at least 60 days, and would make conforming changes. The bill would require the department to use federal funds, which are made available through the Money Follows the Person Rebalancing Demonstration, to implement prescribed services, and to administer those services in a manner that attempts to maximize federal financial participation if those services are not reauthorized or if there are insufficient funds. The bill would extend the provision of those services to January 1, 2029, and would extend the repeal date of those provisions to January 1, 2030.

This bill would require the department to implement and administer the California Community Transitions program to provide services for qualified beneficiaries who have resided in the facility for 60 days or longer. The bill would require a lead organization to provide services under the program. The bill would require program services to include prescribed services, such as transition coordination services. The bill would authorize a Medi-Cal beneficiary to participate in this program if the Medi-Cal beneficiary meets certain requirements, and would require eligible Medi-Cal beneficiaries to continue to receive program services once they have transitioned into a qualified residence. The bill would require the department to use federal funds, which are made available through the Money Follows the Person Rebalancing Demonstration, to implement this program, and to administer the program in a manner that attempts to maximize federal financial participation if that program is not reauthorized or if there are insufficient funds. The bill would repeal these provisions January 1, 2030.

This bill would declare that it is to take effect immediately as an urgency statute.

Digest Key

Vote: 2/3   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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Bill Text

The people of the State of California do enact as follows:

SECTION 1.

 The heading of Article 6.2 (commencing with Section 14196.2) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code is amended to read:

Article  6.2. Short Term Community Transitions

SEC. 2.

 Section 14196.2 of the Welfare and Institutions Code is amended to read:

14196.2.

 (a) (1) The Legislature finds and declares that in order to reduce the risk of transmission of COVID-19 during the current pandemic and to further the objectives of the Money Follows the Person Rebalancing Demonstration, a temporary program is hereby established to facilitate the transition of individuals from an inpatient facility who have resided in that setting for fewer than 60 days.

(2) The department shall provide services consistent with the Money Follows the Person Rebalancing Demonstration Program, program, pursuant to Section 6071 of Public Law 109-171, as amended, for transitioning eligible individuals out of inpatient facilities.

(b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this article by means of letters, provider bulletins, or similar instructions, without taking regulatory action.

(c) Commencing January 1, 2023, 2028, the department shall cease to enroll beneficiaries pursuant to this article and commencing January 1, 2024, 2029, the department shall cease to provide services pursuant to this article.

SEC. 3.

 Section 14196.4 of the Welfare and Institutions Code is amended to read:

14196.4.

 The following definitions apply for purposes of this article:

(a)  “Eligible individual” means a Medi-Cal beneficiary who meets both of the following requirements:

(1) The individual meets the definition of an “eligible individual” under Section 6071(b)(2) of Public Law 109-171, except that the individual is not required to have resided for at least 60 consecutive days in an inpatient facility.

(2) The individual is targeted to receive assistance in transitioning from an inpatient facility to a qualified residence, identified in the agreement between the department and the federal Centers for Medicare and Medicaid Services for the Money Follows the Person Rebalancing Demonstration, except the individual shall not be required to have resided for at least 60 consecutive days in an inpatient facility.

(b) “Inpatient facility” has the same meaning as that term is defined in Section 6071(b)(3) of Public Law 109-171.

SEC. 4.

 Section 14196.5 of the Welfare and Institutions Code is amended to read:

14196.5.

 (a) A Medi-Cal beneficiary who has resided for at least 60 consecutive days in an inpatient facility, as required by the Money Follows the Person Rebalancing Demonstration, is not eligible for services under this article unless the department determines that any necessary federal approvals have been obtained and federal financial participation is available for this purpose.

(b) Services shall not be provided pursuant to this article during any period that the department has obtained any necessary federal approvals under the Money Follows the Person Rebalancing Demonstration to not apply the eligibility requirement that the beneficiary has resided for at least 60 consecutive days in an inpatient facility.

SEC. 5.Section 14196.7 is added to the Welfare and Institutions Code, to read:

14196.7.

(a)The department shall use federal funds made available through the Money Follows the Person Rebalancing Demonstration, as authorized under Section 1396a of Title 42 of the United States Code, to implement the services described in this article.

(b)If the Money Follows the Person Rebalancing Demonstration is not reauthorized, or if sufficient funds are not appropriated through the Money Follows the Person Rebalancing Demonstration, the department shall fund the services described in this article, and shall administer those services in a manner that attempts to maximize federal financial participation.

(c)The department may seek enhanced and complementary funding to increase the utilization of services described in this article.

SEC. 5.

 Section 14196.6 of the Welfare and Institutions Code is repealed.

14196.6.

This article shall remain in effect only until January 1, 2025, and as of that date is repealed.

SEC. 6.

 Section 14196.6 is added to the Welfare and Institutions Code, to read:

14196.6.

 This article shall remain in effect only until January 1, 2030, and as of that date is repealed.

SEC. 6.SEC. 7.

 Article 6.25 (commencing with Section 14196.71) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:

Article  6.25. California Community Transitions

14196.71.

 (a) The department shall provide services consistent with the Money Follows the Person Rebalancing Demonstration Program, program, pursuant to Section 6071 of Public Law 109-171, as amended, for transitioning eligible individuals out of inpatient facilities.

(b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this article by means of letters, provider bulletins, or similar instructions, without taking regulatory action.

14196.72.

 (a) The department shall implement and administer the California Community Transitions (CCT) program to help an eligible Medi-Cal beneficiary move to a qualified residence after the beneficiary has resided in an institutional health facility for a period of 60 days or longer. The department shall administer this program consistent with the federal Money Follows the Person Rebalancing Demonstration, as authorized under Section 1396a of Title 42 of the United States Code.

(b) CCT program services shall be provided by a lead organization, as defined in subdivision (d) of Section 14196.74. A lead organization shall coordinate and ensure the delivery of all services necessary to implement this article. Lead organization functions shall include all of the following:

(1) Ascertaining the eligibility and interest of a CCT-eligible beneficiary to return to a qualified residence by completing the following:

(A) Reviewing the beneficiary’s medical records, including prior and current medical conditions, current treatments, functional impairments, cognitive and behavioral status, and ability to perform activities and instrumental activities of daily living.

(B) Reviewing the beneficiary’s family support.

(C) Interviewing the beneficiary, and if applicable, their legal representatives, guardians, conservators, or anyone else authorized in writing by the beneficiary to speak with the CCT lead organization.

(2) Conducting an independent assessment to ascertain the beneficiary’s functional ability and identify associated risks that must be addressed to ensure their health and welfare in the community.

(3) Developing a person-centered initial CCT transition and care plan, as defined in subdivision (c) of Section 14196.74, and a final CCT transition and care plan, as defined in subdivision (d) of Section 14196.74.

(4) Following up with the CCT program beneficiary to ensure home- and community-based long-term services and supports that are provided pursuant to the final CCT transition and care plan continue to meet the needs and preferences of the beneficiary in the community for 365 days after transition.

(c) The CCT program services shall include, but are not limited to, all of the following:

(1) Transition coordination services, including enrollment, transition and care planning, and post-transition followup.

(A) Enrollment shall include, but is not limited to, interviewing a potential participant, conducting a clinical assessment, and developing a person-centered initial CCT transition and care plan, as defined in subdivision (c) of Section 14916.74.

(B) Transition and care planning shall include, but is not limited to, developing a final CCT transition and care plan as defined in subdivision (b) of Section 14196.74 and setting up and securing proposed home- and community-based long-term services and supports.

(C) Post-transition followup shall include, but is not limited to, services to ensure that long-term services and supports are in place and a participant’s needs continue to be met by the services and supports available to them in the community.

(2) Habilitation services, including coaching and life skills development, training for the individual to learn, improve, or retain adaptive, self-advocacy, and social skills. Habilitation services shall support transitions and improve the beneficiary’s quality of life in the community. Habilitation services shall include both of the following:

(A) Pretransition habilitation services, which shall be provided to a CCT program beneficiary while the beneficiary is still living in an inpatient facility. The services shall ensure the beneficiary is able to live safely in the community on the day of transition.

(B) Post-transition habilitation services, which shall be provided to a CCT program beneficiary who has transitioned out of an inpatient facility and shall provide ongoing support to the beneficiary in the community.

(3) Family and informal caregiver training.

(4) Personal care services to assist a beneficiary to remain at home including, but not limited to, assistance with independent activities of daily living and adult companionship.

(5) Home setup services, including, but not limited to, nonrecurring setup expenses for goods and services for a beneficiary who will be directly responsible for living expenses upon transition.

(6) Home modification services, including environmental adaptions to a beneficiary’s home, including, but not limited to, grab bar and ramp installation, modifications to existing doorways and bathrooms, and installation or removal of specialized electric and plumbing systems.

(7) Vehicle adaption services, including, but not limited to, devices, controls, and training required to enable beneficiaries, their family members, and their caregivers to transport beneficiaries in their own vehicles.

(8) Provision of assistive devices, which means adaptive equipment designed to accommodate a beneficiary’s functional limitations and promote independence, including, but not limited to, lift chairs, stair lifts, diabetic shoes, and adaptations to personal computers.

(d) Eligible Medi-Cal beneficiaries shall continue to receive program services once they have transitioned into a qualified residence for up to 365 days after the transition date.

(1) If an eligible Medi-Cal beneficiary receiving CCT services is readmitted to an inpatient facility for a period of less than 30 days, the beneficiary remains enrolled in the CCT program and eligible for services up to 365 days after the beneficiary was admitted into the facility.

(2) If an eligible Medi-Cal beneficiary receiving CCT program services is readmitted to an inpatient facility for a period of more than 30 days, the beneficiary shall complete a new clinical assessment and a new transition and care plan. Upon approval of the new plan, the beneficiary may reenroll in the program without meeting the requirement set forth in subparagraph (A) of paragraph (1) of subdivision (e).

(e) (1) Participation in the CCT program shall be voluntary for an eligible individual. The CCT program shall be made available to an eligible individual.

(2) The CCT program shall target Medi-Cal beneficiaries who meet at least one of the following criteria:

(A) Individuals who are 65 years of age and older who have one or more functional, medical, or chronic conditions, including Alzheimer’s disease and other dementias.

(B) Individuals who have an intellectual or developmental disability, or both, that manifested before 18 years of age.

(C) Individuals who are under 65 years of age who have at least one physical disability, including individuals who are HIV positive or have AIDS.

(D) Individuals who have been diagnosed with a chronic mental illness.

(E) Individuals who have experienced brain trauma resulting in functional challenges, but who do not have a mental illness.

(F) Individuals who are residents of nursing facilities with few or no care options outside the facility due to the individual’s medical or behavioral conditions.

(f) (1) CCT program services shall be provided by a CCT lead organization pursuant to a contract with the department.

(2) (A) A lead organization that intends to enroll a beneficiary for CCT services shall do all the following:

(i) Complete a clinical assessment of the beneficiary.

(ii) Provide the beneficiary with a new enrollee information form.

(iii) Work with the beneficiary to establish an initial CCT transition and care plan, which shall be approved by the department before the beneficiary receiving receives the services.

(B) (i) Before enrolling the beneficiary in the CCT program, the lead organization shall ensure the beneficiary meets the requirements established in subdivision (e).

(ii) The completed clinical assessment, new enrollee information form, and final CCT transition and care plan shall be submitted to the department.

(3) All services provided pursuant to this article shall be person-centered and driven by the beneficiary receiving the services and supports.

(4) (A) A clinical assessment using the consolidated Assisted Living Waiver (ALW)-CCT assessment tool shall be performed by a registered nurse.

(B) The department may exempt a lead organization from the requirement specified in subparagraph (A) if a staff member of the lead organization meets competency criteria established by the department and is able to perform the assessment.

14196.74.

 The following definitions apply for purposes of this article:

(a) “Eligible individual” is a Medi-Cal beneficiary who meets all of the following requirements:

(1) The beneficiary has resided continuously in an inpatient nursing facility for a minimum of 60 days and has received Medi-Cal benefits for services furnished by the facility for at least one day.

(2) The beneficiary has expressed interest in returning to the community and has been identified, referred by facility staff or family members, or self-referred to a CCT lead organization.

(3) The beneficiary has been deemed willing and eligible to transition to a qualified residence.

(4) The beneficiary would continue to require the level of care provided by an inpatient facility, but for the provision of home- and community-based services after transferring to a qualified residence.

(b) “Final CCT transition and care plan” means the final plan for the beneficiary’s transition to the community. The final CCT transition and care plan includes the secured housing option, medical and other services required to maintain continuation of care in the community, supervision of, or assistance with, activities and instrumental activities of daily living, finalized plans for managing identified risks and challenges the beneficiary may experience upon returning to the community, and the final transition date.

(c) “Initial CCT transition and care plan” includes the beneficiary’s preferred, qualified housing option; anticipated need for medical services and other services required to maintain continuation of care in the community, based on medical necessity; anticipated need for supervision of, or assistance with, activities and instrumental activities of daily living, plans for managing identified risks and challenges the beneficiary may experience upon returning to the community; and a targeted transition date.

(d) “Lead organization” means an organization that is qualified to provide Medi-Cal home- and community-based services and meets any other requirements established by the department for the purposes of implementing this article.

(e) “Person-centered” refers to a care planning process that is driven by the beneficiary receiving services and supports, which includes people chosen by the beneficiary, provides necessary information and support to the beneficiary to ensure the beneficiary directs the process to the maximum extent desired, and, includes individually identified goals and preferences related to relationships, community participation, employment, income and saving, health care and wellness, education, and risk factors and plans to minimize them.

(f) “Qualified residence” means a home owned or leased by an eligible Medi-Cal beneficiary or their family member, an apartment with sleeping, bathing, and cooking areas over which the beneficiary or the beneficiary’s family has domain and control, or another residence in a community-based residential setting that meets the requirements of the federal home- and community-based settings rule, as determined by the department, and consistent with the requirements identified in Parts 430 and 431 of Title 42 of the Code of Federal Regulations and Section 1915 of the Social Security Act (42 U.S.C. Sec. 1396n).

14196.75.

(a)A Medi-Cal beneficiary who has resided for fewer than 60 days in an inpatient facility, as required by the Money Follows the Person Rebalancing Demonstration, is only eligible for services under this article if the department determines that any necessary federal approvals have been obtained and federal financial participation is available for this purpose.

(b)Services shall not be provided pursuant to this article during any period that the department has obtained any necessary federal approvals under the Money Follows the Person Rebalancing Demonstration to not apply the eligibility requirement that the beneficiary has resided for fewer than 60 days in an inpatient facility.

14196.76. 14196.75.

 (a) The department shall use federal funds made available through the Money Follows the Person Rebalancing Demonstration, authorized under Section 1396a of Title 42 of the United States Code, to implement the CCT program.

(b) If the Money Follows the Person Rebalancing Demonstration is not reauthorized, or if sufficient funds are not appropriated through the Money Follows the Person Rebalancing Demonstration, the department shall fund the CCT program and shall administer the program in a manner that attempts to maximize federal financial participation.

(c) The department may seek enhanced and complementary funding to increase participation in the CCT program.

14196.77.

This article shall remain in effect only until January 1, 2030, and as of that date is repealed.

SEC. 7.SEC. 8.

 This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:

In order to ensure continuity of integrated, high-quality health and community-based services for Medi-Cal beneficiaries that seek to transition from a health care facility to the community, it is necessary that this act take effect immediately.