Assembly Joint Resolution
No. 27
CHAPTER 29
Relative to social health maintenance organizations.
[
Filed with
Secretary of State
April 15, 2002.
]
LEGISLATIVE COUNSEL'S DIGEST
AJR 27, Oropeza.
Social HMO’s.
This measure would memorialize the President and Congress of the United States, the federal Department of Health and Human Services, and the Centers for Medicare and Medicaid Services to take various actions with respect to social health maintenance organizations.
Digest Key
WHEREAS, Government spending for nursing homes, home health care, and prescription drugs is rising at a rate of almost 10 percent a year, faster than the overall medical health care inflation rate of 4.3 percent for November 2000; and
WHEREAS, The growth of long-term care expenditures, estimated at 2.6 percent nationally on an annual basis coupled with the growing number of older Americans, will significantly increase costs to the nation’s Medicaid and Medicare programs; and
WHEREAS, Innovative and cost-effective models of care are needed to address the needs of aging Americans; and
WHEREAS, In the federal Deficit Reduction Act of 1984, Congress mandated the social health maintenance organization (social HMO) demonstration, which has since benefited over 125,000 individuals; and
WHEREAS, The social HMO demonstration has been reinforced and expanded by Congress in 1987, 1990, 1993, 1997, and 1999; and
WHEREAS, The social HMO is a community-based approach to integrating acute and long-term care for older Americans; and
WHEREAS, The primary purpose of the social HMO is to finance, provide, and coordinate additional services as an extension of benefits covered by Medicare and Medicaid, thereby helping frail seniors live safely in their own homes and avoid costly skilled nursing home placement; and
WHEREAS, The social HMO targets individuals at risk for nursing home placement and chronic illnesses; and
WHEREAS, The social HMO supplements the standard benefits required of Medicare+Choice with essential benefits, including geriatric-specific case management, adult day care, personal care, homemaker services, nutrition support, and medication management; and
WHEREAS, Sixty-eight percent of nursing home costs are financed by Medicaid, avoiding or delaying longer nursing home stays and directly saving federal and state funds, by reducing Medicaid nursing home expenditures; and
WHEREAS, California has 3.3 million residents aged 65 years and older, and is home to the largest elderly population in the country; and
WHEREAS, The number of Californians aged 60 years and older is projected to grow 154 percent over the next 40 years; and
WHEREAS, The fastest growing population group in California is aged 85 years and older; and
WHEREAS, Only one social HMO exists in California, serving over 48,000 seniors, of which 10,300 are eligible for nursing home placement; and
WHEREAS, The Senior Care Action Network (SCAN), the only social HMO in California, has been able to maintain these skilled nursing home-certifiable seniors in their own homes by providing home and community-based programs and services; and
WHEREAS, SCAN members are 53 percent less likely than their counterparts in other health care programs to have a long nursing home stay; and
WHEREAS, SCAN offers financial savings and security to older adults, their families, and taxpayers by alleviating anxiety about exhausting personal savings for long-term care by providing a benefit package that includes in-home services; and
WHEREAS, The permanency of the social HMO as a benefit option under the Medicare+Choice program will allow organizations like SCAN to provide comprehensive services to seniors anywhere in the nation; and
WHEREAS, The social HMO will serve as a national model of cost-effective care that provides older Americans with greater health, independence, and dignity ; now, therefore, be it
Resolved by the Assembly and Senate of the State of California, jointly, That the Legislature of the State of California hereby urges the President and Congress of the United States, the federal Department of Health and Human Services, and the Centers for Medicare and Medicaid Services to do all of the following:
(a) Affirm the intent of the social HMO program to provide services for frail and chronically ill seniors.
(b) Fully support the transition of the social HMO demonstration into a permanent benefit option as part of Medicare+Choice.
(c) Include Medicaid beneficiaries in the social HMO Medicare+Choice option.
(d) Allow the social HMO option to offer comprehensive services in addition to fundamental Medicare benefits.
(e) Approve and support a payment methodology needed for the advanced care for the nation’s frail and chronically ill elderly; and be it further
Resolved, That the Chief Clerk of the Assembly transmit copies of this resolution to the President and Vice President of the United States, the Speaker of the House of Representatives, the United States Secretary of Health and Human Services, the Administrator of the Centers for Medicare and Medicaid Services, and to each Senator and Representative from California in the Congress of the United States.