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SB-214 Medi-Cal: California Community Transitions program.(2019-2020)

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Date Published: 08/12/2019 02:00 PM
SB214:v95#DOCUMENT

Amended  IN  Assembly  August 12, 2019
Amended  IN  Senate  May 17, 2019
Amended  IN  Senate  May 02, 2019
Amended  IN  Senate  April 11, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill
No. 214


Introduced by Senator Dodd

February 06, 2019


An act to add Article 6.2 (commencing with Section 14196.2) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to Medi-Cal, and declaring the urgency thereof, to take effect immediately.


LEGISLATIVE COUNSEL'S DIGEST


SB 214, as amended, Dodd. Medi-Cal: California Community Transitions program.
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 establishes the Money Follows the Person Rebalancing Demonstration, which is designed to achieve various objectives with respect to institutional and home home- and community-based long-term care services provided under State state Medicaid programs.
This bill would require the department to implement and administer the California Community Transitions (CCT) program, as authorized under federal law and pursuant to the terms of the Money Follows the Person Rebalancing Demonstration, to help an eligible Medi-Cal beneficiary move to a qualified residence, as defined, after residing in an institutional health facility for a period of 90 days or longer. The bill would require CCT program services to be provided by a lead organization, as defined, which would coordinate and ensure the delivery of all services necessary to implement the program. The bill would specify the functions of the lead organization, the services to be offered under the CCT program, and the targeted populations for those services. The bill would specify that the CCT program is voluntary, and that eligibility to participate in the program would be determined by CCT lead organizations in accordance with specified requirements. The bill would require the department to use federal funds made available through the Money Follows the Person Rebalancing Demonstration to implement the CCT program, and if the demonstration is not reauthorized or sufficient funds are unavailable, to fund and administer the program in a manner that attempts to maximize federal financial participation. The bill would also authorize the department to seek enhanced and complementary funding. The bill would be operative only upon an appropriation in the annual Budget Act or another statute for the purposes of the bill.
This bill would declare that it is to take effect immediately as an urgency statute.
Vote: 2/3   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Article 6.2 (commencing with Section 14196.2) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:
Article  6.2. Community Living with Choice, Independence, and Dignity Act

14196.2.
 This article shall be known, and may be cited, as the California Community Living with Choice, Independence, and Dignity Act.

14196.3.
 (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, as defined in paragraph (5) of subdivision (g), after the beneficiary has resided in an institutional health facility for a period of 90 days or longer. The department shall administer this program consistent with the federal Money Follows the Person Rebalancing Demonstration 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 paragraph (3) of subdivision (g). A lead organization shall coordinate and ensure the delivery of all services necessary to implement this article. Lead organization functions include all of the following:
(1) Ascertaining the eligibility and interest of a CCT-eligible beneficiary to return to a qualified residence, as defined in paragraph (5) of subdivision (g), 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 paragraph (2) of subdivision (g) and a final CCT transition and care plan, as defined in paragraph (1) of subdivision (g).
(4) Following up with the CCT program beneficiary to ensure home and community based home- and community-based long-term services and supports that are provided pursuant to the final CCT transition and care plan continues 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. Enrollment includes, 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 paragraph (2) of subdivision (g). Transition and care planning shall include, but is not limited to, developing a final CCT transition and care plan as defined in paragraph (1) of subdivision (g), and setting up and securing proposed home- and community-based long-term services and supports. Post-transition followup includes, 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.
(A) Habilitation services shall include 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) Habilitation services shall include posttransition 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 set-up 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 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 including, but not limited to 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, as defined in paragraph (5) of subdivision (g), 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. The CCT program shall be made available to a Medi-Cal beneficiary who meets the following requirements:
(A) The beneficiary has resided continuously in an inpatient nursing facility for a minimum of 90 days and has received Medi-Cal benefits for services furnished by the facility for at least one day.
(B) 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.
(C) The beneficiary has been deemed willing and eligible to transition to a qualified residence.
(D) 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.
(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 lead organization that wishes to enroll a beneficiary for CCT services shall complete a clinical assessment of the beneficiary, provide the beneficiary with a new enrollee information form, and work with the beneficiary to establish an initial CCT transition and care plan, which shall be approved by the department prior to the beneficiary receiving services. Prior to enrolling the beneficiary in the CCT program, the lead organization shall ensure the beneficiary meets the requirements established in paragraph (1) of subdivision (e). 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 clinical assessment using the consolidated Assisted Living Waiver (ALW)-CCT assessment tool shall be performed by a registered nurse. The department may exempt a lead organization from this requirement if a staff member of the lead organization meets competency criteria established by the department and is able to perform the assessment.
(g) The following definitions apply for purposes of this section:
(1) “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.
(2) “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.
(3) “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.
(4) “Person-centered planning” means the “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.
(5) “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).

14196.4.
 (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.

14196.5.
 This article shall become operative only upon an express appropriation in the annual Budget Act or another statute for the purposes of this article.

SEC. 2.

 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.