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SB-1033 Medi-Cal cost reporting: private duty nursing and congregate living health facilities. (2023-2024)

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Date Published: 05/17/2024 11:16 AM
SB1033:v96#DOCUMENT

Amended  IN  Senate  May 16, 2024
Amended  IN  Senate  April 15, 2024
Amended  IN  Senate  March 11, 2024

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill
No. 1033

Introduced by Senator Menjivar

February 06, 2024

An act to add Section 14105.14 to, and to add Article 3.87 (commencing with Section 14127) to Chapter 7 of Part 3 of Division 9 of of, the Welfare and Institutions Code, relating to health facilities. Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


SB 1033, as amended, Menjivar. Health facilities: Medi-Cal cost reporting: private duty nursing and congregate living health facilities.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 law requires a private duty nursing agency, as defined, to be a provider of skilled nursing services covered under certain Medicaid waiver programs, subject to federal approval and availability of federal financial participation. Existing law requires the agency, in addition to satisfying any other requirements as a condition for participation in the Medi-Cal program, to satisfy specified requirements, including the provision of skilled nursing services on a shift basis in a patient’s home or other community-based site appropriate for patient care.
This bill would require, by January 10, 2026, the department to develop and submit a cost estimate, on private duty nursing services provided to pediatric patients, to the appropriate fiscal and policy committees of the Legislature. The bill would require the cost estimate to estimate the cost of raising the Medi-Cal rates of private duty nursing services provided to pediatric patients to 87% of, and to 100% of, rates for corresponding services under the federal Medicare Program.
Existing law provides for the licensure and regulation of health facilities, including congregate living health facilities, by the State Department of Public Health. Existing law defines “congregate living health facility” as a residential home with a capacity of no more than 18 beds, with exceptions, that provides inpatient care that is generally less intense than that provided in general acute care hospitals but more intense than that provided in skilled nursing facilities.
Existing law, the Medi-Cal Long-Term Care Reimbursement Act, requires the State Department of Health Care Services to implement a facility-specific ratesetting system for nursing facilities using a cost-based reimbursement rate methodology and to update these rates annually.
This bill would require, under Medi-Cal provisions, by January 10, 2026, the State Department of Health Care Services to prepare and submit a cost study, on licensed congregate living health facilities, to the appropriate fiscal and policy committees of the Legislature. The bill would require the cost study to evaluate all financial and operational costs associated with those facilities, as specified. The bill would require the department to consult with facility providers, patients or families, caregivers, and other relevant parties in developing the study.

Existing law provides for the licensure and regulation by the State Department of Public Health of health facilities, including, congregate living health facilities. Existing law defines “congregate living health facility” as a residential home with a capacity of 18 beds that provides inpatient and skilled nursing care, as specified. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal Long-Term Care Reimbursement Act requires the department to implement a facility-specific ratesetting system using a cost-based reimbursement rate methodology and to update these rates annually.

This bill would require, beginning January 10, 2026, and every 3 years thereafter, the State Department of Health Care Services to prepare and submit a cost study to the appropriate fiscal and policy committees of the Legislature. The bill would require the cost study to evaluate all financial and operational costs associated with licensed congregate living health facilities, as specified. The bill would require the department to consult with congregate living health facility providers, patients or families, caregivers, and other relevant parties in preparing the study. The bill would require the department to adjust rates in a manner consistent with the study. The bill would require, after January 10, 2026, and each year thereafter, rate changes to be included in the Medi-Cal estimate, consistent with the annual Budget Act released on or before January 10 of each year, and are to be indexed to the previous fiscal year.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 14105.14 is added to the Welfare and Institutions Code, to read:

14105.14.
 (a) By January 10, 2026, the department shall develop and submit a cost estimate, on private duty nursing services provided to pediatric patients, to the appropriate fiscal and policy committees of the Legislature. The cost estimate shall be submitted in accordance with Section 9795 of the Government Code.
(b) The cost estimate described in subdivision (a) shall estimate the cost of raising the Medi-Cal rates of private duty nursing services provided to pediatric patients to 87 percent of, and to 100 percent of, rates for corresponding services under the federal Medicare Program.
(c) For purposes of this section, “private duty nursing services” has the same meaning as set forth in Section 14105.13 of this code and Section 1743.2 of the Health and Safety Code.

SECTION 1.SEC. 2.

 Article 3.87 (commencing with Section 14127) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:
Article  3.87. Congregate Living Health Facilities Cost Study

14127.
 (a) On or before January 10, 2026, and every three years thereafter, the State Department of Health Care Services shall submit a cost study to the appropriate fiscal and policy committees of the Legislature. This cost study shall (1) By January 10, 2026, the State Department of Health Care Services shall develop and submit a cost study, on licensed congregate living health facilities, to the appropriate fiscal and policy committees of the Legislature. The cost study shall be submitted in accordance with Section 9795 of the Government Code.
(2) The cost study described in paragraph (1) shall evaluate all financial and operational costs associated with licensed congregate living health facilities in California. In developing the cost study, the department shall consult with congregate living health facility providers, patients or families, caregivers, and other relevant parties.
(b) The cost study shall include, but not be limited to, an assessment of the operational costs of direct and indirect labor, licensing fees, medical equipment, food, utilities, liability insurance, property tax, and staff training.

(c)Notwithstanding any other law, the department shall adjust rates in a manner consistent with the triennial rate study required by subdivision (a). After January 10, 2026, and each year thereafter, rate changes shall be included in the Medi-Cal estimate, consistent with the annual Budget Act released on or before January 10 of each year, and shall be indexed to the previous fiscal year.