CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 781

Author:(Maienschein)

As Amended Ver:June 10, 2019

Majority vote

SUMMARY:

Requires Medi-Cal coverage of pediatric day health care (PDHC) services to be provided at any time of the day and on any day of the week, so long as the total number of authorized hours is not exceeded, up to 23 hours per calendar day.

The Senate Amendments:

Limit the authorization for coverage of pediatric day health care services to up to 23 hours per calendar day.

COMMENTS:

PDHC is an early and periodic screening, diagnosis treatment (EPSDT) supplemental skilled nursing service when rendered by a PDHC facility. PDHC is a day program of less than 24 hours that is individualized and family-centered, with developmentally appropriate activities of play, learning, and social interaction, designed to optimize the individuals’ medical status and developmental functioning so that they can remain within the family. There are 18 PDHCs and the PDHC providers indicate approximately 500 children receive services. To be eligible for PDHC services, recipients must be under 21 years of age and meet all of the following conditions:

1. The child must be medically fragile with an acute or chronic health problem that requires skilled nursing care and therapeutic intervention during all or part of the day;
2. The child must reside with parent(s), foster parent(s), or legal guardian(s); and,
3. The child cannot reside in any 24-hour inpatient facility.

PDHC does not contain a statutory or regulatory limit on the hours of operation or days of week a PDHC can operate. PDHC services require a treatment authorization request (TARs are a utilization control, and require approval by DHCS for payment). State regulations restrict the provision of PDHC services to an individual to less than 24 hours per day. The number of hours authorized for an individual child depends upon the child’s need. This bill is intended to clarify that the number of hours authorized per month for each child can be used any time, as long as the total number of hours is not exceeded.

According to the Author:

This bill will bring certainty to PDHC center providers who provide vital and lifesaving services, that their services will be considered skilled care regardless of the time of day, or day of week the care is provided.

Arguments in Support:

Several PDHC providers and the Pediatric Day Health Care Coalition write in support of this bill to clarify that PDHC can provide PDHC services at any time of day or day of the week as long as the total number of authorized hours of service have not been exceeded. Supporters argue their programs allow parents to work and provide quality care for their medically fragile children, and having flexibility in the times of day and days of week allow the centers to provide the support to best meet the needs of children and their families.

Arguments in Opposition:

There is no known opposition.

FISCAL COMMENTS:

None

VOTES:

ASM HEALTH: 15-0-0

YES: Wood, Mayes, Aguiar-Curry, Bigelow, Bonta, Burke, Carrillo, Flora, Limón, McCarty, Nazarian, Ramos, Rodriguez, Santiago, Waldron

ASSEMBLY FLOOR: 75-0-5

YES: Aguiar-Curry, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Muratsuchi, Nazarian, O'Donnell, Obernolte, Patterson, Petrie-Norris, Quirk, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

ABS, ABST OR NV: Arambula, Carrillo, Eduardo Garcia, Mullin, Quirk-Silva

SENATE FLOOR: 40-0-0

YES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dahle, Dodd, Durazo, Galgiani, Glazer, Lena Gonzalez, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Jones, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Stone, Umberg, Wieckowski, Wiener, Wilk

UPDATED:

VERSION: June 10, 2019

CONSULTANT: Scott Bain / HEALTH / (916) 319-2097 FN: 0001115

 CONSENT  

Bill No: AB 781

Author: Maienschein (D)

Amended: 6/10/19 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 9-0, 6/5/19

AYES: Pan, Stone, Durazo, Grove, Hurtado, Leyva, Mitchell, Monning, Rubio

ASSEMBLY FLOOR: 75-0, 4/4/19 (Consent) - See last page for vote

SUBJECT: Medi-Cal: family respite care

SOURCE: Pediatric Day Health Care Coalition

DIGEST:

This bill authorizes pediatric day health care services, for purposes of Medi-Cal coverage, to be provided at any time of the day and on any day of week, so long as the total number of authorized hours is not exceeded. This bill authorizes pediatric day health services to be covered for up to 23 hours per calendar day.

ANALYSIS:

Existing law:

1. Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), under which low-income individuals are eligible for medical coverage. [WIC §14000, et seq.]
2. Requires early and periodic screening, diagnosis treatment (EPSDT) for any individual under 21 years of age to be a covered benefit, consistent with federal law. [WIC §14132]
3. Requires pediatric day health care (PDHC) services, provided by a health facility licensed by the Department of Public Health (DPH) to provide PDHC services, to be a covered benefit, subject to terms, conditions and utilization control developed by DHCS. Prohibits PDHC services to include inpatient long-term care or family respite care. [WIC §14132.10]
4. Prohibits DHCS from approving a request for authorization for PDHC services if it determines that the total cost incurred by Medi-Cal for providing PDHC services and all other medically necessary services to the beneficiary is greater than the total cost incurred by the Medi-Cal program in providing equivalent services at the otherwise appropriate level of institutional or home care. [WIC §14132.10]
5. Requires DPH to create a program for licensing pediatric day health and respite care facilities (PDHRCF). Defines “pediatric day health and respite care facility” as a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology dependent children, except as provided under existing law. [HSC §1760 and 1760.2]

This bill:

1. Authorizes PDHC services, for purposes of Medi-Cal coverage, to be provided at any time of the day and on any day of week, so long as the total number of authorized hours is not exceeded.
2. Authorizes PDHC services to be covered up for up to 23 hours per calendar day.

Comments

1. Author’s statement. According to the author, there are currently 18 PDHCs operating in the state providing skilled nursing care to medically fragile and technology dependent children, serving approximately 500 families. The PDHCs provide center based care so that the participants are able to have socialized experiences and not be confined to a home setting. The skilled nursing care provided at all hours and on all days allows parents to work and still provide care to their children. In 2018, the state increased the rates paid to both PDHCs and pediatric services in Home Health care. The higher rate of $44.12 has provided PDHCs the ability to hire staff to remain competitive with the home health providers. The home health providers do not have any restriction on the hours of the day or days of the week that they can provide services. This bill clarifies that the two types of providers will be able to provide the same services at any time of day.
2. PDHC services. State and federal law mandate that Medi-Cal covers EPSDT services for all individuals under age 21 who have full-scope coverage. EPSDT services provide infants, children, and youth with age-appropriate preventive services, including screening for medical, dental, vision, hearing, and mental health, and for substance use disorders, as well as receiving developmental and specialty services. In addition to the regular Medi-Cal benefits, a beneficiary may receive additional medically necessary services, including supplemental skilled nursing service.

PDHC is an EPSDT supplemental skilled nursing service. PDHC facilities provide individualized and family-centered day programs, including play, learning, and social interaction, which is appropriate for a beneficiary’s medical status and developmental functioning and enables the beneficiary to remain with their family. To be eligible for PDHC services, beneficiaries must be under 21 years of age and meet all of the following conditions:

• 1. Be medically fragile with an acute or chronic health problem that requires skilled nursing care and therapeutic intervention during all or part of the day;
  2. Reside with their parent, foster parent, or legal guardians; and,
  3. Not reside in a 24-hour inpatient facility.

PDHC facilities must render services as prescribed by the beneficiary’s primary physician. Services provided must be consistent with the individual’s plan of care and authorized by DHCS through a Treatment Authorization Request (TAR). The TAR includes the number of service hours authorized and may be authorized for up to three or six months, depending on the type of request. State regulations provide rules on the total number of PDHC hours that may be authorized and the number of hours per day (not to exceed 24 hours per day), but does not include rules on the time of day or day of week services may be provided.

The 2018 Budget Act used revenues from the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) to increase the reimbursement rates for home health providers and PDHC facilities and directed DHCS to develop the structure and parameters of those rate increases. DHCS proposed to increase the PDHC rate by 50%, from $29.41 per hour to $44.22 per hour, and submitted to the Centers for Medicare and Medicaid Services the proposal for approval. DHCS received approval for the State Plan Amendment (SPA 18-0037) on September 17, 2018, and implemented the rate increase on December 28, 2018.

Related/Prior Legislation

AB 1147 (Maienschein, Chapter 206, Statutes of 2015) authorized a PDHRCF to establish a Transitional Health Care Needs Optional Service Unit, as specified. Authorized individuals 22 years of age and older to continue to receive care in a PDHRCF that has a Transitional Health Care Needs Optional Service Unit.

FISCAL EFFECT: Appropriation: No Fiscal Com.: No Local: No

SUPPORT: (Verified 6/11/19)

Pediatric Day Health Care Coalition (source)

Association of Regional Center Agencies

California Academy of Child & Adolescent Psychiatry

California Association for Health Services at Home

Caring Corner

Disability Rights California

KidShip Pediatric Day Health and Preschool

Loretta’s Little Miracles

My Friends Pediatric Day Healthcare Center

PTL Pediatric Daycare

Ridgeline Pediatric Day Health Care

Scribbles and Giggles

Together We Grow

OPPOSITION: (Verified 6/11/19)

None received

ARGUMENTS IN SUPPORT: This bill is sponsored by the Pediatric Day Health Care Coalition, which writes that the programs provided by their coalition members allow parents to work while knowing their children are being cared for in a safe, supportive, and nurturing environment. The Association of Regional Center Agencies writing in support of this bill, states that PDHC services provide a unique and valuable service to families with a child who has significant health needs, but there is a lack of clarity on whether providers are allowed to provide services at any time of the week. Together We Grow, a PDHC Center, also supports this bill and states that this bill provides flexibility in times of day and days of week that will enable them provide services to best meet the needs of children and families.

ASSEMBLY FLOOR: 75-0, 4/4/19

AYES: Aguiar-Curry, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

NO VOTE RECORDED: Arambula, Carrillo, Eduardo Garcia, Mullin, Quirk-Silva

Prepared by: Kimberly Chen / HEALTH / (916) 651-4111

6/12/19 14:12:24

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: AB 781

SUBJECT: Medi-Cal: family respite care

SUMMARY:

Authorizes pediatric day health care services, for purposes of Medi-Cal coverage, to be provided at any time of the day and on any day of week, so long as the total number of authorized hours is not exceeded.

Existing law:

1. Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), under which low-income individuals are eligible for medical coverage. [WIC §14000, et seq.]
2. Requires early and periodic screening, diagnosis treatment (EPSDT) for any individual under 21 years of age to be a covered benefit, consistent with federal law. [WIC §14132]
3. Requires pediatric day health care (PDHC) services, provided by a health facility licensed by the Department of Public Health (DPH) to provide PDHC services, to be a covered benefit, subject to terms, conditions and utilization control developed by DHCS. Prohibits PDHC services to include inpatient long-term care or family respite care. [WIC §14132.10]
4. Prohibits DHCS from approving a request for authorization for PDHC services if it determines that the total cost incurred by Medi-Cal for providing PDHC services and all other medically necessary services to the beneficiary is greater than the total cost incurred by the Medi-Cal program in providing equivalent services at the otherwise appropriate level of institutional or home care. [WIC §14132.10]
5. Requires DPH to create a program for licensing pediatric day health and respite care facilities (PDHRCF). Defines “pediatric day health and respite care facility” as a facility that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology dependent children, except as provided under existing law. [HSC §1760 and 1760.2]

This bill: Authorizes PDHC services, for purposes of Medi-Cal coverage, to be provided at any time of the day and on any day of week, so long as the total number of authorized hours is not exceeded.

FISCAL EFFECT:

This bill is keyed non-fiscal.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, there are currently 18 PDHCs operating in the state providing skilled nursing care to medically fragile and technology dependent children, serving approximately 500 families. The PDHCs provide center based care so that the participants are able to have socialized experiences and not be confined to a home setting. The skilled nursing care provided at all hours and on all days allows parents to work and still provide care to their children. In 2018, the state increased the rates paid to both PDHCs and pediatric services in Home Health care. The higher rate of $44.12 has provided PDHCs the ability to hire staff to remain competitive with the home health providers. The home health providers do not have any restriction on the hours of the day or days of the week that they can provide services. This bill clarifies that the two types of providers will be able to provide the same services at any time of day.
2. PDHC services. State and federal law mandate that Medi-Cal covers EPSDT services for all individuals under age 21 who have full-scope coverage. EPSDT services provide infants, children, and youth with age-appropriate preventive services, including screening for medical, dental, vision, hearing, and mental health, and for substance use disorders, as well as receiving developmental and specialty services. In addition to the regular Medi-Cal benefits, a beneficiary may receive additional medically necessary services, including supplemental skilled nursing service.

PDHC is an EPSDT supplemental skilled nursing service. PDHC facilities provide individualized and family-centered day programs, including play, learning, and social interaction, which is appropriate for a beneficiary’s medical status and developmental functioning and enables the beneficiary to remain with their family. To be eligible for PDHC services, beneficiaries must be under 21 years of age and meet all of the following conditions:

1. Be medically fragile with an acute or chronic health problem that requires skilled nursing care and therapeutic intervention during all or part of the day;
2. Reside with their parent, foster parent, or legal guardians; and,
3. Not reside in a 24-hour inpatient facility.

PDHC facilities must render services as prescribed by the beneficiary’s primary physician. Services provided must be consistent with the individual’s plan of care and authorized by DHCS through a Treatment Authorization Request (TAR). The TAR includes the number of service hours authorized and may be authorized for up to three or six months, depending on the type of request. State regulations provide rules on the total number of PDHC hours that may be authorized and the number of hours per day (not to exceed 24 hours per day), but does not include rules on the time of day or day of week services may be provided.

The 2018 Budget Act used revenues from the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) to increase the reimbursement rates for home health providers and PDHC facilities and directed DHCS to develop the structure and parameters of those rate increases. DHCS proposed to increase the PDHC rate by 50%, from $29.41 per hour to $44.22 per hour, and submitted to the Centers for Medicare and Medicaid Services (CMS) the proposal for approval. DHCS received approval for the State Plan Amendment (SPA 18-0037) on September 17, 2018 and implemented the rate increase on December 28, 2018.

1. Prior legislation. AB 1147 (Maienschein, Chapter 206, Statutes of 2015) authorized a PDHRCF to establish a Transitional Health Care Needs Optional Service Unit, as specified. Authorized individuals 22 years of age and older to continue to receive care in a PDHRCF that has a Transitional Health Care Needs Optional Service Unit.
2. Support. This bill is sponsored by the Pediatric Day Health Care Coalition, which writes that the programs provided by their coalition members allow parents to work while knowing their children are being cared for in a safe, supportive, and nurturing environment. The Association of Regional Center Agencies writing in support of the bill, states that PDHC services provide a unique and valuable service to families with a child who has significant health needs, but there is a lack of clarity on whether providers are allowed to provide services at any time of the week. Together We Grow, a PDHC Center, also supports the bill and states that the bill provides flexibility in times of day and days of week that will enable them provide services to best meet the needs of children and families.
3. Amendments. Existing regulations specify that PDHC is a day program that is less than 24 hours per day. The author proposes amendments to make clear that PDHC services may be covered up to 23 hours per calendar day.

SUPPORT AND OPPOSITION:

Support: Pediatric Day Health Care Coalition (sponsor)

Association of Regional Center Agencies

California Academy of Child & Adolescent Psychiatry

California Association for Health Services at Home

Caring Corner

Disability Rights California

KidShip Pediatric Day Health and Preschool

Loretta’s Little Miracles

My Friends Pediatric Day Healthcare Center

PTL Pediatric Daycare

Ridgeline Pediatric Day Health Care

Scribbles and Giggles

Together We Grow

Oppose: None received

-- END --

Date of Hearing: March 26, 2019

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 781 (

Author:Maienschein) – As Introduced Ver:February 19, 2019

SUBJECT: Medi-Cal: family respite care.

SUMMARY: Requires Medi-Cal coverage of pediatric day health care (PDHC) services to be provided at any time of the day and on any day of the week, so long as the total number of authorized hours is not exceeded.

EXISTING LAW:

1. Establishes a schedule of benefits in the Medi-Cal program, which includes early and periodic screening, diagnosis, and treatment (EPSDT) for any individual under 21 years of age, consistent with federal Medicaid law, and PDHC provided by a health facility licensed by the Department of Public Health (DPH) as a PDHC facility or a respite care facility, subject to terms, conditions, and utilization controls developed by the Department of Health Care Services (DHCS).
   
2. Defines a “pediatric day health and respite care facility” (aka as a PDHC facility) as a facility licensed by DPH that provides an organized program of therapeutic social and day health activities and services and limited 24-hour inpatient respite care to medically fragile children 21 years of age or younger, including terminally ill and technology-dependent patients.
   
3. Excludes inpatient long-term care or family respite care from the scope of coverage provided under Medi-Cal coverage of pediatric day care.
   
4. Requires coverage for PDHC services to be available only to the extent that no additional net program costs are incurred.
   
5. Prohibits DHCS from approving a request for authorization of PDHC when the beneficiary for whom the authorization is requested is an inpatient in a licensed healthcare facility.
   
6. Prohibits DHCS from approving a request for authorization of pediatric day care if DHCS determines that the total cost incurred by the Medi-Cal program for providing PDHC services and all other medically necessary services to the individual beneficiary is greater than the total cost incurred by the Medi-Cal program in providing medically equivalent services at the beneficiary’s otherwise appropriate level of institutional or home care.
   
7. Requires coverage for PDHC services to be available only to the extent that federal financial participation in the cost of providing these services is available pursuant to a federally approved state plan amendment including those services as a Medi-Cal program benefit.

FISCAL EFFECT: None

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill will bring certainty to PDHC center providers who provide vital and lifesaving services, that their services will be considered skilled care regardless of the time of day, or day of week the care is provided.
2. BACKGROUND. PDHC is an EPSDT supplemental skilled nursing service when rendered by a PDHC facility. PDHC is a day program of less than 24 hours that is individualized and family-centered, with developmentally appropriate activities of play, learning, and social interaction, designed to optimize the individuals’ medical status and developmental functioning so that they can remain within the family. There are 18 PDHCs and the PDHC providers indicate approximately 500 children receive services. To be eligible for PDHC services, recipients must be under 21 years of age and meet all of the following conditions:
   1. The child must be medically fragile with an acute or chronic health problem that requires skilled nursing care and therapeutic intervention during all or part of the day;
   2. The child must reside with parent(s), foster parent(s), or legal guardian(s); and,
   3. The child cannot reside in any 24-hour inpatient facility.

PDHC does not contain a statutory or regulatory limit on the hours of operation or days of week a PDHC can operate. PDHC services require a treatment authorization request (TARs are a utilization control, and require approval by DHCS for payment). State regulations restrict the provision of PDHC services to an individual to less than 24 hours per day. The number of hours authorized for an individual child depends upon the child’s need. This bill is intended to clarify that the number of hours authorized per month for each child can be used any time, as long as the total number of hours is not exceeded.

1. The 2018-19 BUDGET ACT. The 2018 Budget Act required DHCS to develop the structure and parameters for supplemental provider payments and rate increases to be made for certain categories of providers. Included in those increases were rate increases for PDHC facilities in the Medi-Cal fee-for-service (FFS) system. DHCS was required to post the proposed payment structure of these provider payments on its Internet Website by September 30, 2018, upon the approval of the Director of Finance. Effective for dates of services on and after July 1, 2018, DHCS increased PDHC services rates by 50%, using Proposition 56 revenue (which increased tobacco product and electronic cigarette taxes) to fund the non-federal share of these rate increases. The Centers for Medicare and Medicaid Services (CMS) approved State Plan Amendment 180037 on September 17, 2018, which increased PDHC rates, effective July 1, 2018. The current Medi-Cal FFS reimbursement rate for PDHC services is $29.41 per hour. The reimbursement rate for EPSDT PDHC support service rates will increase by 50%, to $44.12 an hour, effective July 1, 2018. The PDHC rate increase is expected to be implemented in January 2019. DHCS will issue Erroneous Payment Correction for the retroactive period of July 2018 through December 2018, which is expected to be implemented in April 2019.
2. SUPPORT. Several PDHC providers and the Pediatric Day Health Care Coalition write in support of this bill to clarify that PDHC can provide PDHC services at any time of day or day of the week as long as the total number of authorized hours of service have not been exceeded. Supporters argue their programs allow parents to work and provide quality care for their medically fragile children, and having flexibility in the times of day and days of week allow the centers to provide the support to best meet the needs of children and their families.
3. RELATED LEGISLATION. AB 1147 (Maienschein), Chapter 206, Statutes of 2015, created a licensing category for pediatric day health and respite care facilities (PDHRCFs), including all the requirements and standards that such facilities must adhere to, and revised the definition of a pediatric day health and respite care facility, which was currently limited to children 21 years of age or younger, to also permit an individual who is 22 years of age or older to receive care if the facility receives approval for a Transitional Health Care Needs Optional Service Unit, which is established by this bill.
4. CLARIFYING AMENDMENT TO EXISTING LAW. The code section this bill amends uses the phrase “pediatric day health care” and “pediatric day care.” In conversations with the sponsor, they indicate these two phrases mean the same thing. Staff recommends a technical amendment to change existing law references to “pediatric day care” to “pediatric day health care.”

REGISTERED SUPPORT / OPPOSITION:

Support

California Association for Health Services at Home

Disability Rights California

Kidship Pediatric Day Health and Preschool

Loretta’s Little Miracles

Pediatric Day Health Care Coalition

Scribbles and Giggles

Together We Grow

Opposition

None on file.

Analysis Prepared by: Scott Bain / HEALTH / (916) 319-2097