|
AB 499, (Aroner). Medi-Cal: assisted living demonstration project. Existing law provides for the Medi-Cal program, administered by the State Department of Health Services, under which qualified low-income persons are provided with health care services. This bill would require the department to develop a federal waiver program to test the efficacy of providing an assisted living benefit, as described, to beneficiaries under the Medi-Cal program. The program would involve reimbursement for services provided to Medi-Cal recipients placed in residential care facilities. It would impose various duties upon both the department and the State Department of Social Services in implementing the bill. The bill would impose certain conditions upon implementation of the waiver program, and would require an evaluation of that program. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. (a) It is the intent of the Legislature to develop options that allow elderly and disabled individuals maximum choice in determining their living arrangements, including the choice to remain in the least restrictive and most homelike environment as they age or grow frail. (b) It is further the intent of the Legislature to ensure that elderly and disabled individuals have access to appropriate health care and personal assistance, regardless of their income level, health status, or choice of housing arrangement. SEC. 2. Section 14132.26 is added to the Welfare and Institutions Code, to read: 14132.26. (a) The department shall develop a program that requires a waiver of federal law to test the efficacy of providing an assisted living benefit to beneficiaries under the Medi-Cal program. Assisted living benefits shall include, but are not limited to, the care and supervision activities specified in Section 1569.2 of the Health and Safety Code and Section 87101 of Title 22 of the California Code of Regulations, and other health-related services.The program developed pursuant to this section shall be known as thewaiver program for purposes of this section. The department shall submit any necessary waiver applications or modifications to the medicaid state plan to the Health Care Financing Administration to implement the waiver program, and shall implement the waiver program only to the extent federal financial participation is available. (b) The department shall develop the waiver program in conjunction with other state departments, consumers, consumer advocates, housing and service providers, and experts in the fields of gerontology, geriatric health, nursing services, and independent living. (c) The assisted living benefit shall be designed to provide eligible individuals with a range of services that enable them to remain in the least restrictive and most homelike environment while receiving the medical and personal care necessary to protect their health and well-being. Benefits provided pursuant to this waiver program shall include only those not otherwise available under the state plan, and may include, but are not limited to, medicine management, coordination with a primary health care provider, and case management. (d) (1) Eligible individuals shall be those who are eligible for the Medi-Cal program and are determined by the department to be eligible for placement in a nursing facility, as defined under subdivisions (c) and (d) of Section 1250 of the Health and Safety Code. Eligibility shall be based on an assessment of an individual's ability to perform functional and instrumental activities of daily living, as well as the individual's medical diagnosis and prognosis, and other criteria, including other Medi-Cal services that the beneficiary is receiving, as specified in the waiver. California Health and Safety Code Section 1250 (c) "Skilled nursing facility" means a health facility that
provides skilled nursing care and supportive care to patients whose
primary need is for availability of skilled nursing care on an extended basis. |
|||