Bill Text: CA AB488 | 2023-2024 | Regular Session | Introduced
Bill Title: Medi-Cal: skilled nursing facilities: vision loss.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Failed) 2024-02-01 - From committee: Filed with the Chief Clerk pursuant to Joint Rule 56. [AB488 Detail]
Download: California-2023-AB488-Introduced.html
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Assembly Bill
No. 488
| Introduced by Assembly Member Stephanie Nguyen |
February 07, 2023 |
An act to amend Section 14126.024 of the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 488, as introduced, Stephanie Nguyen.
Medi-Cal: skilled nursing facilities: vision loss.
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 the department, subject to any necessary federal approvals, for managed care rating periods that begin between January 1, 2023, and December 31, 2026, inclusive, to establish and implement the Workforce and Quality Incentive Program under which a network provider furnishing skilled nursing facility services to a Medi-Cal managed care enrollee may earn performance-based directed payments from the Medi-Cal managed care plan with which they contract, as specified. Existing law, subject to an appropriation, requires the department to set the
amounts of those directed payments under a specified formula.
Existing law requires the department to establish the methodology or methodologies, parameters, and eligibility criteria for the directed payments, including the milestones and metrics that network providers of skilled nursing facility services must meet in order to receive a directed payment from a Medi-Cal managed care plan, with at least 2 of these milestones and metrics tied to workforce measures.
This bill would require that the measures and milestones include program access, staff training, and capital improvement measures aimed at addressing the needs of skilled nursing facility residents with vision loss. The bill would make related legislative findings.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
The Legislature finds and declares all of the following:(a) Data indicate that close to half of skilled nursing facility residents have a significant vision impairment.
(b) In general, skilled nursing facilities do not provide staff training that specifically addresses the needs of those with vision loss.
(c) These facilities seldom produce materials in large font, and therefore individuals with limited vision are often unable to have access to registration documents, schedules, menus, and other materials of importance to facility residents.
(d) (1) Numerous other issues exist for skilled nursing facility residents with vision loss, including the lack of assistive technology that could enable them to use available technology in these facilities, an inability to navigate around the facility due to difficult paths of travel and the lack of training and assistance by facility staff to gain this capacity, and the lack of inclusion in the facility’s programs and services in a way that is fully accessible to those with vision loss.
(2) In most areas of California, seniors with vision loss can have access to a variety of services, including orientation and mobility, daily living skills, technology training, including the availability and use of low-vision aids, and vision therapy services that are essential for those with recent vision loss to maximize their ability to live independently and even overcome some of the hurdles described in paragraph (1).
Yet, skilled nursing facility staff is rarely aware of these services. Even when staff is aware, a referral is rarely made to providers of these services for skilled nursing facility residents.
(e) Failure by skilled nursing facilities to meet the needs of residents with vision loss is a violation of federal and state law, including the federal Americans with Disabilities Act of 1990, Section 1557 of the federal Patient Protection and Affordable Care Act, and Section 11135 of the Government Code.
(f) Therefore, it is important that the needs of skilled nursing facility residents with vision loss begin to be addressed through milestones developed as part of the directed payment process in effect for payments from Medi-Cal managed care plans to providers pursuant to Section 14126.024 of the Welfare and Institutions Code.
SEC. 2.
Section 14126.024 of the Welfare and Institutions Code is amended to read:14126.024.
(a) For managed care rating periods that begin between January 1, 2023, and December 31, 2026, inclusive, the department, in consultation with representatives from the long-term care industry, organized labor, consumer advocates, and Medi-Cal managed care plans, shall establish and implement the Workforce and Quality Incentive Program under which a network provider furnishing skilled nursing facility services to a Medi-Cal managed care enrollee may earn performance-based directed payments from the Medi-Cal managed care plan they contract with in accordance with this section.(b) Subject to appropriation by the Legislature in the annual Budget Act, the department shall do all of the following:
(1) Set the amount of performance-based directed payments to target an aggregate amount of two hundred eighty million dollars ($280,000,000) for the 2023 calendar year.
(2) For the 2024 through 2026 calendar years, the department shall set the amount of the performance-based directed payments to target the previous calendar year’s target plus the annual increase specified by clause (ii) of subparagraph (A) of paragraphs (18), (19), and (20) of subdivision (c) of Section 14126.033.
(3) No sooner than December 31, 2023, the department shall make a one-time increase to the performance-based directed payment target amount by the amounts described in subdivision (f) of Section 14126.032. This one-time increase shall not be factored into the amount calculated for a subsequent calendar year pursuant to paragraph (2).
(c) The department, in consultation with stakeholders listed in subdivision (a), shall establish the methodology or methodologies, parameters, and eligibility criteria for the directed payments pursuant to this section. This shall include, but is not limited to, the milestones and metrics that network providers of skilled nursing facility services must meet in order to receive a directed payment from a Medi-Cal managed care plan pursuant to this section, with at least two of these milestones and metrics tied to workforce measures. The measures and milestones developed pursuant to this subdivision shall include program access, staff training, and capital improvement measures aimed at addressing the needs of skilled nursing facility residents with vision loss. Subject to subdivision (j), the department may implement the directed payment described in this section using one or more of the
models authorized at Section 438.6(c)(1)(i)-(iii), inclusive, of Title 42 of the Code of Federal Regulations.
(d) A freestanding pediatric subacute care facility, as defined in Section 51215.8 of Title 22 of the California Code of Regulations, shall be exempt from the directed payments described in this section.
(e) Notwithstanding any other law, special program services for the mentally disordered that are entitled to receive the supplemental payment under Section 51511.1 of Title 22 of the California Code of Regulations shall be exempt from the directed payments described in this section.
(f) Directed payments made pursuant to this section shall be in addition to any other payments made by the a Medi-Cal managed care plan to applicable network providers of skilled nursing facility services and shall not supplant
amounts that would otherwise be payable by a Medi-Cal managed care plan to a provider of skilled nursing facility services, including those payments made in accordance with paragraph (2) of subdivision (b) of Section 14184.201.
(g) For managed care rating periods during which this section is implemented, capitation rates paid by the department to a Medi-Cal managed care plan shall be actuarially sound and shall account for the directed payments described in this section.
(h) The department may require Medi-Cal managed care plans and network providers of skilled nursing facility services to submit information the department deems necessary to implement this section, at the times and in the form and manner specified by the department.
(i) Payments pursuant to this section shall be made in accordance with the
requirements for directed payment arrangements described in Section 438.6(c) of Title 42 of the Code of Federal Regulations and any associated federal guidance.
(j) In implementing this section, the department may contract, as necessary, with California’s Medicare Quality Improvement Organization, or other entities deemed qualified by the department, not associated with a skilled nursing facility, to assist with development, collection, analysis, and reporting of the performance data pursuant to this section. The department may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis for purposes of implementing this subdivision. Contracts entered into or amended pursuant to this subdivision shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and
the State Administrative Manual, and the State Contracting Manual, and shall be exempt from the review or approval of any division of the State Department of General Services.
(k) This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(l) For purposes of this section, the following definitions apply:
(1) “Medi-Cal managed care plan” has the same meaning as set forth in subdivision (j) of Section 14184.101.
(2) “Network provider” has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal
Regulations.
(3) “Skilled nursing facility” has the same meaning as set forth in subdivision (c) of Section 1250 of the Health and Safety Code, excluding a nursing facility that is a distinct part of a facility that is licensed as a general acute care hospital as described in subdivision (a) of Section 1250 of the Health and Safety Code.
