Bill Text: CA SB998 | 2009-2010 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Long-term care: assessment and planning.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced - Dead) 2010-05-27 - Held in committee and under submission. [SB998 Detail]

Download: California-2009-SB998-Amended.html

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BILL NUMBER: SB 998	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 5, 2010

INTRODUCED BY    Senator   Liu 
 Senators   Liu   and Alquist 

                        FEBRUARY 9, 2010

   An act to  amend Section 1262.5 of, and to add Section 1264.5
to, the Health and Safety Code, and to  add Division 13
(commencing with Section 22100) to  , and to repeal Section 22104
of,  the Welfare and Institutions Code, relating to long-term
care services.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 998, as amended, Liu. Long-term care: assessment and planning.
   Existing law provides for the licensure of various health
facilities, including general acute care  facilities
  hospitals  , skilled nursing facilities, and
intermediate care facilities,  and congregate living health
facilities  by the State Department of Public Health. 
Certain of these facilities are included under the category of
long-term health car   e facilities, as defined. A violation
of these provisions is a crime. Existing law requires each hospital
to have in effect a written discharge planning policy and process
that requires appropriate arrangements for posthospital care and a
process   that requires that each patient be informed,
orally or in writing, of the continuing care requirements following
discharge from the hospital, as specified and additionally requires
specific information to be provided to a patient anticipated to be in
need of posthospital care.  
   This bill would require the hospital to provide the information
given to a patients anticipated to need posthospital care both orally
and in writing to the patient and, if necessary, to his or her
representative, at the earliest possible opportunity prior to
discharge. By changing the definition of an existing crime, this bill
would impose a state-mandated local program. 
   Existing law establishes the California Partnership for Long-Term
Care Program and requires the State Department of Health Care
Services to adopt regulations to administer the program.
   This bill would require the State Department of Health Care
Services to initiate a process to develop  or identify  , by
no later than July 1, 2012, a tool for the uniform long-term care
services assessment of individuals in order to assist  eligible
 consumers in finding long-term care services of their choice,
as specified. The department would be required to submit a report on
the use of these assessments to the Legislature.  The bill
would, commencing July 1, 2012, require, with certain exceptions,
every long-term health care facility that receives an application for
admission of a Medi-Cal eligible or Medicare/Medi-Cal eligible
person to initiate the assessment prior to admission or on the first
day for which Medi-Cal reimbursement is requested. It would also
require, commencing July 1, 2012, with certain exceptions, every
general acute care hospital that identifies a Medi-Cal eligible or
Medicare/Medi-Cal eligible person for referral to a long-term health
facility to initiate a uniform long-term care services assessment at
the time of referral. It would also prohibit, on and after January 1,
2013, any facility that admits a Medi-Cal eligible or
Medicare/Medi-Cal eligible person that has not initiated a required
uniform long-term care services assessment within 48 hours of
admission from receiving reimbursement until the assessment has been
initiated, and from being reimbursed for those days during which
assessment could have been initiated, but was not initiated.

   This bill would, among other things,  if the director makes a
specified certification,  require  every  
a  county  department of social services or public
health, when it establishes   to establish  a
long-term care case management program  , to assign case
managers to each acute care hospital, skilled nursing facility, and
other licensed long-term care facility located within the county
department's jurisdiction.   for specified persons. The
bill would require the program to provide prescribed services,
including assessment of care needed for persons in long-term health
care facilities, as defined, to enable them to reside in the
community and the services necessary to provide that case, and would
require the county or its designees to assign care managers to each
long-term health care facility within the county.  After these
facilities are notified of the appropriate case manager, each
facility would be required to inform the case manager when a new
patient or resident is admitted and  that  may need
specified assistance. 
   The bill also would require a long-term health care facility to
display at least one poster, in an area accessible to residents,
advertising the telephone number of the facility's designated case
manager, thus changing the definition of an existing crime and
imposing a state-mandated local program. 
   The bill would also require these persons, upon a discharge from a
long-term  health  care facility, to be provided with
prescribed services by the county, and would express intent
pertaining to the funding of these services. Because the bill would
impose various duties on each county, the bill would create a
state-mandated local program. 
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.  
   This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.  
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.  
   This bill would provide that with regard to certain mandates no
reimbursement is required by this act for a specified reason. 

   With regard to any other mandates, this bill would provide that,
if the Commission on State Mandates determines that the bill contains
costs so mandated by the state, reimbursement for those costs shall
be made pursuant to the statutory provisions noted above. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.   (a)    
California   The Legislature finds and declares all of
the following: 
    (a)     California  is home to the
largest older adult population in the nation. Currently,
approximately 4.4 million older adults will comprise almost 15
percent of the state's population. By 2030, projections suggest that
8.3 million older adults will account for nearly 18 percent of the
population.
   (b) California's services for older adults and other adults with
long-term care needs currently exist in an uncoordinated patchwork of
programs overseen by multiple state agencies and organizations,
rather than a coordinated continuum of care focused on providing
services that are consumer-centered, least restrictive, and most cost
effective.
   (c) All older adults and other adults with long-term care 
needs, whether they are residing in a nursing facility or living in
the community,   needs  should have access to
information about the services that are available in order to avoid
institutionalization and the services of a counselor or case manager
who can help navigate the multiple health and social service programs
that may provide benefits to that individual.
   (d) Given recent reports and recommendations, California needs a
strategic plan for long-term care services that will maximize the use
of finite resources and reduce the use of institutional care.
California's plan for the implementation of the federal Olmstead
decision is the beginning of the process of providing the statewide
service coordination and assessment necessary for a continuum of
services for those in need of long-term care, including older adults.

   (e) The public interest would best be served by a broad array of
long-term care services that support persons who need these services
at home or in the community whenever practicable, and that promote
individual autonomy, dignity, and choice. In-home supportive services
and adult day health care are examples of services that the state
should prioritize with stable and adequate funding.
   (f) Other states  that   , including
Pennsylvania and Washington,  have invested in a coordinated
approach for long-term care and home- and community-based services
 have   that has  improved the
effectiveness of the overall delivery system and reduced the rate of
growth of institutional care.
   (g) In order for California to adequately meet the challenges of
an aging population and implement the Olmstead decision, it is the
intent of the Legislature to establish an integrated system of
long-term care that will enable older adults and other adults with
long-term care needs to remain at home whenever possible and live in
the least restrictive environment with autonomy, dignity, and choice
whenever possible. 
   (h) Providing case management and transition services to residents
of institutions is in keeping with the federal Olmstead v. L.C.
(1999) 527 U.S. 581 decision and its focus on the rights of persons
with disabilities, including those who are aged, to have a choice in
where they live.  
   (i) Services provided through various Medicaid waivers and through
independent living centers, that assist persons to remain in or
return to their homes, can serve as a basis for providing case
management and transition services to additional individuals eligible
for these services.  
   (j) There is a need for a practical assessment of barriers to
returning home for aged persons and persons with disabilities who
reside in institutional care. 
   SEC. 2.    Section 1262.5 of the   Health
and Safety Code   is amended to read: 
   1262.5.  (a) Each hospital shall have a written discharge planning
policy and process.
   (b) The policy required by subdivision (a) shall require that
appropriate arrangements for posthospital care, including, but not
limited to, care at home, in a skilled nursing or intermediate care
facility, or from a hospice, are made prior to discharge for those
patients who are likely to suffer adverse health consequences upon
discharge if there is no adequate discharge planning. If the hospital
determines that the patient and family members or interested persons
need to be counseled to prepare them for posthospital care, the
hospital shall provide for that counseling.
   (c) The process required by subdivision (a) shall require that the
patient be informed, orally or in writing, of the continuing health
care requirements following discharge from the hospital. The right to
information regarding continuing health care requirements following
discharge shall apply to the person who has legal responsibility to
make decisions regarding medical care on behalf of the patient, if
the patient is unable to make those decisions for himself or herself.
In addition, a patient may request that friends or family members be
given this information, even if the patient is able to make his or
her own decisions regarding medical care.
   (d) (1) A transfer summary shall accompany the patient upon
transfer to a skilled nursing or intermediate care facility or to the
distinct part-skilled nursing or intermediate care service unit of
the hospital. The transfer summary shall include essential
information relative to the patient's diagnosis, hospital course,
pain treatment and management, medications, treatments, dietary
requirement, rehabilitation potential, known allergies, and treatment
plan, and shall be signed by the physician.
   (2) A copy of the transfer summary shall be given to the patient
and the patient's legal representative, if any, prior to transfer to
a skilled nursing or intermediate care facility.
   (e) A hospital shall establish and implement a written policy to
ensure that each patient receives, at the time of discharge,
information regarding each medication dispensed, pursuant to Section
4074 of the Business and Professions Code.
   (f) A hospital shall provide every patient anticipated to be in
need of long-term care at the time of discharge with contact
information for at least one public or nonprofit agency or
organization dedicated to providing information or referral services
relating to community-based long-term care options in the patient's
county of residence and appropriate to the needs and characteristics
of the patient. At a minimum, this information shall include contact
information for the area agency on aging serving the patient's county
of residence, local independent living centers, or other information
appropriate to the needs and characteristics of the patient. 
This information shall be provided both orally and in writing, and
shall be provided to the patient, and, if applicable, the patient's
authorized representative,   at the earliest possible
opportunity prior to discharge. 
   (g) A contract between a general acute care hospital and a health
care service plan that is issued, amended, renewed, or delivered on
or after January 1, 2002, may not contain a provision that prohibits
or restricts any health care facility's compliance with the
requirements of this section.
   SEC. 3.    Section 1264.5 is added to the  
Health and Safety Code   , to read:  
   1264.5.  Commencing January 1, 2012, a licensed long-term health
care facility, as defined in Section 22109 of the Welfare and
Institutions Code, shall display at least one poster, in an area
accessible to residents, advertising the telephone number of the
facility's designated case manager. The poster shall be developed in
consultation with the designated case manager and the State
Department of Health Care Services. 
   SEC. 2.   SEC. 4.   Division 13
(commencing with Section 22100) is added to the Welfare and
Institutions Code, to read:

      DIVISION 13.  LONG-TERM CARE ASSESSMENT AND PLANNING FOR
INDIVIDUALS


   22100.  It is the intent of the Legislature to establish a
long-term care services system that does all of the following:
   (a) Provides a continuum of social and health services that foster
independence and self-reliance, maintain individual dignity, and
allow consumers of long-term care services to remain an integral part
of their family and community life. Essential features of this
continuum may include any or all of the following:
   (1) Discharge planning in hospitals, skilled nursing facilities,
and other licensed care with the goal of returning an individual to
his or her home as soon as possible, with support services if
necessary. Discharge planning includes both diversion from hospital
to home and transition from skilled nursing facility or another
residential care setting to home. Discharge planning may begin before
a scheduled hospital visit.
   (2) The ability to maintain or make modifications on homes
necessary for a person to remain or to return. 
   (3) Budget flexibility within a unified budget for long-term care.
This includes funds for nursing facility services, in-home
supportive services (IHSS), adult day health care, a multipurpose
senior services project (MSSP), waiver programs, and other home- and
community-based services.  
   (3) A single point of entry that ensures that all individuals who
receive long-term care services understand their options for
remaining at home or in the community and that ensures that all
long-term care service providers know where to direct individuals for
an assessment of their options for home- and community-based
services. 
   (4) The integration and expansion of  federal 
 Medi-Cal  waiver programs to realize maximum federal fund
participation.
   (5) Rental assistance vouchers for those who are able to transfer
from an institution, but who have no permanent home.
   (6) A common database that is accessible and interoperable across
programs enabling the state and counties to combine and analyze data
from treatment authorization requests (TARs), in-home supportive
services, hospitals, nursing homes, and other facilities and
programs. 
   (7) Wraparound services, including case management, as described
in Section 22102, for individuals whose income and situation are
insufficient to enable them to navigate the obstacles to remain
successfully at home or in the community, when these options are
available and appropriate. 
   (b) Ensures that, if out-of-home placement is necessary, it is at
the appropriate level of care, and prevents unnecessary utilization
of acute care hospitals, skilled nursing facilities, and other
licensed residential care facilities.
   (c) Delivers long-term care services in the least restrictive
environment appropriate for the consumer, based on the consumer's
individual needs and choices.
   (d) Provides older adults with the information and supports needed
to exercise self-direction and to make choices, given  those
adults   their  capability and interest, and
involves them and their family members as partners in the development
and implementation of long-term care services.
   22101.  (a)  (1)    The State Department of
Health Care Services shall initiate a process, in collaboration with
stakeholders, to develop  or identify  no later than July 1,
2012, a tool for the uniform, long-term care services assessment of
individuals in order to assist  consumers  
eligible consumers, as described in subdivision (b) of Section 22102,
 in finding long-term care services of their choice.
Stakeholders in this process shall include consumer advocates,
advocates for older adults, disability rights advocates, public and
private hospitals, long-term  health  care facilities, home
health and hospice agencies, long-term care program representatives,
including in-home supportive services and county representatives 
, and formal and informal direct caregivers  . The uniform
long-term care services assessment tool  that  shall be
developed  to assist consumers make   or
identified   shall assist eligible consumers in making 
informed choices about home and community options for individuals
who are hospitalized and likely to need long-term care, 
individuals who reside in an institution,  or individuals in the
community who are likely to need long-term care.  In
 
   (2) The department may develop or identify the uniform, long-term
care services assessment without meeting the rulemaking requirements
of the Administrative Procedure Act, provided that at least one
30-day public comment period is used. 
    (3)     In  addition, the department
shall, in collaboration with the stakeholders, establish training
standards  for case management and  for the use of the
uniform long-term care services assessment tool  for use by
an individual pursuant to Section 22102.   as part of
the long-term care case management program described in Section
22102.  
   (b) Individuals eligible for the uniform long-term care services
assessment tool shall include all of the following: 

   (1) Medicaid enrollees and recipients, Medicaid applicants, or
individuals eligible for both Medicare and Medicaid. 

   (2) Individuals who apply or are likely to apply for admission to
a nursing facility.  
   (3) Individuals who are reasonably expected to become Medicaid
recipients within 180 days of admission to a nursing facility.
 
   (c) 
    (b)  In developing the uniform long-term care services
assessment tool, the department and stakeholders in the development
process shall consider  for inclusion in the assessment tool
 all of the following:
   (1) The long-term care programs for which the individual is or may
become eligible.
   (2) The individual's strengths, limitations, and preferences.
   (3) The individual's preferred living situation and environment.
   (4) The individual's physical health, and functional and cognitive
abilities.
   (5) The individual's available informal supports and other paid or
unpaid resources. 
   (6) The individual's need for intervention.  
   (6) The identification of barriers that prevent the individual
from living at home, in the community, or in a less restrictive
environment. 
   (7) The individual's need for case management activities.
   (8) The individual's need for referrals  to programs and
services  .
   (9) The individual's plan of care needs,  including all
  which may include, but is  not limited to,
any  of the following:
   (A) Personal care and household assistance needs.
   (B) Treatments or therapies, or both.
   (C) Medication management.
   (D) Seizures.
   (E) Skin care.
   (F) Preventive care.
   (G) Risk of falls.
   (H) Pain management.
   (I) Cognitive capacity.
   (J) Depression.
   (K) Problem behaviors.
   (L) Suicide risk.
   (M) Substance abuse.
   (N) Communication.
   (O) Family supports and other nonfamilial support systems.
   (P) Consumer goals. 
   (c) In developing or identifying the uniform, long-term care
services assessment, the department shall, in collaboration with the
stakeholders identified in subdivision (a), evaluate whether existing
federal, state, or county assessment tools or information systems
and processes may be used, integrated, or further developed to meet
the purposes of this section. Before the department, in collaboration
with the stakeholders, decides not to develop its own uniform,
long-term care services assessment and, instead, decides to identify
existing federal, state, or county assessment tools or information
systems and processes to use as the uniform, long-term care services
assessment, the department and the stakeholders shall consider the
extent to which the existing federal, state, or county assessment
tools or information systems and processes consider the items listed
in paragraphs (1) to (10), inclusive, of subdivision (c), and the
extent to which the use of these tools, systems, or process is
authorized or required pursuant to federal law. 
   (d) The department shall, in collaboration with the stakeholder
groups identified in subdivision (a), develop  a process by
  recommended best practices under  which
individuals who receive the uniform long-term care services
assessment and express a preference for living  appropriately
 at home or in another community-based setting,  may
 also receive all of the following:
   (1) A comprehensive community services plan, to be developed with
the individual and, as appropriate, the individual's representative.
   (2) Information about the availability of services that could meet
the individual's needs, as set forth in the community services plan,
and an explanation of the cost to the individual of the available
in-home and community services in relation to  nursing
  long-term health care  facility care.
   (3) Information on retention of Supplemental Security Income/State
Supplementary Plan benefits,  rental assistance vouchers, 
home modification allowances, or home maintenance allowances, and any
other financial supports that would assist the individual in
maintaining his or her home during a hospital or nursing facility
stay.
   (4) Opportunity for discussion, evaluation, and ongoing
involvement with a case manager or counselor. 
   22102.  Any individual employed by the state or by a county may
perform the long-term care services assessment if the individual
employee has attained a level of training that meets the training
standards established in subdivision (a) of Section 22101. 

   22102.  (a) It is the intent of the Legislature to establish a
case management program that identifies and secures services that
will enable an individual to return home from a hospital following an
illness or injury, to return home from a skilled nursing facility or
other long-term health care facility, and to remain at home or in
the community rather than residing in an institution.
   (b) With assistance from the State Department of Health Care
Services, each county shall establish a long-term care case
management program for persons who are Medi-Cal recipients or
applicants or individuals eligible for both Medicare and Medi-Cal who
are residing in a long-term health care facility, or who apply for
admission to a long-term health care facility or are at imminent risk
of being placed in a long-term health care facility.
   (c) (1) In establishing the long-term care case management program
pursuant to subdivision (b), the county shall identify one or more
county departments or nonprofit organizations or a combination of
departments and nonprofit organizations to provide case management. A
county may contract with nonprofit organizations for this purpose.
These organizations may include, but are not limited to, independent
living centers, area agencies on aging, providers of multipurpose
senior services, linkages, aging and disability resource connections
programs, and public authorities.
   (2) The State Department of Health Care Services shall provide
guidance to counties to promote the provision of case management
services in ways that maximize federal financial participation. The
State Department of Health Care Services may contract directly with
nonprofit organizations, or a combination of departments and
nonprofit organizations, in lieu of a particular county or counties,
upon the request of a county or counties, to satisfy the requirements
of this section.
   (d) The county shall identify eligible individuals described in
subdivision (b) who need support services in order to live at home or
in the community, and shall arrange for the provision of those
services to the extent that the services are not provided by any
other program, and to the extent that the provision of these services
would allow them to live safely at home or in the community. Of
these eligible individuals, the county shall give first priority to
individuals who have been or are expected to be residents of a
long-term health care facility for more than 21 days, but who can
reasonably be expected to return home or to the community if case
management services are provided. The next priority shall be given to
individuals who are referred by a general acute care hospital who
may be diverted from care at a licensed long-term health care
facility if case management services are provided and for individuals
who request and are eligible for case management services in order
to avoid being placed in a long-term health care facility either from
the community or home setting.
   (e) Services provided through the case management program shall
include, but are not limited to, all of the following:
   (1) Identifying, until the uniform, long-term care services
assessment is either developed or identified pursuant to Section
22101, any barriers to the individual's return to or remainder at
home or in the community. This identification of barriers shall be
replaced by the use of uniform, long-term care services assessment
when available.
   (2) Enrolling, or assisting in the enrollment of, the individual
in home- and community-based programs, to the extent authorized by
the individual or individual's authorized representative, if
necessary for the individual.
   (3) Developing and executing a care plan.
   (4) Ensuring the coordination of health and social services that
meet the individual's needs.
   (5) Coordinating maintenance of or renovations to a home to
accommodate an individual's disability or infirmity, if necessary for
the individual.
   (6) Arranging for the payment of a home upkeep allowance for
utilities, including light, heat, water, and garbage pickup, if
necessary, for the individual.
   (7) Applying for rental assistance vouchers or other retention of
income, to the extent authorized by the individual or individual's
authorized representative, if necessary for the individual. The case
manager may also provide rental assistance vouchers if an individual
requires accommodation while home renovations are made or while
arrangements are made for permanent housing if the individual cannot
return to his or her residence at the time of discharge from a
hospital, but can live in a less restrictive environment than a
skilled nursing facility or other licensed long-term health care
facility.
   (8) Followup services to ensure that an individual's ongoing or
changing needs are being met.
   (9) Community-reentry training or independent living training for
the individual, if necessary.
   (f) If requested, a copy of the assessment provided for in
paragraph (1) of subdivision (e), shall be provided to the
individual.
   (g) The county or its designee shall assign case managers to each
long-term health care facility located within the county and notify
each of these long-term health care facilities of any changes in
personnel.
   (h) Case managers and those doing the assessment shall not be
employees of a long-term health care facility or a general acute care
hospital, and shall meet the training standards established pursuant
to subdivision (a) of Section 22101.
   (i) Any individual designated as a case manager shall have access
to any long-term health care facility in order to provide case
management services. Failure to provide this access may result in the
imposition of an administrative penalty against the long-term health
care facility.  
   22103.  (a) Except as provided in subdivision (c), commencing July
1, 2012, every long-term care facility that receives an application
for admission of a Medi-Cal eligible or Medicare/Medi-Cal eligible
person shall, using the assessment tool developed pursuant to Section
22101, initiate a uniform long-term care services assessment prior
to admission or on the first day for which Medi-Cal reimbursement is
requested.
   (b) Except as provided in subdivision (c), commencing July 1,
2012, every general acute care hospital, as defined in Section 1250
of the Health and Safety Code, that identifies a Medi-Cal eligible or
Medicare/Medi-Cal eligible person for referral to a long-term
facility shall initiate a uniform long-term care services assessment
at the time of referral.
   (c) A uniform long-term care services assessment shall not be
required for persons referred to programs for the mentally ill or
developmentally disabled administered by the State Department of
Mental Health or the State Department of Developmental Services where
an assessment is in place for mental health services, development
center services, or regional center services.
   (d) On and after January 1, 2013, a long-term care facility that
admits a Medi-Cal eligible or Medicare/Medi-Cal eligible person and
that has not initiated a uniform long-term care services assessment
required pursuant to subdivisions (a) and (b) within 48 hours of
admission shall not receive reimbursement until the assessment has
been initiated, and shall not be reimbursed for those days during
which assessment could have been initiated, but was not initiated.

    22103.    (a) A general acute care hospital may make
a referral to the designated case manager when it has a patient who
will be referred to a long-term health care facility and the hospital
anticipates that the placement will be needed
                     for more than 21 days, or when it has a patient
it believes can return home upon discharge if certain services or
modifications can be made that the case manager can arrange and that
without those services or modifications a referral to a long-term
health care facility will be necessary.  
   (b) A licensed long-term health care facility shall inform the
designated case manager assigned to that facility when a new patient
or resident who is described in subdivision (b) of Section 22102 is
admitted and has been or is expected to be a resident for 21 days or
who has expressed a preference for living at home or in the community
and may need assistance in identifying and securing home- and
community-based services. Referrals may be made before a patient has
been a resident for 21 days if it is likely that without assistance
from the case manager, the patient will not be able to return home in
fewer than 21 days from admission. Referrals shall be made on or
before the 21st day of a patient's residence.  
   (c) On and after January 1, 2013, a long-term health care facility
that admits a new patient or resident who is described in
subdivision (b) of Section 22102 and that has not made a referral
pursuant to subdivision (b) shall not receive reimbursement until the
referral has been made, and shall not be reimbursed for those days
during which a referral should have been made but was not made. 

   (e) A uniform long-term care services assessment shall be
considered initiated when a facility or provider has made a request
for the assessment to the county or the appropriate department.
 
   (f) Individuals admitted to a long-term care facility who have
been residing in the independent living or residential care facility
portion of a multilevel facility that includes residents of
continuing care retirement communities shall be subject to the
uniform long-term care services assessment.  
   (g) 
    22104.    (a)    By December 1, 2013,
the State Department of Health Care Services  , in consultation
with the Office of Statewide Health Planning and Development, 
shall report to the Legislature the total number of long-term care
services assessments performed in the state, along with all of the
following:
   (1) The total number of assessments of individuals from the
community.
   (2) The total number of assessments of individuals  from
  in  nursing facilities.
   (3) The total number of assessments of individuals  from
 in  hospitals.
   (4) The total number of individuals assessed who were placed in
community care. 
   (5) The total number of individuals assessed who were placed in
nursing homes.  
   (6) 
    (5)  The total number of individuals assessed who were
diverted from nursing home placement. 
   (7) 
    (6)  The total number of individuals assessed who were
not able to be diverted, and why, including, but not limited to,
personal choice, medical condition, unavailability of community-based
services, such as in-home supportive services, adult day health
care, Alzheimer's-specific programs, independent living programs,
housing assistance, residential care facilities for the elderly,
home-delivered meals, home health care, protective services, respite
care, social day care, transportation services, or legal assistance.

   (b) (1) A report to be submitted pursuant to subdivision (a) shall
be submitted in compliance with Section 9795 of the Government Code.
 
   (2) Pursuant to Section 10231.5 of the Government Code, this
section shall remain in effect only until January 1, 2015, and as of
that date is repealed, unless a later enacted statute, that is
enacted before January 1, 2015, deletes or extends that date. 
    22105.    (a) The Department of Finance, with the
assistance of the California Health and Human Services Agency and
subject to review by the Legislative Analyst, shall establish a
baseline of expenditures for long-term health care facility care
based on the average of state and county expenditures for the
services in the 2008-09, 2009-10, and 2010-11 fiscal years. This
information shall be used to determine the amounts that are saved
each subsequent year from implementation of this division.  

   (b) When the budget for home- and community-based services is
considered by the appropriate budget committees of the Legislature,
the Department of Finance, subject to review by the Legislative
Analyst, shall provide an estimate of the state savings realized from
placing individuals who would otherwise be placed in or transferred
to a licensed long-term health care facility in a home or to a less
restrictive environment.  
   (h) (1) 
    22106.   The department shall pursue any additional
necessary waivers and state plan amendments to ensure federal
financial participation in funding increases to home- and
community-based services, including, but not limited to, in-home
supportive services and adult day health care, home maintenance and
home modification allowances, as well as training and employment of
individuals who will conduct the uniform long-term care assessments
and case management or counseling of individuals eligible or at risk
of needing long-term care. 
   (2) 
    22107.    (a)    On or before July 1,
2011, the department shall, in collaboration with stakeholders
identified in subdivision (a) of Section 22101, submit to the
Legislature a financing plan for providing long-term care services
pursuant to this division.  By December 1, 2011, the
department shall, in collaboration with stakeholders, submit to the
Legislature a proposal for the temporary or permanent restructuring
of bed rates and reimbursements to nursing facilities and the
redirection of penalties and fines to fund its plan for long-term
care services, if necessary.  
   (3) Subdivisions (g) and (h) shall not be implemented unless

    (b)    Sections 22102, 22103, 22104, and
22105 shall not be implemented unless  the  director of
the department   Director of Health Care Services 
certifies that the collection of federal funds, other revenue from
restructuring of reimbursements, penalties, and fines, or private
funds, is sufficient to fund the implementation of long-term care
services assessments, case management or counseling, and services
pursuant to this division. 
   (i) The department may, in collaboration with the stakeholders
identified in subdivision (a) of Section 22101, evaluate whether
existing state or county information systems and processes may be
developed to meet the purposes of this division. 
    22108.    (a) As part of their responsibilities to
develop the process described in subdivision (d) of Section 22101,
stakeholder groups may review the treatment authorization requests
process described in Sections 14133.01 and 14133.05 and recommend to
the State Department of Health Care Services ways to improve the role
of the treatment authorization requests process in assisting those
who wish to return home from a long-term health care facility. 

   (b) By December 1, 2011, the department, in collaboration with the
stakeholders, shall submit to the Legislature recommended changes,
if any, to each of the following:  
   (1) The treatment authorization request process to promote the
more rapid movement of residents of long-term health care facilities
to home and community.  
   (2) The temporary or permanent restructuring of long-term care
reimbursement to provide reimbursement for a coordinated program of
home- and community-based services in lieu of reimbursement for
services provided in a skilled nursing facility, when this program
would allow an individual to remain in or return to a community
setting.  
   (3) Reimbursement for hospital, skilled nursing, and
rehabilitation care, so that this care will be provided at levels
sufficient to ensure beneficiary access to optimal medical and
functional recovery and to provide patient and caregiver education
directed toward successful transition to the community setting. 

   (j) For purposes of this section 
    22109.    For purposes of this division  , a
long-term  health  care facility includes a skilled nursing
facility, intermediate care facility, intermediate care
facility/developmentally disabled, intermediate care
facility/developmentally disabled habilitative, intermediate care
facility/developmentally disabled nursing, and congregate living
health facility, as these terms are defined in Section 1250 of the
Health and Safety Code. 
   22104.  The Legislature finds and declares all of the following:
   (a) A principal purpose of case management is to enable an
individual to return home from a hospital following an illness or
injury and to return home from a skilled nursing facility or other
long-term care facility.
   (b) The purpose of case management in discharge planning is to
divert an individual who would otherwise enter a skilled nursing
facility from a general acute care hospital and to transfer an
individual out of a skilled nursing facility when he or she is able
to be home or in a less restrictive environment.
   (c) If case management for long-term care is to be phased in, then
it is the intent of the Legislature for case management to be
established as early as possible for persons newly placed in a
skilled nursing facility, as defined in Section 1250 of the Health
and Safety Code, or other licensed facilities and for patients of a
general acute care hospital who may be discharged if certain home-
and community-based services are immediately available. 

   22105.  (a) When a county department of social services or public
health establishes a long-term care case management program for
persons who are eligible for Medi-Cal or Medicare, the county
department shall assign case managers to each general acute care
hospital, skilled nursing facility, and other licensed long-term care
facility located within the department's jurisdiction. After these
health facilities are notified of the appropriate case manager, each
facility shall inform the case manager of when a new patient or
resident is admitted and that this person may need assistance in
identifying and securing home- and community-based services.
   (b) The county shall provide those individuals eligible for
Medi-Cal and Medicare who may need support services in order to
return home upon discharge with those services to the extent that the
services are not provided by any other program. The county shall
also provide those who may need support services after a stay in a
skilled nursing facility or other licensed long-term care facility in
order to return home with those services to the extent that the
services are not provided by any other program.
   (c) Services provided through case management may include
maintenance or renovations to a home to accommodate an individual's
disability or infirmity that brought on the hospitalization or stay
in the skilled nursing facility and may include rental vouchers if an
individual requires accommodation while renovations are completed or
arrangements are made for permanent housing in the event the
individual cannot return to their residence at the time of
hospitalization but can live in a less restrictive environment than a
skilled nursing facility or other licensed long-term facility.
 
   22106.  (a) Funds for case management, rental vouchers, and home
renovation to enable a person to return to or remain in his or her
residence shall be from both of the following sources:
   (1) Federal funds for Medicare and Medicaid, including waivers.
   (2) State savings realized from diverting individuals from
placement in skilled nursing facilities and other institutions and
transferring persons from those facilities to home or a less
restrictive environment.
   (b) The Department of Finance, with the assistance of the
California Health and Human Services Agency and subject to review by
the Legislative Analyst, shall establish a baseline of expenditures
for skilled nursing facility care based on the average of state and
county expenditures for this care in the 2008-09, 2009-10, and
2010-11 fiscal years. This information may be used to determine the
amounts that are saved each subsequent year from implementation of
this division
   (c) The expansion of case management services shall occur as
savings in other programs allow.  
  SEC. 3.    If the Commission on State Mandates
determines that this act contains costs mandated by the state,
reimbursement to local agencies and school districts for those costs
shall be made pursuant to Part 7 (commencing with Section 17500) of
Division 4 of Title 2 of the Government Code. 
   SEC. 5.    No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution for certain costs that may be incurred by a local agency
or school district because, in that regard, this act creates a new
crime or infraction, eliminates a crime or infraction, or changes the
penalty for a crime or infraction, within the meaning of Section
17556 of the Government Code, or changes the definition of a crime
within the meaning of Section 6 of Article XIII B of the California
Constitution.  
   However, if the Commission on State Mandates determines that this
act contains other costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division 4 of
Title 2 of the Government Code. 
                              ____ CORRECTIONS  Text--Pages 9, 15,
16, 17, 19 and 20.
           ____