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| 1 | + | CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 654Introduced by Assembly Member Maienschein(Coauthors: Assembly Members Voepel and Waldron)(Coauthor: Senator Anderson)February 14, 2017 An act to add and repeal Section 14132.78 of the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGESTAB 654, as introduced, Maienschein. Pediatric home health care.Existing law provides for the licensure and regulation of home health agencies by the State Department of Public Health. Existing law requires all private or public organizations that provide or arrange for skilled nursing services to patients in the home to obtain a home health agency license. Existing law also provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Existing law provides that home health care services are covered Medi-Cal benefits, subject to utilization controls. This bill would require the department, on or before January 1, 2018, to establish an incentive-based, supplemental payment program, as defined, which would apply to licensed home health agencies that treat children who are receiving continuous nursing care or private nursing services through the Medi-Cal program. The purpose of the program would be to increase access to quality in-home nursing services and encouraging additional home health agencies to participate in nursing care for children receiving Medi-Cal services. The bill would require the department to collaborate with designated stakeholders in establishing the payments, and would authorize the department to establish reasonable provider standards, as specified. The supplemental payment program would be implemented only to the extent that federal financial participation is available and would require the department to submit any necessary applications to the federal Centers for Medicare and Medicaid Services to implement the supplemental payment program. The bill would require the department to submit a report evaluating the effectiveness of the supplemental payment program to specified committees of the Legislature on or before July 1, 2021. The bill would become inoperative on December 31, 2021, and would be repealed on January 1, 2022.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 14132.78 is added to the Welfare and Institutions Code, to read:14132.78. (a) (1)On or before July 1, 2018, the department shall establish an incentive-based, supplemental payment program applicable to licensed home health agencies that treat children who are receiving continuous nursing care or private nursing services through the Medi-Cal program.(2) The program established pursuant to paragraph (1) shall create a supplemental payment designed to increase access to quality in-home nursing services and encourage additional home health agencies to participate in nursing care for children receiving Medi-Cal services. (3) In establishing these payments, the department shall collaborate with Medi-Cal certified home health agencies, hospitals, pediatric physicians, and nurses, as well as other stakeholders. Supplemental payments may be provided for purposes including, but not limited to, the following:(A) Improving completion of weekly nursing shifts for approved hours.(B) Completing a higher percentage of nursing shifts consistent with the patients plan of care.(C) Accepting additional patients from area hospitals within a time frame specified by the department.(D) Developing higher reimbursement rates for patients with higher acuity and complex needs, night, or weekend nursing shifts.(E) Using a blended nursing rate for registered nurses and licensed vocational nurses hourly shifts.(F) Developing a rural reimbursement rate.(4) For the purposes of this section, supplemental payment means a payment made to a home health agency for continuous nursing or private duty nursing services that would be in addition to the states Medi-Cal fee schedule for home health agencies. The level of supplemental payment shall be determined by the department, taking into consideration a reasonable cost basis to reduce the risk of home health agencies continuing to leave the private duty nursing segment of the Medi-Cal program. The supplemental payment may be paid on a quarterly basis after the department has verified that the program requirements have been met.(b) This section shall be implemented only to the extent that federal financial participation is available. The department shall submit any necessary application to the federal Centers for Medicare and Medicaid Services for a state plan amendment, waiver, or amendment to a waiver to implement the supplemental payment program described in this section.(c) The department may establish reasonable provider eligibility standards and participation requirements for the supplemental payment program, including, but not limited to, home health agencies in good standing with the State Department of Public Health, agencies that are currently participating in the Medi-Cal program, and agencies that are accredited by the Accreditation Commission for Health Care or a similar independent accrediting organization.(d) On or before July 1, 2021, the department shall submit a report evaluating the effectiveness of the supplemental payment program to the Senate Committee on Health, the Assembly Committee on Health, the Senate Committee on Budget and Fiscal Review, and the Assembly Committee on Budget.(1) In order to compare access to necessary and approved services before and after the establishment of the supplemental payment program, the department may request participating home health agencies to report on key access to care indicators identified by the department, the participating agencies, and referring hospitals. The key access to care indicators shall include, but need not be limited to, the following:(A) The increase or decrease in hospital discharges to home health agencies.(B) The number of nursing hours filled, as compared to the number of hours that have been approved.(C) The number of available licensed home health agencies that accept pediatric patients.(2) In evaluating the effectiveness of the supplemental payment program, the department shall cooperate with, and consider input from, home health agencies, consumer groups, hospitals, and other provider associations.(e) This section shall become inoperative on December 31, 2021, and as of January 1, 2022, is repealed. | |
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| 3 | + | CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 654Introduced by Assembly Member Maienschein(Coauthors: Assembly Members Voepel and Waldron)(Coauthor: Senator Anderson)February 14, 2017 An act to add and repeal Section 14132.78 of the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGESTAB 654, as introduced, Maienschein. Pediatric home health care.Existing law provides for the licensure and regulation of home health agencies by the State Department of Public Health. Existing law requires all private or public organizations that provide or arrange for skilled nursing services to patients in the home to obtain a home health agency license. Existing law also provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Existing law provides that home health care services are covered Medi-Cal benefits, subject to utilization controls. This bill would require the department, on or before January 1, 2018, to establish an incentive-based, supplemental payment program, as defined, which would apply to licensed home health agencies that treat children who are receiving continuous nursing care or private nursing services through the Medi-Cal program. The purpose of the program would be to increase access to quality in-home nursing services and encouraging additional home health agencies to participate in nursing care for children receiving Medi-Cal services. The bill would require the department to collaborate with designated stakeholders in establishing the payments, and would authorize the department to establish reasonable provider standards, as specified. The supplemental payment program would be implemented only to the extent that federal financial participation is available and would require the department to submit any necessary applications to the federal Centers for Medicare and Medicaid Services to implement the supplemental payment program. The bill would require the department to submit a report evaluating the effectiveness of the supplemental payment program to specified committees of the Legislature on or before July 1, 2021. The bill would become inoperative on December 31, 2021, and would be repealed on January 1, 2022.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO | |
| 4 | 4 | ||
| 5 | - | Amended IN Assembly March 13, 2017 | |
| 6 | 5 | ||
| 7 | - | Amended IN Assembly March 13, 2017 | |
| 6 | + | ||
| 7 | + | ||
| 8 | 8 | ||
| 9 | 9 | CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION | |
| 10 | 10 | ||
| 11 | 11 | Assembly Bill No. 654 | |
| 12 | 12 | ||
| 13 | - | Introduced by Assembly Member Maienschein | |
| 13 | + | Introduced by Assembly Member Maienschein(Coauthors: Assembly Members Voepel and Waldron)(Coauthor: Senator Anderson)February 14, 2017 | |
| 14 | 14 | ||
| 15 | - | Introduced by Assembly Member Maienschein | |
| 15 | + | Introduced by Assembly Member Maienschein(Coauthors: Assembly Members Voepel and Waldron)(Coauthor: Senator Anderson) | |
| 16 | 16 | February 14, 2017 | |
| 17 | 17 | ||
| 18 | 18 | An act to add and repeal Section 14132.78 of the Welfare and Institutions Code, relating to Medi-Cal. | |
| 19 | 19 | ||
| 20 | 20 | LEGISLATIVE COUNSEL'S DIGEST | |
| 21 | 21 | ||
| 22 | 22 | ## LEGISLATIVE COUNSEL'S DIGEST | |
| 23 | 23 | ||
| 24 | - | AB 654, as | |
| 24 | + | AB 654, as introduced, Maienschein. Pediatric home health care. | |
| 25 | 25 | ||
| 26 | - | Existing law provides for the licensure and regulation of home health agencies by the State Department of Public Health. Existing law requires all private or public organizations that provide or arrange for skilled nursing services to patients in the home to obtain a home health agency license. Existing law also provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Existing law provides that home health care services are covered Medi-Cal benefits, subject to utilization controls.This bill would require the department, on or before January 1, 2018, to establish an incentive-based, supplemental payment program, as defined, which would apply to licensed home health agencies that treat children who are receiving continuous nursing care or private | |
| 26 | + | Existing law provides for the licensure and regulation of home health agencies by the State Department of Public Health. Existing law requires all private or public organizations that provide or arrange for skilled nursing services to patients in the home to obtain a home health agency license. Existing law also provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Existing law provides that home health care services are covered Medi-Cal benefits, subject to utilization controls. This bill would require the department, on or before January 1, 2018, to establish an incentive-based, supplemental payment program, as defined, which would apply to licensed home health agencies that treat children who are receiving continuous nursing care or private nursing services through the Medi-Cal program. The purpose of the program would be to increase access to quality in-home nursing services and encouraging additional home health agencies to participate in nursing care for children receiving Medi-Cal services. The bill would require the department to collaborate with designated stakeholders in establishing the payments, and would authorize the department to establish reasonable provider standards, as specified. The supplemental payment program would be implemented only to the extent that federal financial participation is available and would require the department to submit any necessary applications to the federal Centers for Medicare and Medicaid Services to implement the supplemental payment program. The bill would require the department to submit a report evaluating the effectiveness of the supplemental payment program to specified committees of the Legislature on or before July 1, 2021. The bill would become inoperative on December 31, 2021, and would be repealed on January 1, 2022. | |
| 27 | 27 | ||
| 28 | 28 | Existing law provides for the licensure and regulation of home health agencies by the State Department of Public Health. Existing law requires all private or public organizations that provide or arrange for skilled nursing services to patients in the home to obtain a home health agency license. Existing law also provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Existing law provides that home health care services are covered Medi-Cal benefits, subject to utilization controls. | |
| 29 | 29 | ||
| 30 | - | This bill would require the department, on or before January 1, 2018, to establish an incentive-based, supplemental payment program, as defined, which would apply to licensed home health agencies that treat children who are receiving continuous nursing care or private | |
| 30 | + | This bill would require the department, on or before January 1, 2018, to establish an incentive-based, supplemental payment program, as defined, which would apply to licensed home health agencies that treat children who are receiving continuous nursing care or private nursing services through the Medi-Cal program. The purpose of the program would be to increase access to quality in-home nursing services and encouraging additional home health agencies to participate in nursing care for children receiving Medi-Cal services. The bill would require the department to collaborate with designated stakeholders in establishing the payments, and would authorize the department to establish reasonable provider standards, as specified. The supplemental payment program would be implemented only to the extent that federal financial participation is available and would require the department to submit any necessary applications to the federal Centers for Medicare and Medicaid Services to implement the supplemental payment program. The bill would require the department to submit a report evaluating the effectiveness of the supplemental payment program to specified committees of the Legislature on or before July 1, 2021. The bill would become inoperative on December 31, 2021, and would be repealed on January 1, 2022. | |
| 31 | 31 | ||
| 32 | 32 | ## Digest Key | |
| 33 | 33 | ||
| 34 | 34 | ## Bill Text | |
| 35 | 35 | ||
| 36 | - | The people of the State of California do enact as follows:SECTION 1. Section 14132.78 is added to the Welfare and Institutions Code, to read:14132.78. (a) (1)On or before July 1, 2018, the department shall establish an incentive-based, supplemental payment program applicable to licensed home health agencies that treat children who are receiving continuous nursing care or private | |
| 36 | + | The people of the State of California do enact as follows:SECTION 1. Section 14132.78 is added to the Welfare and Institutions Code, to read:14132.78. (a) (1)On or before July 1, 2018, the department shall establish an incentive-based, supplemental payment program applicable to licensed home health agencies that treat children who are receiving continuous nursing care or private nursing services through the Medi-Cal program.(2) The program established pursuant to paragraph (1) shall create a supplemental payment designed to increase access to quality in-home nursing services and encourage additional home health agencies to participate in nursing care for children receiving Medi-Cal services. (3) In establishing these payments, the department shall collaborate with Medi-Cal certified home health agencies, hospitals, pediatric physicians, and nurses, as well as other stakeholders. Supplemental payments may be provided for purposes including, but not limited to, the following:(A) Improving completion of weekly nursing shifts for approved hours.(B) Completing a higher percentage of nursing shifts consistent with the patients plan of care.(C) Accepting additional patients from area hospitals within a time frame specified by the department.(D) Developing higher reimbursement rates for patients with higher acuity and complex needs, night, or weekend nursing shifts.(E) Using a blended nursing rate for registered nurses and licensed vocational nurses hourly shifts.(F) Developing a rural reimbursement rate.(4) For the purposes of this section, supplemental payment means a payment made to a home health agency for continuous nursing or private duty nursing services that would be in addition to the states Medi-Cal fee schedule for home health agencies. The level of supplemental payment shall be determined by the department, taking into consideration a reasonable cost basis to reduce the risk of home health agencies continuing to leave the private duty nursing segment of the Medi-Cal program. The supplemental payment may be paid on a quarterly basis after the department has verified that the program requirements have been met.(b) This section shall be implemented only to the extent that federal financial participation is available. The department shall submit any necessary application to the federal Centers for Medicare and Medicaid Services for a state plan amendment, waiver, or amendment to a waiver to implement the supplemental payment program described in this section.(c) The department may establish reasonable provider eligibility standards and participation requirements for the supplemental payment program, including, but not limited to, home health agencies in good standing with the State Department of Public Health, agencies that are currently participating in the Medi-Cal program, and agencies that are accredited by the Accreditation Commission for Health Care or a similar independent accrediting organization.(d) On or before July 1, 2021, the department shall submit a report evaluating the effectiveness of the supplemental payment program to the Senate Committee on Health, the Assembly Committee on Health, the Senate Committee on Budget and Fiscal Review, and the Assembly Committee on Budget.(1) In order to compare access to necessary and approved services before and after the establishment of the supplemental payment program, the department may request participating home health agencies to report on key access to care indicators identified by the department, the participating agencies, and referring hospitals. The key access to care indicators shall include, but need not be limited to, the following:(A) The increase or decrease in hospital discharges to home health agencies.(B) The number of nursing hours filled, as compared to the number of hours that have been approved.(C) The number of available licensed home health agencies that accept pediatric patients.(2) In evaluating the effectiveness of the supplemental payment program, the department shall cooperate with, and consider input from, home health agencies, consumer groups, hospitals, and other provider associations.(e) This section shall become inoperative on December 31, 2021, and as of January 1, 2022, is repealed. | |
| 37 | 37 | ||
| 38 | 38 | The people of the State of California do enact as follows: | |
| 39 | 39 | ||
| 40 | 40 | ## The people of the State of California do enact as follows: | |
| 41 | 41 | ||
| 42 | - | SECTION 1. Section 14132.78 is added to the Welfare and Institutions Code, to read:14132.78. (a) (1)On or before July 1, 2018, the department shall establish an incentive-based, supplemental payment program applicable to licensed home health agencies that treat children who are receiving continuous nursing care or private | |
| 42 | + | SECTION 1. Section 14132.78 is added to the Welfare and Institutions Code, to read:14132.78. (a) (1)On or before July 1, 2018, the department shall establish an incentive-based, supplemental payment program applicable to licensed home health agencies that treat children who are receiving continuous nursing care or private nursing services through the Medi-Cal program.(2) The program established pursuant to paragraph (1) shall create a supplemental payment designed to increase access to quality in-home nursing services and encourage additional home health agencies to participate in nursing care for children receiving Medi-Cal services. (3) In establishing these payments, the department shall collaborate with Medi-Cal certified home health agencies, hospitals, pediatric physicians, and nurses, as well as other stakeholders. Supplemental payments may be provided for purposes including, but not limited to, the following:(A) Improving completion of weekly nursing shifts for approved hours.(B) Completing a higher percentage of nursing shifts consistent with the patients plan of care.(C) Accepting additional patients from area hospitals within a time frame specified by the department.(D) Developing higher reimbursement rates for patients with higher acuity and complex needs, night, or weekend nursing shifts.(E) Using a blended nursing rate for registered nurses and licensed vocational nurses hourly shifts.(F) Developing a rural reimbursement rate.(4) For the purposes of this section, supplemental payment means a payment made to a home health agency for continuous nursing or private duty nursing services that would be in addition to the states Medi-Cal fee schedule for home health agencies. The level of supplemental payment shall be determined by the department, taking into consideration a reasonable cost basis to reduce the risk of home health agencies continuing to leave the private duty nursing segment of the Medi-Cal program. The supplemental payment may be paid on a quarterly basis after the department has verified that the program requirements have been met.(b) This section shall be implemented only to the extent that federal financial participation is available. The department shall submit any necessary application to the federal Centers for Medicare and Medicaid Services for a state plan amendment, waiver, or amendment to a waiver to implement the supplemental payment program described in this section.(c) The department may establish reasonable provider eligibility standards and participation requirements for the supplemental payment program, including, but not limited to, home health agencies in good standing with the State Department of Public Health, agencies that are currently participating in the Medi-Cal program, and agencies that are accredited by the Accreditation Commission for Health Care or a similar independent accrediting organization.(d) On or before July 1, 2021, the department shall submit a report evaluating the effectiveness of the supplemental payment program to the Senate Committee on Health, the Assembly Committee on Health, the Senate Committee on Budget and Fiscal Review, and the Assembly Committee on Budget.(1) In order to compare access to necessary and approved services before and after the establishment of the supplemental payment program, the department may request participating home health agencies to report on key access to care indicators identified by the department, the participating agencies, and referring hospitals. The key access to care indicators shall include, but need not be limited to, the following:(A) The increase or decrease in hospital discharges to home health agencies.(B) The number of nursing hours filled, as compared to the number of hours that have been approved.(C) The number of available licensed home health agencies that accept pediatric patients.(2) In evaluating the effectiveness of the supplemental payment program, the department shall cooperate with, and consider input from, home health agencies, consumer groups, hospitals, and other provider associations.(e) This section shall become inoperative on December 31, 2021, and as of January 1, 2022, is repealed. | |
| 43 | 43 | ||
| 44 | 44 | SECTION 1. Section 14132.78 is added to the Welfare and Institutions Code, to read: | |
| 45 | 45 | ||
| 46 | 46 | ### SECTION 1. | |
| 47 | 47 | ||
| 48 | - | 14132.78. (a) (1)On or before July 1, 2018, the department shall establish an incentive-based, supplemental payment program applicable to licensed home health agencies that treat children who are receiving continuous nursing care or private | |
| 48 | + | 14132.78. (a) (1)On or before July 1, 2018, the department shall establish an incentive-based, supplemental payment program applicable to licensed home health agencies that treat children who are receiving continuous nursing care or private nursing services through the Medi-Cal program.(2) The program established pursuant to paragraph (1) shall create a supplemental payment designed to increase access to quality in-home nursing services and encourage additional home health agencies to participate in nursing care for children receiving Medi-Cal services. (3) In establishing these payments, the department shall collaborate with Medi-Cal certified home health agencies, hospitals, pediatric physicians, and nurses, as well as other stakeholders. Supplemental payments may be provided for purposes including, but not limited to, the following:(A) Improving completion of weekly nursing shifts for approved hours.(B) Completing a higher percentage of nursing shifts consistent with the patients plan of care.(C) Accepting additional patients from area hospitals within a time frame specified by the department.(D) Developing higher reimbursement rates for patients with higher acuity and complex needs, night, or weekend nursing shifts.(E) Using a blended nursing rate for registered nurses and licensed vocational nurses hourly shifts.(F) Developing a rural reimbursement rate.(4) For the purposes of this section, supplemental payment means a payment made to a home health agency for continuous nursing or private duty nursing services that would be in addition to the states Medi-Cal fee schedule for home health agencies. The level of supplemental payment shall be determined by the department, taking into consideration a reasonable cost basis to reduce the risk of home health agencies continuing to leave the private duty nursing segment of the Medi-Cal program. The supplemental payment may be paid on a quarterly basis after the department has verified that the program requirements have been met.(b) This section shall be implemented only to the extent that federal financial participation is available. The department shall submit any necessary application to the federal Centers for Medicare and Medicaid Services for a state plan amendment, waiver, or amendment to a waiver to implement the supplemental payment program described in this section.(c) The department may establish reasonable provider eligibility standards and participation requirements for the supplemental payment program, including, but not limited to, home health agencies in good standing with the State Department of Public Health, agencies that are currently participating in the Medi-Cal program, and agencies that are accredited by the Accreditation Commission for Health Care or a similar independent accrediting organization.(d) On or before July 1, 2021, the department shall submit a report evaluating the effectiveness of the supplemental payment program to the Senate Committee on Health, the Assembly Committee on Health, the Senate Committee on Budget and Fiscal Review, and the Assembly Committee on Budget.(1) In order to compare access to necessary and approved services before and after the establishment of the supplemental payment program, the department may request participating home health agencies to report on key access to care indicators identified by the department, the participating agencies, and referring hospitals. The key access to care indicators shall include, but need not be limited to, the following:(A) The increase or decrease in hospital discharges to home health agencies.(B) The number of nursing hours filled, as compared to the number of hours that have been approved.(C) The number of available licensed home health agencies that accept pediatric patients.(2) In evaluating the effectiveness of the supplemental payment program, the department shall cooperate with, and consider input from, home health agencies, consumer groups, hospitals, and other provider associations.(e) This section shall become inoperative on December 31, 2021, and as of January 1, 2022, is repealed. | |
| 49 | 49 | ||
| 50 | - | 14132.78. (a) (1)On or before July 1, 2018, the department shall establish an incentive-based, supplemental payment program applicable to licensed home health agencies that treat children who are receiving continuous nursing care or private | |
| 50 | + | 14132.78. (a) (1)On or before July 1, 2018, the department shall establish an incentive-based, supplemental payment program applicable to licensed home health agencies that treat children who are receiving continuous nursing care or private nursing services through the Medi-Cal program.(2) The program established pursuant to paragraph (1) shall create a supplemental payment designed to increase access to quality in-home nursing services and encourage additional home health agencies to participate in nursing care for children receiving Medi-Cal services. (3) In establishing these payments, the department shall collaborate with Medi-Cal certified home health agencies, hospitals, pediatric physicians, and nurses, as well as other stakeholders. Supplemental payments may be provided for purposes including, but not limited to, the following:(A) Improving completion of weekly nursing shifts for approved hours.(B) Completing a higher percentage of nursing shifts consistent with the patients plan of care.(C) Accepting additional patients from area hospitals within a time frame specified by the department.(D) Developing higher reimbursement rates for patients with higher acuity and complex needs, night, or weekend nursing shifts.(E) Using a blended nursing rate for registered nurses and licensed vocational nurses hourly shifts.(F) Developing a rural reimbursement rate.(4) For the purposes of this section, supplemental payment means a payment made to a home health agency for continuous nursing or private duty nursing services that would be in addition to the states Medi-Cal fee schedule for home health agencies. The level of supplemental payment shall be determined by the department, taking into consideration a reasonable cost basis to reduce the risk of home health agencies continuing to leave the private duty nursing segment of the Medi-Cal program. The supplemental payment may be paid on a quarterly basis after the department has verified that the program requirements have been met.(b) This section shall be implemented only to the extent that federal financial participation is available. The department shall submit any necessary application to the federal Centers for Medicare and Medicaid Services for a state plan amendment, waiver, or amendment to a waiver to implement the supplemental payment program described in this section.(c) The department may establish reasonable provider eligibility standards and participation requirements for the supplemental payment program, including, but not limited to, home health agencies in good standing with the State Department of Public Health, agencies that are currently participating in the Medi-Cal program, and agencies that are accredited by the Accreditation Commission for Health Care or a similar independent accrediting organization.(d) On or before July 1, 2021, the department shall submit a report evaluating the effectiveness of the supplemental payment program to the Senate Committee on Health, the Assembly Committee on Health, the Senate Committee on Budget and Fiscal Review, and the Assembly Committee on Budget.(1) In order to compare access to necessary and approved services before and after the establishment of the supplemental payment program, the department may request participating home health agencies to report on key access to care indicators identified by the department, the participating agencies, and referring hospitals. The key access to care indicators shall include, but need not be limited to, the following:(A) The increase or decrease in hospital discharges to home health agencies.(B) The number of nursing hours filled, as compared to the number of hours that have been approved.(C) The number of available licensed home health agencies that accept pediatric patients.(2) In evaluating the effectiveness of the supplemental payment program, the department shall cooperate with, and consider input from, home health agencies, consumer groups, hospitals, and other provider associations.(e) This section shall become inoperative on December 31, 2021, and as of January 1, 2022, is repealed. | |
| 51 | 51 | ||
| 52 | - | 14132.78. (a) (1)On or before July 1, 2018, the department shall establish an incentive-based, supplemental payment program applicable to licensed home health agencies that treat children who are receiving continuous nursing care or private | |
| 52 | + | 14132.78. (a) (1)On or before July 1, 2018, the department shall establish an incentive-based, supplemental payment program applicable to licensed home health agencies that treat children who are receiving continuous nursing care or private nursing services through the Medi-Cal program.(2) The program established pursuant to paragraph (1) shall create a supplemental payment designed to increase access to quality in-home nursing services and encourage additional home health agencies to participate in nursing care for children receiving Medi-Cal services. (3) In establishing these payments, the department shall collaborate with Medi-Cal certified home health agencies, hospitals, pediatric physicians, and nurses, as well as other stakeholders. Supplemental payments may be provided for purposes including, but not limited to, the following:(A) Improving completion of weekly nursing shifts for approved hours.(B) Completing a higher percentage of nursing shifts consistent with the patients plan of care.(C) Accepting additional patients from area hospitals within a time frame specified by the department.(D) Developing higher reimbursement rates for patients with higher acuity and complex needs, night, or weekend nursing shifts.(E) Using a blended nursing rate for registered nurses and licensed vocational nurses hourly shifts.(F) Developing a rural reimbursement rate.(4) For the purposes of this section, supplemental payment means a payment made to a home health agency for continuous nursing or private duty nursing services that would be in addition to the states Medi-Cal fee schedule for home health agencies. The level of supplemental payment shall be determined by the department, taking into consideration a reasonable cost basis to reduce the risk of home health agencies continuing to leave the private duty nursing segment of the Medi-Cal program. The supplemental payment may be paid on a quarterly basis after the department has verified that the program requirements have been met.(b) This section shall be implemented only to the extent that federal financial participation is available. The department shall submit any necessary application to the federal Centers for Medicare and Medicaid Services for a state plan amendment, waiver, or amendment to a waiver to implement the supplemental payment program described in this section.(c) The department may establish reasonable provider eligibility standards and participation requirements for the supplemental payment program, including, but not limited to, home health agencies in good standing with the State Department of Public Health, agencies that are currently participating in the Medi-Cal program, and agencies that are accredited by the Accreditation Commission for Health Care or a similar independent accrediting organization.(d) On or before July 1, 2021, the department shall submit a report evaluating the effectiveness of the supplemental payment program to the Senate Committee on Health, the Assembly Committee on Health, the Senate Committee on Budget and Fiscal Review, and the Assembly Committee on Budget.(1) In order to compare access to necessary and approved services before and after the establishment of the supplemental payment program, the department may request participating home health agencies to report on key access to care indicators identified by the department, the participating agencies, and referring hospitals. The key access to care indicators shall include, but need not be limited to, the following:(A) The increase or decrease in hospital discharges to home health agencies.(B) The number of nursing hours filled, as compared to the number of hours that have been approved.(C) The number of available licensed home health agencies that accept pediatric patients.(2) In evaluating the effectiveness of the supplemental payment program, the department shall cooperate with, and consider input from, home health agencies, consumer groups, hospitals, and other provider associations.(e) This section shall become inoperative on December 31, 2021, and as of January 1, 2022, is repealed. | |
| 53 | 53 | ||
| 54 | 54 | ||
| 55 | 55 | ||
| 56 | - | 14132.78. (a) (1)On or before July 1, 2018, the department shall establish an incentive-based, supplemental payment program applicable to licensed home health agencies that treat children who are receiving continuous nursing care or private | |
| 56 | + | 14132.78. (a) (1)On or before July 1, 2018, the department shall establish an incentive-based, supplemental payment program applicable to licensed home health agencies that treat children who are receiving continuous nursing care or private nursing services through the Medi-Cal program. | |
| 57 | 57 | ||
| 58 | 58 | (2) The program established pursuant to paragraph (1) shall create a supplemental payment designed to increase access to quality in-home nursing services and encourage additional home health agencies to participate in nursing care for children receiving Medi-Cal services. | |
| 59 | 59 | ||
| 60 | 60 | (3) In establishing these payments, the department shall collaborate with Medi-Cal certified home health agencies, hospitals, pediatric physicians, and nurses, as well as other stakeholders. Supplemental payments may be provided for purposes including, but not limited to, the following: | |
| 61 | 61 | ||
| 62 | 62 | (A) Improving completion of weekly nursing shifts for approved hours. | |
| 63 | 63 | ||
| 64 | + | (B) Completing a higher percentage of nursing shifts consistent with the patients plan of care. | |
| 64 | 65 | ||
| 66 | + | (C) Accepting additional patients from area hospitals within a time frame specified by the department. | |
| 65 | 67 | ||
| 66 | - | ( | |
| 68 | + | (D) Developing higher reimbursement rates for patients with higher acuity and complex needs, night, or weekend nursing shifts. | |
| 67 | 69 | ||
| 70 | + | (E) Using a blended nursing rate for registered nurses and licensed vocational nurses hourly shifts. | |
| 68 | 71 | ||
| 72 | + | (F) Developing a rural reimbursement rate. | |
| 69 | 73 | ||
| 70 | - | (A) Completing a higher percentage of nursing shifts consistent with the patients plan of care. | |
| 71 | - | ||
| 72 | - | (C) Accepting additional | |
| 73 | - | ||
| 74 | - | ||
| 75 | - | ||
| 76 | - | (B) Actively servicing additional patients from area hospitals within a time frame timeframe specified by the department. | |
| 77 | - | ||
| 78 | - | (D) | |
| 79 | - | ||
| 80 | - | ||
| 81 | - | ||
| 82 | - | (C) Developing higher reimbursement rates for patients with higher acuity and complex needs, night, or weekend nursing shifts. | |
| 83 | - | ||
| 84 | - | (E) | |
| 85 | - | ||
| 86 | - | ||
| 87 | - | ||
| 88 | - | (D) Using a blended nursing rate for registered nurses and licensed vocational nurses hourly shifts. | |
| 89 | - | ||
| 90 | - | (F) | |
| 91 | - | ||
| 92 | - | ||
| 93 | - | ||
| 94 | - | (E) Developing a rural reimbursement rate. | |
| 95 | - | ||
| 96 | - | (4) For the purposes of this section, supplemental payment means a payment made to a home health agency for continuous nursing or private duty nursing services that would be in addition to the states regular Medi-Cal fee schedule for home health agencies. The level of supplemental payment shall be determined by the department, taking into consideration a reasonable cost basis to reduce the risk of home health agencies continuing to leave the private duty nursing segment of the Medi-Cal program. The supplemental payment may be paid on a quarterly basis after the department has verified that the program requirements have been met. | |
| 74 | + | (4) For the purposes of this section, supplemental payment means a payment made to a home health agency for continuous nursing or private duty nursing services that would be in addition to the states Medi-Cal fee schedule for home health agencies. The level of supplemental payment shall be determined by the department, taking into consideration a reasonable cost basis to reduce the risk of home health agencies continuing to leave the private duty nursing segment of the Medi-Cal program. The supplemental payment may be paid on a quarterly basis after the department has verified that the program requirements have been met. | |
| 97 | 75 | ||
| 98 | 76 | (b) This section shall be implemented only to the extent that federal financial participation is available. The department shall submit any necessary application to the federal Centers for Medicare and Medicaid Services for a state plan amendment, waiver, or amendment to a waiver to implement the supplemental payment program described in this section. | |
| 99 | 77 | ||
| 100 | - | (c) The department may establish reasonable provider eligibility standards and participation requirements for the supplemental payment program, including, but not limited to, home health agencies in good standing with the State Department of Public Health, | |
| 78 | + | (c) The department may establish reasonable provider eligibility standards and participation requirements for the supplemental payment program, including, but not limited to, home health agencies in good standing with the State Department of Public Health, agencies that are currently participating in the Medi-Cal program, and agencies that are accredited by the Accreditation Commission for Health Care or a similar independent accrediting organization. | |
| 101 | 79 | ||
| 102 | 80 | (d) On or before July 1, 2021, the department shall submit a report evaluating the effectiveness of the supplemental payment program to the Senate Committee on Health, the Assembly Committee on Health, the Senate Committee on Budget and Fiscal Review, and the Assembly Committee on Budget. | |
| 103 | 81 | ||
| 104 | 82 | (1) In order to compare access to necessary and approved services before and after the establishment of the supplemental payment program, the department may request participating home health agencies to report on key access to care indicators identified by the department, the participating agencies, and referring hospitals. The key access to care indicators shall include, but need not be limited to, the following: | |
| 105 | 83 | ||
| 106 | 84 | (A) The increase or decrease in hospital discharges to home health agencies. | |
| 107 | 85 | ||
| 108 | 86 | (B) The number of nursing hours filled, as compared to the number of hours that have been approved. | |
| 109 | 87 | ||
| 110 | - | (C) The number of available licensed home health agencies that accept pediatric patients. actively service pediatric patients by providing private duty nursing services. | |
| 111 | - | ||
| 112 | - | (D) The number of patients able to receive private duty nursing services. | |
| 113 | - | ||
| 114 | - | (E) The number of beneficiaries unable to receive private duty nursing services due to the lack of an available provider. | |
| 88 | + | (C) The number of available licensed home health agencies that accept pediatric patients. | |
| 115 | 89 | ||
| 116 | 90 | (2) In evaluating the effectiveness of the supplemental payment program, the department shall cooperate with, and consider input from, home health agencies, consumer groups, hospitals, and other provider associations. | |
| 117 | 91 | ||
| 118 | 92 | (e) This section shall become inoperative on December 31, 2021, and as of January 1, 2022, is repealed. | |
| 119 | - | ||
| 120 | - | ||
| 121 | - | ||
| 122 | - | (e) This section shall remain in effect only until January 1, 2022, and as of that date is repealed. |