CAHSAH Sets Priority Legislation for Lobby Day Advocacy
The California Legislature is in full swing and April marks a very busy month for committees to meet and act upon important legislation. CAHSAH's Policy, Advocacy and Public Affairs Committee (PAPA) has reviewed and analyzed hundreds of bills which will impact home care, home health and hospice providers. Positions have been taken on all bills impacting our industry’s services and a few key bills have been selected as priority legislation. Those priority bills will be the focus of CAHSAH’s upcoming Annual Virtual Lobby Day being held April 9 – April 11.
Lobby Day is your chance to speak on behalf of your clients and patients and to let the Legislature know about important issues facing our Industry. CAHSAH has prepared a fact sheet detailing all the relevant talking points for each priority bill and will provide a briefing on the priority issues the opening morning of Lobby Day. Below you will find a brief description of the key bills and issues and the position we will be advocating for during our legislative appointments which are a key part of Lobby Day.
Support AB 2104 (Soria) & SB 895 (Roth)
Community Colleges: Baccalaureate Degree in Nursing Pilot Program
AB 2104 and SB 895 will permit the Chancellor of the California Community Colleges to develop a Baccalaureate Degree in Nursing Pilot Program that authorizes up to 15 community college districts to offer a Bachelor of Science in Nursing degree. Home health has traditionally had difficulty attracting and retaining nurses because the industry cannot compete with hospitals and other facilities that have not had their reimbursement rates cut and do not have a one-year professional nursing experience requirement prior to being employed.
Support AB 2185 (Jackson)
Employment Agencies: Domestic Workers
AB 2185 is vitally needed to stop domestic referral agencies from deceptively marketing themselves as providing care to seniors and make ongoing wage payments on an independent contractor basis to domestic workers. Domestic Referral Agencies are a form of employment agency that refers caregivers to prospective clients, but does not directly employ the workers and is not permitted to train, supervise or monitor the care provided, nor provide any tools, equipment or supplies to the workers. Under the domestic referral model, consumers typically establish “trust accounts” to make payments to the agency trust, instead of making two separate payments to the caregiver and to the referral agency. The referral agency then collects its fee and pays the worker's wages from the trust, providing the worker with an IRS 1099 as an independent contractor. AB 2185 would continue to allow Domestic Referral Agencies to provide referral services, but not allow them to function as unlicensed home care organizations. California passed AB 5 over three years ago to end the practice of employee misclassification of independent contractors.
Support AB 2340 (Bonta)
Medi-Cal EPSDT Services
Existing law covers early and periodic screening, diagnostic, and treatment (EPSDT) services under Medi-Cal for an individual under 21 years of age in accordance with certain federal provisions. For an individual under 21 years of age, a service is medically necessary if the service meets the standards set forth in one of those federal EPSDT provisions, including the correction or amelioration of defects and physical and mental illnesses and conditions discovered by the screening services, whether or not those services are covered under the state plan. AB 2340 would prohibit limits on EPSDT services when those services are medically necessary and would require a Medi-Cal managed care plan to cover all medically necessary EPSDT services, unless otherwise carved out of the contract between the managed care plan and the Department of Health Care Services regardless of whether those services are covered under the Medi-Cal State Plan. AB 2340 would establish much needed definitions for “EPSDT services” and “medically necessary” which would specify that EPSDT services also include all age-specific assessments and services listed under the most current periodicity schedule by the American Academy of Pediatrics (AAP) and Bright Futures, and any other medically necessary assessments and services that exceed those listed by AAP and Bright Futures. The Department of Health Care Services and its contractors would be required to accurately reflect these provisions in any model evidence-of-coverage documents, beneficiary handbooks, and related material.
Support AB 3232 (Dahle)
Licensed Registered Nurses and Licensed Vocational Nurses: Nurse Licensure Compact
AB 3232 would enact the Nurse Licensure Compact, under which the Board of Registered Nursing and the Board of Vocational Nursing and Psychiatric Technicians would be authorized to issue a multistate license that would authorize the holder to practice as a registered nurse or a licensed vocational nurse in all party states under a multistate licensure privilege. Home Health has traditionally had difficulty attracting and retaining nurses because the industry cannot compete with hospitals and other facilities that have not had their reimbursement rates cut and do not have a one-year professional nursing experience requirement prior to being employed. Because of the shortage of personnel, patients are forced to remain in more costly institutional settings and away from family because there are not enough home-based alternatives. With the public health emergency, we saw that flex waivers needed to be granted by the Department of Public Health before nurses from other states could practice in California because our state is not one of the compact nursing states. There are currently 41 states that have already adopted the compact agreement.
Support SB 1492 (Menjivar)
Medi-Cal Reimbursement Rates: Private Duty Nursing.
For decades, California has suffered from a shortage of Registered Nurses (RN’s) and Licensed Vocational Nurses (LVN's). This challenge has been exacerbated in recent years due to a global pandemic and is expected to worsen due to an increase in nurse retirements. While this is a national problem, it is particularly acute in California, where there are 995 RNs per 100,000 people – ranking 40th out of 50 states. One contributing factor to this crisis is that California’s nursing school capacity has not been able to keep up with demand. Existing law imposes a managed care organization (MCO) provider tax, administered and assessed by the department, on licensed health care service plans and managed care plans contracted with the Department of Health Care Services to provide full-scope Medi-Cal services. The MCO provider tax may be used, upon appropriation by the Legislature, for the increased costs incurred as a result of reimbursement requirements, among other things. SB 1492 would provide that private duty nursing services provided to a child under 21 years of age by a home health agency are considered eligible for funding from MCO tax revenues.
Private Attorneys General Act (PAGA)
Support Ballot Initiative
Enacted in 2004, California’s Private Attorneys General Act (PAGA) was intended to be a more effective way to help workers resolve labor disputes. Its primary purpose was to supplement public enforcement of the Labor Code with a new, private lawsuit option because the California Division of Labor Standards Enforcement (DLSE) was failing to process claims in a satisfactory manner due to underfunding. DLSE was funded through the General Fund and therefore subject to vulnerabilities of the state’s budget. However, two decades later, it’s clear that PAGA’s “lawsuit-first approach” has failed, it’s ineffective and inefficient for workers and unfair for thousands of small businesses. California has an existing, capable administrative process and agency, the Labor and Workforce Development Agency (LWDA) that is now funded and has a proven record of resolving claims faster with money going directly into workers’ pockets. California voters will have an opportunity to repeal PAGA on the November ballot.
Delay Implementation of Healthcare Worker Minimum Wage
Ask the Legislature to delay the implementation of the healthcare worker minimum wage which is set to begin at $21 in June of 2024, and increasing to $23 in June of 2026 and $25 in June of 2028.
We encourage you to be a part of Lobby Day and ask that you email our Legislative Specialist, Mary Adorno at madorno@cahsah.org and just say “Yes for Lobby!” Mary will get you registered and answer any questions you may have about Lobby Day.