CHAPTER 3.5. Coordinated System of Care [9250 - 9256]
( Chapter 3.5 added by Stats. 2002, Ch. 541, Sec. 14. )
(a) The Legislature finds and declares all of the following:
(1) Our delivery of long-term care needs to be vastly improved in order to coordinate services that are appropriate to each individual’s functional needs and financial situation. Care services should be holistic and address the needs of the entire person, including the person’s mental, physical, social, and emotional needs.
(2) The coming age wave will bankrupt California if we maintain the current uncoordinated system of long-term care.
(3) The new generation of aging Californians will desire, expect, and demand a much more responsive, coherent, and human-dignified system of care services.
(4) Multiple funding streams and varied eligibility criteria have created “silos” of services, making it difficult for consumers to move with ease from one service or program to another.
(5) Separate funding streams and uncoordinated services for older adults and adults with disabilities have created barriers in services for these populations. Adults with disabilities often receive long-term care services designed to support and protect the institutionalized older population. Instead, services need to be individualized to empower older adults and persons with disabilities to live in the community.
(6) Historically, two delivery systems, referred to as the medical model and the social model of care, have evolved with little or no coordination between the two.
(7) A high percentage of consumers enter the long-term care system after a hospitalization. Assistance and support following hospitalization would reduce the number of nursing home placements.
(8) The Legislature affirms the notion that individuals should be able to receive care in the least restrictive environment.
(9) Skilled nursing facilities account for 5 percent of the long-term care caseload and 52 percent of the long-term care expenditures. Home and community-based services account for 78 percent of the long-term care caseload, and 13 percent of long-term care expenditures. It is, therefore, more cost-effective to connect consumers with services in the community than to continue to place individuals in institutions.
(10) A number of counties and programs have developed and implemented innovative Internet-based information systems. Some of these systems are designed to help consumers access information regarding long-term care services, and others are designed to help providers track client information.
(11) The California Health and Human Services Agency is developing the “CalCareNet” Web site, which is designed to help the consumer find state-licensed providers of health services, social services, mental health services, alcohol and other drug services, and disability services, and also to find state-licensed care facilities.
(b) It the intent of the Legislature to enact legislation to do all of the following:
(1) Ensure that each consumer is able to connect with the appropriate services necessary to meet individual needs.
(2) Better coordinate long-term care delivery, recognizing the elements that are already in place, and expand the availability of long-term care.
(3) Deliver long-term care services in the most cost-effective manner.
(4) Access multiple public and private funding streams, without supplanting existing funding for programs and services.
(Added by Stats. 2002, Ch. 541, Sec. 14. Effective January 1, 2003.)
For purposes of this chapter, the following definitions apply:
(a) The term “long-term care” refers to a wide range of supportive and health and social services for older adults and adults with disabilities. Long-term care differs from other types of care in that the goal of long-term care is not to cure illnesses, but to allow individuals to attain and maintain optimal levels of functioning in their homes or in their communities. The provision of long-term services involves a continuum of health and social services in a variety of home- and community-based settings.
(b) The term “care navigation” describes any of the following services, performed in multiple settings, including, but not limited to, area agencies on aging, hospitals, caregiver resource centers, independent living centers, and senior centers:
(1) Consumer information delivered over the Internet, by telephone, including a statewide information hotline, or in person.
(2) Referral to programs or services delivered over the Internet, by telephone, including a statewide information telephone hotline, or in person.
(3) Short-term assistance for the consumer or caregiver, provided by persons qualified to work with the consumer to define needs, to refer the consumer to services that are free of charge or that may be purchased by the consumer, and to develop a plan of coordinated care.
(4) Recognition of the need for ongoing assistance, with the ability to link consumers to ongoing assistance, care coordination, services coordination, or case management.
(c) (1) The term “care navigator” describes an individual who provides care navigation to older persons or persons with disabilities in need of long-term care services, or to caregivers. Care navigators consider an individual’s medical and functional needs, financial resources, and social support, in order to partner with the individual and, together, determine which services offered in the community are most appropriate for the consumer. The intervention with the consumer may be limited, depending on the consumer’s needs.
(2) Care navigation may be performed within existing programs and at multiple points of entry, including, but not limited to, area agencies on aging, independent living centers, county welfare departments, hospitals, caregiver resource centers, and senior centers.
(d) The term “CalCareNet” describes a self-directed statewide, Internet-based application using the State of California Internet portal to link local Internet information systems. The CalCareNet Web site is designed to help the consumer find state-licensed providers of health services, social services, mental health services, alcohol and other drug services, and disability services, and also to find state-licensed care facilities. The purpose of CalCareNet is to enable the consumer to better navigate the long-term care system.
(Added by Stats. 2002, Ch. 541, Sec. 14. Effective January 1, 2003.)
Implementation of this chapter shall be grounded on the following principles:
(a) Services shall be provided in the least restrictive, most home-based environment compatible with the health condition, mental status, and long-term needs of each consumer.
(b) Services shall be accessible through multiple points of entry into a continuum of long-term care services that meet a wide range of needs of the aging population and for persons with disabilities.
(c) Home- and community-based long-term care services shall be readily accessible from the hospital.
(d) Home- and community-based long-term care services that meet a wide range of consumer needs shall be available.
(Added by Stats. 2002, Ch. 541, Sec. 14. Effective January 1, 2003.)
By June 1, 2003, pursuant to the California long-term care plan developed pursuant to Section 96 of Assembly Bill 442 of the 2001–02 Regular Session, the Long-Term Care Council shall assess the current availability of home- and community-based services, identify gaps in service availability, and evaluate changes that could be made to enable consumers to be served in the most integrated setting possible.
(Added by Stats. 2002, Ch. 541, Sec. 14. Effective January 1, 2003.)
(a) The Legislature finds and declares all of the following:
(1) Providers of long-term care programs, including, but not limited to, programs of all-inclusive care for the elderly, skilled nursing facilities, adult day care, adult day services, Alzheimer’s day care centers, and multipurpose senior services programs, are regulated by numerous state and local agencies.
(2) Overlapping and duplicative oversight of long-term care programs often results in conflicting interpretations of statutes and regulations. Also, oversight by multiple agencies creates an operational burden that ultimately deprives residents or clients of valuable staff time.
(3) The State Auditor has completed an audit investigation of the duplicative overlapping regulatory oversight of long-term care programs.
(b) By March 1, 2005, the California Health and Human Services Agency shall determine the appropriate single entity to provide oversight of the waiver standards for adult day health care centers.
(c) The State Department of Health Services shall determine a percentage of the number of oversight reviews it conducts of the Multipurpose Senior Services Program (MSSP) utilization surveys that are conducted by the California Department of Aging. The percentage of surveys reviewed shall be sufficient to ensure effective oversight, but small enough to avoid unnecessary duplication of effort.
(Added by Stats. 2004, Ch. 455, Sec. 1. Effective January 1, 2005.)
(a) By January 1, 2005, the agency, with recommendations from the Long-Term Care Council, shall set standards for CalCareNet, with the goal of creating an Internet site that links to counties and planning service areas, and that provides information on long-term care services that are available to the consumer. The agency shall recommend guidelines for local Internet information systems, allowing for flexibility in design and structure. The local entities with existing systems are encouraged to maintain existing systems, assuming CalCareNet guidelines are met.
(b) State funds shall not be appropriated for purposes of this section. The agency is not required to undertake any new task described in this section unless it receives federal or private funds for that purpose.
(c) Information shared between, and tracked by, providers through CalCareNet may in no way violate Section 15633, pertaining to client confidentiality, or any other statute requiring that client information be kept confidential, unless otherwise exempted by law.
(d) In crafting its guidelines for the local-level information systems, the Long-Term Care Council shall seek input from interested stakeholders, including, but not limited to, all of the following:
(1) Consumers.
(2) Consumer advocacy organizations.
(3) Area agencies on aging.
(4) Senior legal services.
(5) The California Commission on Aging.
(6) Caregiver resource centers.
(7) Veterans’ services.
(8) Senior centers.
(9) PACE (Program for All Inclusive Care for the Elderly).
(10) The Senior Care Action Network (SCAN).
(11) The Multipurpose Senior Services Program (MSSP) services.
(12) Ombudspersons.
(13) County-level programs, including, but not limited to, In-Home Supportive Services (IHSS), county welfare departments, public health departments, and adult protective services agencies.
(14) Programs for persons with disabilities, including, but not limited to, independent living centers.
(15) Other social service programs, including, but not limited to, employment development programs.
(e) By January 1, 2004, the agency shall link the CalCareNet Web site to local Internet information systems. The agency shall permit counties and planning service areas to design local information systems, contingent upon the availability of funding and resources for these purposes.
(Added by Stats. 2002, Ch. 541, Sec. 14. Effective January 1, 2003.)
(a) By January 1, 2004, the agency, based on recommendations from the Long-Term Care Council, shall recommend to the Legislature standards for care navigation, including suggestions for connecting consumers from the acute care system, to and through the long-term care system.
(b) In its recommendations to the Legislature, the agency shall address care navigator educational and training requirements, the care navigator location within the long-term care continuum, licensure and oversight requirements, and potential funding impact. In its recommendations, the agency shall discuss the need for waivers, enhancing access to home- and community-based services for private payers, connecting the acute care system with the long-term care system, and obtaining private and public funding. The agency shall also discuss means for the cooperative participation of insurance companies, physicians, hospitals, assisted living facilities, home health agencies, and skilled nursing facilities.
(c) In crafting its recommendations to the agency, the Long-Term Care Council shall seek input from interested stakeholders, including, but not limited to, those stakeholders described in subdivision (d) of Section 9254.
(d) Care navigation must be consistent with the goal of developing a program that is based on the existing state and local systems, to ensure that consumers are connected to the necessary care and services.
(e) State funds shall not be appropriated for the purpose of implementing this section. The agency is not required to undertake any new task specified in this section unless it receives federal or private funds for that purpose.
(Added by Stats. 2002, Ch. 541, Sec. 14. Effective January 1, 2003.)
The implementation of a care navigation program, as described in Section 9255, shall be subject to the enactment of legislation requiring implementation.
(Added by Stats. 2002, Ch. 541, Sec. 14. Effective January 1, 2003.)