No. 09-01
WHEREAS, Assembly Bill 1040 (Bates) required the California Department of Health Services to administer the Long-Term Care Integration Pilot Program to improve long-term care services for older and disabled adults; and,
WHEREAS, the purpose of AB 1040 is to integrate the financing and administration of long-term care services, under a capitated, at-risk payment system, for the full continuum of medical, social and supportive services, which is intended to further the development of an integrated long-term care service delivery system; and,
WHEREAS, the San Francisco Health Commission previously approved the Department of Public Health’s pursuit of a long-term care integration pilot project under AB 1040, the Long-Term Care Integration Pilot Program (Health Commission Resolution #41-95); and,
WHEREAS, the San Francisco Health Commission previously supported the designation of the Department of Public Health as lead agency for the development of a long-term care integration pilot project under AB 1040 (Health Commission Resolution #14-96); and,
WHEREAS, the San Francisco Board of Supervisors previously designated the Department of Public Health to serve as lead agency for the development of a long-term care integration pilot project under AB 1040 and created the Long-Term Care Pilot Project Task Force for said purpose (Board of Supervisors Resolution #1024-96); and,
WHEREAS, the Long-Term Care Pilot Project Task Force has made recommendations on:
(1) the optimal model of care; (2) scope of services to be provided; (3) consumer and caregiver rights; (4) strategies to develop supportive housing; and (5) approaches to organizing the service delivery system that would enhance consumer choice and maintain quality of life; and,
WHEREAS, there have been significant policy changes since AB 1040 was adopted in 1995 such as: (1) the adoption of the federal Balanced Budget Act of 1997, which has had a adverse impact on Medicare and Medicaid reimbursement rates; and (2) establishment of the Governor’s Aging with Dignity Initiative in FY 1999-00, including the long-term care innovation grant program, which is being administered by the California Department of Aging; and,
WHEREAS, increasing concerns have been raised by long-term care service providers about their ability to obtain sufficient funding to support services under capitated managed care and by the Long-Term Care Pilot Project Task Force regarding the appropriateness of developing a fully capitated, at-risk managed care system that would serve long-term care consumers for the same reason; and,
WHEREAS, the California Department of Health Services, which administers the State’s Long-Term Care Integration Pilot Program (AB 1040), has indicated that any project developed under this legislation must include capitated managed care financing for service providers, given that it is a primary goal of AB 1040; and,
WHEREAS, San Francisco’s Long-Term Care Pilot Project Task Force will neither prepare a comprehensive long-term care plan based on the requirements of the State’s Long-Term Care Integration Pilot Program (AB 1040) nor present the plan to the San Francisco Health Commission and San Francisco Board of Supervisors for review and approval; and,
WHEREAS, the Long-Term Care Pilot Project Task Force, along with a number of other counties, is now exploring alternative models to improve long-term care services, which may involve federal waivers to expand home and community-based services, but not involve capitated, at-risk managed care financing arrangements; and,
WHEREAS, in July 2000, San Francisco created the Department of Aging and Adult Services
to consolidate existing county services for older and disabled adults, and to create and sustain a coordinated service delivery system, including long-term care services; and,
WHEREAS, the Department of Aging and Adult Services has defined a target population that is broader than AB 1040 and incorporates well elders, frail elders, younger disabled adults, veterans and families, irrespective of Medi-Cal eligibility; and,
WHEREAS, the Department of Aging and Adult Services, under its new responsibilities, is establishing a Continuum of Care Policy Committee, with a broad spectrum of stakeholders, which will address issues related to providing social and health services, prevention activities, and long-term care services for its target population; now, therefore, be it
RESOLVED, that the San Francisco Health Commission recommends that San Francisco’s participation in the State’s Long-Term Care Integration Pilot Program (AB 1040) be terminated; and, be it
FURTHER RESOLVED, that the San Francisco Health Commission urges the San Francisco Board of Supervisors to disband the Long-Term Care Pilot Project Task Force for the purpose of developing a comprehensive plan for a long-term care integration pilot project under AB 1040; and, be it
FURTHER RESOLVED, that the San Francisco Health Commission urges the San Francisco Board of Supervisors to terminate the Department of Public Health as lead agency for the implementation of a long-term care integration pilot project under AB 1040; and, be it
FURTHER RESOLVED, that the Department of Public Health will provide technical assistance to the Department of Aging and Adult Services on long-term care, and participate on its Continuum of Care Policy Committee and any other policy committees that will oversee the implementation of improvements in San Francisco’s long-term care service delivery system; and, be it
FURTHER RESOLVED, that the San Francisco Health Commission supports, along with other counties and the State, the continued exploration of alternative models to AB 1040 in order to improve long-term care services for older and disabled adults, which may involve expansion of home and community-based services, but without capitated managed care as its primary goal.
I hereby certify that the Health Commission at its meeting of April 17, 2001 adopted the foregoing resolution.
Arthur R. Greenberg, Interim Health Commission Secretary