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Yamada Takes a Lonely Stand on ADHC Bill

The Senate Committee on Health yesterday rejected a bill designed to perpetuate adult day health care services in one of the strangest votes in recent memory.

The legislators on the committee voiced strong support for the bill and said they wanted to vote for it, but bill author Assembly member Mariko Yamada (D-Davis) adamantly refused to consider an amendment removing a restriction on for-profit adult day health businesses. After a long and awkward discussion of personal philosophy, the committee rejected the bill.

It failed to garner a single vote.

In fact, no actual vote was taken on AB 518 because no legislator would even move the bill.

“This is one of the most unique debates I’ve seen since I’ve been here in the Legislature,” said Sen. Kevin de León (D-Los Angeles). De León had offered Yamada an out, to postpone a vote on the bill and try to work out some kind of compromise, rather than take a vote after so many legislators had voiced their reluctant opposition.

“I wonder if it’s possible we don’t have a vote today, and maybe something can be worked out,” de León said. “Perhaps you can find a happy medium. Otherwise this is just an exercise.”

Yamada wasn’t willing. “I’m fine with a vote,” Yamada said.

AB 518 would have codified the legal settlement that spawned the state’s Community Based Adult Services program. Under Yamada’s proposal, CBAS services would have become a Medi-Cal benefit.

The settlement expires in August 2014. At that point, Yamada said, the state could choose to eliminate the CBAS program.

The provision that caused all the fuss was a requirement that all CBAS providers be not-for-profit organizations. Many of the current CBAS centers also provide other services under a fee-for-service model. It doesn’t make economic or organizational sense to require not-for-profit status for all centers, according to Laurel Mildred, legislative advocate for the California Association of Adult Day Services.

“This one provision will undermine many of the centers, by requiring that all be nonprofit entities,” Mildred said. That will mean more closures of adult day health care centers, she said, “and that will severely restrict access to care.”

Mildred said there is no not-for-profit requirement in the settlement agreement, and even the Department of Health Care Services, which originally wanted all centers to be not-for-profit, has tabled implementation of that policy.

“We don’t understand why we should pass a bill that’s unworkable,” she said. “The question is, beyond wishful thinking, how will centers survive? These are struggling small businesses. … This provision has no policy footprint, no precedent. Why do we want to go further than the settlement?”

Yamada said she believes the governor will veto the legislation unless it has the provision requiring not-for-profit status.

And the other answer, Yamada said, is that not-for-profits can receive government money, but businesses should not make a profit on state investments, she said.

“I have a fundamental position and belief that people can make a living from this, but not a profit from this,” Yamada said.

Sen. Ed Hernandez (D-West Covina), an optometrist and chair of the Senate health committee, pointed out that a number of for-profit providers, such as physicians and nurses — and optometrists — all make a profit and receive state and federal money in Medi-Cal and Medicare payments.

“We have for-profits all the time … they all do business with the state, they all take Medi-Cal,” Hernandez said. “I think that whoever provides the service there needs to be measures to ensure people are getting the care, that’s the important thing.”

Sen. Lois Wolk (D-Davis) pointed out that hospice care, home health care and other service providers don’t have the not-for-profit requirement.

“[Adult day health care] may have been envisioned as a nonprofit in the beginning,” she said, “but the Legislature decided they could be for-profit in the ’90s. I hope you reconsider.”

“We hear a term here sometimes,” said Sen. Bill Monning (D-Carmel). “Don’t let the perfect be the enemy of the good. [You have] a noble aspiration, but you have to consider in the day-to-day work the practical impact of elders who have access now and who would lose access.”

“As state lawmakers, I don’t want to be the architect of this program without a fundamental statement that public dollars should not be used for profit,” Yamada said.

And, she added, the for-profit organizational structure could doom the bill.

“It’s pretty clear to me that, in the [Brown] Administration, the for-profit model is not the preferred model,” Yamada said. “Should this bill fail, I don’t want it to go down as a philosophical decision. But I find it a bit counter-intuitive.”

Hernandez summed it up.

“So you’re not going to hold the bill over, and you’re not willing to address or entertain the idea of a study [of the two options],” he said. “I’m supportive of what your intent is. … With that, what is the pleasure of the committee?”

And there was a long silence.

“Seeing no motion, we won’t be able to move the bill,” Hernandez said.

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