1. Orange County Association of Health Facilities
Education Meeting
September 20, 2017
Jim Gomez
CEO/President, CAHF

2. Economic Update Low inflation Revenues steady at state level
Cash steady at state level
Federal deficit getting worse
Real estate and stock market ↑↑
Unemployment ↓↓ 4.3%
Medical Inflation ↓

3. State Budget $125 billion general fund $185 billion total fund
New gas tax
New tobacco tax
New marijuana tax
14.1 million on Medi-Cal – 50% of children
4.1 million expansion population – adults 21-64
$20 billion for expansion population

4. State Health Budget 3.62% rebase $170 million for SNFs
$90 million QASP – payment April 30, 2018
50% of tobacco tax – $500 million to providers

5. Budget Trailer Bill Bad news 3.5 staffing – 2.4 CNA – 7/1/18
AB /1/18 – – 2.4
1/1/19 – – 2.6
1/1/20 – – 2.8
We are arguing for up to $50 million in 17/18
See chart and difficulties
Only 3.2 staffing for QASP payments

6. California Free Standing SNFs Direct-Care Hours/Patient Day by Job Category

7. QASP PAYMENT $88 million for 16/17 Paid May 1
387 homes paid for excellence
178 homes paid for improvement
$204K average payment for excellence
$49K average payment for improvement
17/18 payment April 2018
18/19 performance period just began

8. State Legislation AB 859 (Eggman) Elder Abuse
Lowers burden of proof
AB 1335 (Kalra) AA Citation on License Revocation
Makes AA violation easier to suspend/revoke
Amended to neutral – two-year bill
AB 940 (Weber) Transfer/Discharge Notification
LTC Ombudsman for all 370,000 – 24 hours
Modified for facility initiated transfers
Pushing to be same as Federal guidelines
AB 219 (Wiener) LGBT Bill of Rights in SNF
Created 10 specific bill of rights
Amended significantly - neutral

10. Dietary Grant $1 million over three years – CMP Starts August 2017
Reduce the number of dietary deficiencies
Training material: For all levels of staff
Four statewide training conferences
Hiring a Registered Dietician

11. Quality Outcomes are Improving or remaining high for 16 of the 18 Quality Outcome Measures Reported on nursing home compare

12. Federal Issues Medicare – 1% increase October 1, 2017
– Characteristics-based system proposed
– AHCA Episodic Payment Reform
Medicaid – Repeal and Replace – defended
– Why Medicaid
– Expansion Population

23. Future Resiliency of members Two more years on 1629 deal
Good Demographic
Resiliency of members
Two more years on 1629 deal
Uncertain Medi-Cal program
Medicare population increasing