BILL ANALYSIS Ó SENATE COMMITTEE ON BUDGET AND FISCAL REVIEW Mark Leno, Chair Bill No: AB 1496 Author: Committee on Budget As Amended: June 25, 2012 Consultant: Jennifer Troia Fiscal: Yes Hearing Date: June 26, 2012 Subject: Budget Act of 2012: Coordinated Care Initiative: Human Services Summary: Contains necessary statutory and technical changes to implement the human services provisions related to the Integration of Home and Community Based and Long-Term Care Services, including In-Home Supportive Services (IHSS), into Medi-Cal Managed Care, as specified, in the Budget Act of 2012. Background: IHSS is a county-administered program through which low-income individuals who are aged, blind, or disabled can receive personal care and domestic services that allow them to remain safely in their own homes and avoid institutionalization. IHSS services include tasks like feeding, bathing, bowel and bladder care, meal preparation and clean-up, laundry, and paramedical care. These services frequently help program recipients to avoid or delay more expensive and less desirable institutional care settings. There are currently around 440,000 recipients of IHSS statewide, and as of the end of 2011, there were approximately 366,000 IHSS providers. County social workers currently determine eligibility for IHSS after conducting a standardized in-home assessment, and periodic reassessments, of an individual's ability to perform specified activities of daily living. Once eligible, recipients are responsible for hiring, firing, directing and supervising their own IHSS provider or providers. The counties or public authorities must conduct a criminal background check and provide an orientation before a provider can receive payment. Local public authorities are designated as "employers of record" for collective bargaining purposes, while the state administers -1- payroll, workers' compensation, and benefits. In approximately 72 percent of cases, IHSS recipients choose a family member to provide care (including roughly 45 percent of providers who are a spouse, child, or parent of the recipient). IHSS is funded with federal, state, and county resources. The state and counties split the non-federal share of IHSS funding at 65 and 35 percent, respectively. The average annual cost of services per IHSS client is estimated at $11,420 for 2012-13. Proposed Law This bill would make the following changes, as specified: No sooner than March 1, 2013, establishes IHSS as a Medi-Cal Managed Care plan benefit in counties participating in the Duals Demonstration Project (as specified in another budget trailer bill contained in AB 1468/SB 1008) with a goal of maximizing access to, and coordination of, long-term services and supports, including IHSS. Protects the rights of IHSS recipients to hire, fire, direct, schedule and supervise their own IHSS provider(s) and control their own care in accordance with existing law. Authorizes the creation of care coordination teams, with a recipient's consent, to coordinate individual care plan development. Makes the Individual Provider mode of delivering IHSS accessible to consumers in all managed care health plans in each participating county. Requires the Department of Social Services (DSS) and the Department of Health Care Services (DHCS), in consultation with IHSS recipients and other stakeholders, to develop a voluntary training curriculum for IHSS providers, while maintaining the recipients' rights to train their own providers. Authorizes DHCS, DSS, and the Department of Aging to establish a stakeholder workgroup to develop a -2- universal assessment process for specified home- and community-based services, including IHSS. Further, allows health plans and providers to test the use of this tool in two to four counties, no sooner than January 1, 2015. Establishes a required county Maintenance of Effort (MOE) level of funding for IHSS, with specified adjustments in future years, in order to stabilize the county share of cost for the program. Requires managed care plans to enter into Memorandums of Understanding (MOUs) with counties so that counties can continue their current functions with respect to eligibility assessments and final determinations of authorized IHSS hours, while also allowing health plans to authorize additional home- and community-based services hours. Allows counties to continue to contract with non-profit consortiums and local public authorities to carry out current IHSS operations and functions, including the provision of training to IHSS providers and of registry services to assist consumers in finding providers. As IHSS comes on-line as a managed care benefit, establishes an IHSS Statewide Authority for purposes of collective bargaining. Gives discretion to the Director of the Department of Health Care Services to make these provisions inoperative based on specified criteria. Makes the provisions of this bill contingent on enactment of AB 1468 (SB 1008), the health budget trailer bill that proposes to implement the Duals Demonstration Project through Coordinated Care. Support: Unknown Opposed: Unknown -3- -4-