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 
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          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 
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               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


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