BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1036|
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UNFINISHED BUSINESS
Bill No: SB 1036
Author: Senate Budget and Fiscal Review Committee
Amended: 6/26/12
Vote: 21
PRIOR VOTES NOT RELEVANT
ASSEMBLY FLOOR : Not available
SUBJECT : Budget Act of 2012: Coordinated Care
Initiative: Human
Services
SOURCE : Author
DIGEST : This bill 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.
Assembly Amendments delete the Senate version of the bill
and insert the above language.
ANALYSIS : 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
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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
payroll, workers' compensation, and benefits. In
approximately 72% of cases, IHSS recipients choose a family
member to provide care (including roughly 45% 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%, respectively. The average annual
cost of services per IHSS client is estimated at $11,420
for 2012-13.
This bill makes the following changes, as specified:
1. 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.
2. 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.
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3. Authorizes the creation of care coordination teams, with
a recipient's consent, to coordinate individual care
plan development.
4. Makes the Individual Provider mode of delivering IHSS
accessible to consumers in all managed care health plans
in each participating county.
5. 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.
6. Authorizes DHCS, DSS, and the Department of Aging to
establish a stakeholder workgroup to develop a 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.
7. Establishes a required county Maintenance of Effort
level of funding for IHSS, with specified adjustments in
future years, in order to stabilize the county share of
cost for the program.
8. Requires managed care plans to enter into Memorandums of
Understanding 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.
9. 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.
10.As IHSS comes on-line as a managed care benefit,
establishes an IHSS Statewide Authority for purposes of
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collective bargaining.
11.Gives discretion to the Director of the DHCS to make
these provisions inoperative based on specified
criteria.
12.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.
FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes
Local: Yes
CTW:m:d 6/27/12 Senate Floor Analyses
SUPPORT/OPPOSITION: NONE RECEIVED
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