BILL ANALYSIS �
AB 776
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Date of Hearing: April 23, 2013
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Mariko Yamada, Chair
AB 776 (Yamada) - As Introduced: February 21, 2013
SUBJECT : Coordinated Care Initiative, an 1115 waiver
demonstration program of Medi-Cal.
SUMMARY : Defines "Stakeholder," and establishes Area Agencies
on Aging (AAA) and Independent Living Centers (ILC) as
participants of statutorily mandated stakeholder processes for
the development and testing of a universal assessment process
for Long-Term Services and Supports (LTSS), and the issuance of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions. Specifically, this bill :
1)Defines "stakeholder" for the purposes of Article 5.7 of
Division 9, Part 3, Chapter 7 of the Welfare and Institutions
Codes pertaining to Long-Term Services and Supports
Integration under the Coordinated Care Initiative.
2)Assures that AAAs and ILCs are stakeholders of workgroups
convened by the Department of Aging (CDA) and the Department
of Social Services (DSS) to develop a uniform assessment
process and a uniform assessment tool for home- and
community-based.
3)Assures that AAAs and ILCs are stakeholders of workgroups
convened by DSS and Department of Health Care Services (DHCS)
in the event that the DHCS director deems the quality of care
for managed care beneficiaries, efficiency, or
cost-effectiveness within the CCI would be jeopardized.
EXISTING LAW
1)Establishes the Medicaid Program (Medi-Cal in California) as a
joint federal-state program to provide health care services to
low-income families with children, seniors, and persons with
disabilities (SPDs).
2)Establishes Medicare as a federal health insurance program to
provide coverage to eligible individuals who are disabled or
over age 65.
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3)Allows the Center for Medicare and Medicaid Innovation to test
innovative payment and delivery models to lower costs and
improve quality for enrollees who are dually eligible for
Medi-Cal and Medicare ("dual eligibles").
4)Establishes the CCI that requires DHCS to seek federal
approval to establish demonstration sites in up to eight
counties to provide coordinated Medi-Cal and Medicare benefits
to dual eligibles and authorizes DHCS to require SPDs who are
eligible for Medi-Cal only to mandatorily enroll in Medi-Cal
managed care (MCMC) plans (MCPs).
5)Requires consultation with stakeholders in implementing these
provisions.
6)Requires county agencies to conduct In Home Supportive
Services (IHSS) assessments and authorization processes and
provides for the development and utilization of a universal
assessment tool no sooner than January 1, 2015.
7)Establishes AAA, through the federal Older Americans Act, and
the Mello-Granlund Older Californians Act of 1996. AAAs
receive federal, state, and local funds to contract with local
organizations for service to seniors. There are 33 AAAs
designated by the CDA as local Planning Services Agencies
(PSAs).
8)Establishes ILCs through the Rehabilitation Act of 1973, which
are consumer controlled, community based, cross disability,
nonresidential private nonprofit agencies that are designed
and operated within a local community by individuals with
disabilities. Independent living services maximize the ability
to live independently in the environment of a client's own
choosing. There are 29 ILCs in California.
FISCAL EFFECT : Unknown
PURPOSE OF THE BILL : Based upon materials submitted by the
author, "stakeholders" are currently undefined under the CCI.
AAAs and ILCs are uniquely positioned with long-standing working
relationships and expertise in serving the CCI population.
Including AAA's and ILC's in CCI implementation will contribute
to better planning, organizing, monitoring and assessing of
services to California's older adults, persons with disabilities
and their families, thus assuring the highest and best use of
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scarce public resources, and avoiding unnecessary planning and
resource deployment choices.
BACKGROUND: The CCI, enacted by SB 1008 and SB 1036 in July
2012, transforms the way California's 1.4M low-income seniors
and persons with disabilities and those dually eligible for
Medi-Cal and Medicare, will access a variety of medical,
behavioral, and long-term services and supports. It was widely
broadcast that these changes would allow the state to reduce
system fragmentation, better align fiscal incentives, improve
care, reduce institutionalization and increase home and
communitybased services. The state and federal governments hope
to achieve improvements in system function and at the same time
score financial savings. While there is agreement and
documentation that Californias system of LTSS is dysfunctional
and challenged by a range of competing authorities and funding
streams, the speed of change combined with the goals of
balancing good policy while achieving fiscal savings present
challenges. Providing for the participation of stakeholders
representing systems already engaged with consumers at the
grassroots level, such as AAAs and ILCs, AB 776 will offer an
additional layer of assurance that unnecessary duplication will
be minimized, and the highest level of coordination and cost
savings can be achieved.
Based upon conditions established in recent authorization and
approval from the Centers for Medicare and Medicaid Services
(CMS), beginning October 1, 2013, those dual-eligibles will be
enrolled into managed health care plans. An eight-county pilot
program affecting approximately 545,000 individuals eligible for
both Med-Cal and Medicare includes the counties of Alameda, Los
Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo
and Santa Clara. Services covered are preventative and acute
medical services including out-patient, primary care, specialty
care, care coordination, in-patient services, durable medical
equipment, drugs, medical transportation, and long-term services
and supports such as IHSS, Community-Based Adult Services
(CBAS), Multipurpose Senior Services (MSSP), and skilled-nursing
facility (SNF) services. Part of this transition includes a
"stakeholder" process to develop uniform assessment.
Trailer bill language in 2012 required the Administration to
consult with "stakeholders" while preparing for various aspects
of CCI implementation and oversight. SB 1036 (Committee on
Budget and Fiscal Review) Chapter 45, Statutes of 2012 made
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changes to the IHSS program, including changes to a county's
share of cost for IHSS, and a shift to statewide collective
bargaining for provider wages and benefits-but only for the
eight piloted counties. SB 1036 also required a stakeholder
workgroup to develop a universal assessment tool for the range
of home and community-based services (IHSS, CBAS, MSSP, skilled
nursing facility care). Currently, DHCS has convened six
stakeholder workgroups to solicit input and develop standards
related to LTSS and IHSS integration, behavioral health
integration, beneficiary notices and protections, quality and
evaluation, provider outreach, and fiscal and rate-setting.
California's programs and services for older adults and persons
with disabilities are undergoing a rapid and dramatic system
change. Driven by state budget deficits as well as incentives
to improve outcomes offered by health care reform, the programs
and services that support longterm living are being reshaped
into a system of managed care.
PREVIOUS LEGISLATION:
SB 1008 and SB 1036 authorize the CCI as an eight-county pilot
project to: i) integrate Medi-Cal
and Medicare benefits under managed care for dual eligibles;
and, ii) integrate LTSS under
managed care for dual eligibles and Medi-Cal-only SPDs.
SB 208 (Steinberg), Chapter 714, Statutes of 2010, contained the
provisions implementing Section 1115(b) Medicaid Demonstration
Waiver from CMS entitled "A Bridge to Reform Waiver." Among the
provisions, this waiver authorized mandatory enrollment into
MCPs of over 600,000 low-income SPDs who are eligible for
Medi-Cal only (not Medicare) in 16 counties.
This bill passed out of Assembly Health on April 9th with a vote
of 18-0 with recommendation to consent.
REGISTERED SUPPORT / OPPOSITION :
Support
Alzheimer's Association
California Association of Area Agencies on Aging (C4A)
California Association of Public Authorities (CAPA)
AB 776
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Opposition
None on file.
Analysis Prepared by : Robert MacLaughlin / AGING & L.T.C. /
(916) 319-3990