BILL ANALYSIS �
AB 776
Page 1
Date of Hearing: May 8, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 776 (Yamada) - As Introduced: February 21, 2013
Policy Committee: HealthVote:18-0
Aging and Long Term Care 7-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill specifically includes area agencies on aging (AAAs)
and independent living centers (ILCs) as stakeholders to be
included in a current law stakeholder workgroup required as part
of the implementation of the Coordinated Care Initiative (CCI),
an integrated health care delivery system through which many of
the state's seniors and people with disabilities will receive
Medi-Cal benefits.
FISCAL EFFECT
Negligible state costs.
COMMENTS
1)According to the author this bill is needed to define
stakeholders to ensure that specific groups, such as AAAs and
ILCs are consulted in order to establish proper long term
services and supports (LTSSs) and managed care services for
dual eligibles in the implementation of the CCI in eight
designated pilot project counties. Dual eligibles are seniors
and people with disabilities (SPDs) who receive health
services under both the federal Medicare program and the
state-operated Medicaid program. Medi-Cal is California's
Medicaid program.
2)Passage of the CCI marked an important step toward
transforming California's Medi-Cal care delivery system to
better serve the state's low-income SPDs. After years of
stakeholder discussions, CCI begins the process of integrating
delivery of medical, behavioral, and LTSS and provides a road
AB 776
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map to integrate Medicare and Medi-Cal for people in both
programs. The author notes SB 1008 (Committee on Budget and
Fiscal Review), Chapter 33, Statutes of 2012 requires DHCS to
consult with stakeholders while preparing for various aspects
of the CCI implementation and oversight. Stakeholders are not
defined under the CCI. Including AAA's and ILC's in CCI
implementation will contribute to better planning, organizing,
monitoring, and assessing of services to California's SPDs and
their families.
3)Background . In November of 2010, California obtained federal
approval for a Section 1115(b) Medicaid Demonstration Waiver
intended as a bridge to health reform. Among other
provisions, this waiver authorized mandatory managed care plan
(MCP) enrollment of over 600,000 low-income SPDs who are
eligible for Medi-Cal only (not Medicare) in 16 counties.
Enrollment was phased in over a one-year period in the
affected counties; beginning on June 1, 2011. LTSS were carved
out of managed care and are largely provided through
fee-for-service (FFS).
In the proposed 2012-13 Budget, the Brown administration
requested legislative authority for a statewide CCI and
proposed to include LTSS for dual eligibles and SPDs in a
coordinated delivery system delivered using managed care
models. The LTSSs proposed to be integrated included In Home
Supportive Services (IHSS), Community-Based Adult Services
(CBAS), Multipurpose Senior Services (MSSP), and
skilled-nursing facility (SNF) services. The Legislature
enacted a modified version of the Governor's proposal in SB
1008, and SB 1036 (Committee on Budget and Fiscal Review),
Chapter 45, Statutes of 2012.
The administration is required under both SB 1008 and SB 1036
to consult with stakeholders in planning various aspects of
implementation.
4)AAAs and ILCs . AAAs are established by federal law through
the Older Americans Act to lead in the planning, development
and monitoring of local systems of care for older adults.
The state is divided into 33 Planning and Service Areas (PSAs)
and within each PSA is an AAA responsible for planning and
administering services to seniors. ILCs are non-profit
organizations that assist people with disabilities with a
variety of daily living tasks. ILCs also work with local and
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regional governments to improve infrastructure, raise
awareness about disability issues, and advocate for
legislation that promotes equal opportunities and prohibits
segregation and discrimination against people with
disabilities.
The California Association of Area Agencies on Aging (C4A)
supports this bill calling it a modest but important step to
ensure the integration of AAAs and ILCs in the dual
demonstration pilots and establish a linkage to their system
planning and coordination expertise. C4A contends that by not
specifying these entities as stakeholders, the CCI statutes
created a systemic barrier for the coordination of LTSS. The
California Commission on Aging and the Alzheimer's Association
argue the AAAs and the ILCs will enhance and strengthen CCI
planning and development efforts and provide a more accurate
model for comprehensive coordination of care across all
sectors: primary, acute, behavioral health and LTSS.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081