BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 776
AUTHOR: Yamada
INTRODUCED: February 21, 2013
HEARING DATE: June 5, 2013
CONSULTANT: Bain
SUBJECT : Medi-Cal.
SUMMARY : Defines, for purposes of the Long-Term Services and
Supports Integration component of the Coordinated Care
Initiative, the term "stakeholder" to include, but not be
limited to, area agencies on aging (AAAs) and independent living
centers (ILCs) for purposes of stakeholder consultation
requirements. Adds AAAs and ILCs to the list of stakeholders the
Department of Health Care Services (DHCS) is required to notify
and consult with prior to issuing all plan letters, plan or
provider bulletins or similar instructions without taking
regulatory action.
Existing law:
1.Establishes the Medi-Cal program, which is administered by the
DHCS, under which qualified low-income individuals receive
health care services.
2.Requires DHCS, to the extent that federal financial
participation is available, and pursuant to a demonstration
project or waiver of federal law, to establish specified
Medi-Cal pilot projects in up to 8 counties, and requires
long-term services and supports (LTSS) to be available to
beneficiaries residing in counties participating in those
pilot projects. This demonstration project is known as the
Coordinated Care Initiative (CCI).
3.Requires, as part of the CCI, all Medi-Cal LTSS to be services
covered under Medi-Cal managed care health plan contracts and
available only through plans to beneficiaries residing in
counties participating in the demonstration, except for
exemptions provided (referred to hereafter as LTSS
Integration).
4.Requires DHCS to consult with stakeholders in implementing
various requirements of the LTSS Integration in Medi-Cal
managed care health plans, including determining the
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implementation date of the LTSS Integration, whether to
implement a phased-in enrollment approach, the Medi-Cal
beneficiaries exempt from mandatory enrollment, service fee
structures, services and care coordination models for the
provision of home- and community-based services (HCBS) in
plans, the transition plan report to the Legislature, and a
referral process and informational materials for the appeals
process applicable to HCBS.
5.Requires DHCS, the Department of Social Services (DSS), and
the California Department of Aging (CDA), no later than June
1, 2013 to establish a stakeholder workgroup to develop a
universal assessment process, including a universal assessment
tool, for HCBS. Requires the stakeholder workgroup to include,
but not be limited to, consumers of In-Home Supportive
Services (IHSS) and other HCBS and their authorized
representatives, managed care health plans, counties, IHSS,
Multipurpose Senior Services Program (MSSP), and Community
Based Adult Services (CBAS) providers, and legislative staff.
Requires a report to the Legislature on the stakeholder
workgroup's progress in developing the universal assessment
process, and to report on the results of the initial use of
the universal assessment process.
This bill:
1.Defines, for purposes of the LTSS Integration, the term
"stakeholder" to include, but not be limited to, AAAs and ILCs
for purpose of the existing stakeholder consultation
requirements in the LTSS Integration of CCI.
2.Requires the stakeholder workgroup established as part of the
LTSS Integration to develop a universal assessment process and
universal assessment tool for HCBS to include AAAs and ILCs.
3.Adds AAAs and ILCs to the list of stakeholders DHCS is
required to notify and consult with prior to issuing all plan
letters, plan or provider bulletins or similar instructions
without taking regulatory action.
FISCAL EFFECT : According to the Assembly Appropriations
Committee analysis, negligible state costs.
PRIOR VOTES :
Assembly Health: 18- 0
Assembly Aging and Long Term Care: 7- 0
Assembly Appropriations: 17- 0
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Assembly Floor: 70- 0
COMMENTS :
1.Author's statement. Currently, "stakeholders" are undefined under
the CCI. Defining "stakeholders" will ensure that specific
groups, such as AAAs and ILCs are consulted in order to establish
proper LTSS and managed care services for dual eligibles in the
implementation of the CCI in the eight designated pilot project
counties. The author argues AAAs and ILCs are uniquely positioned
with long-standing working relationships and expertise in serving
the CCI population. Including AAAs and ILCs 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.
2.AAAs and ILCs. AAAs are established by federal law through the
Older Americans Act and are required by state law to function as
the community link at the local level for development of HCBS
provided under the CDA. Statewide, there are 33 Planning and
Service Areas (PSAs), and within each PSA is an AAA responsible
for planning and administering services to seniors. The network of
AAAs is comprised of public agencies and non-profit organizations
whose work focuses upon improving access to LTSS.
ILCs are a private, nonprofit organization controlled by a board of
directors comprised by a majority of individuals with
disabilities. ILCs are required to be staffed by persons trained
to assist persons with disabilities in achieving social and
economic independence. ILCs are required to provide services to
individuals with disabilities, including peer counseling,
advocacy, attendant referral, housing assistance, information and
referral, and to provide other services and referrals as
necessary, such as transportation, job development, equipment
maintenance and evaluation, training in independent living skills,
mobility assistance, assistive technology, and communication
assistance.
3.Coordinated Care Initiative. In March 2013, California
received federal approval for a three-year "dual eligible"
demonstration program with two components. The first
component, known as "Cal MediConnect," is a three-year program
for Medicare and Medi-Cal dual eligibles to receive
coordinated medical, behavioral health, LTSS and HCBS through
a single health plan. The second major component is the LTSS
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Integration in Medi-Cal managed care plans and a requirement
that, in order to receive any LTSS through Medi-Cal,
beneficiaries must mandatorily enroll in a managed care plan
for those services.
Demonstration sites selected for the Cal MediConnect program are
Alameda, Los Angeles, Orange, Riverside, San Bernardino, San
Diego, San Mateo and Santa Clara counties. The health plans
selected to participate in the Cal MediConnect program will
receive a blended monthly payment from Medi-Cal and Medicare
to provide their enrollees all needed services through new
health plan products.
The Governor's proposed May Budget Revision proposes the
following changes to CCI.
a. Delay the CCI start date from October 1, 2013 to no
sooner than January 1, 2014. Implement a scheduled
phasing in of CCI enrollment;
b. Los Angeles County would phase-in beneficiaries over
12 months (subject to discussions with the federal
government). San Mateo County would enroll all
beneficiaries over three months. Orange, San Diego, San
Bernardino, Riverside, Alameda, and Santa Clara counties
would phase in over 12 months; and,
c. Reflect a revised number of enrollees estimated at
456,000, which is almost half the size of the number of
enrollees estimated in the 2012 budget. This includes a
cap of no more than 200,000 participants in Los Angeles
County.
4.Prior legislation. SB 208 (Steinberg), Chapter 714, Statutes
of 2010, contained the provisions implementing the Section
1115(b) Medicaid Demonstration Waiver from CMS entitled "A
Bridge to Reform Waiver." Included in that measure was a
requirement that DHCS seek federal approval to establish a
pilot project that enable dual eligibles to receive a
continuum of services that maximizes coordination of benefits
between Medicare and Medi-Cal.
SB 1008 (Committee on Budget) Chapter 33, Statutes of 2012 and
SB 1036 (Committee on Budget) Chapter 45, Statutes of 2012
authorized the CCI as an eight-county pilot project to
integrate Medi-Cal and Medicare benefits under managed care
for dual eligibles and to integrate LTSS into managed care.
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5.Support. The California Association of Area Agencies on Aging
(C4A), the statewide organization representing California's 33
area agencies on aging, writes in support that this bill is a
modest but important step to ensure the integration of AAAs
and ILCs in the dual demonstration pilots, and to establish a
linkage to their system planning and coordination expertise.
By not specifying that AAAs and ILCs as "stakeholders", the
CCI created a systemic barrier for the coordination of LTSS,
which is a primary goal of the CCI. Failing to include AAAs
and ILCs sets up the risk of overlooking the important role of
the broader LTSS network lead by these entities as these
respective systems comprise most LTSS that the Medi-Cal
managed care plans will rely on keep beneficiaries independent
and living at home. Inclusion of the AAA and ILCs will enhance
and strengthen CCI planning and development efforts and
provide a more accurate model for comprehensive coordination
of care across all sectors, such as primary, acute, behavioral
health and long term services and supports.
SUPPORT AND OPPOSITION :
Support: California Association of Area Agencies on Aging
(co-sponsor)
California Commission on Aging (co-sponsor)
Alzheimer's Association
The Arc and United Cerebral Palsy California
Collaboration
Area 4 Agency on Aging
California Association of Public Authorities
California Foundation for Independent Living Centers
State Independent Living Council
Opposition:None received.
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