BILL ANALYSIS Ó
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THIRD READING
Bill No: AB 776
Author: Yamada (D)
Amended: As introduced
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 6/5/13
AYES: Hernandez, Anderson, Beall, De León, DeSaulnier, Monning,
Nielsen, Pavley, Wolk
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 70-0, 5/16/13 (Consent) - See last page for
vote
SUBJECT : Medi-Cal
SOURCE : California Association of Area Agencies on Aging
California Commission on Aging
DIGEST : This bill defines, for purposes of the Long-Term
Services and Supports (LTSS) Integration component of the
Coordinated Care Initiative (CCI), 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 (APLs), plan or provider bulletins or similar
instructions without taking regulatory action.
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ANALYSIS :
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 eight counties, and requires
LTSS to be available to beneficiaries residing in counties
participating in those pilot projects. This demonstration
project is known as the Coordinated Care Initiative.
3. Requires, as part of the CCI, all Medi-Cal LTSS to be 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
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, and the
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, and Community Based Adult Services
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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 APLs,
plan or provider bulletins or similar instructions without
taking regulatory action.
Comments
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 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 composed of 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
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living skills, mobility assistance, assistive technology, and
communication assistance.
CCI . 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 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.
Governor Brown'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.
Prior Legislation
SB 208 (Steinberg, Chapter 714, Statutes of 2010) contained the
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provisions implementing the Section 1115(b) Medicaid
Demonstration Waiver from the federal Centers for Medicaid and
Medicare Services entitled "A Bridge to Reform Waiver." The
bill also includes a requirement that DHCS seek federal approval
to establish a pilot project that enables dual eligible to
receive a continuum of services that maximizes coordination of
benefits between Medicare and Medi-Cal.
SB 1008 (Senate Budget and Fiscal Review Committee, Chapter 33,
Statutes of 2012) and SB 1036 (Senate Budget and Fiscal Review
Committee, 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Assembly Appropriations Committee analysis,
negligible state costs.
SUPPORT : (Verified 6/25/13)
California Association of Area Agencies on Aging (co-source)
California Commission on Aging (co-source)
Alzheimer's Association
Area 4 Agency on Aging
California Association of Public Authorities
California Foundation for Independent Living Centers
State Independent Living Council
The Arc and United Cerebral Palsy California Collaboration
ARGUMENTS IN SUPPORT : This bill's sponsor, California
Association of Area Agencies on Aging (C4A), the statewide
organization representing California's 33 AAAs, writes 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
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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 LTSS.
ASSEMBLY FLOOR : 70-0, 5/16/13
AYES: Achadjian, Alejo, Ammiano, Atkins, Bigelow, Bloom,
Blumenfield, Bocanegra, Bonilla, Bonta, Bradford, Brown, Ian
Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,
Dahle, Daly, Dickinson, Donnelly, Fong, Fox, Frazier, Garcia,
Gatto, Gomez, Gordon, Gorell, Gray, Hagman, Hall, Harkey,
Roger Hernández, Jones, Jones-Sawyer, Levine, Linder, Logue,
Lowenthal, Maienschein, Mansoor, Medina, Mitchell, Mullin,
Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea,
V. Manuel Pérez, Quirk, Quirk-Silva, Rendon, Salas, Skinner,
Ting, Torres, Wagner, Waldron, Weber, Wieckowski, Wilk,
Williams, Yamada, John A. Pérez
NO VOTE RECORDED: Allen, Buchanan, Eggman, Beth Gaines, Grove,
Holden, Melendez, Morrell, Stone, Vacancy
JL:k 6/25/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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