BILL ANALYSIS �
AB 776
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CONCURRENCE IN SENATE AMENDMENTS
AB 776 (Yamada)
As Amended July 9, 2013
Majority vote
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|ASSEMBLY: |70-0 |(May 16, 2013) |SENATE: |38-0 |(August 15, |
| | | | | |2013) |
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Original Committee Reference: HEALTH
SUMMARY : Defines stakeholder for purposes of the Medi-Cal
Coordinated Care Initiative (CCI) and Long Term Services and
Support Integration (LTSS) Demonstration Project as including,
but not limited to, area agencies on aging (AAAs) and
independent living centers (ILCs). Adds AAAs and ILCs to the
stakeholder group currently required to be established by June
1, 2013, to develop a uniform assessment tool for In-Home
Support Services (IHSS) and other Home and Community Based
Services (HCBS). Adds AAAs and ILCs to the list of stakeholders
that are to be notified and consulted by the Department of
Health Care Services (DHCS) and the Department of Social
Services (DSS) prior to taking action by means of the all-county
letters, plan or provider bulletins, or similar instructions in
lieu of taking regulatory action when implementing the LTSS
Demonstration Project.
The Senate amendments include changes to the same code section
enacted by SB 94 (Budget and Fiscal Review Committee), Chapter
37, Statutes of 2013, in order to avoid chaptering out those
changes in this bill.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS : 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 LTSSs
and managed care services for individuals who are dually
eligible for Medi-Cal and Medicare in the implementation of the
CCI in the eight designated pilot project counties. The author
points out that SB 1008 (Budget and Fiscal Review Committee),
Chapter 33, Statutes of 2012, requires DHCS to consult with
stakeholders while preparing for various aspects of the CCI
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implementation and oversight. However, stakeholders are
undefined under the CCI. The author concludes that AAAs and
ILCs are uniquely positioned with long-standing working
relationships and expertise in serving the CCI population. The
author states that including AAAs and ILCs in CCI implementation
will contribute to better planning, organizing, monitoring, and
assessing of services to California's seniors and persons with
disabilities (SPDs) and their families.
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 California Department of
Aging (CDA) divides the state in 33 Planning and Service Areas
(PSAs). Within each PSA is an AAA responsible for planning and
administering services to seniors. The network of AAAs is
comprised of public agencies and nonprofit organizations whose
work focuses upon improving access to LTSS. AAAs directly
manage a wide array of federal and state-funded services that
help older adults find employment; support older and disabled
individuals to live as independently as possible in the
community; promote healthy aging and community involvement; and,
assist family members in their vital care giving role. ILCs are
non-profit organizations that assist people with disabilities
with a variety of daily living tasks. ILCs also work with local
and regional governments to improve infrastructure, raise
awareness about disability issues, and advocate for legislation
that promotes equal opportunities and prohibits segregation and
discrimination of people with disabilities.
In the proposed 2012-13 Budget, the Brown Administration
requested authority from the Legislature to allow a statewide
CCI and proposed to include LTSS for dual eligibles and SPDs
into a coordinated delivery system that would be delivered using
managed care models. The LTSSs proposed to be integrated
included 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
(Budget and Fiscal Review Committee), Chapter 45, Statutes of
2012. The two major parts of the CCI are the "Duals
Demonstration" and "Managed Medi-Cal LTSS." The Duals
Demonstration is a voluntary three-year demonstration for
Medicare-Medi-Cal dual eligible beneficiaries to receive
coordinated medical, behavioral health, long-term institutional,
and HCBS services through a single organized delivery system.
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The demonstration is limited to eight counties. The eight
counties selected are Alameda, Los Angeles, Orange, Riverside,
San Bernardino, San Diego, San Mateo, and Santa Clara. The
Managed Medi-Cal LTSS requires Medi-Cal-only SPDs (who are
currently mandated to enroll in a Managed Care Plan for health
care services) and dual eligibles to receive their Medi-Cal LTSS
and behavioral and health care services through the same plans.
SB 1008 requires the Administration to consult with stakeholders
while preparing for various aspects of CCI implementation and
oversight. SB 1036 primarily made changes to IHSS, including
changes to counties' share of cost for IHSS and a shift to
statewide collective bargaining for IHSS provider wages and
benefits-beginning with the eight demonstration counties. SB
1036 also required a stakeholder workgroup to develop a
universal assessment tool for HCBS.
Federal approval for the dual eligible portion of the CCI was
received on March 27, 2013, in the form of a Memorandum of
Understanding (MOU), referred to as the Cal MediConnect program.
This component is the framework for the demonstration allowing
the combination of all Medicare and Medi-Cal benefits into one
plan. The MOU contained several changes from the state's
original proposal, such as requiring enrollment begin no earlier
than October 2013. On June 18, 2013, DHCS submitted amendments
to the Section 1115 "Bridge to Reform" Demonstration (Waiver) to
allow the DHCS to carry out the CCI no sooner than January 1,
2014. Beneficiaries who enroll in a Cal MediConnect health plan
can opt out at any time. The number of enrollees in Los Angeles
County will be capped at 200,000.
SB 1036 also requires DSS, DHCS, and CDA to establish a
stakeholder workgroup to develop a universal assessment process
no later than June 1, 2013, and to develop a universal
assessment tool for IHSS, CBAS, and MSSP. The work group is
required to build on the IHSS assessment process, the MSSP
assessment process, and other appropriate HCBS assessment tools
to develop a single assessment tool that can be used to
determine a person's level of need for all three HCBS programs.
SB 1036 stipulates that a universal assessment tool will be used
no sooner than January 1, 2015.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
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FN: 0001454