Amended in Assembly March 26, 2015

California Legislature—2015–16 Regular Session

Assembly BillNo. 97


Introduced by Assembly Member Weber

January 8, 2015


An actbegin insert to amend Section 12317 of the Welfare and Institutions Code,end insert relating to in-home supportive services.

LEGISLATIVE COUNSEL’S DIGEST

AB 97, as amended, Weber. In-home supportive services: provider wages.

Existing law establishes the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons are provided with services in order to permit them to remain in their own homes and avoid institutionalization. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

Existing law provides, as part of the Coordinated Care Initiative, that not sooner than March 1, 2013, all Medi-Cal long-term services and supports, including IHSS, are required to be services that are covered under managed care health plan contracts and to be available only through managed care health plans to beneficiaries residing in Coordinated Care Initiative counties, except for the provided exemptions.begin insert Existing law allows managed care health plans to authorize personal care services and related domestic services in addition to the hours authorized for IHSS by existing law. Existing law requires the managed care health plans to be responsible for paying for these services at no share of cost to the county.end insert

begin insert

This bill would require the State Department of Social Services to program its Case Management Information and Payroll System to be able to receive payments from managed care health plans for these additional personal care service and related domestic service hours, to issue a single payroll check to providers, and to differentiate between the two types of authorized hours.

end insert
begin delete

This bill would declare the intent of the Legislature to enact legislation to create a mechanism to pay In-Home Supportive Services program providers for additional hours worked through the Coordinated Care Initiative.

end delete

Vote: majority. Appropriation: no. Fiscal committee: begin deleteno end deletebegin insertyesend insert. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1begin insert

begin insertSECTION 1.end insert  

end insert

begin insertSection 12317 of the end insertbegin insertWelfare and Institutions
2Code
end insert
begin insert is amended to read:end insert

3

12317.  

(a) The State Department of Social Services shall be
4responsible for procuring and implementing a new Case
5Management Information and Payroll System (CMIPS) for the
6In-Home Supportive Services Program and Personal Care Services
7Program (IHSS/PCSP). This section shall not be interpreted to
8transfer any of the IHSS/PCSP policy responsibilities from the
9State Department of Social Services or the State Department of
10Health Care Services.

11(b) At a minimum, the new system shall provide case
12management, payroll, and management information in order to
13support the IHSS/PCSP, and shall do all of the following:

14(1) Provide current and accurate information in order to manage
15the IHSS/PCSP caseload.

16(2) Calculate accurate wage and benefit deductions.

17(3) Provide management information to monitor and evaluate
18the IHSS/PCSP.

19(4) Coordinate benefits information and processing with the
20California Medicaid Management Information System.

begin insert

21(5) In order to implement subparagraph (B) of paragraph (6)
22of subdivision (b) of Section 14186, the system shall be
23programmed to enable it to do all of the following:

end insert
begin insert

P3    1(A) Receive payments from managed care health plans for the
2additional personal care service hours and related domestic service
3hours authorized by the managed care health plan.

end insert
begin insert

4(B) Issue a single payroll check to providers that covers both
5the hours authorized pursuant to Article 7 (commencing with
6Section 12300) and the hours authorized by the managed care
7health plan pursuant to subparagraph (B) of paragraph (6) of
8subdivision (b) of Section 14186.

end insert
begin insert

9(C) Differentiate between hours authorized pursuant to Article
107 (commencing with Section 12300) and the hours authorized by
11the managed care health plan pursuant to subparagraph (B) of
12paragraph (6) of subdivision (b) of Section 14186 for purposes of
13federal reimbursement and to enable managed care health plans
14to track the effect of providing the additional benefits.

end insert

15(c) The new system shall be consistent with current state and
16federal laws, shall incorporate technology that can be readily
17enhanced and modernized for the expected life of the system, and,
18to the extent possible, shall employ open architectures and
19standards.

20(d) By August 31, 2004, the State Department of Social Services
21shall begin a fair and open competitive procurement for the new
22CMIPS. All state agencies shall cooperate with the State
23Department of Social Services and the California Health and
24Human Services Agency Data Center to expedite the procurement,
25design, development, implementation, and operation of the new
26CMIPS.

27(e) The State Department of Social Services, with any necessary
28assistance from the State Department of Health Care Services,
29shall seek all federal approvals and waivers necessary to secure
30federal financial participation and system design approval of the
31new system.

32(f) The new CMIPS shall include features to strengthen fraud
33prevention and detection, as well as to reduce overpayments.
34Program requirements shall include, but shall not be limited to,
35the ability to readily identify out-of-state providers, recipient
36hospital stays that are five days or longer, and excessive hours
37paid to a single provider, and to match recipient information with
38death reports. This functionality shall be available by April 1,
392010, and implemented statewide by July 1, 2011.

begin delete
P4    1

SECTION 1.  

It is the intent of the Legislature to enact legislation
2to create a mechanism to pay In-Home Supportive Services
3program providers for additional hours worked through the
4Coordinated Care Initiative.

end delete


O

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