Amended in Senate August 31, 2015

Amended in Assembly March 26, 2015

California Legislature—2015–16 Regular Session

Assembly BillNo. 97


Introduced by Assembly Member Weber

January 8, 2015


An act to amend Section 12317 of the Welfare and Institutions Code, 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. 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.

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 thesebegin delete additionalend delete personal care service and related domestic service hours, to issue abegin delete singleend delete payroll check tobegin delete providers,end deletebegin insert providers of personal care service hours and related domestic service hours, which shall not include payment of wages for service hours provided pursuant to other specified provisions,end insert and tobegin insert track andend insert differentiate between the two types of authorized hours.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

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

P2    1

SECTION 1.  

Section 12317 of the Welfare and Institutions
2Code
is amended to read:

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.

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

P3    1(A) Receive payments from managed care health plans for the
2begin delete additionalend delete personal care service hours and related domestic service
3hours authorized by the managed care healthbegin delete plan.end deletebegin insert plan, which are
4separate and distinct from in-home supportive service hours
5authorized pursuant to this article and Sections 14132.95,
614132.952, and 14132.956.end insert

7(B) Issue abegin delete singleend delete payroll check to providersbegin delete that covers both
8the hours authorized pursuant to Article 7 (commencing with
9Section 12300) and the hours authorized by the managed care
10health plan pursuant to subparagraph (B) of paragraph (6) of
11subdivision (b) of Section 14186.end delete
begin insert of personal care service hours
12and related domestic service hours for services rendered pursuant
13to subparagraph (B) of paragraph (6) of subdivision (b) of Section
1414186, which shall not include payment of wages for services
15provided pursuant to this article and Sections 14132.95, 14132.952,
16and 14132.956.end insert

17(C)  begin deleteDifferentiate between hours authorized pursuant to Article
187 (commencing with Section 12300) and end delete
begin insertTrack and differentiate
19between end insert
the hours authorizedbegin delete byend deletebegin insert pursuant to this article and
20Sections 14132.95, 14132.952, and 14132.956, and the hours
21authorized byend insert
the managed care health plan pursuant to
22subparagraph (B) of paragraph (6) of subdivision (b) of Section
2314186begin delete for purposes of federal reimbursement andend delete to enable
24managed care health plans to track the effect of providing the
25additional benefits.

26(c) The new system shall be consistent with current state and
27federal laws, shall incorporate technology that can be readily
28enhanced and modernized for the expected life of the system, and,
29to the extent possible, shall employ open architectures and
30standards.

31(d) By August 31, 2004, the State Department of Social Services
32shall begin a fair and open competitive procurement for the new
33CMIPS. All state agencies shall cooperate with the State
34Department of Social Services and the California Health and
35Human Services Agency Data Center to expedite the procurement,
36design, development, implementation, and operation of the new
37CMIPS.

38(e) The State Department of Social Services, with any necessary
39assistance from the State Department of Health Care Services,
40shall seek all federal approvals and waivers necessary to secure
P4    1federal financial participation and system design approval of the
2new system.

3(f) The new CMIPS shall include features to strengthen fraud
4prevention and detection, as well as to reduce overpayments.
5Program requirements shall include, but shall not be limited to,
6the ability to readily identify out-of-state providers, recipient
7hospital stays that are five days or longer, and excessive hours
8paid to a single provider, and to match recipient information with
9death reports. This functionality shall be available by April 1,
102010, and implemented statewide by July 1, 2011.



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