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 these
begin delete additionalend delete personal care service and related domestic service hours, to issue a begin delete singleend delete payroll check to begin delete providers,end delete and to 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:
Section 12317 of the Welfare and Institutions
2Code is amended to read:
(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
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
begin delete additionalend delete
personal care service hours and related domestic service
3hours authorized by the managed care health
begin delete plan.end delete
7(B) Issue a
begin delete singleend delete payroll check to providers begin 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
between hours authorized pursuant to Article
187 (commencing with Section 12300) and end delete
begin delete byend delete the managed care health plan pursuant to
22subparagraph (B) of paragraph (6) of subdivision (b) of Section
begin delete for purposes of federal reimbursement andend delete to enable
24managed care health plans to track the effect of providing the
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
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
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
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.