BILL ANALYSIS                                                                                                                                                                                                    

                                                                      AB 97

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          Date of Hearing:   April 28, 2015


                                  Kansen Chu, Chair

          AB 97  
          (Weber) - As Amended March 26, 2015

          SUBJECT:  In-Home Supportive Services:  provider wages

          SUMMARY:  Requires reprogramming of the Case Management  
          Information and Payrolling System (CMIPS II) for In-Home  
          Supportive Services (IHSS) to enable IHSS recipients in  
          Coordinated Care Initiative (CCI) counties to receive additional  
          services authorized and paid for by managed care health plans.

          Specifically, this bill:

          1)Requires CMIPS II, the IHSS payrolling system, to be  
            programmed to do all of the following to ensure managed care  
            health plans are able to pay a provider for personal care  
            services and related domestic services that the plan  
            authorizes in addition to the IHSS hours already authorized  
            for a recipient in a CCI county:

             a)   Receive payments from managed care health plans for the  
               additional hours of service;

             b)   Issue a single payroll check to providers that covers  


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               both the IHSS hours and the hours authorized by the managed  
               care health plan; and

             c)   Differentiate between IHSS hours and the hours  
               authorized by the managed care health plan for purposes of  
               federal reimbursement and to enable managed care health  
               plans to track the recipient impact of the additional  

          EXISTING LAW:

          1)Establishes the IHSS program as a benefit available to  
            Medi-Cal beneficiaries that provides in-home care and  
            supportive services to low-income aged, blind, or disabled  
            persons who are unable to provide or care for themselves and  
            who cannot live safely in their homes without assistance.   
            Defines supportive services within the program to include  
            domestic services, personal care services, protective  
            supervision, paramedical services, and other services, as  
            specified.  (WIC 12300 et seq.)

          2)Requires the Department of Social Services (DSS) to procure  
            and implement a new automated Case Management Information and  
            Payroll System (CMIPS) for the IHSS and Personal Care Services  
            Program.  Requires the system to incorporate technology that  
            can be readily enhanced and modernized, and employ open  
            architecture and standards, to the extent possible.  (WIC  

          3)Establishes the Coordinated Care Initiative (CCI)  
            demonstration project in up to eight counties, subject to  
            federal approval, to better serve the state's low-income  
            seniors and persons with disabilities by integrating the  
            delivery of medical, behavioral, and long-term care services  
            for those individuals, as specified.  (SB 1008 (Senate Budget  
            and Fiscal Review Committee), Chapter 33, Statutes of 2012 and  


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            SB 1036 (Senate Budget and Fiscal Review Committee), Chapter  
            45, Statutes of 2012)

          4)Requires, as an additional component of the CCI, that all  
            Medi-Cal long-term services and supports, which include IHSS,  
            be services that are covered under managed care health plan  
            contracts and available only through managed care health plans  
            for beneficiaries residing in counties participating in the  
            CCI demonstration project, with specified exceptions.  (WIC  
            14186 et seq.)

          5)Expresses the intent of the Legislature that managed care  
            health plans be allowed to authorize and pay for personal care  
            services and related domestic services that are provided in  
            addition to the IHSS hours already authorized for a recipient  
            in a CCI demonstration county, at no cost to the county.   
            Requires the Department of Health Care Services, in  
            consultation with the Department of Social Services to develop  
            policies and procedures for these additional benefits  
            authorized and paid for by health plans.  (WIC 14186  

          FISCAL EFFECT:  Unknown


          In-Home Supportive Services (IHSS):   The IHSS program provides  
          personal care and domestic services to approximately 420,000  
          qualified, low-income individuals who are aged, blind, or  
          disabled.  Through the IHSS program, recipients are cared for  
          and assisted with activities of daily living, allowing them to  
          remain safely in their own homes and avoid institutionalization.  
           IHSS services include:  Paramedical services, such as giving  
          medications and changing a colostomy bag; Non-Medical Personal  
          Care services, such as toileting, dressing, and transportation;  
          Domestic services, such as housework, shopping for groceries and  
          meal preparation; and, Protective supervision for those who, due  


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          to cognitive decline or dementia, cannot be left alone for  
          extended periods. 

          County social workers determine eligibility for IHSS and the  
          authorized hours of care after conducting a standardized in-home  
          assessment, and periodic reassessments, of an individual's  
          ability to perform specified activities of daily living.  Once  
          eligible, recipients are responsible for hiring, firing,  
          directing and supervising their own IHSS provider or providers.   
          Prior to receiving payment for services, providers must submit  
          to a criminal background check and a provider orientation.  IHSS  
          is funded with federal, state, and county resources. 

          Coordinated Care Initiative (CCI):  The Budget Act of 2012  
          enacted the CCI, one component of which is a framework for  
          integrating the delivery of medical, behavioral and long-term  
          care services through a single health plan for persons eligible  
          for both Medicare and Medi-Cal.  This demonstration project  
          component of the CCI, also known as Cal MediConnect, was  
          originally limited to the following eight counties:  Alameda,  
          Los Angeles, Orange, San Diego, San Mateo, Riverside, San  
          Bernardino, and Santa Clara, in which approximately 65% of IHSS  
          recipients reside.  Alameda County withdrew from the CCI  
          demonstration in 2014.

          While CCI-related code sections clearly maintain county  
          responsibility for assessing and reassessing IHSS recipients and  
          determining a recipient's authorized number of hours, they also  
          spell out the role of the managed care health plans in  
          coordinating services for individuals receiving long-term  
          services and supports (LTSS) and implementing best practices to  
          help recipients of those services avoid institutionalization and  
          experience overall better health outcomes.  

          Care Plan Option (CPO) services:  CCI statute expresses  
          legislative intent that a mechanism be developed to allow  
          managed care health plans to authorize and pay for hours of  
          personal care and domestic and related services for IHSS  
          recipients beyond the hours of IHSS services they receive  


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          pursuant to county authorization.  More specifically, it calls  
          for the Department of Health Care Services, in consultation with  
          the Department of Social Services, to develop policies and  
          procedures for the additional benefits that the managed care  
          health plans can authorize.  It is important to note that CPO  
          services authorized by a managed care health plan, which can be  
          offered to LTSS recipients beyond what is required by law, are  
          prohibited from being used to replace any care and service hours  
          authorized under IHSS.  CPO services are intended to enhance a  
          recipient's care and better support a recipient's ability to  
          remain at home and avoid institutional care.

          In its Duals Plan Letter 13-006, the Department of Health Care  
          Services addresses how CPO service hours are to be used and what  
          steps the Cal MediConnect plans must take to prepare for  
          implementation of CPO services.  According to this directive,  
          the plans must create the following:

          a)Policies and procedures that guide how LTSS recipients will be  
            assessed for CPO service hours;

          b)Policies and procedures for identifying enrollees that may  
            need CPO services and for referring them to community-based  
            organizations and other available entities that provide these  

          c)A training curriculum and program for Cal MediConnect plan  
            staff related to the Americans with Disabilities Act, the  
            Olmstead decision, CPO services issues, and community and  
            county home- and community-based services that may be  
            available; and

          d)A grievance system under which enrollees may submit their  
            grievances to their Cal MediConnect plan.

          CMIPS II:  The Case Management Information and Payrolling  
          System, is administered by the Office of Systems Integration  
          (OSI) on behalf of DSS to track IHSS case information and  
          process payments for all IHSS providers.  CMIPS II, which now  


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          serves all 58 counties, was implemented after a multi-year  
          effort to update the original 30-year-old CMIPS system, bringing  
          with it enhanced capacity for making timely changes to the  
          system that better respond to changing statutory requirements.   
          The OSI CMIPS II Project Internet Web site indicates that the  
          new system "provides modern web-based case management  
          functionality and sophisticated processing of payroll" and that  
          it "includes over 50 interfaces for timely verifications and  

          Need for this bill:  According to the author, "The CCI statute  
          includes the provision for managed care plans providing services  
          in CCI to authorize and pay for extra homecare services beyond  
          what an IHSS social worker has authorized for a consumer  
          enrolled in CCI.  However, the managed care plans are prohibited  
          by statute from paying an individual provider of homecare  
          services directly.  Further, there is no mechanism in current  
          statute to pay an individual provider to provide these extra  
          homecare services that are authorized and funded by the managed  
          care plans.  The managed care plans could contract with a  
          private homecare agency to hire and pay homecare providers to  
          work these additional hours.  However, there is no guarantee  
          that the agency would hire the existing IHSS provider to work  
          these hours.  Nor is there any way to force a plan to enter into  
          such a contract.  In order to maintain the continuity of care  
          necessary for IHSS consumers enrolled in CCI, in other words, in  
          order for the IHSS consumer to have the option to hire his or  
          her existing IHSS provider to work these extra hours, the  
          managed care plans must find a way to pay providers who provide  
          these additional services."

          Staff comments:  While this bill seeks to bring the state closer  
          to realizing an important component of the CCI, the requirement  
          to include payment for both IHSS hours authorized by a county  
          and CPO hours authorized by a managed care health plan on a  
          single payroll check could be challenging within the limitations  
          of CMIPS II.  Because there is a 283 hour per month cap on the  


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          number of hours of care that can be authorized by a county and  
          provided to an IHSS recipient, the current payrolling system  
          will need to be able to produce payments for hours of care that  
          exceed that maximum number.  Additionally, because CPO services  
          hours will only apply to CCI enrollees in CCI counties, the  
          payrolling system will need to be reconfigured in a way that can  
          accommodate different needs from one county to another and from  
          one recipient to another.

          Conversely, reconfiguring the payrolling system to embrace both  
          sets of authorized hours could help managed care health plans  
          track the benefit of the CPO hours, which is explicit in the  
          language of this bill, as well as help counties and the state  
          track service needs that go unmet within a recipient's  
          county-authorized IHSS hours.  Ultimately, through facilitating  
          the provision of additional personal care and domestic and  
          related services, this bill seeks to increase the number of  
          individuals with high care needs who are able to safely remain  
          at home and avoid institutionalization.

          Support for this bill:  Further explaining the need for this  
          bill, the Health Plan of San Mateo (HPSM) states, "The CCI  
          legislation included provisions for health plans to authorize  
          IHSS services in addition to those authorized by county social  
          workers.  This flexibility is needed to ensure managed care  
          plans could respond timely and nimbly in those situations where  
          a consumer was at risk of entering institutional care.  In  
          addition, these CCI provisions allow health plans to continue  
          paying a consumer's current IHSS provider rather than assigning  
          an unknown provider, without the consumer's approval, to provide  
          services.  HPSM cannot pay providers for additional hours  
          without the payment mechanism proposed in [this bill];  
          contracting with and paying independent IHSS providers outside  
          CMIPS is beyond the scope of HPSM's administrative capacity and  
          would not be cost-effective for our health plan."



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          SB 94 (Senate Budget and Fiscal Review Committee), Chapter 37,  
          Statutes of 2013, enacted changes to existing law regarding the  
          CCI and de-linked CCI components to allow the mandatory  
          enrollment of Medi-Cal and Medicare beneficiaries  
          (dual-eligibles) into Medi-Cal managed care, the integration of  
          long-term services and supports into managed care plans, and the  
          commencement of the IHSS Statewide Authority, to proceed  
          separately from Cal MediConnect.

          SB 1036 (Senate Budget and Fiscal Review Committee), Chapter 45,  
          Statutes of 2012, was the Human Services budget trailer bill  
          that contained the necessary statutory changes to implement the  
          human services provisions related to the integration of home-  
          and community-based and long-term care services, including IHSS,  
          into Medi-Cal managed care under the CCI.

          SB 1008 (Senate Budget and Fiscal Review Committee), Chapter 33,  
          Statutes of 2012, implemented the Duals Demonstration Pilot  
          Project, including integration of long-term services and  



          UDW/AFSCME Local 3930, co-sponsor

          American Federation of State, County and Municipal Employees  

          California Association of public Authorities (CAPA)


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          California Commission on Aging 

          Congress of California Seniors (CCS)

          Justice in Aging 

          Health Plan of San Mateo (HPSM)


          None on file.

          Analysis Prepared by:Myesha Jackson / HUM. S. / (916) 319-2089


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