BILL ANALYSIS Ó
AB 97
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Date of Hearing: April 28, 2015
ASSEMBLY COMMITTEE ON HUMAN SERVICES
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
benefits.
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
12317)
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
(b)(6)(B))
FISCAL EFFECT: Unknown
COMMENTS:
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
services;
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
interactions."
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."
PRIOR LEGISLATION:
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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
supports.
REGISTERED SUPPORT / OPPOSITION:
Support
UDW/AFSCME Local 3930, co-sponsor
American Federation of State, County and Municipal Employees
(AFSCME)
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)
Opposition
None on file.
Analysis Prepared by:Myesha Jackson / HUM. S. / (916) 319-2089
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