BILL ANALYSIS Ó AB 97 Page 1 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 AB 97 Page 2 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 AB 97 Page 3 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 AB 97 Page 4 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 AB 97 Page 5 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 AB 97 Page 6 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 AB 97 Page 7 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: AB 97 Page 8 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) AB 97 Page 9 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 AB 97 Page 10