BILL ANALYSIS Ó
AB 97
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Date of Hearing: May 13, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
97 (Weber) - As Amended March 26, 2015
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill 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
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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:
a) Receive payments from managed care health plans for the
additional hours of service;
b) Issue a single payroll check to providers that covers
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.
FISCAL EFFECT:
1)One-time costs to the Department of Social Services (DSS) of
$6 million ($3 million GF) to design, develop, and implement
the CMIPS II system changes.
2)One-time costs to DSS of approximately $550,000 (GF) for two
years for 4.5 positions for implementation.
3)On-going annual operating costs to DSS of $1 million ($500,000
GF) to operate the new payrolling system.
COMMENTS:
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1)Purpose. 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, 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, the managed care
plans must find a way to pay providers who provide these
additional services."
2)Background. 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 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.
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:
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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.
The CCI statute expresses Legislative intent 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. This
bill seeks to implement this intent.
3)Prior Legislation:
a) SB 94 (Senate Budget and Fiscal Review Committee),
Chapter 37, Statutes of 2013, enacted changes to 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.
b) SB 1036 (Senate Budget and Fiscal Review Committee),
Chapter 45, Statutes of 2012, was the Human Services budget
trailer bill that implemented 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.
c) 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.
Analysis Prepared by:Jennifer Swenson / APPR. / (916)
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319-2081