BILL ANALYSIS Ó AB 97 Page 1 Date of Hearing: May 13, 2015 ASSEMBLY COMMITTEE ON APPROPRIATIONS Jimmy Gomez, Chair AB 97 (Weber) - As Amended March 26, 2015 ----------------------------------------------------------------- |Policy |Human Services |Vote:|7 - 0 | |Committee: | | | | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | | | | | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | | | | | | | | | | | | | | | ----------------------------------------------------------------- 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 AB 97 Page 2 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: AB 97 Page 3 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: AB 97 Page 4 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) AB 97 Page 5 319-2081