BILL ANALYSIS                                                                                                                                                                                                    

                                                                      AB 97

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          Date of Hearing:  May 13, 2015


                                 Jimmy Gomez, Chair

          97 (Weber) - As Amended March 26, 2015

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          Urgency:  No  State Mandated Local Program:  NoReimbursable:  No


          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  

          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.



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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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