BILL ANALYSIS                                                                                                                                                                                                    



                                                                        AB 97


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          ASSEMBLY THIRD READING


          AB  
          97 (Weber)


          As Amended  March 26, 2015


          Majority vote


           ----------------------------------------------------------------- 
          |Committee       |Votes |Ayes                |Noes                |
          |                |      |                    |                    |
          |                |      |                    |                    |
          |----------------+------+--------------------+--------------------|
          |Human Services  |7-0   |Chu, Mayes,         |                    |
          |                |      |Calderon, Lopez,    |                    |
          |                |      |Maienschein,        |                    |
          |                |      |                    |                    |
          |                |      |                    |                    |
          |                |      |Mark Stone,         |                    |
          |                |      |Thurmond            |                    |
          |                |      |                    |                    |
          |----------------+------+--------------------+--------------------|
          |Appropriations  |17-0  |Gomez, Bigelow,     |                    |
          |                |      |Bonta, Calderon,    |                    |
          |                |      |Chang, Daly,        |                    |
          |                |      |Eggman, Gallagher,  |                    |
          |                |      |                    |                    |
          |                |      |                    |                    |
          |                |      |Eduardo Garcia,     |                    |
          |                |      |Gordon, Holden,     |                    |
          |                |      |Jones, Quirk,       |                    |
          |                |      |Rendon, Wagner,     |                    |
          |                |      |Weber, Wood         |                    |
          |                |      |                    |                    |








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          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 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  








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            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.  (Welfare and Institutions Code  
            (WIC) Section 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 Section 12317)


          3)Establishes the 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  
            (Budget and Fiscal Review Committee), Chapter 33, Statutes of  
            2012, and SB 1036 (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 Section  
            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  








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            demonstration county, at no cost to the county.  Requires the  
            Department of Health Care Services, in consultation with the DSS  
            to develop policies and procedures for these additional benefits  
            authorized and paid for by health plans.  (WIC Section 14186  
            (b)(6)(B))


          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee:


          1)One-time costs to the DSS of $6 million ($3 million General Fund  
            (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:


          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 to cognitive decline or  
          dementia, cannot be left alone for extended periods. 








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          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. 


          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  








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          hours of IHSS services they receive pursuant to county  
          authorization.  More specifically, it calls for the Department of  
          Health Care Services, in consultation with the DSS, 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:


          1)Policies and procedures that guide how LTSS recipients will be  
            assessed for CPO service hours;
          2)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;


          3)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


          4)A grievance system under which enrollees may submit their  
            grievances to their Cal MediConnect plan.


          CMIPS II:  The Case Management Information and Payrolling System,  








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          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.  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."


          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  








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          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."


          Analysis Prepared by:                                               
                          Myesha Jackson / HUM. S. / (916) 319-2089  FN:  
          0000583