BILL ANALYSIS Ó
AB 97
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ASSEMBLY THIRD READING
AB
97 (Weber)
As Amended March 26, 2015
Majority vote
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|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 | |
| | | | |
AB 97
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| | | | |
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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