BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: AB 97
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|Author: |Weber |
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|Version: |March 26, 2015 |Hearing |June 23, 2015 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Sara Rogers |
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Subject: In-home supportive services: provider wages
SUMMARY
This bill requires the Case Management Information and
Payrolling System (CMIPS II) for In-Home Supportive Services
(IHSS) to be reprogrammed to enable IHSS recipients in
Coordinated Care Initiative (CCI) counties to receive additional
services authorized and paid for by managed care health plans.
ABSTRACT
Existing law:
1)Establishes in state law a program of public Medi-Cal benefits
to provide health care for people who lack sufficient annual
income to meet the costs of health care, and whose other
assets are so limited that their application toward the costs
of such care would jeopardize the person or family's future
minimum self-maintenance and security. (WIC 14000 et seq.)
2)Establishes the IHSS program to provide in-home domestic
supportive and personal care services for aged, blind or
disabled individuals living at or below the poverty level for
the purpose of enabling consumers to avoid
institutionalization and remain safely in their homes. (WIC
12300 et seq.)
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3)Requires the California Department of Social Services (CDSS)
to be responsible for procuring and implementing a new Case
Management Information and Payroll System (CMIPS II) for IHSS
and establishes minimum functionalities that are required to
be provided by the system. (WIC 12317)
4)Establishes the CCI, subject to federal approval, which
establishes in eight counties an integrated health and
long-term managed care plan for individuals and seniors and
persons with disabilities who receive both Medi-Cal and
Medicare benefits, and includes IHSS under managed care health
plan contracts, available only through managed care health
plans for beneficiaries residing in counties participating in
the CCI demonstration project, with specified exceptions. (WIC
14182.16) (WIC 14186.35)
5)Declares legislative intent that managed care health plans may
authorize and pay for personal-care services and related
domestic services in addition to the IHSS hours already
authorized for a recipient in a CCI demonstration county, at
no cost to the county. Requires the Department of Health Care
Services, in consultation with the CDSS to develop policies
and procedures for these additional benefits authorized and
paid for by health plans. (WIC 14186 (b)(6)(B))
This bill:
1)Requires CMIPS II to be programmed to do all of the following
in order to enable managed care health plans to pay a provider
for the additional personal care and related domestic services
that the plan authorizes beyond the IHSS hours authorized by 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
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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 IMPACT
According to the Assembly Appropriations Committee, this bill
will incur the following costs:
One-time costs to CDSS of $6 million ($3 million GF) to
design, develop, and implement the CMIPS II system changes.
One-time costs to CDSS of approximately $550,000 (GF)
for two years for 4.5 positions for implementation.
On-going annual operating costs to CDSS of $1 million
($500,000 GF) to operate the new payroll system.
A subsequent analysis of the Assembly Budget Committee of a
similar proposal estimated that the budget year General Fund
cost for the project would be approximately $2 million GF ($7
million total funds).
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, the CCI permits a managed care health
plan to authorize additional hours of IHSS services if the
services are necessary to allow the consumer to continue living
in his or her own home, instead of residing in a more costly
institution. The author cites existing law which states the
Department of Health Care Services (DHCS), "in consultation with
the State Department of Social Services, shall develop policies
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and procedures for these additional benefits, which managed care
health plans may authorize." However, the author states that the
state has not created a mechanism to pay an individual provider
to work these additional service hours authorized by the managed
care health plans. The author states that in order to maintain
the continuity of care for the medically fragile CCI population,
the consumer should have the option to have his or her existing
IHSS provider work these additional service hours, instead of
assigning an unknown provider, without the consumer's approval,
to enter his or her home.
In Home Supportive Services Program (IHSS)
The IHSS program was established in 1973 as an innovative
alternative to institutional care, and evolved in the context of
a growing "independent living" civil rights movement led by
persons with disabilities.<1> The program has experienced
continuous growth following the U.S. Supreme Court decision
Olmstead v. L.C. in 1999 which established the rights of people
with disabilities to receive services in the most integrated
setting possible to "provide individuals with disabilities
opportunities to live their lives like individuals without
disabilities"<2> under the American with Disabilities Act.
The IHSS program is operated as benefit under the Medi-Cal
program, providing in-home services to more than 467,000
qualified low-income individuals who are aged, blind, or
disabled. County welfare agencies administer the program under
CDSS oversight and county social workers determine eligibility
and assess eligible consumers to determine the allowable
services and number of allotted hours following a standardized
in home assessment.
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<1> http://www.cicaihss.org/ihss-public-authority-history
<2> Statement of the Department of Justice on Enforcement of the
Integration Mandate of Title II of the Americans with
Disabilities Act and Olmstead v. L.C. June 22 2011.
http://www.ada.gov/olmstead/q&a_olmstead
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Coordinated Care Initiative (CCI)
Pursuant to federal law under the Patient Protection and
Affordable Care Act (P.L. 111-148) and the Health Care and
Education Reconciliation Act of 2010 (P.L. 111-152),
California's Budget Act of 2012<3> enacted the CCI, with the
intention of better coordinating the medical, mental and
long-term care provided to Medi-Cal recipients while achieving
fiscal savings for the General Fund. Specifically, according to
a Senate Budget Subcommittee 3 agenda, the CCI broadly
encompasses three components:<4>
Long-Term Supports and Services (LTSS) as a Medi-Cal
Managed Care Benefit: CCI incorporated LTSS into Medi-Cal
managed care, including nursing facility care, IHSS, the
Multipurpose Senior Services Program, and Community-Based
Adult Services. A Senate Budget Committee agenda states
this change is estimated to impact about 600,000
Medi-Cal-only enrollees and up to 456,000 persons eligible
for both Medicare and Medi-Cal who are in Cal MediConnect.
Cal MediConnect Program: A three-year demonstration
project for persons eligible for both Medicare and Medi-Cal
(dual eligibles) to receive coordinated medical, behavioral
health, long-term institutional, and home-and
community-based services through a single organized
delivery system (health plan). The Senate Budget Committee
states that no more than 456,000 beneficiaries would be
eligible for the duals demonstration in the participating
counties. This demonstration project is a joint project
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<3> SB 1008 (Committee on Budget and Fiscal Review, Chapter 33,
Statutes of 2012), and SB 1036 (Committee on Budget and Fiscal
Review, Chapter 45, Statutes of 2012), and amended by SB 94
(Committee on Budget and Fiscal Review, Chapter 37, Statutes of
2013)
<4>
http://sbud.senate.ca.gov/sites/sbud.senate.ca.gov/files/SUB3/042
42014Sub3_DPH_DHCS_HHSA.pdf
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with the federal Centers for Medicare and Medicaid Services
(CMS).
Mandatory Enrollment of Dual Eligibles and Others into
Medi-Cal Managed Care. Most Medi-Cal beneficiaries,
including dual eligibles, partial dual eligibles, and
previously excluded Seniors and Persons with Disabilities
(SPDs) who are Medi-Cal only, are required to join a
Medi-Cal managed care health plan to receive their Medi-Cal
benefits.
Under Cal MediConnect, Medi-Cal managed care health plans are
responsible for providing and coordinating Medicare and Medi-Cal
benefits, including LTSS. Health plans will receive a blended
rate from the state and the federal government for these
services, including IHSS. However, existing CCI statutes clearly
specify that counties retain responsibility for assessing and
reassessing IHSS recipients and determining a recipient's
authorized number of hours, in addition the county operated
CMIPS will remain responsible for processing payroll.
Existing CCI statutes 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 hours of IHSS
services they receive pursuant to county authorization referred
to as "Care Plan Option (CPO) services." Furthermore, existing
law calls for the DHCS, in consultation with the CDSS, to
develop policies and procedures for the additional benefits that
the managed care health plans can authorize and these CPO
services are prohibited from being used to replace any care and
service hours authorized under IHSS.
In its Duals Plan Letter 13-006, DHCS directs Medi-Cal managed
care plans to establish the following:
a) Policies and procedures that guide how LTSS recipients
will be assessed for CPO service hours;
b) Policies and procedures for identifying enrollees that
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may need CPO services and for referring them to
community-based organizations and other available entities
that provide these services;
c) 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
d) A grievance system under which enrollees may submit
their grievances to their Cal MediConnect plan.
The new Case Management Information and Payrolling System: CMIPS
II
The new Case Management Information and Payrolling System, was
designed, and is now operated by, the Office of Systems
Integration (OSI) on behalf of CDSS to track IHSS case
management information and process payroll for IHSS providers.
CMIPS II now serves all 58 counties and was implemented after a
multi-year effort to update the original 30-year-old CMIPS
system and according to OSI "provides modern web-based case
management functionality and sophisticated processing of
payroll" and that it "includes over 50 interfaces for timely
verifications and interactions." Additionally, CDSS states that
CMIPS II offers "increased accountability to program
administrators including counties, the state and the federal
government."
COMMENTS
The potential for managed care health plans to authorize
additional services was highlighted as a significant advantage
of the CCI, which anticipated moving significant numbers of
Medi-Cal recipients into managed care despite vocal concerns
raised by advocacy groups about the ability of managed care
plans to provide adequate care to IHSS recipients with complex
health needs. As of May 2015, nearly 123,000 individuals were
enrolled into Cal MediConnect, however among IHSS consumers, 64
percent of potential enrollees have opted out, and an additional
17 percent have disenrolled, numbers that are significantly
higher than those of the non-IHSS population. These opt-out
rates have raised concerns about the ability of the state to
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achieve the requisite savings upon which CCI was conditioned.
The Administration testified at numerous budget committee
hearings regarding the importance of the Care Plan Option
services in keeping recipients out of institutions, however the
additional services have not been implemented because the
current CMIPS payroll system lacks the functionality to allow
for medical managed care plans to pay IHSS workers for the
additional hours. Furthermore, staff notes that during the
development and implementation of CMIPS II, the new system was
touted as offering substantially more flexibility for
reprogramming associated with changing state and federal laws.
However, at recent budget hearings, the Administration testified
against adding this functionality to the current CMIPS system,
citing cost and other priorities. Supporters of this bill state
that this bill may assist the administration in fulfilling one
of the highlighted promises of CCI, and thus attract IHSS
consumers to opt-in to Cal MediConnect.
PRIOR VOTES
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|Assembly Floor: |79 - |
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|Assembly Appropriations Committee: |17 - |
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|Assembly Human Services Committee: |7 - |
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POSITIONS
Support:
United Domestic Workers of America/AFSCME Local 3930
(Co-Sponsor)
AFSCME
California Association of Public Authorities
Health Plan of San Mateo
Inland Empire Health Plan
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Local Health Plans of California
Molina Health Care of
California
Oppose:
None received.
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