BILL ANALYSIS Ó SENATE COMMITTEE ON HUMAN SERVICES Senator McGuire, Chair 2015 - 2016 Regular Bill No: AB 97 ----------------------------------------------------------------- |Author: |Weber | ----------------------------------------------------------------- |----------+-----------------------+-----------+-----------------| |Version: |March 26, 2015 |Hearing |June 23, 2015 | | | |Date: | | |----------+-----------------------+-----------+-----------------| |Urgency: |No |Fiscal: |Yes | ---------------------------------------------------------------- ----------------------------------------------------------------- |Consultant|Sara Rogers | |: | | ----------------------------------------------------------------- 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.) AB 97 (Weber) PageB of? 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 AB 97 (Weber) PageC of? 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 AB 97 (Weber) PageD of? 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. --------------------------- <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 AB 97 (Weber) PageE of? 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 -------------------------- <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 AB 97 (Weber) PageF of? 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 AB 97 (Weber) PageG of? 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 AB 97 (Weber) PageH of? 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 ----------------------------------------------------------------- |Assembly Floor: |79 - | | |0 | |-----------------------------------------------------------+-----| |Assembly Appropriations Committee: |17 - | | |0 | |-----------------------------------------------------------+-----| |Assembly Human Services Committee: |7 - | | |0 | ----------------------------------------------------------------- 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 AB 97 (Weber) PageI of? Local Health Plans of California Molina Health Care of California Oppose: None received. -- END --