BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 97|
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THIRD READING
Bill No: AB 97
Author: Weber (D)
Amended: 8/31/15 in Senate
Vote: 21
SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/23/15
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
ASSEMBLY FLOOR: 79-0, 6/1/15 - See last page for vote
SUBJECT: In-home supportive services: provider wages
SOURCE: United Domestic Workers of America/AFSCME Local 3930
DIGEST: This bill requires the Case Management Information and
Payrolling System (CMIPS II) for the In-Home Supportive Services
(IHSS) program to be reprogrammed to enable managed health care
plans to pay a provider for additional services authorized for
IHSS recipients in participating counties of the Coordinated
Care Initiative (CCI), as specified.
ANALYSIS:
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
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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.)
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 Coordinated Care Initiative (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
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hours of service authorized by the managed care plan, which
are separate and distinct from in-home supportive service
hours authorized by the county;
b) Issue a payroll check to providers that covers the
personal care service and related domestic service hours
authorized by the managed care health plan; and
c) Track and differentiate between county authorized IHSS
hours and the hours authorized by the managed care health
plan to enable managed care health plans to track the
recipient impact of the additional benefits.
Background
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
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. 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" under the
American with Disabilities Act.
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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.
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 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:
1)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.
2)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 with the federal Centers for Medicare and
Medicaid Services (CMS).
3)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
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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:
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.
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The new Case Management Information and Payrolling System: CMIPS
II
The new CMIPS II, 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."
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee, this bill will
incur one-time costs of $6 million ($3 million General Fund) for
reprogramming of CMIPS II and ongoing costs of $1 million ($0.5
million General Fund). Additionally, this bill will potentially
increase county administrative costs (Federal Fund/General Fund)
to enter data from two payroll systems into the CMIPS II
database in order to differentiate between authorized hours for
IHSS and by managed health care plans.
SUPPORT: (Verified8/28/15)
United Domestic Workers of America/AFSCME Local 3930 (source)
AFSCME
California Association of Public Authorities
California Labor Federation
Health Plan of San Mateo
Inland Empire Health Plan
Local Health Plans of California
Molina Health Care of
CaliforniaOPPOSITION: (Verified 8/28/15)
None received
ASSEMBLY FLOOR: 79-0, 6/1/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
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Bonilla, Bonta, Brown, Burke, Calderon, Campos, Chang, Chau,
Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly,
Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,
Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,
Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,
Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Brough
Prepared by:Sara Rogers / HUMAN S. / (916) 651-1524
8/30/15 19:09:45
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