BILL ANALYSIS                                                                                                                                                                                                    Ó

          |SENATE RULES COMMITTEE            |                         AB 97|
          |Office of Senate Floor Analyses   |                              |
          |(916) 651-1520    Fax: (916)      |                              |
          |327-4478                          |                              |

                                   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

           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.

          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.

          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  

          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  
          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  

          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)
          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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