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 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 AB 97 Page 2 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 AB 97 Page 3 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. AB 97 Page 4 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 AB 97 Page 5 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. AB 97 Page 6 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, AB 97 Page 7 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 **** END ****