BILL ANALYSIS Ó
AB 97
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CONCURRENCE IN SENATE AMENDMENTS
AB
97 (Weber)
As Amended August 31, 2015
Majority vote
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|ASSEMBLY: |79-0 |(June 1, 2015) |SENATE: |40-0 | (September 1, |
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Original Committee Reference: HUM. S.
SUMMARY: Requires reprogramming of the Case Management
Information and Payrolling System (CMIPS II) for In-Home
Supportive Services (IHSS) to enable IHSS recipients in
Coordinated Care Initiative (CCI) counties to receive additional
services authorized and paid for by managed care health plans.
Specifically, this bill:
1)Requires CMIPS II, the IHSS payrolling system, to be
programmed to do all of the following to ensure managed care
health plans are able to pay a provider for personal care
services and related domestic services that the plan
authorizes in addition to the IHSS hours already authorized
for a recipient in a CCI county:
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a) Receive payments from managed care health plans for the
additional hours of service;
b) Issue a payroll check to providers of personal care
service hours and related domestic service hours authorized
by a managed care health plan, which shall not include
payment of wages for IHSS, as specified; and
c) Track and differentiate between IHSS hours and the hours
authorized by the managed care health plan and to enable
managed care health plans to track the recipient impact of
the additional benefits.
The Senate amendments:
1)Ensure separation and distinct consideration of hours of
service authorized by a managed care health plan and IHSS
hours, as specified.
2)Simplify implementation of this bill through reprogramming
CMIPS II by eliminating the requirement that IHSS hours of
service provided and hours authorized by a managed care health
plan be combined on a single payroll check.
EXISTING LAW:
1)Establishes the IHSS program as a benefit available to
Medi-Cal beneficiaries that provides in-home care and
supportive services to low-income aged, blind, or disabled
persons who are unable to provide or care for themselves and
who cannot live safely in their homes without assistance.
Defines supportive services within the program to include
domestic services, personal care services, protective
supervision, paramedical services, and other services, as
specified. (Welfare and Institutions Code (WIC) Section 12300
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et seq.)
2)Requires the Department of Social Services (DSS) to procure
and implement a new automated Case Management Information and
Payroll System (CMIPS) for the IHSS and Personal Care Services
Program. Requires the system to incorporate technology that
can be readily enhanced and modernized, and employ open
architecture and standards, to the extent possible. (WIC
Section 12317)
3)Establishes the CCI demonstration project in up to eight
counties, subject to federal approval, to better serve the
state's low-income seniors and persons with disabilities by
integrating the delivery of medical, behavioral, and long-term
care services for those individuals, as specified. (SB 1008
(Budget and Fiscal Review Committee), Chapter 33, Statutes of
2012, and SB 1036 (Budget and Fiscal Review Committee),
Chapter 45, Statutes of 2012)
4)Requires, as an additional component of the CCI, that all
Medi-Cal long-term services and supports, which include IHSS,
be services that are covered under managed care health plan
contracts and available only through managed care health plans
for beneficiaries residing in counties participating in the
CCI demonstration project, with specified exceptions. (WIC
Section 14186 et seq.)
5)Expresses the intent of the Legislature that managed care
health plans be allowed to authorize and pay for personal care
services and related domestic services that are provided 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 DSS to develop policies and procedures
for these additional benefits authorized and paid for by
health plans. (WIC Section 14186 (b)(6)(B))
FISCAL EFFECT: According to the Senate Appropriations
Committee, this bill may have the following fiscal impact:
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1)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).
2)Potential increase in 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.
COMMENTS:
IHSS: The IHSS program provides personal care and domestic
services to approximately 420,000 qualified, low-income
individuals who are aged, blind, or disabled. Through the IHSS
program, recipients are cared for and assisted with activities
of daily living, allowing them to remain safely in their own
homes and avoid institutionalization. IHSS services include:
paramedical services, such as giving medications and changing a
colostomy bag; non-medical personal care services, such as
toileting, dressing, and transportation; domestic services, such
as housework, shopping for groceries and meal preparation; and,
protective supervision for those who, due to cognitive decline
or dementia, cannot be left alone for extended periods.
County social workers determine eligibility for IHSS and the
authorized hours of care after conducting a standardized in-home
assessment, and periodic reassessments, of an individual's
ability to perform specified activities of daily living. Once
eligible, recipients are responsible for hiring, firing,
directing and supervising their own IHSS provider or providers.
Prior to receiving payment for services, providers must submit
to a criminal background check and a provider orientation. IHSS
is funded with federal, state, and county resources.
CCI: The Budget Act of 2012 enacted the CCI, one component of
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which is a framework for integrating the delivery of medical,
behavioral and long-term care services through a single health
plan for persons eligible for both Medicare and Medi-Cal. This
demonstration project component of the CCI, also known as Cal
MediConnect, was originally limited to the following eight
counties: Alameda, Los Angeles, Orange, San Diego, San Mateo,
Riverside, San Bernardino, and Santa Clara, in which
approximately 65% of IHSS recipients reside. Alameda County
withdrew from the CCI demonstration in 2014.
While CCI-related code sections clearly maintain county
responsibility for assessing and reassessing IHSS recipients and
determining a recipient's authorized number of hours, they also
spell out the role of the managed care health plans in
coordinating services for individuals receiving long-term
services and supports (LTSS) and implementing best practices to
help recipients of those services avoid institutionalization and
experience overall better health outcomes.
Care Plan Option (CPO) services: CCI statute 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. More specifically, it calls
for the Department of Health Care Services, in consultation with
the DSS, to develop policies and procedures for the additional
benefits that the managed care health plans can authorize. It
is important to note that CPO services authorized by a managed
care health plan, which can be offered to LTSS recipients beyond
what is required by law, are prohibited from being used to
replace any care and service hours authorized under IHSS. CPO
services are intended to enhance a recipient's care and better
support a recipient's ability to remain at home and avoid
institutional care.
In its Duals Plan Letter 13-006, the Department of Health Care
Services addresses how CPO service hours are to be used and what
steps the Cal MediConnect plans must take to prepare for
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implementation of CPO services. According to this directive,
the plans must create 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.
CMIPS II: The Case Management Information and Payrolling
System, is administered by the Office of Systems Integration
(OSI) on behalf of DSS to track IHSS case information and
process payments for all IHSS providers. CMIPS II, which now
serves all 58 counties, was implemented after a multi-year
effort to update the original 30-year-old CMIPS system, bringing
with it enhanced capacity for making timely changes to the
system that better respond to changing statutory requirements.
The OSI CMIPS II Project Internet Web site indicates that the
new system "provides modern web-based case management
functionality and sophisticated processing of payroll" and that
it "includes over 50 interfaces for timely verifications and
interactions."
Need for this bill: According to the author, "The CCI statute
includes the provision for managed care plans providing services
in CCI to authorize and pay for extra homecare services beyond
what an IHSS social worker has authorized for a consumer
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enrolled in CCI. However, the managed care plans are prohibited
by statute from paying an individual provider of homecare
services directly. Further, there is no mechanism in current
statute to pay an individual provider to provide these extra
homecare services that are authorized and funded by the managed
care plans. The managed care plans could contract with a
private homecare agency to hire and pay homecare providers to
work these additional hours. However, there is no guarantee
that the agency would hire the existing IHSS provider to work
these hours. Nor is there any way to force a plan to enter into
such a contract. In order to maintain the continuity of care
necessary for IHSS consumers enrolled in CCI, in other words, in
order for the IHSS consumer to have the option to hire his or
her existing IHSS provider to work these extra hours, the
managed care plans must find a way to pay providers who provide
these additional services."
Further explaining the need for this bill, the Health Plan of
San Mateo (HPSM) states, "The CCI legislation included
provisions for health plans to authorize IHSS services in
addition to those authorized by county social workers. This
flexibility is needed to ensure managed care plans could respond
timely and nimbly in those situations where a consumer was at
risk of entering institutional care. In addition, these CCI
provisions allow health plans to continue paying a consumer's
current IHSS provider rather than assigning an unknown provider,
without the consumer's approval, to provide services. HPSM
cannot pay providers for additional hours without the payment
mechanism proposed in [this bill]; contracting with and paying
independent IHSS providers outside CMIPS is beyond the scope of
HPSM's administrative capacity and would not be cost-effective
for our health plan."
Analysis Prepared by:
Myesha Jackson / HUM. S. / (916) 319-2089 FN: 0001939
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