BILL ANALYSIS                                                                                                                                                                                                    



                                                                      AB 97


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          GOVERNOR'S VETO


          AB  
          97 (Weber)


          As Enrolled  September 8, 2015


          2/3 vote


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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  








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          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:


             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  








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            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  
            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,  








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            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:


          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  








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          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  
          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  








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          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  
          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  








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            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  
          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  








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          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."


          GOVERNOR'S VETO MESSAGE:


          This bill would require the California Department of Social  
          Services to reprogram the In-Home Supportive Services (IHSS)  
          payroll system so that paychecks issued by the system would  
          include payment for home care service hours authorized by both  
          IHSS and managed health care plans.


          While I support streamlining the payment system for home care  
          service workers, we have yet to find a permanent fund source to  
          restore the seven percent reduction in recipients' authorized  
          hours.  When that fiscal uncertainty has been resolved, I would  








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          be open to reconsidering the policy in this bill.




          Analysis Prepared by:                                             
                          Myesha Jackson / HUM. S. / (916) 319-2089  FN:  
          00025300001939