AB 664, as amended, Dodd. Medi-Cal: universal assessment tool report.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including, among other services, home- and community-based services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.
Existing law, until July 1, 2017, requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to establish a stakeholder workgroup, as prescribed, to develop a universal assessment process, including a universal assessment tool, to be used for home- and community-based services. No sooner than January 1, 2015, upon completion of the design and development of that universal assessment tool, existing law authorizes managed care health plans, counties, and other home- and community-based services providers to test the use of the tool for certain beneficiaries in no fewer than 2, and no more than 4, specified counties if certain conditions have been met.
This bill wouldbegin insert extend the operation of these provisions until December 31, 2017. The bill would alsoend insert require, on or before January 1, 2017, the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging, in consultation with the stakeholder workgroup described above, to evaluate and report to the Legislature on the outcomes of, and lessons learned from, the universal assessment tool pilot authorized by the provisions described above. The bill would require the report to include, among other things, findings from consumers assessed using the universal assessment tool and findings from consumers choosing to be assessed using previous assessment tools.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14186.36 of the Welfare and Institutions
2Code is amended to read:
(a) It is the intent of the Legislature that a universal
4assessment process for LTSS be developed and tested. The initial
5uses of this tool may inform future decisions about whether to
6amend existing law regarding the assessment processes that
7currently apply to LTSS programs, including IHSS.
8(b) (1) In addition to the activities set forth in paragraph (9) of
9subdivision (a) of Section 14186.35, county agencies shall continue
10IHSS assessment and authorization processes, including making
11final determinations of IHSS hours pursuant to Article 7
12(commencing with Section 12300) of Chapter 3 and regulations
13promulgated by the State Department of Social Services.
14(2) No sooner than January 1, 2015, for the counties and
15beneficiary categories specified in subdivision (e), counties shall
16also utilize the universal assessment tool, as described in
17subdivision (c), if one is available and upon completion of the
18stakeholder process, system design and testing, and county training
19described in subdivisions (c) and (e), for the provision of IHSS
20services. This paragraph shall only apply to beneficiaries who
21consent to the use of the universal assessment process. The
22managed care health plans shall be required to cover IHSS services
23based on the results of the universal assessment process specified
24in this section.
P3 1(c) (1) No later than June 1, 2013, the department, the State
2Department of Social Services, and the
California Department of
3Aging shall establish a stakeholder workgroup to develop the
4universal assessment process, including a universal assessment
5tool, for home- and community-based services, as defined in
6subdivision (b) of Section 14186.1. The stakeholder workgroup
7shall include, but not be limited to, consumers of IHSS and other
8home- and community-based services and their authorized
9representatives, managed care health plans, counties, IHSS, MSSP,
10and CBAS providers, area agencies on aging, independent living
11centers, and legislative staff. The universal assessment process
12shall be used for all home- and community-based services,
13including IHSS. In developing the process, the workgroup shall
14build upon the IHSS uniform assessment process and hourly task
15guidelines, the MSSP assessment process, and other appropriate
16home- and community-based assessment tools.
17(2) (A) In developing the universal assessment process, the
18departments described in paragraph (1) shall develop a universal
19assessment tool that will inform the universal assessment process
20and facilitate the development of plans of care based on the
21
individual needs of the consumer. The workgroup shall consider
22issues including, but not limited to, the following:
23(i) The roles and responsibilities of the health plans, counties,
24and home- and community-based services providers administering
25the assessment.
26(ii) The criteria for reassessment.
27(iii) How the results of new assessments would be used for the
28oversight and quality monitoring of home- and community-based
29services providers.
30(iv) How the appeals process would be affected by the
31assessment.
32(v) The ability to automate and exchange data and information
33between home-
and community-based services providers.
34(vi) How the universal assessment process would incorporate
35person-centered principles and protections.
36(vii) How the universal assessment process would meet the
37legislative intent of this article and the goals of the demonstration
38project pursuant to Section 14132.275.
39(viii) The qualifications for, and how to provide guidance to,
40the individuals conducting the assessments.
P4 1(B) The workgroup shall also consider how this assessment may
2be used to assess the need for nursing facility care and divert
3individuals from nursing facility care to home- and
4community-based services.
5(d) No later than March 1, 2014, the department, the State
6Department of Social Services, and the California Department of
7Aging shall report to the Legislature on the stakeholder
8
workgroup’s progress in developing the universal assessment
9process, and shall identify the counties and beneficiary categories
10for which the universal assessment process may be implemented
11pursuant to subdivision (e).
12(e) (1) No sooner than January 1, 2015, upon completion of the
13design and development of a new universal assessment tool,
14managed care health plans, counties, and other home- and
15community-based services providers may test the use of the tool
16for a specific and limited number of beneficiaries who receive or
17are potentially eligible to receive home- and community-based
18services pursuant to this article in no fewer than two, and no more
19than four, of the counties where the provisions of this article are
20implemented, if the following conditions have been met:
21(A) The department has obtained any federal approvals through
22necessary federal waivers or amendments, or state plan
23amendments, whichever occurs later.
24(B) The system used to calculate the results of the tool has been
25tested.
26(C) Any entity responsible for using the tool has been trained
27in its usage.
28(2) To the extent the universal assessment tool or universal
29assessment process results in changes to the authorization process
30and provision of IHSS services, those changes shall be automated
31in the Case Management Information and Payroll System.
32(3) The department shall develop materials to inform consumers
33of the option to participate in the
universal assessment tool testing
34phase pursuant to this paragraph.
35(4) On or before January 1, 2017, the department, the State
36Department of Social Services, and the California Department of
37Aging shall, in consultation with the workgroup described in
38subdivision (c), evaluate and report to the Legislature on the
39outcomes of, and lessons learned from, the universal assessment
40tool pilot authorized by this subdivision. The report shall comply
P5 1with Section 9795 of the Government Code. At a minimum, the
2report shall include all of the following:
3(A) Findings from consumers assessed using the universal
4assessment tool. Interviews with consumers who chose to be
5assessed using the universal assessment tool shall be conducted
6to evaluate all of the following:
7(i) The level of satisfaction consumers experienced with the
8universal assessment tool as compared to the previous assessment
9approach.
10(ii) The level of satisfaction consumers experienced with the
11assessor from either the county or the managed care plan.
12(iii) The ability of consumers to understand and respond to the
13assessor administering the universal assessment tool for the
14duration of the assessment.
15(iv) Any challenges experienced by consumers during the
16administration of the universal assessment tool.
17(B) Findings from consumers choosing to be assessed using
18previous assessment tools.
Interviews with consumers who chose
19to be assessed using previous assessment tools shall be conducted
20to evaluate both of the following:
21(i) Reasons why the consumer chose to be assessed using the
22previous assessment tools.
23(ii) Concerns the consumer may have had with the universal
24assessment tool determining the services to be provided.
25(C) Data on the amount and type of services identified by the
26previous assessment tools as compared to the amount and types
27of services determined through the universal assessment tool, in
28order to better understand any discrepancies that may exist between
29the assessment approaches.
30(D) Data on the home- and community-based
services utilization
31and costs of consumers before and after the use of the universal
32assessment tool, in order to better understand how the universal
33assessment tool may impact the home- and community-based
34services system.
35(E) Data on the percentage of consumers who experience
36hospitalizations and skilled nursing facility stays over a specific
37time period before and after the use of the universal assessment
38tool, in order to better understand how the universal assessment
39tool may impact acute care utilization.
P6 1(f) The department, the State Department of Social Services,
2and the California Department of Aging shall implement a
3rapid-cycle quality improvement system to monitor the
4implementation of the universal assessment process, identify
5significant changes in
assessment results, and make modifications
6to the universal assessment process to more closely meet the
7legislative intent of this article and the goals of the demonstration
8project pursuant to Section 14132.275.
9(g) Until existing law relating to the IHSS assessment process
10pursuant to Article 7 (commencing with Section 12300) of Chapter
113 is amended, beneficiaries shall have the option to request an
12additional assessment using the previous assessment process for
13those home- and community-based services and to receive services
14according to the results of the additional assessment.
15(h) No later than nine months after the implementation of the
16universal assessment process, the department, the State Department
17of Social Services, and the California Department of Aging, in
18consultation
with stakeholders, shall report to the Legislature on
19the results of the initial use of the universal assessment process,
20and may identify proposed additional beneficiary categories or
21counties for expanded use of this process and any necessary
22changes to provide statutory authority for the continued use of the
23universal assessment process. These departments shall report
24annually thereafter to the Legislature on the status and results of
25the universal assessment process.
26(i) This section shall remain operative only untilbegin delete July 1,end delete
27begin insert December 31,end insert 2017.
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