BILL NUMBER: AB 664	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 25, 2015

INTRODUCED BY   Assembly Member Dodd
   (Principal coauthor: Senator Hancock)

                        FEBRUARY 24, 2015

   An act to amend Section 14186.36 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


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