Amended in Senate August 31, 2015

Amended in Senate June 25, 2015

California Legislature—2015–16 Regular Session

Assembly BillNo. 664


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.begin insert No later than March 1, 2014, existing law requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to report to the Legislature on the stakeholder workgroup’s progress in developing the universal assessment process and to identify the counties and beneficiary categories for which the universal assessment process may be implemented.end insert 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.begin insert No later than 9 months after the implementation of the universal assessment process, existing law requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging, to report to the Legislature on the results of the initial use of the universal assessment process.end insert

This bill would extend the operation of these provisions untilbegin delete 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.end deletebegin insert September 1, 2018. The bill would instead require the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to report to the Legislature on the stakeholder workgroup’s progress no later than December 1, 2016. The bill would instead require the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to report to the Legislature on the results of the initial use of the universal assessment process no later than 15 months after theend insertbegin insert implementation of the universal assessment process.end insert The bill would requirebegin delete theend deletebegin insert thisend insert report to include, among other things, findings from consumers assessed using the universal assessment toolbegin delete and findings from consumers choosing to be assessed using previous assessment tools.end deletebegin insert regarding their satisfaction of the universal assessment process.end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P3    1

SECTION 1.  

Section 14186.36 of the Welfare and Institutions
2Code
is amended to read:

3

14186.36.  

(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.

25(c) (1) No later than June 1, 2013, the department, the State
26Department of Social Services, and the California Department of
27Aging shall establish a stakeholder workgroup to develop the
28universal assessment process, including a universal assessment
29tool, for home- and community-based services, as defined in
30subdivision (b) of Section 14186.1. The stakeholder workgroup
31shall include, but not be limited to, consumers of IHSS and other
32home- and community-based services and their authorized
33representatives, managed care health plans, counties, IHSS, MSSP,
34and CBAS providers, area agencies on aging, independent living
35centers, and legislative staff. The universal assessment process
36shall be used for all home- and community-based services,
37including IHSS. In developing the process, the workgroup shall
38build upon the IHSS uniform assessment process and hourly task
P4    1guidelines, the MSSP assessment process, and other appropriate
2home- and community-based assessment tools.

3(2) (A) In developing the universal assessment process, the
4departments described in paragraph (1) shall develop a universal
5assessment tool that will inform the universal assessment process
6and facilitate the development of plans of care based on the
7 individual needs of the consumer. The workgroup shall consider
8issues including, but not limited to, the following:

9(i) The roles and responsibilities of the health plans, counties,
10and home- and community-based services providers administering
11the assessment.

12(ii) The criteria for reassessment.

13(iii) How the results of new assessments would be used for the
14oversight and quality monitoring of home- and community-based
15services providers.

16(iv) How the appeals process would be affected by the
17assessment.

18(v) The ability to automate and exchange data and information
19between home- and community-based services providers.

20(vi) How the universal assessment process would incorporate
21person-centered principles and protections.

22(vii) How the universal assessment process would meet the
23legislative intent of this article and the goals of the demonstration
24project pursuant to Section 14132.275.

25(viii) The qualifications for, and how to provide guidance to,
26the individuals conducting the assessments.

27(B) The workgroup shall also consider how this assessment may
28be used to assess the need for nursing facility care and divert
29individuals from nursing facility care to home- and
30community-based services.

31(d) No later thanbegin delete March 1, 2014,end deletebegin insert December 1, 2016,end insert the
32department, the State Department of Social Services, and the
33California Department of Aging shall report to the Legislature on
34the stakeholder workgroup’s progress in developing the universal
35assessment process, and shall identify the counties and beneficiary
36categories for which the universal assessment process may be
37implemented pursuant to subdivision (e).

38(e) (1) No sooner than January 1, 2015, upon completion of
39the design and development of a new universal assessment tool,
40managed care health plans, counties, and other home- and
P5    1community-based services providers may test the use of the tool
2for a specific and limited number of beneficiaries who receive or
3are potentially eligible to receive home- and community-based
4services pursuant to this article in no fewer than two, and no more
5than four, of the counties where the provisions of this article are
6implemented, if the following conditions have been met:

7(A) The department has obtained any federal approvals through
8necessary federal waivers or amendments, or state plan
9amendments, whichever occurs later.

10(B) The system used to calculate the results of the tool has been
11tested.

12(C) Any entity responsible for using the tool has been trained
13in its usage.

14(2) To the extent the universal assessment tool or universal
15assessment process results in changes to the authorization process
16and provision of IHSS services, those changes shall be automated
17in the Case Management Information and Payroll System.

18(3) The department shall develop materials to inform consumers
19of the option to participate in the universal assessment tool testing
20phase pursuant to this paragraph.

begin delete

21(4) On or before January 1, 2017, the department, the State
22Department of Social Services, and the California Department of
23Aging shall, in consultation with the workgroup described in
24subdivision (c), evaluate and report to the Legislature on the
25outcomes of, and lessons learned from, the universal assessment
26tool pilot authorized by this subdivision. The report shall comply
27with Section 9795 of the Government Code. At a minimum, the
28report shall include all of the following:

29(A) Findings from consumers assessed using the universal
30assessment tool. Interviews with consumers who chose to be
31assessed using the universal assessment tool shall be conducted
32to evaluate all of the following:

33(i) The level of satisfaction consumers experienced with the
34universal assessment tool as compared to the previous assessment
35approach.

36(ii) The level of satisfaction consumers experienced with the
37assessor from either the county or the managed care plan.

38(iii) The ability of consumers to understand and respond to the
39assessor administering the universal assessment tool for the
40duration of the assessment.

P6    1(iv) Any challenges experienced by consumers during the
2administration of the universal assessment tool.

3(B) Findings from consumers choosing to be assessed using
4previous assessment tools. Interviews with consumers who chose
5to be assessed using previous assessment tools shall be conducted
6to evaluate both of the following:

7(i) Reasons why the consumer chose to be assessed using the
8previous assessment tools.

9(ii) Concerns the consumer may have had with the universal
10assessment tool determining the services to be provided.

11(C) Data on the amount and type of services identified by the
12previous assessment tools as compared to the amount and types
13of services determined through the universal assessment tool, in
14order to better understand any discrepancies that may exist between
15the assessment approaches.

16(D) Data on the home- and community-based services utilization
17and costs of consumers before and after the use of the universal
18assessment tool, in order to better understand how the universal
19assessment tool may impact the home- and community-based
20services system.

21(E) Data on the percentage of consumers who experience
22hospitalizations and skilled nursing facility stays over a specific
23time period before and after the use of the universal assessment
24tool, in order to better understand how the universal assessment
25tool may impact acute care utilization.

end delete

26(f) The department, the State Department of Social Services,
27and the California Department of Aging shall implement a
28rapid-cycle quality improvement system to monitor the
29implementation of the universal assessment process, identify
30significant changes in assessment results, and make modifications
31to the universal assessment process to more closely meet the
32legislative intent of this article and the goals of the demonstration
33project pursuant to Section 14132.275.

34(g) Until existing law relating to the IHSS assessment process
35pursuant to Article 7 (commencing with Section 12300) of Chapter
363 is amended, beneficiaries shall have the option to request an
37additional assessment using the previous assessment process for
38those home- and community-based services and to receive services
39according to the results of the additional assessment.

P7    1(h) begin insert(1)end insertbegin insertend insertNo later thanbegin delete nineend deletebegin insert 15end insert months after the implementation
2of the universal assessment process, the department, the State
3Department of Social Services, and the California Department of
4Aging, in consultation with stakeholders, shall report to the
5Legislature on the results of the initial use of the universal
6assessment process, and may identify proposed additional
7beneficiary categories or counties for expanded use of this process
8and any necessary changes to provide statutory authority for the
9continued use of the universal assessment process. These
10departments shall report annually thereafter to the Legislature on
11the status and results of the universal assessment process.begin insert At a
12minimum, the report shall include, but not be limited to, all of the
13following:end insert

begin insert

14(A) Findings from consumers assessed using the universal
15assessment tool regarding their satisfaction with both the universal
16assessment process and the assessor.

end insert
begin insert

17(B) Analysis of the consumers’ ability to follow and accurately
18respond to all assessment items.

end insert
begin insert

19(C) Data collected from the universal assessment process that
20is compared to previous assessment tool data and this information
21shall be reported to distinguish the impact of the universal
22assessment process through the new data collection process.

end insert
begin insert

23(2) A report submitted pursuant to this subdivision shall be
24submitted in compliance with Section 9795 of the Government
25Code.

end insert

26(i) This section shall remain operative only untilbegin delete December 31,
272017.end delete
begin insert September 1, 2018.end insert



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