BILL ANALYSIS Ó
AB 664
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Date of Hearing: April 21, 2015
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Cheryl Brown, Chair
AB 664
(Dodd) - As Introduced February 24, 2015
SUBJECT: Medi-Cal: universal assessment tool report.
SUMMARY: Requires the California Department of Aging, The
California Department of Social Services the California
Department of Health Care Services and specified stakeholders to
evaluate and report to the Legislature, outcomes and lessons
learned from the universal assessment tool pilot project.
Specifically, this bill:
1)No later than January 1, 2017, directs the Department of
Health Care Services (DHCS), the Department of Social Services
(DSS) and the California Department of Aging (CDA) to consult
with a work group required to have been convened by those
three department to develop a universal assessment process,
including a universal assessment tool for In-Home Supportive
Services (IHSS), Community-Based Adult Services (CBAS), and
Multipurpose Senior Services Program (MSSP) services.
2)Evaluate and report to the Legislature on the outcomes and
lessons learned from the universal assessment tool pilot
authorized by SB 1036 (Chapter 45, Statues of 2012) a trailer
bill of the Budget Act of 2012, related to Human Services.
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3)Specifies that the evaluation include findings from interviews
with consumers who chose to be assessed using the universal
assessment. The evaluation shall include:
a. The level of satisfaction consumers experienced
compared to previous assessments.
b. The level of satisfaction that the consumer
experienced from the assessor.
c. The ability of consumers to understand and respond
to the assessor administering the universal assessment
tool for the duration of the assessment.
d. Findings from consumers choosing to be evaluated
using previous assessment tools, including reasons why
the consumer chose the previous assessment process, and
concerns that the consumer had with the universal
assessment tool.
e. Data on the amount and type of services identified
by the previous assessment tools as compared to the
amount and type of services determined through the
universal assessment process to identify and understand
discrepancies, if any.
f. Data on home-and community-based services
utilization and costs of those services before and after
the use of the universal assessment tool in order to
understand how and if the universal assessment tool
impacts the Home and Community Based Services (HCBS)
system.
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g. Data on the rate of hospitalizations and skilled
nursing care utilization in order to understand how the
universal assessment tool may impact acute hospital care
utilization.
EXISTING LAW:
1)Establishes the Medi-Cal program, a free or low-cost health
care service for families, seniors, persons with disabilities,
children in foster care, pregnant women, and childless adults
with incomes below 138 percent of the federal poverty level
(FPL). Benefits include ambulatory patient services,
emergency services, hospitalization, maternity and newborn
care, and long term services and supports. Medi-Cal is
administered through federal-state-county partnerships with
the federal Centers for Medicare and Medicaid Services (CMS),
the California Department of Health Care Services (DHCS), and
county welfare departments in each of the 58 counties.
2)Establishes the Coordinated Care Initiative in Alameda, Los
Angeles, Orange, Riverside,
San Bernardino, San Diego, San Mateo, and Santa Clara counties
which begins the process of integrating the delivery of
medical, behavioral, and long-term services and supports while
attempting to integrate Medicare and Medi-Cal for people in
both programs, known as "dual eligible" beneficiaries.
Consumers at the local delivery points know the program as
"Cal MediConnect," while policy makers in Sacramento know the
program best as "Coordinated Care Initiative."
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3)Requires DHCS, the Department of Social Services, and
California Department of Aging (CDA), in consultation with a
stakeholder work group comprised of IHSS and other home and
community-based service consumers (or their representatives),
managed care plans, counties, IHSS, MSSP, and CBAS providers,
area agencies on aging, independent living centers,
legislative staff and unspecified others, to develop a
universal assessment process drawing upon the IHSS uniform
assessment process and hourly task guidelines, the MSSP
assessment process, and other appropriate Home and Community
Based Services (HCBS) assessment tools, to develop individual
plans of care, and to consider how the assessment tool may be
used to assess the need for nursing home care, and to divert
individuals from nursing facility level of care and to HCBS.
4)Authorizes the testing of the Universal Assessment Tool (UAT)
in no fewer than two, but no more than four counties.
Requires DHCS, DSS, and CDA, to report to the Legislature on
the counties and beneficiary categories for which the
universal assessment tool may be implemented.
5)Requires DHCS, DSS, and CDA to, no later than nine months
following the implementation of the universal assessment
process, report to the Legislature on the results of the
initial use of the process, and authorizes the departments to
propose additional beneficiary categories or counties for
expanded use of the process.
6)Repeals these provisions by January 1, 2017.
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FISCAL EFFECT: Unknown.
COMMENTS:
Author's Statement: "California provides Home and Community
Based Services (HCBS) to low-income seniors and persons with
disabilities to help them remain in their own homes and
communities. Each of the three main HCBS programs rely on
workers to determine eligibility and conduct an assessment for
the type of services that are needed. Currently, those who
receive services for more than one program undergo multiple
assessments that, in some cases, collect duplicative
information.
In 2012, the Legislature recognized that competing eligibility
determination and assessment processes create several forms of
inefficiency in the administration of these programs. The
Universal Assessment Tool (UAT) was identified as an alternative
to the current assessment system. A UAT is a single application
and data system that would streamline eligibility determinations
and assessments. It would shift the existing HCBS framework
from a "program-based" approach to a "person-centered" approach.
The goal of this new framework is to facilitate better care
coordination, enhance consumer choices, reduce administrative
inefficiencies, improve data analysis capabilities, and
potentially create long-term fiscal savings. Without fully
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understanding the outcomes of the Universal Assessment Tool, it
will be difficult for the legislature to determine if this is
worth implementing state-wide."
A Shattered System: According to "A Shattered System: Reforming
Long-Term Care in California," a thorough assessment of the
state's deficiencies in program and service design and delivery
to meet the growing needs of an aging population published
recently by the Senate Select Committee on Aging and Long Term
Care, the most critical issue facing California's Long Term Care
(LTC) system is the fragmentation of programs at the state,
regional, and local levels. This fragmentation reflects decades
of bureaucratic convenience, though it creates barriers to
citizens accessing appropriate services, and drives, supports
and promotes a lack of usable data to inform policy-makers
struggling with critical decisions about scarce resources.
California lacks a strategic plan on long-term services and
supports that would set priorities for services for the future
to maximize the use of finite resources. Despite the lack of a
strategic plan, the state should take specific steps to position
itself in a more favorable position to absorb the impact of a
rapidly expanding population of individuals in need of long-term
services and supports.
California has an array of programs and services for individuals
with disabilities. The programs are located in multiple
agencies, use different delivery systems and challenge
consumers, family members, seeking to access services. Law
makers, agency staff, and providers are routinely confounded by
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the results of a poor long-term care strategy. Multiple
reports have concluded that California's long-term care services
delivery system operates in different 'silos' causing so-called
'fragmentation,' and a barrier to service between each fragment,
or silo. As a consumer ages, and develops greater dependence on
services, they are challenged by an assessment process that
invades their privacy, seeking detailed information about their
health, personal, and familial lives. The repetitive exposure
of personal information serves to deter people from accessing
services as the discomfort of disclosing deeply personal details
about themselves to yet another stranger can aggravate and
demoralize the client.
Universal assessment offers a single uniform process to connect
services and corresponding data elements about service needs and
preferences, while evaluating an individual consumer's needs in
a consistent manner. According to one of the five principle
recommendations within the Senate Select Committee on Aging's
report, the state should commit to universal assessment as a
statewide initiative that can transform the existing system; it
can be utilized not only for more accurate and efficient service
delivery purposes, but also to support outcome analysis by
gathering information that can be used as quality measures. At
the state level, universal assessment data can help law makers
and program planners simultaneously understand the needs of
individual consumers, and consumers as a whole, support more
strategic allocation of resources, and evaluate quality. A
universal assessment tool will also assist the state to develop
a data infrastructure with the capacity to collect and report
integrated data from across programs to reduce redundancies and
duplication while driving high quality program, fiscal and
policy decisions.
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Arguments in Support: The American Federation of State, County
and Municipal Employees (AFSCME) cites AB 664 as a measure that
will help the state shift the existing framework of the HCBS
system to one that is more "person centered," and though it was
piloted, no formal investigation of its outcomes were
authorized. LeadingAge, a not-for-profit organization
representing over 400 providers of HCBS and institutional
services for about 100,000 Californians cites improved
efficiencies in the existing service delivery system for low
income older Californians that foreshadows improved choices for
consumers, reduced administrative inefficiencies, better data,
and potentially long-term savings.
Arguments in opposition: None.
Dual Referral: AB 664 was previously heard by the Assembly
Health Committee on
April 7, 2015 and passed 17-0.
Related Legislation:
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SB 21 (Liu) 2011: Require DHCS to work with stakeholders to
develop or identify a long-term care assessment tool by July 1,
2013, that would identify eligible individuals' long-term care
needs; died in Senate Appropriations Committee.
SB 998 (Liu) 2009: Required DHCS to work with stakeholders to
develop or identify a long-term care assessment tool that would
identify an individual's long-term care needs; died in Senate
Appropriations Committee.
AB 3019 (Daucher) 2005: Required the Health and Human Services
Agency to develop and test the Community Options and Assessment
Protocol to minimize duplication and redundancy of multiple
assessments for home- and community-based services, and to
connect consumers with the appropriate program services; held in
Senate Appropriations Committee.
AB 786 (Daucher), Chapter 436, Statutes of 2003: Created a
pilot project which required the county of San Mateo to seek
funding for an evaluation of the use of an assessment instrument
by an independent research organization, and would require the
results of the evaluation to be reported to the Legislature and
to the Long-Term Care Council in the California Health and Human
Services Agency on or before May 31, 2009. The bill provided
that state funds shall not be appropriated for its purposes, and
required the county to implement the bill only to the extent
that the county received federal or private funds for that
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purpose.
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REGISTERED SUPPORT / OPPOSITION:
Support
American Association of Retired Persons (AARP)
American Federation of State, County and Municipal Employees
(AFSCME), AFL-CIO
California Association of Area Agencies on Aging (C4A)
California Commission on Aging
California Senior Legislature
LeadingAge California
United Domestic Workers of America-UDW/AFSCME Local 3930
Opposition
None on file.
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Analysis Prepared by:Robert MacLaughlin / AGING & L.T.C. / (916)
319-3990