BILL ANALYSIS Ó
AB 664
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ASSEMBLY THIRD READING
AB
664 (Dodd)
As Introduced February 24, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+---------------------+---------------------|
|Health |17-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Chávez, Chiu, Gomez, | |
| | |Lackey, Nazarian, | |
| | |Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron, Wood | |
| | | | |
|----------------+------+---------------------+---------------------|
|Aging |7-0 |Brown, Hadley, | |
| | |Gipson, Gray, | |
| | |Levine, Lopez, | |
| | |Mathis | |
| | | | |
|----------------+------+---------------------+---------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, Eggman, | |
| | |Gallagher, | |
AB 664
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| | | | |
| | | | |
| | |Eduardo Garcia, | |
| | |Gordon, Holden, | |
| | |Jones, Quirk, | |
| | |Rendon, Wagner, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Requires, on or before January 1, 2017, the Department
of Health Care Services (DHCS), Department of Social Services
(DSS), and the California Department of Aging (CDA) to, in
consultation with a stakeholder workgroup, to evaluate and report
to the Legislature on outcomes and lessons of the existing
Medi-Cal universal assessment tool (UAT) pilot. Requires the UAT
report to include findings from consumers assessed using the UAT,
and from consumers choosing to be assessed using previous
assessment tools; data regarding the amount and type of services
identified by the previous assessment tools as compared to the
amount and types of services determined through the UAT; and, data
regarding home and community based services (HCBS) utilization and
costs, and percentages of consumers experiencing hospitalization
and skilled nursing facility (SNF) stays.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, this bill would result in costs in the low hundreds of
thousands of dollars to DHCS (50% General Fund/50% federal).
COMMENTS: According to the author, California provides HCBS to
low-income seniors and disabled persons (SPDs) to help them remain
in their own homes and communities. The author states that each
of the three main HCBS programs; In-Home Supportive Services
(IHSS); Community-Based Adult Services (CBAS); and, Multipurpose
Senior Services Program (MSSP) perform their own eligibility
determinations and service assessments, requiring those who
receive services for more than one program to undergo multiple
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assessments that, in some cases, collect duplicative information.
The author states that, in 2012, the Legislature recognized that
separate eligibility determination and assessment processes create
inefficiency in the administration of HCBS programs, and directed
the state to develop a UAT to be pilot-tested in two to four
counties with the goal of facilitating better care coordination,
enhance consumer choices, reduce administrative inefficiencies,
improve data analysis, and potentially create long-term fiscal
savings. However, the author states that the law establishing the
UAT pilot test does not require the administration to conduct a
formal evaluation. Thus, the author concludes that this bill is
necessary to require a formal evaluation of the UAT pilot program,
and to require the administration to report to the Legislature on
the pilot's outcomes and lessons learned.
Background. According to the Legislative Analyst's Office (LAO),
approximately 1.9 million SPDs are enrolled in Medi-Cal, which
provides long-term services and supports (LTSS), mainly comprised
of HCBS, to beneficiaries who meet certain eligibility
requirements. Three of the main Medi-Cal HCBS programs are IHSS,
CBAS, and MSSP. Each HCBS program has its own distinct
eligibility criteria and processes for eligibility determinations
and assessment processes to determine the amount and types of
services provided to consumers. Individuals needing services from
more than one program must undergo separate assessments for each.
The 2012 State Budget authorized the Coordinated Care Initiative
(CCI) with the goal of promoting the coordination of health,
behavioral health and social services for certain Medi-Cal
beneficiaries through managed care. One component of the CCI is
managed LTSS (MLTSS), which provides for the integration of
nursing facility care, IHSS, CBAS, and MSSP as managed care
benefits. Under the CCI, HCBS administrators are required to
share data with managed care plans, but, according to the LAO,
there has been no systematic data sharing among HCBS programs and
consequently no comprehensive HCBS assessment record on which
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assessors and care managers can rely to coordinate the provision
of services to consumers. The LAO states that, in light of the
integration of LTSS as a managed care benefit, and the challenges
presented by a disintegrated assessment process, universal
assessment for HCBS through the use of a UAT is looked upon as
having many potential benefits, including the creation of a single
HCBS assessment record, improvement of care coordination,
reduction in administrative inefficiencies, and improved data
collection to better understand consumer needs.
Pursuant to the CCI, DHCS, DSS, and CDA are required to work with
stakeholders to develop a UAT. The workgroup is required to
consider various factors in the development of the UAT, including
the roles and responsibilities of health plans, counties, and HCBS
providers administering the assessment; criteria for reassessment;
how results from the new assessments can be used for oversight and
quality monitoring of HCBS providers, and how the universal
assessment process would incorporate person-centered principles
and protections. This bill implements a recent recommendation of
the LAO to require a formal evaluation of the UAT pilot.
Supporters state that the UAT is designed to streamline HCBS
eligibility assessments, and address inefficiencies and burdens
created by the state's current assessment process which requires
HCBS consumers undergo unnecessary and duplicative assessments.
Supporters argue that a formal evaluation of the UAT pilot, as
proposed by this bill, will ensure that the state's UAT properly
shifts HCBS assessment to a person-centered approach integrating
all aspects of an individual's care coordination.
This bill has no known opposition.
Analysis Prepared by:
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Kelly Green / HEALTH / (916) 319-2097 FN: 0000777