BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: AB 664 --------------------------------------------------------------- |AUTHOR: |Dodd | |---------------+-----------------------------------------------| |VERSION: |June 25, 2015 | --------------------------------------------------------------- --------------------------------------------------------------- |HEARING DATE: |July 8, 2015 | | | --------------------------------------------------------------- --------------------------------------------------------------- |CONSULTANT: |Scott Bain | --------------------------------------------------------------- SUBJECT : Medi-Cal: universal assessment tool report. SUMMARY :1) Extends by six months, from July 1, 2017 to December 31, 2017, the duration of the existing provisions of law requiring the Department of Health Care Services (DHCS), the Department of Social Services (DSS) and the California Department of Aging (CDA) to establish a stakeholder workgroup to develop a universal assessment process, a universal assessment tool (UAT), authorization for piloting of the UAT, and reporting requirements on those provisions. Requires, on or before January 1, 2017, DHCS, DSS, and CDA to evaluate and report to the Legislature on the outcomes of, and lessons learned from, the UAT pilot authorized, and would require the report to include, among other things, findings from consumers assessed using the UAT and findings from consumers choosing to be assessed using previous assessment tools. Existing law: 1)States legislative intent that a universal assessment process for long-term services and supports (LTSS) be developed and tested. 2)Requires, no later than January 1, 2013, DHCS, DSS, and CDA to establish a stakeholder workgroup to develop the universal assessment process, including a UAT, for home- and community-based services (HCBS). 3)Requires the stakeholder workgroup to include, but not be limited to, consumers of In-Home Supportive Services (IHSS), and other HCBS and their authorized representatives, managed care health plans, counties, Multipurpose Senior Services Program (MSSP) providers, Community-Based Adult Services (CBAS) providers, area agencies on aging, independent living AB 664 (Dodd) Page 2 of ? centers, and legislative staff. 4)Requires the universal assessment process to be used for all HCBS, including IHSS. Requires the workgroup, in developing the process, to build upon the IHSS uniform assessment process and hourly task guidelines, the MSSP assessment process, and other appropriate home- and community-based assessment tools. 5)Requires DHCS, DSS and CDA, in developing the universal assessment process, to develop a UAT that will inform the universal assessment process and facilitate the development of plans of care based on the individual needs of the consumer. Requires the workgroup to consider specified issues. 6)Requires DHCS, DSS and CDA, no later than March 1, 2014, 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 7)Permits, no sooner than January 1, 2015, upon completion of the design and development of a new UAT, managed care health plans, counties, and other HCBS services providers to test the use of the tool for a specific and limited number of beneficiaries who receive or are potentially eligible to receive HCBS in no fewer than two, and no more than four, of the counties where the Coordinated Care Initiative is implemented, if the following conditions have been met: a) DHCS 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; and, c) Any entity responsible for using the tool has been trained in its usage. 8)Requires counties in which the tool has been piloted, no sooner than January 1, 2015, to also utilize the UAT if one is available and upon completion of the stakeholder process, system design and testing, and county training for the provision of IHSS services, if beneficiaries consent to the use of the universal assessment process. Requires managed care health plans to cover IHSS services based on the results of the universal assessment process. AB 664 (Dodd) Page 3 of ? 9)Requires, to the extent the UAT or universal assessment process results in changes to the authorization process and provision of IHSS services, those changes to be automated in the Case Management Information and Payroll System. 10)Requires DHCS to develop materials to inform consumers of the option to participate in the UAT testing phase. 11)Requires DHCS, DSS and CDA to 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. 12)Requires beneficiaries to have the option to request an additional assessment using the previous assessment process for those HCBS and to receive services according to the results of the additional assessment until existing law relating to the IHSS assessment process is amended. 13)Requires, no later than nine months after the implementation of the universal assessment process, DHCS, DSS, and CDA, in consultation with stakeholders, to report to the Legislature on the results of the initial use of the universal assessment process, and permits these entities to 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. Requires DHCS, DSS and CDA to report annually thereafter to the Legislature on the status and results of the universal assessment process. 14)Sunsets the above-described provisions on July 1, 2017. This bill: 1)Extends, from July 1, 2017 to December 31, 2017 the duration of the existing provisions of law requiring DHCS, DSS and CDA to establish a stakeholder workgroup, to develop a universal assessment process, a UAT, authorization for piloting of the UAT, and reporting requirements. 2)Requires, on or before January 1, 2017, DHCS, DSS, and CDA, in consultation with the existing workgroup, to evaluate and report to the Legislature on the outcomes of, and lessons AB 664 (Dodd) Page 4 of ? learned from, the UAT pilot. Requires the report, at a minimum, to include all of the following: a) Findings from consumers assessed using the UAT. Requires interviews with consumers who chose to be assessed using the UAT to be conducted to evaluate all of the following: i. The level of satisfaction consumers experienced with the UAT 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 UAT for the duration of the assessment; and, iv. Any challenges experienced by consumers during the administration of the UAT. b) Findings from consumers choosing to be assessed using previous assessment tools. Requires 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; and, ii. Concerns the consumer may have had with the UAT determining the services to be provided. 3)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 UAT, in order to better understand any discrepancies that may exist between the assessment approaches. 4)Data on HCBS utilization and costs of consumers before and after the use of the UAT, in order to better understand how the UAT may impact the HCBS system. 5)Data on the percentage of consumers who experience AB 664 (Dodd) Page 5 of ? hospitalizations and skilled nursing facility stays over a specific time period before and after the use of the UAT, in order to better understand how the UAT may impact acute care utilization. FISCAL EFFECT : According to the Assembly Appropriations Committee, costs in the low hundreds of thousands of dollars to DHCS (50% GF/50% federal). PRIOR VOTES : ----------------------------------------------------------------- |Assembly Floor: |80 - 0 | |------------------------------------+----------------------------| |Assembly Appropriations Committee: |17 - 0 | |------------------------------------+----------------------------| |Assembly Health Committee: |17 - 0 | | | | ----------------------------------------------------------------- COMMENTS : 1)Author's statement. According to the author, California provides 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 separate eligibility determination and assessment processes create several forms of inefficiency in the administration of these programs. The 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 AB 664 (Dodd) Page 6 of ? potentially create long-term fiscal savings. Without a formal evaluation, the Legislature will not know if the UAT will work as it was intended to. 2)Background on HCBS assessments. Medi-Cal provides services to low-income SPDs to help these individuals remain in their own homes and communities rather than being placed in institutional care. Each of the state's three main HCBS programs (IHSS, CBAS, and MSSP) rely on workers to determine eligibility and conduct an assessment to determine the amount and type of services that a consumer may need. Currently, clients who receive services from more than one HCBS program undergo multiple assessments that, in some cases, collect duplicative information. These assessments are typically paper forms-unique to each program-used by assessors. Assessors for each HCBS program determine eligibility and conduct an assessment to determine the amount and type of services that a client may need from the particular program to remain safely in his/her home and community. An assessment generally includes questions that cover one or more of the following three areas: (a) medical needs, (b) routine daily functional needs, and/or (c) consumer characteristics. 3)Budget action and status of universal assessment. As part of the 2012-13 budget, the Legislature enacted the Coordinated Care Initiative (CCI), with the intent to promote care coordination among SPDs by integrating health care LTSS benefits in up to eight pilot counties. The CCI legislation, SB 1036 (Committee on Budget and Fiscal Review), Chapter 45, Statutes of 2012 also established the universal assessment requirements. The workgroup met for the first time in September 2013 and plans to continue its work of developing the UAT through 2015. The affected state departments have received a draft assessment tool but it is not yet public. Department staff indicate they are not likely to begin piloting the UAT until July 2016. 4)Support. The American Federation of State, County, and Municipal Employees (AFSCME) states that, under the state's current assessment process, HCBS consumers undergo unnecessary and duplicative assessments, and that this bill will require a formal evaluation of the UAT pilot to ensure that the state's UAT properly shifts HCBS assessment to a person-centered approach integrating all aspects of an individual's care coordination. AFSMCE states the evaluation proposed in this AB 664 (Dodd) Page 7 of ? bill is necessary, because if the UAT is successful, the Legislature should expand the program to all California counties. 5)Policy issues. a) Bill and current statute afford little time for UAT pilot implementation and evaluation. The most recent amendments to this bill extend the duration of the universal assessment provisions of law by an additional six months, to December 31, 2017. However, given that implementation of the UAT pilot may not commence until July 2016, there will be little time for evaluation prior to the statute sunset date. b) Existing reporting requirements. Existing law requires a report by March 1, 2014 by DHCS, DSS and CDA on the stakeholder workgroup's progress in developing the universal assessment process, and which identifies the counties and beneficiary categories for which the universal assessment process may be implemented. A second report is required nine months after the implementation of the universal assessment process on the results of the initial use of the universal assessment process. Finally, existing law requires these departments to report annually thereafter to the Legislature after the second report on the status and results of the universal assessment process. In discussions with department staff, one of the issues raised is whether the information sought in the report required by this bill is in a separate report from those that are currently required. SUPPORT AND OPPOSITION : Support: American Federation of State, County and Municipal Employees California Alliance for Retired Americans California Senior Legislature LeadingAge California Oppose: None received -- END -- AB 664 (Dodd) Page 8 of ?