BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 664
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|AUTHOR: |Dodd |
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|VERSION: |June 25, 2015 |
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|HEARING DATE: |July 8, 2015 | | |
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|CONSULTANT: |Scott Bain |
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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
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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 :
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|Assembly Floor: |80 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
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|Assembly Health Committee: |17 - 0 |
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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
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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
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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
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