BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          AB 664 (Dodd) - Medi-Cal:  universal assessment tool report
          
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          |Version: June 25, 2015          |Policy Vote: HEALTH 8 - 0       |
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          |Urgency: No                     |Mandate: No                     |
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          |Hearing Date: August 17, 2015   |Consultant: Brendan McCarthy    |
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          This bill meets the criteria for referral to the Suspense File.


          Bill  
          Summary:  AB 664 would extend existing provisions of law until  
          December 31, 2017, requiring the Department of Health Care  
          Services and other state agencies to develop a universal  
          assessment tool that could be used to assess the need for home  
          and community based services by seniors and persons with  
          disabilities. The bill would also require the Department to  
          report to the Legislature on the lessons learned from the  
          authorized pilot project using the universal assessment tool.


          Fiscal  
          Impact:  
           No significant costs are anticipated by extending the  
            statutory sunset on the authority to develop the universal  
            assessment tool and conduct a pilot project using it.

           One-time costs of between $500,000 and $1,000,000 are  
            anticipated for the Department of Health Care Services to  
            conduct an evaluation of the universal assessment tool pilot  
            project (General Fund and federal funds). The Department  







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            indicates that it will either conduct the evaluation  
            internally or contract with an independent organization.


          Background:  Under state and federal law, the Department of Health Care  
          Services operates the Medi-Cal program, which provides health  
          care coverage to low income individuals, families, and children.  
          Medi-Cal provides coverage to childless adults and parents with  
          household incomes up to 138% of the federal poverty level and to  
          children with household incomes up to 266% of the federal  
          poverty level. The federal government provides matching funds  
          that vary from 50% to 90% of expenditures depending on the  
          category of beneficiary.
          As part of the Medi-Cal program, the state offers home and  
          community based services to seniors and persons with  
          disabilities, with the intent of using less costly services  
          provided in the community to avoid more costly institutional  
          care. Home and community based services offered in the state  
          include In-Home Supportive Services (IHSS), Multipurpose Senior  
          Services Program (MSSP), and Community-Based Adult Services  
          (CBAS). In order for a Medi-Cal beneficiary to qualify for home  
          and community based services, their needs must be assessed.  
          Historically, each of the home and community based services  
          programs has used a separate assessment tool to determine what  
          services and how many hours of services an individual needs to  
          remain in the community. The process of conducting an assessment  
          is usually done in person and takes considerable time. Having  
          each of the programs use separate assessments, even though an  
          individual may qualify for more than one of the programs, is  
          administratively inefficient and burdensome to beneficiaries.


          As part of the 2012 Budget Act, the Legislature approved the  
          development of the Coordinated Care Initiative, which seeks to  
          combine Medi-Cal, Medicare, and long-term services and supports  
          (such as IHSS) into a single managed care benefit for seniors  
          and persons with disabilities. As part of the authorization of  
          the Coordinated Care Initiative, the Legislature directed the  
          Department of Health Care Services, the Department of Social  
          Services, and the Department of Aging to work with stakeholders  
          to develop a universal assessment tool for determining a  
          beneficiary's need for home and community based services.  
          Current law authorizes the Department of Health Care Services to  
          conduct a pilot project using the newly developed universal  








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          assessment tool in two to four counties in which the Coordinated  
          Care Initiative is being implemented. Current law sunsets the  
          authority to develop and pilot the universal assessment tool on  
          July 1, 2017.


          The departments are currently in the process of developing the  
          universal assessment tool and the pilot project has not yet  
          begun.




          Proposed Law:  
            AB 664 would extend existing provisions of law until December  
          31, 2017, requiring the Department of Health Care Services and  
          other state agencies to develop a universal assessment tool that  
          could be used to assess the need for home and community based  
          services by seniors and persons with disabilities. 
          The bill would also require the Department to report to the  
          Legislature on the lessons learned from the authorized pilot  
          project using the universal assessment tool. The report on the  
          outcomes and lessons learned would be due to the Legislature by  
          January 1, 2017.




          Staff  
          Comments:  The universal assessment tool has not been developed  
          (although the departments have developed an early draft tool).  
          According to the departments, actual implementation of the pilot  
          project is not expected to occur until July 2016. It does not  
          seem likely that the pilot project could take place and a  
          meaningful evaluation of the results of that pilot be completed  
          by January 1, 2017.


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