BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 664|
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THIRD READING
Bill No: AB 664
Author: Dodd (D), et al.
Amended: 8/31/15 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 7/8/15
AYES: Hernandez, Nguyen, Hall, Monning, Nielsen, Pan, Roth,
Wolk
NO VOTE RECORDED: Mitchell
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
ASSEMBLY FLOOR: 80-0, 6/1/15 - See last page for vote
SUBJECT: Medi-Cal: universal assessment tool report
SOURCE: Author
DIGEST: This bill extends, from July 1, 2017, to September 1,
2018, 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. Delays two existing reports to
the Legislature on program of implementation and a
post-implementation report. Requires the existing
post-implementation report to include additional information
from consumers assessed.
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ANALYSIS:
Existing law:
1) 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).
2) Requires the universal assessment process to be used for all
HCBS, including In-Home Supportive Services (IHSS). Requires
the workgroup, in developing the process, to build upon the
IHSS uniform assessment process and hourly task guidelines,
the Multipurpose Senior Services Program (MSSP) assessment
process, and other appropriate home- and community-based
assessment tools.
3) 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.
4) 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.
5) 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;
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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.
6) 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.
7) Requires DHCS to develop materials to inform consumers of
the option to participate in the UAT testing phase.
8) 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.
9) 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.
10)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.
11)Sunsets the above-described provisions on July 1, 2017.
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This bill:
1) Extends, from July 1, 2017, to September 1, 2018, 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) Delays, from March 1, 2014, to December 1, 2016, the
requirement that DHCS, DSS and CDA report to the Legislature
on the stakeholder workgroup's progress in developing the
universal assessment process, and identifying the counties
and beneficiary categories for the assessment process may be
implemented.
3) Delays an existing report to the Legislature after
implementation of the universal assessment process, to
fifteen months after implementation, instead of nine months
in existing law.
4) Requires the existing post-implementation report to the
Legislature to include, at minimum:
a) Findings from consumers assessed using the UAT
regarding their satisfaction with both the universal
assessment process and the assessor.
b) Analysis of the consumers' ability to follow and
accurately respond to all assessment items.
c) Data collected from the universal assessment process
that is compared to previous assessment tool data. This
information would be required to be reported to
distinguish the impact of the universal assessment process
through the new data collection process.
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
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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
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 seniors and persons with disabilities (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
(community-based adult services), 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
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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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
1)No significant costs are anticipated by extending the
statutory sunset on the authority to develop the UAT and
conduct a pilot project using it.
2)One-time costs of between $500,000 and $1,000,000 are
anticipated for the DHCS to conduct an evaluation of the
universal assessment tool pilot project (General Fund and
federal funds). DHCS indicates that it will either conduct the
evaluation internally or contract with an independent
organization.
SUPPORT: (Verified8/28/15)
AARP
American Federation of State, County and Municipal Employees,
AFL-CIO
California Alliance for Retired Americans
California Commission on Aging
California Senior Legislature
LeadingAge California
On Lok Senior Health Services
UDW/AFSCME Local 3930
OPPOSITION: (Verified8/28/15)
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Department of Finance
ARGUMENTS IN 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
bill is necessary, because if the UAT is successful, the
Legislature should expand the program to all California
counties.
ARGUMENTS IN OPPOSITION: The Department of Finance writes in
opposition to the previous version of this bill that it believes
this bill is unnecessary, may be difficult to implement and
imposes additional costs on the state's General Fund that are
not included in the 2015 Budget Act.
ASSEMBLY FLOOR: 80-0, 6/1/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,
Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,
Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,
Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins
Prepared by:Scott Bain / HEALTH /
8/31/15 8:54:40
**** END ****
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