BILL ANALYSIS Ó
AB 664
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CONCURRENCE IN SENATE AMENDMENTS
AB
664 (Dodd)
As Amended August 31, 2015
Majority vote
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|ASSEMBLY: |80-0 |(June 1, 2015) |SENATE: |37-0 |(September 1, |
| | | | | |2015) |
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Original Committee Reference: HEALTH
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 stays.
The Senate amendments delay the sunset on the existing body of
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law requiring the development of a universal assessment tool
until September 1, 2018; delay the deadline for a report on the
working group's status until December 1, 2016; delay the
deadline for reporting on the initial use of the universal
assessment until fifteen months after implementation; and revise
the information required to be in the report.
FISCAL EFFECT: According to the Senate Appropriations
Committee, one-time costs of between $500,000 and $1,000,000 are
anticipated for DHCS to conduct an evaluation of the universal
assessment tool pilot project.
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 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.
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
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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 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.
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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:
Kelly Green / HEALTH / (916) 319-2097 FN:
0001909