BILL ANALYSIS Ó
SB 492
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Date of Hearing: June 23, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
SB
492 (Liu) - As Amended May 5, 2015
SENATE VOTE: 29-7
SUBJECT: Coordinated Care Initiative: consumer educational and
informational guide.
SUMMARY: Requires the Department of Health Care Services (DHCS)
to develop, publish, and distribute an educational and
informational guide for consumers and patients regarding the
Coordinated Care Initiative (CCI), as specified. Specifically,
this bill:
1)Establishes the Coordinated Care Initiative Consumer and
Patient Educational and Informational Guide in existing law.
2)Requires DHCS to develop an educational and information guide
for consumers and patients on the CCI, as specified, and post
it on its website.
3)Requires the educational and informational guide to include
information about individuals who are dually eligible for
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Medicare and Medi-Cal, and seniors and persons with
disabilities who are required to receive long-term services
and supports (LTSS) through a Medi-Cal managed care plan, as
specified. LTSS includes nursing facility services, home and
community-based services (HCBS), home health services, and
personal care services.
4)Requires DHCS to distribute the educational and informational
guide to organizations throughout the state, as specified.
5)Requires DHCS to make the educational and informational guide
easy to read and understand, and make available in a
culturally competent manner in all Medi-Cal threshold
languages.
EXISTING LAW:
1)Establishes the Medicare Program under federal law to provide
individuals over 65 years of age, individuals under the age of
65 with specific disabilities, and individuals with end stage
renal disease, basic protection against the costs of hospital,
related post-hospital, home health services, and hospice care.
2)Establishes the Medi-Cal Program under the direction of DHCS
to provide low-income qualifying individuals health care and a
uniform schedule of benefits, including HCBS.
3)Requires DHCS, upon federal approval, to establish a
demonstration project that enables dual eligible beneficiaries
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(individuals who are eligible to receive both Medicare and
Medi-Cal) to receive health care services that maximize access
to, and coordination of, benefits between the Medi-Cal and
Medicare programs and access to LTSS and behavioral health
services, including mental health and substance use disorder
treatment services. The purpose of the demonstration project
is to integrate services authorized under Medi-Cal and
Medicare.
4)Authorizes DHCS to contract with the federal Centers for
Medicare and Medicaid Services (CMS) and demonstration sites,
which are established in counties, to operate the Medicare and
Medicaid benefits in a demonstration project that is overseen
by the state as a delegated Medicare benefit administrator,
and may enter into financing arrangements with CMS to share in
any Medicare program savings generated by the demonstration
project.
5)Requires demonstration sites to be established in up to eight
counties, as specified, including at least one county that
provides Medi-Cal services using a two-plan model (a model in
which the county has both a county-organized plan and a
commercial plan, both of which contract with DHCS), and one
that provides Medi-Cal services under a county organized
health system, in accordance with existing law.
6)Requires DHCS to enter into a memorandum of understanding
(MOU) with CMS when developing the process for selecting,
financing, monitoring, and evaluating the health care models
for the demonstration project.
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7)Establishes in-home supportive services (IHSS) as a Medi-Cal
managed care plan benefit in counties participating in the
duals demonstration project with a goal of maximizing access
to, and coordination of, long-term services and supports,
including IHSS.
8)Requires all Medi-Cal LTSS to be covered services under
managed care health plan contracts and be available only
through managed care health plans to beneficiaries residing in
CCI counties, except for specified exemptions.
FISCAL EFFECT: According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS:
1)PURPOSE OF THIS BILL. The author asserts that CCI consumers
remain one of the most vulnerable populations in California's
health care system. The author contends the recent
implementation of CCI has generated confusion among
beneficiaries with regard to the enrollment process and the
rights they have under the program. The author references a
guide published by DHCS with a partial list of rights made
available to only an estimated 34% of CCI participants in the
Cal MediConnect program, stating it is incomplete and that a
full list of rights should be made available and distributed
to all CCI consumers, including those qualifying for Medi-Cal
managed LTSS.
The author points to an informational hearing held in August
2014 by the Select Committee on Aging and Long Term Care
entitled "California's Service Delivery System for Older
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Adults: Envisioning the Ideal." The author states that at the
hearing, the SCAN Foundation presented "California in
Comparison to Other States: A Look at the LTSS Scorecard"
which was a framework for assessing LTSS System Performance
among the 50 states and the District of Columbia. One of the
five recommendations in the presentation was for the state to
establish a bill of rights in statute for dually eligible
Californians that outlines the rights of dual eligible
individuals including access to an array of services in an
integrated setting, consumer choice, and empowerment. The
author contends these rights would establish the foundation of
system change efforts, establish accountability for the health
plans, and communicate what people can expect from coordinated
services that are grounded in meeting the needs, desires, and
preferences of consumers.
The author concludes that by requiring a consumer-friendly
informational guide containing specific information on
services and resources for CCI beneficiaries, this bill
increases consumer awareness of the CCI, and places an
emphasis on serving individuals with truly integrated care.
2)BACKGROUND.
a) CCI. In July 2012, California enacted the CCI to better
serve the state's low-income seniors and persons with
disabilities by integrating the delivery of medical,
behavioral, and long-term care services, and providing
protocols to integrate Medicare and Medi-Cal for dually
eligible individuals. Existing law authorizes eight
counties to participate in the CCI, however there are
currently only six counties actively participating: Los
Angeles, Riverside, San Bernardino, San Diego, San Mateo,
and Santa Clara. Participation by Orange County is
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currently pending readiness reviews by DHCS. Although
initially approved to participate, the Medi-Cal manage care
plan in Alameda County opted to withdraw from the
demonstration project.
The CCI is broken into two components, one of which is Cal
MediConnect, a voluntary three-year demonstration program
for Medicare and Medi-Cal dual eligible beneficiaries which
coordinates medical, behavioral health, long-term
institutional, and HCBS through a single health plan. The
CCI provides state authority for Cal MediConnect. As of
May 1, 2015, there were 122,787 active enrollments in Cal
MediConnect. The second component of the CCI is the
Medi-Cal LTSS, which is the integration of HCBS, IHSS,
community-based adult services, multipurpose senior
services program services, and skilled nursing facility
services and subacute care services, as specified. LTSS
does not include any category of intermediate care facility
for the developmentally disabled.
b) Legislative hearing and report. In December 2014, the
Senate Select Committee on Aging and Long Term Care
released a report entitled "A Shattered System: Reforming
Long-Term Care in California: Envisioning and Implementing
an IDEAL Long-Term Care System in California." One of the
recommendations in the report was for the Legislature to
establish a bill of rights for dually eligible
Californians.
3)SUPPORT. The Government Action and Communications Institute
is in support of this bill, stating DHCS currently provides a
partial list of rights to only Cal MediConnect CCI
participants, and contends that DHCS should be required to
inform consumers of their rights, given the extensive nature
of the changes the CCI brings to the health and social
services of hundreds of thousands of Californians. The
American Federation of State, County, and Municipal Employees
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(AFSCME) supports this bill maintaining that improving quality
of care for beneficiaries and maximizing the ability of
beneficiaries to remain safely in their homes and communities
with appropriate services can only be done if Californians who
receive health care services under CCI know and understand
their rights. The United Domestic Workers of America - AFSCME
Local 3930 / AFL-CIO also supports, writing that this bill is
needed to provide CCI consumers with a clear sense of their
rights and to improve access to programs and services.
4)OPPOSITION. The California Association of Health Plans
opposes this bill, stating it is unnecessary because DHCS
currently publishes a guide, the "Cal MediConnect Plan
Guidebook," for CCI beneficiaries and the development of a new
guide is duplicative of current efforts managed by the state.
5)RELATED LEGISLATION.
a) AB 211 (Gomez) disconnects implementation of the
Statewide Authority for collective bargaining within the
IHSS program from the state's CCI and implements it
separately, beginning January 1, 2016. AB 211 is currently
pending in the Senate Human Services Committee.
b) AB 461 (Mullin) authorizes a Medi-Cal beneficiary
receiving services through a regional center or who is
enrolled in a Medi-Cal home- and community-based waiver who
resides in San Mateo County to voluntarily enroll in the
CalMediConnect demonstration project for individuals dually
eligible for Medicare and Medi-Cal under the CCI. AB 461
is currently pending in the Senate Appropriations
Committee.
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6)PREVIOUS LEGISLATION.
a) SB 857 (Committee on Budget and Fiscal Review), Chapter
31, Statutes of 2014, institutes various requirements
regarding contracts and enrollment limitations on dual
eligible special need plans in the context of the CCI.
b) SB 1008 (Committee on Budget and Fiscal Review), Chapter
33, Statutes of 2012, implements the main components of the
CCI, including the criteria for dual demonstration
projects, enrollment for dual beneficiaries into Medi-Cal
managed care, long-term services and supports integration,
readiness requirements, and medical exemption review.
c) SB 1036 (Committee on Budget and Fiscal Review), Chapter
45, Statues of 2012, authorizes other components of the
CCI, includes provisions that require the development and
pilot implementation of a universal assessment tool as well
as data-sharing agreements between managed care plans and
HCBS administrators.
d) SB 208 (Steinberg), Chapter 714, Statutes of 2010,
authorizes a pilot project in up to four counties, to
integrate the full range of Medicare and Medi-Cal services,
including LTSS and behavioral health services for dual
eligible individuals.
7)SUGGESTED AMENDMENT. This bill requires DHCS to develop an
educational and informational guide for the CCI program;
however it is silent as to how often the guide must be
updated. As implementation of the CCI pilot programs continue
to rollout, there may be additional changes to the program
that would be beneficial for CCI beneficiaries to be aware of.
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As such, the Committee may wish to amend this bill to require
DHCS to update the guide on an annual basis, depending on
whether or not there are updates to the program.
REGISTERED SUPPORT / OPPOSITION:
Support
American Federation of State, County and Municipal Employees
(AFSCME)
California Association of Public Authorities for IHSS
Community Clinic Association of Los Angeles
Consumer Federation of California
Government Action and Communication Institute
United Domestic Workers of America - AFSCME Local 3930/ AFL-CIO
Western Center on Law and Poverty
Opposition
California Association of Health Plans
Analysis Prepared by:An-Chi Tsou / HEALTH / (916)
319-2097
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