BILL ANALYSIS �
SENATE COMMITTEE ON BUDGET AND FISCAL REVIEW
Mark Leno, Chair
Bill No: AB 1496
Author: Committee on Budget
As Amended: June 25, 2012
Consultant: Jennifer Troia
Fiscal: Yes
Hearing Date: June 26, 2012
Subject: Budget Act of 2012: Coordinated Care Initiative:
Human Services
Summary: Contains necessary statutory and technical
changes to implement the human services provisions related
to the Integration of Home and Community Based and
Long-Term Care Services, including In-Home Supportive
Services (IHSS), into Medi-Cal Managed Care, as specified,
in the Budget Act of 2012.
Background: IHSS is a county-administered program through
which low-income individuals who are aged, blind, or
disabled can receive personal care and domestic services
that allow them to remain safely in their own homes and
avoid institutionalization. IHSS services include tasks
like feeding, bathing, bowel and bladder care, meal
preparation and clean-up, laundry, and paramedical care.
These services frequently help program recipients to avoid
or delay more expensive and less desirable institutional
care settings. There are currently around 440,000
recipients of IHSS statewide, and as of the end of 2011,
there were approximately 366,000 IHSS providers.
County social workers currently determine eligibility for
IHSS after conducting a standardized in-home assessment,
and periodic reassessments, of an individual's ability to
perform specified activities of daily living. Once
eligible, recipients are responsible for hiring, firing,
directing and supervising their own IHSS provider or
providers. The counties or public authorities must conduct
a criminal background check and provide an orientation
before a provider can receive payment. Local public
authorities are designated as "employers of record" for
collective bargaining purposes, while the state administers
-1-
payroll, workers' compensation, and benefits. In
approximately 72 percent of cases, IHSS recipients choose a
family member to provide care (including roughly 45 percent
of providers who are a spouse, child, or parent of the
recipient). IHSS is funded with federal, state, and county
resources. The state and counties split the non-federal
share of IHSS funding at 65 and 35 percent, respectively.
The average annual cost of services per IHSS client is
estimated at $11,420 for 2012-13.
Proposed Law
This bill would make the following changes, as specified:
No sooner than March 1, 2013, establishes IHSS as a
Medi-Cal Managed Care plan benefit in counties
participating in the Duals Demonstration Project (as
specified in another budget trailer bill contained in
AB 1468/SB 1008) with a goal of maximizing access to,
and coordination of, long-term services and supports,
including IHSS.
Protects the rights of IHSS recipients to hire,
fire, direct, schedule and supervise their own IHSS
provider(s) and control their own care in accordance
with existing law.
Authorizes the creation of care coordination teams,
with a recipient's consent, to coordinate individual
care plan development.
Makes the Individual Provider mode of delivering
IHSS accessible to consumers in all managed care
health plans in each participating county.
Requires the Department of Social Services (DSS)
and the Department of Health Care Services (DHCS), in
consultation with IHSS recipients and other
stakeholders, to develop a voluntary training
curriculum for IHSS providers, while maintaining the
recipients' rights to train their own providers.
Authorizes DHCS, DSS, and the Department of Aging
to establish a stakeholder workgroup to develop a
-2-
universal assessment process for specified home- and
community-based services, including IHSS. Further,
allows health plans and providers to test the use of
this tool in two to four counties, no sooner than
January 1, 2015.
Establishes a required county Maintenance of Effort
(MOE) level of funding for IHSS, with specified
adjustments in future years, in order to stabilize the
county share of cost for the program.
Requires managed care plans to enter into
Memorandums of Understanding (MOUs) with counties so
that counties can continue their current functions
with respect to eligibility assessments and final
determinations of authorized IHSS hours, while also
allowing health plans to authorize additional home-
and community-based services hours.
Allows counties to continue to contract with
non-profit consortiums and local public authorities to
carry out current IHSS operations and functions,
including the provision of training to IHSS providers
and of registry services to assist consumers in
finding providers.
As IHSS comes on-line as a managed care benefit,
establishes an IHSS Statewide Authority for purposes
of collective bargaining.
Gives discretion to the Director of the Department
of Health Care Services to make these provisions
inoperative based on specified criteria.
Makes the provisions of this bill contingent on
enactment of AB 1468 (SB 1008), the health budget
trailer bill that proposes to implement the Duals
Demonstration Project through Coordinated Care.
Support: Unknown
Opposed: Unknown
-3-
-4-