BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 1503|
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THIRD READING
Bill No: SB 1503
Author: Steinberg (D), et al.
Amended: 4/9/12
Vote: 21
SENATE HEALTH COMMITTEE : 6-3, 4/25/12
AYES: Hernandez, Alquist, De Le�n, DeSaulnier, Rubio, Wolk
NOES: Harman, Anderson, Blakeslee
SENATE APPROPRIATIONS COMMITTEE : 5-2, 5/7/12
AYES: Kehoe, Alquist, Lieu, Price, Steinberg
NOES: Walters, Dutton
SUBJECT : In-Home Supportive Services program
SOURCE : California United Homecare Workers
SEIU California
United Domestic Workers/AFSCME Local 3930
DIGEST : This bill requires the Director of the
Department of Social Services (DSS) and the Director of the
Department of Health Care Services (DHCS) to convene a
stakeholder group to design a plan for the integration of
long-term services and supports (LTSS) programs, and
requires the plan to include specified components.
ANALYSIS :
Existing law:
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1. Establishes the county-administered In-Home Supportive
Services (IHSS) program, under which qualified aged,
blind, and disabled persons are provided with services
to permit them to remain in their own homes and avoid
institutionalization.
2. Establishes a list of covered benefits under the
Medi-Cal program, which includes hospital services,
prescription drugs, physician services, skilled nursing
facility (SNF) care, and personal care services.
3. Requires DHCS to seek federal approval to establish a
pilot program in up to four counties for Medi-Cal
beneficiaries who are dually eligible for Medicare and
Medi-Cal, under which DHCS can require that dual
eligibles are assigned as mandatory enrollees into
Medi-Cal managed care plans.
This bill:
1. Requires the Director of DSS and the Director of DHCS to
convene a stakeholder group to design a plan for the
integration of programs, and requires the plan to
include specified components.
2. Requires, prior to development of the plan, a process
for receiving and including consumer input to be
established. Requires the plan to do at least all of
the following:
A. Build incentives into the health care delivery
system so that home- and community-based services
become the first option for long-term care, and
specify that the purpose of these incentives is to
ensure that a person who is able to receive long-term
care at home receives it;
B. Adopt coordinated care models that integrate IHSS
and other LTSS programs, including SNF, to ensure
that consumer needs are met across the entire
spectrum of care;
C. Specify that the overall intent of this
integration is to improve consumer health and
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well-being, and to maximize the cost-effectiveness of
health care delivery to consumers;
D. Maintain the key social model components of the
IHSS program and refocus the health care delivery
system to include the social model as a primary
component of coordinated care delivery;
E. Maintain a consumer's right to hire, fire, and
supervise his or her home care provider or providers
to the extent the consumer is able;
F. Require that consumers who elect to be a part of
an integrated care plan are authorized to participate
on their own health care teams, and to be able to
allow their home care providers to also be a part of
their health care teams;
G. Ensure that home care providers have the tools
they need to help consumers manage chronic conditions
and prevent additional health care needs, including
access to adequate training based on the wants and
needs of the consumer; and
H. Specify that county social workers continue to
assess and reassess consumers to determine their care
needs and the number of care hours they receive.
Comments
Governor's budget proposal . The Governor's 2012-13 Budget
proposes a Coordinated Care Initiative phased in over three
years with the goal of improving beneficiary health
outcomes and care quality while achieving substantial
savings from the rebalancing of care delivery away from
institutional settings and into people's homes and
communities. The proposal consists of three major
components: an expansion of mandatory enrollment of dual
eligibles into Medi-Cal managed care; an expansion of
geographic regions covered by Medi-Cal managed care, and an
expansion of the scope of services covered within a
Medi-Cal managed care plan (instead of fee-for-service
�FFS]).
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First, the Governor's Administration proposal would expand
the existing four-county, dual-eligible demonstration
project to up to 10 counties in 2013, by an additional 20
counties in 2014, and statewide in 2015. Under these
pilots, dual-eligible individuals would be required to
enroll in a Medi-Cal managed care plan for Medi-Cal
services (instead of receiving services through FFS
Medi-Cal), and would be passively enrolled for Medicare
services (meaning individuals could "opt out" of managed
care for Medicare services). Second, the proposal requires
LTSS programs (including IHSS) to be provided through
managed care plans, instead of through FFS. Third, the
proposal requires the geographic expansion of the mandatory
enrollment of individuals into Medi-Cal managed care in the
28 counties that are still currently FFS.
This bill addresses the integration of LTSS programs into
Medi-Cal managed care. Major LTSS programs that are part
of Medi-Cal include IHSS, the Multi-Purpose Senior Services
Program, Community-Based Adult Services (Community-Based
Adult Services will be taking the place of the Adult Day
Health Care Program), and SNFs. LTSS programs are
generally provided through Medi-Cal FFS, while medical
services, such as hospital and physician services, are
provided through Medicare or Medi-Cal managed care.
One of the major LTSS programs is the IHSS program, which
provides in-home care for persons who cannot safely remain
in their own homes without such assistance. Under the IHSS
program, approximately 365,000 in-home care workers provide
care to approximately 445,000 recipients. In order to
qualify for IHSS, a recipient must be aged, blind, or
disabled and in most cases have income below the level
necessary to qualify for the Supplemental Security
Income/State Supplementary Program. County social workers
perform an assessment to determine the number of hours and
types of service to authorize an IHSS recipient to receive
each month. Recipients are eligible to receive up to 283
hours per month of assistance with tasks such as bathing,
housework, feeding, and dressing. The recipient is
responsible for hiring and supervising a provider. IHSS is
administered by DSS at the state level.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
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Local: No
According to the Senate Appropriations Committee,
"Absorbable costs to convene the stakeholder group and
develop plans. The two departments have already initiated
an extensive stakeholder group to consider issues relating
to the integration of LTSS pursuant to the dual-eligible
demonstration project. The requirements of this bill
should be absorbable within those efforts."
SUPPORT : (Verified 5/8/12)
California United Homecare Workers (co-source)
SEIU California (co-source)
United Domestic Workers/AFSCME Local 3930 (co-source)
ARGUMENTS IN SUPPORT : This bill is jointly sponsored by
United Domestic Workers/AFSCME Local 3930 (UDW/AFSCME),
California United Homecare Workers and SEIU. UDW/AFSCME
writes that this bill protects the IHSS benefit as an
entitlement and its key social model components while
providing fiscal incentives for home and community-based
care over more costly and less desirable institutional
care, while ensuring that home care providers have the
appropriate tools and training necessary to care for
California's most vulnerable population.
UDW/AFSCME states California's current system for
delivering medical care and LTSS programs, including IHSS,
to seniors and people with disabilities is fragmented. A
lack of care coordination and misaligned financial
incentives often result in high rates of avoidable
hospitalization and institutionalization, hard to navigate
bureaucratic structures, and escalating costs. UDW/AFSCME
states there is a clear need to reduce fragmentation,
increase access to necessary services, and create financial
incentives that promote and prioritize home and
community-based care. This bill aims to address these
issues by integrating IHSS and other LTSS programs,
including SNF care, into a coordinated care model that
ensures that consumer needs are met across the entire
spectrum of care.
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CTW:kc 5/9/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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