Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including, among other services, home- and community-based services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

Existing law, until July 1, 2017, requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to establish a stakeholder workgroup, as prescribed, to develop a universal assessment process, including a universal assessment tool, to be used for home- and community-based services. No later than March 1, 2014, existing law requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to report to the Legislature on the stakeholder workgroups progress in developing the universal assessment process and to identify the counties and beneficiary categories for which the universal assessment process may be implemented. No sooner than January 1, 2015, upon completion of the design and development of that universal assessment tool, existing law authorizes managed care health plans, counties, and other home- and community-based services providers to test the use of the tool for certain beneficiaries in no fewer than 2, and no more than 4, specified counties if certain conditions have been met. No later than 9 months after the implementation of the universal assessment process, existing law requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging, to report to the Legislature on the results of the initial use of the universal assessment process.

This bill would extend the operation of these provisions until September 1, 2018. The bill would instead require the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to report to the Legislature on the stakeholder workgroups progress no later than December 1, 2016. The bill would instead require the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to report to the Legislature on the results of the initial use of the universal assessment process no later than 15 months after the implementation of the universal assessment process. The bill would require this report to include, among other things, findings from consumers assessed using the universal assessment tool regarding their satisfaction of the universal assessment process.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including, among other services, home- and community-based services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

Existing law, until July 1, 2017, requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to establish a stakeholder workgroup, as prescribed, to develop a universal assessment process, including a universal assessment tool, to be used for home- and community-based services. No later than March 1, 2014, existing law requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to report to the Legislature on the stakeholder workgroups progress in developing the universal assessment process and to identify the counties and beneficiary categories for which the universal assessment process may be implemented. No sooner than January 1, 2015, upon completion of the design and development of that universal assessment tool, existing law authorizes managed care health plans, counties, and other home- and community-based services providers to test the use of the tool for certain beneficiaries in no fewer than 2, and no more than 4, specified counties if certain conditions have been met. No later than 9 months after the implementation of the universal assessment process, existing law requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging, to report to the Legislature on the results of the initial use of the universal assessment process.

This bill would extend the operation of these provisions until September 1, 2018. The bill would instead require the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to report to the Legislature on the stakeholder workgroups progress no later than December 1, 2016. The bill would instead require the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to report to the Legislature on the results of the initial use of the universal assessment process no later than 15 months after the implementation of the universal assessment process. The bill would require this report to include, among other things, findings from consumers assessed using the universal assessment tool regarding their satisfaction of the universal assessment process.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including, among other services, home- and community-based services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

Existing law, until July 1, 2017, requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to establish a stakeholder workgroup, as prescribed, to develop a universal assessment process, including a universal assessment tool, to be used for home- and community-based services. No later than March 1, 2014, existing law requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to report to the Legislature on the stakeholder workgroups progress in developing the universal assessment process and to identify the counties and beneficiary categories for which the universal assessment process may be implemented. No sooner than January 1, 2015, upon completion of the design and development of that universal assessment tool, existing law authorizes managed care health plans, counties, and other home- and community-based services providers to test the use of the tool for certain beneficiaries in no fewer than 2, and no more than 4, specified counties if certain conditions have been met. No later than 9 months after the implementation of the universal assessment process, existing law requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging, to report to the Legislature on the results of the initial use of the universal assessment process.

This bill would extend the operation of these provisions until December 31, 2017. The bill would also require, on or before January 1, 2017, the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging, in consultation with the stakeholder workgroup described above, to evaluate and report to the Legislature on the outcomes of, and lessons learned from, the universal assessment tool pilot authorized by the provisions described above. September 1, 2018. The bill would instead require the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to report to the Legislature on the stakeholder workgroups progress no later than December 1, 2016. The bill would instead require the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to report to the Legislature on the results of the initial use of the universal assessment process no later than 15 months after the implementation of the universal assessment process. The bill would require the this report to include, among other things, findings from consumers assessed using the universal assessment tool and findings from consumers choosing to be assessed using previous assessment tools. regarding their satisfaction of the universal assessment process.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including, among other services, home- and community-based services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

Existing law, until July 1, 2017, requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to establish a stakeholder workgroup, as prescribed, to develop a universal assessment process, including a universal assessment tool, to be used for home- and community-based services. No sooner than January 1, 2015, upon completion of the design and development of that universal assessment tool, existing law authorizes managed care health plans, counties, and other home- and community-based services providers to test the use of the tool for certain beneficiaries in no fewer than 2, and no more than 4, specified counties if certain conditions have been met.

This bill would extend the operation of these provisions until December 31, 2017. The bill would also require, on or before January 1, 2017, the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging, in consultation with the stakeholder workgroup described above, to evaluate and report to the Legislature on the outcomes of, and lessons learned from, the universal assessment tool pilot authorized by the provisions described above. The bill would require the report to include, among other things, findings from consumers assessed using the universal assessment tool and findings from consumers choosing to be assessed using previous assessment tools.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including, among other services, home- and community-based services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

Existing law, until July 1, 2017, requires the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging to establish a stakeholder workgroup, as prescribed, to develop a universal assessment process, including a universal assessment tool, to be used for home- and community-based services. No sooner than January 1, 2015, upon completion of the design and development of that universal assessment tool, existing law authorizes managed care health plans, counties, and other home- and community-based services providers to test the use of the tool for certain beneficiaries in no fewer than 2, and no more than 4, specified counties if certain conditions have been met.

This bill would require, on or before January 1, 2017, the State Department of Health Care Services, the State Department of Social Services, and the California Department of Aging, in consultation with the stakeholder workgroup described above, to evaluate and report to the Legislature on the outcomes of, and lessons learned from, the universal assessment tool pilot authorized by the provisions described above. The bill would require the report to include, among other things, findings from consumers assessed using the universal assessment tool and findings from consumers choosing to be assessed using previous assessment tools.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 664

Author:(Dodd)

As Amended Ver:August 31, 2015

Majority vote

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 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 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.

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

 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.

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:

1. DHCS has obtained any federal approvals through necessary federal waivers or amendments, or state plan amendments, whichever occurs later;

2. The system used to calculate the results of the tool has been tested; and,

3. 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.

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:
   
   

   1. Findings from consumers assessed using the UAT regarding their satisfaction with both the universal assessment process and the assessor.

2. Analysis of the consumers' ability to follow and accurately respond to all assessment items.

3. 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 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 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.: Yes Local: 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: (Verified 8/28/15)

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: (Verified 8/28/15)

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 ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 664 (Dodd) - Medi-Cal: universal assessment tool report

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on August 27, 2015

Bill Summary:

AB 664 would extend existing provisions of law until September 1, 2018, requiring the Department of Health Care Services and other state agencies to develop a universal assessment tool that could be used to assess the need for home and community based services by seniors and persons with disabilities. The bill would also require the Department to report to the Legislature on the lessons learned from the authorized pilot project using the universal assessment tool.

Fiscal Impact:

• No significant costs are anticipated by extending the statutory sunset on the authority to develop the universal assessment tool and conduct a pilot project using it.

• One-time costs of between $500,000 and $1,000,000 are anticipated for the Department of Health Care Services to conduct an evaluation of the universal assessment tool pilot project (General Fund and federal funds). The Department indicates that it will either conduct the evaluation internally or contract with an independent organization.

Author Amendments:

Delay the sunset on the existing body of 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.

-- END --

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 664 (Dodd) - Medi-Cal: universal assessment tool report

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

AB 664 would extend existing provisions of law until December 31, 2017, requiring the Department of Health Care Services and other state agencies to develop a universal assessment tool that could be used to assess the need for home and community based services by seniors and persons with disabilities. The bill would also require the Department to report to the Legislature on the lessons learned from the authorized pilot project using the universal assessment tool.

Fiscal Impact:

• No significant costs are anticipated by extending the statutory sunset on the authority to develop the universal assessment tool and conduct a pilot project using it.

• One-time costs of between $500,000 and $1,000,000 are anticipated for the Department of Health Care Services to conduct an evaluation of the universal assessment tool pilot project (General Fund and federal funds). The Department indicates that it will either conduct the evaluation internally or contract with an independent organization.

Background:

Under state and federal law, the Department of Health Care Services operates the Medi-Cal program, which provides health care coverage to low income individuals, families, and children. Medi-Cal provides coverage to childless adults and parents with household incomes up to 138% of the federal poverty level and to children with household incomes up to 266% of the federal poverty level. The federal government provides matching funds that vary from 50% to 90% of expenditures depending on the category of beneficiary.

As part of the Medi-Cal program, the state offers home and community based services to seniors and persons with disabilities, with the intent of using less costly services provided in the community to avoid more costly institutional care. Home and community based services offered in the state include In-Home Supportive Services (IHSS), Multipurpose Senior Services Program (MSSP), and Community-Based Adult Services (CBAS). In order for a Medi-Cal beneficiary to qualify for home and community based services, their needs must be assessed. Historically, each of the home and community based services programs has used a separate assessment tool to determine what services and how many hours of services an individual needs to remain in the community. The process of conducting an assessment is usually done in person and takes considerable time. Having each of the programs use separate assessments, even though an individual may qualify for more than one of the programs, is administratively inefficient and burdensome to beneficiaries.

As part of the 2012 Budget Act, the Legislature approved the development of the Coordinated Care Initiative, which seeks to combine Medi-Cal, Medicare, and long-term services and supports (such as IHSS) into a single managed care benefit for seniors and persons with disabilities. As part of the authorization of the Coordinated Care Initiative, the Legislature directed the Department of Health Care Services, the Department of Social Services, and the Department of Aging to work with stakeholders to develop a universal assessment tool for determining a beneficiary’s need for home and community based services. Current law authorizes the Department of Health Care Services to conduct a pilot project using the newly developed universal assessment tool in two to four counties in which the Coordinated Care Initiative is being implemented. Current law sunsets the authority to develop and pilot the universal assessment tool on July 1, 2017.

The departments are currently in the process of developing the universal assessment tool and the pilot project has not yet begun.

Proposed Law:

AB 664 would extend existing provisions of law until December 31, 2017, requiring the Department of Health Care Services and other state agencies to develop a universal assessment tool that could be used to assess the need for home and community based services by seniors and persons with disabilities.

The bill would also require the Department to report to the Legislature on the lessons learned from the authorized pilot project using the universal assessment tool. The report on the outcomes and lessons learned would be due to the Legislature by January 1, 2017.

Staff Comments:

The universal assessment tool has not been developed (although the departments have developed an early draft tool). According to the departments, actual implementation of the pilot project is not expected to occur until July 2016. It does not seem likely that the pilot project could take place and a meaningful evaluation of the results of that pilot be completed by January 1, 2017.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: AB 664

SUBJECT: Medi-Cal: universal assessment tool report.

SUMMARY:

1. Extends by six months, from July 1, 2017 to December 31, 2017, 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. Requires, on or before January 1, 2017, DHCS, DSS, and CDA to evaluate and report to the Legislature on the outcomes of, and lessons learned from, the UAT pilot authorized, and would require the report to include, among other things, findings from consumers assessed using the UAT and findings from consumers choosing to be assessed using previous assessment tools.

Existing law:

1. States legislative intent that a universal assessment process for long-term services and supports (LTSS) be developed and tested.

2. 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).

3. Requires the stakeholder workgroup to include, but not be limited to, consumers of In-Home Supportive Services (IHSS), and other HCBS and their authorized representatives, managed care health plans, counties, Multipurpose Senior Services Program (MSSP) providers, Community-Based Adult Services (CBAS) providers, area agencies on aging, independent living centers, and legislative staff.
   

4. Requires the universal assessment process to be used for all HCBS, including IHSS. Requires the workgroup, in developing the process, to build upon the IHSS uniform assessment process and hourly task guidelines, the MSSP assessment process, and other appropriate home- and community-based assessment tools.

5. 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.

6. 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

7. 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:

1. DHCS has obtained any federal approvals through necessary federal waivers or amendments, or state plan amendments, whichever occurs later;

2. The system used to calculate the results of the tool has been tested; and,

3. Any entity responsible for using the tool has been trained in its usage.

8. 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.

9. Requires, to the extent the UAT or universal assessment process results in changes to the authorization process and provision of IHSS services, those changes to be automated in the Case Management Information and Payroll System.

10. Requires DHCS to develop materials to inform consumers of the option to participate in the UAT testing phase.

11. 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.

12. 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.

13. 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.

14. Sunsets the above-described provisions on July 1, 2017.

This bill:

1. Extends, from July 1, 2017 to December 31, 2017 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. Requires, on or before January 1, 2017, DHCS, DSS, and CDA, in consultation with the existing workgroup, to evaluate and report to the Legislature on the outcomes of, and lessons learned from, the UAT pilot. Requires the report, at a minimum, to include all of the following:
   
   

1. Findings from consumers assessed using the UAT. Requires interviews with consumers who chose to be assessed using the UAT to be conducted to evaluate all of the following:
   
   

   1. The level of satisfaction consumers experienced with the UAT as compared to the previous assessment approach;

   2. The level of satisfaction consumers experienced with the assessor from either the county or the managed care plan;

   3. The ability of consumers to understand and respond to the assessor administering the UAT for the duration of the assessment; and,

   4. Any challenges experienced by consumers during the administration of the UAT.
      
      

2. Findings from consumers choosing to be assessed using previous assessment tools. Requires interviews with consumers who chose to be assessed using previous assessment tools shall be conducted to evaluate both of the following:
   
   

   1. Reasons why the consumer chose to be assessed using the previous assessment tools; and,

   2. Concerns the consumer may have had with the UAT determining the services to be provided.
      
      

3. Data on 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, in order to better understand any discrepancies that may exist between the assessment approaches.
   
   

4. Data on HCBS utilization and costs of consumers before and after the use of the UAT, in order to better understand how the UAT may impact the HCBS system.
   
   

5. Data on the percentage of consumers who experience hospitalizations and skilled nursing facility stays over a specific time period before and after the use of the UAT, in order to better understand how the UAT may impact acute care utilization.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, costs in the low hundreds of thousands of dollars to DHCS (50% GF/50% federal).

PRIOR VOTES:

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 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 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, 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 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.

4. 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.

5. Policy issues.

1. Bill and current statute afford little time for UAT pilot implementation and evaluation. The most recent amendments to this bill extend the duration of the universal assessment provisions of law by an additional six months, to December 31, 2017. However, given that implementation of the UAT pilot may not commence until July 2016, there will be little time for evaluation prior to the statute sunset date.

2. Existing reporting requirements. Existing law requires a report by March 1, 2014 by DHCS, DSS and CDA on the stakeholder workgroup’s progress in developing the universal assessment process, and which identifies the counties and beneficiary categories for which the universal assessment process may be implemented. A second report is required nine months after the implementation of the universal assessment process on the results of the initial use of the universal assessment process. Finally, existing law requires these departments to report annually thereafter to the Legislature after the second report on the status and results of the universal assessment process. In discussions with department staff, one of the issues raised is whether the information sought in the report required by this bill is in a separate report from those that are currently required.

SUPPORT AND OPPOSITION:

Support: American Federation of State, County and Municipal Employees

California Alliance for Retired Americans

California Senior Legislature

LeadingAge California

Oppose: None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 664

Author:(Dodd)

As Introduced Ver:February 24, 2015

Majority vote

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 (SNF) stays.

FISCAL EFFECT: According to the Assembly Appropriations Committee, this bill would result in costs in the low hundreds of thousands of dollars to DHCS (50% General Fund/50% federal).

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.

Background. 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 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.

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: 0000777

Date of Hearing: April 29, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

ABPCA Bill Id:AB 664

Author:(Dodd) – As Introduced Ver:February 24, 2015

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires a formal evaluation of a currently authorized Medi-Cal pilot project that is testing a "universal assessment tool" for standardized assessment of an individual's needs for long-term supports and services.

FISCAL EFFECT:

Costs in the low hundreds of thousands of dollars to the Department of Health Care Services (DHCS) (50% GF/50% federal).

COMMENTS:

1. Purpose. California has an array of programs and services for individuals who are aged or disabled. The programs are located in multiple agencies, use different delivery systems and challenge consumers seeking to access services. Universal assessment offers a single uniform process to connect services and corresponding data elements about service needs and preferences, while evaluating an individual consumer’s needs in a consistent manner. This bill implements a recent recommendation of the Legislative Analyst's Office to require a formal evaluation of a current pilot related to universal assessment.

2. Background. In 2012, the Legislature recognized that competing eligibility determination and assessment processes create several forms of inefficiency in the administration of these programs, which include In-Home Supportive Services, Community-Based Adult Services, and Multipurpose Senior Services Program services. The Universal Assessment Tool (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. The intention is to shift the existing home and community-based services framework from a “program-based” approach to a “person-centered” approach.

3. Prior Legislation. SB 1036 (Chapter 45, Statues of 2012) a trailer bill of the Budget Act of 2012, related to Human Services, required the development and implementation of a UAT pilot.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 7, 2015

ASSEMBLY COMMITTEE ON HEALTH

Rob Bonta, Chair

ABPCA Bill Id:AB 664

Author:(Dodd) – As Introduced Ver:February 24, 2015

SUBJECT: Medi-Cal: universal assessment tool report.

SUMMARY: Requires the Department of Health Care Services (DHCS), Department of Social Services (DSS), and the California Department of Aging (CDA) to evaluate and report to the Legislature on the outcomes of, and lessons learned from, the Medi-Cal universal assessment tool report (UAT) pilot. Specifically, this bill:

1. Requires, on or before January 1, 2017, that DHCS, DSS, and CDA, in consultation with the stakeholder workgroup established to develop the UAT, evaluate and report to the Legislature on the outcomes of, and lessons learned from, the UAT pilot.
   
   
   

2. Requires the UAT report to include:
   
   
   

   1. Findings from consumers assessed using the UAT, and from consumers choosing to be assessed using previous assessment tools. Specifies that interviews with consumers to evaluate various items including satisfaction or challenges with the administration of the UAT and concerns with how the UAT determines the services to be provided.
      
      
      

   2. 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.
      
      
      

   3. Data regarding home and community based services (HCBS) utilization and costs before and after the use of the UAT and the percentage of consumers who experience hospitalization and skilled nursing facility (SNF) stays before and after the use of the UAT.

EXISTING LAW:

1. Establishes the Medi-Cal program, under which qualified low-income individuals receive health care services, including HCBS.

2. Establishes, in eight counties throughout the state, the Coordinated Care Initiative (CCI), which is designed to integrate, as managed care plan benefits, medical care and long-term services and supports (LTSS) for individuals dually eligible for Medicare and Medi-Cal (dual eligibles) and seniors and persons with disabilities (SPDs) enrolled in Medi-Cal only.

3. Requires DHCS, DSS, and CDA, in consultation with a stakeholder workgroup, as specified, to develop a universal assessment process, including the development of a UAT for specified HCBS, in order to inform the universal assessment process and facilitate the development of plans of care based on the individual needs of the consumer.

4. Authorizes, no sooner than January 1, 2015, and upon completion of various conditions including federal approval, for managed health care plans, counties, and other HCBS providers to test the UAT for a specific and limited number of beneficiaries who receive or are potentially eligible to receive HCBS.

5. Authorizes the testing of the UAT in no fewer than two, but no more than four counties. Requires DHCS, DSS, and CDA, to, no later than March 1, 2014, report to the Legislature on the counties and beneficiary categories for which the universal assessment tool may be implemented.

6. Requires DHCS, DSS, and CDA to, no later than nine months following the implementation of the universal assessment process, report to the Legislature on the results of the initial use of the process, and authorizes the departments to propose additional beneficiary categories or counties for expanded use of the process.

7. Sets a July 1, 2017 sunset date for universal assessment provisions.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, California provides HCBS to low-income 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.
   
   

2. BACKGROUND.

1. HCBS programs. According to the Legislative Analyst’s Office (LAO), approximately 1.9 million SPDs are enrolled in Medi-Cal, which provides LTSS to beneficiaries who meet certain eligibility requirements. LTSS are mainly comprised of HCBS provided in a client’s home or community, or institutional care provided in a facility. 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. The table¹ below briefly describes each program, as well as the respective populations served and current assessment process.

HCBS Program	Population Served	Assessment Process
IHSS Provides in-home personal care and domestic services to individuals to help them remain safely in their own homes and communities.	Individuals aged 65 and older, blind, or disabled.	In-home assessment conducted by a county social worker using a statewide standardized assessment to determine the number of service hours to be provided to each consumer.
CBAS Outpatient facility-based program that provides services to program participants by a multidisciplinary staff including nurses, therapists, social workers, and CBAS center directors.	Adults with chronic medical, cognitive, or mental health conditions and/or disabilities who are at risk of needing institutional care.	Eligibility determination conducted by a Medi-Cal managed care plan (or by a nurse if CBAS is provide on a fee-for-service (FFS) basis), which is followed by a multidisciplinary team assessment and individual plan of care developed by the CBAS multidisciplinary staff and approved by the managed care plan (or Medi-Cal field office for FFS applicants).
MSSP Provides social and health case management services.	Adults age 65 and older who are eligible for SNF placement.	An MSSP nurse and social worker conduct an initial health and psychosocial assessment, respectively, to determine eligibility and needs for case management services.

According to the LAO, while the vast majority of HCBS recipients statewide receive only IHSS, approximately 28,000 of these recipients require services from more than one HCBS program. As demonstrated in the table above, each of the three HCBS program requires its own assessment to determine the amount and type of services a client is authorized to receive from a particular program, thus requiring individuals needing services from more than one program to undergo separate assessments for each. Additionally, each program collects much of the same information during its respective assessment. For example, IHSS, CBAS, and MSSP each collect biographical information, medical diagnoses, medications taken, determination of functional needs, and alternative resources of other HCBS received. IHSS and MSSP each collect information about cognitive impairment on their respective assessments. CBAS and MSSP separately collect information about bodily systems review and medication management.

2. CCI and the UAT. The 2012 State Budget authorized the CCI with the goal of promoting the coordination of health, behavioral health and social services for certain Medi-Cal beneficiaries. The CCI is currently being implemented in seven California counties, and has the following three major components:

1. Cal MediConnect Program: a three-year demonstration project for dual eligible to receive coordinated medical, behavioral, health, long-term institutional, and HCBS through a single managed care plan;

2. Mandatory enrollment of dual eligibles and Medi-Cal only SPDs into Medi-Cal managed care; and,

3. Managed Long-Term Supports and Services (MLTSS): Integration of nursing facility care, IHSS, CBAS, and MSSP as managed care benefits. MLTSS is intended to create fiscal incentives for delivering care to beneficiaries at lower cost in the home and community as compared to services provided in an institution such as a SNF.
   
   

The CCI requires managed care plans to conduct a brief health risk assessment either in person, by telephone, or by mail for all new beneficiaries, and use historical health utilization data to identify SPDs enrolled in the plan who likely have a higher-risk of experiencing an adverse health outcome or decline in health or functional status. If a beneficiary is found to be at higher-risk, the managed care plan is required to develop a care plan that coordinates programs and services delivered by other entities, such as county welfare departments for IHSS.

Under the CCI, HCBS administrators are required to share data with managed care plans, but 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. DSS shares IHSS data with managed care plans in CCI counties, and CBAS centers submit individual plans of care to managed care plans. According to the LAO, managed care plans have entered into agreements with MSSP providers to define roles and responsibilities and establish policies and procedures for sharing information and coordinating care.

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.

3. Status of UAT development. Pursuant to the CCI, DHCS, DSS, and CDA are required to work with stakeholders representing HCBS consumers, HCBS providers, managed care plans, counties, area agencies on aging, independent living centers, and legislative staff 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.
   
   Stakeholder engagement on the development of a universal assessment process began in 2013 and is ongoing. To date, no counties have been selected to pilot the UAT, and in order to accommodate time for additional stakeholder engagement, research, pre-pilot testing, pilot county selection, and other action items necessary prior to the launch of the UAT pilot, it is currently estimated that the pilot will begin July 2016.

3. 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.

3. PREVIOUS LEGISLATION.

SB 1008 (Committee on Budget and Fiscal Review), Chapter 33, Statutes of 2012, established the main components of the CCI, including the provisions for the Cal MediConnect Program, mandatory Medi-Cal managed care for SPDs, and MLTSS.

1. SB 1036 (Committee on Budget and Fiscal Review), Chapter 45, Statutes of 2012, legislation authorizing other components of the CCI, includes provisions that require the development and pilot implementation of the UAT as well as data-sharing agreements between managed care plans and HCBS administrators.

5. Policy Comment. Bill and current statute afford little time for UAT pilot evaluation. This bill would require a report to the Legislature on the UAT pilot on or before January 1, 2017. However, given that implementation of the UAT pilot may not commence until July 2016, there will be little time for evaluation prior to the reporting deadline. Also, given that existing law sets forth a July 1, 2017 sunset of existing universal assessment provisions, there is not much room to adjust the timeline for a UAT report. Successful implementation of the UAT pilot report required under this bill will require strict adherence to the proposed timelines for launching the UAT pilot itself.

REGISTERED SUPPORT / OPPOSITION:

Support

American Federation of State, County, and Municipal Employees, AFL-CIO

United Domestic Workers of America/AFSCME Local 3930

Opposition

None on file.

Analysis Prepared by: Kelly Green / HEALTH / (916) 319-2097