Existing law establishes the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons are provided with services in order to permit them to remain in their own homes and avoid institutionalization. Existing law establishes 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. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

Existing law provides, as part of the Coordinated Care Initiative, that not sooner than March 1, 2013, all Medi-Cal long-term services and supports, including IHSS, are required to be services that are covered under managed care health plan contracts and to be available only through managed care health plans to beneficiaries residing in Coordinated Care Initiative counties, except for the provided exemptions. Existing law allows managed care health plans to authorize personal care services and related domestic services in addition to the hours authorized for IHSS by existing law. Existing law requires the managed care health plans to be responsible for paying for these services at no share of cost to the county.

This bill would require the State Department of Social Services to program its Case Management Information and Payroll System to be able to receive payments from managed care health plans for these personal care service and related domestic service hours, to issue a payroll check to providers of personal care service hours and related domestic service hours, which shall not include payment of wages for service hours provided pursuant to other specified provisions, and to track and differentiate between the two types of authorized hours.

Existing law establishes the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons are provided with services in order to permit them to remain in their own homes and avoid institutionalization. Existing law establishes 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. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

Existing law provides, as part of the Coordinated Care Initiative, that not sooner than March 1, 2013, all Medi-Cal long-term services and supports, including IHSS, are required to be services that are covered under managed care health plan contracts and to be available only through managed care health plans to beneficiaries residing in Coordinated Care Initiative counties, except for the provided exemptions. Existing law allows managed care health plans to authorize personal care services and related domestic services in addition to the hours authorized for IHSS by existing law. Existing law requires the managed care health plans to be responsible for paying for these services at no share of cost to the county.

This bill would require the State Department of Social Services to program its Case Management Information and Payroll System to be able to receive payments from managed care health plans for these additional personal care service and related domestic service hours, to issue a single payroll check to providers, providers of personal care service hours and related domestic service hours, which shall not include payment of wages for service hours provided pursuant to other specified provisions, and to track and differentiate between the two types of authorized hours.

Existing law establishes the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons are provided with services in order to permit them to remain in their own homes and avoid institutionalization. Existing law establishes 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. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

Existing law provides, as part of the Coordinated Care Initiative, that not sooner than March 1, 2013, all Medi-Cal long-term services and supports, including IHSS, are required to be services that are covered under managed care health plan contracts and to be available only through managed care health plans to beneficiaries residing in Coordinated Care Initiative counties, except for the provided exemptions. Existing law allows managed care health plans to authorize personal care services and related domestic services in addition to the hours authorized for IHSS by existing law. Existing law requires the managed care health plans to be responsible for paying for these services at no share of cost to the county.

Existing law establishes the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons are provided with services in order to permit them to remain in their own homes and avoid institutionalization. Existing law establishes 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. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

Existing law provides, as part of the Coordinated Care Initiative, that not sooner than March 1, 2013, all Medi-Cal long-term services and supports, including IHSS, are required to be services that are covered under managed care health plan contracts and to be available only through managed care health plans to beneficiaries residing in Coordinated Care Initiative counties, except for the provided exemptions.

This bill would declare the intent of the Legislature to enact legislation to create a mechanism to pay In-Home Supportive Services program providers for additional hours worked through the Coordinated Care Initiative.

GOVERNOR'S VETO

GV Bill Id:AB 97

Author:(Weber)

As Enrolled Ver:September 8, 2015

2/3 vote

Original Committee Reference: HUM. S.

SUMMARY: Requires reprogramming of the Case Management Information and Payrolling System (CMIPS II) for In-Home Supportive Services (IHSS) to enable IHSS recipients in Coordinated Care Initiative (CCI) counties to receive additional services authorized and paid for by managed care health plans. Specifically, this bill:

1. Requires CMIPS II, the IHSS payrolling system, to be programmed to do all of the following to ensure managed care health plans are able to pay a provider for personal care services and related domestic services that the plan authorizes in addition to the IHSS hours already authorized for a recipient in a CCI county:

1. Receive payments from managed care health plans for the additional hours of service;

2. Issue a payroll check to providers of personal care service hours and related domestic service hours authorized by a managed care health plan, which shall not include payment of wages for IHSS, as specified; and

3. Track and differentiate between IHSS hours and the hours authorized by the managed care health plan and to enable managed care health plans to track the recipient impact of the additional benefits.

The Senate amendments:

1. Ensure separation and distinct consideration of hours of service authorized by a managed care health plan and IHSS hours, as specified.

2. Simplify implementation of this bill through reprogramming CMIPS II by eliminating the requirement that IHSS hours of service provided and hours authorized by a managed care health plan be combined on a single payroll check.

EXISTING LAW:

1. Establishes the IHSS program as a benefit available to Medi-Cal beneficiaries that provides in-home care and supportive services to low-income aged, blind, or disabled persons who are unable to provide or care for themselves and who cannot live safely in their homes without assistance. Defines supportive services within the program to include domestic services, personal care services, protective supervision, paramedical services, and other services, as specified. (Welfare and Institutions Code (WIC) Section 12300 et seq.)

2. Requires the Department of Social Services (DSS) to procure and implement a new automated Case Management Information and Payroll System (CMIPS) for the IHSS and Personal Care Services Program. Requires the system to incorporate technology that can be readily enhanced and modernized, and employ open architecture and standards, to the extent possible. (WIC Section 12317)

3. Establishes the CCI demonstration project in up to eight counties, subject to federal approval, 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 for those individuals, as specified. (SB 1008 (Budget and Fiscal Review Committee), Chapter 33, Statutes of 2012, and SB 1036 (Budget and Fiscal Review Committee), Chapter 45, Statutes of 2012)

4. Requires, as an additional component of the CCI, that all Medi-Cal long-term services and supports, which include IHSS, be services that are covered under managed care health plan contracts and available only through managed care health plans for beneficiaries residing in counties participating in the CCI demonstration project, with specified exceptions. (WIC Section 14186 et seq.)

5. Expresses the intent of the Legislature that managed care health plans be allowed to authorize and pay for personal care services and related domestic services that are provided in addition to the IHSS hours already authorized for a recipient in a CCI demonstration county, at no cost to the county. Requires the Department of Health Care Services, in consultation with the DSS to develop policies and procedures for these additional benefits authorized and paid for by health plans. (WIC Section 14186 (b)(6)(B))

FISCAL EFFECT: According to the Senate Appropriations Committee, this bill may have the following fiscal impact:

1. One-time costs of $6 million ($3 million General Fund) for reprogramming of CMIPS II and ongoing costs of $1 million ($0.5 million General Fund).

2. Potential increase in county administrative costs (Federal Fund/General Fund) to enter data from two payroll systems into the CMIPS II database in order to differentiate between authorized hours for IHSS and by managed health care plans.

COMMENTS:

IHSS: The IHSS program provides personal care and domestic services to approximately 420,000 qualified, low-income individuals who are aged, blind, or disabled. Through the IHSS program, recipients are cared for and assisted with activities of daily living, allowing them to remain safely in their own homes and avoid institutionalization. IHSS services include: paramedical services, such as giving medications and changing a colostomy bag; non-medical personal care services, such as toileting, dressing, and transportation; domestic services, such as housework, shopping for groceries and meal preparation; and, protective supervision for those who, due to cognitive decline or dementia, cannot be left alone for extended periods.

County social workers determine eligibility for IHSS and the authorized hours of care 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. Prior to receiving payment for services, providers must submit to a criminal background check and a provider orientation. IHSS is funded with federal, state, and county resources.

CCI: The Budget Act of 2012 enacted the CCI, one component of which is a framework for integrating the delivery of medical, behavioral and long-term care services through a single health plan for persons eligible for both Medicare and Medi-Cal. This demonstration project component of the CCI, also known as Cal MediConnect, was originally limited to the following eight counties: Alameda, Los Angeles, Orange, San Diego, San Mateo, Riverside, San Bernardino, and Santa Clara, in which approximately 65% of IHSS recipients reside. Alameda County withdrew from the CCI demonstration in 2014.

While CCI-related code sections clearly maintain county responsibility for assessing and reassessing IHSS recipients and determining a recipient’s authorized number of hours, they also spell out the role of the managed care health plans in coordinating services for individuals receiving long-term services and supports (LTSS) and implementing best practices to help recipients of those services avoid institutionalization and experience overall better health outcomes.

Care Plan Option (CPO) services: CCI statute expresses legislative intent that a mechanism be developed to allow managed care health plans to authorize and pay for hours of personal care and domestic and related services for IHSS recipients beyond the hours of IHSS services they receive pursuant to county authorization. More specifically, it calls for the Department of Health Care Services, in consultation with the DSS, to develop policies and procedures for the additional benefits that the managed care health plans can authorize. It is important to note that CPO services authorized by a managed care health plan, which can be offered to LTSS recipients beyond what is required by law, are prohibited from being used to replace any care and service hours authorized under IHSS. CPO services are intended to enhance a recipient's care and better support a recipient's ability to remain at home and avoid institutional care.

In its Duals Plan Letter 13-006, the Department of Health Care Services addresses how CPO service hours are to be used and what steps the Cal MediConnect plans must take to prepare for implementation of CPO services. According to this directive, the plans must create the following:

1. Policies and procedures that guide how LTSS recipients will be assessed for CPO service hours;

2. Policies and procedures for identifying enrollees that may need CPO services and for referring them to community-based organizations and other available entities that provide these services;

3. A training curriculum and program for Cal MediConnect plan staff related to the Americans with Disabilities Act, the Olmstead decision, CPO services issues, and community and county home- and community-based services that may be available; and

4. A grievance system under which enrollees may submit their grievances to their Cal MediConnect plan.

CMIPS II: The Case Management Information and Payrolling System, is administered by the Office of Systems Integration (OSI) on behalf of DSS to track IHSS case information and process payments for all IHSS providers. CMIPS II, which now serves all 58 counties, was implemented after a multi-year effort to update the original 30-year-old CMIPS system, bringing with it enhanced capacity for making timely changes to the system that better respond to changing statutory requirements. The OSI CMIPS II Project Internet Web site indicates that the new system "provides modern web-based case management functionality and sophisticated processing of payroll" and that it "includes over 50 interfaces for timely verifications and interactions."

Need for this bill: According to the author, "The CCI statute includes the provision for managed care plans providing services in CCI to authorize and pay for extra homecare services beyond what an IHSS social worker has authorized for a consumer enrolled in CCI. However, the managed care plans are prohibited by statute from paying an individual provider of homecare services directly. Further, there is no mechanism in current statute to pay an individual provider to provide these extra homecare services that are authorized and funded by the managed care plans. The managed care plans could contract with a private homecare agency to hire and pay homecare providers to work these additional hours. However, there is no guarantee that the agency would hire the existing IHSS provider to work these hours. Nor is there any way to force a plan to enter into such a contract. In order to maintain the continuity of care necessary for IHSS consumers enrolled in CCI, in other words, in order for the IHSS consumer to have the option to hire his or her existing IHSS provider to work these extra hours, the managed care plans must find a way to pay providers who provide these additional services."

Further explaining the need for this bill, the Health Plan of San Mateo (HPSM) states, "The CCI legislation included provisions for health plans to authorize IHSS services in addition to those authorized by county social workers. This flexibility is needed to ensure managed care plans could respond timely and nimbly in those situations where a consumer was at risk of entering institutional care. In addition, these CCI provisions allow health plans to continue paying a consumer’s current IHSS provider rather than assigning an unknown provider, without the consumer's approval, to provide services. HPSM cannot pay providers for additional hours without the payment mechanism proposed in [this bill]; contracting with and paying independent IHSS providers outside CMIPS is beyond the scope of HPSM’s administrative capacity and would not be cost-effective for our health plan."

GOVERNOR'S VETO MESSAGE:

This bill would require the California Department of Social Services to reprogram the In-Home Supportive Services (IHSS) payroll system so that paychecks issued by the system would include payment for home care service hours authorized by both IHSS and managed health care plans.

While I support streamlining the payment system for home care service workers, we have yet to find a permanent fund source to restore the seven percent reduction in recipients' authorized hours. When that fiscal uncertainty has been resolved, I would be open to reconsidering the policy in this bill.

Analysis Prepared by: Myesha Jackson / HUM. S. / (916) 319-2089 FN: 00025300001939

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 97

Author:(Weber)

As Amended Ver:August 31, 2015

Majority vote

Original Committee Reference: HUM. S.

SUMMARY: Requires reprogramming of the Case Management Information and Payrolling System (CMIPS II) for In-Home Supportive Services (IHSS) to enable IHSS recipients in Coordinated Care Initiative (CCI) counties to receive additional services authorized and paid for by managed care health plans. Specifically, this bill:

1. Requires CMIPS II, the IHSS payrolling system, to be programmed to do all of the following to ensure managed care health plans are able to pay a provider for personal care services and related domestic services that the plan authorizes in addition to the IHSS hours already authorized for a recipient in a CCI county:

1. Receive payments from managed care health plans for the additional hours of service;

2. Issue a payroll check to providers of personal care service hours and related domestic service hours authorized by a managed care health plan, which shall not include payment of wages for IHSS, as specified; and

3. Track and differentiate between IHSS hours and the hours authorized by the managed care health plan and to enable managed care health plans to track the recipient impact of the additional benefits.

The Senate amendments:

1. Ensure separation and distinct consideration of hours of service authorized by a managed care health plan and IHSS hours, as specified.

2. Simplify implementation of this bill through reprogramming CMIPS II by eliminating the requirement that IHSS hours of service provided and hours authorized by a managed care health plan be combined on a single payroll check.

EXISTING LAW:

1. Establishes the IHSS program as a benefit available to Medi-Cal beneficiaries that provides in-home care and supportive services to low-income aged, blind, or disabled persons who are unable to provide or care for themselves and who cannot live safely in their homes without assistance. Defines supportive services within the program to include domestic services, personal care services, protective supervision, paramedical services, and other services, as specified. (Welfare and Institutions Code (WIC) Section 12300 et seq.)

2. Requires the Department of Social Services (DSS) to procure and implement a new automated Case Management Information and Payroll System (CMIPS) for the IHSS and Personal Care Services Program. Requires the system to incorporate technology that can be readily enhanced and modernized, and employ open architecture and standards, to the extent possible. (WIC Section 12317)

3. Establishes the CCI demonstration project in up to eight counties, subject to federal approval, 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 for those individuals, as specified. (SB 1008 (Budget and Fiscal Review Committee), Chapter 33, Statutes of 2012, and SB 1036 (Budget and Fiscal Review Committee), Chapter 45, Statutes of 2012)

4. Requires, as an additional component of the CCI, that all Medi-Cal long-term services and supports, which include IHSS, be services that are covered under managed care health plan contracts and available only through managed care health plans for beneficiaries residing in counties participating in the CCI demonstration project, with specified exceptions. (WIC Section 14186 et seq.)

5. Expresses the intent of the Legislature that managed care health plans be allowed to authorize and pay for personal care services and related domestic services that are provided in addition to the IHSS hours already authorized for a recipient in a CCI demonstration county, at no cost to the county. Requires the Department of Health Care Services, in consultation with the DSS to develop policies and procedures for these additional benefits authorized and paid for by health plans. (WIC Section 14186 (b)(6)(B))

FISCAL EFFECT: According to the Senate Appropriations Committee, this bill may have the following fiscal impact:

1. One-time costs of $6 million ($3 million General Fund) for reprogramming of CMIPS II and ongoing costs of $1 million ($0.5 million General Fund).

2. Potential increase in county administrative costs (Federal Fund/General Fund) to enter data from two payroll systems into the CMIPS II database in order to differentiate between authorized hours for IHSS and by managed health care plans.

COMMENTS:

IHSS: The IHSS program provides personal care and domestic services to approximately 420,000 qualified, low-income individuals who are aged, blind, or disabled. Through the IHSS program, recipients are cared for and assisted with activities of daily living, allowing them to remain safely in their own homes and avoid institutionalization. IHSS services include: paramedical services, such as giving medications and changing a colostomy bag; non-medical personal care services, such as toileting, dressing, and transportation; domestic services, such as housework, shopping for groceries and meal preparation; and, protective supervision for those who, due to cognitive decline or dementia, cannot be left alone for extended periods.

County social workers determine eligibility for IHSS and the authorized hours of care 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. Prior to receiving payment for services, providers must submit to a criminal background check and a provider orientation. IHSS is funded with federal, state, and county resources.

CCI: The Budget Act of 2012 enacted the CCI, one component of which is a framework for integrating the delivery of medical, behavioral and long-term care services through a single health plan for persons eligible for both Medicare and Medi-Cal. This demonstration project component of the CCI, also known as Cal MediConnect, was originally limited to the following eight counties: Alameda, Los Angeles, Orange, San Diego, San Mateo, Riverside, San Bernardino, and Santa Clara, in which approximately 65% of IHSS recipients reside. Alameda County withdrew from the CCI demonstration in 2014.

While CCI-related code sections clearly maintain county responsibility for assessing and reassessing IHSS recipients and determining a recipient’s authorized number of hours, they also spell out the role of the managed care health plans in coordinating services for individuals receiving long-term services and supports (LTSS) and implementing best practices to help recipients of those services avoid institutionalization and experience overall better health outcomes.

Care Plan Option (CPO) services: CCI statute expresses legislative intent that a mechanism be developed to allow managed care health plans to authorize and pay for hours of personal care and domestic and related services for IHSS recipients beyond the hours of IHSS services they receive pursuant to county authorization. More specifically, it calls for the Department of Health Care Services, in consultation with the DSS, to develop policies and procedures for the additional benefits that the managed care health plans can authorize. It is important to note that CPO services authorized by a managed care health plan, which can be offered to LTSS recipients beyond what is required by law, are prohibited from being used to replace any care and service hours authorized under IHSS. CPO services are intended to enhance a recipient's care and better support a recipient’s ability to remain at home and avoid institutional care.

In its Duals Plan Letter 13-006, the Department of Health Care Services addresses how CPO service hours are to be used and what steps the Cal MediConnect plans must take to prepare for implementation of CPO services. According to this directive, the plans must create the following:

1. Policies and procedures that guide how LTSS recipients will be assessed for CPO service hours;

2. Policies and procedures for identifying enrollees that may need CPO services and for referring them to community-based organizations and other available entities that provide these services;

3. A training curriculum and program for Cal MediConnect plan staff related to the Americans with Disabilities Act, the Olmstead decision, CPO services issues, and community and county home- and community-based services that may be available; and

4. A grievance system under which enrollees may submit their grievances to their Cal MediConnect plan.

CMIPS II: The Case Management Information and Payrolling System, is administered by the Office of Systems Integration (OSI) on behalf of DSS to track IHSS case information and process payments for all IHSS providers. CMIPS II, which now serves all 58 counties, was implemented after a multi-year effort to update the original 30-year-old CMIPS system, bringing with it enhanced capacity for making timely changes to the system that better respond to changing statutory requirements. The OSI CMIPS II Project Internet Web site indicates that the new system "provides modern web-based case management functionality and sophisticated processing of payroll" and that it "includes over 50 interfaces for timely verifications and interactions."

Need for this bill: According to the author, "The CCI statute includes the provision for managed care plans providing services in CCI to authorize and pay for extra homecare services beyond what an IHSS social worker has authorized for a consumer enrolled in CCI. However, the managed care plans are prohibited by statute from paying an individual provider of homecare services directly. Further, there is no mechanism in current statute to pay an individual provider to provide these extra homecare services that are authorized and funded by the managed care plans. The managed care plans could contract with a private homecare agency to hire and pay homecare providers to work these additional hours. However, there is no guarantee that the agency would hire the existing IHSS provider to work these hours. Nor is there any way to force a plan to enter into such a contract. In order to maintain the continuity of care necessary for IHSS consumers enrolled in CCI, in other words, in order for the IHSS consumer to have the option to hire his or her existing IHSS provider to work these extra hours, the managed care plans must find a way to pay providers who provide these additional services."

Further explaining the need for this bill, the Health Plan of San Mateo (HPSM) states, "The CCI legislation included provisions for health plans to authorize IHSS services in addition to those authorized by county social workers. This flexibility is needed to ensure managed care plans could respond timely and nimbly in those situations where a consumer was at risk of entering institutional care. In addition, these CCI provisions allow health plans to continue paying a consumer’s current IHSS provider rather than assigning an unknown provider, without the consumer's approval, to provide services. HPSM cannot pay providers for additional hours without the payment mechanism proposed in [this bill]; contracting with and paying independent IHSS providers outside CMIPS is beyond the scope of HPSM’s administrative capacity and would not be cost-effective for our health plan."

Analysis Prepared by: Myesha Jackson / HUM. S. / (916) 319-2089 FN: 0001939

 THIRD READING  

Bill No: AB 97

Author: Weber (D)

Amended: 8/31/15 in Senate

Vote: 21

SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/23/15

AYES: McGuire, Berryhill, Hancock, Liu, Nguyen

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15

AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen

ASSEMBLY FLOOR: 79-0, 6/1/15 - See last page for vote

SUBJECT: In-home supportive services: provider wages

SOURCE: United Domestic Workers of America/AFSCME Local 3930

DIGEST: This bill requires the Case Management Information and Payrolling System (CMIPS II) for the In-Home Supportive Services (IHSS) program to be reprogrammed to enable managed health care plans to pay a provider for additional services authorized for IHSS recipients in participating counties of the Coordinated Care Initiative (CCI), as specified.

ANALYSIS:

Existing law:

1. Establishes in state law a program of public Medi-Cal benefits to provide health care for people who lack sufficient annual income to meet the costs of health care, and whose other assets are so limited that their application toward the costs of such care would jeopardize the person or family’s future minimum self-maintenance and security. (WIC 14000 et seq.)

2. Establishes the IHSS program to provide in-home domestic supportive and personal care services for aged, blind or disabled individuals living at or below the poverty level for the purpose of enabling consumers to avoid institutionalization and remain safely in their homes. (WIC 12300 et seq.)

3. Requires the California Department of Social Services (CDSS) to be responsible for procuring and implementing a new Case Management Information and Payroll System (CMIPS II) for IHSS and establishes minimum functionalities that are required to be provided by the system. (WIC 12317)

4. Establishes the Coordinated Care Initiative (CCI), subject to federal approval, which establishes in eight counties an integrated health and long-term managed care plan for individuals and seniors and persons with disabilities who receive both Medi-Cal and Medicare benefits, and includes IHSS under managed care health plan contracts, available only through managed care health plans for beneficiaries residing in counties participating in the CCI demonstration project, with specified exceptions. (WIC 14182.16) (WIC 14186.35)

5. Declares legislative intent that managed care health plans may authorize and pay for personal-care services and related domestic services in addition to the IHSS hours already authorized for a recipient in a CCI demonstration county, at no cost to the county. Requires the Department of Health Care Services, in consultation with the CDSS to develop policies and procedures for these additional benefits authorized and paid for by health plans. (WIC 14186 (b)(6)(B))

This bill:

1. Requires CMIPS II to be programmed to do all of the following in order to enable managed care health plans to pay a provider for the additional personal care and related domestic services that the plan authorizes beyond the IHSS hours authorized by a CCI county:

1. Receive payments from managed care health plans for the hours of service authorized by the managed care plan, which are separate and distinct from in-home supportive service hours authorized by the county;

2. Issue a payroll check to providers that covers the personal care service and related domestic service hours authorized by the managed care health plan; and

3. Track and differentiate between county authorized IHSS hours and the hours authorized by the managed care health plan to enable managed care health plans to track the recipient impact of the additional benefits.

Background

According to the author, the CCI permits a managed care health plan to authorize additional hours of IHSS services if the services are necessary to allow the consumer to continue living in his or her own home, instead of residing in a more costly institution. The author cites existing law which states the Department of Health Care Services (DHCS), “in consultation with the State Department of Social Services, shall develop policies and procedures for these additional benefits, which managed care health plans may authorize.” However, the author states that the state has not created a mechanism to pay an individual provider to work these additional service hours authorized by the managed care health plans. The author states that in order to maintain the continuity of care for the medically fragile CCI population, the consumer should have the option to have his or her existing IHSS provider work these additional service hours, instead of assigning an unknown provider, without the consumer’s approval, to enter his or her home.

In Home Supportive Services Program (IHSS): The IHSS program was established in 1973 as an innovative alternative to institutional care, and evolved in the context of a growing “independent living” civil rights movement led by persons with disabilities. The program has experienced continuous growth following the U.S. Supreme Court decision Olmstead v. L.C. in 1999 which established the rights of people with disabilities to receive services in the most integrated setting possible to “provide individuals with disabilities opportunities to live their lives like individuals without disabilities” under the American with Disabilities Act.

The IHSS program is operated as benefit under the Medi-Cal program, providing in-home services to more than 467,000 qualified low-income individuals who are aged, blind, or disabled. County welfare agencies administer the program under CDSS oversight and county social workers determine eligibility and assess eligible consumers to determine the allowable services and number of allotted hours following a standardized in home assessment.

Coordinated Care Initiative (CCI) Pursuant to federal law under the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), California’s Budget Act of 2012 enacted the CCI, with the intention of better coordinating the medical, mental and long-term care provided to Medi-Cal recipients while achieving fiscal savings for the General Fund. Specifically, according to a Senate Budget Subcommittee 3 agenda, the CCI broadly encompasses three components:

1. Long-Term Supports and Services (LTSS) as a Medi-Cal Managed Care Benefit: CCI incorporated LTSS into Medi-Cal managed care, including nursing facility care, IHSS, the Multipurpose Senior Services Program, and Community-Based Adult Services. A Senate Budget Committee agenda states this change is estimated to impact about 600,000 Medi-Cal-only enrollees and up to 456,000 persons eligible for both Medicare and Medi-Cal who are in Cal MediConnect.

2. Cal MediConnect Program: A three-year demonstration project for persons eligible for both Medicare and Medi-Cal (dual eligibles) to receive coordinated medical, behavioral health, long-term institutional, and home-and community-based services through a single organized delivery system (health plan). The Senate Budget Committee states that no more than 456,000 beneficiaries would be eligible for the duals demonstration in the participating counties. This demonstration project is a joint project with the federal Centers for Medicare and Medicaid Services (CMS).

3. Mandatory Enrollment of Dual Eligibles and Others into Medi-Cal Managed Care. Most Medi-Cal beneficiaries, including dual eligibles, partial dual eligibles, and previously excluded Seniors and Persons with Disabilities (SPDs) who are Medi-Cal only, are required to join a Medi-Cal managed care health plan to receive their Medi-Cal benefits.

Under Cal MediConnect, Medi-Cal managed care health plans are responsible for providing and coordinating Medicare and Medi-Cal benefits, including LTSS. Health plans will receive a blended rate from the state and the federal government for these services, including IHSS. However, existing CCI statutes clearly specify that counties retain responsibility for assessing and reassessing IHSS recipients and determining a recipient’s authorized number of hours, in addition the county operated CMIPS will remain responsible for processing payroll.

Existing CCI statutes expresses legislative intent that a mechanism be developed to allow managed care health plans to authorize and pay for hours of personal care and domestic and related services for IHSS recipients beyond the hours of IHSS services they receive pursuant to county authorization referred to as “Care Plan Option (CPO) services.” Furthermore, existing law calls for the DHCS, in consultation with the CDSS, to develop policies and procedures for the additional benefits that the managed care health plans can authorize and these CPO services are prohibited from being used to replace any care and service hours authorized under IHSS.

In its Duals Plan Letter 13-006, DHCS directs Medi-Cal managed care plans to establish the following:

1. Policies and procedures that guide how LTSS recipients will be assessed for CPO service hours;

2. Policies and procedures for identifying enrollees that may need CPO services and for referring them to community-based organizations and other available entities that provide these services;

3. A training curriculum and program for Cal MediConnect plan staff related to the Americans with Disabilities Act, the Olmstead decision, CPO services issues, and community and county home- and community-based services that may be available; and

4. A grievance system under which enrollees may submit their grievances to their Cal MediConnect plan.

The new Case Management Information and Payrolling System: CMIPS II

The new CMIPS II, was designed, and is now operated by, the Office of Systems Integration (OSI) on behalf of CDSS to track IHSS case management information and process payroll for IHSS providers. CMIPS II now serves all 58 counties and was implemented after a multi-year effort to update the original 30-year-old CMIPS system and according to OSI “provides modern web-based case management functionality and sophisticated processing of payroll” and that it “includes over 50 interfaces for timely verifications and interactions.” Additionally, CDSS states that CMIPS II offers “increased accountability to program administrators including counties, the state and the federal government.”

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, this bill will incur one-time costs of $6 million ($3 million General Fund) for reprogramming of CMIPS II and ongoing costs of $1 million ($0.5 million General Fund). Additionally, this bill will potentially increase county administrative costs (Federal Fund/General Fund) to enter data from two payroll systems into the CMIPS II database in order to differentiate between authorized hours for IHSS and by managed health care plans.

SUPPORT: (Verified 8/28/15)

United Domestic Workers of America/AFSCME Local 3930 (source)

AFSCME

California Association of Public Authorities

California Labor Federation

Health Plan of San Mateo

Inland Empire Health Plan

Local Health Plans of California

Molina Health Care of California

OPPOSITION: (Verified 8/28/15)

None received

ASSEMBLY FLOOR: 79-0, 6/1/15

AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, 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

NO VOTE RECORDED: Brough

Prepared by: Sara Rogers / HUMAN S. / (916) 651-1524

8/30/15 19:09:45

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 97 (Weber) - In-home supportive services: provider wages

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

The following information is revised to reflect amendments

adopted by the committee on August 27, 2015

Bill Summary:

AB 97 would require the Case Management Information and Payrolling System (CMIPS II) for the In-Home Supportive Services (IHSS) program to be reprogrammed to enable managed health care plans to pay a provider for additional services authorized for IHSS recipients in participating counties of the Coordinated Care Initiative (CCI), as specified.

Fiscal Impact:

• One-time costs of $6 million ($3 million General Fund) for reprogramming of CMIPS II and ongoing costs of $1 million ($0.5 million General Fund).

• Potential increase in county administrative costs (Federal Fund/General Fund) to enter data from two payroll systems into the CMIPS II database in order to differentiate between authorized hours for IHSS and by managed health care plans.

Author Amendments:

Clarify that IHSS service hours and managed care health plan service hours are separate and distinct.

Staff notes this amendment addresses the potential fiscal impact associated with an increase in IHSS program costs for overtime and related activities, to the extent issuing a single payroll check to providers for both IHSS authorized hours and hours authorized by managed health care plans triggers the requirements related to overtime under the federal Fair Labor Standards Act (FLSA).

-- END --

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 97 (Weber) - In-home supportive services: provider wages

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

Bill Summary:

AB 97 would require the Case Management Information and Payrolling System (CMIPS II) for the In-Home Supportive Services (IHSS) program to be reprogrammed to enable managed health care plans to pay a provider for additional services authorized for IHSS recipients in participating counties of the Coordinated Care Initiative (CCI), as specified.

Fiscal Impact:

• One-time costs of $6 million ($3 million General Fund) for reprogramming of CMIPS II and ongoing costs of $1 million ($0.5 million General Fund).

• Potential increase in county administrative costs (Federal Fund/General Fund) to enter data from two payroll systems into the CMIPS II database in order to differentiate between authorized hours for IHSS and by managed health care plans.

• Potential increase in IHSS program costs (General Fund) for overtime and related activities, to the extent issuing a single payroll check to providers for both IHSS authorized hours and hours authorized by managed health care plans triggers the requirements under the federal Fair Labor Standards Act (FLSA) and the federal rule is upheld.

Background:

Existing law provides that the Department of Social Services (DSS) is responsible for procuring and implementing a new Case Management Information and Payrolling System (CMIPS II) for IHSS and establishes minimum functionalities that are required to be provided by the system including payroll and management information, the ability to calculate wage and benefit deductions, and coordinate benefits information and processing with the California Medicaid Management Information System.

Existing law declares the intent of the Legislature that managed care health plans may authorize personal care services and related domestic services in addition to the hours authorized under IHSS, which managed care health plans shall be responsible for paying at no share of cost to the county. Legislative intent additionally states that the Department of Health Care Services, in consultation with DSS, shall be required to develop policies and procedures for these additional benefits, which managed care health plans may authorize. (Welfare and Institutions Code § 14186(b)(6)(B).)

Proposed Law:

This bill requires CMIPS II to be programmed to enable the system to do all of the following:

• Receive payments from managed care health plans for the additional personal care service hours and related domestic service hours authorized by the managed care health plan.

• Issue a single payroll check to providers that covers both the hours authorized under IHSS and the hours authorized by the managed care health plan, as specified.

• Differentiate between IHSS authorized hours and the hours authorized by the managed care health plan for purposes of federal reimbursement and to enable managed care health plans to track the effect of providing the additional benefits.

Related Legislation:

The 2015-16 Budget Conference Committee took an action to include a similar proposal. This provision was not included, however, in the final budget bill, AB 93 (Committee on Budget and Fiscal Review) Chapter 10/2015 or the human services budget trailer bill, SB 79 (Committee on Budget and Fiscal Review) Chapter 20/2015, signed by the Governor.

Staff Comments: The DSS has indicated one-time costs of $6 million ($3 million General Fund) for the reprogramming of CMIPS II as specified in this measure and ongoing costs of $1 million ($0.5 million General Fund).

In order to differentiate between the number of authorized hours for IHSS and authorized by managed health care plans as required under the provisions of this measure, county social workers could incur additional workload to enter data from two payroll systems into the CMIPS II database. The magnitude of the increase in IHSS administrative costs would be dependent on the additional time required to input the required information and the number of cases impacted, which is unknown at this time. SB 1036 (Chapter 45/2012) altered the historical county contribution of IHSS funding by enacting a county IHSS maintenance of effort (MOE), which replaced the county contribution of 17.5 percent with a requirement that counties generally maintain their Fiscal Year (FY) 2011-12 expenditure level for IHSS program costs as of FY 2012-13, to be adjusted annually for inflation beginning in FY 2014-15. As a result, all increases in the non-federal share of IHSS costs above the county IHSS MOE are now borne by the General Fund.

Additionally, the provisions of this measure could potentially result in a significant increase in future IHSS program costs (Federal Fund/General Fund) for overtime and related activities, to the extent issuing a single payroll check to providers for both IHSS authorized hours and hours authorized by managed health care plans triggers the requirements under the federal FLSA, assuming the federal rule is upheld. In the absence of data regarding the number of recipients eligible to receive additional hours in the pilot counties and the applicable number of authorized hours, the magnitude of this impact cannot be determined at this time.

-- END --

SENATE COMMITTEE ON HUMAN SERVICES

Senator McGuire, Chair

2015 - 2016 Regular

Bill No: AB 97

Subject: In-home supportive services: provider wages

SUMMARY

This bill requires the Case Management Information and Payrolling System (CMIPS II) for In-Home Supportive Services (IHSS) to be reprogrammed to enable IHSS recipients in Coordinated Care Initiative (CCI) counties to receive additional services authorized and paid for by managed care health plans.

ABSTRACT

Existing law:

1. Establishes in state law a program of public Medi-Cal benefits to provide health care for people who lack sufficient annual income to meet the costs of health care, and whose other assets are so limited that their application toward the costs of such care would jeopardize the person or family’s future minimum self-maintenance and security. (WIC 14000 et seq.)

2. Establishes the IHSS program to provide in-home domestic supportive and personal care services for aged, blind or disabled individuals living at or below the poverty level for the purpose of enabling consumers to avoid institutionalization and remain safely in their homes. (WIC 12300 et seq.)

3. Requires the California Department of Social Services (CDSS) to be responsible for procuring and implementing a new Case Management Information and Payroll System (CMIPS II) for IHSS and establishes minimum functionalities that are required to be provided by the system. (WIC 12317)

4. Establishes the CCI, subject to federal approval, which establishes in eight counties an integrated health and long-term managed care plan for individuals and seniors and persons with disabilities who receive both Medi-Cal and Medicare benefits, and includes IHSS under managed care health plan contracts, available only through managed care health plans for beneficiaries residing in counties participating in the CCI demonstration project, with specified exceptions. (WIC 14182.16) (WIC 14186.35)

5. Declares legislative intent that managed care health plans may authorize and pay for personal-care services and related domestic services in addition to the IHSS hours already authorized for a recipient in a CCI demonstration county, at no cost to the county. Requires the Department of Health Care Services, in consultation with the CDSS to develop policies and procedures for these additional benefits authorized and paid for by health plans. (WIC 14186 (b)(6)(B))

This bill:

1. Requires CMIPS II to be programmed to do all of the following in order to enable managed care health plans to pay a provider for the additional personal care and related domestic services that the plan authorizes beyond the IHSS hours authorized by a CCI county:

1. Receive payments from managed care health plans for the additional hours of service;

2. Issue a single payroll check to providers that covers both the IHSS hours and the hours authorized by the managed care health plan; and

3. Differentiate between IHSS hours and the hours authorized by the managed care health plan for purposes of federal reimbursement and to enable managed care health plans to track the recipient impact of the additional benefits.

FISCAL IMPACT

According to the Assembly Appropriations Committee, this bill will incur the following costs:

• One-time costs to CDSS of $6 million ($3 million GF) to design, develop, and implement the CMIPS II system changes.

• One-time costs to CDSS of approximately $550,000 (GF) for two years for 4.5 positions for implementation.

• On-going annual operating costs to CDSS of $1 million ($500,000 GF) to operate the new payroll system.

A subsequent analysis of the Assembly Budget Committee of a similar proposal estimated that the budget year General Fund cost for the project would be approximately $2 million GF ($7 million total funds).

BACKGROUND AND DISCUSSION

Purpose of the bill:

According to the author, the CCI permits a managed care health plan to authorize additional hours of IHSS services if the services are necessary to allow the consumer to continue living in his or her own home, instead of residing in a more costly institution. The author cites existing law which states the Department of Health Care Services (DHCS), “in consultation with the State Department of Social Services, shall develop policies and procedures for these additional benefits, which managed care health plans may authorize.” However, the author states that the state has not created a mechanism to pay an individual provider to work these additional service hours authorized by the managed care health plans. The author states that in order to maintain the continuity of care for the medically fragile CCI population, the consumer should have the option to have his or her existing IHSS provider work these additional service hours, instead of assigning an unknown provider, without the consumer’s approval, to enter his or her home.

In Home Supportive Services Program (IHSS)

The IHSS program was established in 1973 as an innovative alternative to institutional care, and evolved in the context of a growing “independent living” civil rights movement led by persons with disabilities.¹ The program has experienced continuous growth following the U.S. Supreme Court decision Olmstead v. L.C. in 1999 which established the rights of people with disabilities to receive services in the most integrated setting possible to “provide individuals with disabilities opportunities to live their lives like individuals without disabilities”² under the American with Disabilities Act.

The IHSS program is operated as benefit under the Medi-Cal program, providing in-home services to more than 467,000 qualified low-income individuals who are aged, blind, or disabled. County welfare agencies administer the program under CDSS oversight and county social workers determine eligibility and assess eligible consumers to determine the allowable services and number of allotted hours following a standardized in home assessment.

Coordinated Care Initiative (CCI)

Pursuant to federal law under the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), California’s Budget Act of 2012³ enacted the CCI, with the intention of better coordinating the medical, mental and long-term care provided to Medi-Cal recipients while achieving fiscal savings for the General Fund. Specifically, according to a Senate Budget Subcommittee 3 agenda, the CCI broadly encompasses three components:⁴

• Long-Term Supports and Services (LTSS) as a Medi-Cal Managed Care Benefit: CCI incorporated LTSS into Medi-Cal managed care, including nursing facility care, IHSS, the Multipurpose Senior Services Program, and Community-Based Adult Services. A Senate Budget Committee agenda states this change is estimated to impact about 600,000 Medi-Cal-only enrollees and up to 456,000 persons eligible for both Medicare and Medi-Cal who are in Cal MediConnect.

• Cal MediConnect Program: A three-year demonstration project for persons eligible for both Medicare and Medi-Cal (dual eligibles) to receive coordinated medical, behavioral health, long-term institutional, and home-and community-based services through a single organized delivery system (health plan). The Senate Budget Committee states that no more than 456,000 beneficiaries would be eligible for the duals demonstration in the participating counties. This demonstration project is a joint project with the federal Centers for Medicare and Medicaid Services (CMS).

• Mandatory Enrollment of Dual Eligibles and Others into Medi-Cal Managed Care. Most Medi-Cal beneficiaries, including dual eligibles, partial dual eligibles, and previously excluded Seniors and Persons with Disabilities (SPDs) who are Medi-Cal only, are required to join a Medi-Cal managed care health plan to receive their Medi-Cal benefits.

Under Cal MediConnect, Medi-Cal managed care health plans are responsible for providing and coordinating Medicare and Medi-Cal benefits, including LTSS. Health plans will receive a blended rate from the state and the federal government for these services, including IHSS. However, existing CCI statutes clearly specify that counties retain responsibility for assessing and reassessing IHSS recipients and determining a recipient’s authorized number of hours, in addition the county operated CMIPS will remain responsible for processing payroll.

Existing CCI statutes expresses legislative intent that a mechanism be developed to allow managed care health plans to authorize and pay for hours of personal care and domestic and related services for IHSS recipients beyond the hours of IHSS services they receive pursuant to county authorization referred to as “Care Plan Option (CPO) services.” Furthermore, existing law calls for the DHCS, in consultation with the CDSS, to develop policies and procedures for the additional benefits that the managed care health plans can authorize and these CPO services are prohibited from being used to replace any care and service hours authorized under IHSS.

In its Duals Plan Letter 13-006, DHCS directs Medi-Cal managed care plans to establish the following:

1. Policies and procedures that guide how LTSS recipients will be assessed for CPO service hours;

2. Policies and procedures for identifying enrollees that may need CPO services and for referring them to community-based organizations and other available entities that provide these services;

3. A training curriculum and program for Cal MediConnect plan staff related to the Americans with Disabilities Act, the Olmstead decision, CPO services issues, and community and county home- and community-based services that may be available; and

4. A grievance system under which enrollees may submit their grievances to their Cal MediConnect plan.

The new Case Management Information and Payrolling System: CMIPS II

The new Case Management Information and Payrolling System, was designed, and is now operated by, the Office of Systems Integration (OSI) on behalf of CDSS to track IHSS case management information and process payroll for IHSS providers. CMIPS II now serves all 58 counties and was implemented after a multi-year effort to update the original 30-year-old CMIPS system and according to OSI “provides modern web-based case management functionality and sophisticated processing of payroll” and that it “includes over 50 interfaces for timely verifications and interactions.” Additionally, CDSS states that CMIPS II offers “increased accountability to program administrators including counties, the state and the federal government.”

COMMENTS

The potential for managed care health plans to authorize additional services was highlighted as a significant advantage of the CCI, which anticipated moving significant numbers of Medi-Cal recipients into managed care despite vocal concerns raised by advocacy groups about the ability of managed care plans to provide adequate care to IHSS recipients with complex health needs. As of May 2015, nearly 123,000 individuals were enrolled into Cal MediConnect, however among IHSS consumers, 64 percent of potential enrollees have opted out, and an additional 17 percent have disenrolled, numbers that are significantly higher than those of the non-IHSS population. These opt-out rates have raised concerns about the ability of the state to achieve the requisite savings upon which CCI was conditioned.

The Administration testified at numerous budget committee hearings regarding the importance of the Care Plan Option services in keeping recipients out of institutions, however the additional services have not been implemented because the current CMIPS payroll system lacks the functionality to allow for medical managed care plans to pay IHSS workers for the additional hours. Furthermore, staff notes that during the development and implementation of CMIPS II, the new system was touted as offering substantially more flexibility for reprogramming associated with changing state and federal laws.

However, at recent budget hearings, the Administration testified against adding this functionality to the current CMIPS system, citing cost and other priorities. Supporters of this bill state that this bill may assist the administration in fulfilling one of the highlighted promises of CCI, and thus attract IHSS consumers to opt-in to Cal MediConnect.

PRIOR VOTES

POSITIONS

Support:

United Domestic Workers of America/AFSCME Local 3930 (Co-Sponsor)

AFSCME

California Association of Public Authorities

Health Plan of San Mateo

Inland Empire Health Plan

Local Health Plans of California

Molina Health Care of California

Oppose:

None received.

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 97

Author:(Weber)

As Amended Ver:March 26, 2015

Majority vote

SUMMARY: Requires reprogramming of the Case Management Information and Payrolling System (CMIPS II) for In-Home Supportive Services (IHSS) to enable IHSS recipients in Coordinated Care Initiative (CCI) counties to receive additional services authorized and paid for by managed care health plans. Specifically, this bill:

1. Requires CMIPS II, the IHSS payrolling system, to be programmed to do all of the following to ensure managed care health plans are able to pay a provider for personal care services and related domestic services that the plan authorizes in addition to the IHSS hours already authorized for a recipient in a CCI county:

1. Receive payments from managed care health plans for the additional hours of service;

2. Issue a single payroll check to providers that covers both the IHSS hours and the hours authorized by the managed care health plan; and

3. Differentiate between IHSS hours and the hours authorized by the managed care health plan for purposes of federal reimbursement and to enable managed care health plans to track the recipient impact of the additional benefits.

EXISTING LAW:

1. Establishes the IHSS program as a benefit available to Medi-Cal beneficiaries that provides in-home care and supportive services to low-income aged, blind, or disabled persons who are unable to provide or care for themselves and who cannot live safely in their homes without assistance. Defines supportive services within the program to include domestic services, personal care services, protective supervision, paramedical services, and other services, as specified. (Welfare and Institutions Code (WIC) Section 12300 et seq.)

2. Requires the Department of Social Services (DSS) to procure and implement a new automated Case Management Information and Payroll System (CMIPS) for the IHSS and Personal Care Services Program. Requires the system to incorporate technology that can be readily enhanced and modernized, and employ open architecture and standards, to the extent possible. (WIC Section 12317)

3. Establishes the CCI demonstration project in up to eight counties, subject to federal approval, 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 for those individuals, as specified. (SB 1008 (Budget and Fiscal Review Committee), Chapter 33, Statutes of 2012, and SB 1036 (Budget and Fiscal Review Committee), Chapter 45, Statutes of 2012)

4. Requires, as an additional component of the CCI, that all Medi-Cal long-term services and supports, which include IHSS, be services that are covered under managed care health plan contracts and available only through managed care health plans for beneficiaries residing in counties participating in the CCI demonstration project, with specified exceptions. (WIC Section 14186 et seq.)

5. Expresses the intent of the Legislature that managed care health plans be allowed to authorize and pay for personal care services and related domestic services that are provided in addition to the IHSS hours already authorized for a recipient in a CCI demonstration county, at no cost to the county. Requires the Department of Health Care Services, in consultation with the DSS to develop policies and procedures for these additional benefits authorized and paid for by health plans. (WIC Section 14186 (b)(6)(B))

FISCAL EFFECT: According to the Assembly Appropriations Committee:

1. One-time costs to the DSS of $6 million ($3 million General Fund (GF)) to design, develop, and implement the CMIPS II system changes.

2. One-time costs to DSS of approximately $550,000 (GF) for two years for 4.5 positions for implementation.

3. On-going annual operating costs to DSS of $1 million ($500,000 GF) to operate the new payrolling system.

COMMENTS:

IHSS: The IHSS program provides personal care and domestic services to approximately 420,000 qualified, low-income individuals who are aged, blind, or disabled. Through the IHSS program, recipients are cared for and assisted with activities of daily living, allowing them to remain safely in their own homes and avoid institutionalization. IHSS services include: paramedical services, such as giving medications and changing a colostomy bag; non-medical personal care services, such as toileting, dressing, and transportation; domestic services, such as housework, shopping for groceries and meal preparation; and, protective supervision for those who, due to cognitive decline or dementia, cannot be left alone for extended periods.

County social workers determine eligibility for IHSS and the authorized hours of care 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. Prior to receiving payment for services, providers must submit to a criminal background check and a provider orientation. IHSS is funded with federal, state, and county resources.

CCI: The Budget Act of 2012 enacted the CCI, one component of which is a framework for integrating the delivery of medical, behavioral and long-term care services through a single health plan for persons eligible for both Medicare and Medi-Cal. This demonstration project component of the CCI, also known as Cal MediConnect, was originally limited to the following eight counties: Alameda, Los Angeles, Orange, San Diego, San Mateo, Riverside, San Bernardino, and Santa Clara, in which approximately 65% of IHSS recipients reside. Alameda County withdrew from the CCI demonstration in 2014.

While CCI-related code sections clearly maintain county responsibility for assessing and reassessing IHSS recipients and determining a recipient’s authorized number of hours, they also spell out the role of the managed care health plans in coordinating services for individuals receiving long-term services and supports (LTSS) and implementing best practices to help recipients of those services avoid institutionalization and experience overall better health outcomes.

Care Plan Option (CPO) services: CCI statute expresses legislative intent that a mechanism be developed to allow managed care health plans to authorize and pay for hours of personal care and domestic and related services for IHSS recipients beyond the hours of IHSS services they receive pursuant to county authorization. More specifically, it calls for the Department of Health Care Services, in consultation with the DSS, to develop policies and procedures for the additional benefits that the managed care health plans can authorize. It is important to note that CPO services authorized by a managed care health plan, which can be offered to LTSS recipients beyond what is required by law, are prohibited from being used to replace any care and service hours authorized under IHSS. CPO services are intended to enhance a recipient’s care and better support a recipient’s ability to remain at home and avoid institutional care.

In its Duals Plan Letter 13-006, the Department of Health Care Services addresses how CPO service hours are to be used and what steps the Cal MediConnect plans must take to prepare for implementation of CPO services. According to this directive, the plans must create the following:

1. Policies and procedures that guide how LTSS recipients will be assessed for CPO service hours;

2. Policies and procedures for identifying enrollees that may need CPO services and for referring them to community-based organizations and other available entities that provide these services;

3. A training curriculum and program for Cal MediConnect plan staff related to the Americans with Disabilities Act, the Olmstead decision, CPO services issues, and community and county home- and community-based services that may be available; and

4. A grievance system under which enrollees may submit their grievances to their Cal MediConnect plan.

CMIPS II: The Case Management Information and Payrolling System, is administered by the Office of Systems Integration (OSI) on behalf of DSS to track IHSS case information and process payments for all IHSS providers. CMIPS II, which now serves all 58 counties, was implemented after a multi-year effort to update the original 30-year-old CMIPS system, bringing with it enhanced capacity for making timely changes to the system that better respond to changing statutory requirements. The OSI CMIPS II Project Internet Web site indicates that the new system "provides modern web-based case management functionality and sophisticated processing of payroll" and that it "includes over 50 interfaces for timely verifications and interactions."

Need for this bill: According to the author, "The CCI statute includes the provision for managed care plans providing services in CCI to authorize and pay for extra homecare services beyond what an IHSS social worker has authorized for a consumer enrolled in CCI. However, the managed care plans are prohibited by statute from paying an individual provider of homecare services directly. Further, there is no mechanism in current statute to pay an individual provider to provide these extra homecare services that are authorized and funded by the managed care plans. The managed care plans could contract with a private homecare agency to hire and pay homecare providers to work these additional hours. However, there is no guarantee that the agency would hire the existing IHSS provider to work these hours. Nor is there any way to force a plan to enter into such a contract. In order to maintain the continuity of care necessary for IHSS consumers enrolled in CCI, in other words, in order for the IHSS consumer to have the option to hire his or her existing IHSS provider to work these extra hours, the managed care plans must find a way to pay providers who provide these additional services."

Further explaining the need for this bill, the Health Plan of San Mateo (HPSM) states, "The CCI legislation included provisions for health plans to authorize IHSS services in addition to those authorized by county social workers. This flexibility is needed to ensure managed care plans could respond timely and nimbly in those situations where a consumer was at risk of entering institutional care. In addition, these CCI provisions allow health plans to continue paying a consumer’s current IHSS provider rather than assigning an unknown provider, without the consumer's approval, to provide services. HPSM cannot pay providers for additional hours without the payment mechanism proposed in [this bill]; contracting with and paying independent IHSS providers outside CMIPS is beyond the scope of HPSM’s administrative capacity and would not be cost-effective for our health plan."

Analysis Prepared by: Myesha Jackson / HUM. S. / (916) 319-2089 FN: 0000583

Date of Hearing: May 13, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

ABPCA Bill Id:AB 97

Author:(Weber) – As Amended Ver:March 26, 2015

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

SUMMARY:

This bill requires reprogramming of the Case Management Information and Payrolling System (CMIPS II) for In-Home Supportive Services (IHSS) to enable IHSS recipients in Coordinated Care Initiative (CCI) counties to receive additional services authorized and paid for by managed care health plans. Specifically, this bill:

1. Requires CMIPS II, the IHSS payrolling system, to be programmed to do all of the following:

1. Receive payments from managed care health plans for the additional hours of service;

2. Issue a single payroll check to providers that covers both the IHSS hours and the hours authorized by the managed care health plan; and

3. Differentiate between IHSS hours and the hours authorized by the managed care health plan for purposes of federal reimbursement and to enable managed care health plans to track the recipient impact of the additional benefits.

FISCAL EFFECT:

1. One-time costs to the Department of Social Services (DSS) of $6 million ($3 million GF) to design, develop, and implement the CMIPS II system changes.

2. One-time costs to DSS of approximately $550,000 (GF) for two years for 4.5 positions for implementation.

3. On-going annual operating costs to DSS of $1 million ($500,000 GF) to operate the new payrolling system.

COMMENTS:

1. Purpose. According to the author, “The CCI statute includes the provision for managed care plans providing services in CCI to authorize and pay for extra homecare services beyond what an IHSS social worker has authorized for a consumer enrolled in CCI. However, the managed care plans are prohibited by statute from paying an individual provider of homecare services directly. Further, there is no mechanism in current statute to pay an individual provider to provide these extra homecare services that are authorized and funded by the managed care plans. The managed care plans could contract with a private homecare agency to hire and pay homecare providers to work these additional hours. However, there is no guarantee that the agency would hire the existing IHSS provider, nor is there any way to force a plan to enter into such a contract. In order to maintain the continuity of care necessary for IHSS consumers enrolled in CCI, the managed care plans must find a way to pay providers who provide these additional services.”

2. Background. CMIPS II: The Case Management Information and Payrolling System, is administered by the Office of Systems Integration (OSI) on behalf of DSS to track IHSS case information and process payments for all IHSS providers. CMIPS II, which now serves all 58 counties, was implemented after a multi-year effort to update the original 30-year-old CMIPS system, bringing with it enhanced capacity for making timely changes to the system that better respond to changing statutory requirements.

Coordinated Care Initiative (CCI): The Budget Act of 2012 enacted the CCI, one component of which is a framework for integrating the delivery of medical, behavioral and long-term care services through a single health plan for persons eligible for both Medicare and Medi-Cal. This demonstration project component of the CCI, also known as Cal MediConnect, was originally limited to the following eight counties: Alameda, Los Angeles, Orange, San Diego, San Mateo, Riverside, San Bernardino, and Santa Clara, in which approximately 65% of IHSS recipients reside. Alameda County withdrew from the CCI demonstration in 2014.

The CCI statute expresses Legislative intent that managed care health plans be allowed to authorize and pay for personal care services, and related domestic services, that are provided in addition to the IHSS hours already authorized for a recipient in a CCI demonstration county, at no cost to the county. This bill seeks to implement this intent.

3. Prior Legislation:

1. SB 94 (Senate Budget and Fiscal Review Committee), Chapter 37, Statutes of 2013, enacted changes to the CCI and de-linked CCI components to allow the mandatory enrollment of Medi-Cal and Medicare beneficiaries (dual-eligibles) into Medi-Cal managed care, the integration of long-term services and supports into managed care plans, and the commencement of the IHSS Statewide Authority, to proceed separately from Cal MediConnect.

2. SB 1036 (Senate Budget and Fiscal Review Committee), Chapter 45, Statutes of 2012, was the Human Services budget trailer bill that implemented the human services provisions related to the integration of home- and community-based and long-term care services, including IHSS, into Medi-Cal managed care under the CCI.

3. SB 1008 (Senate Budget and Fiscal Review Committee), Chapter 33, Statutes of 2012, implemented the Duals Demonstration Pilot Project, including integration of long-term services and supports.

Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081

Date of Hearing: April 28, 2015

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Kansen Chu, Chair

ABPCA Bill Id:AB 97

Author:(Weber) – As Amended Ver:March 26, 2015

SUBJECT: In-Home Supportive Services: provider wages

SUMMARY: Requires reprogramming of the Case Management Information and Payrolling System (CMIPS II) for In-Home Supportive Services (IHSS) to enable IHSS recipients in Coordinated Care Initiative (CCI) counties to receive additional services authorized and paid for by managed care health plans.

Specifically, this bill:

1. Requires CMIPS II, the IHSS payrolling system, to be programmed to do all of the following to ensure managed care health plans are able to pay a provider for personal care services and related domestic services that the plan authorizes in addition to the IHSS hours already authorized for a recipient in a CCI county:

1. Receive payments from managed care health plans for the additional hours of service;

2. Issue a single payroll check to providers that covers both the IHSS hours and the hours authorized by the managed care health plan; and

3. Differentiate between IHSS hours and the hours authorized by the managed care health plan for purposes of federal reimbursement and to enable managed care health plans to track the recipient impact of the additional benefits.

EXISTING LAW:

1. Establishes the IHSS program as a benefit available to Medi-Cal beneficiaries that provides in-home care and supportive services to low-income aged, blind, or disabled persons who are unable to provide or care for themselves and who cannot live safely in their homes without assistance. Defines supportive services within the program to include domestic services, personal care services, protective supervision, paramedical services, and other services, as specified. (WIC 12300 et seq.)

2. Requires the Department of Social Services (DSS) to procure and implement a new automated Case Management Information and Payroll System (CMIPS) for the IHSS and Personal Care Services Program. Requires the system to incorporate technology that can be readily enhanced and modernized, and employ open architecture and standards, to the extent possible. (WIC 12317)

3. Establishes the Coordinated Care Initiative (CCI) demonstration project in up to eight counties, subject to federal approval, 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 for those individuals, as specified. (SB 1008 (Senate Budget and Fiscal Review Committee), Chapter 33, Statutes of 2012 and SB 1036 (Senate Budget and Fiscal Review Committee), Chapter 45, Statutes of 2012)

4. Requires, as an additional component of the CCI, that all Medi-Cal long-term services and supports, which include IHSS, be services that are covered under managed care health plan contracts and available only through managed care health plans for beneficiaries residing in counties participating in the CCI demonstration project, with specified exceptions. (WIC 14186 et seq.)

5. Expresses the intent of the Legislature that managed care health plans be allowed to authorize and pay for personal care services and related domestic services that are provided in addition to the IHSS hours already authorized for a recipient in a CCI demonstration county, at no cost to the county. Requires the Department of Health Care Services, in consultation with the Department of Social Services to develop policies and procedures for these additional benefits authorized and paid for by health plans. (WIC 14186 (b)(6)(B))

FISCAL EFFECT: Unknown

COMMENTS:

In-Home Supportive Services (IHSS): The IHSS program provides personal care and domestic services to approximately 420,000 qualified, low-income individuals who are aged, blind, or disabled. Through the IHSS program, recipients are cared for and assisted with activities of daily living, allowing them to remain safely in their own homes and avoid institutionalization. IHSS services include: Paramedical services, such as giving medications and changing a colostomy bag; Non-Medical Personal Care services, such as toileting, dressing, and transportation; Domestic services, such as housework, shopping for groceries and meal preparation; and, Protective supervision for those who, due to cognitive decline or dementia, cannot be left alone for extended periods.

County social workers determine eligibility for IHSS and the authorized hours of care 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. Prior to receiving payment for services, providers must submit to a criminal background check and a provider orientation. IHSS is funded with federal, state, and county resources.

Coordinated Care Initiative (CCI): The Budget Act of 2012 enacted the CCI, one component of which is a framework for integrating the delivery of medical, behavioral and long-term care services through a single health plan for persons eligible for both Medicare and Medi-Cal. This demonstration project component of the CCI, also known as Cal MediConnect, was originally limited to the following eight counties: Alameda, Los Angeles, Orange, San Diego, San Mateo, Riverside, San Bernardino, and Santa Clara, in which approximately 65% of IHSS recipients reside. Alameda County withdrew from the CCI demonstration in 2014.

While CCI-related code sections clearly maintain county responsibility for assessing and reassessing IHSS recipients and determining a recipient’s authorized number of hours, they also spell out the role of the managed care health plans in coordinating services for individuals receiving long-term services and supports (LTSS) and implementing best practices to help recipients of those services avoid institutionalization and experience overall better health outcomes.

Care Plan Option (CPO) services: CCI statute expresses legislative intent that a mechanism be developed to allow managed care health plans to authorize and pay for hours of personal care and domestic and related services for IHSS recipients beyond the hours of IHSS services they receive pursuant to county authorization. More specifically, it calls for the Department of Health Care Services, in consultation with the Department of Social Services, to develop policies and procedures for the additional benefits that the managed care health plans can authorize. It is important to note that CPO services authorized by a managed care health plan, which can be offered to LTSS recipients beyond what is required by law, are prohibited from being used to replace any care and service hours authorized under IHSS. CPO services are intended to enhance a recipient’s care and better support a recipient’s ability to remain at home and avoid institutional care.

In its Duals Plan Letter 13-006, the Department of Health Care Services addresses how CPO service hours are to be used and what steps the Cal MediConnect plans must take to prepare for implementation of CPO services. According to this directive, the plans must create the following:

1. Policies and procedures that guide how LTSS recipients will be assessed for CPO service hours;
   
   

2. Policies and procedures for identifying enrollees that may need CPO services and for referring them to community-based organizations and other available entities that provide these services;
   
   

3. A training curriculum and program for Cal MediConnect plan staff related to the Americans with Disabilities Act, the Olmstead decision, CPO services issues, and community and county home- and community-based services that may be available; and
   
   

4. A grievance system under which enrollees may submit their grievances to their Cal MediConnect plan.

CMIPS II: The Case Management Information and Payrolling System, is administered by the Office of Systems Integration (OSI) on behalf of DSS to track IHSS case information and process payments for all IHSS providers. CMIPS II, which now serves all 58 counties, was implemented after a multi-year effort to update the original 30-year-old CMIPS system, bringing with it enhanced capacity for making timely changes to the system that better respond to changing statutory requirements. The OSI CMIPS II Project Internet Web site indicates that the new system “provides modern web-based case management functionality and sophisticated processing of payroll” and that it “includes over 50 interfaces for timely verifications and interactions.”

Need for this bill: According to the author, “The CCI statute includes the provision for managed care plans providing services in CCI to authorize and pay for extra homecare services beyond what an IHSS social worker has authorized for a consumer enrolled in CCI. However, the managed care plans are prohibited by statute from paying an individual provider of homecare services directly. Further, there is no mechanism in current statute to pay an individual provider to provide these extra homecare services that are authorized and funded by the managed care plans. The managed care plans could contract with a private homecare agency to hire and pay homecare providers to work these additional hours. However, there is no guarantee that the agency would hire the existing IHSS provider to work these hours. Nor is there any way to force a plan to enter into such a contract. In order to maintain the continuity of care necessary for IHSS consumers enrolled in CCI, in other words, in order for the IHSS consumer to have the option to hire his or her existing IHSS provider to work these extra hours, the managed care plans must find a way to pay providers who provide these additional services.”

Staff comments: While this bill seeks to bring the state closer to realizing an important component of the CCI, the requirement to include payment for both IHSS hours authorized by a county and CPO hours authorized by a managed care health plan on a single payroll check could be challenging within the limitations of CMIPS II. Because there is a 283 hour per month cap on the number of hours of care that can be authorized by a county and provided to an IHSS recipient, the current payrolling system will need to be able to produce payments for hours of care that exceed that maximum number. Additionally, because CPO services hours will only apply to CCI enrollees in CCI counties, the payrolling system will need to be reconfigured in a way that can accommodate different needs from one county to another and from one recipient to another.

Conversely, reconfiguring the payrolling system to embrace both sets of authorized hours could help managed care health plans track the benefit of the CPO hours, which is explicit in the language of this bill, as well as help counties and the state track service needs that go unmet within a recipient’s county-authorized IHSS hours. Ultimately, through facilitating the provision of additional personal care and domestic and related services, this bill seeks to increase the number of individuals with high care needs who are able to safely remain at home and avoid institutionalization.

Support for this bill: Further explaining the need for this bill, the Health Plan of San Mateo (HPSM) states, “The CCI legislation included provisions for health plans to authorize IHSS services in addition to those authorized by county social workers. This flexibility is needed to ensure managed care plans could respond timely and nimbly in those situations where a consumer was at risk of entering institutional care. In addition, these CCI provisions allow health plans to continue paying a consumer’s current IHSS provider rather than assigning an unknown provider, without the consumer’s approval, to provide services. HPSM cannot pay providers for additional hours without the payment mechanism proposed in [this bill]; contracting with and paying independent IHSS providers outside CMIPS is beyond the scope of HPSM’s administrative capacity and would not be cost-effective for our health plan.”

PRIOR LEGISLATION:

SB 94 (Senate Budget and Fiscal Review Committee), Chapter 37, Statutes of 2013, enacted changes to existing law regarding the CCI and de-linked CCI components to allow the mandatory enrollment of Medi-Cal and Medicare beneficiaries (dual-eligibles) into Medi-Cal managed care, the integration of long-term services and supports into managed care plans, and the commencement of the IHSS Statewide Authority, to proceed separately from Cal MediConnect.

SB 1036 (Senate Budget and Fiscal Review Committee), Chapter 45, Statutes of 2012, was the Human Services budget trailer bill that contained the necessary statutory changes to implement the human services provisions related to the integration of home- and community-based and long-term care services, including IHSS, into Medi-Cal managed care under the CCI.

SB 1008 (Senate Budget and Fiscal Review Committee), Chapter 33, Statutes of 2012, implemented the Duals Demonstration Pilot Project, including integration of long-term services and supports.

REGISTERED SUPPORT / OPPOSITION:

Support

UDW/AFSCME Local 3930, co-sponsor

American Federation of State, County and Municipal Employees (AFSCME)

California Association of public Authorities (CAPA)

California Commission on Aging

Congress of California Seniors (CCS)

Justice in Aging

Health Plan of San Mateo (HPSM)

Opposition

None on file.

Analysis Prepared by: Myesha Jackson / HUM. S. / (916) 319-2089