AB 675: In-home supportive services.
- Session Year: 2017-2018
- House: Assembly
- Latest Version Date: 2017-04-19
(1)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. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid Program program provisions. Existing law, the Coordinated Care Initiative, provides, among other things, that long-term services and supports, including in-home supportive services (IHSS), are a Medi-Cal benefit available through managed care health plans in specified counties. law provides for the federal Medicare Program, which is a public health insurance program for persons 65 years of age and older and specified persons with disabilities who are under 65 years of age.
Existing law, the Coordinated Care Initiative (CCI), requires the department to seek federal approval pursuant to a Medicare or Medicaid demonstration project or waiver, or a combination thereof, to establish a demonstration project that enables beneficiaries who are dually eligible for the Medi-Cal program and the Medicare Program to receive a continuum of services that maximizes access to, and coordination of, benefits between these programs. Existing law requires, with some exceptions, Medi-Cal beneficiaries who have dual eligibility in the Medi-Cal program and the Medicare Program to be assigned as mandatory enrollees into Medi-Cal managed care health plans for their Medi-Cal benefits in counties participating in the CCI. Existing law conditions implementation of the CCI on whether the Director of Finance estimates that the CCI will generate net General Fund savings, as specified. Existing law, with certain exceptions, specifies those provisions of law that are within the scope of the CCI, including those relating to the demonstration project described above, to become inoperative if this condition is not met.
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 requires, as part of the CCI, Medi-Cal long-term services and supports, including IHSS, to be covered services under managed care health plan contracts and to be available only through managed care health plans to beneficiaries residing in the CCI counties, except as specified.
This bill would provide that the provision conditioning implementation of the CCI on the above-described estimation by the Director of Finance shall not apply to the requirement that IHSS be a covered service available through managed care health plans in CCI counties, and would continue IHSS as a covered service available through Medi-Cal managed care health plans in those counties. The bill would make conforming changes to related provisions.
(2)Existing law permits services to be provided under the IHSS program through the employment of individual providers, a contract between the county and an entity for the provision of services, the creation by the county of a public authority, or a contract between the county and a nonprofit consortium. Under existing law, any public authority created under the IHSS program is deemed to be the employer of in-home support services personnel within the meaning of the Meyers-Milias-Brown Act, which governs local employer-employee relations. Existing law also provides that any nonprofit consortium contracting with a county is deemed the employer of in-home supportive services personnel for the purposes of collective bargaining over wages, hours, and other terms and conditions of employment.
Existing law, as part of the CCI, establishes the California In-Home Supportive Services Authority, referred to as the Statewide Authority, and requires the authority to be the entity authorized to meet and confer in good faith regarding wages, benefits, and other terms and conditions of employment with representatives of recognized employee organizations for any individual provider who is employed by a recipient of supportive services, as specified. Existing law establishes the In-Home Supportive Services Fund within the State Treasury. Existing law requires that moneys in the fund be made available, upon appropriation by the Legislature, to the Statewide Authority for the purposes of funding its functions.
Existing law establishes, as part of the CCI, the In-Home Supportive Services Employer-Employee Relations Act, which serves to resolve disputes regarding wages, benefits, and other terms and conditions of employment between the Statewide Authority and recognized employee organizations providing in-home supportive services. Under the act, the Statewide Authority is deemed to be the employer of record, for purposes of collective bargaining, of individual providers of in-home supportive services in each county, as specified.
This bill would provide that the provision conditioning implementation of the CCI on the above-described estimation by the Director of Finance shall not apply to the provisions establishing the Statewide Authority, the provisions establishing the In-Home Supportive Services Fund, and the IHSS Employer-Employee Relations Act.
(3)Existing law requires the state and counties to share the annual cost of providing in-home supportive services, with the state paying to the county 65% of the nonfederal cost and each county paying 35% of the nonfederal cost. Notwithstanding that provision, existing law requires all counties to have a County IHSS Maintenance of Effort (MOE) and requires counties to pay the County IHSS MOE instead of paying the nonfederal share of IHSS costs, as specified. Existing law provides that the County IHSS MOE base year is the 201112 state fiscal year and requires the County IHSS MOE from the previous year to be annually adjusted by an inflation factor of 3.5%. Existing law conditions the IHSS MOE requirement on the above-described determination by the Director of Finance.
This bill would provide that the provision conditioning implementation of the CCI on the above-described estimation by the Director of Finance shall not apply to the IHSS MOE requirement. The bill would make conforming changes in related provisions.
This bill would appropriate $650,000,000 from the General Fund to the department for the purpose of continuing to make IHSS available to Medi-Cal beneficiaries through Medi-Cal managed care health plans under the Coordinated Care Initiative. pursuant to these provisions.
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. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid Program provisions. Existing law, the Coordinated Care Initiative, provides, among other things, that long-term services and supports, including in-home supportive services (IHSS), are a Medi-Cal benefit available through managed care health plans in specified counties.
This bill would appropriate $650,000,000 from the General Fund to the department for the purpose of continuing to make IHSS available to Medi-Cal beneficiaries through Medi-Cal managed care health plans under the Coordinated Care Initiative.
(a)There is hereby created the California In-Home Supportive Services Authority, hereafter referred to as the Statewide Authority. Notwithstanding any other law, the Statewide Authority shall be deemed a joint powers authority created pursuant to this article and is a public entity separate and apart from the parties that have appointing power to the Statewide Authority or the employers of those individuals so appointed. Notwithstanding the requirements of this article, an agreement shall not be required to create the Statewide Authority.
(b)The Statewide Authority shall consist of the following five members:
(1)Two members shall be county officials who are appointed by, and who serve at the pleasure of, the Governor.
(2)Three members shall be the Director of Social Services, the Director of Health Care Services, and the Director of Finance in their ex officio capacities, or their duly appointed representatives.
(c)The members of the Statewide Authority shall serve without compensation.
(d)The Statewide Authority shall not be subject to Sections 6501, 6505, and 53051.
(e)The Statewide Authority shall appoint an advisory committee that shall be comprised of not more than 13 individuals. No less than 50 percent of the membership of the advisory committee shall be individuals who are current or past users of personal assistance services paid for through public or private funds or recipients of in-home supportive services.
(1)At least two members of the advisory committee shall be a current or former provider of in-home supportive services.
(2)Individuals who represent organizations that advocate for people with disabilities or seniors may be appointed to the advisory committee.
(3)Individuals from each representative organization that are designated representatives of IHSS providers shall be appointed to the advisory committee.
(4)The Statewide Authority shall designate a department employee to provide ongoing advice and support to the advisory committee.
(f)Prior to the appointment of members to a committee authorized by subdivision (e), the Statewide Authority shall solicit recommendations for qualified members through a fair and open process that includes the provision of reasonable written notice to, and reasonable response time by, members of the general public and interested persons and organizations.
(g)The advisory committee established pursuant to subdivision (e) shall provide ongoing advice and recommendations regarding in-home supportive services to the Statewide Authority, the State Department of Social Services, and the State Department of Health Care Services.
(h)Notwithstanding subdivisions (c) and (d) of Section 34 of Chapter 37 of the Statutes of 2013, this section shall not be made inoperative as a result of any determination made by the Director of Finance pursuant to Section 34 of Chapter 37 of the Statutes of 2013.
SEC. 2.Section 110003.5 is added to the Government Code, to read:110003.5.Notwithstanding subdivisions (c) and (d) of Section 34 of Chapter 37 of the Statutes of 2013, this title shall not be made inoperative as a result of any determination made by the Director of Finance pursuant to Section 34 of Chapter 37 of the Statutes of 2013.
SEC. 3.Section 10101.1 of the Welfare and Institutions Code, as amended by Section 5 of Chapter 37 of the Statutes of 2013, is amended to read:10101.1.(a)For the 199192 fiscal year and each fiscal year thereafter, the states share of the costs of the county services block grant and the in-home supportive services administration requirements shall be 70 percent of the actual nonfederal expenditures or the amount appropriated by the Legislature for that purpose, whichever is less.
(b)Federal funds received under Title 20 of the federal Social Security Act (42 U.S.C. Sec. 1397 et seq.) and appropriated by the Legislature for the county services block grant and the in-home supportive services administration shall be considered part of the state share of cost and not part of the federal expenditures for this purpose.
(c)For the period during which Section 12306.15 is operative, each countys share of the nonfederal costs of the county services block grant and the in-home supportive services administration requirements as specified in subdivision (a) shall remain, but the County IHSS Maintenance of Effort pursuant to Section 12306.15 shall be in lieu of that share.
(d)This section shall be inoperative if the Coordinated Care Initiative becomes inoperative pursuant to Section 34 of the act that added this subdivision.(d)Notwithstanding subdivisions (c) and (d) of Section 34 of Chapter 37 of the Statutes of 2013, this section shall not be made inoperative as a result of any determination made by the Director of Finance pursuant to Section 34 of Chapter 37 of the Statutes of 2013.
(e)This section shall be inoperative if Section 12306.15 becomes inoperative.
SEC. 4.Section 10101.1 of the Welfare and Institutions Code, as amended by Section 6 of Chapter 37 of the Statutes of 2013, is amended to read:10101.1.(a)For the 199192 fiscal year and each fiscal year thereafter, the states share of the costs of the county services block grant and the in-home supportive services administration requirements shall be 70 percent of the actual nonfederal expenditures or the amount appropriated by the Legislature for that purpose, whichever is less.
(b)Federal funds received under Title 20 of the federal Social Security Act (42 U.S.C. Sec. 1397 et seq.) and appropriated by the Legislature for the county services block grant and the in-home supportive services administration shall be considered part of the state share of cost and not part of the federal expenditures for this purpose.
(c)This section shall be operative only if Section 5 of the act that added this subdivision becomes inoperative pursuant to subdivision (d) of that Section 5.(c)This section shall be operative if Section 12306.15 becomes inoperative.
SEC. 5.Section 12300.5 of the Welfare and Institutions Code is amended to read:12300.5.(a)The California In-Home Supportive Services Authority, hereafter referred to as the Statewide Authority, established pursuant to Section 6531.5 of the Government Code, shall be the entity authorized to meet and confer in good faith regarding wages, benefits, and other terms and conditions of employment in accordance with Title 23 (commencing with Section 110000) of the Government Code, with representatives of recognized employee organizations for any individual provider who is employed by a recipient of in-home supportive services described in Section 12300 after the county implementation date as described in subdivision (a) of Section 12300.7.
(b)The Statewide Authority and the Department of Human Resources and other state departments may enter into a memorandum of understanding or other agreement to have the Department of Human Resources meet and confer on behalf of the Statewide Authority for the purposes described in subdivision (a) or to provide the Statewide Authority with other services, including, but not limited to, administrative and legal services.
(c)The state, the Statewide Authority, or any county that has met the conditions in Section 12300.7 shall not be deemed to be the employer of any individual provider who is employed by a recipient of in-home supportive services as described in Section 12300 for purposes of liability due to the negligence or intentional torts of the individual provider.
(d)Notwithstanding subdivisions (c) and (d) of Section 34 of Chapter 37 of the Statutes of 2013, this section shall not be made inoperative as a result of any determination made by the Director of Finance pursuant to Section 34 of Chapter 37 of the Statutes of 2013.
SEC. 6.Section 12300.6 of the Welfare and Institutions Code is amended to read:12300.6.(a)There is hereby created the In-Home Supportive Services Fund in the State Treasury. Moneys in the fund shall be made available, upon appropriation by the Legislature, to the California In-Home Supportive Services Authority, for the purposes of funding the functions of the Statewide Authority.
(b)Notwithstanding subdivisions (c) and (d) of Section 34 of Chapter 37 of the Statutes of 2013, this section shall not be made inoperative as a result of any determination made by the Director of Finance pursuant to Section 34 of Chapter 37 of the Statutes of 2013.
SEC. 7.Section 12300.7 of the Welfare and Institutions Code is amended to read:12300.7.(a)No sooner than March 1, 2013, the The California In-Home Supportive Services Authority shall assume the responsibilities set forth in Title 23 (commencing with Section 110000) of the Government Code in a county or city and county upon notification by the Director of Health Care Services that the enrollment of eligible Medi-Cal beneficiaries described in Section 14132.275 or 14182.16, or Article 5.7 (commencing with Section 14186) of Chapter 7 eligible to receive services pursuant to Section 14186.35 has been completed in that county or city and county.
(b)A county or city and county, subject to subdivision (a) and upon notification from the Director of Health Care Services, shall do one or both of the following:
(1)Have the entity that performed functions set forth in the county ordinance or contract in effect at the time of the notification pursuant to subdivision (a) and established pursuant to Section 12301.6 continue to perform those functions, excluding subdivision (c) of that section.
(2)Assume the functions performed by the entity, at the time of the notification pursuant to subdivision (a), pursuant to Section 12301.6, excluding subdivision (c) of that section.
(c)If a county or city and county assumes the functions described in paragraph (2) of subdivision (b), it may establish or contract with an entity for the performance of any or all of the functions assumed.
(d)Notwithstanding subdivisions (c) and (d) of Section 34 of Chapter 37 of the Statutes of 2013, this section shall not be made inoperative as a result of any determination made by the Director of Finance pursuant to Section 34 of Chapter 37 of the Statutes of 2013.
SEC. 8.Section 12302.6 of the Welfare and Institutions Code is amended to read:12302.6.(a)A managed care health plan may enter into contracts pursuant to paragraph (14) of subdivision (a) of Section 14186.35 solely in the manner prescribed in this section.
(b)For purposes of this section:
(1)Agency means a city, county, city and county agency, local health district, proprietary agency, or an entity that has or seeks a contract to provide in-home supportive services pursuant to Section 12301.6 or 12302 or this article.
(2)Contract provider means any person employed by an agency for the provision of services listed in this section.
(3)County means a political unit, unless otherwise indicated.
(4)Department means the State Department of Social Services.
(5)Individual provider means any person authorized to provide in-home supportive services under this article and Sections 14132.95, 14132.952, and 14132.956, pursuant to the individual provider mode referenced in Section 12302.2. As used in this paragraph, individual provider shall not include any person providing in-home supportive services pursuant to a county-employed homemaker mode or a contract provider.
(6)Individual provider rate means the combined total rate for wages and benefits for individual providers, as approved by the Statewide Authority or its delegate.
(7)Managed care health plan shall have the same meaning as set forth in Section 14186.1.
(8)Qualified agency means an agency that has been certified by the department.
(9)Responsible party means an officer or director of the applicant, a shareholder with a beneficial interest in the applicant exceeding 10 percent, or the person who will be primarily responsible for any contract with the managed care health plan.
(10)Statewide Authority means the California In-Home Supportive Services Authority established pursuant to Section 6531.5 of the Government Code.
(c)Managed care health plans shall assume the authority granted to counties pursuant to Section 12302 to contract for the provision of in-home supportive services with an agency.
(1)(A)Managed care health plans shall assume the authority as described in subdivision (a) only upon the integration of the In-Home Supportive Services Program into Medi-Cal managed care pursuant to Article 5.7 (commencing with Section 14186) of Chapter 7 in the counties participating in the demonstration project authorized under Section 14132.275. Section 14816.35. For individuals exempt from the provisions of Article 5.7 (commencing with Section 14186) of Chapter 7, as specified in subdivision (c) of Section 14186.2, Section 14186.35, as specified in subdivision (g) of Section 14186.35, this section shall not apply, and Section 12302 shall apply.
(B)If, at the time a managed care health plan assumes contracting authority pursuant to this subdivision with respect to a particular geographic area, there is an existing contract between the county and an agency for the provision of in-home supportive services, the managed care health plan shall enter into a contract with the county to continue providing the services, and the county shall maintain its existing contract with the agency for the provision of in-home supportive services until such time as that contract is due to expire. Agencies that have these existing contracts with a county at the time a managed care health plan assumes contracting authority pursuant to this subdivision shall automatically be certified as qualified agencies.
(2)An agency that is a county, or has an existing contract with a county, as of the date that the managed care health plan in the corresponding geographic area assumes contracting authority with respect to agencies, shall be deemed to be certified as a qualified agency with respect to the geographic area in which the agency has a contract to provide in-home supportive services with respect to the type of in-home supportive services provided pursuant to that contract. Where a county has an existing contract with an agency, the certification provided for in this subdivision shall remain in effect until the triennial deadline established by paragraph (3) of subdivision (d) that occurs no less than one year after the expiration of the contract in effect at the time that the managed care health plan assumes contracting authority with respect to agencies. However, if an agency that is party to such a contract seeks to expand the geographic area in which it is certified to provide services or seeks to expand the types of services for which it is certified, it must submit an application in accordance with subdivision (d).
(d)An agency contracting with a managed care health plan for the provision of in-home supportive services shall be certified as a qualified agency by the department in consultation with the State Department of Health Care Services.
(1)The certification of an agency as a qualified agency shall be with respect to a specific geographic area and an identified category of services.
(2)The department shall develop an application form and establish the conditions to be met for certification as a qualified agency.
(3)An agency seeking certification as a qualified agency shall submit to the department a verified application showing that it satisfies the conditions established by the department, pursuant to this subdivision, and shall provide the information specified, which shall include all of the following:
(A)The three most recent audited financial statements or other independently verified documentation showing that the applicant maintains liquid assets sufficient to cover 180 days of in-home supportive services operating expenses. A nonprofit or public entity applicant may instead satisfy this requirement by providing a letter of support signed by a representative of the public entity or managed care organization responsible for the majority of the applicants revenue stating its intent to continue to provide funding for IHSS in the event there is a disruption in the applicants revenue.
(B)Evidence of liability and workers compensation insurance.
(C)Evidence that the applicant has not been the subject of bankruptcy proceedings in the last five years.
(4)The department shall establish an annual deadline for submitting applications for certification pursuant to this subdivision. The department shall also establish a triennial deadline for submitting renewals of certification pursuant to this subdivision. The department shall process and approve or deny applications within 120 days of receipt of a completed application.
(5)In determining whether an agency may be certified as a qualified agency, the department, in consultation with the State Department of Health Care Services, shall consider documents and evidence to ensure that, among other things identified by the department, the agency:
(A)Guarantees the continuity and reliability of services to recipients.
(B)Guarantees the supervision of contract providers.
(C)Guarantees that each contract provider has been screened in accordance with Sections 12305.81 and 12305.87.
(D)Guarantees that each contract provider is capable of and is providing the service authorized.
(E)Complies with applicable rules and regulations regarding civil rights.
(F)Is capable of providing high-quality and reliable in-home supportive services.
(G)Is capable of complying with this section, any rules or regulations promulgated under this section, and any applicable federal rules and regulations.
(H)Has not demonstrated a pattern and practice of violations of state or federal laws and regulations based on any available information.
(6)An application for certification under this subdivision may be denied by the department if the department determines that the applying agency or a responsible party has violated a law or regulation that is substantially related to the qualifications or duties of the applying agency or is substantially related to the functions of the business for which certification was, or is to be, issued, or on the ground that an applying agency knowingly made a false statement of fact required to be revealed in an application for certification.
(7)The department shall develop a written appeal process for any agency dissatisfied with the decision of the department regarding certification.
(e)(1)A qualified agency shall submit verified cost reports to the department documenting that the qualified agency is in compliance with subdivision (i). The cost reports shall be verified by the responsible party and by a representative of a certified public accounting firm.
(2)The verified cost reports required by paragraph (1) shall be submitted within 90 calendar days after the end of each year and within 60 calendar days after any change in compensation negotiated by the Statewide Authority for individual providers has gone into effect.
(f)A managed care health plan that has entered into a contract in the manner prescribed in this section shall notify the department within 30 days if the contract between the managed care health plan and the qualified agency is suspended or terminated for any reason.
(g)A recipient of in-home supportive services may only be referred to a qualified agency by the county, managed care health plan, or care coordination teams. Qualified agencies, counties, and managed care health plans shall establish procedures to ensure contract limitations on caseload specified in subdivision (k) are being met and there is coordination of information between managed care health plans, qualified agencies, counties, and the department. When a recipient has been referred by the managed care health plan, the qualified agency may provide services in the following circumstances:
(1)It has been determined that the recipient is unable to function as the employer of the provider due to dementia, cognitive impairment, or other similar issues.
(2)The recipient has been identified to need services under this mode by the care coordination team created pursuant to paragraph (3) of subdivision (b) of Section 14186.
(3)The recipient is unable to retain a provider due to geographic isolation and distance, authorized hours, or other reasons.
(h)When a recipient who is severely impaired, as described in subdivision (b) of Section 12303.4, is referred to a qualified agency by a managed care health plan, the county, or the care coordination team, the qualified agency may provide emergency backup services, as needed, when a provider is unavailable due to vacation, illness, or other extraordinary circumstances, or the recipient is in the process of hiring or replacing a provider. Qualified agencies shall establish procedures to ensure contract limitations on caseload are being met and there is coordination of information between managed care health plans, qualified agencies, counties, and the department.
(i)Service hours provided under this section shall be deducted from the in-home supportive services recipients current authorized hours of services and on an hour-to-hour basis coordinated with the county and the department to ensure hours are accurately captured and not duplicated per in-home supportive services program requirements.
(j)Wages and benefits for contract providers for their provision of in-home supportive services shall not be less than the individual provider rate negotiated by the Statewide Authority for the county where services are provided.
(k)Any contract entered into between a managed care health plan and a qualified agency shall provide for a minimum amount of service utilization and shall be approved by the department. In no case, however, shall in-home supportive services recipients referred for services exceed 5 percent of the in-home supportive services caseload in the county where services are provided.
(l)The department shall establish reasonable fees to be paid by agencies and qualified agencies for administering the provisions of this section, including, but not limited to, fees associated with processing applications for certification and renewals of certification, and fees associated with monitoring and enforcing compliance, including any fees reflecting the costs associated with investigating complaints, to the extent permissible by law. These fees shall be sufficient to cover the departments reasonable costs incurred in administering the provisions of this section.
(m)The state shall be immune from liability resulting from the states implementation of this section or from the negligence or intentional torts of a contract provider providing services pursuant to this section.
(n)Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the department may implement, interpret, or make specific this section by means of all-county letters, or similar instructions, without taking regulatory action. Prior to issuing any letter or similar instrument authorized pursuant to this section, the department shall notify and consult with stakeholders, including beneficiaries, providers, and advocates.
(o)Notwithstanding subdivisions (c) and (d) of Section 34 of Chapter 37 of the Statutes of 2013, this section shall not be made inoperative as a result of any determination made by the Director of Finance pursuant to Section 34 of Chapter 37 of the Statutes of 2013.
SEC. 9.Section 12306 of the Welfare and Institutions Code, as amended by Section 8 of Chapter 37 of the Statutes of 2013, is amended to read:12306.(a)The state and counties shall share the annual cost of providing services under this article as specified in this section.
(b)Except as provided in subdivisions (c) and (d), the state shall pay to each county, from the General Fund and any federal funds received under Title XX of the federal Social Security Act available for that purpose, 65 percent of the cost of providing services under this article, and each county shall pay 35 percent of the cost of providing those services.
(c)For services eligible for federal funding pursuant to Title XIX of the federal Social Security Act under the Medi-Cal program and, except as provided in subdivisions (b) and (d) the state shall pay to each county, from the General Fund and any funds available for that purpose 65 percent of the nonfederal cost of providing services under this article, and each county shall pay 35 percent of the nonfederal cost of providing those services.
(d)(1)For the period of July 1, 1992, to June 30, 1994, inclusive, the states share of the cost of providing services under this article shall be limited to the amount appropriated for that purpose in the annual Budget Act.
(2)The department shall restore the funding reductions required by subdivision (c) of Section 12301, fully or in part, as soon as administratively practicable, if the amount appropriated from the General Fund for the 199293 fiscal year under this article is projected to exceed the sum of the General Fund expenditures under Section 14132.95 and the actual General Fund expenditures under this article for the 199293 fiscal year. The entire amount of the excess shall be applied to the restoration. Services shall not be restored under this paragraph until the Department of Finance has determined that the restoration of services would result in no additional costs to the state or to the counties relative to the combined state appropriation and county matching funds for in-home supportive services under this article in the 199293 fiscal year.
(e)For the period during which Section 12306.15 is operative, each countys share of the costs of providing services pursuant to this article specified in subdivisions (b) and (c) shall remain, but the County IHSS Maintenance of Effort pursuant to Section 12306.15 shall be in lieu of that share.
(f)This section shall be inoperative if the Coordinated Care Initiative becomes inoperative pursuant to Section 34 of the act that added this subdivision.(f)Notwithstanding subdivisions (c) and (d) of Section 34 of Chapter 37 of the Statutes of 2013, this section shall not be made inoperative as a result of any determination made by the Director of Finance pursuant to Section 34 of Chapter 37 of the Statutes of 2013.
(g)This section shall be inoperative if Section 12306.15 becomes inoperative.
SEC. 10.Section 12306 of the Welfare and Institutions Code, as amended by Section 9 of Chapter 37 of the Statutes of 2013, is amended to read:12306.(a)The state and counties shall share the annual cost of providing services under this article as specified in this section.
(b)Except as provided in subdivisions (c) and (d), the state shall pay to each county, from the General Fund and any federal funds received under Title XX of the federal Social Security Act available for that purpose, 65 percent of the cost of providing services under this article, and each county shall pay 35 percent of the cost of providing those services.
(c)For services eligible for federal funding pursuant to Title XIX of the federal Social Security Act under the Medi-Cal program and, except as provided in subdivisions (b) and (d) the state shall pay to each county, from the General Fund and any funds available for that purpose 65 percent of the nonfederal cost of providing services under this article, and each county shall pay 35 percent of the nonfederal cost of providing those services.
(d)(1)For the period of July 1, 1992, to June 30, 1994, inclusive, the states share of the cost of providing services under this article shall be limited to the amount appropriated for that purpose in the annual Budget Act.
(2)The department shall restore the funding reductions required by subdivision (c) of Section 12301, fully or in part, as soon as administratively practicable, if the amount appropriated from the General Fund for the 199293 fiscal year under this article is projected to exceed the sum of the General Fund expenditures under Section 14132.95 and the actual General Fund expenditures under this article for the 199293 fiscal year. The entire amount of the excess shall be applied to the restoration. Services shall not be restored under this paragraph until the Department of Finance has determined that the restoration of services would result in no additional costs to the state or to the counties relative to the combined state appropriation and county matching funds for in-home supportive services under this article in the 199293 fiscal year.
(e)This section shall be operative only if Section 8 of the act that added this subdivision becomes inoperative pursuant to subdivision (f) of that Section 8.(e)This section shall become operative only if Section 12306.15 becomes inoperative.
SEC. 11.Section 12306.1 of the Welfare and Institutions Code, as amended by Section 10 of Chapter 37 of the Statutes of 2013, is amended to read:12306.1.(a)When any increase in provider wages or benefits is negotiated or agreed to by a public authority or nonprofit consortium under Section 12301.6, then the county shall use county-only funds to fund both the county share and the state share, including employment taxes, of any increase in the cost of the program, unless otherwise provided for in the annual Budget Act or appropriated by statute. No increase in wages or benefits negotiated or agreed to pursuant to this section shall take effect unless and until, prior to its implementation, the department has obtained the approval of the State Department of Health Care Services for the increase pursuant to a determination that it is consistent with federal law and to ensure federal financial participation for the services under Title XIX of the federal Social Security Act, and unless and until all of the following conditions have been met:
(1)Each county has provided the department with documentation of the approval of the county board of supervisors of the proposed public authority or nonprofit consortium rate, including wages and related expenditures. The documentation shall be received by the department before the department and the State Department of Health Care Services may approve the increase.
(2)Each county has met department guidelines and regulatory requirements as a condition of receiving state participation in the rate.
(b)Any rate approved pursuant to subdivision (a) shall take effect commencing on the first day of the month subsequent to the month in which final approval is received from the department. The department may grant approval on a conditional basis, subject to the availability of funding.
(c)The state shall pay 65 percent, and each county shall pay 35 percent, of the nonfederal share of wage and benefit increases negotiated by a public authority or nonprofit consortium pursuant to Section 12301.6 and associated employment taxes, only in accordance with subdivisions (d) to (f), inclusive.
(d)(1)The state shall participate as provided in subdivision (c) in wages up to seven dollars and fifty cents ($7.50) per hour and individual health benefits up to sixty cents ($0.60) per hour for all public authority or nonprofit consortium providers. This paragraph shall be operative for the 200001 fiscal year and each year thereafter unless otherwise provided in paragraphs (2), (3), (4), and (5), and without regard to when the wage and benefit increase becomes effective.
(2)The state shall participate as provided in subdivision (c) in a total of wages and individual health benefits up to nine dollars and ten cents ($9.10) per hour, if wages have reached at least seven dollars and fifty cents ($7.50) per hour. Counties shall determine, pursuant to the collective bargaining process provided for in subdivision (c) of Section 12301.6, what portion of the nine dollars and ten cents ($9.10) per hour shall be used to fund wage increases above seven dollars and fifty cents ($7.50) per hour or individual health benefit increases, or both. This paragraph shall be operative for the 200102 fiscal year and each fiscal year thereafter, unless otherwise provided in paragraphs (3), (4), and (5).
(3)The state shall participate as provided in subdivision (c) in a total of wages and individual health benefits up to ten dollars and ten cents ($10.10) per hour, if wages have reached at least seven dollars and fifty cents ($7.50) per hour. Counties shall determine, pursuant to the collective bargaining process provided for in subdivision (c) of Section 12301.6, what portion of the ten dollars and ten cents ($10.10) per hour shall be used to fund wage increases above seven dollars and fifty cents ($7.50) per hour or individual health benefit increases, or both. This paragraph shall be operative commencing with the next state fiscal year for which the May Revision forecast of General Fund revenue, excluding transfers, exceeds by at least 5 percent, the most current estimate of revenue, excluding transfers, for the year in which paragraph (2) became operative.
(4)The state shall participate as provided in subdivision (c) in a total of wages and individual health benefits up to eleven dollars and ten cents ($11.10) per hour, if wages have reached at least seven dollars and fifty cents ($7.50) per hour. Counties shall determine, pursuant to the collective bargaining process provided for in subdivision (c) of Section 12301.6, what portion of the eleven dollars and ten cents ($11.10) per hour shall be used to fund wage increases or individual health benefits, or both. This paragraph shall be operative commencing with the next state fiscal year for which the May Revision forecast of General Fund revenue, excluding transfers, exceeds by at least 5 percent, the most current estimate of revenues, excluding transfers, for the year in which paragraph (3) became operative.
(5)The state shall participate as provided in subdivision (c) in a total cost of wages and individual health benefits up to twelve dollars and ten cents ($12.10) per hour, if wages have reached at least seven dollars and fifty cents ($7.50) per hour. Counties shall determine, pursuant to the collective bargaining process provided for in subdivision (c) of Section 12301.6, what portion of the twelve dollars and ten cents ($12.10) per hour shall be used to fund wage increases above seven dollars and fifty cents ($7.50) per hour or individual health benefit increases, or both. This paragraph shall be operative commencing with the next state fiscal year for which the May Revision forecast of General Fund revenue, excluding transfers, exceeds by at least 5 percent, the most current estimate of revenues, excluding transfers, for the year in which paragraph (4) became operative.
(e)(1)On or before May 14 immediately prior to the fiscal year for which state participation is provided under paragraphs (2) to (5), inclusive, of subdivision (d), the Director of Finance shall certify to the Governor, the appropriate committees of the Legislature, and the department that the condition for each subdivision to become operative has been met.
(2)For purposes of certifications under paragraph (1), the General Fund revenue forecast, excluding transfers, that is used for the relevant fiscal year shall be calculated in a manner that is consistent with the definition of General Fund revenues, excluding transfers, that was used by the Department of Finance in the 200001 Governors Budget revenue forecast as reflected on Schedule 8 of the Governors Budget.
(f)Any increase in overall state participation in wage and benefit increases under paragraphs (2) to (5), inclusive, of subdivision (d), shall be limited to a wage and benefit increase of one dollar ($1) per hour with respect to any fiscal year. With respect to actual changes in specific wages and health benefits negotiated through the collective bargaining process, the state shall participate in the costs, as approved in subdivision (c), up to the maximum levels as provided under paragraphs (2) to (5), inclusive, of subdivision (d).
(g)For the period during which Section 12306.15 is operative, each countys share of the costs of negotiated wage and benefit increases specified in subdivision (c) shall remain, but the County IHSS Maintenance of Effort pursuant to Section 12306.15 shall be in lieu of that share.
(h)This section shall be inoperative if the Coordinated Care Initiative becomes inoperative pursuant to Section 34 of the act that added this subdivision.(h)Notwithstanding subdivisions (c) and (d) of Section 34 of Chapter 37 of the Statutes of 2013, this section shall not be made inoperative as a result of any determination made by the Director of Finance pursuant to Section 34 of Chapter 37 of the Statutes of 2013.
(i)This section shall be inoperative if Section 12306.15 becomes inoperative.
SEC. 12.Section 12306.1 of the Welfare and Institutions Code, as amended by Section 11 of Chapter 37 of the Statutes of 2013, is amended to read:12306.1.(a)When any increase in provider wages or benefits is negotiated or agreed to by a public authority or nonprofit consortium under Section 12301.6, then the county shall use county-only funds to fund both the county share and the state share, including employment taxes, of any increase in the cost of the program, unless otherwise provided for in the annual Budget Act or appropriated by statute. No increase in wages or benefits negotiated or agreed to pursuant to this section shall take effect unless and until, prior to its implementation, the department has obtained the approval of the State Department of Health Care Services for the increase pursuant to a determination that it is consistent with federal law and to ensure federal financial participation for the services under Title XIX of the federal Social Security Act, and unless and until all of the following conditions have been met:
(1)Each county has provided the department with documentation of the approval of the county board of supervisors of the proposed public authority or nonprofit consortium rate, including wages and related expenditures. The documentation shall be received by the department before the department and the State Department of Health Care Services may approve the increase.
(2)Each county has met department guidelines and regulatory requirements as a condition of receiving state participation in the rate.
(b)Any rate approved pursuant to subdivision (a) shall take effect commencing on the first day of the month subsequent to the month in which final approval is received from the department. The department may grant approval on a conditional basis, subject to the availability of funding.
(c)The state shall pay 65 percent, and each county shall pay 35 percent, of the nonfederal share of wage and benefit increases negotiated by a public authority or nonprofit consortium pursuant to Section 12301.6 and associated employment taxes, only in accordance with subdivisions (d) to (f), inclusive.
(d)(1)The state shall participate as provided in subdivision (c) in wages up to seven dollars and fifty cents ($7.50) per hour and individual health benefits up to sixty cents ($0.60) per hour for all public authority or nonprofit consortium providers. This paragraph shall be operative for the 200001 fiscal year and each year thereafter unless otherwise provided in paragraphs (2), (3), (4), and (5), and without regard to when the wage and benefit increase becomes effective.
(2)The state shall participate as provided in subdivision (c) in a total of wages and individual health benefits up to nine dollars and ten cents ($9.10) per hour, if wages have reached at least seven dollars and fifty cents ($7.50) per hour. Counties shall determine, pursuant to the collective bargaining process provided for in subdivision (c) of Section 12301.6, what portion of the nine dollars and ten cents ($9.10) per hour shall be used to fund wage increases above seven dollars and fifty cents ($7.50) per hour or individual health benefit increases, or both. This paragraph shall be operative for the 200102 fiscal year and each fiscal year thereafter, unless otherwise provided in paragraphs (3), (4), and (5).
(3)The state shall participate as provided in subdivision (c) in a total of wages and individual health benefits up to ten dollars and ten cents ($10.10) per hour, if wages have reached at least seven dollars and fifty cents ($7.50) per hour. Counties shall determine, pursuant to the collective bargaining process provided for in subdivision (c) of Section 12301.6, what portion of the ten dollars and ten cents ($10.10) per hour shall be used to fund wage increases above seven dollars and fifty cents ($7.50) per hour or individual health benefit increases, or both. This paragraph shall be operative commencing with the next state fiscal year for which the May Revision forecast of General Fund revenue, excluding transfers, exceeds by at least 5 percent, the most current estimate of revenue, excluding transfers, for the year in which paragraph (2) became operative.
(4)The state shall participate as provided in subdivision (c) in a total of wages and individual health benefits up to eleven dollars and ten cents ($11.10) per hour, if wages have reached at least seven dollars and fifty cents ($7.50) per hour. Counties shall determine, pursuant to the collective bargaining process provided for in subdivision (c) of Section 12301.6, what portion of the eleven dollars and ten cents ($11.10) per hour shall be used to fund wage increases or individual health benefits, or both. This paragraph shall be operative commencing with the next state fiscal year for which the May Revision forecast of General Fund revenue, excluding transfers, exceeds by at least 5 percent, the most current estimate of revenues, excluding transfers, for the year in which paragraph (3) became operative.
(5)The state shall participate as provided in subdivision (c) in a total cost of wages and individual health benefits up to twelve dollars and ten cents ($12.10) per hour, if wages have reached at least seven dollars and fifty cents ($7.50) per hour. Counties shall determine, pursuant to the collective bargaining process provided for in subdivision (c) of Section 12301.6, what portion of the twelve dollars and ten cents ($12.10) per hour shall be used to fund wage increases above seven dollars and fifty cents ($7.50) per hour or individual health benefit increases, or both. This paragraph shall be operative commencing with the next state fiscal year for which the May Revision forecast of General Fund revenue, excluding transfers, exceeds by at least 5 percent, the most current estimate of revenues, excluding transfers, for the year in which paragraph (4) became operative.
(e)(1)On or before May 14 immediately prior to the fiscal year for which state participation is provided under paragraphs (2) to (5), inclusive, of subdivision (d), the Director of Finance shall certify to the Governor, the appropriate committees of the Legislature, and the department that the condition for each subdivision to become operative has been met.
(2)For purposes of certifications under paragraph (1), the General Fund revenue forecast, excluding transfers, that is used for the relevant fiscal year shall be calculated in a manner that is consistent with the definition of General Fund revenues, excluding transfers, that was used by the Department of Finance in the 200001 Governors Budget revenue forecast as reflected on Schedule 8 of the Governors Budget.
(f)Any increase in overall state participation in wage and benefit increases under paragraphs (2) to (5), inclusive, of subdivision (d), shall be limited to a wage and benefit increase of one dollar ($1) per hour with respect to any fiscal year. With respect to actual changes in specific wages and health benefits negotiated through the collective bargaining process, the state shall participate in the costs, as approved in subdivision (c), up to the maximum levels as provided under paragraphs (2) to (5), inclusive, of subdivision (d).
(g)This section shall be operative only if Section 10 of the act that added this subdivision becomes inoperative pursuant to subdivision (h) of that Section 10.(g)This section shall be inoperative if Section 12306.15 becomes inoperative.
SEC. 13.Section 12306.15 of the Welfare and Institutions Code is amended to read:12306.15.(a)Commencing July 1, 2012, all All counties shall have a County IHSS Maintenance of Effort (MOE). In lieu of paying the nonfederal share of IHSS costs as specified in Sections 10101.1, 12306, and 12306.1, counties shall pay the County IHSS MOE.
(b)(1)The County IHSS MOE base year shall be the 201112 state fiscal year. The County IHSS MOE base shall be defined as the amount actually expended by each county on IHSS services and administration in the County IHSS MOE base year, as reported by each county to the department, except that for administration, the County IHSS MOE base shall include no more or no less than the full match for the countys allocation from the state.
(2)Administration expenditures shall include both county administration and public authority administration. The County IHSS MOE base shall be unique to each individual county.
(3)For a county that made 14 months of health benefit payments for IHSS providers in the 201112 fiscal year, the Department of Finance shall adjust that countys County IHSS MOE base calculation.
(4)The County IHSS MOE base for each county shall be no less than each countys 201112 expenditures for the Personal Care Services Program and IHSS used in the caseload growth calculation pursuant to Section 17605.
(c)(1)On July 1, 2014, the County IHSS MOE base shall be adjusted by an inflation factor of 3.5 percent.
(2)Beginning on July 1, 2015, and annually thereafter, the County IHSS MOE from the previous year shall be adjusted by an inflation factor of 3.5 percent.
(3)(A)Notwithstanding paragraphs (1) and (2), in fiscal years when the combined total of 1991 realignment revenues received pursuant to Sections 11001.5, 6051.2, and 6201.2 of the Revenue and Taxation Code, for the prior fiscal year is less than the combined total received for the next prior fiscal year, the inflation factor shall be zero.
(B)The Department of Finance shall provide notification to the appropriate legislative fiscal committees and the California State Association of Counties by May 14 of each year whether the inflation factor will apply for the following fiscal year, based on the calculation in subparagraph (A).
(d)In addition to the adjustment in subdivision (c), the County IHSS MOE shall be adjusted for the annualized cost of increases in provider wages or health benefits that are locally negotiated, mediated, or imposed before the Statewide Authority assumes the responsibilities set forth in Section 110011 of the Government Code for a given county as provided in Section 12300.7.
(1)(A)If the department approves the rates and other economic terms for a locally negotiated, mediated, or imposed increase in the provider wages, health benefits, or other economic terms pursuant to Section 12306.1 and paragraph (3), the state shall pay 65 percent, and the affected county shall pay 35 percent, of the nonfederal share of the cost increase in accordance with subparagraph (B).
(B)With respect to any increase in provider wages or health benefits approved after July 1, 2012, pursuant to subparagraph (A), the state shall participate in that increase as provided in subparagraph (A) up to the amount specified in subdivision (d) of Section 12306.1.
(C)The county share of these expenditures shall be included in the County IHSS MOE, in addition to the amount established under subdivisions (b) and (c). For any increase in provider wages or health benefits that becomes effective on a date other than July 1, the Department of Finance shall adjust the countys County IHSS MOE to reflect the annualized cost of the countys share of the nonfederal cost of the wage or health benefit increase.
(2)(A)If the department does not approve the rates and other economic terms for a locally negotiated, mediated, or imposed increase in the provider wages, health benefits, or other economic terms pursuant to Section 12306.1 or paragraph (3), the county shall pay the entire nonfederal share of the cost increase.
(B)The county share of these expenditures shall be included in the County IHSS MOE, in addition to the amount established under subdivisions (b) and (c). For any increase in provider wages or health benefits that becomes effective on a date other than July 1, the Department of Finance shall adjust the countys County IHSS MOE to reflect the annualized cost of the countys share of the nonfederal cost of the wage or health benefit increase.
(3)In addition to the rate approval requirements in Section 12306.1, it shall be presumed by the department that locally negotiated rates and other economic terms within the following limits are approved:
(A)A net increase in the combined total of wages and health benefits of up to 10 percent per year above the current combined total of wages and health benefits paid in that county.
(B)A cumulative total of up to 20 percent in the sum of the combined total of changes in wages or health benefits, or both, until the Statewide Authority assumes the responsibilities set forth in Section 110011 of the Government Code for a given county as provided in Section 12300.7.
(e)The County IHSS MOE shall only be adjusted pursuant to subdivisions (c) and (d).
(f)The Department of Finance shall consult with the California State Association of Counties to implement the County IHSS MOE, which shall include, but not be limited to, determining each countys County IHSS MOE base pursuant to subdivision (b), developing the computation for the annualized amount pursuant to subdivision (d), and the process by which it will be determined that each county has met its County IHSS MOE each year.
(g)Notwithstanding subdivisions (c) and (d) of Section 34 of Chapter 37 of the Statutes of 2013, this section shall not be made inoperative as a result of any determination made by the Director of Finance pursuant to Section 34 of Chapter 37 of the Statutes of 2013.
SEC. 14.Section 12330 of the Welfare and Institutions Code is amended to read:12330.(a)No later than January 1, 2014, the The department, in consultation with the State Department of Health Care Services, and in collaboration with stakeholders including, but not limited to, IHSS recipients and recognized employee representatives, shall develop a training curriculum for IHSS providers that shall address issues of consistency, accountability, and increased quality of care for IHSS recipients.
(b)Participation in the training developed pursuant to subdivision (a) shall be voluntary.
(c) Nothing in this section shall require that training be funded by the state.
(d)This section shall not be construed to preclude a managed care health plan, as part of the care coordination team, from developing recipient-specific voluntary training curriculum for an IHSS provider who has been integrated into a beneficiarys care coordination team.
(e)The IHSS recipient shall continue to have the right to train his or her individual provider.
(f)Notwithstanding subdivisions (c) and (d) of Section 34 of Chapter 37 of the Statutes of 2013, this section shall not be made inoperative as a result of any determination made by the Director of Finance pursuant to Section 34 of Chapter 37 of the Statutes of 2013.
SEC. 15.Section 14186.35 of the Welfare and Institutions Code is amended to read:14186.35.(a)Not sooner than March 1, 2013, in-home In-home supportive services (IHSS) shall be a Medi-Cal benefit available through managed care health plans in a county where this article is effective. the Counties of Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. Managed care health plans shall cover IHSS in accordance with the standards and requirements set forth in Article 7 (commencing with Section 12300) of Chapter 3. Specifically, managed care health plans shall do all of the following:
(1)Ensure access to, provision of, and payment for IHSS for individuals who meet the eligibility criteria for IHSS.
(2)Ensure recipients retain the right to be the employer, to select, engage, direct, supervise, schedule, and terminate IHSS providers in accordance with Section 12301.6.
(3)Assume all financial liability for payment of IHSS services for recipients receiving said services pursuant to managed care.
(4)Create a care coordination team, as needed, unless the consumer objects. If the consumer is an IHSS recipient, his or her participation and the participation of his or her provider shall be at the recipients option. The care coordination team shall include the consumer, his or her authorized representative, managed care health plan, county social services agency, Community Based Adult Services (CBAS) case manager for CBAS clients, Multipurpose Senior Services Program (MSSP) case manager for MSSP clients, and may include others as identified by the consumer.
(5)Maintain the paramedical role and function of providers as authorized pursuant to Sections 12300 and 12301.
(6)Ensure compliance with all requirements set forth in Section 14132.956 and any resulting state plan amendments.
(7)Adhere to quality assurance provisions and individual data and other standards and requirements as specified by the State Department of Social Services including state and federal quality assurance requirements.
(8)Share confidential beneficiary data with the contractors specified in this section to improve care coordination, promote shared understanding of the consumers needs, and ensure appropriate access to IHSS and other long-term services and supports.
(9)(A)Enter into a memorandum of understanding with a county agency and the countys public authority or nonprofit consortium pursuant to Section 12301.6 to continue to perform their respective functions and responsibilities pursuant to the existing ordinance or contract until the Director of Health Care Services provides notification pursuant to subdivision (a) of Section 12300.7 for that county.
(B)Following the notification pursuant to subdivision (a) of Section 12300.7, enter into a memorandum of understanding with the county agencies to perform the following activities:
(i)Assess, approve, and authorize each recipients initial and continuing need for services pursuant to Article 7 (commencing with Section 12300) of Chapter 3. County agency assessments shall be shared with the care coordination teams established under paragraph (4), when applicable, and the county agency thereafter may receive and consider additional input from the care coordination team.
(ii)Plans may contract with counties for additional assessments for purposes of paragraph (6) of subdivision (b) of Section 14186.(iii)(ii)Enroll providers, conduct provider orientation, and retain enrollment documentation pursuant to Sections 12301.24 and 12305.81.
(iv)(iii)Conduct criminal background checks on all potential providers and exclude providers consistent with the provisions set forth in Sections 12305.81, 12305.86, and 12305.87.
(v)(iv)Provide assistance to IHSS recipients in finding eligible providers through the establishment of a provider registry as well as provide training for providers and recipients as set forth in Section 12301.6.
(vi)(v)Refer all providers to the California In-Home Supportive Services Authority or nonprofit consortium for the purposes of wages, benefits, and other terms and conditions of employment in accordance with subdivision (a) of Section 12300.7 and Title 23 (commencing with Section 110000) of the Government Code.
(vii)(vi)Pursue overpayment recovery pursuant to Section 12305.83.
(viii)(vii)Perform quality assurance activities including routine case reviews, home visits, and detecting and reporting suspected fraud pursuant to Section 12305.71.
(ix)(viii)Share confidential data necessary to implement the provisions of this section.
(x)(ix)Appoint an advisory committee of not more than 11 people, and no less than 50 percent of the membership of the advisory committee shall be individuals who are current or past users of personal assistance paid for through public or private funds or recipients of IHSS services.
(xi)(x)Continue to perform other functions necessary for the administration of the IHSS program pursuant to Article 7 (commencing with Section 12300) of Chapter 3 and regulations promulgated by the State Department of Social Services pursuant to that article.
(C)A county may contract with an entity or may establish a public authority pursuant to Section 12301.6 for the performance of any or all of the activities set forth in a contract with a managed care health plan pursuant to this section.
(10)Enter into a contract with the State Department of Social Services to perform the following activities:
(A)Pay wages and benefits to IHSS providers in accordance with the wages and benefits negotiated pursuant to Title 23 (commencing with Section 110000) of the Government Code.
(B)Perform obligations on behalf of the IHSS recipient as the employer of his or her provider, including unemployment compensation, disability benefits, applicable federal and state taxes, and federal old age survivors and disability insurance through the states payroll system for IHSS in accordance with Sections 12302.2 and 12317.
(C)Provide technical assistance and support for all payroll-related activities involving the states payroll system for IHSS, including, but not limited to, the monthly restaurant allowance as set forth in Section 12303.7, the monthly cash payment in advance as set forth in Section 12304, and the direct deposit program as set forth in Section 12304.4.
(D)Share recipient and provider data with managed care health plans for members who are receiving IHSS to support care coordination.
(E)Provide an option for managed care health plans to participate in quality monitoring activities conducted by the State Department of Social Services pursuant to subdivision (f) of Section 12305.7 for recipients who are plan members.
(11)In concert with the department, timely reimburse the state for payroll and other obligations of the beneficiary as the employer, including unemployment compensation, disability benefits, applicable federal and state taxes, and federal old age survivors and disability insurance benefits through the states payroll system.
(12)In a county where services are provided in the homemaker mode, enter into a contract with the county to implement the provision of services pursuant to the homemaker mode as set forth in Section 12302.
(13)Retain the IHSS individual provider mode as a choice available to beneficiaries in all participating managed care health plans in each county.
(14)In a county where services are provided pursuant to a contract, and as needed, enter into a contract with a city, county, or city and county agency, a local health district, a voluntary nonprofit agency, or a proprietary agency as set forth in Section 12302 and in accordance with Section 12302.6.
(15)Assume the financial risk associated with the cost of payroll and associated activities set forth in paragraph (10).
(b)IHSS recipients receiving services through managed care health plans shall retain all of the following:
(1)The responsibilities as the employer of the IHSS provider for the purposes of hiring, firing, and supervising their provider of choice as set forth in Section 12301.6.
(2)The ability to appeal any action relating to his or her application for or receipt of services pursuant to Article 7 (commencing with Section 12300) of Chapter 3.
(3)The right to employ a provider applicant who has been convicted of an offense specified in Section 12305.87 by submitting a waiver of the exclusion.
(4)The ability to request a reassessment pursuant to Section 12301.1.
(c)The department and the State Department of Social Services, along with the counties, managed care health plans, consumers, advocates, and other stakeholders, shall develop a referral process and informational materials for the appeals process that is applicable to home- and community-based services plan benefits authorized by a managed care health plan. The process established by this paragraph shall ensure ease of access for consumers.
(d)For services provided through managed care health plans, the IHSS provider shall continue to adhere to the requirements set forth in subdivision (b) of Section 12301.24, subdivision (a) of Section 12301.25, subdivision (a) of Section 12305.81, and subdivision (a) of Section 12306.5.
(e)In accordance with Section 14186.2, as the provision of IHSS transitions to managed care health plans in a phased-in approach, the State Department of Social Services shall do all of the following:
(1)Retain program administration functions, in coordination with the department, including policy development, provider appeals and general exceptions, and quality assurance and program integrity for the IHSS program in accordance with Article 7 (commencing with Section 12300) of Chapter 3.
(2)Perform the obligations on behalf of the recipient as employer relating to workers compensation as set forth in Section 12302.2 and Section 12302.21 for those entities that have entered into a contract with a managed care health plan pursuant to Section 12302.6.
(3)Retain responsibilities related to the hearing process for IHSS recipient appeals as set forth in Chapter 7 (commencing with Section 10950) of Part 2.
(4)Continue to have access to and provide confidential recipient data necessary for the administration of the program.
(f)A managed care health plan shall not be deemed be the employer of an individual in-home supportive services provider referred to recipients under this section for purposes of liability due to the negligence or intentional torts of the individual provider.
(g)(1)The provisions of this article shall not apply to any of the following individuals:
(A)Medi-Cal beneficiaries who meet any of the following and shall, therefore, continue to receive any medically necessary Medi-Cal benefits, including IHSS, through fee-for-service Medi-Cal:
(i)Except in counties with county organized health systems operating pursuant to Article 2.8 (commencing with Section 14087.5) have other health coverage.
(ii)Receive services through any state foster care program, including the program described in Article 5 (commencing with Section 11400) of Chapter 2, unless the beneficiary is already receiving services through a managed care health plan.
(iii)Are not eligible for enrollment in managed care health plans for medically necessary reasons determined by the department.
(iv)Reside in one of the Veterans Homes of California, as described in Chapter 1 (commencing with Section 1010) of Division 5 of the Military and Veterans Code.
(B)Persons enrolled in the Program of All-Inclusive Care for the Elderly (PACE) pursuant to Chapter 8.75 (commencing with Section 14591), or a managed care organization licensed under the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code) that has previously contracted with the department as a primary care case management plan pursuant to Article 2.9 (commencing with Section 14088) of Chapter 7 to provide services to beneficiaries who are HIV-positive or who have been diagnosed with AIDS.
(C)Persons who are under 21 years of age.
(D)Other specific categories of beneficiaries specified by the department based on extraordinary medical needs of specific patient groups or to meet federal requirements, in consultation with stakeholders.
(2)Beneficiaries who have been diagnosed with HIV/AIDS are not exempt from mandatory enrollment, but may opt out of managed care enrollment at the beginning of any month.
(h)For purposes of this section, the following definitions shall apply:
(1)In-home supportive services (IHSS) means services provided pursuant to Article 7 (commencing with Section 12300) of Chapter 3, and Sections 14132.95, 14132.952, and 14132.956.
(2)Managed care health plan means an individual, organization, or entity that enters into a contract with the department pursuant to Article 2.7 (commencing with Section 14087.3), Article 2.8 (commencing with Section 14087.5), Article 2.81 (commencing with Section 14087.96), or Article 2.91 (commencing with Section 14089), of this chapter, or Chapter 8 (commencing with Section 14200). For purposes of this article, managed care health plan shall not include an individual, organization, or entity that enters into a contract with the department to provide services pursuant to Chapter 8.75 (commencing with Section 14591) or the Senior Care Action Network.
(3)Other health coverage means health coverage providing the same full or partial benefits as the Medi-Cal program, health coverage under another state or federal medical care program except for the Medicare Program (Title XVIII of the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.)), or health coverage under a contractual or legal entitlement, including, but not limited to, a private group or indemnification insurance program.
(4)Recipient means a Medi-Cal beneficiary eligible for IHSS provided pursuant to Article 7 (commencing with Section 12300) of Chapter 3, and Sections 14132.95, 14132.952, and 14132.956.
(i)This section shall be implemented only to the extent that all necessary federal approvals and waivers have been obtained and only if and to the extent that federal financial participation is available.
(j)Notwithstanding subdivisions (c) and (d) of Section 34 of Chapter 37 of the Statutes of 2013, this section shall not be made inoperative as a result of any determination made by the Director of Finance pursuant to Section 34 of Chapter 37 of the Statutes of 2013.
SECTION 1.SEC. 16.The sum of six hundred fifty million dollars ($650,000,000) is hereby appropriated from the General Fund to the State Department of Health Care Services for the purpose of continuing the provision of in-home supportive services as a benefit available through Medi-Cal managed care health plans in Coordinated Care Initiative counties pursuant to Section 14186.35 of the Welfare and Institutions Code. in the state pursuant to the provisions of this act.
The sum of six hundred fifty million dollars ($650,000,000) is hereby appropriated from the General Fund to the State Department of Health Care Services for the purpose of continuing the provision of in-home supportive services as a benefit available through Medi-Cal managed care health plans in Coordinated Care Initiative counties pursuant to Section 14186.35 of the Welfare and Institutions Code.
REVISIONS: HeadingLine 2.|
Date
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Status
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| Feb 1, 2018 | From committee: Filed with the Chief Clerk pursuant to Joint Rule 56. |
| Jan 31, 2018 | Died pursuant to Art. IV, Sec. 10(c) of the Constitution. |
| May 26, 2017 | In committee: Held under submission. |
| May 17, 2017 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| Apr 26, 2017 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 7. Noes 0.) (April 25). Re-referred to Com. on APPR. |
| Apr 20, 2017 | Re-referred to Com. on HUM. S. |
| Apr 19, 2017 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HUM. S. Read second time and amended. |
| Apr 5, 2017 | From committee: Do pass and re-refer to Com. on HUM. S. (Ayes 15. Noes 0.) (April 4). Re-referred to Com. on HUM. S. |
| Mar 14, 2017 | Coauthors revised. |
| Mar 2, 2017 | Referred to Coms. on HEALTH and HUM. S. |
| Feb 16, 2017 | From printer. May be heard in committee March 18. |
| Feb 15, 2017 | Read first time. To print. |
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Date
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Description
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Location
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Votes
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| Apr 25, 2017 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Human Services |
Passed |
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| Apr 4, 2017 | Do pass and be re-referred to the Committee on [Human Services] | Assembly Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
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Organization
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Position
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Date
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|---|---|---|
| Alameda County Board of Supervisors | ** Support | Apr 21, 2017 |
| Alameda County of Supervisors | * Support | Apr 25, 2017 |
| CA Long-Term Care Ombudsman | ** Support | Apr 21, 2017 |
| California Access Coalition | ** Support | Mar 31, 2017 |
| California State Association Of Counties | * Neutral | Apr 4, 2017 |
| Los Angeles County Of | * Neutral | Apr 25, 2017 |
| Los Angeles County Professional Peach Officers Association | ** Support | Apr 21, 2017 |
| National Association of Social Workers, CA Chapter | ** Support | Apr 21, 2017 |
Date of Hearing: May 17, 2017
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
ABPCA Bill Id:AB 675
Author:(Ridley-Thomas) – As Amended Ver:April 19, 2017
Policy Committee: | Health | Vote: | 15 - 0 |
Human Services | 7 - 0 | ||
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Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill prevents components of the Coordinated Care Initiative (CCI) related to the In-Home Supportive Services (IHSS) program from being made inoperative based on a specified finding by the Department of Finance. Specifically, this bill:
- Preserves a 2012 maintenance-of-effort (MOE) as the cost-sharing arrangement for counties' non-federal share of costs for the IHSS program (this cost-sharing arrangement would otherwise revert to a 65% state / 35% county cost-sharing ratio, pursuant to a finding made by DOF earlier this year.)
- Preserves other key aspects of IHSS-related components of the CCI, including statewide bargaining for IHSS workers, worker training, the provision of IHSS through managed care, and the existence of an IHSS Fund for purposes of funding the functions of the IHSS Statewide Authority and related functions.
- Makes a variety of other related, technical, and/or conforming changes.
FISCAL EFFECT:
- At least $623 million in 2017-18: Since the MOE was instituted, total IHSS program costs have grown at a faster rate than the county's 3.5% statutory MOE growth factor. This has created a widening gap between what the counties would have paid under the prior methodology, and what they pay under the MOE. This gap equates to about $623 million in 2017-18, according to the Governor's January Budget estimate. The budget assumes this amount in savings from reverting to the prior cost-sharing methodology; this bill appropriates $650 million from the GF for the 2017-18 budget year, apparently to cover this gap and related expenses.
- Ongoing costs above that level in future years: The state would also incur costs, as well as cost growth, in future years. The annual out-year cost for preserving the MOE would be $623 million plus cumulative annual cost growth, which would depend on a number of factors. Costs would likely exceed $1 billion per year within five years. Caseload growth, a rise in hours per case, and wage increases for IHSS providers have been key drivers of IHSS service costs, and the planned implementation of mandatory sick leave for IHSS workers will increase costs as well.
COMMENTS:
- Purpose. This bill is introduced with the intent to avoid a devastating fiscal impact to counties, as well as the potential for lower wages and benefits to IHSS providers, which the author believes will result under the reversion to the prior cost-sharing methodology, pursuant to the recent DOF declaration that the CCI is not cost-effective and will therefore be terminated.
- IHSS in the Coordinated Care Initiative (CCI). The CCI included several components related to better coordinating health care and long term care services and supports for elderly and disabled individuals enrolled in Medi-Cal. The IHSS component of CCI created an IHSS statewide bargaining authority, whereas collective bargaining was done at the county level prior to CCI. It also integrated IHSS into Medi-Cal managed care, and created an MOE to replace the prior cost-sharing arrangement.
- Creation of the IHSS MOE. Historically, the state paid for 65% of nonfederal program costs and counties paid for the remaining 35%. Beginning in 2012-13, the CCI replaced the prior county contribution rate with a county MOE. The county MOE generally sets counties’ contributions to IHSS at their 2011-12 expenditure levels and increases the contributions annually by 3.5%, plus any additional costs associated with locally negotiated IHSS wage increases. Since the implementation of the MOE, the General Fund has assumed all nonfederal IHSS costs above counties’ MOE expenditure levels. All 58 counties contribute to the IHSS MOE; the application of the MOE was not restricted to the seven counties in the CCI.
- County MOE and General Fund Interaction. Since the IHSS county MOE was instituted, the General Fund has borne a disproportionate amount of growing IHSS program costs, growing at an average rate of 20% annually, from $1.7 billion in 2012-13 to an estimated $3.5 billion in 2016-17. County IHSS program costs, by contrast, have increased at an average rate of around 4% annually over the same period.
State law contains a poison pill provision that automatically discontinues the pilot program if the Director of Finance determines that the CCI does not generate annual net General Fund savings and is therefore not cost-effective. The Governor’s budget reflects a determination that the CCI is not cost-effective, which the administration primarily attributes to growing General Fund costs under the IHSS county MOE. As a result, the Governor proposes that the IHSS county MOE will end on July 1, 2017, and be replaced with the prior IHSS program cost-sharing ratio of counties paying 35% of nonfederal program costs and the state paying the remaining 65%.
- Related Budget Negotiations and Subcommittee Action. The declaration ending the CCI Governor's budget proposal has been discussed in both relevant budget subcommittees. The administration has expressed openness to exploring ways to mitigate the significant fiscal impact of this declaration on counties, and these discussions are ongoing. On March 29th, the Assembly Subcommittee #1 on Health and Human Services took a series of actions related to IHSS: re-benching the IHSS county MOE based on adding an additional $623 million in county costs, protecting county budgets by supplementing 1991 Realignment funds with other state funds until growth funds fully cover the new costs of the increased MOE, and retaining the statewide authority for collective bargaining.
- May Revision Proposal. On May 11, 2017, the administration released an updated proposal related to the IHSS and the CCI. The new proposal mitigates the fiscal risk to counties by providing offsetting GF assistance of $400 million in 2017-18, $330 million in 2018-19, $200 million in 2019-20, and $150 million in 2020-21, and ongoing. It also redirects growth in the Vehicle License Fee (VLF) revenues counties receive to pay for various local health programs from these programs to pay for IHSS costs, and the redirection is then backfilled by the GF contributions listed above. It also would institute a new MOE structure for counties, which would include an inflation factor used to calculate a county cost base for IHSS. The inflation factor will vary based on the performance of the 1991 Realignment revenue stream. The proposal also allows counties who experience financial hardship with respect to IHSS costs to apply for a low-interest loan from the state. Finally, the proposal does not reinstate statewide collective bargaining, but allows for a state share of costs for wage and benefit increases that exceed a current cap on state contributions.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: April 25, 2017
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Blanca Rubio, Chair
ABPCA Bill Id:AB 675 (
Author:Ridley-Thomas) – As Amended Ver:April 19, 2017
SUBJECT: Medi-Cal: in-home supportive services: funding
SUMMARY: Prohibits components of the Coordinated Care Initiative (CCI) related to in-home supportive services (IHSS) from being made inoperative due to a determination made by the Director of Finance, and appropriates $650 million from the General Fund to the Department of Health Care Services (DHCS) for the purposes of continuing CCI-related IHSS components.
Specifically, this bill:
- Prohibits the following from being made inoperative as a result of any determination made by the Director of Finance pursuant to the CCI “poison pill” in state law, as specified:
- Provisions of Government Code and Welfare and Institutions Code establishing the California IHSS Authority (Statewide Authority) and creating authority, requirements, and responsibilities related to it;
- Provisions of Welfare and Institutions Code creating the IHSS Fund in the State Treasury and requiring moneys in the fund to be made available, upon appropriation by the Legislature, for purposes of funding the functions of the Statewide Authority;
- Provisions of Government Code establishing the IHSS Employer-Employee Relations Act;
- Provisions of Welfare and Institutions Code requiring IHSS to be a covered service through Medi-Cal managed care health plans in CCI counties and relevant provisions integrating long-term supports and services into CCI, and provisions establishing related authority, requirements, responsibilities, and exemptions;
- Provisions of Welfare and Institutions Code establishing, defining, and delineating a methodology for calculating a County IHSS Maintenance of Effort (MOE) for all counties to be paid in lieu of counties’ nonfederal share of IHSS costs; and
- Provisions of Welfare and Institution Code requiring DSS, in consultation with DHCS and in collaboration with certain stakeholders, to develop a curriculum for voluntary training for IHSS providers on issues of consistency, accountability, and increased quality of care of IHSS recipients.
- Appropriates $650 million from the General Fund to DHCS for the purpose of continuing the provision of IHSS in California pursuant to the provisions of this bill.
- Makes conforming and other technical changes.
EXISTING LAW:
- Establishes the IHSS program to provide supportive services, including domestic, protective supervision, personal care, and paramedical services as specified, to individuals who are aged, blind, or living with disabilities, and who are unable to perform the services themselves or remain safely in their homes without receiving these services. (WIC 12300 et seq.)
- States that counties may choose to contract with a nonprofit consortium or establish a public authority for the provision of IHSS services. Requires nonprofit consortia and public authorities to, among other things, establish a registry to assist recipients in locating IHSS providers, and to investigate the background and qualifications of potential providers, as specified. (WIC 12301.6)
- Maintains an IHSS recipient’s right to hire, fire, and supervise the work of any IHSS provider, regardless of the employer responsibilities of a public authority or nonprofit consortium, as specified. (WIC 12301.6)
- Establishes the California In-Home Supportive Services Authority (Statewide Authority) and provides that it shall be the entity authorized to meet and confer in good faith regarding wages, benefits, and other terms and conditions of employment with recognized employee organizations for any individual provider who is employed by a recipient of IHSS, as specified. These provisions are conditionally inoperative pursuant to Chapter 37, Section 34, Statutes of 2013. (GOV 6531.5, WIC 12300.5)
- Requires, no sooner than March 1, 2013, IHSS to be a Medi-Cal benefit available through managed health plans in CCI counties, as specified. These provisions are conditionally inoperative pursuant to Chapter 37, Section 34, Statutes of 2013. (WIC 14186.35)
- Requires all counties, as of July 1, 2012, to pay the County Maintenance of Effort (MOE), defined as the actual amount spent by each county on IHSS services and administration in the base year of 2011-12 plus, starting on July 1, 2014, an annual adjustment by an inflation factor of 3.5 percent, in lieu of paying the nonfederal share of IHSS costs, as specified. These provisions are conditionally inoperative pursuant to Chapter 37, Section 34, Statutes of 2013. (WIC 12306.15)
- Requires the Director of Finance to estimate the net General Fund savings obtained from the implementation of CCI and, if the Director finds that CCI will not generate General Fund savings, requires: termination of the authority of the Statewide Authority under specified circumstances; the IHSS MOE to become inoperative as of July 1 of the same calendar year; and CCI to become inoperative as of January 1st of the following year. (Chapter 37, Section 34, Statutes of 2013)
FISCAL EFFECT: Unknown.
COMMENTS:
In-Home Supportive Services: The IHSS program enables low-income individuals who are at least 65 years old, living with disabilities, or blind to remain in their own homes by paying for care providers to assist with personal care services (such as toileting, bathing, and grooming), domestic and related services (meal preparation, housecleaning, and the like), paramedical services, and protective supervision. Approximately 466,000 Californians receive IHSS each month, with about 98% receiving it as a Medicaid benefit.
When an individual is determined eligible for IHSS services by a county social worker, he or she is authorized for a certain number of hours of care. IHSS recipients are responsible for hiring, firing, directing, and supervising their IHSS workers. These responsibilities also include some administrative duties, such as scheduling and signing timesheets; however, the state handles payroll. There are currently about 460,554 eligible IHSS providers in the state; approximately 69% are relatives and an estimated 44% are relatives who live in the same home as the recipient. Providers must complete an enrollment process, including submitting fingerprint images for a criminal background check and participating in a provider orientation prior to receiving payment for services.
Coordinated Care Initiative: SB 1036 (Senate Committee on Budget and Fiscal Review), Chapter 45, Statutes of 2012, enacted a joint state-federal demonstration project referred to as the Coordinated Care Initiative (CCI) to improve coordination of care for seniors and persons with disabilities (SPDs) who are dually eligible for Medi-Cal and Medicaid. It was implemented in seven counties (Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara) and contained a number of components, including: integrating Medi-Cal and Medicare benefits under a program known as “Cal MediConnect”; mandating enrollment for dual eligibles into Medi-Cal managed care; integrating long-term supports and services (LTSS, which includes IHSS, skilled nursing facility, Community-Based Adult Services, and the Multipurpose Senior Services Program) under Medi-Cal managed care; transitioning to statewide collective bargaining for IHSS providers under the California IHSS Authority; and establishing a universal assessment tool to assess for various LTSS programs.
Additionally, on a statewide level, CCI altered the methodology by which the county and state shares of nonfederal IHSS costs were determined. Historically, counties covered 35% of the nonfederal share of costs. CCI replaced this with the county IHSS MOE; as of July 1, 2012, all counties in the state were required to maintain their 2011-12 IHSS expenditure levels, to be later increased by an annual 3.5% growth factor along with any IHSS costs attributable to locally negotiated increases in IHSS wages.
State law also contains a “poison pill” related to CCI. SB 94 (Senate Committee on Budget and Fiscal Review), Chapter 37, Statutes of 2013, required the Director of Finance to estimate the net General Fund savings obtained from the implementation of CCI and, if the Director found that CCI will not generate General Fund savings, automatically discontinued all components of CCI, including requiring the IHSS MOE to become inoperative as of July 1 of the same calendar year and CCI to become inoperative as of January 1st of the following year.
When the Governor’s 2017-18 budget was released in January, it was announced that Department of Finance estimates indicated that CCI would cost $278 million to the General Fund in 2016-17 and $42 million in 2017-18. The Governor’s budget therefore terminated CCI. However, the Governor’s budget proposes to continue Cal MediConnect, mandatory enrollment of dual eligibles in Medi-Cal managed care, and integration of LTSS (with the exception of IHSS) under Medi-Cal managed care. In effect, then, IHSS would be removed from CCI: the historical state-county cost-sharing arrangement would be restored, with counties paying 35% of the nonfederal share of IHSS program costs; funding for IHSS managed care coordination would be eliminated; state-level bargaining for IHSS provider wages and benefits would be terminated; and development of the universal assessment tool would be abandoned.
Need for this bill: According to the author:
“Ceasing the CCI, dismantling of IHSS MOE cost sharing arrangement, dissolving of the Statewide IHSS Authority, and shifting collective bargaining for IHSS workers from the Statewide IHSS Authority to the seven CCI counties will have a devastating fiscal impact to counties that will impact county programs beyond IHSS. Additionally, this negative fiscal impact to the county will ultimately result in lower wages and benefits to IHSS providers and potentially impact services to IHSS recipients.”
PRIOR LEGISLATION:
SB 94 (Senate Committee on Budget and Fiscal Review), Chapter 37, Statutes of 2013, among other things, required the Director of Finance to estimate the net General Fund savings obtained from the implementation of CCI and, if the Director found that CCI will not generate General Fund savings, required: termination of the authority of the Statewide Authority under specified circumstances; the IHSS MOE to become inoperative as of July 1 of the same calendar year; and CCI to become inoperative as of January 1st of the following year.
AB 1471 (Assembly Committee on Budget), Chapter 439, Statutes of 2012, contained clean-up language related to CCI.
SB 1036 (Senate Committee on Budget and Fiscal Review), Chapter 45, Statutes of 2012, enacted CCI.
SECOND COMMITTEE OF REFERENCE. This bill was previously heard in the Assembly Health Committee on April 4, 2017, and was approved on a 15-0 vote.
REGISTERED SUPPORT / OPPOSITION:
Support
Alameda County Board of Supervisors
CA Long-Term Care Ombudsman
Los Angeles County Professional Peach Officers Association
National Association of Social Workers, CA Chapter
Opposition
None on file.
Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089
Date of Hearing: April 4, 2017
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 675
Author:(Ridley-Thomas) – As Introduced Ver:February 15, 2017
SUBJECT: Medi-Cal: in-home supportive services: funding.
SUMMARY: Appropriates $650 million from the General Fund (GF) to the Department of Health Care Services for the purpose of continuing to make in-home supportive services (IHSS) available to Medi-Cal beneficiaries through Medi-Cal managed care health plans under the Coordinated Care Initiative (CCI).
EXISTING LAW:
- Establishes the Medi-Cal program to provide comprehensive health benefits to low-income individuals who meet specified eligibility criteria, including IHSS services.
- Authorizes the formation of CCI in seven counties to provide better outcomes for seniors an persons with disabilities (SPDs) who are both Medicare and Medi-Cal eligible (dual eligible) by enrolling them into managed health care plans.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, dismantling the IHSS Maintenance of Effort (MOE) cost sharing arrangement, dissolving of the Statewide IHSS Authority, and shifting collective bargaining for IHSS workers from the Statewide IHSS Authority to the seven CCI counties will have a devastating fiscal impact to counties which in turn will impact county programs beyond IHSS. Additionally, this negative fiscal impact to the county will ultimately result in lower wages and benefits to IHSS providers and potentially impact services to IHSS recipients.
- BACKGROUND. According to the Legislative Analyst’s Office (LAO), over 2 million SPDs are enrolled in Medi-Cal, which provides medical services and long-term supports and services (LTSS), including IHSS to low-income persons; the majority of SPDs are also eligible for Medicare. The SPDs who are eligible for both Medi-Cal and Medicare are known as dual eligible and receive services paid for by both programs. While SPDs eligible for Medi-Cal only have been mandatorily enrolled in Medi-Cal managed care since 2012, dual eligibles have historically been exempt from mandatory managed care enrollment. Dual eligibles have historically utilized either a fee-for-service (FFS) or the managed care delivery system for the Medi-Cal portion of their health care and LTSS benefits.
- IHSS. IHSS is generally a Medi-Cal FFS benefit administered by county welfare agencies. County social workers carry out IHSS eligibility determinations and redeterminations and assess IHSS recipients for their level of need for service hours. While the IHSS recipient is considered the employer of his or her provider, counties have historically been responsible for setting provider wages and benefits through collective bargaining. Since IHSS is a Medi-Cal benefit, around 50% of IHSS program costs are paid for by the federal government. The nonfederal costs are shared by the state and counties. The 1991 Realignment provides primary funding for IHSS.
- CCI. From 2012 to 2015, the CCI demonstration project was implemented. The intent of CCI was to improve the coordination of health care and long-term care for SPDs with the goal of reducing the overall costs of providing care. To achieve these goals, the CCI made a number of changes related to the delivery of care to SPDs. Although the Governor originally proposed statewide implementation of CCI to all 58 counties within three years, CCI was only implemented in the following seven counties: Los Angeles; Orange; Riverside; San Bernardino; San Diego; San Mateo; and, Santa Clara. The CCI made major policy changes in the demonstration counties, including the following:
- CCI enabled dual eligibles to receive their Medicare benefits through the same Medi-Cal managed care plans that provide their Medi-Cal benefits, known as Cal MediConnect. Initially, dual eligibles were automatically enrolled in Medi-Cal managed care plans for their Medicare and Medi-Cal benefits, unless they made the initial choice to opt out. This passive enrollment began in 2014 and ended in 2016. Once enrolled in a CalMediConnect health plan, enrollees are free to opt out in any given month and return to receiving the Medi-Cal and Medicare benefits through separate systems of care;
- The CCI requires most dual eligibles to enroll in managed care plans to access their Medi-Cal benefits, including LTSS benefits. Since participation in CalMediConnet is optional, dual eligibles mandatorily enrolled in Medi-Cal managed care may continue to receive their Medicare benefits, such as doctor visits and hospitalizations, separately; and,
- The CCI transitioned collective bargaining over IHSS provider wages and benefits from the local level to the state, establishing the California IHSS Authority, or Statewide IHSS Authority, for the demonstration counties. The CCI replaced counties’ share of IHSS program costs with the MOE, known as the IHSS MOE. This meant that effective July 1, 2012, all counties were required to maintain their fiscal year (FY) 2011-12 expenditure levels for IHSS, to which an annual growth factor of 3.5% was applied in subsequent years.
According to the LAO, analyses carried out by participating managed care plans, between April 2014 and June 2016, indicate that Cal MediConnect has helped achieve reductions in hospital and skilled nursing facility (SNF) utilization. Managed care plans reported making use of enhanced care coordination to avoid unnecessary SNF stays and hospitalizations. However, enrollment in CalMediConnect has fallen short of the state’s initial goals. According to the LAO, out of the estimated 400,000 dual eligibles living in CCI counties eligible for CalMediConnect, only about 115,000 are enrolled.
c) 2017-18 Governor’s Budget Proposal. Current law gives the Department of Finance (DOF) the authority to discontinue the CCI without having to seek legislative approval, if the CCI is shown not to generate net GF savings (poison pill provision). In the Governor’s FY 2017-18 Budget proposal, DOF made the determination that the CCI was not generating net GF savings, thus the Governor is proposing to eliminate CCI. According to the LAO, the termination of the IHSS MOE and restoration of the prior IHSS cost-sharing ratio is projected to shift over $600 million in IHSS General Fund costs back to counties in 2017-18. This shift in costs will create significant short- and long-term fiscal challenges for counties
According to the Administration, although CCI was not cost-effective during the initial demonstration period, the dual eligibles demonstration program provided the potential to reduce the cost of health care for SPDs and improve health outcomes. Thus, the Governor’s Budget is proposing to extend the Cal MediConnect Program, continue mandatory enrollment of dual eligible, and integrate LTSS (except IHSS) into managed care.
On March 29, 2017, the Assembly Budget Subcommittee No. 1 on Health and Human Services took an action that is an alternative to the Governor’s proposal. Further information could be found on the Assembly Budget Committee’s Internet Website.
- SUPPORT. The Alameda County Board of Supervisors states in support that for Alameda County alone, the Governor’s proposal to discontinue the IHSS MOE, will cost the county $40 million in the first year. This bill will provide essential supplemental funding which will enable counties to continue providing quality health care services to Medi-Cal beneficiaries most in need. The California Access Coalition states in support that IHSS has been shown to be a cost-effective program for providing very effective care to Medi-Cal beneficiaries. Fully funding IHSS through Medi-Cal not only maximizes the effectiveness of that program but it also places the costs with the state which reaps to benefit not only that program but also the county mental health programs which keep people out of hospitals and prisons.
- DOUBLE REFERRAL. This bill is double referred; upon passage in this Committee, this bill will be referred to the Assembly Committee on Human Services.
REGISTERED SUPPORT / OPPOSITION:
Support
Alameda County Board of Supervisors
California Access Coalition
Opposition
None on file.
Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097
Discussed in Hearing
1H
Assembly Standing Committee on Appropriations
6MIN
Assembly Standing Committee on Human Services
3MIN
Assembly Standing Committee on Health
Bill Author
