Bill Text: CA AB776 | 2013-2014 | Regular Session | Chaptered
Bill Title: Medi-Cal.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Passed) 2013-09-09 - Chaptered by Secretary of State - Chapter 298, Statutes of 2013. [AB776 Detail]
Download: California-2013-AB776-Chaptered.html
BILL NUMBER: AB 776 CHAPTERED
BILL TEXT
CHAPTER 298
FILED WITH SECRETARY OF STATE SEPTEMBER 9, 2013
APPROVED BY GOVERNOR SEPTEMBER 9, 2013
PASSED THE SENATE AUGUST 15, 2013
PASSED THE ASSEMBLY AUGUST 19, 2013
AMENDED IN SENATE JULY 9, 2013
INTRODUCED BY Assembly Member Yamada
FEBRUARY 21, 2013
An act to amend Sections 14186.1, 14186.36, and 14186.4 of the
Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 776, Yamada. Medi-Cal.
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 and funded by federal
Medicaid Program provisions.
Existing law requires, to the extent that federal financial
participation is available, and pursuant to a demonstration project
or waiver of federal law, the department to establish specified pilot
projects in up to 8 counties, and requires long-term services and
supports, as defined, to be available to beneficiaries residing in
Coordinated Care Initiative counties, as specified.
In implementing the requirements that beneficiaries residing in
Coordinated Care Initiative counties be provided long-term services
and supports, existing law requires the department to consult
stakeholders. For the purposes of existing law, specified terms are
defined.
This bill would additionally define the term "stakeholder" to
include area agencies on aging and independent living centers. The
bill would also make related conforming changes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14186.1 of the Welfare and Institutions Code,
as amended by Section 22 of Chapter 37 of the Statutes of 2013, is
amended to read:
14186.1. For purposes of this article, the following definitions
shall apply unless otherwise specified:
(a) "Coordinated Care Initiative counties" shall have the same
meaning as that term is defined in paragraph (1) of subdivision (b)
of Section 14182.16.
(b) "Home- and community-based services" means services provided
pursuant to paragraphs (1), (2), and (3) of subdivision (c).
(c) "Long-term services and supports" or "LTSS" means all of the
following:
(1) In-home supportive services (IHSS) provided pursuant to
Article 7 (commencing with Section 12300) of Chapter 3, and Sections
14132.95, 14132.952, and 14132.956.
(2) Community-Based Adult Services (CBAS).
(3) Multipurpose Senior Services Program (MSSP) services include
those services approved under a federal home- and community-based
services waiver or, beginning January 1, 2015, or after 19 months,
equivalent services.
(4) Skilled nursing facility services and subacute care services
established under subdivision (c) of Section 14132, including those
services described in Sections 51511 and 51511.5 of Title 22 of the
California Code of Regulations, regardless of whether the service is
included in the basic daily rate or billed separately, and any leave
of absence or bed hold provided consistent with Section 72520 of
Title 22 of the California Code of Regulations or the state plan.
However, services provided by any category of intermediate care
facility for the developmentally disabled shall not be considered
long-term services and supports.
(d) "Home- and community-based services (HCBS) plan benefits" may
include in-home and out-of-home respite, nutritional assessment,
counseling, and supplements, minor home or environmental adaptations,
habilitation, and other services that may be deemed necessary by the
managed care health plan, including its care coordination team. The
department, in consultation with stakeholders, may determine whether
health plans shall be required to include these benefits in their
scope of service, and may establish guidelines for the scope,
duration, and intensity of these benefits. The grievance process for
these benefits shall be the same process as used for other benefits
authorized by managed care health plans, and shall comply with
Section 14450, and Sections 1368 and 1368.1 of the Health and Safety
Code.
(e) "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
the 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.
(f) "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.
(g) "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.
(h) "Stakeholder" shall include, but shall not be limited to, area
agencies on aging and independent living centers.
SEC. 2. Section 14186.36 of the Welfare and Institutions Code, as
amended by Section 26 of Chapter 37 of the Statutes of 2013, is
amended to read:
14186.36. (a) It is the intent of the Legislature that a
universal assessment process for LTSS be developed and tested. The
initial uses of this tool may inform future decisions about whether
to amend existing law regarding the assessment processes that
currently apply to LTSS programs, including IHSS.
(b) (1) In addition to the activities set forth in paragraph (9)
of subdivision (a) of Section 14186.35, county agencies shall
continue IHSS assessment and authorization processes, including
making final determinations of IHSS hours pursuant to Article 7
(commencing with Section 12300) of Chapter 3 and regulations
promulgated by the State Department of Social Services.
(2) No sooner than January 1, 2015, for the counties and
beneficiary categories specified in subdivision (e), counties shall
also utilize the universal assessment tool, as described in
subdivision (c), if one is available and upon completion of the
stakeholder process, system design and testing, and county training
described in subdivisions (c) and (e), for the provision of IHSS
services. This paragraph shall only apply to beneficiaries who
consent to the use of the universal assessment process. The managed
care health plans shall be required to cover IHSS services based on
the results of the universal assessment process specified in this
section.
(c) (1) No later than June 1, 2013, the department, the State
Department of Social Services, and the California Department of Aging
shall establish a stakeholder workgroup to develop the universal
assessment process, including a universal assessment tool, for home-
and community-based services, as defined in subdivision (b) of
Section 14186.1. The stakeholder workgroup shall include, but not be
limited to, consumers of IHSS and other home- and community-based
services and their authorized representatives, managed care health
plans, counties, IHSS, MSSP, and CBAS providers, area agencies on
aging, independent living centers, and legislative staff. The
universal assessment process shall be used for all home- and
community-based services, including IHSS. In developing the process,
the workgroup shall build upon the IHSS uniform assessment process
and hourly task guidelines, the MSSP assessment process, and other
appropriate home- and community-based assessment tools.
(2) (A) In developing the universal assessment process, the
departments described in paragraph (1) shall develop a universal
assessment tool that will inform the universal assessment process and
facilitate the development of plans of care based on the individual
needs of the consumer. The workgroup shall consider issues including,
but not limited to, the following:
(i) The roles and responsibilities of the health plans, counties,
and home- and community-based services providers administering the
assessment.
(ii) The criteria for reassessment.
(iii) How the results of new assessments would be used for the
oversight and quality monitoring of home- and community-based
services providers.
(iv) How the appeals process would be affected by the assessment.
(v) The ability to automate and exchange data and information
between home- and community-based services providers.
(vi) How the universal assessment process would incorporate
person-centered principles and protections.
(vii) How the universal assessment process would meet the
legislative intent of this article and the goals of the demonstration
project pursuant to Section 14132.275.
(viii) The qualifications for, and how to provide guidance to, the
individuals conducting the assessments.
(B) The workgroup shall also consider how this assessment may be
used to assess the need for nursing facility care and divert
individuals from nursing facility care to home- and community-based
services.
(d) No later than March 1, 2014, the department, the State
Department of Social Services, and the California Department of Aging
shall report to the Legislature on the stakeholder workgroup's
progress in developing the universal assessment process, and shall
identify the counties and beneficiary categories for which the
universal assessment process may be implemented pursuant to
subdivision (e).
(e) (1) No sooner than January 1, 2015, upon completion of the
design and development of a new universal assessment tool, managed
care health plans, counties, and other home- and community-based
services providers may test the use of the tool for a specific and
limited number of beneficiaries who receive or are potentially
eligible to receive home- and community-based services pursuant to
this article in no fewer than two, and no more than four, of the
counties where the provisions of this article are implemented, if the
following conditions have been met:
(A) The department has obtained any federal approvals through
necessary federal waivers or amendments, or state plan amendments,
whichever is later.
(B) The system used to calculate the results of the tool has been
tested.
(C) Any entity responsible for using the tool has been trained in
its usage.
(2) To the extent the universal assessment tool or universal
assessment process results in changes to the authorization process
and provision of IHSS services, those changes shall be automated in
the Case Management Information and Payroll System.
(3) The department shall develop materials to inform consumers of
the option to participate in the universal assessment tool testing
phase pursuant to this paragraph.
(f) The department, the State Department of Social Services, and
the California Department of Aging shall implement a rapid-cycle
quality improvement system to monitor the implementation of the
universal assessment process, identify significant changes in
assessment results, and make modifications to the universal
assessment process to more closely meet the legislative intent of
this article and the goals of the demonstration project pursuant to
Section 14132.275.
(g) Until existing law relating to the IHSS assessment process
pursuant to Article 7 (commencing with Section 12300) of Chapter 3 is
amended, beneficiaries shall have the option to request an
additional assessment using the previous assessment process for those
home- and community-based services and to receive services according
to the results of the additional assessment.
(h) No later than nine months after the implementation of the
universal assessment process, the department, the State Department of
Social Services, and the California Department of Aging, in
consultation with stakeholders, shall report to the Legislature on
the results of the initial use of the universal assessment process,
and may identify proposed additional beneficiary categories or
counties for expanded use of this process and any necessary changes
to provide statutory authority for the continued use of the universal
assessment process. These departments shall report annually
thereafter to the Legislature on the status and results of the
universal assessment process.
(i) This section shall remain operative only until July 1, 2017.
SEC. 3. Section 14186.4 of the Welfare and Institutions Code, as
amended by Section 27 of Chapter 37 of the Statutes of 2013, is
amended to read:
14186.4. (a) This article 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.
(b) To implement this article, the department may contract with
public or private entities. Contracts, or amendments to current
contracts, entered into under this article may be on a noncompetitive
bid basis and shall be exempt from all of the following:
(1) Part 2 (commencing with Section 10100) of Division 2 of the
Public Contract Code and any policies, procedures, or regulations
authorized by that part.
(2) Article 4 (commencing with Section 19130) of Chapter 5 of Part
2 of Division 5 of Title 2 of the Government Code.
(3) Review or approval of contracts by the Department of General
Services.
(4) Review or approval of feasibility study reports and the
requirements of Sections 4819.35 to 4819.37, inclusive, and Sections
4920 to 4928, inclusive, of the State Administrative Manual.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the State
Department of Health Care Services and State Department of Social
Services may implement, interpret, or make specific this section by
means of all-county letters, plan letters, plan or provider
bulletins, or similar instructions, without taking regulatory action.
Prior to issuing any letter or similar instrument authorized
pursuant to this section, the departments shall notify and consult
with stakeholders, including beneficiaries, providers, area agencies
on aging, independent living centers, and advocates.
(d) Beginning July 1, 2012, the department shall provide the
fiscal and appropriate policy committees of the Legislature with a
copy of any report submitted to the federal Centers for Medicare and
Medicaid Services (CMS) that is required under an approved federal
waiver or waiver amendments or any state plan amendment for any LTSS.
(e) The department shall enter into an interagency agreement with
the Department of Managed Health Care to perform some or all of the
department's oversight and readiness review activities specified in
this article. These activities may include providing consumer
assistance to beneficiaries affected by this article, and conducting
financial audits, medical surveys, and a review of the provider
networks of the managed care health plans participating in this
article. The interagency agreement shall be updated, as necessary, on
an annual basis in order to maintain functional clarity regarding
the roles and responsibilities of the Department of Managed Health
Care and the department. The department shall not delegate its
authority as the single state Medicaid agency under this article to
the Department of Managed Health Care.
(f) (1) Beginning with the May Revision to the 2013-14 Governor's
Budget, and annually thereafter, the department shall report to the
Legislature on the enrollment status, quality measures, and state
costs of the actions taken pursuant to this article.
(2) (A) By January 1, 2013, or as soon thereafter as practicable,
the department shall develop, in consultation with CMS and
stakeholders, quality and fiscal measures for managed care health
plans to reflect the short- and long-term results of the
implementation of this article. The department shall also develop
quality thresholds and milestones for these measures. The department
shall update these measures periodically to reflect changes in this
program due to implementation factors and the structure and design of
the benefits and services being coordinated by the health plans.
(B) The department shall require managed care health plans to
submit Medicare and Medi-Cal data to determine the results of these
measures. If the department finds that a health plan is not in
compliance with one or more of the measures set forth in this
section, the health plan shall, within 60 days, submit a corrective
action plan to the department for approval. The corrective action
plan shall, at a minimum, include steps that the health plan shall
take to improve its performance based on the standard or standards
with which the health plan is out of compliance. The corrective
action plan shall establish interim benchmarks for improvement that
shall be expected to be met by the health plan in order to avoid a
sanction pursuant to Section 14304. Nothing in this paragraph is
intended to limit the application of Section 14304.
(C) The department shall publish the results of these measures,
including via posting on the department's Internet Web site, on a
quarterly basis.
