May 21, 2012 - Human Services Agency of San Francisco

Rebecca Malberg commented that we need to use all of our resources as the incidence of chronic
disease is greatly increasing in SF. Tangerine Brigham remarked that there needs to be a transfer of
care, and a decrease in the use of emergency rooms and urgent care centers for non‐urgent care. We
need to place acute care recipients in the community and get them out of the hospitals. Savings will
come from managed care, managing the acute care population, and not reducing their hospitalization.
Tangerine Brigham also suggested that Ron Smith be contacted and invited to attend a Design Group
meeting on behalf of the Hospital Council.
4. Update on IHSS and LTSS Work Groups (DHCS)
Megan Elliott provided an update on In‐Home Supportive Services and Long Term Services and Supports
Work Groups. She explained that the California Duals project has a variety of subcommittees, and that
she has attended the long term services and supports meetings. At these LTSS meetings, they discussed:
approaches to network capacity and network quality, how to establish readiness, the standards for a
medical network, the required number of providers, operational readiness, financial stability, customer
service, the ability of providers to submit bills and obtain reimbursement, challenges for defining LTSS
network adequacy, and the fact that there is no federal standard for LTSS network adequacy. At the
LTSS meetings, they also covered geographic challenges.
Rebecca Malberg asked how we educate people about the services available. Megan Elliott explained
that under managed care, county social workers will work with managed care plans and participate on
care coordination teams. Managed care providers, county social workers and care‐coordination teams
will advise recipients of the services available. The teams will be used as needed for complex care cases
to assist in an overall plan that will improve health outcomes. In addition, it would be the recipient’s
choice to have a care team, if they want to participate on the team, and if they want their IHSS provider
on the team.
Megan Elliott also pointed out that IHSS recommended: the implementation of readiness criteria,
guidelines for creating the care coordination teams and creating a care assessment tool, and the
development of a home and community‐based care assessment tool which will be used by all programs
for dual eligibles. She also explained that the database that IHSS runs is called CMIPS. In addition, IHSS
is developing a universal assessment tool along with its development of CMIPS2 (the database under
development). In 2015, a coordinated care initiative will consider transitioning to a universal
assessment tool which will be used by all counties. While there is a functional ranking of recipients to
determine their eligibility for IHSS services, there is no state‐wide universal assessment tool to
determine their needs for home care and transportation for example. The goal of IHSS is to have statewide
uniformity in the assessment of recipients needs with a universal assessment tool.
Rebecca Malberg commented that county social workers need to use the same assessment tools. Then
if it is necessary for the number of care hours to be increased in order for the recipient to remain in the
community; the assessment tool will indicate the need for those increased hours of care.
Megan Elliott further commented that IHSS has said, that the number of hours of home care cannot be
decreased by the health plans, but only increased so as to avoid recipients’ hospitalizations.
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