BILL ANALYSIS
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: AB 682
A
AUTHOR: Lowenthal
B
VERSION: June 1, 2009
HEARING DATE: June 23, 2009
6
FISCAL: To Appropriations
8
2
CONSULTANT:
Hailey
SUBJECT
In-Home Supportive Services program: fraud
SUMMARY
Requires the state Department of Social Services to
evaluate implementation of provisions intended to combat
fraud in the In-Home Supportive Services program.
ABSTRACT
Current law
1)Establishes the In-Home Supportive Services (IHSS)
program to provide personal services and home care for
444,000 eligible poor, aged, blind and disabled
individuals by an average of 325,000 providers throughout
the state to enable recipients to remain in their own
homes and avoid institutionalization.
2)Provides that DSS supervises the IHSS program at the
state level and that counties administer services at the
local level.
3)Provides for funding of the IHSS program through a
Continued---
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combination of about 50 percent federal (Medicaid), 32
percent state, and 18 percent county dollars.
4)Defines "fraud" for purposes of the IHSS program to mean:
"The intentional deception or misrepresentation made by
a person with the knowledge that the deception could
result in some unauthorized benefit to himself or herself
or some other person. Fraud also includes any act that
constitutes fraud under applicable federal or state law."
5)Specifies the responsibilities of DSS, the Department of
Health Care Services, and the counties for various
quality assurance activities, including activities to
ensure program integrity, including fraud detection and
prevention.
6)Prohibits persons who have been convicted of certain
crimes, including fraud against a government health care
or supportive services program, within the preceding 10
years from providing or receiving IHSS services.
7)Provides for the recovery of overpayments to IHSS
providers and, if the overpayment is determined to be the
result of fraud by the service provider, prohibits future
payments to the provider for up to 10 years following
conviction or the term of incarceration following the
conviction for fraud.
This bill
1)Makes findings and declarations, including the intent "to
determine the extent and type of fraud that may occur
within the IHSS program, in order to evaluate the
existing antifraud provisions of the law and to make
revisions as necessary to ensure that the IHSS program
carries out its mission of providing needed services to
seniors and people with disabilities."
2)Requires DSS, beginning January 1, 2010, to use existing
resources or a special appropriation, if any, to dedicate
two positions to evaluating implementation of five
program assurance provisions of the Welfare and
Institutions Code related to the IHSS program.
3)Requires DSS, in consultation with the state Department
of Health Care Services, the district attorney of Los
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Angeles County, and stakeholders, including IHSS
consumers and providers, to provide a report to the
Legislature by December 31, 2010, which shall do all of
the following with respect to convictions or
incarcerations for IHSS-related fraud:
a) Identify the magnitude of fraud in terms of the
total dollars inappropriately spent or removed from
the program, and the number of consumers harmed or
placed at risk of harm as a result of fraudulent
activity, through instances resulting in a fraud
conviction between January 1, 2005 and January 1,
2010;
b) Identify the number of people involved in fraud for
each of the following categories: IHSS providers,
IHSS consumers, state workers, county workers, and
others. In the case of "others," the report shall
describe the function of the persons committing fraud
with specificity but without revealing personal
identifying information; and,
c) Provide recommendations on the best means to combat
IHSS fraud.
4)Provides that the requirements for evaluating and
reporting on IHSS-related fraud shall become operative
only if the governor's proposed funding increase for IHSS
quality assurance in the 2009-10 budget is adopted.
5)Provides that the provisions of the bill will sunset on
January 1, 2011, unless the sunset is deleted or extended
by a later enacted statute; but, also provides that, if
the provision requiring the report to the Legislature is
repealed, the report must nonetheless be prepared and
delivered.
FISCAL IMPACT
According to the Assembly Appropriations Committee,
one-time costs in the range $350,000 General Fund for two
limited-term dedicated positions and for the workload
associated with the stakeholder process and producing the
required report.
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BACKGROUND AND DISCUSSION
Quality assurance in the IHSS program
The IHSS program helps pay for services so that the
elderly, disabled, or blind individuals can remain safely
in their own homes. IHSS services include, but are not
limited to, housecleaning, meal preparation, laundry,
grocery shopping, personal care services (such as bowel and
bladder care, bathing, grooming and paramedical services),
accompaniment to medical appointments, and protective
supervision for people with mental impairments. A portion
of the costs for IHSS services are paid by federal funding.
The entire program consists of over 450,000 recipients and
350,000 IHSS workers.
In 2004, a budget trailer bill, SB 1104 (Committee on
Budget and Fiscal Review), imposed a number of mandatory
duties on DSS, DHCS and the counties with respect to
quality, cost controls and program integrity within the
IHSS program. Among other things, SB 1104 defined and
distinguished between "fraud" and "overpayments," with
fraud being limited to traditional prosecutable acts of
intentional misrepresentation, while overpayment was
defined broadly to include all instances in which providers
are paid in excess of the amount for authorized services,
whether fraudulent or not. SB 1104 authorized DHCS to
investigate fraud in the provision or receipt of supportive
services, and required counties to refer instances of
suspected fraud to DHCS for investigation. It required
DHCS to notify DSS, the county, and the county's nonprofit
consortium or public authority, if any, of a determination
that a provider has engaged in fraud.
Need for the bill
According to the author, notwithstanding quality assurance
measures implemented through SB 1104, "insinuations of
widespread fraud persist." The author suggests that these
insinuations may be unjustified, noting that there may be a
"disconnect between perception and fact" that is "not
acceptable for such a large and growing state program. ...
If we can identify fraud, we can stop it. But we can't
diminsh funding for the program based on anecdotal
evidence." This bill is intended to collect data and
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document instances of fraud within the IHSS program.
Assembly votes
Floor 49-28
Appropriations12-5
Human Services 4-2
COMMENTS AND QUESTIONS
Staffing need too prescriptive?
The bill directs the Department of Social Services to
dedicate for one year two full-time-equivalent persons,
taken from new anti-fraud positions requested by the
governor, to compile and analyze data on five years' worth
of fraud convictions and or incarcerations. Given how few
convictions for fraud have occurred in California courts
since January 1, 2005, the committee and the author may
want to amend the bill to require the report but not
require that two staff work a full year on it. This
amendment would leave to DSS the decision of how many staff
resources to allocate to the project.
POSITIONS
Support: Service Employees International Union
(SEIU) (sponsor)
Aging Services of California
Oppose: None received
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