BILL ANALYSIS Ó SB 411 Page 1 Date of Hearing: July 5, 2011 ASSEMBLY COMMITTEE ON HEALTH William W. Monning, Chair SB 411 (Price) - As Amended: June 21, 2011 SENATE VOTE : 25-13 SUBJECT : Home Care Services Act of 2011. SUMMARY : Establishes the "Home Care Services Act of 2011" (HCSA) which requires the Department of Public Health (DPH) to license and regulate home care organizations. Specifically, this bill : General Provisions 1)Establishes the HCSA to license and regulate home care organizations under DPH. 2)Requires DPH to assess licensure, renewal, background check, and other fees for each location of a home care organization in amounts sufficient to cover the costs of administering the HCSA. 3)Makes various definitions including, but not limited to "home care aide" to mean an individual who provides home care services to a client in the client's residence and is synonymous with "caregiver," "custodial care," "personal care attendant," "homemaker," and "companion." Specifies that "home care aide" does not include a person who is employed by, contracts or vendors with a regional center or the State Department of Developmental Services (DDS) to provide services and support for persons with developmental disabilities when funding for those services is provided through DDS. 4)Defines "home care organization" or "organization" to mean an individual, partnership, corporation, limited liability company, joint venture, association, or other entity that arranges for the provision of home care services. Specifies that "home care organization" does not include any county providing in-home supportive services (IHSS), a home health agency, a hospice facility, a health facility specified in existing law or an organization vendored or contracted through a regional center or DDS to provide services and support for SB 411 Page 2 persons with developmental disabilities when funding for services are provided through DDS. 5)Defines "home care services" to mean services provided by a home care aide to a client who cannot perform these services for himself or herself including: a) bathing; b) dressing; c) feeding; d) exercising; e) personal hygiene and grooming; f) transferring, ambulating, and positioning; g) toileting and incontinence care; h) assisting with medication that the client normally self-administers; i) housekeeping; j) meal planning and preparation; k) laundry; l) transportation; m) correspondence and making telephone calls; n) shopping for personal care items or groceries; and, o) companionship. Specifies that "home care services" does not include services provided by a licensed home health agency, licensed hospice, licensed health facility, or IHSS services. Licensure 6)Requires an individual, partnership, corporation, limited liability company, joint venture, association, or other entity to first obtain a license prior to arranging home care services by a home care aide to a client. 7)Requires a home care organization with its principal place of business in another state to have an office in California and obtain authorization from the Secretary of State to conduct business in California. 8)Requires DPH to adopt rules and regulations to implement the HCSA, establish procedures for the receipt, investigation, and resolution of complaints against home care organizations, and investigate complaints concerning misconduct by certified home care aids. 9)Requires DPH to maintain a registry on their Website of the certification status of the home care aide's employer, home care organization, and the status of any proposed or completed disciplinary action against the certified home care aide. Permits DPH to request and maintain additional employment information for certified home care aides which will not be publicly available on the registry. 10)Requires a home care organization, prior to DPH issuing a SB 411 Page 3 license, to submit an application, pay a licensing fee, submit proof of general and professional liability, submit proof of a valid workers' compensation policy, pass a background clearance, and provide DPH with a list of all of its home care aides. 11)Requires a home care organization to be accredited by The Joint Commission, the Community Health Accreditation Program, or any other nationally recognized accrediting organization that has an accreditation program for home care organizations, and that is approved by DPH. Requires the accrediting organization to forward to DPH copies of all initial and subsequent onsite inspections and other accreditation reports or findings. 12)Requires the accreditation organization, at the request of DPH, to conduct an onsite inspection of an accredited home care organization to ensure the accreditation requirements are satisfied. Requires these inspections to be conducted using selective sample basis. 13)Permits DPH to conduct an onsite inspection of an accredited home care organization to investigate complaints of substantial noncompliance, as determined by DPH, with the accreditation standards. 14)Requires the owners of a home care organization to submit to a background check. Requires DPH to deny a license if the background clearance discloses a conviction for a felony or a crime that evidences an unfitness to operate a home care organization. 15)Prohibits an organization from representing itself as a home care organization or from using the words "home care organization," "homecare," "in-homecare," or any combination of those terms, within its name unless they are licensed as a home care facility pursuant to this legislation. Home Care Organization Operating Requirements 16) Requires a home care organization to do all of the following: a) Post its license in its place of business in a location SB 411 Page 4 visible to clients and its home care aides; b) Operate the organization in a commercial office space that complies with local zoning ordinances; c) Have plans, procedures, and policies in place, including the following: i) Plans and procedures to be followed in the event of emergencies or natural disasters that would result in the interruption of home care services; ii) A documented backup staffing plan in the event that a home care aide scheduled to provide home care services becomes available; iii) A written policy regarding advance directives; and, iv) A receipt and disbursement policy for expenditures made on behalf of a client to ensure that financial abuse does not occur. d) Maintain a valid workers' compensation policy covering its home care aides; e) Maintain an employee dishonesty bond, including third-party coverage, with a minimum limit of $10,000; and, f) Comply with regulations adopted by DPH. 17)Requires a home care organization to consult DPH's registry for home care aides before hiring an individual or placing him or her in direct contact with patients. Requires a home care organization to also do the following: a) Ensure that each of its home care aides meets the requirements established in this legislation; b) Investigate complaints made by the client, or a client's family member or guardian, against home care aides and document the complaints and their resolution; c) Conduct an annual assessment of the performance and effectiveness of each home care aide; d) Supervise, every 62 days, each home care aide providing home care services in the residence of a client; SB 411 Page 5 e) Ensure that a home care aid, when providing services to a client, has access at all times to a representative of the organization who is in a supervisory capacity and who does not regularly render home care services to that client; f) Require a home care aide, while providing home care services to a client, to wear a badge that includes the aide's name, a photograph of the aide, and other information as specified; g) Require home care aides to demonstrate that they are free of active tuberculosis; h) Require home care aides to annually complete not less than eight paid hours of DPH-approved training on job-related topics; and, i) Prohibit home care aides from accepting money or property from a client without written permission from the home care organization. Client Rights 18)Requires a home care organization to advise a client of any changes in the client's plan for home care services. 19)Requires a home care organization, prior to arranging for the provision of home care services, to do the following: a) Distribute to the client its advance directive policy, along with a written summary of applicable state law; b) Advise the client of its policy regarding the disclosure of client records; c) Inform the client of the types and hours of available home care services; and, d) Inform the client, orally and in writing, of the home care services that are not covered by Medi-Cal or Medicare, as applicable, and the extent to which payment may be expected from the client, from Medicare or Medi-Cal, and from any other source. SB 411 Page 6 20)Establishes that home care clients are entitled to the following rights and requires a home care organization to provide a written notice citing these rights: a) The right to have the client's property treated with respect; b) The right to voice grievances free from reprisal regarding a home care service that is or fails to be provided or regarding the violation of any of the rights listed in 20) inclusive; c) The right to be informed of and to participate in the planning of the client's home care services; and, d) The right to confidentiality of the client's personal information. Home Care Aides 21)Requires DPH, beginning January 1, 2013 to require any person hired as a home care aide for the elderly or persons with disabilities to be certified within 30 days from the date of being hired. 22)Requires a prospective home care aide to complete a minimum of five hours of entry-level training as follows: a) Two hours of orientation training regarding his or her role as caregiver and the applicable terms of employment; b) Three hours of safety training, including basic safety precautions, emergency procedures, and infection control; and, c) Other training related to core competencies and population-specific competencies. 23)Requires DPH to only approve the curriculum for the training referenced in 22) above if it satisfies the following conditions: a) The training curriculum has been developed with input from consumer and worker representatives; and, b) The training curriculum requires comprehensive SB 411 Page 7 instruction by qualified instructors on the competencies and training topics prescribed. 24)Requires DPH to issue a home care aide certificate to each individual who meets the training requirements referenced in 22) above. 25)Requires DPH to set a fee for certification and requires the home care aide's employer to pay the certification fee. 26)Requires an individual who wishes, independent of an employer-employee relationship, to obtain a certificate to provide home care aide services, to pay for his or her own certification. 27)Prohibits a home care organization from hiring an individual as a home care aide unless that individual complies with specified requirements. 28)Requires a home care organization that hires an individual to ensure that the individual, within the first 30 days of employment, satisfactorily completes the home care certification training. 29)Requires a home care organization to conduct and pay for a background clearance through the Department of Justice (DOJ), as described, on an individual hired as a home care aide, unless the individual holds a valid, unexpired license or registration in a health-related field that requires a background check as a condition of the license or registration. Requires DPH to request subsequent arrest notification service from DOJ and requires DOJ to charge a fee to cover the actual costs related to these activities, 30)Prohibits a home care organization from hiring or retaining an employee convicted or incarcerated for conviction, within 10 years, for child abuse, senior or dependent adult abuse, a violent or serious felony, as specified, or a felony offense for which the person is required to register as a sex offender, unless the individual has obtained a certificate of rehabilitation, or the information or accusation has been dismissed, as specified. 31)Requires DPH to provide notice, as specified, to the applicant for certification by personal service or registered mail if a license application is denied based on a prior SB 411 Page 8 criminal conviction, and specified procedures for requesting and conducting an administrative hearing. 32)Specifies notice requirements and administrative hearing procedures in the event a request for a general exception is denied. 33)Requires as a condition of initial and continuing employment with a home care organization, an individual hires as a home care aid to submit to an examination, as specified, to determine that the individual is free of active tuberculosis. Requires the home care aide to pay the cost of the examination. Revenues 34)Requires DPH to assess licensure, renewal, background check, and other fees on each home care organization in amounts sufficient to cover the costs of administering the HCSA, including the cost of certifying home care aides, and requires that all fees be deposited in the existing DPH Licensing and Certification Program Fund. 35)Establishes an initial licensure fee equivalent to the fee for home health agencies for the fiscal year (FY) 2011-12. Enforcement and Penalties 36)Requires DPH, in consultation with a working group of affected stakeholders, to adopt regulations establishing procedures for notices, correction plans, appeals, and hearings related to enforcement of HCSA requirements. 37)Requires DPH to verify through annual random, unannounced inspections that a home care organization meets the requirements of this chapter and the regulations adopted. Requires DPH to send a written notice of noncompliance to the individual or entity and to the Attorney General or appropriate district attorney for further action. 38)Establishes that an individual or entity will be liable for a civil penalty not to exceed $900 per day for each calendar day of violations. Requires collected penalties to be deposited into the Home Care Organization and Home Care Aide Penalties Subaccount, which is created within the existing State Health SB 411 Page 9 Facilities Citation Penalties Account, and requires that, upon appropriation by the Legislature, funds in the subaccount be made available to DPH for purposes of enforcing the HCSA. 39)Authorizes DPH to implement and administer the HCSA through all-facility letters or similar instructions until regulations are adopted, and requires DPH to adopt emergency regulations no later than January 1, 2013, which may be readopted once, pending adoption of final regulations within 180 days. EXISTING LAW : 1)Provides for the licensing and regulation of various healthcare facilities by DPH. 2)Establishes home health agencies and requires all organizations that provide skilled nursing services to patients in the home to obtain a home health agency license issued by DPH. 3)Provides for the licensing and regulation of various community care facilities by DSS. 4)Establishes the Community Care Licensing division under DSS which licenses and oversees both day care and residential facilities for children and adults in California. 5)Establishes IHSS, a county-administered program, to provide personal services and home care for eligible poor, aged, blind, and disabled individuals. FISCAL EFFECT : According to the Senate Appropriations Committee, this bill will result in initial and ongoing licensing, certification, inspections, and regulations to DPH's licensing and certification Program Fund in the amount of $3.8 million in FY 2011-12; $6.5 million in FY 2012-13; and, $7.3 million in FY 2013-14. COMMENTS : 1)PURPOSE OF THIS BILL . According to the author, by 2030 it is estimated that the number of California residents age 85 and older will be over 1.3 million people. The author maintains that the best place to care for seniors and persons with disabilities is in the least restrictive environment and private home care organizations are among the options to help SB 411 Page 10 assist individuals stay in their home. According to the author, private agencies that place care providers in the homes of our most vulnerable residents do so without any regulatory oversight from the state and without any requirement that they meet minimum standards of employee screening and training. The author argues that with an increasing number of caregivers entering peoples' homes essentially unchecked, the number of incidents of abuse and neglect by home care aides being reported is alarming. The author states that, according to prosecutors, for every reported incident of abuse or neglect in the home, four go unreported. The author asserts that this bill is necessary to protect our most vulnerable residents and places California on par with the 28 other states that have moved forward with licensing private home care services, including Florida, Illinois, New York, Oregon, Pennsylvania, Washington, and Texas. 2)BACKGROUND . According to the California Senate Office of Oversight and Outcomes report, "Caregiver Roulette: California Fails to Screen those who Care for the Elderly at Home" (Caregiver report) the percentage of seniors in need of ongoing help with the tasks of daily living is expected to double by the year 2025. The Caregiver report finds that the increasing demand for home and personal care services in California is occurring in a largely unregulated arena, where home care organizations and individual contractors compete with each other, advertising their services through the Internet or in newspapers. It is estimated that 1,200 home care organizations operate in California and an unknown number of individuals look independently for home care aide jobs. As a part of its study the Caregiver report made the following findings: a) More than a quarter of home care aides accused or convicted of crimes that were identified from news accounts had committed previous offenses; b) Many home care organizations claim to do "background checks," ranging from a thorough screening required for certification by a state association to an instant Internet check that experts say yields almost no value; c) Few Californians who hire home care aides on their own know that they have a legal right to request a statewide criminal background check through DOJ; and, d) California is part of a small minority of states that does not regulate home care organizations. 3)HOME CARE SERVICES IN CALIFORNIA . Following are three SB 411 Page 11 essential means of providing care to seniors and persons with disabilities in their own homes in California: a) IHSS Program . IHSS is a publicly-funded program administered by counties and DSS providing in-home care to low-income elderly, blind, or disabled persons who are unable to perform activities of daily living and cannot remain safely in their own homes without help. Through IHSS, qualified recipients may receive assistance with daily tasks, such as bathing, dressing, cooking, cleaning, and feeding. To be eligible for IHSS services, a person must receive federal Supplemental Security Income (commonly known as SSI) or meet income and resource guidelines. In addition, the individual must be either 65 years or older, blind, permanently disabled, or be a disabled child requiring extraordinary care. b) Home Health Agencies . Home health agencies are organizations licensed by DPH to provide both skilled nursing and non-medical personal assistance services. Home health aides assist clients with personal services according to a plan of treatment prescribed by a physician. c) Home Care Organizations . Home care organizations employ workers to provide many of the same services provided by home health aides, but do not perform any medical services such as changing non-sterile dressings, taking vital signs, etc. The services are more akin to those provided through the IHSS program for low income individuals. No state or local agency regulates and licenses these providers. It is this category of care that is the subject of this bill. 4)SUPPORT . The Service Employees International Union, California (SEIU California), the sponsor of this bill, writes in support that for the first time this bill will provide important consumer protections for seniors and persons with disabilities who use the services of private, nonmedical, home care aides to enable them to remain safely in their homes. SEIU California maintains that the responsibility for regulating, overseeing, and providing services to California's rapidly expanding population of seniors and persons with disabilities is administered by a confusing hodge-podge of agencies and departments. SEIU California states that the administration of licensing and certification of this industry and its workers proposed in this bill was placed in DPH SB 411 Page 12 because approximately 50% of agencies that provide these services also provide home health services and are already regulated by DPH. SEIU California argues that housing regulatory functions in a single agency reduces redundancy and the regulatory burden on the regulated industry. SEIU California also argues that DPH has demonstrated expertise in effective licensing of a number of health programs and licenses which this legislation would take advantage of to manage the program. This bill, according to SEIU California, takes small steps to begin to build a cohesive system of care and oversight and follows on the heels of 28 other states who have led the way in licensing this important industry. 5)OPPOSE UNLESS AMENEDED . The California Association for Health Services at Home (CAHSAH), a statewide home care association, states that they are opposed unless amended to this bill because it would create an unnecessary mandate for home care aides in California to become certified by the state, along with imposing significant mandates on companies providing critical services to the state's most vulnerable population. CAHSAH voiced views similar to the majority of those with an opposed unless amended position. CAHSAH proposes the following amendments to this bill: a) Remove the provision requiring the certification of all home care aides by the state of California and the placement of their names, along with names of the companies they work for, on a public Website. The rationale for this amendment, according to CAHSAH, is that home care aides are non-medical, personal attendant care that are best regulated and supervised by licensed home care organizations, not by the state, which struggles to maintain adequate oversight of its current licensing and certificaiton requirements. CAHSAH believes that the costs and burden of adding approximately 120,000 additional individuals that the state will have to certify and regulate does not outweigh the minimal benefits that may occur as a result. Furthermore, CAHSAH maintains, the creation of a public Website that contains the names of these aides, along with the names of the companies they work for is a privacy concern that could force a dangerous situation onto workers. b) Remove the provision that mandates the accreditation by a private accrediting company of all agencies as a SB 411 Page 13 prerequisite to state licensure. CAHSAH states that accreditation is costly (approximately $4,000-$8,000 annually) and is performed by private companies that may not be familiar with non-medical home care. CAHSAH arugues that this initial survey for licensure should be performed by the state and shouldn't be outsourced to accrediting bodies. CAHSAH claims that currently the state allows home health agencies seeking certificaiton the option to use an accrediting body if they choose to incur the extra cost, as opposed to waiting for the state; however, this is an option and not a required mandate. c) Place the regulation of home care organizations under DSS as opposed to DPH. CAHSAH states that home care aides provide non-medical services such as bathing, companionship, and hygiene. CAHSAH assertss that IHSS and Residentail Care Facilities for the Elderly provide similar services and are currently regulated by the DSS. CAHSAH claims this is not a medical service therefore should not be placed under DPH. Additionally, CAHSAH maintains DSS has existing programs and partnerships, such as Trusline, that would allow for the licensed home care organizations to utilize the DOJ's Live Scan capabilities so that the background checks of workers are portable. The Network of Domestic Referral Agencies (NODRA) is also opposed unless amended to this bill. While NODRA states that it is supportive of the concept of the amendments that the author has agreed to take in the Assembly Health Committee, the organization believes that many of the amendments are over reaching and may have unintended consequences. For these reasons NODRA opposed unless amended position remains. 6)RELATED LEGISLATION . AB 899 (Yamada) is very similar to this bill. AB 899 also creates the "Home Care Services Act of 2011" but requires DSS to license and regulate home care organizations. AB 899 does not require the certification of employees as required in this bill. AB 899 died on the Suspense File in Assembly Appropriations Committee. 7)PREVIOUS LEGISLATION . a) AB 853 (Jones) of 2007 was identical to AB 899 (Yamada). SB 411 Page 14 AB 853 was held in the Assembly Appropriations Committee. b) SB 692 (Ashburn), Chapter 2, Statutes of 2007, would have allowed individuals hiring a private caregiver to obtain a criminal background check at their own expense. 8)DOUBLE REFERRAL . This bill was previously heard in the Assembly Humans Services Committee, and was approved on a 4-2 vote. 9)AMENDMENTS DISCUSSED IN HUMAN SERVICES . The following amendments were discussed during the Assembly Human Services Committee hearing and will be voted on in the Assembly Health Committee. The amendments primarily attempt to address the concerns expressed by NODRA, which requested that referral agencies or agencies that do not employ home care aides but arranges for home care aides to provide services, be exempted from the licensing requirements of this bill. a) Amend Section 1796.12 to add: (F) An employment agency defined in Civil Code 1812.5095 that procures, offers, refers, provides, or attempts to provide home care aides and/or other workers who provide home care services or domestic services to clients and consumers pursuant to that section, so long as the agency is not the employer of any home care aides or other workers who provide domestic services. b) Amend Section 1796.20 (a) to read: 1796.20. (a) Subject to the exception set forth in subsection (d) of this section, an individual, partnership, corporation, limited liability company, joint venture, association, or other entity shall not arrange for the provision of home care services by a home care aide to a client in this state without first obtaining a license pursuant to this chapter. c) Amend Section 1796.20 to add: (d) The requirements of this section shall not apply to an employment agency defined in Civil Code 1812.5095 that procures, offers, refers, provides, or attempts to provide home care aides and/or other workers who provide home care services or domestic services to clients and consumers pursuant to that section, so long as the agency is not the employer of any SB 411 Page 15 home care aides and/or other workers who provide domestic services. d) Amend Section 1796.27 to read: A private or public organization, with the exceptions set forth in subsection (c) of this section,of a county providing in-home supportive services pursuant to Article 7 (commencing with Section 12300) of Chapter 3 of Part 3 of Division 9 of the Welfare and Institutions Code shall not do any of the following, unless it is licensed under this chapter: e) Amend Section 1796.27 to add: (c) This section does not apply to either of the following: (1) A county providing in-home supportive services pursuant to Article 7 (commencing with Section 12300) of Chapter 3 of Part 3 of Division 9 of the Welfare and Institutions Code; or (2) An employment agency defined in Civil Code 1812.5095 that procures, offers, refers, provides, or attempts to provide home care aides and/or other workers who provide home care services or domestic services to clients and consumers pursuant to that section, so long as the agency is not the employer of any home care aides and/or other workers who provide domestic services. f) Add Section 1796.45 to read: An employment agency defined in Civil Code 1812.5095 that procures, offers, refers, provides, or attempts to provide home care aides and/or other workers who provide home care services or domestic services to clients and consumers pursuant to that section must at all times maintain general and professional liability insurance in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the aggregate. g) Amend Section 1796.60 (a) to read: 1796.60 (a) Beginning January 1, 2013, the department shall require any person hired as a home care aide to be certified within 30 days from the date of being hired and that any person referred by an employment agency defined in Civil Code 1812.5095 be certified prior to any referral. h) Amend Section 1796.61 to add: (c) Notwithstanding any other provision of law, an employment agency defined in Civil Code 1812.5095 shall ensure that any person it refers to provide home care services has been certified under SB 411 Page 16 Section 1796.60 prior to any such referral. i) Amend Section 1796.80. (a) to read: 1796.80 (a) A home care organization or employment agency defined in Civil Code 1812.5095 operating in violation of any requirement or obligation imposed by this chapter or any rule adopted hereunder may be subject to the penalties or fines levied or licensure action taken by the department as specified in this section. j) Amend Section 1796.80 (b) to read: (b) When the department determines that a home care organization or employment agency defined in Civil Code 1812.5095 is in violation of this chapter or any rules promulgated hereunder, a notice of violation shall be served upon the licensee. Each notice of violation shall be prepared in writing and shall specify the nature of the violation and the statutory provision or rule alleged to have been violated. The notice shall inform the licensee of any action the department may take under this chapter, including the requirement of an agency plan of correction, assessment of a penalty, or action to suspend, revoke, or deny renewal of the license. The director or his or her designee shall also inform the licensee of rights to a hearing under this chapter. 10)AUTHOR'S AMENDMENTS . The author is proposing the following amendments that clarify an exemption for organizations vendored or contracted through a regional center or DDS, clarify information required for the registry of home care organizations and aides on DPH's Website, and provide for provisions for home care aide certification training if the training is not offered in an individual's county: a) Amend Section 1796.23, add: (e) Maintain a registry, on the department's Internet Web site, to include the licensure status of all licensed home care organizations as defined in section 1796.12 (d)(1), along with the name, address and phone number of the home care organization, and the status of any proposed or completed disciplinary action against the licensed home care organization. The department also may request and maintain additional information for licensed home care agencies, as necessary, which shall not be publicly available on the registry. SB 411 Page 17 b) On page 7, strike out lines 29 to 32, inclusive, in line 33 strike out "disciplinary action against the certified home care aide.", and insert: (d) Maintain on the department's Internet Website a capability to look up the certification status of any certified home care aide, the name and location of the home care aide's employer, if there is one, and any disciplinary action taken against the home care aide. In the case of the home care aide being an independent contractor and not employed by an organization, the site shall indicate that status. To expedite the ability of a consumer to search and locate an appropriate home care aide, the site shall enable consumers to look up the certification status, including any disciplinary action taken against the home care aide, by providing the home care aide's name, certificate number, and geographic location. The site shall not provide any additional individually identifiable information about a home care aide. c) On page 21, strike out lines 23 to 40 inclusive, and on page 22, strike out lines 1 to 6 inclusive. d) Amend Section 1796.62 to read: (c) If the background check required by subdivision (b) discloses a conviction or incarceration for a conviction of any of the following provisions of the Penal Code within 10 years, the Department shall deny the home care aide certification of that individual. e) Amend Section 1796.12 (c) to add: (2) "Home care aide" does not include any person who is employed by, or contracts with, an organization vendored or contracted through a regional center or the State Department of Developmental Services pursuant to the Lanterman Developmental Disabilities Services Act (Division 4.5 (commencing with Section 4500) of the Welfare and Institutions Code) and the California Early Intervention Services Act (Title 14 (commencing with Section 95000) of the Government Code) to provide services and support for persons with developmental disabilities, as defined in Section 4512 of the Welfare and Institutions Code, when funding for those services is provided through the State Department of Developmental Services and meets the criteria defined in 1796.12 d(2)(G) . SB 411 Page 18 f) Amend Section 1796.12 d (2) to add: (G) An organization vendored or contracted through a regional center or the State Department of Developmental Services pursuant to the Lanterman Developmental Disabilities Services Act (Division 4.5 (commencing with Section 4500) of the Welfare and Institutions Code) and the California Early Intervention Services Act (Title 14 (commencing with Section 95000) of the Government Code) to provide services and support for persons with developmental disabilities, as defined in Section 4512 of the Welfare and Institutions Code, when funding for those services is provided through the State Department of Developmental Services and 51% or more of the recipients of the home care services as defined by 1796.13 are persons with developmental disabilities. g) Amend Section 1796.60 (a) to add: (1) If the department determines training required by (c) of this section is unavailable in an applicant's county within 30 days of the deadline specified in this section, the Department shall issue a temporary home care aide certificate to that individual that will be valid until the date that proper training is made available in that region. (2) Upon completion of the mandatory training as defined in (c) of this section, the Department shall replace the temporary home care aide certification and a permanent home care aide certificate shall be given to the individual by the Department. h) Amend Section 1796.60 to add: (e) The mandatory training requirements for home care aide certification as defined in (c) of this section may be completed through online training program. 11)POLICY COMMENTS : a) Regulatory Agency . This bill requires home care organizations to be licensed and regulated by DPH. The bill further requires DPH to certify home care aides. DPH's Licensing and Certification Division currently licenses health facilities in California as well as oversees the certification of nurse assistants, home health aides, and hemodialysis technicians. Typically DPH licenses and certifies medical care type professions and facilities. Home care agencies and home care aides do not perform medical duties. SB 411 Page 19 It is recommended that the author require DSS to perform the licensing and regulatory activities instead of DPH. DSS currently administers the IHSS program, which provides services that are similar to those provided by home care agencies, to low-income aged, blind, and disabled consumers. b) Certification Timeframe . This bill requires that, beginning January 1, 2013, any person hired as a home care aide be certified within 30 days of hire. This bill also requires, for purposes of meeting training requirements for certification, that curricula be developed with input from consumer and worker representatives and be approved by DPH. A period of one year from the effective date of this bill may not be sufficient time to develop training curricula, complete trainings, and conduct background checks to certify sufficient numbers of home care aides to meet the demand for home care services, thereby creating the "bottleneck" that opponents predict. It is recommended that the author consider amending the bill to extend the deadline for home care worker certification, at least as it applies to current employees. c) National Accreditation Requirement . According to the author, accreditation simplifies the licensing process and, thus, reduces the cost to DPH for licensing. This bill establishes an initial licensure fee equivalent to the fee for home health agencies for the 2011-12 FY, which is $4,129.63. The costs of accreditation, according to opponents of this bill, are in the range of $7,500 to $10,000. Thus, while accreditation may result in a saving of resources for DPH, which might be passed on to home care organizations in the form of lower fees, accreditation would still likely result in a substantial net cost to home care organizations. These added costs would then likely be passed on to home care organization clients in the form of higher fees. The cost issue should be examined more closely to determine the extent of savings to DPH and whether accreditation will result in a net savings or minimal costs to home care organizations. REGISTERED SUPPORT / OPPOSITION : SB 411 Page 20 Support Service Employees International Union, California (cosponsor) California Senior Legislature (cosponsor) Congress of California Seniors (cosponsor) Addus Healthcare Alzheimer's Association Association of California Caregivers Resource Centers California Alliance for Retired Americans Coalition for Humane Immigrant Rights of Los Angeles Consumer Attorneys of California Gray Panthers California National Association of Social Workers, California Chapter Older Women's League of California Older Women's League, Sacramento Capitol Chapter United Domestic Providers of America/AFSCME Oppose Unless Amended A Better Choice-in Home Care Accredited Nursing Care Agility Health Arcadia Home Care and Staffing Around the Clock Care California Association for Health Services at Home California Disability Services Association Cambrian Homecare Care to Stay Home ComForCare Senior Services ComForCare Senior Services - Arcadia Comfort Keepers Competent Care Home Health Nursing Craig Cares DialMED Home Care Help Unlimited Hillendale Home Care Hired Hands Homecare Home and Health Care Management Home Instead Senior Care Homecare Consultants Unlimited, Inc. HomeCare Professionals Innovative Healthcare Consultants Interim Healthcare Kaweah Delta Home Services SB 411 Page 21 Koved Care Love 2 Live Care Services LWF Home Care, Inc. Mad River Community Hospital Home Health Agency Matched CareGivers Medical Home Care Professionals, Inc. Network of Domestic Referral Agencies Northern and Southern California Chapters of the National Private Duty Association Nursing & Rehab at Home Pioneer Home Health Care Reliant In-Home Care Right at Home Select Home Care Sencare, Inc. Senior Helpers St. Joseph Health System Home Health Agency Visiting Angels Living Assistance Services, Inc. Opposition None on file. Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916) 319-2097