BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  SB 411
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          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 








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            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 








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            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 








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               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;









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             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.  









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          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 








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               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 








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            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 








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            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 








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            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 








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            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 








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            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 








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               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). 








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                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 








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               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 Cod  e 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 








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               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.
                








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             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
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             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.  








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             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 :








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           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