BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      



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          |SENATE RULES COMMITTEE            |                   SB 930|
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                              UNFINISHED BUSINESS


          Bill No:  SB 930
          Author:   Evans (D), et al.
          Amended:  8/15/11
          Vote:     21

           
           SENATE HUMAN SERVICES COMMITTEE  :  4-3, 04/26/11
          AYES:  Liu, Hancock, Wright, Yee
          NOES:  Emmerson, Berryhill, Strickland

           SENATE APPROPRIATIONS COMMITTEE  :  6-3, 05/09/11
          AYES:  Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
          NOES:  Walters, Emmerson, Runner

           SENATE FLOOR  :  23-16, 05/19/11
          AYES:  Alquist, Calderon, Corbett, De León, DeSaulnier, 
            Evans, Hancock, Kehoe, Leno, Lieu, Liu, Lowenthal, 
            Negrete McLeod, Padilla, Pavley, Price, Rubio, Simitian, 
            Steinberg, Vargas, Wolk, Wright, Yee
          NOES:  Anderson, Berryhill, Blakeslee, Cannella, Correa, 
            Dutton, Emmerson, Fuller, Gaines, Harman, Huff, La Malfa, 
            Runner, Strickland, Walters, Wyland
          NO VOTE RECORDED:  Hernandez

           ASSEMBLY FLOOR  :  51-27, 8/30/11 - See last page for vote


           SUBJECT  :    In-home supportive services:  enrollment and 
          fingerprinting
                        requirements

           SOURCE  :     California Association of Public Authorities 
          for IHSS
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                      Disability Rights California 
                      SEIU-UHW
                      United Domestic Workers of America/AFSCME Local 
          3930/
                        AFL-CIO
                      California Union of Homecare Workers


          DIGEST  :    This bill repeals requirements that In-Home 
          Supportive Services (IHSS) recipients provide fingerprint 
          images and that provider timesheets include spaces for 
          provider and recipient fingerprints; repeals the 
          prohibition against providers using a post office box 
          address to receive their paychecks; and, corrects problems 
          with the provider appeals process.

           Assembly Amendments  require the county, public authority, 
          or nonprofit consortium to send the State Department of 
          Social Services a copy of the state-level criminal offender 
          record information search response that is provided to that 
          entity by the Department of Justice for any individual who 
          has requested an appeal of a denial of placement on the 
          registry of IHSS personnel or denial of eligibility to 
          provide supportive services to an IHSS recipient.

           ANALYSIS  :    Existing law:

          1.Establishes the in-home supportive services program to 
            provide domestic and personal-care services to aged 
            individuals and to persons with a disability in order to 
            assist them to remain safely in their homes.

          2.Establishes the Medi-Cal program through which health 
            care services are provided to qualified low-income 
            persons.

          3.Provides personal care services to IHSS recipients who 
            are eligible for the Medi-Cal program in lieu of 
            providing those services under the IHSS program.

          4.Requires the Department of Social Services, in 
            consultation with county welfare departments, to develop 
            protocols and procedures for obtaining fingerprint images 
            of all individuals who are being assessed or reassessed 

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            to receive supportive services.

          5.Requires that, by July 1, 2011, the standardized 
            timesheet used to tract the work performed by providers 
            of IHSS include spaces for the index fingerprints of the 
            provider and the recipient.

          6.Requires that providers complete their enrollment form 
            using a physical address and prohibits their use of a 
            post office box address.

          7.Prohibits counties from mailing providers' paychecks to a 
            post office box address unless the county approves a 
            provider request to do so.

          This bill:

          1.Repeals the requirement that IHSS recipients provide 
            fingerprint images at the time of assessment or 
            reassessment. 

          2.Repeals the requirement that the standardized timesheet 
            include designated spaces for the index fingerprints of 
            the provider and the recipient. 

          3.Deletes the requirements and prohibitions related to the 
            use of a post office box address by an IHSS provider. 

          4.Requires the county or IHSS public authority to provide 
            the state Department of Social Services with an 
            unmodified copy of the Department of Justice (DOJ) 
            criminal offender record information search response 
            (CORI) if an IHSS provider or provider applicant has 
            requested an appeal of a denial of placement on the IHSS 
            provider registry as a result of a DOJ criminal 
            background check. 

          5.Requires the county or public authority to provide an 
            IHSS provider or provider applicant with an unmodified 
            copy of his or her CORI with any notice of denial, along 
            with information on how the individual may contest the 
            accuracy or completeness of, or refute any erroneous 
            information in the CORI. 


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           Background
           
          There are currently 19 personnel years attached to IHSS 
          fraud detection, including 14 investigators, two 
          supervisors, a section chief, an analyst, and an office 
          technician.  The investigators are headquartered in San 
          Diego, Los Angeles, and Sacramento.  The department notes 
          that all investigators are peace officers and or public 
          safety officers, responsible for protecting Medicaid 
          dollars, preserving program integrity, protecting and 
          serving the public, and take action when necessary. 

          The Department of Health Care Services (DHCS) reports that 
          in June of 2010, there were 447,635 recipients of IHSS and 
          405,328 active providers in the program.  During the fiscal 
          year, the department:

                 Received 2458 complaints (0.5 percent of  the 
               number of recipients) 
                 Made 347 unannounced home visits in response to 
               complaints
                 Opened 193 criminal investigations
                 Closed 107 criminal investigations with no action
                 Referred 51 complaints to the Department of Justice 
               (0.01 percent of the number of recipients)
                 Referred 577 complaints to other agencies (0.13 
               percent of the number of recipients)
                 Initiated recovery of funds in 70 investigations

          DHCS is also responsible, working in cooperation with 
          county district attorneys and others, for identifying 
          overpayments that may be the result of fraud or errors of 
          various kinds, including clerical.  With nine counties 
          reporting (counties that include 70 percent of the IHSS 
          caseload) $4.15 million in overpayments were identified 
          during the fiscal year and $624,000 has been recovered.  
          See the table below.


                       --------------------------------------------- 
                      |   FY 2009-10 In-Home Supportive Services    |
                      |Overpayments                                 |
                       --------------------------------------------- 
                      |---------------+--------------+-------------|

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                      |               |Identified    |Recovered    |
                      |---------------+--------------+-------------|
                      |Fresno         |$149,263.33   |$64,336.26   |
                      |---------------+--------------+-------------|
                      |Imperial       |$31,312.98    |Not Reported |
                      |---------------+--------------+-------------|
                      |Orange         |$287,932.99   |$192,290.08  |
                      |---------------+--------------+-------------|
                      |Riverside      |$106,160.87   |$12,733.00   |
                      |---------------+--------------+-------------|
                      |Sacramento     |$2,082,828.00 |$83,709.00   |
                      |---------------+--------------+-------------|
                      |San Bernardino |$190,101.94   |$139,901.94  |
                      |---------------+--------------+-------------|
                      |San Diego      |$65,499.28    |$5605.29     |
                      |---------------+--------------+-------------|
                      |San Joaquin    |$180,233.84   |$10,809.37   |
                      |---------------+--------------+-------------|
                      |Los Angeles    |$1,102,004.92 |$120,126.16  |
                      |               |              |             |
                      |---------------+--------------+-------------|
                      |               |              |             |
                      |---------------+--------------+-------------|
                      |Total          |$4,145,245.36 |$623,905.81  |
                      |               |              |             |
                       -------------------------------------------- 

          The 2009-10 estimated expenditures for IHSS was $5.7 
          billion, including administration, and $5.3 billion 
          excluding administration (figures contained in the May 
          Revision).  If the rate of overpayment in California's 
          remaining counties is the same as in these nine counties, 
          then overpayments, which include clerical errors and other 
          mistakes as well as fraud, represent about one-tenth of one 
          percent (0.1 percent) of those expenditures.  

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes   
          Local:  No

          According to the Assembly Appropriations Committee: 

               Savings of $41.6 million ($21 million GF) spread over 
               seven years associated with not implementing the 
               finger imaging requirements. Those savings would be 

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               offset to an unknown degree by forgone savings 
               associated with deterring fraudulent activity. 

               Absent this bill, it is assumed that the 
               administrations would need to comply at some point 
               with current law and implement the finger imaging 
               requirements and the prohibition against providers 
               using post office boxes. Previous budget estimates 
               suggest that total costs for finger imaging would be 
               approximately $41.6 million ($21 million GF) over 
               seven years. Therefore, this bill removes that cost 
               pressure. 

               Though these anti-fraud provisions were never 
               implemented, the Governor's 2010-11 budget assumed all 
               of the anti-fraud initiatives adopted in 2009 would 
               result in approximately $390 million ($135 million GF) 
               in savings in the first full year. It is unclear how 
               much of that would have been attributable to finger 
               imaging and the prohibition against post office boxes. 
               Proponents of this finger imaging policy would argue, 
               however, that there are foregone savings of perhaps 
               tens of millions of dollars associated with this 
               legislation. 

               Proponents of this legislation, on the other hand, 
               argue that there is no evidence of widespread fraud in 
               the IHSS program and therefore it is unlikely the 
               level of savings assumed by the previous 
               administration is realistic. 

           SUPPORT  :   (Verified  8/23/11)

          California Association of Public Authorities for IHSS 
          (co-source) 
          Disability Rights California (co-source) 
          SEIU-UHW (co-source) 
          United Domestic Workers of America/ AFSCME Local 3930/ 
          AFL-CIO                                           
          (co-source) 
          California Union of Homecare Workers (co-source) 
          American Civil Liberties Union
          American Federation for State, County, and Municipal 
          Employees 

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          California Alliance for Retired Americans
          California Disability Community Action Network 
          Californians for Disability Rights, Inc.
          California Foundation for Independent Living Centers
          California In-Home Supportive Services Consumer Alliance
          California State Association of Counties
          California United Homecare Workers Union, SEIU/AFSCME Local 
          4034
          Communities United in Defense of Olmstead
          Contra Costa County
          County Welfare Directors Association of California
          Insurance Commissioner Dave Jones
          In Home Supportive Services Coalition
          AARP-California
          Access to Independence
          ACLU Southern California
          California Alliance for Retired Americans
          California Association of Public Authorities
          California Church IMPACT
          Congress of California Seniors
          Californians for Disability Rights
          California Foundation for Independent Living
          California IHSS Consumer Alliance
          California Senior Legislature
          California Disability Community Action Network
          California United Homecare Workers
          Dayle McIntosh Center for the Disabled
          Disability Rights California
          East Bay Community Law Center
          Friends Committee on Legislation
          Gray Panthers
          Independent Livings Resource Center Inc.
          Marin IHSS Public Authority
          National Senior Citizen's Law Center
          Nevada-Sierra-Plumas Public Authority
          Northern California ADAPT
          Older Women's League
          In Home Supportive Services Public Authority
          National Association of Social Workers
          Pamela Hoye
          Personal Assistance Services Council of Los Angeles County
          State Independent Living Council 
          The ARC
          Western Center on Law & Poverty

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           OPPOSITION  :    (Verified  8/23/11)

          California District Attorneys Association (previous 
          version)

           ARGUMENTS IN SUPPORT  :    The California State Association 
          of Counties and the County Welfare Directors Association 
          write that "the incidence of IHSS fraud is overstated."  Of 
          24,000 cases reviewed (including both randomly selected 
          cases and those referred for suspicious activity), 523 (two 
          percent) were referred for further investigation and less 
          than one percent were found to involve fraud.  These 
          numbers were similar over each of three years.   There are 
          better uses for government funds than these purchases of 
          equipment and review of fingerprints.  Many letters in 
          support claim that there is no evidence that the use of  
          post office boxes results in higher levels of fraud.


           ASSEMBLY FLOOR  :  51-27, 8/30/11
          AYES:  Alejo, Allen, Ammiano, Atkins, Beall, Block, 
            Blumenfield, Bonilla, Bradford, Brownley, Buchanan, 
            Butler, Charles Calderon, Campos, Carter, Cedillo, 
            Chesbro, Davis, Dickinson, Eng, Feuer, Fong, Fuentes, 
            Furutani, Galgiani, Gordon, Hall, Hayashi, Roger 
            Hernández, Hill, Huber, Hueso, Huffman, Lara, Bonnie 
            Lowenthal, Ma, Mendoza, Mitchell, Monning, Pan, Perea, V. 
            Manuel Pérez, Portantino, Skinner, Solorio, Swanson, 
            Torres, Wieckowski, Williams, Yamada, John A. Pérez
          NOES:  Achadjian, Bill Berryhill, Conway, Donnelly, 
            Fletcher, Beth Gaines, Garrick, Gatto, Grove, Hagman, 
            Halderman, Harkey, Jeffries, Jones, Knight, Logue, 
            Mansoor, Miller, Morrell, Nestande, Nielsen, Norby, 
            Olsen, Silva, Smyth, Valadao, Wagner
          NO VOTE RECORDED:  Cook, Gorell


          CTW:nl  8/30/11   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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