BILL ANALYSIS Ó ------------------------------------------------------------ |SENATE RULES COMMITTEE | SB 930| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ 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 CONTINUED SB 930 Page 2 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 CONTINUED SB 930 Page 3 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. CONTINUED SB 930 Page 4 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 | --------------------------------------------- |---------------+--------------+-------------| CONTINUED SB 930 Page 5 | |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 CONTINUED SB 930 Page 6 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 CONTINUED SB 930 Page 7 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 CONTINUED SB 930 Page 8 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 **** END **** CONTINUED SB 930 Page 9 CONTINUED