BILL ANALYSIS Ó AB 753 Page 1 Date of Hearing: April 16, 2013 ASSEMBLY COMMITTEE ON HEALTH Richard Pan, Chair AB 753 (Lowenthal) - As Introduced: February 21, 2013 SUBJECT : Cognitively impaired adults: caregiver resource centers. SUMMARY : Repeals and recasts existing law governing caregiver resource centers (CRCs) to reflect the transfer of their oversight from the former Department of Mental Health (DMH) to the Department of Health Care Services (DHCS) pursuant to the health budget trailer bill, AB 1467 (Budget Committee), Chapter 23, Statutes of 2012. Specifically, this bill : 1)Repeals existing statutes governing CRCs when they were under the jurisdiction of DMH and creates the Comprehensive Act for Families and Caregivers of Cognitively Impaired Adults. 2)Makes a number of legislative findings and declarations regarding the value and role of CRCs and expresses intent to support family caregivers taking care of adults living with cognitive impairment by funding and implementing the California CRCs. 3)Establishes various definitions for purposes of this bill, including that "caregiver" means any unpaid family member or individual who assumes responsibility for the care of a person whose cognitive impairment has occurred after 18 years of age. 4)Requires the Director of DHCS to take the following actions with respect to CRCs: a) Maintain or enter into contracts directly with 11 CRCs to provide direct services to caregivers throughout the state in the existing geographic service areas; b) Maintain a CRC Operations Manual that defines CRC services and procedures and identifies CRC duties and responsibilities; and, c) Seek funding for CRC from federal and private sources. 5)Specifies that agencies designated as CRCs by the Director of DHCS must include in their governing or advisory boards, or AB 753 Page 2 both, persons who represent the ethnic and socioeconomic character of the area served and the client groups served in the geographic area. Specifies the criteria that must be used in selecting CRCs. 6)Requires CRCs to deliver services to, and advocate for, caregivers of cognitively impaired adults in accordance with the CRC Operations Manual and specifies the range of services CRCs must provide. 7)Provides that persons receiving services pursuant to this bill may be required to contribute to the cost of services depending upon their ability to pay, but not to exceed the actual cost. 8)Requires each CRC to submit progress reports with specified information on its activities to the Director of DHCS. 9)Authorizes the Director of DHCS to enter into exclusive or nonexclusive contracts on a bid or negotiated basis and to amend existing contracts to provide or arrange for services provided under this bill. 10)Includes an urgency clause to make the provisions of this bill take effect immediately. EXISTING LAW establishes the Comprehensive Act for Families and Caregivers of Brain-Impaired Adults, previously administered by DMH, to contract with a Statewide Resources Consultant to coordinate a statewide system of CRCs to serve caregivers of adults with Alzheimer's disease, stroke, Parkinson's, traumatic brain injury, and other adult-onset cognitive disorders. FISCAL EFFECT : This bill has not yet been analyzed by a fiscal committee. COMMENTS : 1)PURPOSE OF THIS BILL . The sponsor, the Association of California CRCs, states that for nearly three decades, 11 CRCs throughout the state have supplied information, education, respite, and emotional support to California families and friends who provide long-term care at home for loved ones suffering from chronic and debilitating health conditions. AB 753 Page 3 According to the sponsor, this bill is intended to update the statutes governing CRCs to be more reflective of current terminology and practices in response to the transfer of administration and oversight of this vital community-based program from DMH to DHCS last year as a result of DMH's elimination. 2)CRCs . CRCs provide supportive services to caregivers of people with acquired cognitive impairments. CRC services include mental health support, respite care, legal counseling, support groups, and education. The 11 CRCs in California serve about 14,000 caregivers. The CRC system was created pursuant to AB 2913 (Agnos), Chapter 1658, Statutes of 1984, to provide a single point of entry to long-term care services available to caregiving families in 11 major geographic regions throughout California. The CRC system was the first of its kind in the nation and was looked to as a model for the development of similar services now available in all 50 states. CRC services are unique in that they are not generally available elsewhere, even for people of middle or high-income who have health insurance. Additionally, individuals pay fees on a sliding scale. Funding for CRCs has been reduced by 74% since 2009 and went from a high of $11.5 million in 2008 to $2.9 million today. As a result of these budget reductions, all 11 CRCs maintain waiting lists for various services; the CRC serving the Los Angeles area has a waiting list of over 900 people for respite services alone. When the CRC program was under the authority of DMH, the Family Caregiver Alliance (FCA), the original CRC, was selected to serve as the Statewide Resources Consultant. In this capacity, FCA assisted in statewide program development, data analysis, reporting functions, and technical assistance to the 11 CRC sites. However, the system development efforts, data collection, reporting functions, and information dissemination roles of the FCA were eliminated as a result of budget cuts to DMH in 2008. This bill does not include the Statewide Resources Consultant in the framework under DHCS and instead requires each CRC to submit a progress report describing its activities to DHCS. The Governor's 2012-13 Budget proposed to eliminate all funding AB 753 Page 4 for CRCs. In rejecting this proposal, the Legislature noted that CRCs are a valuable component of the state's overall safety net that allows caregivers to continue providing long-term care in homes, thereby enabling many disabled Californians to continue living in the community rather than in nursing facilities, hospitals, or institutionalized settings. According to the Budget Committees, keeping people at home leads to substantial savings for the state in reduced institutional care costs. The Legislative Analyst's Office (LAO) also commented that eliminating funding for CRCs seemed at odds with the Administration's Coordinated Care Initiative (CCI) to provide better coordinated care for seniors and persons with disabilities in order to reduce fragmentation in the state's long-term care services continuum. 3)CCI . According to a March 2013 fact sheet from DHCS, passage of the CCI in 2012 marked an important step toward transforming California's Medi-Cal care delivery system to better serve the state's low-income seniors and persons with disabilities. Building upon many years of stakeholder discussions, the CCI begins the process of integrating delivery of medical, behavioral, and long-term care services and also provides a road map to integrate Medicare and Medi-Cal for people in both programs, called "dual eligible" beneficiaries. The CCI is expected to produce greater value for the Medicare and Medi-Cal programs by improving health outcomes and containing costs; primarily through shifting service delivery into the home and community and away from expensive institutional settings. The LAO adds that, to the extent that the state would be relying more on home and community-based services under the CCI, the role of CRCs would support those objectives. DHCS states that significant stakeholder feedback informed the beneficiary protections needed to drive success and quality in the CCI's design and implementation. The CCI includes comprehensive protections to ensure beneficiary health, safety, and high quality care delivery, including medical care, long-term services and supports, and behavioral health. 4)SUPPORT . Several individual CRCs note in support that AB 753 Page 5 dedicated families, not institutions, provide most of the long-term care for loved ones with cognitive impairments, often at great physical, emotional, and financial sacrifice. They state that this bill ensures that the state continues to support and fund these programs that give caregivers a place to turn for services. The Peninsula Stroke Association writes in support that the small investment the state makes in CRCs results in large monetary savings over the long-term by preventing or delaying the placement of adults with cognitive impairments in nursing homes or hospitals. 5)DOUBLE REFERRAL . This bill is double-referred. Should it pass out of this Committee, it will be referred to the Assembly Committee on Aging and Long-Term Care. 6)TECHNICAL AMENDMENT . On page 3, line 24, delete "11". REGISTERED SUPPORT / OPPOSITION : Support Association of California Caregiver Resource Centers (sponsor) Alzheimer's Association Coast Caregiver Resource Center Del Mar Caregiver Resource Center Del Oro Caregiver Resource Centers Family Caregiver Alliance Inland Caregiver Resource Center Orange County Caregiver Resource Center Peninsula Stroke Association Redwood Caregiver Resource Centers Southern Caregiver Resource Center Valley Caregiver Resource Center Opposition None on file. Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097 AB 753 Page 6