BILL ANALYSIS Ó
AB 753
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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
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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.
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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
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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
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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
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