BILL ANALYSIS �
AB 1217
Page 1
ASSEMBLY THIRD READING
AB 1217 (Lowenthal)
As Amended May 7, 2013
Majority vote
HUMAN SERVICES 4-2 APPROPRIATIONS 12-5
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|Ayes:|Stone, Ammiano, Ian |Ayes:|Gatto, Bocanegra, |
| |Calderon, | |Bradford, |
| |Garcia | |Ian Calderon, Campos, |
| | | |Eggman, Gomez, Hall, |
| | | |Ammiano, Pan, Quirk, |
| | | |Weber |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Maienschein, Grove |Nays:|Harkey, Bigelow, |
| | | |Donnelly, Linder, Wagner |
| | | | |
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SUMMARY : Enacts the Home Care Services Consumer Protection
(HCSC) Act of 2013. Specifically, this bill :
1)States findings and declarations of the Legislature as to the
need to regulate the home care provider industry through the
establishment of a statewide registration and oversight
system.
2)Establishes the Home Care Services Act of 2011, and requires
the Department of Social Services (DSS) to administer and
enforce the law.
3)Requires, on or after July 1, 2014, non-exempted entities
providing home care services by a home care aide to obtain a
license pursuant to the Home Care Services Act of 2013 (HCSA),
and establishes civil penalties for violations of this
requirement.
4)Allows DSS to adopt rules and regulations to implement the
act; to investigate Priority One and Two Complaints against
home care aides not employed by a home care organization
(HCO); establish procedures for the receipt, investigation and
resolution of complaints; maintain a registry on its Internet
Web site of all certified home care aides, containing limited
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information that includes their employers, their certification
status, and the status of disciplinary actions against them;
and, maintain a registry on its Internet Web site of all
licensed HCOs containing specified information.
5)Requires background clearances of the owners of HCOs, as
described, and requires DSS to request subsequent arrest
notification service from the Department of Justice (DOJ).
Requires DOJ to charge a fee to cover costs related to this
bill.
6)Authorizes DSS to deny a license if the background clearance
discloses a conviction for a felony or crime that is
substantially related to the qualifications, functions, or
duties of operating an HCO, and provides that the license
shall not be denied if, pursuant to applicable Penal Code
provisions, the applicant has obtained a certificate of
rehabilitation or the information or accusation against the
applicant has been dismissed.
7)Requires DSS, in determining whether or not to deny a license
based on a prior conviction, to consider specified factors
related to the nature and seriousness of the crime, its
relationship to the person's employment duties and
responsibilities, the person's post-conviction activities, the
time elapsed, the individual's compliance with conditions of
parole, probation, restitution or other sanctions, other
evidence of rehabilitation, employment history and employer
recommendations, and the circumstances surrounding the
commission of the offense demonstrating the unlikelihood of
repetition.
8)Prohibits a public or private organization, except a county
providing IHSS services or other entity exempted from
licensing under the HCSA, from representing itself to be an
HCO, implying that it has a license to provide home care
services, referring to employee bonding in relation to such
services, or using the terms "health care organization," "home
care," "in-home care," or any combination of such terms in its
name, unless it is licensed pursuant to the HCSA.
9)Allows DSS to investigate complaints against an employment
agency if it fails to comply with the HCSA and levy civil
penalties of up to $900 per day per violation.
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10)Requires HCOs, with respect to home care aides employed by
the organization, to consult the DSS registry before hiring
the individual, ensure that he or she meets the requirements
for home care aides specified in the act, evaluate home care
aides, as provided, and ensure that, when providing services,
home care aides have access to a supervisor at all times and
wear an identification badge.
11)Requires HCOs to investigate complaints against a home care
aide made by a client or the client's family, and if the HCO
determines that the home care aide violated the HCSA, it shall
immediately notify DSS to take the appropriate action to
address the violation.
12)Establishes requirements on HCOs to protect clients' rights,
as specified.
13)Requires DSS to certify any person hired after January 1,
2014, as a home care aide to be within 90 days of the date of
hire and that any person referred by an employment agency who
provides assistance with activities of daily living be
certified prior to any referral.
14)Establishes training requirements for home care aide
certification, including requiring home care aides to complete
five paid hours of DSS approved training on job-related
topics, training curricula that are developed with input from
consumer and worker representatives, require instruction by
qualified instructors, and are approved by DSS.
15)Prohibits, beginning July 1, 2014, an HCO from hiring an
individual as a home care aide unless the individual completes
an interview and meets specified job requirements, and
requires the individual to provide proof of certification.
16)Requires an applicant for employment as a home care aide to
consent to a background clearance, and prohibits a home care
aide employed on or after July 1, 2014, from providing home
care services until he or she passes the required background
clearance.
17)Requires a background clearance through DOJ, as described, on
individuals hired as home care aides, unless the individual
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holds a valid, unexpired license or registration in a
health-related field that requires background checks; requires
DSS to request subsequent arrest notification service from
DOJ; and, requires DOJ to charge a fee to cover the actual
costs related to these activities.
18)Requires that DSS deny certification to an individual
convicted or incarcerated for conviction, within 10 years, for
child abuse, senior or dependent adult abuse, a violent or
serious felony as defined in the Penal Code, 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, pursuant to specified provisions of the Penal Code.
19)Establishes the Home Care Organization and Home Care Aide
Fund within the State Treasury and requires that licensure and
certification funds, as well as fines and penalties, be
deposited into the Fund, from which funds shall, upon
appropriation by the Legislature, be made available to DSS to
administer the HCSA.
20)Establishes requirements for notifying HCOs and employment
agencies of violations of the HCSA or rules promulgated under
the act, and authorizes DSS to impose a fine of up to $900 per
violation per day based on consideration of specified factors.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Assuming there are approximately 3,200 agencies that employ
100,000 home care workers, DSS would be required to license
and investigate complaints for those new entities. This would
constitute almost a 5% increase in the number of facilities
licensed by DSS. Based on that increase, the on-going cost
for DSS' Community Care Licensing Division (CCLD) would be
approximately $5 million. The bill requires that revenue from
licensing and certification fees be sufficient to cover the
on-going cost of the program.
2)One-time costs of approximately $30 million for regulations,
forms, and information technology related with creating the
new licensing system, the initial inspections and licensing of
all 3,200 agencies, and certifying close to 100,000 home care
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workers. In order for these costs to be fully offset by
licensing fees, each agency would need to pay approximately
$9,500 in a licensing application fee.
3)The Department of Justice projects General Fund costs of
$251,000 for 2013-14, $536,000 for 2014-15, and $132,000 for
2015-16 for the workload associated with the background checks
required of all home care aids and home care organizations.
COMMENTS :
Medical and nonmedical home care services : California law
currently provides for two types of in-home care for the
elderly, disabled, and people in need of home-based care;
through In-Home Supportive Services (IHSS) and Home Health
Agencies (HHA).
Licensed by the California Department of Public Health (DPH),
HHAs provide an array of medical and non-medical care and
services, including skilled nursing services, based upon a plan
of treatment prescribed by the patient's physician or surgeon.
These services can range in types of care from regular
day-to-day home care services to significant medical care,
including the administration of intravenous medications and
other services that would otherwise be provided in a skilled
nursing facility (SNF). In order to provide "home health aide
services," home health aides must undergo specified training and
be certified by DPH. HHAs help to provide patients with the
opportunity to live as comfortably as possible at home while
receiving necessary medical care as prescribed by their
physician rather than in a medical facility.
IHSS is a county operated service, in coordination with DSS,
which provides in-home care to low-income elderly or disabled
persons. Although similar in the provision of non-medical care,
IHSS differs from HHAs in that it provides support services and
some "paramedical services" but often not substantial, SNF-level
medical services in the home. The focus of IHSS is to provide
services that make it possible for a patient (or recipient) to
live independently at home while receiving basic personal care
assistance and domestic services from an IHSS provider, in
addition to help with administering medications, assistance with
prosthetic devices, and bowel, bladder and menstrual care.
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Current licensing standards for community care providers : DSS
Community Care Licensing Division (CCLD) is responsible for
carrying out the duties established by the California Community
Care Facilities Act and other related licensing acts in the
Health and Safety Code.
Prior to 2003, CCLD was required to visit most licensed
organizations once per year and family child care homes once
every three years. However, due to the state's ongoing budget
deficit, the state eliminated these requirements in the 2003-04
Budget and limited visits to 10% of facilities based upon their
poor performance history.
For those residential facilities not subject to annual
inspections, CCLD is currently required to conduct comprehensive
compliance inspections of a 30% random sample of facilities each
year, with each facility required to be visited as least once
every five years. There are additional inspection requirements
for new facilities or when changes occur to the license, which
includes pre-licensing and post-licensing inspections that help
to ensure that a new licensee starts off correctly.
Importance of unannounced licensing visits : Unannounced
licensing visits are of fundamental importance in protecting the
health and safety of children and adults receiving care through
facility or home-based care. They ensure that basic health and
safety requirements are being met and also provide opportunities
for increased technical assistance to programs, enhanced
information sharing, the development of best practices, and
ultimately lead to an improvement in the quality of life for
clients under care.
Regulating the home care market : This measure seeks to regulate
what is considered to currently be the home care industry, which
has existed for many years, but has begun to increase as the
nation's elderly population expands and the demand for in-home
care increases to allow individuals to live comfortably at home
with the assistance of a day-to-day home care provider. Home
care providers provide basic daily non-medical living
assistance, such as cooking, cleaning, dressing, feeding, and
other regular daily needs. However, unlike their IHSS and HHA
counterparts, there are no requirements in current law that
require home care aides to have minimum levels of training,
undergo a criminal background check, or comply with basic
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standards of service.
Due to the lack of a regulatory structure and related
enforcement, there is no framework or definition for what is
considered a home care aide. Although the title "home care
aide" implies a level of expertise and integrity associated with
a minimum level of care, any person may represent him or herself
as a home care aide. In some instances, individuals may solicit
their services through notifications posted online on websites
such as Craigslist or in newspaper classified ads. This can
place consumers who are in need of day-to-day living assistance
services in the home in potentially vulnerable situations, as
there are little to no existing legal requirements and
protections established. In some respects, it is not
unreasonable to associate home care aides unaffiliated with
reputable or established organizations or who operate as
independent contractors as part of an underground home care
industry whereby the public rests their faith in the hope that
the elderly and disabled are receiving adequate and beneficial
care in the home.
Regarding established agencies and associations that currently
employ home care aides, there is an expectation and desire to
develop a regulatory framework in anticipation of public demand
for greater standards and accountability. This bill, as
proposed, seeks to regulate the entirety of the home care
industry, addressing home care organizations and the home care
aides they employ, agencies that provide referrals for contract
based home care aides and independent home care aides.
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089
FN: 0000996