BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1217|
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THIRD READING
Bill No: AB 1217
Author: Lowenthal (D), et al.
Amended: 9/5/13 in Senate
Vote: 21
SENATE HUMAN SERVICES COMMITTEE : 4-2, 6/25/13
AYES: Yee, Evans, Liu, Wright
NOES: Berryhill, Emmerson
SENATE APPROPRIATIONS COMMITTEE : 5-2, 8/30/13
AYES: De León, Hill, Lara, Padilla, Steinberg
NOES: Walters, Gaines
ASSEMBLY FLOOR : 52-26, 5/30/13 - See last page for vote
SUBJECT : Home care organizations: licensure
SOURCE : Author
DIGEST : This bill establishes the Home Care Services Consumer
Protection Act of 2013, to provide for the licensure and
regulation of home care organizations and the certification of
home care aides.
Senate Floor Amendments of 9/5/13 clarify that information
shared by the Department of Social Services (DSS) pursuant to
this bill is subject to existing law (Penal Code Section 11142),
which states that the sharing of criminal records or information
from criminal records with persons not authorized by law to
receive such information is a misdemeanor.
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ANALYSIS :
Existing law:
1.Establishes the California Community Care Facilities Act,
which provides for the licensing and regulation of community
care facilities providing non-medical residential care, day
treatment, and adult day care under the Department of Social
Services (DSS).
2.Provides for the licensing and regulation of health care
facilities providing diagnosis, care, prevention, and
treatment of human illness, physical or mental, to which more
than one person is admitted for a 24-hour stay or longer.
3.Provides for the licensing and regulation of home health
agencies and home health aides providing skilled nursing
services to patients in their home residence.
4.Establishes the In-Home Supportive Services (IHSS) program to
provide in-home domestic and personal care services for aged,
blind or disabled individuals living at or below the poverty
level for the purpose of enabling IHSS consumers to avoid
institutionalization and remain safely in their homes with
supportive services.
5.Requires prospective IHSS providers to undergo a criminal
background check and establishes two tiers of exclusionary
crimes.
6.Permits an IHSS consumer or any employer of an unlicensed
in-home care provider to an aged or disabled consumer, to
request a criminal background check for the provider and
requires county welfare agencies to regularly inform the
consumer of this right.
This bill:
1.Establishes the Home Care Services Consumer Protection Act of
2013.
2.Defines "home care aide" to mean an individual who provides
home care services to a client in the client's residence.
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3.Defines "home care services" to include bathing, dressing,
feeding, exercising, personal hygiene and grooming,
transferring, ambulating, positioning, toileting and
incontinence care, assisting with medication that the client
normally self-administers, housekeeping, meal planning and
preparation, laundry, transportation, correspondence, making
telephone calls, shopping and companionship.
4.Defines "home care services" to exclude services provided by a
licensed home health agency, a licensed hospice, services
provided under the IHSS program, services authorized to be
provided by a licensed residential care facility for the
elderly and care provided by religious institutions.
5.Requires home care organizations to obtain a license from DSS
prior to arranging for the provision of home care services.
Provides that the license be issued for two years and that a
violation be punishable by a fine of $900/day.
6.Requires DSS to issue a two-year license to a home care
organization that has satisfied the following requirements:
A. Submitted proof of general and professional liability
insurance of one million dollars per occurrence and three
million dollars in the aggregate.
B. Submitted proof, as specified, of a valid workers
compensation policy covering home health aides.
C. Provided DSS with a complete list of home health aides
and proof that each meets conditions of DSS certification.
D. The owner or owners have passed a background clearance,
as specified.
1.Requires DSS to verify that a home care organization is in
compliance with licensure through random unannounced
inspections at least once every five years and provides that
such inspections may include an inspection of the books,
records, and premises of a home care organization and direct
observation of the provision of home care services in the
client residence, subject to client consent.
2.Requires, any person hired as a home health aide to be
certified by DSS prior to being hired, and requires
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certification to include the following:
A. Completion of minimum training requirements of at least
five hours of entry-level training comprised of two hours
of orientation training, three hours of safety training, as
specified, other training related to core competencies and
population specific competencies, as specified.
B. Completion of a background clearance, as specified.
C. Submission to an examination to determine if he/she is
free of tuberculosis.
1.Requires a home care organization, prior to hiring a home
health aide, to ensure the health aide has complied with the
following:
A. Completed an individual interview.
B. Provided at least two work-or school-related references,
or for an individual with no work experience, two character
references from non-relatives of the aide. Requires the
home care organization to verify these references.
C. Demonstrated that he/she possesses sufficient language
skills to read and understand instructions, prepare and
maintain written reports and records and communicate with a
client.
D. Provided proof of certification as a home health aide.
1.Additionally, requires a home care organization to do all of
the following:
A. Consult the DSS registry, if available, prior to placing
an aide in direct contact with a client.
B. Investigate complaints made by a client, or a client's
family member or guardian, to document the existence and
resolution of those complaints, and to immediately notify
DSS if a home care aide is found to be in violation of
conditions of certification.
C. Evaluate home care aides as follows:
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(1) Conduct an annual assessment of the performance
and effectiveness of each aide including at least one
observation of the aide in the client residence, subject
to client consent.
(2) Every 90 days, supervise each aide in the
residence of the client, subject to the client consent.
Provides that this supervision shall not be billed to
the client, and
(3) Ensure that at all times an aide has access to a
supervisor.
A. Require a home care aide to wear a badge that includes,
in 12-point type or larger, information including the
aide's name, photograph, and certification number; and the
name of the home care organization and the license
expiration date.
B. Require home care aides to demonstrate they are free of
active tuberculosis.
C. Require aides to complete the five-hour training
requirement annually.
D. Prohibit aides from accepting money or property from a
client without written permission from the home care
organization.
E. Immediately notify the department when the home care
organization no longer employs the aide.
F. Post its license conspicuously in its place of business.
G. Operate in a commercial space that complies with local
zoning ordinances.
H. Have plans and procedures in place for the following:
(1) In the event of emergencies or natural disasters.
(2) In the event that a home care aide scheduled to
provide services becomes unavailable.
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(3) A policy regarding advance directives.
(4) Receipt and disbursement polices for expenditures
made on behalf of a client to ensure that financial
abuse does not occur.
A. Maintain a valid workers' compensation policy covering
aides.
B. Maintain an employee dishonesty bond, including third
party coverage, with a minimum limit of $10,000 dollars.
1.Permits DSS to establish procedures for the receipt,
investigation and resolution of complaints and to investigate
priority one and priority two complaints for home care
organizations and aides not employed by a home health
organization.
2.Requires DSS to share information it obtains, including
information reported by home care organizations, home care
aides, and the Department of Justice (DOJ), with specified
governmental entities, upon request and to the fullest extent
permitted by law, and subject to prohibitions in Penal Code
Section 11142 and contracted restrictions applicable to
information reported by DOJ.
3.Establishes two categories of complaints against a home care
organization or home care aide including: a "priority one
complaint" relating to a sexual abuse involving penetration or
physical abuse involving great bodily injury, as specified,
and a "priority two complaint" that involves sexual abuse not
involving penetration, physical abuse that results in minor
injury, or specified felony offenses including robbery, arson,
grand theft and chemical restraint.
4.Establishes a series of client rights, which require a home
care organization to do all of the following:
A. Advise a client of any change in the client's plan for
home care services.
B. Prior to arranging for services:
(1) Distribute a copy of the client's advance health
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care directive to the client along with a written
summary of state law.
(2) Advise the client about the organization's policy
regarding disclosure of client records.
(3) Inform the client of the types and hours of
available home care services.
(4) Inform the client both orally and in writing of
the home care services that are or are not covered by
Medi-Cal or Medicare.
(5) Inform the client of any change to that
information within 30 days.
(6) Have a written agreement with the client that
includes the cost of and the hours during which home
care services will be provided to the client.
1.Specifies that this bill's provisions do not supersede local
laws regulating home care organizations and home care
services, including licensing, reporting, registration, and
providing for civil penalties.
Background
Licensing standards . Existing law generally provides for the
Department of Public Health to license or certify facilities,
organizations and individuals that provide clinical medical
services, whether in a facility or in a patient's residence.
Such services range from minor medical care to intensive skilled
nursing services. Home health providers are required to
complete a minimum of 75 hours of training and complete a
background check.
IHSS program . California's IHSS program is the state's primary
community-based long-term service, providing in-home domestic
and personal care services for 448,000 aged, blind or disabled
individuals living at or below the poverty level. The purpose
of IHSS is to enable seniors and persons with disabilities to
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remain safely in their homes and avoid institutional care
through the provision of a specified number of assistance hours
provided by a home care worker under the direction of the
consumer. The program is administered locally by counties and
county public authorities under the direction and regulation of
DSS. There are approximately 386,000 providers.
Prior Legislation
AB 322 (Yamada, 2013) would have established the Home Care
Services Act of 2013 to license and regulate home care
organizations providing services for the elderly, frail and
persons with disabilities. The bill was held in Assembly
Appropriations Committee.
SB 411 (Price, 2011) would have established the Home Care
Services Act of 2011, which required DPH to license and regulate
home care organizations. The bill was vetoed by Governor Brown.
AB 899 (Yamada, 2011) would have established the Home Care
Services Act of 2013 to license and regulate home care
organizations providing services for the elderly, frail and
persons with disabilities. The bill was held in Assembly
Appropriations Committee.
AB 853 (Jones, 2007) would have established the Home Care
Services Act to license and regulate home care services for the
elderly, frail and persons with disabilities. The bill was held
in Assembly Appropriations Committee.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
One-time costs of approximately $22.5 million (General Fund)
to promulgate regulations, forms, automation changes to create
the new licensing system and development of registries,
inspections and licensing for 2,000 agencies, and
certification of over 101,000 home care aides. Ongoing costs
to be covered by licensure and certification fees from the
newly created Home Care Organization and Home Care Aide
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(HCOHCA) Fund.
Estimated ongoing costs of approximately $20 million (HCOHCA
Fund) to administer the licensure and certification programs,
to be fully offset by licensure and certification fees.
Assuming 60% of ongoing costs would be attributable to
licensure would result in a licensure fee of $6,000 per agency
and $80 certification fee per home care aide.
Fingerprint Fees Account costs to the Department of Justice of
$280,000 in FY 2013-14, $400,000 in FY 2014-15, and $130,000
in FY 2015-16 and annually thereafter for workload associated
with additional background checks required of all home care
aides and home care organization licensees.
Minor ongoing administrative costs to the Secretary of State
to the extent additional organizations register to conduct
business in California.
SUPPORT : (Verified 9/6/13)
AARP
AFSCME
California Commission on Aging
California Senior Legislature
Congress of California Seniors
Los Angeles County District Attorney's Office
Richmond Commission on Aging
SEIU California
The Arc and United Cerebral Palsy
United Domestic Workers
OPPOSITION : (Verified 9/6/13)
California Association for Health Services at Home
Cambrian Homecare
Care to Stay Home
Caring Solutions
Comfort Care Senior Services
Home Care Association of California
Home Instead Senior Care
Matched CareGivers Continuous Care
Maxim Healthcare Services, Inc.
People's Care
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ARGUMENTS IN SUPPORT : According to the author's office, the
number of California residents aged 85 and older will double to
more than 1.3 million by 2030. The author's office states that
many older adults, facing chronic conditions and functional
limitations, will require the provision of medical and
non-medical services in their homes. The author's office notes
that individuals and organizations providing skilled nursing
services at a person's residence are required to be licensed,
however for non-medical in-home personal care services, only the
publicly funded service programs require providers to pass a
background check or meet basic training standards.
The author's office states that approximately 1,200
privately-funded homecare agencies operate in California with a
business license and that an unknown number of independent home
care aides provide services without any oversight or regulation.
The author's office states that this bill requires all home
care aides to be certified and that this bill ensures that all
consumers of home care services have access to quality care from
properly screened and trained caregivers, whether they receive
services through a public or private entity.
ARGUMENTS IN OPPOSITION : The Home Care Association of
California and Maxim Healthcare Services, Inc. write, expressing
their support for licensure in concept, but opposition to this
bill as drafted. Specifically, both state concerns with the
DSS-maintained registry mandated in the bill due to privacy
concerns, the availability of personal information on a website
and potential costs. Additionally, Maxim Healthcare Services
and the California Association for Health Services at Home write
that this bill as drafted requires the maintenance of two
separate registries - one for certified aides and another for
home care agencies - that would make publicly available
information related to disciplinary actions taken against the
aide, regardless of who accessed the information or whether the
disciplinary actions had been substantiated. Maxim additionally
writes in opposition to proposed mandatory annual training
requirements, which it describes as vague.
ASSEMBLY FLOOR : 52-26, 5/30/13
AYES: Alejo, Ammiano, Atkins, Bloom, Blumenfield, Bocanegra,
Bonilla, Bonta, Bradford, Brown, Buchanan, Ian Calderon,
Campos, Chau, Chesbro, Cooley, Daly, Dickinson, Eggman, Fong,
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Fox, Frazier, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gray,
Hall, Roger Hernández, Jones-Sawyer, Levine, Lowenthal,
Medina, Mitchell, Mullin, Muratsuchi, Nazarian, Pan, Perea, V.
Manuel Pérez, Quirk, Quirk-Silva, Rendon, Salas, Skinner,
Stone, Ting, Weber, Wieckowski, Williams, John A. Pérez
NOES: Achadjian, Allen, Bigelow, Chávez, Conway, Dahle,
Donnelly, Beth Gaines, Gorell, Grove, Hagman, Harkey, Jones,
Linder, Logue, Maienschein, Mansoor, Melendez, Morrell,
Nestande, Olsen, Patterson, Wagner, Waldron, Wilk, Yamada
NO VOTE RECORDED: Holden, Vacancy
JL:ej 9/6/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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