BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: AB 1436
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|Author: |Burke |
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|Version: |May 6, 2015 |Hearing | June 23, 2015 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Sara Rogers |
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Subject: In-home supportive services: authorized
representative
SUMMARY
Allows In-Home Supportive Services (IHSS) applicants and
recipients to designate an authorized representative to
accompany, assist or represent an applicant in the application
process, or a recipient in the direction of services, and
eligibility redetermination process.
ABSTRACT
Existing law:
1)Establishes in state law a program of public Medi-Cal benefits
to provide health care for people who lack sufficient annual
income to meet the costs of health care, and whose other
assets are so limited that their application toward the costs
of such care would jeopardize the person or family's future
minimum self-maintenance and security. (WIC 14000 et seq.)
2)Establishes the IHSS program to provide domestic and other
supportive services in every county, as specified, for
individuals who are unable to perform the services themselves
and who cannot safely remain in their homes or abodes of their
own choosing unless these services are provided. (WIC 12300 et
seq.)
AB 1436 (Burke) Page 2
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3)Provides that recipients of in-home supportive services shall
retain the right to choose the individuals that provide their
care and to recruit, select, train, reject, or change any
provider under the contract mode or to hire, fire, train, and
supervise any provider under any other mode of service. (WIC
12302.25)
4)Provides that an IHSS applicant or recipient shall meet
certain conditions including:
a. Submit a three page application for social services.
(SOC 295)
b. Obtain a certification from a licensed health care
professional, as defined, declaring that the applicant or
recipient is unable to perform some activities of daily
living independently without which the applicant or
recipient is at risk of placement in out-of-home care.
(WIC 12309.1)
c. Have the recipient's initial and continuing monthly
need for services assessed by a county social worker at
varying intervals as necessary, but at least once every
12 months. (WIC 12301.1)
d. Participate in unannounced home visits, from a
county social worker, to ensure quality assurance and
program integrity, including fraud detection and
prevention. (WIC 12305.71)
e. Hire, train, supervise, schedule and, when
necessary, fire a provider. (SOC 295)
f. Ensure the total hours reported by all providers
does not exceed authorized hours each month. (SOC 295)
g. Refer any individual the recipient would like to
hire to the county IHSS office to complete the provider
eligibility process. (SOC 295)
h. Notify the county IHSS office when the recipient
hires or fires a provider. (SOC 295)
This bill:
1)Defines "authorized representative" to mean an individual who
is appointed in writing by an IHSS applicant or recipient to
AB 1436 (Burke) Page 3
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act in place or on behalf of the applicant or recipient for
the purposes related to the program, including, but not
limited to, accompanying, assisting, or representing the
applicant in the application process, or the recipient in
directing the services received, and in the redetermination
process.
2)Permits an IHSS applicant or recipient to designate an
authorized representative.
3)Provides that an IHSS applicant or recipient shall specify the
duties to be provided by the authorized representative and
that these duties may be changed or revoked at any time by the
applicant or recipient.
4)Provides that the authorized representative shall have a legal
responsibility to act in the client's best interest.
5)Provides that a court order establishing legal guardianship or
a valid power of attorney to make health care decisions shall
serve in place of a written appointment by the applicant or
recipient.
6)Permits the authorized representative, if so specified by the
IHSS recipient, to sign timesheets for services rendered on
behalf of the recipient, but disallows the authorized
representative who is a care provider from signing his or her
own timesheet unless the provider has legal custody over a
minor recipient, as specified, or the provider is legally
authorized to act on the applicant's or recipient's behalf
under state law.
7)Permits an individual with legal authority to act on behalf of
an IHSS applicant or recipient to designate someone other than
him or herself to act on behalf of the applicant or recipient.
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8)Prohibits persons prevented from being an IHSS provider due to
past criminal history, as well as providers who have been
granted criminal record exemptions from serving as an
authorized representative. Additionally prohibits individuals
found to have perpetrated a substantiated report of abuse of
neglect against a child or elder from serving as an authorized
representative.
9)Directs the California Department of Social Services (CDSS),
in consultation with specified stakeholders to develop a
standardized statewide form and procedures related to the
designation of an authorized representative.
FISCAL IMPACT
According to an Assembly Appropriations analysis, there are
minor and absorbable costs to CDSS associated with the
development of the required form and minor costs to implement
the procedure.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, the authorized representative function
is critical in that it provides applicants and recipients with a
self-directed pathway to receive needed assistance with complex
rules and requirements of these programs. IHSS program
applicants and recipients may struggle with increasingly complex
and changing program rules; yet, while they may have family
members and friends who are able to provide support, there is no
formal process to designate these individuals as authorized
representatives.
Additionally, the author points out, CDSS has at times issued
IHSS forms and All-County letters that reference "authorized
representatives," despite the lack of definition, explanation of
duties and limitations, or formal designation process. As a
result, counties have often developed ad hoc internal processes
for designating authorized representatives for purposes of the
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IHSS program.
The author states that, "IHSS program recipients are the
employer of their care provider for purposes of hiring/firing,
training, supervising, scheduling and signing their timesheet.
Similarly, whether to designate an authorized representative and
who to designate would be their decision. For consumers who
struggle with the maze of programmatic rules and complex
paperwork, allowing them to designate an authorized
representative to work on their behalf will give them the
support they need to continue to direct services in their own
homes and remain independent."
According to the County Welfare Directors Association of
California (CWDA), the sponsor of this bill, it creates "an
authorized representative function for IHSS in statute. Whether
to designate an authorized representative would be the decision
of an individual recipient. Who to designate would also be his
or her choice, with a few exceptions that mirror other
protections in current law. For example, the bill would provide
that an individual who could not meet a criminal background
check to become a provider of services in IHSS could not be
named as an authorized representative unless they were otherwise
legally authorized to act on behalf of the recipient (such as
the parent of a child recipient or a conservator.) Also, an
individual found to have perpetrated abuse or neglect against a
child or adult would be barred from serving as an authorized
representative. As the IHSS program continues to grow, it is
vital to create a standardized structure for designating an
authorized representative to assist an applicant for or
recipient of these services."
IHHS Program
The IHSS program is a county-administered, primarily Medi-Cal
benefit, which provides low-income individuals who are aged,
blind or disabled specified personal care and domestic services
that allow them to remain safely in their own homes and to avoid
institutionalization.
Allowable IHSS services include tasks like feeding, bathing,
bowel and bladder care, meal preparation and clean-up, laundry,
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and paramedical care. Currently, there are approximately 470,000
recipients of IHSS statewide, and, approximately 409,000
providers. Nearly three-fourths of the providers are family
members of care recipients and over half live in the home with
the recipient for whom they provide services. The average
provider cost is $12.62 per hour FY 15-16.
Eligibility for IHSS services is currently determined by county
social workers who conduct a standardized in-home assessment,
and periodic reassessments, of an individual's ability to
perform specific activities of daily living. Based on the
in-home assessment, recipients may be eligible for up to 283
hours of IHSS per month; however the average assessment is for
99 hours per month.
Authorized representatives:
To apply, recipients must submit a three-page application and,
as of 2011, must receive a certification from a licensed health
care professional, as defined, declaring that the applicant or
recipient is unable to perform some activities of daily living
independently without which the applicant or recipient is at
risk of placement in out-of-home care. The recipient must also
undergo an assessment from the county social worker to determine
the needs of the recipient. Once approved, recipients are
responsible for hiring, firing, directing and supervising their
IHSS provider or providers, and for informing CDSS of provider
changes. Additionally, recipients receive frequent notifications
from CDSS, some involving detailed information and instructions
pertaining to eligibility and program changes. Further,
recipients must comply with eligibility rederminations and
unannounced home visits from county social workers intending to
prevent fraud.
Current law provides for the establishment of an authorized
representative within Medi-Cal and the California Benefit
exchange in order to facilitate recipients' full participation
in the programs. Additionally, existing law provides for the
engagement of an authorized representative for developmentally
disabled individuals in accessing services, developing
individual program plans and in fair hearing and appeals
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procedures. These authorized representatives are permitted,
within specified limits, to act on behalf of program applicants
and participants typically for purposes of applying for services
and other required program activities. Additionally, CDSS Manual
of Policies and Procedures Section 63.402-6 outlines rules and
processes regarding the appointment of authorized
representatives by applicants for and recipients of CalFresh
food stamp benefits.
COMMENTS
Existing statute (WIC 12300.4, 14186.35, and 12305.87)
pertaining to IHSS permits an authorized representative to act
as the IHSS employer for the purpose of requesting a public
authority or nonprofit consortium to assist an employer in
obtaining a criminal background check, to sign a criminal
records exclusion waiver request, and to direct the hours of
providers in certain circumstances. Numerous All-County Letters
released by CDSS have referred to the ability for authorized
representatives to act on behalf of recipients in a variety of
ways. However, this bill provides greater specification
regarding who may serve as an authorized representative and the
scope of their involvement in the care of the recipient.
PRIOR VOTES
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|Assembly Floor: |76 - |
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|Assembly Appropriations Committee: |15 - |
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|Assembly Human Services Committee: |7 - |
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POSITIONS
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Support:
California Association of Public Authorities
(Co-Sponsor)
County Welfare Directors Association of California
(Co-Sponsor)
AFSCME
California State Association of Counties
Oppose:
None received.
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