BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          AB 1436 (Burke) - In-home supportive services:  authorized  
          representative
          
           ----------------------------------------------------------------- 
          |                                                                 |
          |                                                                 |
          |                                                                 |
           ----------------------------------------------------------------- 
          |--------------------------------+--------------------------------|
          |                                |                                |
          |Version: May 6, 2015            |Policy Vote: HUMAN S. 5 - 0     |
          |                                |                                |
          |--------------------------------+--------------------------------|
          |                                |                                |
          |Urgency: No                     |Mandate: No                     |
          |                                |                                |
          |--------------------------------+--------------------------------|
          |                                |                                |
          |Hearing Date: July 6, 2015      |Consultant: Jolie Onodera       |
          |                                |                                |
           ----------------------------------------------------------------- 

          This bill meets the criteria for referral to the Suspense File. 

          

          Bill  
          Summary:  AB 1436 would authorize an applicant for, or recipient  
          of, the In-Home Supportive Services (IHSS) program to designate  
          an individual to act as his or her authorized representative for  
          purposes of the IHSS program, as specified.


          Fiscal  
          Impact:  
           One-time costs potentially in excess of $50,000 (General Fund)  
            to the Department of Social Services (DSS) to develop and  
            adopt regulations. One-time costs to develop the standardized  
            statewide form are estimated to be minor.
           Potentially significant increase in IHSS administrative costs  
            (Federal Fund/General Fund) for counties to review agreement  
            forms, verify eligibility of authorized representatives for  
            cases not requiring a written appointment, and potentially  
            issue additional notices similar to the process in the  
            Medi-Cal program.
           Potential increase in IHSS program costs (Federal Fund/General  






          AB 1436 (Burke)                                        Page 1 of  
          ?
          
          
            Fund) related to more successful enrollment and provision of  
            services from assistance in the application and  
            redetermination process, to the extent representatives are  
            able to better represent and/or communicate the actual needs  
            of applicants and recipients. Increases in IHSS program costs  
            could be offset in whole or in part to the extent individuals  
            would have otherwise not been able to remain in their own  
            homes but would require more costly facility care. 


          Background:  The In-Home Supportive Services (IHSS) program provides  
          in-home custodial care to aged, blind, and disabled individuals  
          who meet specified eligibility criteria. Eligible IHSS  
          recipients receive such services as housecleaning, meal  
          preparation, laundry, grocery shopping, personal care services,  
          accompaniment to medical appointments, and protective  
          supervision. 

          Eligibility for the IHSS program is determined by county social  
          workers who conduct a standardized in-home assessment and  
          periodic re-assessments of an individual's ability to perform  
          specific activities of daily living. Under existing law, an  
          authorized representative may be designated in the Medi-Cal  
          program in order to facilitate recipients' full participation in  
          the program. These authorized representatives are permitted,  
          within specified limits, to act on behalf of the applicant or  
          participant for purposes of applying for services and other  
          program activities. Additionally, DSS regulations outline  
          processes regarding the appointment of authorized  
          representatives in the CalFresh program.

          Authorized representatives are currently allowable under  
          specified provisions of the IHSS program. For example, an  
          authorized representative may sign a provider timesheet on  
          behalf of a recipient, however, the recipient cannot assign the  
          provider as the timesheet signatory due to conflict of interest  
          (SOC 839). This bill would provide a statutory definition of  
          "authorized representative" and provide greater specificity  
          regarding the scope of involvement in program activities for a  
          designated authorized representative.  


          Proposed Law:  
           This bill would authorize a competent IHSS applicant or  
          recipient to designate an individual as his or her authorized  







          AB 1436 (Burke)                                        Page 2 of  
          ?
          
          
          representative for purposes of the IHSS program, as follows:
           Defines "authorized representative" as an individual who is  
            appointed in writing, on a form designated by the DSS, by a  
            competent person who is an applicant for or recipient of IHSS,  
            to act in place or on behalf of the applicant or recipient for  
            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 of eligibility  
            process.
           Requires the duties to be provided by the authorized  
            representative to be specified by the applicant or recipient  
            and may be changed or revoked at any time by the applicant or  
            recipient.
           Provides that the authorized representative shall have a legal  
            responsibility to act in the client's best interest.
           Provides that legal documentation of authority to act on  
            behalf of the applicant or recipient under state law,  
            including, but not limited to, 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.
           Authorizes the authorized representative to sign timesheets  
            for services rendered on the recipient's behalf, if specified  
            to do so by the recipient. However, an authorized  
            representative who is the IHSS provider of services for the  
            recipient may not sign his or her own timesheet unless one of  
            the following applies:
                  o         The provider is a parent, guardian, or other  
                    person having legal custody of a minor recipient.
                  o         The provider is legally authorized to act on  
                    behalf of the applicant or recipient under state law.
                 Provides that an individual having legal authority to  
               act on behalf of an applicant or recipient may also specify  
               an individual other than himself or herself to act on  
               behalf of the applicant or recipient if that individual  
               elects to do so.
                 Prohibits an individual who is prevented from being an  
               IHSS provider of services due to criminal history from  
               serving as an authorized representative for an applicant or  
               recipient.
                 Prohibits an individual who has been granted a criminal  
               record exemption to serve as an IHSS provider, as  
               specified, from serving as an authorized representative for  
               an applicant or recipient.







          AB 1436 (Burke)                                        Page 3 of  
          ?
          
          
                 Prohibits an individual from serving as an authorized  
               representative if he or she is found to have perpetrated a  
               substantiated report of abuse or neglect against a child or  
               an elder or dependent adult.
                 Requires DSS, in consultation with the DHCS, the County  
               Welfare Directors Association of California,  
               representatives of applicants for and recipients of IHSS  
               services, and representatives of IHSS providers, to develop  
               a standardized statewide form and procedures for  
               effectuating the designation of an authorized  
               representative.
                 Requires the standard agreement form to include a  
               notification regarding the requirements of the provisions  
               of this bill and a statement that by signing the agreement,  
               the individual named as an authorized representative agrees  
               to abide by those requirements.


          Related  
          Legislation:  None applicable.


          Staff  
          Comments:  To the extent regulations are developed, the DSS  
          could incur one-time costs potentially in excess of $50,000. The  
          one-time cost to develop the standardized statewide form is  
          estimated to be minor.
          This bill provides that the duties to be provided by the  
          designated authorized representative are to be specified by the  
          applicant or recipient and may be changed or revoked at any time  
          by the applicant or recipient. It is not clear that the  
          standardized statewide form to be utilized to indicate  
          appointment of an authorized representative would also include  
          the specific responsibilities and duties to be provided by the  
          authorized representative, as specified by the applicant or  
          recipient. To the extent an additional form is required,  
          additional county administrative workload may be required to  
          review and verify this information. 


          Further, in the absence of an additional/separate form  
          indicating IHSS applicant- or recipient-approved duties, it is  
          unclear how it can be determined and verified that the  
          duties/responsibilities of authorized representatives who do not  
          require a written appointment (those with legal documentation of  







          AB 1436 (Burke)                                        Page 4 of  
          ?
          
          
          authority to act on behalf of the applicant/recipient under  
          state law - legal guardians, conservatorships, power of  
          attorney) are consistent with the IHSS applicant's or  
          recipient's wishes. 


          With regard to authorized representatives in the Medi-Cal  
          program, existing law requires all program notices, including,  
          but not limited to, those related to the application,  
          redetermination, or actions taken by the agency, to be sent to  
          the applicant or beneficiary, and to the authorized  
          representative if authorized by the applicant or beneficiary.  
          While not specifically stated in the bill, to the extent the  
          procedures developed for IHSS authorized representatives are  
          similar, IHSS administrative costs could potentially increase. 


          Under WIC  14014.5, the implementation of authorized  
          representatives under the Medi-Cal program is subject to the  
          availability of federal financial participation and any  
          necessary federal approvals. It is unclear whether a similar  
          provision would be appropriate and/or necessary under the  
          provisions of this bill.


          To the to the extent authorized representatives are able to  
          better represent and/or communicate the actual needs of  
          applicants and recipients, HSS program costs could increase due  
          to more successful enrollment and the provision of additional  
          services from assistance in the application and redetermination  
          process. Increases in IHSS program costs could be offset in  
          whole or in part by cost savings to the extent individuals would  
          have otherwise not been able to remain in their own homes,  
          requiring more costly care. 


                                      -- END --