BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1436|
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THIRD READING
Bill No: AB 1436
Author: Burke (D)
Amended: 8/31/15 in Senate
Vote: 21
SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/23/15
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
ASSEMBLY FLOOR: 76-0, 5/26/15 (Consent) - See last page for
vote
SUBJECT: In-home supportive services: authorized
representative
SOURCE: California Association of Public Authorities
County Welfare Directors Association of California
DIGEST: This bill 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, as specified.
ANALYSIS:
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
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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.)
3) Provides that recipients of IHSS 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)
This bill:
1) Defines "authorized representative" to mean an individual
who is designated in writing, on a form developed by the
California Department of Social Services, by an IHSS
applicant or recipient to accompany, assist, or represent the
applicant or recipient for purposes related to the program,
including, but not limited to, the application process,
direction of services, and predeterminations of eligibility.
2) Permits an IHSS applicant or recipient to designate an
individual to act as an authorized representative.
3) Requires the form, to be developed by CDSS, to do all of the
following:
a) Specify an effective time period, to be determined by
CDSS.
b) Specify the responsibilities to be performed by the
authorized representative.
c) May be revoked or changed by the applicant or
recipient at any time.
4) Provides that the authorized representative designation
pursuant to this section shall not authorize representation
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for an administrative hearing conducted by CDSS.
5) Provides that the authorized representative shall have a
legal responsibility to act in the client's best interest,
and shall not have any other power to act on behalf of the
applicant or recipient, except as specified.
6) Provides that an applicant or recipient who has legal
representation, as specified, that includes decision-making
authority reasonably believed to be related to the program,
shall not be required to complete the authorized
representative form, except for the purpose of signing
timesheets.
7) Permits the authorized representative, if specified by the
IHSS recipient, to sign timesheets or other provider-related
documents 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
authority to act on behalf of the recipient as described in
#6 above.
8) Prohibits an individual from serving as an authorized
representative who is prevented from being an IHSS provider
due to specified criminal convictions, including fraud,
serious or violent felonies, sex offenses, and other crimes
unless that individual is a person with legal authority
described in #6 above.
9) Directs CDSS, in consultation with the California Department
of Health Care Services, the County Welfare Directors
Association of California (CWDA) and specified
representatives to develop a standardized statewide form and
procedures for effectuating the designation of an authorized
representative.
10)Requires the county to retain the form in the applicant or
recipient's in-home supportive services case file, as
specified.
11)Permits CDSS to implement and administer the provisions of
authorized representatives through all-county letters or
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similar instructions until regulations are adopted.
Background
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
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 CWDA, this bill 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. 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."
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IHSS 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,
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.
To apply for the program, 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.
Authorized representatives. Existing law provides for the
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establishment of an authorized representative within Medi-Cal
and the California Health 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 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.
Additionally, 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According the Senate Appropriations Committee, this bill will
incur one-time costs potentially in excess of $50,000 (General
Fund) to CDSS to develop and adopt regulations. Additionally,
one-time costs to develop the standardized statewide form are
estimated to be minor. This bill potentially increases
administrative costs (Federal Fund/General Fund) for counties to
review agreement forms, verify eligibility of authorized
representatives for IHSS cases not requiring a written
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appointment, and potentially issue additional notices similar to
the process in the Medi-Cal program.
Further, this bill potentially increases IHSS program costs
(Federal Fund/General 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. The analysis
notes that 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.
SUPPORT: (Verified8/28/15)
California Association of Public Authorities (co-source)
County Welfare Directors Association of California (co-source)
AFSCME
Alameda County Board of Supervisors
Board of Supervisors of Contra Coast County
California State Association of Counties
County of Santa Cruz Board of Supervisors
Rural Counties Representatives of California
San Francisco Human Services Agency
Santa Cruz County Board of Supervisors
Stanislaus County, Community Services Agency
Tehama County Department of Social Services
UWD/AFSCME Local 3930
Ventura County Board of Supervisors
OPPOSITION: (Verified8/28/15)
None received
ASSEMBLY FLOOR: 76-0, 5/26/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bonilla,
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Page 8
Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau,
Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd,
Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia,
Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,
Grove, Hadley, Roger Hernández, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Bloom, Chávez, Harper, Mathis
Prepared by:Sara Rogers / HUMAN S. / (916) 651-1524
8/30/15 19:27:52
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