BILL ANALYSIS                                                                                                                                                                                                    Ó

          |SENATE RULES COMMITTEE            |                       AB 1436|
          |Office of Senate Floor Analyses   |                              |
          |(916) 651-1520    Fax: (916)      |                              |
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                                   THIRD READING 

          Bill No:  AB 1436
          Author:   Burke (D)
          Amended:  9/4/15 in Senate
          Vote:     21  

           SENATE HUMAN SERVICES COMMITTEE:  5-0, 6/23/15
           AYES:  McGuire, Berryhill, Hancock, Liu, Nguyen

           AYES:  Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen

           ASSEMBLY FLOOR:  76-0, 5/26/15 (Consent) - See last page for  

           SUBJECT:   In-home supportive services:  authorized  

          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.

          Senate Floor Amendments of 9/4/15 correct a technical error,  
          replacing "predeterminations" with "redetermination."

          Existing law:


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          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.) 

          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 (CDSS), 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 redetermination 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  

              a)    Specify an effective time period, to be determined by  
              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.


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          4) Provides that the authorized representative designation  
             pursuant to this section shall not authorize representation  
             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  

          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  

          10)Requires the county to retain the form in the applicant or  
             recipient's in-home supportive services case file, as  

          11)Permits CDSS to implement and administer the provisions of  


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             authorized representatives through all-county letters or  
             similar instructions until regulations are adopted.

          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  

          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  
          establishment of an authorized representative within Medi-Cal  
          and the California Health Benefit Exchange in order to  
          facilitate recipients' full participation in the programs.  


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          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:   Yes

          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  
          appointment, and potentially issue additional notices similar to  
          the process in the Medi-Cal program. 

          Further, this bill potentially increases IHSS program costs  


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          (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:   (Verified9/3/15)

          California Association of Public Authorities (co-source)
          County Welfare Directors Association of California (co-source)
          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:   (Verified9/3/15)

          None received

          ASSEMBLY FLOOR:  76-0, 5/26/15
          AYES:  Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bonilla,  
            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,  


                                                                    AB 1436  
                                                                    Page  8

            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
          9/8/15 15:27:27

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