BILL ANALYSIS                                                                                                                                                                                                    



                                                                    AB 1436


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          CONCURRENCE IN SENATE AMENDMENTS


          AB  
          1436 (Burke)


          As Amended  September 4, 2015


          Majority vote


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          Original Committee Reference:  HUM. S.


          SUMMARY:  Allows In-Home Supportive Services applicants and  
          recipients to designate an authorized representative.   
          Specifically, this bill:  


           1) Defines "authorized representative" to mean an individual  
             who is appointed by an In-Home Supportive Services (IHSS)  
             applicant or recipient in order to represent that applicant  
             or recipient for purposes related to the IHSS program, as  
             specified.


           2) Allows an IHSS applicant or recipient to designate an  
             authorized representative for specified purposes on a form  
             that, among other things, specifies an effective time period  
             determined by the department.










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           3) Requires the county to retain the authorized representative  
             form in the applicant or recipient's case file, as specified.


           4) Specifies that an IHSS applicant or recipient shall  
             determine 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.  


           5) Prohibits the authorized representative designation from  
             authorizing representation at an administrative hearing  
             conducted by the department. 


           6) Requires the authorized representative to have a  
             responsibility to act in the client's best interest, and  
             prohibits him or her from having any other power to act on  
             behalf of the applicant or recipient, except as specified,  
             and prohibits the representative from acting in lieu of the  
             applicant or recipient.


           7) Exempts an applicant's or recipient's legal representative  
             with the legal authority to act on behalf of the applicant or  
             recipient, as specified, from the requirement to complete an  
             authorized representative form. 


           8) Permits a legal representative to designate an authorized  
             representative for an applicant or recipient, as specified.


           9) Prohibits anyone, except for a legal representative as  
             specified, prevented from being an IHSS provider due to past  
             criminal convictions, as well as individuals granted certain  
             exemptions to serve as a provider despite past criminal  
             convictions, as specified, from serving as an authorized  
             representative.


           10)Permits the authorized representative, if so instructed by  








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             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 authority, as  
             specified.


           11)Directs the Department of Social Services (DSS), in  
             consultation with stakeholders, as specified, to develop a  
             standardized statewide form, as specified, and procedures  
             related to the designation of an authorized representative. 


           12)Allows DSS to implement and administer the provisions of  
             authorized representatives through all-county letters or  
             similar instructions until regulations are adopted.


          The Senate amendments:


          1)Prohibit the authorized representative designation from  
            authorizing representation at an administrative hearing  
            conducted by the department. 


          2)Remove the prohibition on an individual becoming an authorized  
            representative if he or she has been found to have perpetrated  
            a substantiated report of abuse or neglect against of child or  
            an elder or dependent adult.


          3)Make other technical amendments.


          EXISTING LAW:  


          1)Establishes the IHSS program to provide supportive services,  
            including domestic, protective supervision, personal care, and  
            paramedical services as specified, to individuals who are  
            aged, blind, or living with disabilities, and who are unable  








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            to perform the services themselves or remain safely in their  
            homes without receiving these services.  (Welfare and  
            Institutions Code (WIC) Section 12300 et seq.)


          2)Specifies requirements regarding IHSS provider timesheets,  
            including that both provider and recipient must sign the  
            timesheet to verify the accuracy of information.  (WIC Section  
            12301.25)


          3)Authorizes counties to contract with a nonprofit consortium or  
            establish a public authority for the provision of IHSS  
            services.  Requires nonprofit consortia and public authorities  
            to, among other things, establish a registry to assist  
            recipients in locating IHSS providers, and to investigate the  
            background and qualifications of potential providers, as  
            specified.  (WIC Section 12301.6)


          4)Maintains an IHSS recipient's right to hire, fire, and  
            supervise the work of any IHSS provider, regardless of the  
            employer responsibilities of a public authority or nonprofit  
            consortium, as specified.  (WIC Sections 12301.6 and 12302.25)


          5)Requires counties to perform a background check on individuals  
            applying to become IHSS providers, and stipulates  
            circumstances under which individuals shall be excluded from  
            becoming an IHSS provider, as well as circumstances under  
            which such an exclusion might be waived, as specified.  (WIC  
            Sections 12305.86 and 12305.87)


          FISCAL EFFECT:  According to the Senate Appropriations  
          Committee, this bill may result in the following costs:


          1)One-time costs potentially in excess of $50,000 (General Fund)  
            to DSS to develop and adopt regulations.  One-time costs to  
            develop the standardized statewide form are estimated to be  
            minor.








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          2)Potential 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.


          3)Potential increase in 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.  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. 


          COMMENTS:  


          In-Home Supportive Services:  The IHSS program enables  
          low-income individuals who are at least 65 years old, living  
          with disabilities, or blind to remain in their own homes by  
          paying for care providers to assist with personal care services  
          (such as toileting, bathing, and grooming), domestic and related  
          services (meal preparation, housecleaning, and the like),  
          paramedical services, and protective supervision. Approximately  
          470,000 Californians receive IHSS, with approximately 99%  
          receiving it as a Medicaid benefit. 


          When an individual is determined eligible for IHSS services by a  
          county social worker, he or she is authorized for a certain  
          number of hours of care.  IHSS recipients are responsible for  
          hiring, firing, directing, and supervising their IHSS workers.   
          These responsibilities include some administrative duties, such  
          as scheduling and signing timesheets; however, the state handles  
          payroll.  As of April 2015, there were about 409,000 IHSS  








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          providers in the state; approximately 73% were relatives and an  
          estimated 52% were live-in.  Providers must complete an  
          enrollment process, including submitting fingerprint images for  
          a criminal background check and participating in a provider  
          orientation prior to receiving payment for services.


          Authorized representatives:  A number of programs administered  
          by the state allow for, and set forth definitions and  
          designation procedures regarding, authorized representatives in  
          order to facilitate recipients' full participation in programs.   
          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.


          For example, WIC Section 14014.5 defines "authorized  
          representative" for purposes of the Medi-Cal program and directs  
          the Department of Health Care Services and the California Health  
          Benefit Exchange to implement policies and prescribe materials  
          to ensure the protection and privacy of applicants and  
          recipients who appoint such a representative.  Additionally, DSS  
          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.


          Need for this bill:  According to the author, "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."


          Analysis Prepared by:                     Daphne Hunt / HUM. S.  








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