BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON HUMAN SERVICES
                               Senator McGuire, Chair
                                2015 - 2016  Regular 

          Bill No:              AB 1797
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          |Author:   |Lackey                                                |
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          |Version:  |February 25, 2016      |Hearing    | June 14, 2016   |
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          |Urgency:  |No                     |Fiscal:    |Yes              |
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          |Consultant|Taryn Smith                                           |
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                 Subject:  In-home supportive services:  application


            SUMMARY
          
          This bill authorizes a person to apply for in-home supportive  
          services (IHSS) in person or through electronic means and  
          requires the county, if an application is filed through  
          electronic means, to provide the applicant a confirmation  
          number, as specified. This bill also requires the county to  
          process an application for IHSS within 30 days.

            ABSTRACT
          
          Existing law:

             1)   Establishes the IHSS program to provide defined  
               supportive services for aged, blind, or disabled persons  
               who are unable to perform the tasks themselves and who  
               cannot safely remain in their homes unless such services  
               are provided. Those supportive services include, but are  
               not limited to, domestic services, heavy cleaning, personal  
               care services, and accompaniment during travel to  
               health-related appointments or to alternative resource  
               sites, yard hazard abatement, protective supervision, and  
               paramedical services, as defined. (WIC 12300 et seq.)
          
             2)   Provides that a recipient who is authorized to receive  
               IHSS supportive services shall direct those authorized  
               services, and the authorized services shall be performed by  








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               a provider or providers within a workweek and in a manner  
               that complies with the requirements, as specified. (WIC  
               12300.4)

             3)   Establishes county authority to contract with a  
               nonprofit consortium or a public authority for the delivery  
               of IHSS supportive services.  Requires those nonprofit  
               consortia and public authorities to establish a registry in  
               order to assist IHSS recipients with hiring providers, and  
               to investigate the background and qualifications of  
               potential providers, as specified. (WIC 12301.6)

             4)   Requires that the application for IHSS services shall  
               contain a notice to the recipient that his or her provider  
               or providers will be given written notice of the  
               recipient's authorized services and full number of services  
               hours allotted to the recipient. The application shall  
               inform recipients of the Medi-Cal toll-free telephone fraud  
               hotline and Internet Web site for reporting suspected fraud  
               or abuse. (WIC 12301.15)

          

          This bill:

             1)   Permits a person to apply for IHSS services in person or  
               through electronic means, including, but not limited to, by  
               telephone. 

             2)   Requires that, if an application for IHSS services is  
               filed through electronic means, the county shall provide  
               the applicant a confirmation number to serve as  
               documentation that the application was filed. 

             3)   Permits the county to use the applicant's case number as  
               the required confirmation number.

             4)   Requires the county to process an application for IHSS  
               services within 30 days of receipt of the completed  
               application.
          

            FISCAL IMPACT
          









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          According to an analysis prepared by Assembly Appropriations  
          Committee, there would be a negligible cost to counties.   
          Because the bill is clear that case numbers, which are  
          automatically generated through the existing application  
          process, can be given as confirmation numbers the county costs  
          would not likely to be significant enough to file a claim for a  
          state mandated reimbursement. Further, the 30 day processing  
          period required in the bill is currently required by regulation.


            BACKGROUND AND DISCUSSION
          
          Purpose of the bill:

          According to the author, many IHSS applications that are filed  
          telephonically have been getting lost in the system, and  
          applicants are not told how to best track their applications.   
          The author states that AB 1797 would provide that any person who  
          needs in-home services to avoid being placed in a nursing home  
          shall have the right to apply for services in-person or by  
          telephone and receive a confirmation number for the application  
          when applying by phone.  AB 1797 would allow the counties to use  
          the currently issued case number as a confirmation number.   
          Furthermore, the bill would require that IHSS applications be  
          acted upon within 30 days. 

          In Home Support Services

          The IHSS program, which is administered by the California  
          Department of Social Services (CDSS) provides in-home services  
          for low-income aged, blind and disabled individuals who are  
          unable to perform the tasks themselves and who cannot safely  
          remain in their homes unless these services are provided.  IHSS  
          recipients need those services in order to avoid out-of-home  
          care. 

          IHSS services may include domestic and related services, like  
          housework, meal preparation, laundry and shopping; personal care  
          services; accompaniment to medical appointments; protective  
          supervision for the mentally-impaired recipients who may place  
          themselves at risk for injury; and hazard or accident and  
          paramedical services when directed by a physician. 

          Potential IHSS recipients must apply for IHSS services with the  









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          county in which they reside.  Often, these applications are  
          initiated over the phone, but they can be completed in person at  
          a county IHSS office.  Either way, county workers assist with  
          completing the application and enter information directly into  
          the Case Management, Information and Pay rolling System (CMIPS),  
          which tracks case information and processes payments for IHSS.   
          CMIPS generates a case number.  

          After the initial application is completed, a county social  
          worker conducts a home visit to determine the type of services  
          needed and the number of hours for each service. The county  
          considers medical condition, living arrangement, and any  
          resources that may already be available.  The applicant also  
          must submit a Health Care Certification Form, which is completed  
          by the applicant's doctor, and certifies the need for IHSS. This  
          form must be completed before services can be authorized.

          Once approved, the county notifies the IHSS recipient which  
          services have been approved, how much time is authorized for  
          each service, and how many total monthly hours have been  
          approved.  IHSS recipients are responsible for hiring, firing,  
          directing and supervising their IHSS provider.  These  
          responsibilities include some administrative duties, such as  
          scheduling and signing timesheets.  However, the state handles  
          payroll via CMIPS.   

          Providers must complete an enrollment process, including  
          submitting fingerprints for a criminal background screening and  
          participating in an orientation prior to receiving payment for  
          services.  

          Approximately 464,000 Californians receive IHSS and about 99% of  
          recipients receive IHSS as a Medicaid benefit. There are  
          currently about 433,400 IHSS providers in the state.   
          Approximately 69 percent are relatives and about 50 percent are  
          live-in providers.   


          Related legislation:

          Assembly Bill 19 (Evans, Chapter 17, Statutes of 2009) a human  
          services budget trailer bill, included a requirement that  
          applications for IHSS shall provide written notice of the  
          recipient's authorized services and full number of services  









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          hours allotted to the recipient, as specified. 

            COMMENTS
          
          CDSS regulations already require that applications be processed  
          within 30 days of the date the application is complete.   
          Specifically, the regulations require that the application shall  
          be processed, including eligibility determination and needs  
          assessment, and that notice of action must be mailed no later  
          than 30 days following the date the written application is  
          completed.  There is an exemption to the 30-day requirement when  
          a disability determination has not been received, as  
          specified.<1> Therefore, codifying a 30-day processing timeline  
          is consistent with current practices.  

          Additionally, CDSS issued All County Letter #12-36 which  
          requires the counties to issue a confirmation number to the IHSS  
          applicant.  The letter reads, in part, "At the time the  
          application information is entered in either Legacy CMIPS or  
          CMIPS II, a case number will be assigned to the applicant.  
          Legacy counties, to the extent that current business practice  
          allows, and all CMIPS II counties shall provide the case number  
          to the applicant or their authorized representative before the  
          end of the telephone call during which the application is taken,  
          or before they leave the IHSS office so the applicant or their  
          authorized representative will be able to refer to the case  
          number in any communications with the county."

          According to CDSS, most counties do not accept IHSS applications  
          in-person and none of the counties have an electronic means to  
          accept IHSS applications. The majority of IHSS applications are  
          initiated via telephone. As it currently reads, AB 1797  
          references electronic and in-person application processes which  
          are generally not available. Therefore, the following amendment  
          is suggested: 

          WIC 12301.16.

          (a)  A person may apply for in-home supportive services in person  
          or through electronic means, including, but not limited to, by  
          telephone.   If an application is filed through electronic means,   
           Upon receipt of an application for in-home supportive services,   
          the county shall provide the applicant a confirmation number to  



          ---------------------------
          <1> CDSS Manual of Policies and Procedures Section 30-759.2








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          serve as documentation that the applicant filed an application  
          for in-home supportive services. The county may use the case  
          number as the confirmation number.

          While these amendments acknowledge the fact that the technology  
          to apply online for IHSS does not exist, the committee  
          encourages the department to consider creating an online  
          platform that would modernize the application process and other  
          services to IHSS applicants, recipients and providers.  

            PRIOR VOTES
          
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          |Assembly Floor:                                            |79 - |
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          |Assembly Appropriations Committee:                         |20 - |
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          |Assembly Human Services Committee:                         |6 -  |
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            POSITIONS
                                          
          Support:  
               Coalition of California Welfare Rights Organizations  
               (Sponsor) 
               AARP California
               Bet Tzedek Legal services
               California Advocates for Nursing Home Reform
               Disability Rights California
               Senior and Disability Action
               The California Commission on Aging
               The California In-Home Supportive Services Consumer  
          Alliance (CICA)
               The Law Foundation of Silicon Valley
               The Personal Assistance Services Council, the Los Angeles  
          County Public Authority
               UDW/AFSCME Local 3930
          
          Oppose:   
               None
                                      -- END --









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