BILL ANALYSIS                                                                                                                                                                                                    






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          |SENATE RULES COMMITTEE            |                        SB 199|
          |Office of Senate Floor Analyses   |                              |
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                                   THIRD READING 


          Bill No:  SB 199
          Author:   Hall (D)
          Amended:  6/2/15  
          Vote:     21  

           SENATE HUMAN SERVICES COMMITTEE:  5-0, 3/24/15
           AYES:  McGuire, Berryhill, Hancock, Liu, Nguyen

           SENATE APPROPRIATIONS COMMITTEE:  7-0, 5/28/15
           AYES:  Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen

           SUBJECT:   In-home supportive services:  reading services for  
                     blind and visually impaired recipients


          SOURCES:   California Council of the Blind
                     UDW/AFSCME Local 3930
                     California Association of Public Authorities for IHSS  



          DIGEST:  This bill expands the scope of personal care services  
          provided within the In-Home Supportive Services (IHSS) program  
          to include up to two hours per month of assistance in reading  
          and completing financial and other documents for a recipient who  
          is blind. This bill requires those services to be implemented  
          beginning on January 1, 2017, only if federal financial  
          participation is available, and establishes that states and  
          counties are immune from liability in delivering these services.


          ANALYSIS:









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          Existing federal law defines legal blindness as persons with  
          central visual acuity of 20/200 or less in the stronger eye,  
          while wearing a correcting lens or glasses; or a limitation in  
          the field of vision in the better eye, so that:

          1)There is contraction of peripheral visual fields to 10 degrees  
            from the point of fixation, or

          2)The widest diameter of the visual field subtends an angle no  
            greater than 20 degrees, or

          3)There is a contraction of peripheral visual fields to 20  
            percent or less visual field efficiency. (Sec. 1614 (42 U.S.C.  
            1382c))

          Existing state law:

          1)Establishes the IHSS program to provide in-home domestic  
            supportive and personal care services for aged, blind or  
            disabled individuals living at or below the poverty level for  
            the purpose of enabling IHSS consumers to avoid  
            institutionalization and remain safely in their homes with  
            supportive services. (WIC 12300 et seq.)

          2)Defines the scope of supportive services available under the  
            IHSS program to include heavy cleaning, personal care  
            services, accompaniment by a provider when needed during  
            necessary travel to health-related appointments or to  
            alternative resource sites, yard hazard abatement, protective  
            supervision, teaching and demonstration directed at reducing  
            the need for other supportive services, and paramedical  
            services which make it possible for the recipient to establish  
            and maintain an independent living arrangement. (WIC 12300  
            (b))

          3)Defines the scope of personal care services available under  
            the IHSS program to include:
                     Assistance with ambulation.
                     Bathing, oral hygiene, and grooming.
                     Dressing.
                     Care and assistance with prosthetic devices.
                     Bowel, bladder, and menstrual care.
                     Repositioning, skin care, range of motion exercises,  







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                 and transfers.
                     Feeding and assurance of adequate fluid intake.
                     Respiration.
                     Assistance with self-administration of medications.  
                 (WIC 12300 (c))

          1)Requires the California Department of Social Services (CDSS),  
            in consultation with county welfare departments to establish  
            and implement statewide hourly task guidelines and  
            instructions to provide counties with a standard tool for  
            consistently and accurately assessing service needs and  
            authorizing service hours to meet those needs. (WIC 12301.2)

          2)Permits certain IHSS recipients with high care needs, as  
            specified, to receive up to 283 hours of IHSS services per  
            month. (WIC 12303.4(b))

          3)Requires county welfare agencies to provide eligible visually  
            impaired or blind IHSS recipients information and referral to  
            non-profit services that provide reading services. (WIC  
            12304.6)

          4)Provides that counties and the state shall be immune from any  
            liability resulting from the administration of the IHSS  
            program due to the negligence or intentional torts of the  
            individual provider. (WIC 12301.6 and 12300.5)  
          
          This bill:
          
          1)Expands the scope of personal care services provided within  
            the IHSS program to include up to two hours per month of  
            assistance in reading and completing financial and other  
            documents for a recipient who is blind.

          2)Requires the Director of Health Care Services, by January 1,  
            2017, to seek any federal approvals necessary to ensure that  
            Medicaid funds may be used in implementing this bill.

          3)Implements provisions of this bill beginning in January 1,  
            2017, only if federal financial participation is available.

          4)Establishes immunity, as defined, for the state and counties  
            from any liability, including negligence or intentional torts  
            of providers, associated with the delivery of the service that  







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            includes assistance in reading and completing financial  
            documents for recipients who are blind.

          5)Permits CDSS to implement the bill through all-county letters  
            or similar instructions.

          6)Requires CDSS to adopt emergency regulations by January 1,  
            2018, and to adopt final regulations on or before January 1,  
            2019.

          Background:

          In Home Supportive Services Program (IHSS). The IHSS program was  
          established in 1973 as an innovative alternative to  
          institutional care, and evolved in the context of a growing  
          "independent living" civil rights movement led by persons with  
          disabilities.  The program has experienced continuous growth  
          following the U.S. Supreme Court decision Olmstead v. L.C. in  
          1999 which established the rights of people with disabilities to  
          receive services in the most integrated setting possible to  
          "provide individuals with disabilities opportunities to live  
          their lives like individuals without disabilities" under the  
          Americans With Disabilities Act (ADA).


          The IHSS program is operated as benefit under the Medi-Cal  
          program, providing in-home services to more than 460,000  
          qualified low-income individuals who are aged, blind, or  
          disabled. Currently, of approximately 464,402 IHSS recipients,  
          an estimated two percent of consumers are visually impaired or  
          blind (approximately 10,153 consumers). County welfare agencies  
          administer the program under CDSS oversight and county social  
          workers determine eligibility and assess eligible consumers to  
          determine the allowable services and number of allotted hours  
          following a standardized in-home assessment. 


          Legal Blindness and the Americans With Disabilities Act. Title  
          16 of the Social Security Act defines legal blindness a central  
          visual acuity of 20/200 or less in the stronger eye, while  
          wearing a correcting lens or glasses; or a limitation in the  
          field of vision in the better eye, so that:









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                     There is contraction of peripheral visual fields to  
                 10 degrees from the point of fixation, or
                     The widest diameter of the visual field subtends an  
                 angle no greater than 20 degrees, or
                     There is a contraction of peripheral visual fields  
                 to 20 percent or less visual field efficiency.

          Titles II and III of the ADA require that government and private  
          sector organizations must provide print materials in an  
          alternative format for people with visual impairment.  
          Specifically, Section 36.303, Title III of the ADA provides, "A  
          public accommodation shall furnish appropriate auxiliary aids  
          and services where necessary to ensure effective communication  
          with individuals with disabilities." These print materials can  
          include billing statements, financial statements, personnel  
          manuals and business cards. 

          According to the U.S. Department of Justice, Civil Rights  
          Division, in practice this means that the ADA requires that  
          effective communication not exclude people with disabilities -  
          which in the case of visually impaired or blind persons may  
          require businesses and government to provide information  
          verbally or in braille.  However, it states the law does not  
          require any measure that would cause an undue financial or  
          administrative burden.


          Braille and Visual Aid Technologies. The National Braille Press  
          states that braille literacy rates for school-age blind children  
          have declined from greater than 50 percent in the 1960s to only  
          12 percent today.  Academic research on braille literacy  
          suggests that a significant reason for the decline has been the  
          growing popularity of magnification equipment or use of large  
          print in cases when a blind child has some residual vision.  
          Children with some residual vision account for approximately 85  
          percent of blind children.


          Certain degenerative conditions, such as glaucoma and  
          degenerative myopia, have an onset early in childhood with  
          vision worsening over time. Low-vision students, in particular  
          those with degenerative visual impairments, are at risk for not  
          receiving appropriate braille instruction while some level of  
          sight remains. 







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          An ADA handbook published by the University of California notes  
          that not all blind people read braille and that "typically,  
          people who have lost their vision later in life tend to rely on  
          speech output as their access strategy." The handbook notes  
          alternative adaptive equipment, such as magnified display of a  
          computer screen, screen reader software, braille input devices  
          and other equipment may be useful, though costly and  
          inaccessible for low-income individuals with visual impairments  
          or blindness, particularly among those whose sole source of  
          income is SSI/SSP.


          
          FISCAL EFFECT:   Appropriation:    No          Fiscal Com.:  
          YesLocal:        Yes           

          According to the Senate Appropriations Committee, this bill  
          would result in potential first-year costs (6 months) of up to  
          $2.1 million (General Fund/Federal Fund), and $3.9 million  
          annually to fund additional authorized IHSS provider hours for  
          services to IHSS recipients who are blind, assuming two percent  
          of the IHSS caseload would be authorized for an additional two  
          hours per month. Additionally, the analysis noted unknown but  
          potentially significant one-time automation costs (General  
          Fund/Federal Fund) and minor one-time costs for the state to  
          submit the request for federal approval of this service.


          SUPPORT:   (Verified5/29/15)


          California Council of the Blind (co-source)
          UDW/AFSCME Local 3930 (co-source)
          California Association of Public Authorities for IHSS  
          (co-source)
          AARP
          American Federation of State, County and Municipal Employees
          California Commission on Aging
          California Communities United Institute 
          California Senior Legislature
          Congress of California Seniors
          Justice in Aging







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          Personal Assistance Services Council of Los Angeles County
          SEIU California


          OPPOSITION:   (Verified5/29/15)


          None received


          ARGUMENTS IN SUPPORT:     The California Association of Public  
          Authorities (CAPA) writes that the current requirement that  
          county welfare departments provide visually impaired IHSS  
          consumers with information and referrals to community public and  
          nonprofit entities that provide reading services is inadequate  
          to protect persons with visual impairments as services may not  
          be provided in a timely manner. CAPA writes that consumers may  
          suffer severe negative consequences such as termination of  
          financial and medical benefits if important deadlines to file  
          documents and medical verifications are not met. In addition,  
          CAPA writes that consequences of not paying bills promptly can  
          include not only additional financial hardships, but loss of  
          essential utility services.  



          Prepared by:Mareva Brown / HUMAN S. / (916) 651-1524
          6/2/15 14:05:59


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