BILL ANALYSIS Ó
SB 199
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Date of Hearing: June 30, 2015
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Kansen Chu, Chair
SB
199 (Hall) - As Amended June 2, 2015
SENATE VOTE: 40-0
SUBJECT: In-home supportive services: reading services for
blind and visually impaired recipients.
SUMMARY: Includes reading and document completion assistance
among the services available to a blind recipient of In-Home
Supportive Services (IHSS).
Specifically, this bill:
1)Adds up to two hours per month of assistance in reading and
completing financial and other documents to the services that
can be provided to a blind IHSS recipient to the extent
federal financial participation is available for this purpose.
2)Requires the director of the Department of Health Care
Services (DHCS) to seek all federal approvals necessary to
ensure that Medicaid funds can be used for reading and
document completion services for blind IHSS recipients by
January 1, 2017.
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3)Provides that states and counties shall be immune from any
liability related to the implementation of reading and
document completion services for blind IHSS recipients, as
specified.
4)Permits the Department of Social Services (DSS) to implement
the bill through all-county letters or similar instructions
from the director.
5)Requires DSS to adopt regulations by January 1, 2018, and
provides that the initial adoption, amendment, or repeal of a
regulation pursuant to the bill is deemed to address an
emergency for the purposes of enacting emergency regulations.
Requires DSS to adopt final regulations on or before January
1, 2019.
EXISTING LAW:
1)Establishes the IHSS program, which provides in-home care and
supportive services to low-income aged, blind, or disabled
persons who are unable to provide or care for themselves and
who cannot live safely in their homes without assistance.
Defines supportive services within the program to include
domestic services, personal care services, protective
supervision, paramedical services, and other services, as
specified. (WIC 12300 et seq.)
2)Requires DSS, 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)
3)Permits certain IHSS recipients with high care needs, as
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specified, to receive up to 283 hours of IHSS services per
month. (WIC 12303.4(b))
4)Provides that, as a condition of IHSS eligibility, an
individual must need in-home supportive care of at least 20
hours per week to carry out any or all of the following:
a) Routine bodily functions, such as bowel and bladder care
and respiration assistance;
b) Dressing, oral hygiene, and grooming;
c) Preparation and consumption of food and meal cleanup for
individuals who require assistance with the preparation and
consumption of food;
d) Moving into and out of bed, other assistance in
transferring, turning in bed, and other repositioning;
e) Bathing, routine bed baths, and washing;
f) Ambulation and care and assistance with prostheses;
g) Rubbing of skin to promote circulation;
h) Paramedical services; or
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i) Any other function of daily living as determined by the
DSS director. (WIC 12304(d))
1)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)
2)Provides that counties and the state shall be immune from any
liability resulting from the administration of the In-Home
Supportive Services program due to the negligence or
intentional torts of the individual provider. (WIC 12301.6
and 12300.5)
3)Defines blind, pursuant to federal law, as visual acuity of
20/200 or less in an individual's stronger eye, while wearing
a correcting lens or glasses; or a limitation in the field of
vision in the better eye, as specified. (42 U.S.C. 1382c)
FISCAL EFFECT: According to the Senate Appropriations
Committee, this bill will 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 will be authorized for
an additional two hours per month. The analysis also included
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.
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COMMENTS:
In-Home Supportive Services (IHSS): The IHSS program provides
personal care and domestic services to approximately 464,000
qualified, low-income individuals who are aged, blind, or
disabled. Through the IHSS program, recipients are cared for
and assisted with activities of daily living, allowing them to
remain safely in their own homes and avoid institutionalization.
IHSS services include: Paramedical services, such as giving
medications and changing a colostomy bag; Non-Medical Personal
Care services, such as toileting, dressing, and transportation;
Domestic services, such as housework, shopping for groceries and
meal preparation; and, Protective supervision for those who, due
to cognitive decline or dementia, cannot be left alone for
extended periods.
County social workers determine eligibility for IHSS and the
authorized hours of care after conducting a standardized in-home
assessment and periodic reassessments of an individual's ability
to perform specified activities of daily living. Once eligible,
recipients are responsible for hiring, firing, directing and
supervising their own IHSS provider or providers. Prior to
receiving payment for services, providers must submit to a
criminal background check and a provider orientation.
IHSS hourly task guidelines: SB 1104 (Committee Budget and
Fiscal Review), Chapter 229, Statutes of 2004, required the
Department of Social Services, in consultation with
stakeholders, to establish and implement statewide hourly task
guidelines for the IHSS program. The hourly task guidelines
were intended to "provide counties with a standard tool for
consistently and accurately assessing service needs and
authorizing service hours to meet those needs." While statute
requires county social workers to adjust the number of hours of
authorized services based on recipient need, only those services
that are included within the IHSS program are allowed. Because
reading services are not included among the covered services,
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social workers are not able to allot hours for reading, document
completion or other related services even when it is clear that
blind recipients cannot complete those activities without
assistance and other sources of support are not readily
available.
According to the Department of Social Services, as of May 2015,
there are 9,824 blind IHSS recipients (2% of the total IHSS
caseload). Of those blind recipients, 114 have already been
assessed for the statutory maximum number of IHSS hours (283
hours per month), meaning they will not be able to receive any
additional hours of service for the purpose of reading
assistance pursuant to this bill. (It is important to note that
these numbers do not include individuals who are visually
impaired but who do not meet the statutory definition for
blind.)
Limited services for blind individuals: The Office of Services
to the Blind (OSB), within the Department of Social Services,
assists blind individuals and their family members with
information and referrals pertaining to programs, entitlements
and products that can be helpful to them. The OSB's referral
services are available to anyone, regardless of income, and
their Handbook of Resources and Services for Persons Who are
Blind or Visually Impaired is publicly available on the DSS web
site and through other means.
Although current law requires counties to provide IHSS
recipients who are blind or visually impaired information and
referrals to non-profit reading services in the community, those
services don't necessarily create a sustainable system for blind
individuals to have their mail read and responded to, or to
complete and return documents, in a timely manner. Even the
OSB's publication, which it describes as "a comprehensive
directory of social, financial, medical, and technology related
to services and products available throughout the State," only
lists 42 community-based organizations throughout the state that
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might provide social services (including reading assistance) to
blind and visually impaired individuals. In most cases, those
organizations that can provide reading and document completion
services do so on-site and often don't travel to people's homes
to provide such assistance. Consequently, blind IHSS recipients
who live far away from services in the community or who are
unable to travel are left with unread mail and unaddressed
notices and other documents until a friend or relative can help
them, which isn't always an option.
Need for this bill: Although they acknowledge the counties'
current requirement to provide information and referrals to
blind individuals, the supporters of this bill and community
organizations, alike, state that the demand for reading
assistance for IHSS recipients far exceeds the availability of
volunteers at local blind/visually impaired service centers.
According to the author, "Reading assistance is critical for
consumers who need to know about notices that may affect their
ability to live independently, including insurance coverage,
prescription drug labels, housing notifications or other time
sensitive information that may require action."
The California Public Authorities for IHSS (CAPA) further
addresses the author's concerns by stating, "These 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,
consequences of not paying bills promptly can include not only
additional financial hardships, but loss of essential utility
services."
Also in support, the California Council of the Blind writes,
"[Low-income individuals who are blind or visually impaired]
cannot independently access their daily mail and other written
materials that they receive. Further, since they are on fixed
incomes, they do not have the excess income necessary to employ
someone to perform the services of reading mail and completing
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documents for them?Although the General Fund cost to implement
[this bill] would be extremely low, the impact on those
relatively few IHSS recipients who would be affected by the bill
would be immense."
PRIOR LEGISLATION:
AB 1703 (Hall), 2014, was similar to this bill but more
expansive, as it would have added assistance in reading and
document completion to the list of services covered under IHSS
without a specified number of hours for providing the service,
and it would have impacted a greater number of IHSS recipients,
as it included individuals who were blind or visually impaired,
or who had another disability that significantly impaired an
individual's ability to read. It died on the Senate
Appropriations Committee suspense file.
AB 238 (Beall), 2007, was nearly identical to AB 1703 (Hall).
It was vetoed by the Governor.
REGISTERED SUPPORT / OPPOSITION:
Support
AARP
American Federation of State, County and Municipal Employees
(AFSCME), AFL-CIO
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California Association of Area Agencies on Aging (C4A)
California Association of Public Authorities for IHSS (CAPA),
co-sponsor
California Council of the Blind
UDW/AFSCME Local 3930
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Opposition
None on file.
Analysis Prepared by:Myesha Jackson / HUM. S. / (916)
319-2089