BILL ANALYSIS                                                                                                                                                                                                    



                                                                     SB 199


                                                                    Page  1





          SENATE THIRD READING


          SB  
          199 (Hall)


          As Amended  August 28, 2015


          Majority vote


          SENATE VOTE:  40-0


           ------------------------------------------------------------------ 
          |Committee       |Votes|Ayes                  |Noes                |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Human Services  |7-0  |Chu, Mayes, Calderon, |                    |
          |                |     |Lopez, Maienschein,   |                    |
          |                |     |Mark Stone, Thurmond  |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Appropriations  |17-0 |Gomez, Bigelow,       |                    |
          |                |     |Bloom, Bonta,         |                    |
          |                |     |Calderon, Chang,      |                    |
          |                |     |Nazarian, Eggman,     |                    |
          |                |     |Gallagher, Eduardo    |                    |
          |                |     |Garcia, Holden,       |                    |
          |                |     |Jones, Quirk, Rendon, |                    |
          |                |     |Wagner, Weber, Wood   |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
           ------------------------------------------------------------------ 









                                                                     SB 199


                                                                    Page  2






          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.


          3)Permits the Department of Social Services (DSS) to implement  
            this bill through all-county letters or similar instructions  
            from the director.


          4)Requires DSS to adopt regulations by January 1, 2018, and  
            provides that the initial adoption, amendment, or repeal of a  
            regulation pursuant to this 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.   








                                                                     SB 199


                                                                    Page  3





            Defines supportive services within the program to include  
            domestic services, personal care services, protective  
            supervision, paramedical services, and other services, as  
            specified.  (Welfare and Institutions Code (WIC) Section 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 Section  
            12301.2)


          3)Permits certain IHSS recipients with high care needs, as  
            specified, to receive up to 283 hours of IHSS services per  
            month.  (WIC Section12303.4(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  








                                                                     SB 199


                                                                    Page  4





               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



             i)   Any other function of daily living as determined by the  
               DSS director.  (WIC Section 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  
            Section 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 Sections  
            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  








                                                                     SB 199


                                                                    Page  5





            a correcting lens or glasses; or a limitation in the field of  
            vision in the better eye, as specified.  (42 United States  
            Code Section 1382c)


          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee, this bill will result in the following fiscal impact:


          1)One-time costs in 2015-16 of up to $1.7 million (General  
            Fund/Federal Fund), and up to $3 million on-going to fund  
            additional authorized IHSS provider hours for services to  
            9,710 IHSS recipients who are blind, assuming all potential  
            recipients are authorized for an additional two hours per  
            month.  These costs will be lower to the extent that not all  
            potential recipients are authorized for this service or are  
            authorized for fewer than two hours.


          2)Unknown but potentially significant one-time automation costs  
            (General Fund/Federal Fund). 


          3)Minor one-time costs to DHCS to submit the request for federal  
            approval of this service.


          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;  








                                                                     SB 199


                                                                    Page  6





          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 (Budget and Fiscal Review  
          Committee), 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,  
          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  








                                                                     SB 199


                                                                    Page  7





          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  
          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.  









                                                                     SB 199


                                                                    Page  8






          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  
          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."


          There is no known opposition on file.










                                                                     SB 199


                                                                    Page  9







          Analysis Prepared by:                                             
                          Myesha Jackson / HUM. S. / (916) 319-2089  FN:  
          0001695