BILL ANALYSIS Ó 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