Amended in Senate January 4, 2016

Senate Bill No. 547

Introduced by Senator Liu

(Principal coauthor: Assembly Member Brown)

February 26, 2015

An act begin delete to amend Section 12803 of the Government Code, and end delete to add Division 121 (commencing with Section 152000) to the Health and Safety Code, relating to begin delete long-term care. end delete begin insert aging. end insert

LEGISLATIVE COUNSEL’S DIGEST

SB 547, as amended, Liu. begin delete Long-term care: Assistant Secretary of Aging and Long-term Care: Department of Community Living. end delete begin insert Aging and long-term care services, supports, and program coordination. end insert

Existing law establishes the California Health and Human Services Agency consisting of the Departments of Aging, Child Support services, Community Services and Development, Developmental Services, Health Care Services, Managed Health Care, Public Health, Rehabilitation, Social Services, and State Hospitals.

Existing law sets forth legislative findings and declarations regarding long-term care services, including that consumers of those services experience great differences in service levels, eligibility criteria, and service availability that often result in inappropriate and expensive care that is not responsive to individual needs. Those findings and declarations also state that the laws governing long-term care facilities have established an uncoordinated array of long-term care services that are funded and administered by a state structure that lacks necessary integration and focus.

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This bill would establish the Department of Community Living within the agency. The department would, among other duties, serve as the single state-level contact on issues of aging and long-term care, oversee statewide long-term care service delivery, promote coordinated long-term care service delivery and access to home and community-based services at the local and regional level, and serve as the organizational unit designated to oversee all long-term care programs in the state and to consolidate all long-term care programs administered throughout all departments of the agency. The bill would also create the office of Assistant Secretary of Aging and Long-term Care Coordination within the agency, who would be appointed by the Governor and confirmed by the Senate.

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The bill would require the Assistant Secretary to develop a systemwide long-term care plan that would, among other things, address the expansion of managed care and the changes to, and differences in, access to health care for older and disabled adults in counties throughout the state, propose a support network for unpaid family caregivers, and include an analysis of workforce needs, including the training and education requirements of a long-term care workforce, and a strategy for aligning the available resources to meet those needs.

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This bill, among other things, would create the Statewide Aging and Long-Term Care Services Coordinating Council, chaired by the Secretary of California Health and Human Services, and would consist of the heads, or their designated representative, of specified departments and offices. The secretary would have specified responsibilities, including, but not limited to, leading the council in the development and implementation of a state aging and long-term care services strategic plan to address how the state will meet the needs of the aging population in the years 2020, 2025, and 2030. The bill would also require the secretary to enter into a contract with the Regents of the University of California so that the council may either partner with the University of California, San Francisco, to operate, revise, and manage the CalQualityCare.org Internet Web site or acquire the rights to operate the CalQualityCare.org Internet Web site to function as a consumer-oriented portal that provides specified aging and long-term care information on a statewide basis.

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Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

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begin insert Division 121 (commencing with Section 152000)
is added to the end insert begin insert Health and Safety Code end insert begin insert , to read: end insert

begin insert

 

Division  begin insert 121. end insert   Aging and Long-Term Care Services,
Supports, and Program Coordination

 

begin insert 152000. end insert   

The Legislature finds and declares all of the following:

(a) The California Health and Human Services Agency consists
of the following departments: the California Department of Aging,
the Department of Community Services and Development, the State
Department of Developmental Services, the State Department of
Health Care Services, the Department of Managed Health Care,
the State Department of Public Health, the Department of
Rehabilitation, the State Department of Social Services, and the
State Department of State Hospitals.

(b) The agency also includes the Emergency Medical Services
Authority, the Office of Health Information Integrity, the Office of
Patient Advocate, the Office of Statewide Health Planning and
Development, the Office of Systems Integration, the Office of Law
Enforcement Support, and the State Council on Developmental
Disabilities.

(c) California baby boomers are turning 65 years of age at the
highest rate in the nation, and over 20 percent of California’s
population will be 65 years of age or older by 2030.

(d) Among persons 65 years of age and older, an estimated 70
percent will use long-term services and supports (LTSS).

(e) Persons 85 years of age and older are the fastest growing
segment of the United States population, and they are four times
more likely to need LTSS than persons between 65 and 84 years
of age.

(f) People are living longer, and the aging population is
increasingly diverse.

(g) A report by the Senate Select Committee on Aging and Long
Term Care on January 2015, called, “A Shattered System:
Reforming Long-Term Care in California. Envisioning and
Implementing an IDEAL Long-Term Care System in California,”
found that the state’s system of 112 aging long-term care programs
administered by 20 agencies and departments is almost impossible
for consumers to navigate.

(h) Other deficiencies of the system include no person-centered
care, poor transitions from hospital to home or to other institutions,
limited access to a range of services that enable aging in place,
deficiency of services and supports in rural areas, limited cultural
competency, skilled workforce shortages across a range of
disciplines, no uniform data, no universal assessment tool, and
limited caregiver supports.

(i) Also, the End of Life Option Act authorizes an adult, who
meets certain qualifications and who has been determined by his
or her attending physician to be suffering from a terminal disease,
to make a request for a drug for the purpose of ending his or her
life. Paragraph (5) of subdivision (i) of Section 443.1 states that
an individual choosing the end of life option is required to be
informed of “feasible alternatives or additional treatment
opportunities, including, but not limited to, comfort care, hospice
care, palliative care, and pain control.” Better system wide
coordination of aging and long-term care services and supports
is needed to ensure access to services and information, so
individuals can plan for, access, and make informed decisions on
end of life options.

begin insert 152001. end insert   

The Secretary of California Health and Human
Services shall be responsible for all of the following:

(a) Inter- and intra-agency coordination of state aging and
long-term care services, supports, and programs.

(b) Ensuring efficient and effective use of state funds.

(c) Maximizing the drawdown, and the efficient and effective
use of federal funds.

begin insert 152002. end insert   

There is hereby created a Statewide Aging and
Long-Term Care Services Coordinating Council, chaired by the
Secretary of California Health and Human Services, and consisting
of the heads, or their designated representative, of all of the
following:

(a) The California Department of Aging.

(b) The Department of Community Services and Development.

(c) The Department of Consumer Affairs.

(d) The Department of Food and Agriculture.

(e) The Department of Human Resources.

(f) The Department of Insurance.

(g) The Department of Justice.

(h) The Department of Motor Vehicles.

(i) The Department of Rehabilitation.

(j) The Department of Transportation.

(k) The Department of Veterans Affairs.

(l) The Emergency Medical Services Authority.

(m) The Employment Development Department.

(n) The Office of Health Information Integrity.

(o) The Office of Law Enforcement Support.

(p) The Office of Patient Advocate.

(q) The Office of Statewide Health Planning and Development.

(r) The Office of Systems Integration.

(s) The State Department of Developmental Services.

(t) The State Department of Health Care Services.

(u) The State Department of Public Health.

(v) The State Department of Social Services.

begin insert 152003. end insert   

(a) The secretary shall lead the council in the
development and implementation of a state aging and long-term
care services strategic plan to address how the state will meet the
needs of the aging population in the years 2020, 2025, and 2030.
The strategic plan shall incorporate clear benchmarks and
timelines for achieving the goals set forth in the strategic plan and
be updated every five years. In developing the strategic plan, the
council shall consult with all of the following:

(1) Experts, researchers, practitioners, service providers, and
facility operators in the field of aging and long-term care.

(2) Consumer advocates and stakeholders, including the
Olmstead Advisory Committee, the California Commission on
Aging, the area agency on aging, the State Council on
Developmental Disabilities, the California Foundation for
Independent Living Centers, and the Milton Marks “Little Hoover”
Commission on California State Government Organization and
Economy.

(3) Rural and urban communities in order to identify
infrastructure capacity issues, the need for uniform access
standards for home and community-based services, and
mechanisms for supporting coordination of regional and local
service access and delivery.

(4) The California Task Force on Family Caregiving, the
findings and recommendations of which shall be incorporated into
the strategic plan.

(b) Technical support for the development of the strategic plan
shall be provided by the Office of Health Equity in the State
Department of Public Health and by the California Department
of Aging.

(c) The strategic plan shall address all of the following:

(1) Integration and coordination of services that support
independent living, aging in place, social and civic engagement,
and preventative care.

(2) Long-term care financing.

(3) Managed care expansion and continuum of care.

(4) Advanced planning for end of life care.

(5) Elder justice.

(6) Care guidelines for Alzheimer’s disease, dementia,
Amyotrophic Lateral Sclerosis (ALS), and other debilitating
diseases.

(7) Caregiver support.

(8) Data collection, consolidation, uniformity, analysis, and
access.

(9) Affordable housing.

(10) Mobility.

(11) Workforce.

(12) The alignment of state programs with the federal
Administration for Community Living.

(13) The potential for integration and coordination of aging
and long-term care services with services and supports for people
with disabilities.

(d) In developing the strategic plan, the council shall examine
model programs in various cities, counties, and states. The
strategic plan shall consider how to scale up local, regional, and
state-level best practices and innovations designed to overcome
the challenges related to long-term care services delivery.

(e) Notwithstanding Section 10231.5 of the Government Code,
the strategic plan shall be submitted to the Secretary of the Senate
and the Chief Clerk of the Assembly, to the appropriate chairs of
the policy committees of the Legislature with jurisdiction over any
aging and long-term care related issues, and to the chairs of the
fiscal committees of the Legislature by July 1, 2018, with updates
submitted by July 1, 2023, and by July 1, 2028.

(f) Notwithstanding Section 10231.5 of the Government Code,
beginning on July 1, 2017, the secretary shall report on an annual
basis to the appropriate policy committees of the Legislature with
jurisdiction over any aging and long-term care related issues and
to the fiscal committees of the Legislature regarding the current
status of long-term care in the state, the level of state spending on
long-term care programs, federal funding received, progress in
developing and implementing the strategic plan as provided in
this section, and the statewide Internet Web site portal as provided
in Section 152004.

begin insert 152004. end insert   

Notwithstanding Chapter 2 (commencing with Section
10290) and Chapter 3 (commencing with Section 12100) of Part
2 of Division 2 of the Public Contract Code, the Secretary shall
enter into a contract with the Regents of the University of
California so that the council may either partner with the
University of California, San Francisco, to operate, revise, and
manage the CalQualityCare.org Internet Web site or acquire the
rights to operate the CalQualityCare.org Internet Web Site to
function as a consumer-oriented portal that provides all of the
following information on a statewide basis:

(a) Comprehensive, free, unbiased information on long-term
care services and supports, including licensed skilled nursing
facilities (freestanding and hospital-based), congregate living
health facilities, hospice, home health, assisted living, continuing
care retirement communities, adult day care, adult day health
care, and intermediate care for the developmentally disabled
(ICF/DD).

(b) Depending on the availability and reliability of the data,
information within all of the following domains shall be provided:

(1) Provider characteristics, such as location, size, and
ownership.

(2) Ratings of skilled nursing facilities, home health, hospice,
and ICF/DD.

(3) Staffing, such as number and type.

(4) Quality of the facility, such as deficiencies and complaints.

(5) Quality of care, such as incidence of pressure ulcers and
infections.

(6) Cost and finances.

(c) The CalQualityCare.org Internet Web site shall include
information that assists the consumer to learn about options and
how to make decisions on long-term care services and supports,
advanced planning, and end of life options.

(d) By July 1, 2018, the Secretary shall expand the
CalQualityCare.org Internet Web site to provide all of the
following:

(1) Information about long-term services and supports eligibility
and how to access long-term care services and supports.

(2) Internet links to reputable local resource portals, such as
county long-term care services and supports Internet Web sites.

(3) Internet links to reputable caregiver resources.

(4) Information on additional licensed providers, such as
nonmedical home care aides.

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SECTION 1.  

Section 12803 of the Government Code is
amended to read:

12803.  

(a) The California Health and Human Services Agency
consists of the following departments: Aging; Community Services
and Development; Developmental Services; Health Care Services;
Managed Health Care; Public Health; Rehabilitation; Social
Services; and State Hospitals.

(b) The agency also includes the Emergency Medical Services
Authority, the Managed Risk Medical Insurance Board, the Office
of Health Information Integrity, the Office of Patient Advocate,
the Office of Statewide Health Planning and Development, the
Office of Systems Integration, the Office of Law Enforcement
Support, and the State Council on Developmental Disabilities.

(c) The Department of Child Support Services is hereby created
within the agency commencing January 1, 2000, and shall be the
single organizational unit designated as the state’s Title IV-D
agency with the responsibility for administering the state plan and
providing services relating to the establishment of paternity or the
establishment, modification, or enforcement of child support
obligations as required by Section 654 of Title 42 of the United
States Code. State plan functions shall be performed by other
agencies as required by law, by delegation of the department, or
by cooperative agreements.

(d) There shall be an Assistant Secretary of Aging and
Long-term Care Coordination within the agency who shall be
appointed by the Governor and confirmed by the Senate. The
person appointed shall have an appropriate background in and
knowledge of long-term care.

(e) The Department of Community Living is hereby created
within the agency.

SEC. 2.  

Division 121 (commencing with Section 152000) is
added to the Health and Safety Code, to read:

 

Division 121.  Department of Community Living

 

152000.  

There is in the California Health and Human Services
Agency the Department of Community Living.

152001.  

The Assistant Secretary of Aging and Long-term Care
Coordination shall serve as liaison to the federal Administration
for Community Living and shall be responsible for ensuring that
the state maximizes the use of available federal funding
opportunities. The Assistant Secretary of Aging and Long-term
Care Coordination shall do all of the following:

(a) Consolidate data and programs regarding long-term care
from all departments and programs in the agency.

(b) Coordinate and direct the establishment of the Department
of Community Living.

(c) Lead the development and implementation of a statewide
long-term care strategic plan.

(d) Oversee and coordinate the integration of health care and
long-term care services.

(e) Work with rural and urban communities to identify
infrastructure capacity issues and lead in the development of access
standards for home and community-based services.

(f) Facilitate the coordination of long-term care services at the
local level.

(g) Report on an annual basis to the legislative and fiscal policy
committees regarding the current status of long-term care in the
state, the level of state spending on long-term care programs,
federal funding received, progress in improving the continuum of
services, and policy recommendations to enhance the coordination
and delivery of long-term care services.

152002.  

The department shall be aligned, to the extent
practicable, with the federal Administration for Community Living.
The department shall serve as the single state-level contact on
issues of aging and long-term care, oversee statewide long-term
care service delivery, promote coordinated long-term care service
delivery and access to home and community-based services at the
local and regional level, and provide leadership and information
to local agencies on best practices. The department shall also serve
as the organizational unit designated to oversee all long-term care
programs in the state and to consolidate all long-term care programs
administered throughout all departments of the agency, including
programs serving older adults and those serving persons with
disabilities. The department may develop statewide standards for
the delivery of long-term care services to ensure consistent access
to those services throughout the state, but shall provide sufficient
flexibility to local agencies to meet the specific needs of the local
population.

152003.  

The Assistant Secretary of Aging and Long-term Care
Coordination shall develop a system-wide long-term care plan.
The plan shall establish the priorities of the state, maximize the
use of limited resources, engage a range of stakeholders
representing the population of aging and disabled persons who
need long-term care services, and incorporate clear benchmarks
and timelines for achieving the goals set forth in the plan. The plan
shall do all of the following:

(a) The plan shall address the expansion of managed care in
Coordinated Care Initiative counties, as defined in Section
14182,16 of the Welfare and Institutions Code, and the changes
to, and differences in, access to health care for older and disabled
adults in counties throughout the state. The plan shall include a
strategy for integrating the health care system statewide, including
recommended budgeting practices and incentives to make home
and community-based services more accessible regardless of where
persons in need of long-term care reside.

(b) The plan shall propose a support network for unpaid family
caregivers in this state. The plan would review and analyze existing
programs, services, and deficiencies. The plan shall also consider
employment-related policies and offer proposals to improve the
support network, such as increasing the length of protected leave.

(c) The plan shall develop principles and standards for
person-centered planning in an integrated system of care to ensure
that individuals and families have the opportunity to engage in
service planning across the health and long-term care continuum
in a manner that reflects their needs, desires, and preferences.

(d) The plan shall include an analysis of workforce needs,
including the training and education requirements of a long-term
care workforce, and a strategy for aligning the available resources
to meet those needs.

(e) The plan shall include directives for ensuring that the
integrated long-term care system screens individuals prior to
placement in a “nursing home” or similar long-term care facility,
to avoid unnecessary admissions to those facilities. The plan shall
also examine how a preadmission screening program may be
integrated into a managed care system and shall include a
discussion of best practices in other states, such as Oregon, that
are used to determine whether an individual is appropriate for
community-based care as opposed to institutional placement. The
plan shall specify the minimum levels of functional limitations
that an individual must have in order for a facility to receive
Medi-Cal reimbursement.

(f) The plan shall include a strategy for developing a
public/private partnership to raise Californians’ awareness of, and
engagement in, long-term care planning. The plan shall consult
advocates, private foundations, and other stakeholders in
developing a strategy to engage the general population on
long-term care issues.

(g) The plan shall include guidance on enhancing
decision-making capacity for impaired individuals, as well as
options for supported and surrogate decision-making that are
appropriate for various levels of impairment and risk. The plan
shall also specify measures to evaluate a consumer’s capacity to
provide or oversee self-care and consent to or refuse services. The
plan shall also address how to educate long-term care consumers
and providers, the legal system, and the public about “safe”
advance directives, limited conservatorships, and affordable access
to conservators.

(h) The plan shall address end-of-life planning issues
emphasizing a consumer’s rights to make decisions about options
to die with dignity. The plan shall also address improvements to
end-of-life care, while promoting access to quality health and
long-term care services, including palliative care, for consumers
and their families.

(i) The plan shall consider how to expand local and state-level
innovations designed to address the challenges related to long-term
care services delivery. The plan shall examine model programs in
various cities and counties.

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