BILL NUMBER: SB 547 AMENDED
BILL TEXT
AMENDED IN SENATE JANUARY 4, 2016
INTRODUCED BY Senator Liu
(Principal coauthor: Assembly Member Brown)
FEBRUARY 26, 2015
An act to amend Section 12803 of the Government Code, and
to add Division 121 (commencing with Section 152000) to
the Health and Safety Code, relating to long-term care.
aging.
LEGISLATIVE COUNSEL'S DIGEST
SB 547, as amended, Liu. Long-term care: Assistant
Secretary of Aging and Long-term Care: Department of Community
Living. Aging and long-term care services, supports,
and program coordination.
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.
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.
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.
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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Division 121 (commencing with Section
152000) is added to the Health and Safety Code
, to read:
DIVISION 121. Aging and Long-Term Care Services, Supports, and
Program Coordination
152000. 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.
152001. 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.
152002. 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.
152003. (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.
152004. 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.
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.