BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 547
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|AUTHOR: |Liu |
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|VERSION: |January 4, 2016 |
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|HEARING DATE: |January 13, | | |
| |2016 | | |
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|CONSULTANT: |Teri Boughton |
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SUBJECT : Aging and long-term care services, supports, and
program coordination.
SUMMARY :1. Creates a Statewide Aging and Long-Term Care Services and
Coordinating Council (Council), chaired by the Secretary of the
California Health and Human Services Agency and requires the
Council to develop and implement a state aging and long-term
care services strategic plan to address how California will meet
the needs of the aging population in 2020, 2025, and 2030.
Existing law:
1)Establishes the California Health and Human Services Agency
(CHHS), an umbrella agency over 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.
2)Establishes the Coordinate Care Initiative which: mandates
that most Medi-Cal beneficiaries over age 21 enroll in a
Medi-Cal managed care health plan in order to receive Medi-Cal
benefits, including long-term supports and services (LTSS);
creates a demonstration program for Medicare and Medi-Cal dual
eligible beneficiaries to coordinate medical, behavioral
health, long-term institutional, and home- and community-based
services through a single health plan; and, provides state
authority for Cal MediConnect.
3)Requires the Department of Public Health (DPH) to license and
certify long-term care facilities to: administer the
Alzheimer's Disease Program; California Arthritis Partnership
Program; Preventive Health Care for Adults; Well-Integrated
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Screening and Evaluation for Women Across the Nation;
California Colon Cancer Control Program; Acquired Immune
Deficiency Syndrome Waiver; Home Health Aide Certification;
Nursing Home Licensing & Certification; and, Community-Based
Adult Services Facility Licensing & Certification.
4)Requires the Department of Health Care Services (DHCS) to
administer Medi-Cal, through which the following programs
operate: Community-Based Adult Services; Caregiver Resource
Centers; Acquired Immune Deficiency Syndrome waiver; Home and
Community-Based Services for the Developmentally Disabled;
Assisted Living Waiver; California Community Transitions
Project; California Partnership for Long-Term Care; Community
Living Support Benefit waiver; Proving Access, Counseling &
Treatment for Californians with Prostate Cancer, In-Home
Operations waiver; Developmentally-Disabled/Continuous Nursing
Care Program; Nursing Home/Acute Hospital waiver; Home
Supportive Services Plus State Plan Option Program; Program of
All-Inclusive Care for the Elderly; Senior Care Action Network
Health Plan; State Plan Services, Medi-Cal Managed Care;
Prescription Drug Discount Program for Medicare Recipients;
and, Genetically Handicapped Persons Program.
5)Requires the Department of Developmental Service to administer
Home and Community-Based Services for the Developmentally
Disabled, Developmental Centers, Office of Protective
Services, Foster Grandparent and Senior Companion Programs
6)Establishes the California Department of Aging (CDA) to
administer programs that serve older adults, adults with
disabilities, family caregivers, and residents in long-term
care facilities throughout the State.
7)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.
8)Sets forth legislative findings and declarations stating 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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9)Under federal law, establishes the U.S. Administration for
Community Living (ACL), bringing together the Administration
on Aging, the Office on Disability and the Administration on
Developmental Disabilities to: reduce fragmentation in Federal
programs that address the community living service and support
needs of aging and disabled populations; enhance access to
quality health care and LTSS for all individuals; and, promote
consistency in community living policy across other areas of
the federal government.
This bill:
1)Requires the Secretary of CHHS (Secretary) to be responsible
for the inter- and intra-agency coordination of state aging
and long-term care services, supports, and programs, ensuring
efficient and effective use of state funds, and maximizing the
drawdown, and the efficient and effective use of federal
funds.
2)Creates a Statewide Aging and Long-Term Care Services and
Coordinating Council (Council), chaired by the Secretary and
consisting of the heads, or designees, representing 22 state
departments.
3)Requires the Council to develop and implement a state aging
and long-term care services strategic plan to address how
California will meet the needs of the aging population in
2020, 2025, and 2030. Requires the strategic plan to
incorporate clear benchmarks and timelines for achieving the
goals set forth in the strategic plan, and be updated every
five years.
4)Requires consultation with specified experts, advocates and
stakeholders in developing the strategic plan, and requires
technical support to be provided by the Office of Health
Equity in DPH and the CDA.
5)Requires the strategic plan to address all of the following:
a. Integration and coordination of services that
support independent living, aging in place, social and
civic engagement, and preventative care;
b. Long-term care financing;
c. Managed care expansion and continuum of care;
d. Advanced planning for end-of-life care;
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e. Elder justice;
f. Care guidelines for Alzheimer's disease, dementia,
Amyotrophic Lateral Sclerosis, and other debilitating
diseases;
g. Caregiver support;
h. Data collection, consolidation, uniformity,
analysis, and access;
i. Affordable housing;
j. Mobility;
aa. Workforce;
bb. The alignment of state programs with the federal
ACL; and,
cc. The potential for integration and coordination of
aging and long-term care services with services and
supports for people with disabilities.
6)Requires the Council to examine model programs and consider
how to scale up local, regional, and state-level best
practices and innovations to overcome long-term care services
delivery.
7)Requires the strategic plan to be submitted to the specified
committees of the Legislature by July 1, 2018, with updates
submitted by July 1, 2023, and July 1, 2028. Requires,
beginning July 1, 2017, the Secretary to report on an annual
basis to specified committees of the Legislature, the status
of the long-term care programs, federal funding received,
progress in developing and implementing the strategic plan as
provided in this bill and the statewide Internet Website
portal (CalQualityCare.org), as specified below in 8) and 9).
8)Requires 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 (UCSF) to operate, revise, and manage the
CalQualtiyCare.org Internet Website or acquire the rights to
operate the Website to function as a consumer-oriented portal,
as specified in 9).
9)Requires the CalQualityCare.org Website to provide all of the
following information:
a. Comprehensive, free unbiased information on LTSS,
including licensed skilled nursing facilities, and
others, as specified;
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b. Depending upon availability and reliability of the
data,
i. Provider characteristics, such as
location, size and ownership;
ii. Ratings of SNFs, home health, hospice and
ICF/DDs;
iii. Staffing, such as number and type;
iv. Quality of the facility, such as
deficiencies and complaints;
v. Quality of care, such as incidence of
pressure ulcers and infections; and,
vi. Cost and finances.
c. Information that assists the consumer to learn about
options and how to make decisions on LTSS, advanced
planning, and end of life options;
d. Requires the Secretary, by July 1, 2018, to expand
the CalQualityCare.org Internet Website to include:
i. Information about LTSS eligibility and
how to access LTSS;
ii. Internet links to reputable local
resource portals, such as county LTSS Internet Web
sites; and,
iii. Information on additional licensed
providers, such as nonmedical home care aides.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1.Author's statement. According to the author, "California's
population of residents 65 years old and older will grow from
about 13% of the population in 2015 to almost 20 % of the
population by 2030. The state is not prepared for this silver
tsunami. The overwhelming conclusion the Senate Select
Committee on Aging and Long Term Care drew from its research
and public hearings in 2014 is that California's aging and
long term care system of services and supports is fragmented
to the point of being almost impossible for consumers,
caregivers, and providers to navigate. There are 112 aging
and long term care programs spread over 20 state agencies and
departments and very little coordination among them. We cannot
change overnight, but change we must. California must begin
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now to organize our services and supports delivery system and
plan our investments in long term care to maximize returns in
the form of improved quality of life and cost savings to
consumers and taxpayers before we are faced with an
overwhelming crisis. It is time for California to commit to
creating a rational system of supports and services that will
meet the needs of aging and disabled adults. The costs of
failure to the state and to society are too great for us not
to act."
2.California's aging population. According to the 2011 study "A
Long-Term Strategy for Long-Term Care" by the Little Hoover
Commission, the number of Californians over age 65 is
projected to double by 2030 to 8.84 million people, or 18 % of
California's population. Working age adults with disabilities
likely will increase in number to more than half a million by
2030, exerting additional pressure on California's long-term
care system. The aging population also is living longer, many
with physical or cognitive disabilities or chronic illnesses
such as Alzheimer's disease, high blood pressure, diabetes and
obesity, or with a history of heart attack or stroke.
According to a series of articles in the Sacramento Bee from
2010 and 2011, California's growing population will place
unprecedented level of demand on the state's health care
resources.
3.Select Committee on Aging and Long Term Care Report. The
Select Committee on Aging and Long Term Care's 2014 report, "A
Shattered System: Reforming Long Term Care in California"
(report) was the result of a comprehensive effort in 2014 to
identify the structural, policy, and administrative changes
necessary to realize an ideal long-term care delivery system
and develop recommendations and a strategy to achieve that
vision. One of the critical policy areas identified by the
report was the fragmented long-term care system, with the
report stating that California's fragmented structure
complicates comprehensive long-term care reform, and that in
lieu of a cohesive strategic plan, California has instead
adopted a piecemeal and reactive approach to change. To
address this issue, the report recommended creating the
Department of Community Living within CHHS, appointing an
individual to lead the Department, and developing and
implementing a long-term care strategic plan. The Little
Hoover Commission Report from 2011 recommends that the
Governor and Legislature should consolidate all long-term care
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programs and funding into a single long-term care entity
within the CHHS.
4.CalQualityCare.org. CalQualityCare.org is a free Website,
managed by the California HealthCare Foundation (CHCF) , which
features information on California hospitals, medical groups,
nursing homes, and other long-term care facilities, along with
tips and checklists about how to choose a health care
provider, questions to ask, how to pay for care, and what to
do if something goes wrong. CHCF has plans to transfer control
of CalQualityCare.org to UCSF. According to CHHS, UCSF has
approached several CHHS departments to see if they would be
able to both finance and manage the website, including website
maintenance, data collection, analysis and linkage. CHHS did
engage in a discussion with the departments to assess the
capacity and resources that would be required to assume
management of this website. After further review and
discussion, CHHS determined that the information available on
CalQualityCare.org is made available to consumers through
various existing efforts. As examples, CHHS refers to federal
CMS sites designed to provide consumer-friendly information on
physicians, hospitals, nursing homes, home health and
dialysis. CHHS also indicates that state specific data are
made publicly available through CHHS departments and some data
are included in the CHHS Open Data Portal.
5.Existing Committees. CHHS has two advisory bodies on
long-term care, the Olmstead Advisory Committee and the
Alzheimer's Disease and Related Disorders Committee. The
Olmstead Advisory Committee was established in 2005 in
reaction to a 1999 ruling in which the United States Supreme
Court held in Olmstead v. L.C. that unjustified segregation of
persons with disabilities constitutes discrimination in
violation of title II of the Americans with Disabilities Act.
The federal government advised states that one way states
could demonstrate compliance was to develop an Olmstead plan
and stakeholder committee to address implementation of the
plan's goals and objectives. The committee, which meets
quarterly, is led by the Secretary along with the Chair, and
directors also participate from the departments of Social
Services, Aging, Health Care Services, Developmental Services,
and Rehabilitation. There were also at least 30
non-government organizations with members represented on the
committee as of January 2015. According to the Alzheimer's
Disease and Related Disorders Committee was established in
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1988 and continues to meet to provide ongoing advice,
assistance, and planning support concerning the needs of
persons with Alzheimer's disease and related disorders.
6.Existing long-term care strategic plans. According to CHHS,
California has a number of plans on long-term care. For
example, in 2010, CHHS and the Alzheimer's Association
collaborated on California's State Plan for Alzheimer's
disease: An Action Plan for 2011-2021. In addition to the
Olmstead Plan and the State Plan for Alzheimer's Disease, a
Centers for Medicare and Medicaid Services (CMS) grant
provided funding for a 2009 California LTC Financing Study
that provided a review of the existing LTSS populations,
Medi-Cal funding for services and supports and identified new
strategies the state could consider to provide these services
in a more cost effective way that also increased resources to
support living more independently in the community. Also, SB
910 (Vasconcellos, Chapter 948, Statutes of 1999) required
CHHS to develop a statewide strategic plan to address the
impending demographic, economic, and social changes tied to
California's increasingly diverse and rapidly growing aging
population. Funding was provided to the University of
California which produced a series of reports addressing the
topics specified in SB 910.
7.Double referral. A previous version of this bill was heard in
the Senate Governmental Organization Committee on April 14,
2015, and passed by an 8-3 vote.
8.Related legislation. SB 571 (Liu) would have required CHHS to
update the standards for CalCareNet and create an Internet Web
site that provides information to consumers, caregivers, and
health and social service providers on how to effectively
navigate long-term care services and that assists consumers,
caregivers, and health and social service providers in making
informed decisions relating to long-term care services. SB 571
was held in the Senate Committee on Appropriations.
AB 310 (Mathis) would require the Insurance Commissioner to
commission an annual study comparing the statutory
requirements for long-term care products in this state with
the statutory requirements governing long-term care products
as defined. AB 310 also requires the commissioner to provide
an annual report to the Legislature comparing the
marketability and affordability of long-term care insurance
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products in this state with similar products in other states.
AB 310 is currently pending hearing in the Assembly Committee
on Insurance.
AB 1235 (Gipson) would require the home upkeep allowance for
Medi-Cal beneficiaries in long-term care facilities to be
based on the actual cost to maintain the beneficiary's home
and allow Medi-Cal beneficiaries in long-term care facilities
that do not have a home to establish a transitional needs fund
to set aside up to $7,500 for the purpose of securing a home.
AB 1235 was held in the Assembly Committee on Appropriations.
9.Prior legislation. AB 332 (Calderon of 2015) would have
required the Insurance Commissioner to convene a task force to
examine the components necessary to design a statewide
long-term care insurance program, as specified. AB 332 was
vetoed by the Governor. In his veto message, the Governor
states, "Since the federal government and a number of private
organizations have undertaken essentially the same task, I
don't think that this bill is necessary. Moreover, I'm
hesitant to start down a path that may lead to a large and
potentially costly new mandate."
AB 2014 (Berg of 2006) would have established the California
Department of Adult and Aging Services for the purpose of
coordinating and promoting those programs that support adults
who are aging or disabled so that they may remain in their
homes and communities as long as practically possible. AB 2014
was referred to the Senate Committee on Human Services but was
never heard.
SB 2008 (Alquist Chapter 339, Statutes of 2008) expands the
membership of the Alzheimer's Disease and Related Disorders
Advisory Committee, and requires the Committee to update the
1987 Task Force Report on Alzheimer's and make recommendations
to the Secretary and Legislature.
AB 452 (Mazzoni Chapter 895, Statutes of 1999) established the
Long-Term Care Council to coordinate long-term care policy
development and program operations, and provide leadership in
developing a long-term care system from the array of existing
programs. The bill contained a sunset of the council
effective January 1, 2007.
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SB 910 required CHHS, with the advice of the California
Commission on Aging, to develop a statewide strategic plan for
regarding aging and long-term care issues, and to provide
three annual reports to the Legislature beginning July 1,
2000.
SB 139 (Mello, Chapter 303, Statutes of 1988) established the
Alzheimer's Disease and Related Disorders Committee as well as
a grant program and report requirements.
10.Support. Writing in support of this bill, the California
Association of Area Agencies on Aging (C4A) states that
uncoordinated services for older adults and adults with
disabilities have created barriers in services, and that
services need to be individualized to empower older adults to
live independently in the community. C4A supports the notion
to charge the Secretary with the responsibility to coordinate
aging and long-term care services and to convene a
coordinating council. The California Commission on Aging
writes that silos and fragmentation have long impeded the
delivery of services to the state's most frail and vulnerable
adults. Through creation of a Council, this bill focuses the
attention of 23 state departments and divisions on their
shared role in meeting the needs of a growing population of
older adults and persons with disabilities. The Council's
development of an Aging & Long-Term Care Services Strategic
Plan will spell out the steps to better organize and
coordinate the administration and delivery of critical LTSS.
11.Support (prior version): The California Retired Teachers
Association states that "fractured oversight and the
complexity of the administrative 'spider web' have been
ongoing issues of discussion in recent years, especially with
heightened interest in improving the system of long-term care.
For example, nursing homes are overseen by the Department of
Public Health, while residential care facilities for the
elderly are under the jurisdiction of the Department of Social
Services. As our population ages and requires more nuanced
and specialized care, the artificial bifurcation of programs
within the administration is illogical and burdensome to
navigate for seniors, their families, and caregivers.
Additionally, lack of coordination between state departments
has created a system with compromised transparency and
accountability, meaning that bad actors regulated by one
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department may subsequently be licensed to run programs under
the banner of a second department." The California Retired
Teachers Association believes that this bill will improve the
likelihood that community-based services will meet the needs
of seniors, reducing hospitalizations and institutional
placements and ultimately improving their health and
well-being. The National Association of Social Workers states
that silos and fragmentation have long been a problem in the
delivery of services to the state's most frail and vulnerable
adults, and that this bill will enhance coordination and
provide consumers with the services they need.
12.Policy Comment. A prior version of this bill called for a
reorganization and major restructuring of state departments
to create a new Department of Community Living within CHHS and
establish an Assistant Secretary of Aging and Long-term Care
Coordination with an extensive list of requirements on the
Assistant Secretary and Department of Community Living. While
this bill has been significantly narrowed to require the
development of a council and strategic plan, it is not clear
how this Council and another strategic plan will bring about
the outcome sought by proponents (i.e., better integration and
delivery of LTSS). With respect to CalQualityCare.org, CHHS
points out that the data are available elsewhere. A Website
where all data are brought together in one place for
California consumers is worthwhile but the state may not be
best situated to operate the Website given its track record
with technology projects.
SUPPORT AND OPPOSITION :
Support: California Association of Area Agencies on Aging
California Commission on Aging
Support (prior version) :
California Alzheimer's Association
California Chapter of the National Association of
Social Workers
California Collaborative for Long Term Services and
Supports
California Commission on Aging
California Foundation for Independent Living Centers
California Retired Teachers Association
Congress of California Seniors
Justice in Aging
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LeadingAge California
National Association of Social Workers
Service Employees International Union (SEIU) United
Long Term Care Workers
State Independent Living Council
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