BILL ANALYSIS                                                                                                                                                                                                    Ó




           ----------------------------------------------------------------- 
          |SENATE RULES COMMITTEE            |                        SB 547|
          |Office of Senate Floor Analyses   |                              |
          |(916) 651-1520    Fax: (916)      |                              |
          |327-4478                          |                              |
           ----------------------------------------------------------------- 


                                   THIRD READING 


          Bill No:  SB 547
          Author:   Liu (D), et al.
          Amended:  1/26/16  
          Vote:     21  

           SENATE GOVERNMENTAL ORG. COMMITTEE:  8-3, 4/14/15
           AYES:  Hall, Block, Galgiani, Hernandez, Hill, Hueso, Lara,  
            McGuire
           NOES:  Berryhill, Gaines, Vidak

           SENATE HEALTH COMMITTEE:  6-0, 1/13/16
           AYES:  Hernandez, Nguyen, Monning, Nielsen, Roth, Wolk
           NO VOTE RECORDED:  Hall, Mitchell, Pan

           SENATE APPROPRIATIONS COMMITTEE:  5-1, 1/21/16
           AYES:  Lara, Beall, Hill, Leyva, Mendoza
           NOES:  Nielsen
           NO VOTE RECORDED:  Bates

           SUBJECT:   Aging and long-term care services, supports, and  
                     program coordination


          SOURCE:    Author
          
          DIGEST:  This bill 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 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.  
          
          ANALYSIS: 

          Existing law:








                                                                     SB 547  
                                                                    Page  2



          
          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)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  
            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 and Certification; and, Community-Based  
            Adult Services Facility Licensing and Certification.

          3)Requires the Department of Health Care Services 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 and  
            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.

          4)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.

          5)Sets forth legislative findings and declarations regarding  
            long-term care services, including that consumers of those  








                                                                     SB 547  
                                                                    Page  3



            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. 

          6)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.

          7)Establishes, under federal law, 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 long-term supports and services (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 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 include a cost benefit analysis for  
            each goal or recommendation included in the plan.








                                                                     SB 547  
                                                                    Page  4




          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;
             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.  

          Comments

          1)Author's statement.  According to the author, "California's  
            population of residents 65 years old and older will grow from  








                                                                     SB 547  
                                                                    Page  5



            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  
            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)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  
            programs and funding into a single long-term care entity  
            within the CHHS. 








                                                                     SB 547  
                                                                    Page  6




          3)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 CHHS, the  
            Alzheimer's Disease and Related Disorders Committee was  
            established in 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.
          
          4)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 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  








                                                                     SB 547  
                                                                    Page  7



            California which produced a series of reports addressing the  
            topics specified in SB 910. 

          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   No

          According to the Senate Appropriations Committee: 


           Likely ongoing costs of about $300,000 per year for CHHS to  
            coordinate state policy and support the new Council (General  
            Fund). In order to coordinate programs and activities between  
            various state agencies and provide ongoing staff support to  
            the newly created Council, CHHS is likely to need additional  
            staff positions.

           Likely one-time costs of about $600,000 to develop the  
            required strategic plan (General Fund). Given the breadth of  
            issues facing an aging population and the complexity of the  
            current system for providing services to senior citizens, it  
            is likely that CHHS will need to dedicate a significant amount  
            of staff time to performing the necessary research,  
            facilitating the Council's deliberations, and drafting the  
            required strategic plan. 


          SUPPORT:   (Verified  1/26/16)


          California Association of Area Agencies on Aging 
          California Commission on Aging


          OPPOSITION:   (Verified  1/26/16)


          None received


          ARGUMENTS IN 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  








                                                                     SB 547  
                                                                    Page  8



          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 the 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 and  
          Long-Term Care Services Strategic Plan will spell out the steps  
          to better organize and coordinate the administration and  
          delivery of critical LTSS.


           

          Prepared by:Teri Boughton / HEALTH / 
          1/26/16 16:39:29


                                   ****  END  ****