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 ****