BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 547|
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VETO
Bill No: SB 547
Author: Liu (D), et al.
Amended: 8/1/16
Vote: 21
PRIOR VOTES NOT RELEVANT
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
SENATE FLOOR: 35-4, 1/27/16
AYES: Allen, Bates, Beall, Block, Cannella, De León, Fuller,
Gaines, Galgiani, Glazer, Hall, Hancock, Hernandez, Hertzberg,
Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire,
Mendoza, Mitchell, Monning, Nguyen, Pan, Pavley, Roth, Runner,
Stone, Vidak, Wieckowski, Wolk
NOES: Anderson, Moorlach, Morrell, Nielsen
NO VOTE RECORDED: Berryhill
SENATE FLOOR: 38-1, 8/24/16
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,
Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson,
Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning,
Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Stone, Vidak,
Wieckowski, Wolk
NOES: Moorlach
ASSEMBLY FLOOR: 76-0, 8/22/16 - See last page for vote
SB 547
Page 2
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
(CHHS) 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:
1)Establishes 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
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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
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
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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 the 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.
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
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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
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
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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.
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
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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
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 Assembly Appropriations Committee:
1)One-time costs, potentially in the hundreds of thousands, in
staff or contract costs to convene the council and produce a
strategic plan that includes goals, timelines, and
cost-benefit analyses (GF, or potentially private or in-kind
funds). Staff time from a number of departments and agencies
will be required as well; however, no significant increased
staffing appears necessary (various funds). The cost will
vary based on the robustness of the effort.
2)The creation of a legislatively mandated strategic plan may
result in unknown cost pressure (potentially
GF/federal/special funds) if various improvements to the
long-term care system are recommended as goals in the plan.
Improvements could also result in cost avoidance by increasing
efficiency and effectiveness of aging services and long-term
care services and supports. The magnitude of any such costs,
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and net effect on costs, are unknown.
SUPPORT: (Verified8/22/16)
California Alliance for Retired Americans
California Association of Area Agencies on Aging
California Association of Public Authorities
California Commission on Aging
California Foundation for Independent Living Centers
California Retired Teachers Association
California State Retirees
California Welfare Directors Association
Congress of California Seniors
Little Hoover Commission
National Association of Social Workers
Solano County Board of Supervisors
Yolo County Healthy Aging Alliance
OPPOSITION: (Verified8/22/16)
California Health and Human Services Agency
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
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
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Long-Term Care Services Strategic Plan will spell out the steps
to better organize and coordinate the administration and
delivery of critical LTSS.
ARGUMENTS IN OPPOSITION: CHHS writes that this bill is very
broad in scope, and the Agency provides guidance to and
coordinates the efforts of departments, including significant
work undertaken related to aging and the provision of long-term
care services. In addition, CHHS has conducted a review of
opportunities to improve administrative and service delivery
efficiency and quality improvement. Given these and other
ongoing efforts, the added value of a broad Council would not
outweigh the cost in time, attention and administrative burden.
GOVERNOR'S VETO MESSAGE:
I am returning Senate Bill 547 without my signature.
This bill establishes the Statewide Aging and Long-Term Care
Services Coordinating Council and requires it to develop a
strategic plan that addresses California's aging population.
These are important issues, but I'm not convinced that
creating such an unwieldy state council would advance the
goals we both share.
ASSEMBLY FLOOR: 76-0, 8/22/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,
Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley,
Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier,
Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson,
Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Roger Hernández,
Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine,
Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty,
Medina, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Quirk,
Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark
Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams,
Wood, Rendon
NO VOTE RECORDED: Beth Gaines, Harper, Melendez, Patterson
SB 547
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Prepared by:Teri Boughton / HEALTH / (916) 651-4111
10/21/16 15:22:24
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