BILL ANALYSIS
SB 142
Page 1
Date of Hearing: June 30, 2009
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Jim Beall, Jr., Chair
SB 142 (Maldonado) - As Amended: May 19, 2009
SENATE VOTE : 32-1
SUBJECT : In-home supportive services: authorized tasks
SUMMARY : Requires the Department of Social Services (DSS), on
or before December 31, 2011, in consultation with county welfare
departments and other stakeholders, to develop a process to
ensure that In-Home Supportive Services (IHSS) program providers
receive a list of approved tasks to be performed for each
recipient under the provider's care.
EXISTING LAW
1)Establishes the IHSS program to assist qualifying aged, blind,
and disabled individuals to remain safely in their homes.
2)Requires DSS to establish statewide hourly task guidelines for
the chores and services provided through IHSS and to provide a
standardized tool for consistent and accurate assessment of a
recipient's service needs.
3)Requires county social services staff to do an assessment, at
least annually, of the needs of each IHSS recipient and to
authorize that certain tasks and services be provided to that
recipient by a provider of his/her choosing.
4)Permits recipients of IHSS to select their own provider(s).
5)Requires recipients and providers of IHSS to sign a timesheet
every fourteen days showing the number of hours per day of
services received, and to submit that timesheet to the county
for payment for services rendered.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS :
Need for this bill : The author believes that there is a need to
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continue the professionalization of the IHSS program, a process
significantly boosted by statutory changes that established
quality assurance activities: SB 1104 (Committee on Budget and
Fiscal Review), Chapter 229, Statutes of 2004.
One of the centerpieces of the quality assurance program is a
statewide standard for the various services available through
IHSS: "time for task" guidelines are now in place and are used
by social workers in calculating the amount of time that a
provider is available to work for an IHSS recipient. A provider
is not paid for more hours of service than are authorized for a
recipient by the county social worker during the assessment.
An IHSS recipient is not obliged to give his or her service
provider a copy of the assessment or a list of the approved
tasks on that assessment, however. The provider knows the
maximum hours of service for which he or she will be paid, and
the provider receives direction from the client as to what to
do.
The author believes that if the provider knows what tasks have
been approved for the client, the provider will provide those
services needed and will submit a time sheet that covers only
the time used to provide those services. The result will be a
closer match between services authorized and services provided.
Oversight hearing policy debate of this issue : On March 24,
2009 the Senate Human Services Committee conducted an oversight
hearing on IHSS. In conjunction with that hearing, the
California Senate Office of Oversight and Outcomes prepared a
report entitled, In-Home Supportive Services: Examination of the
Impact of SB 1104: The 2004 Quality Assurance Initiative (OOO
Report). The OOO Report (pages 20-24) discusses the policy
debate on the advantages and disadvantages of having providers
know which chores, tasks, and services the county has authorized
for a particular individual. The OOO Report notes that the
Legislative Analyst's Office (LAO) recommended that recipients
be required to notify providers of the authorized tasks and to
direct that only authorized tasks be done.
The Senate Human Services Committee analysis of this bill
summarizes the March 24th oversight hearing testimony on this
issue as follows:
Representatives of providers in general testified that
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sharing this information is a good idea and would add to
the program's integrity. Representatives from the LAO also
discussed their recommendation that such a change be
enacted into law.
Representatives of IHSS clients either raised
implementation questions or opposed the idea. Those
raising implementation questions had two main concerns.
First, they argued that any disclosure process would need
to protect the client's privacy. For example, witnesses
did not want personal identifying information such as
social security numbers and personal information such as
medical diagnoses shared with providers. Second, clients
with more than one provider would need ways to control the
information given each service provider.
Those opposing the idea outright noted that there is
generally at least one year between assessments, so the
list of authorized tasks may be out of date before another
assessment is completed. IHSS clients often have
complicated medical problems, multiple disabilities, or
changing symptoms. The current system allows the client to
be in control of using IHSS to address his or her needs at
the time the services are provided.
Witnesses also spoke of the positive aspect of IHSS being a
virtual block grant for services needed to assist an
individual to remain safely at home--again, with the client
in control of how his or her budget for services is
utilized.
In support of this bill, United Domestic Workers of
America/AFSCME, argues that giving providers information about
the specific list of tasks that have been approved for the
recipient "would be a valuable tool to IHSS providers to best
manage the provision of services within the total amount of
hours that are authorized for the consumer."
It should be noted that the issue addressed by this bill may
also be under consideration in the budget process as part of the
Governor's anti-fraud initiative.
Arguments in opposition : Opponents, on the other hand, are
concerned that provision of this list would mean that providers
would not have the flexibility needed, based on common sense, to
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meet a consumer's needs on a particular day if they vary at all
from the assessment used to determine the individual's total
allotted hours. Disability Rights California (DRC) asserts that
this bill conflicts with a fundamental principle underlying the
IHSS statute: the consumer is the employer for the purposes of
hiring, firing and supervising the worker. Moreover, DRC
argues, strictly adhering to a prescriptive list of tasks and
hours assigned to each would be impractical. For example, they
note, "if a consumer doesn't have hours approved for meal
preparation because usually she or he can do that independently,
but becomes sick with a flu and can't prepare meals, that
consumer should be able to direct the worker to prepare meals--a
legitimate IHSS task."
The hourly task guidelines are a useful tool for creating
uniformity in how the total number of hours consumers need on a
weekly or monthly basis are determined; however, they are less
useful as a tool for identifying the specific assistance a
consumer needs on a particular day. Absent either some degree
of flexibility or some means of getting immediate approval of
alternative tasks, recipients' day-to-day needs will often go
unmet. As an alternative, DRC proposes that providers, instead,
be given a generic list of approved IHSS services. With a
generic list of IHSS services, and information on the individual
consumer's total allotted hours, a consumer could direct the
provider to perform IHSS-authorized tasks to meet his or her
needs on a particular day, even if they do not exactly match the
tasks reflected in the most recent assessment, which could be
many months old.
PROPOSED AMENDMENT :
The author is reportedly agreeable to the following amendment,
as an author's amendment:
Amend Section 12301.22, page 2, lines 3-8, as follows:
12301.22. On or before December 31, 2011, the department,
in consultation with county welfare departments and other
stakeholders, shall develop a process to ensure that a
provider of services under this article receives a list
specifying the approved duties to be performed for each
recipient under the provider's care and a complete list of
supportive service tasks available under the IHSS program .
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REGISTERED SUPPORT / OPPOSITION :
Support
United Domestic Workers of America/AFSCME
Opposition
Disability Rights California (unless amended)
Analysis Prepared by : Eric Gelber / HUM. S. / (916) 319-2089