BILL ANALYSIS                                                                                                                                                                                                    �






                                  SENATE HUMAN
                               SERVICES COMMITTEE
                            Senator Carol Liu, Chair


          BILL NO:       AB 1714                                     
          A
          AUTHOR:        Halderman                                   
          B
          VERSION:       March 27, 2012
          HEARING DATE:  June 26, 2012                               
          1
          FISCAL:        Yes                                         
          7
                                                                     
          1
          CONSULTANT:     Sara Rogers                                
          4

                                        

                                     SUBJECT
                                         
                In-home supportive services: excluded providers

                                     SUMMARY  

          Add specified felony offenses to the list of Tier 2 
          criminal convictions that preclude an applicant from 
          providing services through the In-Home Supportive Services 
          (IHSS) program for 10 years unless the exclusion is waived, 
          as specified.  Requires the Department of Supportive 
          Services to make according revisions to the provider 
          enrollment form.

                                         
                                    ABSTRACT  

           Current law


           1.Establishes the In-Home Supportive Services (IHSS) 
            program to provide in-home domestic and personal care 
            services for aged, blind or disabled individuals living 
            at or below the poverty level for the purpose of enabling 
            IHSS consumers to avoid institutionalization and remain 
                                                         Continued---



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            safely in their homes with supportive services.  


           2.Establishes the Department of Social Services (DSS) as 
            the state agency with regulatory authority over the IHSS 
            program and delegates administration of the program to 
            counties and county public authorities.   


           3.Provides IHSS recipients with the right to hire, fire, 
            and supervise the work of any in-home supportive services 
            personnel providing services for them.  


           4.Deems any county public authority or non-profit 
            consortium under contract with a county as the employer 
            of record with regard to the terms and conditions of 
            employment, including the investigation of the 
            qualifications and background of potential personnel.  


           5.Requires prospective providers to undergo a criminal 
            background check and establishes two tiers of 
            exclusionary crimes. The first tier excludes, without 
            exception, any provider applicant convicted within the 
            last 10 years for:


                     Specified abuse of a child (Penal Code section 
                 273a)
                     Abuse of an elder or dependent adult (PC 
                 section 368)
                     Fraud against a government health care or 
                 supportive services program 


          1.Establishes a second tier of exclusionary crimes, which 
            may be waived or exempted, including:


                     A violent or serious felony, as specified in PC 
                 section 667.5(c), and PC section 1192.7(c)
                     A felony offense for which a person is required 
                 to register as a sex offender pursuant to PC section 
                 290(c)




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                     A felony offense for fraud against a public 
                 social services program, as defined in WIC sections 
                 10980(c)(2) and (g)(2)


          1.Provides that prospective providers excluded due to a 
            Tier 2 conviction who receive a certificate of 
            rehabilitation or an expungement (dismissal pursuant to 
            PC section 1203.4) shall not be excluded.


          2.Provides that an IHSS recipient may submit an individual 
            waiver of the exclusion for a Tier 2 crime, signed by the 
            recipient or the recipient's authorized representative, 
            if applicable.  Requires the service recipient or his or 
            her authorized representative to be informed of any 
            relevant criminal convictions.


          3.Permits DSS to provide a general exclusion exemption to 
            prospective providers convicted of a Tier 2 crime and 
            establishes specified considerations DSS may use in 
            making a determination.


          4.Permits an IHSS consumer or any employer of an unlicensed 
            in-home care provider to an aged or disabled consumer, to 
            request a criminal background check for the provider and 
            requires county welfare agencies to regularly inform the 
            consumer of this right.


           This bill  


          1.Adds the following crimes to the list of Tier 2 offenses: 

                     A felony forgery offense, as specified in PC 
                 Section 470
                     A felony embezzlement offense, as specified in 
                 PC Section 503
                     A felony extortion offense, as specified in PC 
                 Section 518
                     A felony identity theft offense, as specified 
                 in PC Section 530.5




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          1.Requires DSS to revise the provider employer form to 
            reflect the additional Tier 2 exclusionary convictions.

                                         

                                 FISCAL IMPACT
                                         
          The Assembly Appropriations Committee states that out of 
          the more than 500,000 registered IHSS providers, there are 
          only 516 providers with felony convictions who were 
          provided with waivers and concludes that "given the small 
          number of excluded providers, it is unlikely that adding 
          four additional crimes to the list of felonies would result 
          in significant workload costs or reduction in the pool of 
          providers." 

          Additional potential minor nonreimbursable costs to 
          counties for prosecution and incarceration related to 
          violations of the bill's provisions, offset to some extent 
          by fine revenues. 

          The Department of Finance submitted an oppose position on 
          this bill stating that "this bill would create additional 
          workload for the Department of Social Services and counties 
          to review Criminal Offender Record Information reports and 
          process additional individual waiver and general exception 
          requests for the felony offences specified."

                                         
                           BACKGROUND AND DISCUSSION
                                         
          According to the author, current law does not adequately 
          protect In-Home Supportive Services recipients from 
          financial abuse at the hands of providers who are in close 
          proximity to their identification and financial records.  
          The author cites a 1998 National Elder Abuse Incidence 
          Study which found that financial/material abuse is the 
          second most likely type of substantiated abuse committed by 
          IHSS providers.  Additionally, the author cites California 
          Department of Corrections recidivism data which indicates 
          that those convicted of forgery or fraud have a recidivism 
          rate of 63.1%.

          The author states that this bill will provide IHSS 




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          recipients with more information and/or protection when 
          choosing an IHSS provider.  The author points out that this 
          bill allows a recipient to complete and individual 
          exclusion waiver if they wish to hire a provider that has a 
          criminal conviction pursuant to this bill.

           In-Home Supportive Services
           
          In Home Supportive Services began as a social services 
          program funded through Title XX of the Social Security Act 
          but has since become an optional federal Medicaid benefit, 
          which is currently its primary funding source.  
          Historically, the goal of the program was to assist seniors 
          and disabled individuals with activities of daily living in 
          order to enable them to live at home safely, but it was 
          limited in its scope due to long waiting lists for waiver 
          slots that provided funding for the services.

          On June 19, 1999, the United States Supreme Court issued 
          the landmark Olmstead decision which held that the American 
          with Disabilities Act (ADA) and the Rehabilitation Act 
          requires public entities to administer services "in the 
          most integrated setting appropriate" and to "make 
          reasonable modifications in policies, practices, or 
          procedures?to avoid discrimination on the basis of 
          disability?"

          Following this decision, California has dramatically 
          increased its use of the program to enable IHSS consumers 
          to avoid institutionalization and remain safely in their 
          homes with proper supportive services.
           
          Provider Background checks and Exclusionary Crimes

           Facing significant budget shortfalls, as part of the 2009 
          Budget Act, the legislature adopted sweeping changes to the 
          IHSS program intended to address and prevent fraud and 
          abuse of the program.  AB X4 19 (Evans, Chapter 17, 
          Statutes of 2009) among other changes, required all 
          prospective IHSS providers to submit to Department of 
          Justice criminal background checks at the providers 
          expense.  Prior to this change, a public authority was 
          authorized but not required to perform a criminal 
          background check on prospective providers.  Additionally, 
          AB 1612 (Committee on Budget, Chapter 725, Statutes of 




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          2009) added a new tier of exclusionary convictions for new 
          providers, which may be waived or exempted upon request of 
          the recipient or following a determination by the 
          Department of Social Services (see current law section of 
          this analysis for the list of Tier 2 offenses).
           
           Importantly, federally mandated Tier 1 exclusions currently 
          prevent individuals convicted of Penal Code 368 violations 
          which include actions of embezzlement, forgery, or fraud, 
          or identity theft against elders or dependent adults from 
          being or becoming providers in the program.  This bill 
          would add these crimes, when committed against the general 
          population, to the list of Tier 2 exclusions.   

           Opposition Arguments

           The opposition states that there is no evidence indicating 
          that recent legislation that added new Tier 2 exclusionary 
          convictions has been successful in reducing fraud or abuse 
          against recipients or improving program integrity.  
          Opponents state that Governor Schwarzenegger's 2007 
          Performance Review indicated a fraud rate of less than 2% 
          and that this measure will increase state costs and do 
          little to reduce fraud and abuse in the program. 

          AFSCME/UDW writes in opposition that, "given the increasing 
          demand for home care workers and the high turnover, AB 1714 
          will have an adverse impact on the quality of home care by 
          reducing the pool of qualified workers."  

          Disability Rights California writes in opposition to the 
          bill stating that this bill interferes with the rights of 
          the consumers, and that there is no evidence that the 
          enormous expense of criminal background checks produces the 
          desired result.


          The Congress of California Seniors writes that, "Under the 
          last Administration there were claims of fraud in the IHSS 
          program which have proven largely spurious. This bill will 
          divert scarce resource from direct services and create 
          greater barriers for client-chosen caregivers to meet the 
          needs of a growing population."

                                   PRIOR VOTES




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           Assembly Floor 45-10 (25 members not voting)
          Assembly Appropriations9-6-2
          Assembly Human Services4-2-0
           Related Legislation
           
          SB 930 (Evans, Chapter 649, Statutes of 2011)  Repealed the 
          requirement that IHSS recipients provide fingerprint images 
          at the time of assessment or reassessment and on 
          standardized timesheets.  Required the county to provide 
          DSS with the DOJ criminal offender record information 
          (CORI) if an IHSS provider or applicant appeals a denial of 
          placement on the IHSS provider registry as a result of a 
          DOJ criminal background check. 


          AB 876 (Valadeo, Chapter 73, Statutes of 2011) Provides 
          that, except in the case the parent, guardian, or person 
          having legal custody of a minor recipient, a conservator of 
          an adult recipient, or a spouse or registered domestic 
          partner of the recipient, a provider applicant shall not 
          sign his or her own individual waiver form as the 
          recipient's authorized representative.  


          ABX4 19 (Evans, Chapter 17, Statutes of 2009 4th 
          Extraordinary Session) Requires criminal background checks 
          to be completed for all prospective IHSS providers as of 
          October 1, 2009, as specified.


          AB 1612 (Committee on Budget, Chapter 725, Statutes of 
          2009) Establishes a new tier of exclusionary crimes, which 
          may at the request of the recipient be waived, and may be 
          exempted by the Department of Social Services.


          AB 1841 (Silva, Introduced:  February 22, 2012) Would have 
          deleted the authority of an In-home Supportive Services 
          (IHSS) recipient to submit a waiver enabling a provider 
          applicant who has been convicted of specified offenses to 
          be employed as that individual's IHSS provider.  Failed 
          passage in the Assembly Human Services Committee.

                                    POSITIONS 




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          Support:  Aging Services of California
                    California Association for Health Services at 
               Home
                    Exceptional Parents Unlimited
                    Santa Clara County Board of Supervisors
                    The Arc and United Cerebral Palsy in California 

          Oppose:AFSCME/UDW
                    All of Us or None
                    American Civil Liberties Union of California
                    California Department of Finance
                    Congress of California Seniors
                    Disability Rights California
                    East Bay Community Law Center
                    Lawyers' Committee for Civil Rights of the San 
               Francisco Bay Area
                    Legal Services for Prisoners with Children
                    National Employment Law Project
                    Rubicon Programs
                    Stanford Community Law Clinic
                    
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