BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
SB 411 (Price)
Hearing Date: 5/26/2011 Amended: 4/28/2011
Consultant: Katie Johnson Policy Vote: Health 5-2
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BILL SUMMARY: SB 411 would require the California Department of
Public Health to license and regulate home care organizations
and certify home care aides.
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Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
Initial and ongoing licensing, $3,800* $6,500*
$7,300Special*
certification, inspections,
and regulations
*State Department of Public Health Licensing and Certification
Program Fund.
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STAFF COMMENTS: SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
This bill would enact the "Home Care Services Act of 2011." It
would require the California Department of Public Health (CDPH),
among other requirements, to:
1) Commencing January 1, 2012, license and regulate home
care organizations that meet specified criteria, including
proof of liability insurance and a workers' compensation
policy. Licenses would be valid for one year. This bill
would prohibit a home care organization from arranging for
home care services provided by a home care aide without a
license.
2) Commencing January 1, 2013, certify home care aides, as
specified, and approve a home care aide training
curriculum.
3) Conduct onsite inspections of home care organizations
that submit applications for licensure or annual renewal.
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4) Provide for the submission of fingerprint images to the
Department of Justice (DOJ) of all home care organization
owners, as specified. DOJ would be permitted to assess a
fee to cover any costs this bill would impose.
5) Set and collect licensing, certification, annual
renewal, background check, and other fees for each location
of a home care organization in an amount sufficient to
cover the costs of this program.
6) Promulgate rules and regulations to implement these
provisions.
7) Establish procedures for the receipt, investigation, and
resolution of complaints against home care organizations
and home care aides as well as conduct annual random,
unannounced inspections on home care organizations.
8) Maintain a registry on its Internet Web site of the
certification status of all certified home care aides.
"Home care organizations" would be defined as an individual,
partnership, corporation, limited liability company, joint
venture, association, or other entity that arranges for the
provision of home care services by a home care aide to a client
in the client's residence and that is licensed. It is estimated
that there are about 2,000 existing home care organizations that
would need to be licensed in FY 2011-2012 and that, ongoing, 255
would apply for licensure annually. This bill would specify
operating requirements for home care organizations and client
rights.
"Home care aides" would be defined as an individual who provides
home care services to a client in the client's residence. This
bill's findings and declarations state that more than 70,000
home care aides work in California.
"Home care services" are defined as services provided by a home
care aide to a client who, because of advanced age or physical
or mental infirmity, cannot perform these services for
him/herself, including bathing, dressing, feeding, exercising,
personal hygiene, grooming, transferring, ambulating, toileting
and incontinence care, shopping, and assisting with
self-administered medication.
Home health agencies, hospice facilities, health facilities, and
a county, including a public authority or through a nonprofit
consortium providing in-home supportive services (IHSS), and the
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services they provide would be exempt from these provisions.
Funding
This bill would establish the Home Care Organization and Home
Care Aide Certification Fund within the State Treasury and would
provide that the fund be continuously appropriated. This bill
would also require that fines and penalties collected pursuant
to these provisions be deposited in a separable penalty account
in the fund and be expended to support the implementation of
these provisions. This bill would permit CDPH to assess a civil
penalty of $900 per day that a home care organization arranges
for the provision of home care services by a home care aide
without a license. CDPH would be required to send a written
notice of noncompliance to the individual or entity and to the
Attorney General or appropriate district attorney.
Costs for regulations, automated system updates, initial and
ongoing licensure and re-licensure of home care organizations,
certification of home care aides, on-site inspections, complaint
investigations, and background checks of home care organization
owners would be approximately $3,800,000 in FY 2011-2012,
$6,500,000 in FY 2012-2013, and $7,300,000 ongoing. Since the
bill does not provide for a baseline fee structure, the
department would need a General Fund loan to pay for the initial
year of licensure. Ongoing costs would be offset by licensing
and certification fees.
Staff recommends that the bill be amended as follows:
1) To strike the proposed fund and to direct fees collected
pursuant to these provisions into the existing State
Department of Public Health Licensing and Certification
Program Fund, the fund that provides for CDPH's Licensing
and Certification Program.
2) Deposit fines and penalties assessed pursuant to these
provisions into the Special Deposit Fund like other fines
and penalties assessed by CDPH.
3) Specify a baseline fee structure that would be based on
the licensing fees of home health agencies, currently set
at $4,129.63 per facility, in order to negate the need for
a General Fund start-up loan.
Similar and Prior Legislation
This bill is similar to AB 899 (Yamada), which also establishes
the "Home Care Services Act of 2011," but does so under the
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authority of the California Department of Social Services and
does not require the certification of home care aides. It is
pending in the Assembly Appropriations Committee. AB 899
(Yamada) is nearly identical to AB 853 (Jones, 2007), which died
on the Assembly Appropriations Committee. According to that
committee's analysis, it had an estimated cost of at least $1
million for regulations and fee methodology development and $12
million annually ongoing. Home care organizations' licensure and
annual renewal fees were estimated at $1,700 per organization.
The author's proposed amendments would:
1) Add accreditation by the Joint Commission on
Accreditation of Healthcare Organizations, the Community
Health Accreditation Program, or any other nationally
recognized accrediting body to the list of requirements for
licensing;
2) Permit CDPH to require a survey of an accredited home
care organization to investigate complaints;
3) Provide that if one accrediting agency denies, revokes,
or suspends accreditation of a home care organization, it
would apply to all other accrediting agencies. A home care
agency would be permitted to reapply for accreditation. The
amendments would require an accreditation agency that
denies, revokes, or suspends accreditation to report
specified information to the department. It is unclear if
California can compel accreditation agencies to comply with
these provisions since they are nationally recognized
agencies.
4) Permit CDPH to implement and administer this licensing
program through all-facility letters or other instructions,
but would require CDPH to adopt emergency regulations by
January 1, 2013, and would permit one readoption of the
emergency regulations.
These amendments would have no fiscal impact.
The proposed committee amendments would:
1) Strike the proposed fund and direct fees collected
pursuant to these provisions into the existing State
Department of Public Health Licensing and Certification
Program Fund.
2) Deposit fines and penalties assessed pursuant to these
provisions into an account in the Special Deposit Fund.
3) Specify a first-year fee structure that would be based
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on the licensing fees of home health agencies, currently
set at $4,129.63 per facility, in order to negate the need
for a General Fund start-up loan.
REVISED: 6/1/2011