BILL ANALYSIS �
SB 411
Page 1
Date of Hearing: August 17, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
SB 411 (Price) - As Amended: August 15, 2011
Policy Committee: HealthVote:12-6
Human Services Vote: 4-2
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill would enact the Home Care Services Act of 2011, which
would provide for the licensure and regulation of home care
organizations, and the certification of home care aides, by the
State Department of Public Health (DPH). Specifically, this
bill:
1)Requires DPH to license and regulate home care agencies and
certify home care aides. Specifically, this bill requires DPH
to:
a) Issue licenses and certificates to home health agencies
and aides, respectively, who meet the requirements for
licensure or certification.
b) Adopt rules and regulations related to licensure and
enforcement, as well as procedures related to complaint
investigation.
c) Receive, investigate, and resolve complaints against
home care organizations and aides.
d) Maintain a publicly accessible web site listing the
certification status of each certified home care aide and
related information, as well as the licensure status of
each licensed home care agency and related information.
e) Charge and collect fee revenue for support of this
workload.
1)Imposes various licensure requirements on a home care
organization, including requirements related to:
a) Accreditation by an approved accrediting body.
b) Payment of licensure fees.
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c) Proof of liability and worker's compensation insurance.
d) Proof that employees are certified as home care aides,
as specified.
e) Background checks of home care organization owners, as
defined.
1)Establishes certain operating requirements for home care
organizations. Specifically, this bill requires home care
organizations to:
a) Ensure home care aides they hire are certified.
b) Investigate complaints related to their employees, and
retain records.
c) Adopt certain plans and procedures.
d) Operate in a commercial office space and post their
business license.
e) Evaluate each home care aide employee annually,
including observation of service delivery in a client's
residence.
f) Supervise each home care aid in a client's residence at
every 62 days, at no charge to the client.
g) Require home care aids to demonstrate that they are free
of active tuberculosis.
h) Ensure each home care aide completed not less than 8
hours of paid training annually.
1)Requires DPH to imposes various certification requirements on
an individual hired as a home care aide, including:
a) A minimum of five hours of training.
b) A background check.
c) Proof of tuberculosis screening.
1)Prescribes enforcement procedures, fines, and penalties for
violations of the act.
2)Requires DPH to assess licensure, renewal, background check,
and other fees on each home care organization in amounts
sufficient to cover the costs of administering this bill,
including the cost of certifying home care aides, and requires
that all fees be deposited in the existing DPH Licensing and
Certification Program Fund.
3)Establishes an initial licensure fee equivalent to the fee for
home health agencies for the fiscal year (FY) 2011-12.
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FISCAL EFFECT
1)One-time costs to DPH for initial program development,
including adoption of regulations, policies, procedures, and
forms; approval of training curricula; development of publicly
accessible web registries; and other one-time expenses in the
range of $1 million. At least $500,000 of this amount would
be needed for start-up workload prior to the collection of
fees, and would be funded through a GF loan.
2)Costs to the Department of Justice of approximately $350,000
for the first year, and $200,000 ongoing (special fund),
associated with processing an increased number of background
checks.
3)Ongoing costs in the range of $12 million (special fund) to
DPH for licensure of home care organizations, certification of
home care aides, and maintenance of online registries.
4)By requiring accreditation and licensure of home care
organizations and certification of home care aides, home care
organizations will face increases in the cost of doing
business. These costs will have a larger impact on smaller
home care organizations, since licensure and accreditation
fees are fixed costs regardless of size. To the extent that
these costs are passed on to clients, this bill will likely
cause some individuals to seek care in the underground market.
To the extent more caregivers choose to provide care through
the underground market and fail to report income for tax
purposes, there could be some indirect negative impact on
payroll tax revenues compared to the status quo. Because
regulatory costs are small compared to total industry
revenues, any impact is expected to be minor.
Conversely, it is also possible that by increasing state
oversight and professional legitimacy of the industry through
licensure, this bill will increase the number of individuals
who would choose to seek care through licensed home care
organizations instead of the underground market. This could
have an indirect positive impact on payroll tax revenues
compared to the status quo. The likelihood and magnitude of
these potential economic impacts is unknown.
5)Individuals seeking certification who are not employed by an
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organization will face costs estimated of $50 to$200 for
training, background checks, tuberculosis screening, and
certification fees. Aides employed by an organization will
bear the cost of the tuberculosis test and certification fee,
which could exceed $50 total.
COMMENTS
1)Rationale . The author states that private agencies that place
providers in the homes of the elderly and/or disabled do so
with no regulatory oversight from the state, and without any
requirement to meet minimum standards of employee screening
and testing. The author contends that vulnerable populations
are placed at risk due to the lack of oversight. SB 411
intends to remedy this problem by requiring all private home
care agencies in California to be licensed by the Department
of Public Health, requiring certification of home care aides,
and providing in-home care clients with consumer protections.
2)Background . Home care aides provide help with activities of
daily living, including light housekeeping and homemaking
tasks such as laundry, errands, and meal planning and
preparation. Aides also may help clients get out of bed,
bathe, dress, groom, or accompany clients to doctors'
appointments or on other errands. Currently, aides are either
hired directly by a client or through a home care agency.
Aides and home care organizations that provide non-medical,
in-home personal care services are not regulated by the state.
According to a report from the Senate Office of Oversight and
Outcomes, California is part of a small minority of states
that does not regulate home care organizations. Last year,
Napa County was the first local jurisdiction to ratify an
ordinance requiring those seeking to provide in-home personal
or domestic services to pass a criminal background check and
obtain an annual permit from the county.
3)Existing Licensure and Oversight . DPH currently licenses home
health agencies, which are licensed to provide in-home health
services as well as home care services. Home care aides
employed by the In-Home Supportive Services program are
certified by the Department of Social Services (DSS).
4)Industry Concerns . The California Association for Health
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Services at Home (CAHSAH), a statewide home care association,
supports licensure but not the requirement for home care aide
certification. CAHSAH states the bill would place unnecessary
mandates and cost burdens on the industry, and could make
legitimate businesses less competitive. CAHSAH also states
their preference for the licensure program to be housed at
DSS, rather than DPH, as they believe DSS has more relevant
expertise.
5)Related Legislation . AB 899 (Yamada), sponsored by CAHSAH, is
very similar to this bill. AB 899 also creates the Home Care
Services Act of 2011 but requires DSS to license and regulate
home care organizations. AB 899 does not require the
certification of employees as required in this bill. AB 899
was held on the Suspense File of this committee in May.
6)Previous Legislation . AB 853 (Jones) of 2007 was identical to
AB 899 (Yamada). AB 853 was held in this committee.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081