BILL ANALYSIS �
AB 1821
Page 1
Date of Hearing: May 14, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 1821 (Gordon) - As Amended: April 22, 2014
Policy Committee: Veterans
AffairsVote: 9-0
Urgency: No State Mandated Local Program:
No Reimbursable:
SUMMARY
This bill authorizes, as a pilot project until January 1, 2018,
a U.S. Department of Veterans Affairs (USDVA) facility to
establish medical foster homes (MFH) for older and medically
frail veterans that are not subject to licensure or regulation
under the California Residential Care Facilities for the Elderly
Act, provided that specified federal requirements are
satisfied, the USDVA facility establishing the home agrees to be
subject to the jurisdiction of the California State Auditor, and
the USDVA obtains criminal background information for caregivers
and specified individuals residing in the home.
Further states legislative intent that the California State
Auditor, through a request to the Joint Legislative Audit
Committee, conduct an audit evaluating the pilot program created
by this bill.
FISCAL EFFECT
1)GF costs to the State Auditor in the range of $250,000 for the
equivalent of two limited term personnel years to evaluate the
MFH program and prepare an audit.
2)Unknown out-year cost-avoidance to the extent the MFH concept
is successful in California without the cost of state
Department of Social Services licensing, regulations and
review.
COMMENTS
1)Rationale. The author's intent is to create authorization for
AB 1821
Page 2
MFHs that provide 24-hour care for up to three elderly and
medically frail veterans in private homes. The author states
that similar MFHs operate in 39 states at 83 sites.
According to the author, to qualify for the MFH program, a
veteran must first be enrolled in the Veterans Health
Administration's (VHA's) Home Based Primary Care program
(HBPC). In this program the veteran's medical care is provided
by an interdisciplinary team of VHA physicians, nurses, and
aides. The private home, where the veteran is placed, is
monitored by the VHA. Families who volunteer to participate in
the MFH program must be approved by the VHA's
interdisciplinary team as well as submit income statements,
and be trained in CPR.
MFHs are inspected by the VHA. Veterans pay room and board in
the MFH program; however, the Veterans Benefits
Administration's "Aid and Attendance" benefit and Social
Security benefits generally cover these costs. MFHs are
distinguished from other typical residential care homes or
facilities because a MFH caregiver is required to reside in
their own private home while providing 24-hour personal care
and supervision to the veteran. The veteran, in turn, receives
their medical care through the VHA in a highly regulated, yet
independent, community-based setting.
In California, a MFH would have to be operated as a
Residential Care Facility for the Elderly (RCFE), which would
require potential MFH caregivers to have their personal home
licensed, become a certified administrator, and incur costs
associated with training and licensure. This creates a barrier
for caregivers to open their home to a veteran and limits
program potential in California.
To create legitimate and safe alternatives to
institutionalization, AB 1821 would establish the Medical
Foster Home Pilot Program. Under the pilot program, a USDVA
facility, such as a VA hospital, may establish a MFH under
specified conditions. The USDVA facility submits a proposal to
establish a medical foster home program to the Director of
Home and Community-Based Care in Geriatrics and Extended Care
Services in the Central Office of the USDVA and that director
authorizes the program; and the USDVA facility establishing
the MFH agrees to be subject to the jurisdiction of the
California State Auditor for purposes of evaluation and agrees
AB 1821
Page 3
to provide data, information, and case files as requested by
the California State Auditor.
2)Prior legislation , AB 559 (Gordon) exempted MFHs approved by
the USDVA from regulation as a RCFE. AB 559 was never heard.
3)Support includes the Public Law Center and the California
Commission on Aging.
4)There is no registered opposition .
5)The author has technical amendments .
Analysis Prepared by : Geoff Long / APPR. / (916) 319-2081