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AB-1801 In-home supportive services: quality assurance and fraud prevention.(2009-2010)

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CALIFORNIA LEGISLATURE— 2009–2010 REGULAR SESSION

Assembly Bill
No. 1801

Introduced  by  Assembly Member Yamada

February 10, 2010

An act to amend Section 12305.84 of the Welfare and Institutions Code, relating to public social services.


LEGISLATIVE COUNSEL'S DIGEST


AB 1801, as introduced, Yamada. In-home supportive services: quality assurance and fraud prevention.
Existing law provides for the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons receive services enabling them to remain in their own homes. Existing law requires the State Department of Social Services, in collaboration with the State Department of Health Care Services, the California State Association of Counties, the County Welfare Directors Association, and stakeholders representing consumers and providers, to convene a workgroup to develop and issue a report evaluating the implementation of quality assurance and fraud prevention and detection activities enacted from 2004 to the present. Existing law requires the department to provide this report on or before December 31, 2010.
This bill would, in addition, require the department to continue to provide this report after December 31, 2010, on an annual basis.
This bill would also require the department, in consultation with the above-mentioned entities, to identify stable ongoing funding sources for IHSS services, solicit recommendations for improving the delivery of long-term care services, as described, and solicit recommendations regarding the role the IHSS program would have in accomplishing those improvements. It would require the department to report these findings and recommendations gathered as a result of these efforts to the Legislature on or before May 1, 2011.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 The Legislature finds and declares all of the following:
(a) On June 22, 1999, the United States Supreme Court issued a decision in the case of Olmstead v. L.C. by Zimring (1999) 527 U.S. 581, finding that the unjustified institutional isolation of people with disabilities is a violation of the Americans with Disabilities Act (ADA). The Olmstead decision established the responsibility of states to ensure that people with disabilities, including seniors and children, receive care in the most integrated setting.
(b) The In-Home Supportive Services (IHSS) program, which is the cornerstone of California’s efforts to comply with the Olmstead decision, is a statewide public program providing essential personal care and domestic services to approximately 450,000 aged, blind, or disabled Californians who are unable to remain safely in their own homes without assistance. There is ample evidence that the IHSS program is successful at keeping people out of more costly and less desirable out-of-home placement in nursing homes or other institutions.
(c) IHSS is a complex program and has undergone substantial change over the past five years. Mechanisms have been put in place to improve IHSS program integrity with the enactment of the IHSS Quality Assurance Initiative, in Senate Bill 1104 of the 2003–04 Regular Session, and the Anti-Fraud Initiative, in Assembly Bill 19 of the 2009–10 Fourth Extraordinary Session.
(d) California faces challenges to meet the needs of seniors and persons with disabilities to live independently in the setting of their choice that is responsive to their gender, age, and cultural and ethnic heritage. The challenges facing the IHSS program are best viewed in the context of California’s changing demographics. Currently, the state has 4,000,000 people over the age of 65, the largest older adult population in the nation. This figure is projected to increase by 172 percent over the next 40 years, with most of the growth occurring in the next 20 years. As the population ages and individuals become less able to care for themselves, there will be an increasing demand for personal assistance services.
(e) These challenges must be addressed by identifying financial and structural barriers to improve IHSS program integrity that consistently promotes home-based care over institutional care.

SEC. 2.

 Section 12305.87 is added to the Welfare and Institutions Code, to read:

12305.87.
 (a) The department, in consultation with the State Department of Health Care Services, the California State Association of Counties, the County Welfare Directors Association, and stakeholder organizations representing consumers and providers, shall do all of the following:
(1) Identify stable ongoing funding sources that would be dedicated to IHSS services to meet the projected caseload associated with the growing population of seniors and people with disabilities in California.
(2) Solicit recommendations for improving the delivery of long-term care services in a manner that reduces the overall costs for long-term care and avoids placements in expensive and inappropriate institutions.
(3) Solicit recommendations regarding the role the IHSS program would have in accomplishing the improvements described in paragraph (2).
(b) The department shall report the findings and recommendations gathered pursuant to subdivision (a) to the Legislature on or before May 1, 2011.

SEC. 3.

 Section 12305.84 of the Welfare and Institutions Code is amended to read:

12305.84.
 (a) Upon enactment of this section, the department shall convene a stakeholder group and begin a process with this group to develop and issue a report evaluating the implementation of the quality assurance and fraud prevention and detection activities enacted from 2004 to the present. The department shall include and collaborate with the State Department of Health Care Services, the California State Association of Counties, the County Welfare Directors Association, and stakeholders representing consumers and providers.
(b) The department shall provide this report to the Legislature on or before December 31, 2010, and annually thereafter.
(c) The stakeholder group shall do all of the following:
(1) Review the annual error reports issued and state-level quality assurance activities to date required by Section 12305.7 and review and evaluate the implementation of county quality assurance activities required by Section 12305.71, including a review of the number of instances, amounts, and causes of overpayments and underpayments identified by quality assurance activity at the state and county level from enactment to date.
(2) Review information available regarding prevention and early detection of fraud, the latter as defined by Section 12305.81 12305.8.
(3) Collect and review information regarding referrals of suspected fraud to the State Department of Health Care Services pursuant to Section 12305.82, and subsequent investigative efforts, including cost-benefit information regarding these efforts, as well as the number of fraud cases handled locally.
(4) Collect and review information regarding final convictions for fraud, including all of the following:
(A) The amount of funds involved in the conviction.
(B) The basis of the fraud conviction, including whether it involved services not provided or falsified consumers or providers, or both.
(C) Aggregate information regarding the number and source of individuals responsible, including, but not limited to, state employees, IHSS providers, consumers, county workers, or others.
(5) Provide recommendations on options for preventing errors and fraud for both the state and county levels, and recommendations for early detection strategies to combat fraud in the program.