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SB-228 Master Plan on Aging.(2019-2020)

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Date Published: 04/25/2019 09:00 PM
SB228:v97#DOCUMENT

Revised  June 26, 2019
Amended  IN  Senate  April 25, 2019
Amended  IN  Senate  April 03, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill
No. 228


Introduced by Senator Jackson
(Coauthors: Senators Caballero and Portantino)
(Coauthors: Assembly Members Boerner Horvath, Diep, Cristina Garcia, Nazarian, Rodriguez, and Voepel Voepel, Kalra, Lackey, Reyes, and Blanca Rubio)

February 07, 2019


An act to add Chapter 13 (commencing with Section 9800) to Division 8.5 of the Welfare and Institutions Code, relating to aging.


LEGISLATIVE COUNSEL'S DIGEST


SB 228, as amended, Jackson. Master Plan on Aging.
Existing law requests the University of California to compile specified information, including a survey of existing resources throughout California’s governmental and administrative structure that are available to address the needs of an aging society. Existing law requires the Secretary of the California Health and Human Services Agency, based upon the information compiled by the University of California and with the consultation or advice of specified entities, to develop a statewide strategic plan on aging for long-term planning purposes and submit the plan to the Legislature.
This bill would require the Governor to appoint a Master Plan Director and establish an Aging Task Force, consisting of 15 13 members, with the President pro Tempore of the Senate, Senate and the Speaker of the Assembly, Assembly each appointing 2 members and the Governor each appointing 5 9 members to the task force. The bill would require the director, with the assistance of the task force, to work with representatives from impacted state departments, stakeholders, and other agencies to identify the policies and priorities that need to be implemented in California to prepare for the aging of its population. The bill would require the task force, under the leadership of the director, to develop a master plan with that identifies possible actions that would accomplish specified components, including, among others, a proposal, with components and that includes a cost estimate for accomplishing, and an identification of potential funding sources, for how the state should accomplish sources to accomplish, specified goals, including expanding access to coordinated, integrated systems of care. The bill would also require the task force to solicit input from stakeholders and gather information on the impact of California’s aging population and develop a master plan implementation process.
This bill would also, as part of the master planning process, require the Office of the Chancellor of the Community Colleges and California State University to develop, and authorize the Office of the President of the University of California to develop, a strategy and fiscal plan to ensure the availability of a culturally competent workforce to meet the needs of an aging population by 2030.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 (a) The Legislature finds and declares all of the following:
(1) The Public Policy Institute of California estimates that California’s older population will nearly double by 2030, bringing an increase of 4 million people over the age of 65.
(2) The implications of the population aging impact not only older adults and people with disabilities, but also their families, local communities, and the state.
(3) Twenty percent of California’s older adults live in poverty, and this number is expected to increase with the rose of rise in aging adults in the state.
(4) Ninety percent of older adults would like to age in their homes, but often lack access to the necessary services and supports to do so.
(5) The cost of long-term services and supports (LTSS) is unaffordable for most Californians: Californians.

(A)The annual cost of 30 hours per week of home care is almost $36,000, three-quarters of the state’s median household income.

(B)The median annual cost of nursing home care is $112,055, more than twice the state’s median household income.

(C)Only 5 percent of Californians aged 40 and older have purchased private long-term care insurance.

(6) Across the state, older adults, people with disabilities, and families rely on services provided through multiple state entities, including, but not limited to, the State Department of Health Care Services, the State Department of Social Services, the California Department of Aging, the Department of Rehabilitation, the Department of Transportation, the Department of Housing and Community Development, the Department of Insurance, the Department of Veterans Affairs, and the State Department of Education.
(7) Despite the programs and services administered by a range of state departments, families struggle to weave together services and to finance care in the hopes of helping loved ones remain at home. Individuals and their families do not know where to turn for help or how to pay for services. When help is finally found, many people are left bouncing between programs with little assurance that their needs will be met.
(8) California is woefully unprepared to care for this growing and increasingly diverse demographic. California cannot meet the workforce needs of older adults and people with disabilities, with a growing shortage of paraprofessionals and professionals needed to provide culturally competent care to an increasingly diverse population.
(9) The AARP Public Policy Institute reports that in 2015, California’s 4.5 million unpaid family caregivers provided approximately $57 billion worth of unpaid care, yet often without the necessary training and support.
(10) As the population ages, the demand for health care, long-term services and supports, affordable housing, accessible transportation, oral health care, mental health care, and other services will continue to outpace supply unless there is intentional leadership and action.

(11)Recent polling data shows that more than two-thirds of likely voters feel the state is not prepared to address the health care and social support needs of its fast-growing older adult population. Nearly 9 out of 10 voters say it is important for the state to have a master plan to invest in services that allow older adults to age in the place that they prefer.

(12)

(11) Numerous entities have issued reports calling for system change, including the Little Hoover Commission in both 1996 and 2011, the Strategic Planning Framework for an Aging Population, a report prepared in response to Chapter 948 of the Statutes of 1999, the Assembly Committee on Aging and Long-Term Care in 2006, and the Senate Select Committee on Aging and Long-Term Care in 2015. Despite hopeful intentions, none of these efforts led to meaningful change.

(13)

(12) The 2015 report by the Senate Select Committee on Aging and Long-Term Care, “A Shattered System: Reforming Long-Term Care in California” identified a number of system challenges including system fragmentation, lack of access to services, workforce challenges and cultural competency, and a crumbling infrastructure.

(14)According to the 2017 Long-Term Services & Supports State Scorecard, the highest-performing states all have one thing in common: a commitment to a clear and strategic plan that guides thoughtful investments as part of an integrated and responsive approach to serving older adults and people with disabilities. As examples, Connecticut, Washington, and Minnesota have outlined clear strategies with a broad framework for systems improvement. Policymakers and elected officials in these states have collaborated in developing a vision with specific benchmarks and goals that serve as the foundation for achieving broad transformation.

(b) It is the intent of the Legislature in enacting this act that a Master Plan for an Aging California is developed that empowers all Californians, including older adults and people with disabilities, to age with dignity, choice, and independence.

SEC. 2.

 Chapter 13 (commencing with Section 9800) is added to Division 8.5 of the Welfare and Institutions Code, to read:
CHAPTER  13. Master Plan for Aging in California

9800.
 (a) The Governor shall appoint a Master Plan Director to lead the planning process for the Master Plan for Aging. The director shall have experience working in the field of aging or long-term care for a minimum of five years, care, preferably with experience in both service delivery and state policy impacting older adults and people with disabilities. The director shall possess an understanding of the issues relating to aging and long-term care and a familiarity with relevant stakeholders. The director shall possess strong interpersonal skills with the ability to work collaboratively with, and develop consensus among, multiple groups, including, but not limited to, state representatives, providers, consumers, and advocates. The director shall express a commitment to developing a comprehensive Master Plan for Aging that addresses the range of issues impacting California’s older adults, people with disabilities, and caregivers.
(b) (1) The Aging Task Force is hereby established. The task force shall consist of 15 13 members to be appointed as following:
(A) Five Two members by the President pro Tempore of the Senate.
(B) Five Two members by the Speaker of the Assembly.
(C) Five Nine members by the Governor.

(2)Members of the task force shall include representation from consumers, consumer advocates, or both, health care, long-term services and supports, labor, transportation, housing, local government, business, and marginalized communities, and shall have experience working in their field, at the state or local level, for a minimum of five years. Task force members shall possess knowledge of the field they represent, including in the policy and regulatory context, strong communication skills, and an expressed commitment to developing a comprehensive Master Plan for Aging that addresses the range of issues impacting California’s older adults, people with disabilities, and caregivers.

(2) (A) The Governor shall appoint one member to represent each of the following fields: consumer advocates, health care, long-term services and supports, labor, transportation, housing, schools of gerontology, local government, and business. Each appointee shall have experience working at the state or local level in the field they represent. Preference shall be given to the appointment of people who also represent marginalized communities.
(B) The President pro Tempore of the Senate and the Speaker of the Assembly shall each appoint one representative with expertise in the delivery of long-term services and supports.

9805.
 (a) The Master Plan Director shall, with the assistance of the Aging Task Force, work with representatives from impacted state departments, including, but not limited to, those identified in subdivision (b), stakeholders, as described in Section 9810, and any other agencies the director or task force deems appropriate, to identify policies that need to be implemented to prepare for the aging of California’s population and that are in accordance with the core values identified in subdivision (c) and goals identified in paragraph (1) of subdivision (e).
(b) The director shall work with representatives of state agencies, including, but not limited to, all of the following, to develop strategies and responses to the aging of California’s population:
(1) The State Department of Health Care Services.
(2) The State Department of Social Services.
(3) The California Department of Aging.
(4) The Department of Rehabilitation.
(5) The Department of Transportation.
(6) The Department of Housing and Community Development.
(7) The Department of Insurance and the Insurance Commissioner.
(8) The Department of Veterans Affairs.
(9) The Department of Finance.
(10) The Chancellor of the California Community Colleges.
(11) The Chancellor of the California State University.
(12) The President of the University of California Office.
(13) The Judicial Council.
(c) Under the leadership of the director, the task force shall ensure the master plan developed pursuant to subdivision (e) is centered on all of the following core values:
(1) Equity. The master plan shall seek to enable older adults and people with disabilities to access long-term services and supports (LTSS) in accordance with individual needs and preferences, to the extent feasible, regardless of individual health or functional status, income, race, religion, or other socioeconomic factors.
(2) Self-determination. The master plan shall seek to enable older adults and people with disabilities to remain in their own homes and communities as long as possible or desired while receiving services and supports that are in line with their individual needs and preferences.
(3) Efficiency. The master plan shall seek to reduce unnecessary costs and reduce duplication through streamlined service delivery.
(4) System rebalancing. The master plan shall prioritize the delivery of home- and community-based services in a home setting as alternatives to institutionalization, in accordance with individual needs, desires, and preferences.
(5) Coordination and integration. The master plan shall seek to streamline service delivery through coordinated and integrated systems of care.
(6) Access. The master plan shall ensure access to health care and LTSS in all communities across the state, including rural, suburban, and urban settings.
(d) (1) Under the leadership of the director, the task force shall, by July 1, 2020, complete The director shall, by July 1, 2021, oversee the completion of an environmental analysis surveying the existing LTSS programs and services for older adults and people with disabilities across the continuum of home- and community-based care to institutional care. The environmental analysis shall identify the availability of programs and services on a county-by-county basis and determine where unmet needs exist. The task force may, as deemed appropriate by the director, assist with the development of the environmental analysis survey.
(2) The information derived from the environmental analysis shall be included on the web-based platform described in clause (i) of subparagraph (A) of paragraph (4) of subdivision (e) and shall be used to map services and inform older adults, people with disabilities, and families about available LTSS.
(e) Under the leadership of the director, the task force shall develop a master plan in accordance with the core values outlined in subdivision (c) that does identifies possible actions that would accomplish all of the following:

(1)Accomplishes all of the following goals:

(A)

(1) Prepares the state for the impact of an aging population, while addressing the needs of all who are impacted, including to address the needs of older adults, people with disabilities, and caregivers.

(B)

(2) Improves the quality and effectiveness of service delivery.

(C)

(3) Ensures adequate and sustainable funding for Medi-Cal and other state and local LTSS programs.

(D)

(4) Enables older adults and people with disabilities to live in the most integrated, community-based setting, in accordance with their needs and preferences.

(E)

(5) Fosters opportunities for older adults and people with disabilities to be meaningfully engaged in their communities.

(F)

(6) Supports the workforce, including unpaid family caregivers, in serving the population.

(G)

(7) Develops modes to relay effective communication models for providing information about available LTSS to older adults, people with disabilities, and families who lack access to digital technology.

(2)

(8) Outlines strategies and tactics in accordance with goals identified in paragraph (1), with criteria for prioritizing near-term and long-term action items. The highest priority action items shall include, but not be limited to, all of the following:
(A) Programs and policies impacting the mental and physical health, safety, and well-being of older adults, people with disabilities, and families.
(B) Programs and policies enabling individuals to receive services in home- and community-based setting as an alternative to institutionalization.
(C) Programs and policies that lift older adults, people with disabilities, and families out of poverty.

(3)Benchmarks to

(9) Establishes benchmarks to assess and measure progress in accomplishing the master plan goals identified in paragraph (1). goals.

(4)Proposes how, and includes with the proposal a cost estimate and an identification of potential funding sources, at

(10) Includes a cost estimate for accomplishing, and identifies potential funding sources to accomplish, at a minimum, the state should accomplish all of the following:
(A) Expand access to coordinated, integrated systems of care by doing all of the following:
(i) Developing a web-based platform that streamlines access to information and supports through a No Wrong Door system.
(ii) Developing and implementing a universal assessment tool to be utilized as part of the No Wrong Door system, enabling streamlined access to LTSS programs.
(iii) Developing a statewide, integrated, coordinated service delivery system that builds upon and improves California’s Coordinated Care Initiative in an effort to better streamline access to services across the medical care and the LTSS continuum.

(B)Strengthen access to LTSS, including the development of a fiscal plan and timeline for building LTSS infrastructure in areas where unmet need exists, prioritizing regions with greatest unmet need, as identified pursuant to paragraph (1) of subdivision (d).

(C)

(B) Prepare families to plan and pay for LTSS.

(D)

(C) Support family caregivers by providing opportunities for respite services, training, and support in the home setting.

(E)

(D) Increase access to LTSS, health care, and related services where there is to address significant unmet need, including but not limited to, oral health care, mental health services, and food and nutrition services.

(F)

(E) Develop affordable housing options, including those allowing individuals to age in place and access assistive technology in the home environment.

(G)

(F) Enhance access to accessible public transportation.

(H)

(G) Develop a culturally competent paraprofessional and professional workforce that meets the needs of older adults and people with disabilities across the service-delivery system, including health care, mental health care, and specialty areas.

(I)

(H) Prevent exploitation and abuse, including financial abuse and physical abuse, of older adults and people with disabilities.

(J)

(I) Streamline state administrative structures to improve service delivery.

(5)Identify a phased timeline for implementation, as specified in Section 9815.

(f) Under the leadership of the director, the task force shall outline a master plan shall include, and shall be implemented in accordance with, a fiscal plan and timeline for building long-term services and supports infrastructure, prioritizing areas where unmet need is the most acute.

(g)The master plan shall be implemented pursuant to the timeline included in the master plan pursuant to paragraph (5) of subdivision (e).

9810.
 Under the leadership of the Master Plan Director the Aging Task Force shall develop and implement a process to solicit input from a wide variety of stakeholders, and shall convene community-specific public forums to gather information on the impact on the community of California’s aging population. The task force shall ensure that underserved communities are represented and that culturally competent resources are provided.

9815.
 (a) The Aging Task Force shall develop an implementation process describing strategies, accountabilities, deliverables, and timeframes necessary for achieving the master plan’s goals.
(b) The task force shall develop a process that will track, monitor, and evaluate progress on implementation of the master plan.
(c) Impacted state departments The director shall work with the Legislature and other state agencies to identify statutory and regulatory changes that are needed to implement the master plan.

9820.
 As part of the aging master planning process, by January 1, 2021, the Chancellor of the Community Colleges and California State University shall develop, and President of the University of California may develop, a strategy and fiscal plan to ensure the availability of a culturally competent workforce to meet the needs of an aging population by 2030.

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REVISIONS:
Heading—Line 4.
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