CDCAN: ASSEMBLY BUDGET COMMITTEE APPROVES AUGUST 27th AMENDED VERSIONS OF BUDGET TRAILER BILLS DEALING WITH IHSS OVERTIME AND WITH ONSITE IHSS PROVIDER ORIENTATION

SACRAMENTO, CA [CDCAN LAST UPDATED 08/28/2014  08:55 PM] – The Assembly Budget Committee heard and approved several “clean-up” budget trailer bills Thursday afternoon, including two bills that have provisions dealing with In-Home Supportive Services (IHSS), as significantly amended yesterday, August 27th:  one (SB 873) addressing some concerns regarding IHSS recipients who receive additional service hours under a special Medicaid program called the “Nursing Facility/Acute Hospital Waiver”, and the other (SB 878) adding new requirements to the existing IHSS provider orientation that will include State and federal laws regarding minimum wage and overtime, in addition to a new requirement of onsite orientations for workers and prospective workers, and allowing presentations at those orientations by recognized unions.
Those bills, along with the other budget trailer bills, now head for a final vote on the Assembly floor and then the Senate floor on Friday, in what will be the final day of the 2014 Legislative Session, barring any last minute developments and surprises.
None of the other budget trailer bills approved by the Assembly Budget Committee focused specifically on people with disabilities, mental health needs, the blind, seniors and low income families and individuals.
[CDCAN Note: “Clean-up” refers to making largely technical adjustments or changes to previously approved budget items, though in some cases – such as the issue regarding IHSS overtime implementation – the provisions sometimes spark some controversy with advocates, policymakers and the Brown Administration. However the two bills dealing with IHSS, aside from some questions by Assemblymember Shannon Grove (Republican – Bakersfield) on IHSS provider orientations and presentations by recognized unions, were approved without debate or significant questions.]

SB 873 AMENDED AGAIN ON AUGUST 27th
SB 873 was amended August 22nd, included a new provision that addresses a  major concern of the State’s implementation of overtime for In-Home Supportive Services (IHSS) workers and its potential impact on some IHSS recipients with significant disabilities who receive additional homecare hours through two special programs (called a “waivers”).  The bill covers other human service issues including foster care and community care facilities. The bill was amended again yesterday, August 27th that made changes to one of the provisions in the bill dealing with overtime, deleting references to the In-Home Operations Medicaid Waiver and gave more latitude to the Department of Health Care Services in how it can help IHSS recipients under the Nursing Facility/Acute Hospital Medicaid Waiver deal with problems related to implementation of overtime for their IHSS workers.
The August 27th amendment to SB 873, according to some advocates, watered down the requirements in the August 22nd amendments to the bill and instead provide the Department of Health Care Services, the state agency that oversees the State’s Medicaid Program (called “Medi-Cal”) with some lee-way in carrying out the requirements of overtime for IHSS recipients and workers under the Nursing Facility/Acute Hospital Medicaid Waiver.
The August 27th amendments to SB 873 requires the Department of Health Care Services to work with and assist IHSS recipients receiving services under  the Nursing Facility/Acute Hospital (NF/AH) Medicaid Waiver who are at or near their individual cost cap to avoid a reduction in the IHSS recipient’s services that may result because of increased overtime pay for IHSS providers – but deleted references to the IHO (In-Home Operations) Waiver).  The August 27th amendments also would require the Department of Health Care Services to consider allowing the IHSS recipient to exceed the individual cost cap – though the new amendments don’t require the department to actually do so or spell out the specifics on what issues should be considered to allow a IHSS recipient to exceed the Nursing Facility/Acute Hospital Waiver cost cap .
The August 27th amendments to SB 873 also deleted references in the August 22nd amendments that would have required the department to work with IHSS recipients under either the IHO or Nursing Facility/Acute Hospital Waiver so that IHSS recipients under those two waivers do not lose services and are not forced to “alter existing [IHSS] provider relationships because of increased overtime pay for providers, including allowing the recipient to exceed the individual [waiver[ cost cap.”
While advocates were not happy with the narrow focus of the amendments, some advocates were “hopeful” that the Department of Health Care Services will move forward in providing “…individual adjustments which will allow people on waivers to keep their services and providers.”

SB 878 AMENDED AUGUST 27th – DELETES INTENT LANGUAGE ON 7% REDUCTION AND REPLACES WITH NEW REQUIREMENTS FOR EXISTING IHSS PROVIDER ORIENTATION
Another bill referred to the Assembly Budget Committee dealing with IHSS is SB 878 that was also amended on August 22nd, was also amended again on August 27th, deleting references to the previous version of the bill and replacing it with provisions dealing with IHSS provider orientations.

NEW FEDERAL REGULATIONS REQUIRE OVERTIME FOR HOME CARE WORKERS IN JANUARY 2015
Last September 2013, the US Department of Labor issued final regulations that eliminates, effective January 1, 2015, a previous exemption of overtime pay for many home care workers – including IHSS workers, and supported living services (SLS) workers and in-home respite workers and other similar home care workers.
Governor Brown last January 2014 at first proposed capping IHSS worker hours and prohibiting overtime effective January 1, 2015, but that proposal was met with intense opposition from legislators and advocates.
The Governor and the Democratic legislative leadership – Senate President Pro Tem Darrell Steinberg and Assembly Speaker Toni Atkins – finally in June agreed on a compromise proposal that allowed for 26 hours of overtime per week per worker (reduced to 21 hours while the current 7% across the board reduction to service hours for all IHSS recipients remains in effect).
The compromise, which was contained in SB 855, the human services budget trailer bill passed by the Legislature and signed into law by the Governor in mid-June, raised several concerns by advocates and some policymakers on its potential negative impact on certain IHSS recipients and their workers – including those people with significant disabilities who receive additional home care type hours through special Medi-Cal funded programs in addition to their IHSS hours; and also impact to parent or guardian providers in families with more than one child receiving IHSS.
SB 873, as amended August 27th, would delete one provision in the enacted version of SB 855 dealing with IHSS recipients under personal care services waiver, and add a new provision (as reported previously).

CONCERNS OF OVERTIME IMPACT FOR IHSS RECIPIENTS UNDER WAIVERS WILL BE FOCUS OF MID-SEPTEMBER CONFERENCE CALL BY DEPARTMENT OF HEALTH CARE SERVICES
Earlier, at an August 15th IHSS public stakeholder meeting on the overtime implementation, Eileen Carroll, Deputy Director of the Adult Programs Division in the Department of Social Services said that a public stakeholder conference call would be held by the Department of Health Care Services in mid-September regarding the concerns raised by IHSS recipients and workers and other advocates regarding overtime implementation’s impact on those IHSS recipients also on the In-Home Operations and Nursing Facility/Acute Hospital Medicaid Waivers.
No specific date or phone number has been released yet (CDCAN will send this information out as soon as it is available).

DEPARTMENT OF SOCIAL SERVICES LOOKING AT POSSIBLE WAYS TO ADDRESS OVERTIME IMPACT ON FAMILIES WITH MORE THAN ONE CHILD ON IHSS
As previously reported, SB 873 (including the latest August 27th amendments to the bill) does not address another major concern previously raised by advocates dealing with families with more than one child receiving IHSS.  Advocates have urged the Brown Administration, through the Department of Social Services – the state agency that oversees statewide the IHSS program to address that issue, and some advocates have expressed confidence that will happen.
Eileen Carroll, Deputy Director of Adult Programs Division in the Department of Social Services, said at the August 15th IHSS stakeholder meeting in Sacramento that the State is looking at reviewing possible options in California’s Medicaid State Plan to address the concerns regarding families with multiple children receiving IHSS.  However no details were offered at the meeting and no specific next steps were outlined regarding a possible amendment to the State’s Medicaid Plan to address to the issue.

CDCAN SUMMARY OF THE TWO IHSS RELATED TRAILER BILLS

SB 873 – HUMAN SERVICES INCLUDES TWO PROVISIONS ON IHSS OVERTIME
CDCAN SUMMARY (AS AMENDED 08/27/2014):
Existing State law requires that in-home supportive services and waiver personal care services be performed by IHSS providers (workers) within a work week that does not exceed 66 hours per week (61 hours while the existing 7% reduction in service hours for all IHSS recipients remains in effect).
    This bill would, if certain conditions are met, deem a IHSS provider authorized to work a IHSS recipient’s county-approved adjusted hours for the week when a recipient’s weekly authorized hours are adjusted and at the time of adjustment the IHSS recipient currently receives all authorized hours of services from one IHSS provider.
    Existing State law requires the Department of Health Care Services, if the IHSS provider of authorized waiver personal care services cannot provide authorize in-home supportive services to a IHSS recipient as a result of the overtime work week limitation (as outlined in SB 855), to work with the IHSS recipient to engage additional IHSS providers, as necessary.
    This bill would delete that provision and instead require the Department of Health Care Services to work with and assist IHSS recipients receiving services under  the Nursing Facility/Acute Hospital (NF/AH) Medicaid Waiver who are at or near their individual cost cap to avoid a reduction in the IHSS recipient’s services that may result because of increased overtime pay for IHSS providers. 
    Would require the Department of Health Care Services, as a part of this effort, to consider allowing the IHSS recipient to exceed the individual cost cap.
    Would require the Department of Health Care Services to provide timely information to waiver recipients regarding the steps that will be taken to implement this provision.
LAST ACTION 08/28/2014:  Heard in Assembly Budget Committee. Passed by Assembly Budget Committee.
NEXT STEPS:  The bill as amended on 8/27/2014 heads to the Assembly floor for likely approval on Friday – and if passed there, heads to the State Senate floor also on Friday for likely approval there.  If passed by both houses, heads to Governor for approval.
PDF DOCUMENT COPY (72 PAGES) OF SB 873 AS AMENDED 08/27/2014:
http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0851-0900/sb_873_bill_20140827_amended_asm_v96.pdf
HTML COPY OF SB 873 AS AMENDED 08/27/2014:
http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0851-0900/sb_873_bill_20140827_amended_asm_v96.htm
CDCAN NOTE: Specific reference to In Home Operations (IHO waivered services as amended into SB 873 on August 22, 2014 were deleted.  There were slight changes in the existing provision dealing with avoiding reductions in services for IHSS recipients under the Nursing Facility/Acute Hospital Waiver.  References to the IHSS provisions start on page 64 of the bill.

SB 878 – IHSS ONSITE IHSS PROVIDER ORIENTATION
AUTHOR: Senate Budget and Fiscal Review Committee
CDCAN SUMMARY (As amended 08/27/2014)
[amendment deletes previous version of this bill that had intent language for the elimination of the existing 7% across the board reduction in service hours for all IHSS recipients]
Existing State law requires all prospective IHSS providers (workers) to, as a condition of IHSS program participation, complete, sign, and submit a provider enrollment form and complete a provider orientation, which is required to include specified topics, including the requirements to be an eligible IHSS provider and a description of the IHSS program.
   This bill would require the existing IHSS provider orientation for IHSS providers (workers) to include the federal and state requirements regarding minimum wage and overtime pay, including paid travel time and wait time, and other specified requirements.
    Requires, beginning no later than April 1, 2015, that the IHSS provider orientation be an onsite orientation, and that all prospective IHSS providers attend in person only after completing the application for the IHSS provider enrollment process.
    Would additionally require that any oral presentation and written materials presented at the orientation be translated into all IHSS threshold languages in the county.
    Would require that representatives of the recognized employee organization (unions) in the county be permitted to make a presentation of up to 30 minutes at the orientation
LAST ACTION 08/28/2014:  Heard in Assembly Budget Committee. Passed by Assembly Budget Committee.
NEXT STEPS:  The bill as amended on 8/27/2014 heads to the Assembly floor for likely approval on Friday – and if passed there, heads to the State Senate floor also on Friday for likely approval there.  If passed by both houses, heads to Governor for approval.
PDF DOCUMENT COPY (5 PAGES) OF SB 878 AS AMENDED 08/27/2014:
http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0851-0900/sb_878_bill_20140827_amended_asm_v96.pdf
HTML COPY OF SB 878 AS AMENDED 08/27/2014:
http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0851-0900/sb_878_bill_20140827_amended_asm_v96.htm

CALIFORNIA HAS SEVERAL MEDICAID WAIVERS
Medi-Cal waivers are programs under California’s federally funded Medicaid program – called “Medi-Cal” that provide additional services to specific groups of individuals, or limit services to specific geographic areas of the state, and provide medical coverage to individuals who may not otherwise be eligible under federal Medicaid rules.
California has a number of Medicaid waivers in place covering different populations and services.  They are called “waivers” because it waives or provides an exception to existing federal Medicaid laws.
California’s Nursing Facility waiver has a capacity of about 3,600 people that it can serve in 2014.
The In-Home Operations waiver has about 200 persons participating in 2014, while the total numbers of people receiving IHSS is over 450,000.  That number includes about 40,000 children and adults with developmental disabilities – including those with autism spectrum and related disorders – eligible also for regional center services under California’s Lanterman Developmental Disabilities Services Act.
For more information on how to access Medicaid Waivers in California, go to the Department of Health Care Services webpage at: http://www.dhcs.ca.gov/services/medi-cal/Pages/AccessMedi-calWaivers.aspx

WHAT IS THE NURSING FACILITY/ACUTE HOSPITAL MEDICAID WAIVER?
Administered by the Department of Health Care Services, the Nursing Facility A/B Waiver was renamed the Nursing Facility/Acute Hospital (NF/AH) effective January 1, 2007.
This Medicaid funded waiver combines the following three prior Medicaid Home and Community-Based Waivers: (1) Nursing Facility (NF) A/B Waiver; (2) the Nursing Facility Subacute (NF SA); and the In-Home Medical Care (IHMC) Waiver.
The purpose of the HCBS NF/AH Waiver is to provide Medi-Cal beneficiaries with long-term medical conditions, who met the acute hospital, adult, or pediatric subacute, nursing facility, distinct-part nursing facility (NF) Level of Care with the option of returning to and/or remaining in his/her home or home-like setting in the community in lieu of hospitalization.
According to the Department of Health Care Services, the goals of the waiver are to: 1) facilitate a safe and timely transition of people who are Medi-Cal eligible from a medical facility to his/her home and community utilizing Nursing Facility/Acute Hospital (NF/AH) Waiver services; and 2) offer those people eligible for Medi-Cal who reside in the community, but are at risk of being institutionalized within the next 30 days, the option of utilizing the Nursing Facility/Acute Hospital (NF/AH) Waiver services to develop a home program that will safely meet his/her medical care needs.
For more information, go to the Department of Health Care Services webpage at: http://www.dhcs.ca.gov/services/medi-cal/Pages/NFAHMedi-CalWaiver.aspx

WHAT IS THE IN-HOME OPERATIONS (IHO) MEDICAID WAIVER?
Administered by the Department of Health Care Services, the In-Home Operations (IHO) Medicaid waiver is a new waiver established to serve either 1) participants previously enrolled in the Nursing Facility (NF) A/B Level of Care Waiver who have continuously been enrolled in a Department of Health Care Services In-Home Operations-administered Home and Community-Based Services Waiver since prior to January 1, 2002, and require direct care services provided primarily by a licensed nurse; or 2) who have been receiving continuous care in a hospital for 36 months or greater and have physician-ordered direct care services that are greater than those available in the Nursing Facility/Acute Hospital (NF/AH)  Waiver for the person’s assessed level of care.
For more information, go to the Department of Health Care Services webpage at: http://www.dhcs.ca.gov/services/medi-cal/Pages/IHOMedi-CalWaiver.aspx
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