Amended  IN  Assembly  April 18, 2023
Amended  IN  Assembly  March 23, 2023

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill
No. 1005

Introduced by Assembly Member Alvarez

February 15, 2023

An act to add Section 442.9 to the Health and Safety Code, and to add Section 12309.2 to the Welfare and Institutions Code, relating to in-home supportive services.


LEGISLATIVE COUNSEL'S DIGEST


AB 1005, as amended, Alvarez. In-home supportive services: terminal illness diagnosis.
Existing law establishes the In-Home Supportive Services (IHSS) program, administered by the State Department of Social Services and counties, under which qualified aged, blind, or disabled persons are provided with supportive services in order to permit them to remain in their own homes.
As a condition of receiving services under the IHSS program, existing law requires an applicant or recipient to obtain a certification from a licensed health care professional declaring that the applicant or recipient is unable to perform some activities of daily living independently, and that without services to assist the applicant or recipient with activities of daily living, the applicant or recipient is at risk of placement in out-of-home care. Existing law requires that the certification be received prior to service authorization, except under certain circumstances. Existing law requires the department to develop a standard certification form, as specified, and to identify alternative documentation, including, but not limited to, hospital or nursing facility discharge plans, containing the required information.
Existing law sets forth various provisions relating to end-of-life care. When a health care provider makes a diagnosis that a patient has a terminal illness, existing law generally requires the health care provider, upon request, to provide the patient or another person authorized to make health care decisions with comprehensive information and counseling regarding legal end-of-life care options.
This bill would, before the discharge of a patient diagnosed with a terminal illness, require the diagnosing health care provider to disclose to ask the patient or authorized person if they are interested in receiving information about the IHSS program and about program. If interest is expressed, the bill would require the health care provider to disclose to the patient or authorized person the information, including the IHSS eligibility criteria and the option for a family member to provide care as an IHSS provider subject to the IHSS provider enrollment conditions.
The bill would require the health care provider to provide a physical IHSS application under the above-described circumstance and to inform the patient or authorized person of the option for sending a digital copy if a family member is identified for purposes of an IHSS provider. If the patient seeks to apply for services under the IHSS program, the bill would require the health care provider to provide a copy of the health care certification form and to complete the applicable portion before the patient’s discharge.
Existing law sets forth various conditions on the number of hours of service authorized for an IHSS provider, with a modified number based on exemptions for a provider who is related to the recipients whom the provider serves, as specified.
Existing law requires the county welfare department to assess each IHSS recipient’s continuing monthly need for in-home supportive services at varying intervals as necessary, but at least once every 12 months, with exceptions. Under existing law, the results of this assessment of monthly need for IHSS hours are divided by 4.33, to establish a recipient’s weekly authorized number of IHSS hours, as specified.
Under this bill, if a patient diagnosed with a terminal illness seeks to apply for services under the IHSS program, and receives a health care certification form that is completed by a health care provider, the patient would be authorized to elect to have the application process expedited by the county.
As part of that expedited process, the bill would require (1) that the IHSS application and the health care certification form be processed before the patient is discharged, (2) that the health care certification form be approved or denied within an unspecified number of days of the county receiving it, one business day after the county receives the form, (3) that, upon approval, an IHSS provider be assigned and provided to the patient within an unspecified number of days of processing the health care certification form, the county welfare department or its designee prioritize the patient with regard to assigning and providing an IHSS provider, and (4) that the approved patient be guaranteed a specified total number of IHSS hours, as a preliminary allotment, as deemed appropriate by the county welfare department or its designee based on specified factors, until a final determination is made based on the needs assessment. By creating additional duties for county officials, the bill would impose a state-mandated local program.
The bill would authorize the department to implement these provisions through all-county letters or similar instructions, until regulations are adopted. The bill would condition implementation of these provisions on receipt of any necessary federal approvals and the availability of federal financial participation for purposes of providing in-home supportive services under the Medi-Cal program or other related provisions.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

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


SECTION 1.

 Section 442.9 is added to the Health and Safety Code, to read:

442.9.
 (a) It is the intent of the Legislature that this section be implemented in conjunction with implementation of Section 12309.2 of the Welfare and Institutions Code.
(b) Before the discharge of a patient diagnosed with a terminal illness, the diagnosing health care provider shall disclose to ask the patient, or another person authorized to make health care decisions for the patient, if they are interested in receiving information about the in-home supportive services (IHSS) program (Article 7 (commencing with Section 12300) of Chapter 3 of Part 3 of Division 9 of the Welfare and Institutions Code), Code). If the patient or authorized person expresses interest in receiving the IHSS information, the diagnosing health care provider shall disclose to the patient or authorized person the information, including the IHSS eligibility criteria, and about criteria and the option for a family member to provide care as an IHSS provider subject to the IHSS provider enrollment conditions set forth in that article.
(c) The For a patient or authorized person who expresses interest in receiving the IHSS information pursuant to subdivision (b), the health care provider shall provide the patient or authorized person with a physical application for the IHSS program, and shall inform the patient or authorized person of the option for the health care provider to send a digital copy of the application if the patient or authorized person identifies a family member whom they would like to be the patient’s IHSS provider.
(d) If the patient seeks to apply for services under the IHSS program, the health care provider shall provide a copy of the health care certification form (SOC 873 or its successor), as described in Section 12309.1 of the Welfare and Institutions Code, and shall complete the health care provider’s portion of that form before the patient’s discharge.

SEC. 2.

 Section 12309.2 is added to the Welfare and Institutions Code, to read:

12309.2.
 (a) (1) The Legislature finds and declares that the purpose of this section is to provide a more streamlined, automatic application process for a patient who has been diagnosed with a terminal illness, who meets all of the IHSS eligibility criteria, and who is interested in receiving services under the IHSS program.
(2) It is the intent of the Legislature that this section be implemented in conjunction with implementation of Section 442.9 of the Health and Safety Code.
(b) If a patient diagnosed with a terminal illness seeks to apply for services under the IHSS program, and receives a health care certification form (SOC 873 or its successor), as described in Section 12309.1, that is completed by a health care provider, the patient may elect to have the application process expedited by the county in the following manner:
(1) The IHSS application and the health care certification form shall be submitted and processed before the patient is discharged by the health care provider who diagnosed the patient with a terminal illness.
(2) The health care certification form shall be processed and either approved or denied within ____ days of the county receiving it. one business day after the county receives the form.
(3) If the patient is approved for services under the IHSS program, an IHSS provider shall be assigned and provided to the patient within ____ days of processing the health care certification form. the county welfare department or its designee shall prioritize the patient with regard to assigning, and providing them with, an IHSS provider.
(4) (A) If the patient becomes an IHSS recipient, they shall be guaranteed a total of ____ number of hours of in-home supportive services, as a preliminary allotment, as deemed appropriate by the county welfare department or its designee, until a final determination is made based on the needs assessment described in Section 12301.1 and other applicable provisions in this article.
(B) For purposes of determining the total number of hours as a preliminary allotment, as described in subparagraph (A), the county welfare department or its designee shall consider the terminal illness diagnosis of the patient, any other relevant information available to the county at that point about the patient’s individualized circumstances, and the county’s available IHSS resources. The number of hours shall not exceed the applicable maximum limit of hours as described in Sections 12300.4 and 12301.1 and other applicable provisions in this article.
(c) For purposes of this section, “terminal illness” has the same meaning as interpreted for Part 1.8 (commencing with Section 442) of Division 1 of the Health and Safety Code.
(d) Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the department may implement, interpret, or make specific this section by means of all-county letters or similar instructions, until regulations are adopted.
(e) This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available for purposes of providing in-home supportive services pursuant to Section 14132.95, 14132.952, 14132.956, or 14132.97, or pursuant to other applicable provisions.

SEC. 3.

 If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.