Existing law establishes the Department of Veterans Affairs, which is responsible for administering various programs and services for the benefit of veterans. Existing law provides for the licensure of residential care facilities for the elderly, community care facilities, and residential care facilities for persons with chronic, life-threatening illness, by the State Department of Social Services.

The Medical Foster Home Pilot Program, which was repealed on January 1, 2018, authorized a United States Department of Veterans Affairs (USDVA) facility to establish a medical foster home in this state for the placement of veterans that is not subject to licensure or regulation as one of the above-listed facilities, but subject to other specified federal and state requirements.

This bill would state the intent of the Legislature to enact legislation that would reestablish the Medical Foster Home Pilot Program for the benefit of veterans.

Date of Hearing: April 18, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 2607

Author:(Berman) – As Amended Ver:March 21, 2018

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill authorizes, as a pilot project until January 1, 2020, 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. This bill conditions establishment of MFHs upon satisfaction of federal requirements, the USDVA facility establishing the home agrees to be subject to the jurisdiction of the California State Auditor, and that caregivers and specified individuals residing in the home register as independent home care aides and submit fingerprints and related information to the Department of Justice (DOJ) for background checks as well as a signed declaration regarding any prior criminal convictions to the Department of Social Services (DSS).

This bill 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. Onetime State Auditor costs in the range of $250,000 to $300,000 (GF) 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 DSS licensing, regulations and review.

COMMENTS:

1. Purpose. The author’s intent is to create authorization for MFHs that provide 24-hour care for elderly and medically frail veterans in private homes. According to the author:

Medical Foster Homes (MFHs) are home-based care models for veterans needing assisted living care. MFHs provide 24-hour a day, 7-days a week care for up to three eligible veterans in a private home. The MFH program is not only affordable, but is a unique and desirable alternative to institutionalization.

Existing state law creates barriers to caregivers who want to open up their home to a veteran…To ensure that the MFH is a feasible alternative to institutionalization for California’s veterans, AB 2607 would establish the Medical Foster Home pilot program in California until January 1, 2022.

1. Background. The USDVA oversees the Medical Foster Home (MFH) program. MFHs are private homes in which a trained caregiver provides services to a few individuals. Homes are allowed beds for three veterans. Some residents, but not all, are veterans. The USDVA approves and inspects the homes but does not provide funding. To be eligible for an MFH, a veteran must be enrolled in Home Based Primary Care, a VA program through which health care services are provided to veterans in their homes.

Veterans must pay for the MFH themselves or rely on insurance. However, the Veterans Aid and Attendance benefit and Social Security benefits generally cover these costs. The charge for an MFH is about $1500 to $3000 each month based on income level and level of care required.

MFHs are distinguished from other typical residential care homes or facilities because an MFH caregiver is required to reside in their own private home while providing 24 hour personal care and supervision to the veteran.

1. Prior Legislation. Assembly Bill 1821, Gordon, Chapter 650 of the Statutes of 2014, established the Medical Foster Home Pilot Program from June 1, 2015, until January 1, 2018, which included the intent that the State Auditor conduct an audit of the program. The authority granted by AB 1821 was never exercised, however, so no audit was conducted.

The current bill’s author cites “complications at the federal level relating to the background check process” as a principle reason for the program’s failure to launch. The provisions in this bill governing background checks are therefore different from those in its predecessor. Rather than requiring the USDVA to collect fingerprints and submit them to the DOJ for background checks, this bill uses California’s existing home care aide background check and registration process, eliminating the role of the USDVA in facilitating background checks.

Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081

Ah Date of Hearing: April 10, 2018

ASSEMBLY COMMITTEE ON VETERANS AFFAIRS

Jacqui Irwin, Chair

ABPCA Bill Id:AB 2607 (

Author:Berman) – As Amended Ver:March 21, 2018

SUBJECT: Veterans: Medical Foster Home Pilot Program

SUMMARY: This bill creates the Medical Foster Home Pilot Program.

Specifically, this bill:

1. Re-establishes the Medical Foster Home Pilot Program, under substantially similar requirements as a pilot program established under previous legislation, which has since expired;
2. The bill would state the intent of the Legislature 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 no sooner than January 1, 2020, as specified;
3. Requires medical foster home caregivers and individuals, other than veteran residents, over 18 years of age and who reside in the medical foster home to register as independent home care aides, under existing provisions, including a background examination, as specified;
4. Requires an applicant for registration as an independent home care aide under the Medical Foster Home Pilot Program to submit to the State Department of Social Services a signed declaration, under penalty of perjury, regarding any prior criminal convictions;
5. Provides that a law enforcement agency or any agency authorized to take fingerprints may charge a reasonable fee to offset the costs of fingerprinting for the purposes of this section, and that the fee revenues shall be deposited in the Fingerprint Fees Account;
6. Requires the Department of Justice to use the fingerprints to search state and Federal Bureau of Investigation criminal offender record information pursuant to Section 1522 of the Health and Safety Code;
7. Exempts from the requirement to submit fingerprints to the State Department of Social Services: A person who is a current licensee or employee in a facility licensed by the State Department of Social Services, a certified foster parent, a certified administrator, or a registered TrustLine provider;
8. Provides that exempted individuals may transfer their current criminal record clearance or exemption pursuant to paragraph (1) of subdivision (h) of Section 1522 of the Health and Safety Code, and instead submit to the State Department of Social Services, along with the person’s registration application, a copy of the person’s identification card described in Section 1796.22 of the Health and Safety Code and sign a declaration verifying their identity;
9. By requiring additional individuals to register as independent home care aides, the bill would expand the scope of the crime of perjury, thereby imposing a state-mandated local program;
10. Is repealed as of January 1, 2022.

EXISTING LAW:

1. Establishes the Department of Veterans Affairs, which is responsible for administering various programs and services for the benefit of veterans.
2. Provides for the licensure of residential care facilities for the elderly (RCFEs), community care facilities, and residential care facilities for persons with chronic, life-threatening illness by the State Department of Social Services.
3. Exempts from the application of these provisions specified facilities, including general acute care hospitals and clinics.
4. Authorizes the California State Auditor, upon the request by the Joint Legislative Audit Committee and to the extent funding is available, to audit a state or local governmental agency, as defined, or any other publicly created entity.

FISCAL EFFECT: This bill has not been analyzed in fiscal committee.

COMMENTS:

Residential Care Facilities for the Elderly. The Community Care Licensing (CCL) division of DSS develops and enforces regulations designed to protect the health and safety of individuals in 24-hour residential care facilities and day care. These facilities include child care centers, RCFEs, and foster family homes and group homes.

The approximately 7,500 RCFEs in California are licensed to provide housing and a range of supportive services, such as assistance with activities of daily living, for up to 175,000 people annually.

Traditionally, RCFEs have been used as nonmedical placements for individuals with less acute medical needs than those who qualify for skilled nursing home placement, with some exceptions.

Nearly 80% of California’s RCFEs are licensed for four to six beds.

MFH Care and Elder Veterans. The federal VA oversees the MFH program. According to the VA, MFHs are private homes in which a trained caregiver provides services to a few individuals. Some, but not all, residents are veterans. VA inspects and approves all MFH, but does not actually provide or pay for the homes.

MFHs often serve as an alternative to a nursing home. It may be appropriate for veterans, who require nursing home care but prefer a non-institutional setting with fewer residents.

MFHs have a trained caregiver on duty 24/7. This caregiver can help the Veteran carry out activities of daily living (e.g., bathing and getting dressed). The VA ensures that the caregiver is well trained to provide VA planned care. While living in a MFH, Veterans receive Home Based Primary Care services.

To be eligible for a MFH, a veteran must be enrolled in Home Based Primary Care, which is a VA program through which health care services are provided to veterans in their homes. Veterans must pay for the MFH themselves or rely on other insurance. The charge for a MFH is about $1500 to $3000 each month based on income level and level of care required.

Typical services provided to veterans by a MFH caregiver include:

• Help with your activities of daily living (e.g., bathing and getting dressed);
• Help in taking medications;
• Some nursing assistance, if the caregiver is a registered nurse;
• All meals; and
• Planned recreational and social activities.

Assembly Bill 1821, Gordon, Chapter 650 of the Statutes of 2014, established the Medical Foster Home Pilot Program from June 1, 2015, until January 1, 2018, which authorized a United States Department of Veterans Affairs (USDVA) facility to establish a medical foster home that is not subject to licensure or regulation as a residential care facility for the elderly, a community care facility, or a residential care facility for persons with chronic, life-threatening illness, pursuant to specified federal requirements. Existing law required the USDVA facility establishing the home to agree to be subject to the jurisdiction of the California State Auditor, and further required the USDVA to obtain criminal background information for caregivers and specified individuals residing in the home.

The authority granted by the bill was never exercised, however, and so no audit was conducted. The bill’s author cites “complications at the federal level relating to the background check process” as a principle reason for the program’s failure to launch. The provisions in this bill governing background checks are therefore different from those in its predecessor. Rather than requiring the U.S. Department of Veterans Affairs to collect fingerprints from MFH caregivers and other (non-veteran resident) people living in the home, and submit them to the Department of Justice for background checks, this bill piggybacks on the existing home care aide background check and registration provisions in Health and Safety Code Section 1796.23., eliminating the role of the U.S. Department of Veterans Affairs in facilitating background checks.

The bill’s author has provided the following statement:

“Medical Foster Homes (MFHs) are home-based care models for veterans needing assisted living care. MFHs provide 24-hour a day, 7-days a week care for up to a maximum of 3 eligible veterans in a private home. The MFH program is not only affordable, but is a unique and desirable alternative to institutionalization.

However, the MFH model does not fit with existing state law, which creates barriers to caregivers who want to open up their home to a veteran. Furthermore, state law is duplicative of the federal regulations, which provide for much more stringent requirements and standards. To ensure that the MFH is a feasible alternative to institutionalization for California’s veterans, AB 2607 would establish the Medical Foster Home pilot program in California until January 1, 2022.

The bill would also provide multiple safeguards to protect the health and safety of veterans and to maintain a level of appropriate state oversight. For example, the MFH program must meet the requirements of the federal regulations, be subject to the jurisdiction of the California State Auditor to evaluate the pilot, and require MFH caregivers and residents of a MFH over the age of 18 to undergo a criminal background check. AB 2607 would allow the MFH program to be a viable care option for California's veterans who want to live and receive care in a smaller setting that feels more like home.”

REGISTERED SUPPORT / OPPOSITION:

Support

American Association of Retired Persons

LeadingAge California

Military Officers Association of America, California Council of Chapters

Paralyzed Veterans of America

Public Law Center

1 Individual

Opposition

None on File

Analysis Prepared by: Christian Burkin / V.A. / (916) 319-3550