Existing law establishes the county-administered In-Home Supportive Services program to provide supportive services to aged, blind, or disabled persons, as defined, who are unable to perform the services themselves and who cannot safely remain in their homes or abodes of their own choosing unless these services are provided. Existing law requires the State Department of Social Services to perform certain administrative duties in connection with the program. Existing law authorizes a county board of supervisors to contract with a nonprofit consortium, or to establish a public authority, to provide in-home supportive services and requires those entities to perform specified functions, including providing training to providers and recipients.

This bill would require the department, on or before July 1, 2019, and in consultation with employee representative organizations, to adopt a process to compensate providers of in-home supportive services for conducting peer-to-peer training. The bill would require the subject areas of the training to include how to enroll as a new provider in the In-Home Supportive Services program and how to navigate the program, as specified. The bill would require a provider conducting peer-to-peer training to be compensated at the countys prevailing wage rate for providing in-home supportive services. The bill would require the department to ensure that peer-to-peer hours are reimbursed to the employee representative organization for disbursement to the provider, no later than the 15th day of the following month. The bill would make attendance at the peer-to-peer training voluntary and would not require compensation to attendees.

By imposing new duties on counties, the bill would impose a state-mandated local program.

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.

Existing law establishes the county-administered In-Home Supportive Services program to provide supportive services to aged, blind, or disabled persons, as defined, who are unable to perform the services themselves and who cannot safely remain in their homes or abodes of their own choosing unless these services are provided. Existing law requires the State Department of Social Services to perform certain administrative duties in connection with the program. Existing law authorizes a county board of supervisors to contract with a nonprofit consortium, or to establish a public authority, to provide in-home supportive services and requires those entities to perform specified functions, including providing training to providers and recipients.

This bill would require the department to adopt a peer-to-peer training course for providers of in-home supportive services and department, on or before July 1, 2019, and in consultation with employee representative organizations, to adopt a process to compensate providers of in-home supportive services for conducting peer-to-peer training. The bill would require the subject areas of the training to include how to enroll as a new provider in the In-Home Supportive Services program and how to navigate the program, as specified. The bill would require the department to ensure that, as of December 31, 2019, every authorized provider in a county has received at least 2 hours of peer-to-peer training and that, beginning on January 1, 2020, all new providers, or returning providers who have not yet received the training, receive at least 2 hours of peer-to-peer training within their first year of employment. The bill would require a provider conducting peer-to-peer training to be compensated at the countys prevailing wage rate for providing in-home supportive services. The bill would require the department to ensure that peer-to-peer hours are reimbursed to the employee representative organization for disbursement to the provider, by the county, nonprofit consortium, or public authority no later than the 10th 15th day of every the following month. The bill would make attendance at the peer-to-peer training voluntary and would not require compensation to attendees.

By imposing new duties on counties, the bill would impose a state-mandated local program.

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.

Existing law establishes the county-administered In-Home Supportive Services program to provide supportive services to aged, blind, or disabled persons, as defined, who are unable to perform the services themselves and who cannot safely remain in their homes or abodes of their own choosing unless these services are provided. Existing law requires the State Department of Social Services to perform certain administrative duties in connection with the program. Existing law authorizes a county board of supervisors to contract with a nonprofit consortium, or to establish a public authority, to provide in-home supportive services and requires those entities to perform specified functions, including providing training to providers and recipients.

This bill would require the department to designate the hours, per county, to compensate providers of in-home supportive services for educating other providers, using peer-to-peer training, in subject areas relating to the program, including adopt a peer-to-peer training course for providers of in-home supportive services and would require the subject areas of the training to include how to enroll as a new provider in the In-Home Supportive Services program and how to navigate the program, as specified. The bill would require the department to ensure that, as of December 31, 2019, every authorized provider in a county has received at least 2 hours of peer-to-peer training and that, beginning on January 1, 2020, all new providers, or returning providers who have not yet received the training, receive at least 2 hours of peer-to-peer training within their first year of employment. The bill would require a provider conducting peer-to-peer training to be compensated at the countys prevailing wage rate for providing in-home supportive services. The bill would require the department to ensure that peer-to-peer hours are reimbursed to the employee representative organization for disbursement to the provider, by the county, nonprofit consortium, or public authority no later than the 10th day of every month.

By imposing new duties on counties, the bill would impose a state-mandated local program.

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.

Existing law establishes the county-administered In-Home Supportive Services program to provide supportive services to aged, blind, or disabled persons, as defined, who are unable to perform the services themselves and who cannot safely remain in their homes or abodes of their own choosing unless these services are provided. Existing law requires the State Department of Social Services to perform certain administrative duties in connection with the program. Existing law authorizes a county board of supervisors to contract with a nonprofit consortium, or to establish a public authority, to provide in-home supportive services and requires those entities to perform specified functions, including providing training to providers and recipients.

This bill would require the department to designate the hours, per county, to compensate providers of in-home supportive services for educating other providers, using peer-to-peer training, in subject areas relating to the program, including how to enroll as a new provider and how to navigate the program, as specified. The bill would require a provider conducting peer-to-peer training to be compensated at the countys prevailing wage rate for providing in-home supportive services. The bill would require the department to ensure that peer-to-peer hours are reimbursed to the employee representative organization for disbursement to the provider, by the county, nonprofit consortium, or public authority no later than the 10th day of every month.

Existing law establishes the county-administered In-Home Supportive Services program to aged, blind, or disabled persons, as defined, who are unable to perform the services themselves and who cannot safely remain in their homes or abodes of their own choosing unless these services are provided. Existing law requires the State Department of Social Services to perform certain administrative duties in connection with the program. Existing law authorizes a county board of supervisors to contract with a nonprofit consortium, or to establish a public authority, to provide in-home supportive services and requires those entities to perform specified functions, including providing training providers and recipients.

This bill would require the department to designate the hours, per county, to compensate providers of in-home supportive services for educating other providers, using peer-to-peer training, in subject areas relating to the program, including how to enroll as a new provider and how to navigate the program, as specified.

GOVERNOR'S VETO

GV Bill Id:AB 2872

Author:(Carrillo)

As Enrolled Ver:September 7, 2018

2/3 vote

SUMMARY: Establishes requirements regarding peer-to-peer training of In-Home Supportive Services (IHSS) providers by IHSS providers.

Specifically, this bill:

1. Requires the Department of Social Services (DSS) to, by July 1, 2019, and in consultation with employee representative organizations, adopt a process for compensating IHSS providers for conducting peer-to-peer training.
2. Requires the subject areas for peer-to-peer training to relate to the IHSS program and include, but not be limited to: how to enroll as a new provider, how to navigate the program, how to avoid making errors on timesheets, how to navigate policy changes to the program, and education on and promotion of other services that may help to lower administrative costs of the program.
3. Requires the peer-to-peer training to supplement, and not supplant, any other training provided by the county, a nonprofit consortium, or a public authority, as specified.
4. Requires attendance at the peer-to-peer training to be voluntary.
5. Requires DSS to designate the hours, per county, to compensate IHSS providers for educating other IHSS providers based on the presumption that every provider in the county may receive a maximum of two hours of peer-to-peer training in a group with no more than 10 total providers.
6. Requires a provider conducting peer-to-peer training to be compensated at the county's prevailing wage rate for IHSS providers, and stipulates that this requirement does not require compensation of attendees of the peer-to-peer training, including, but not limited to, providers and consumers.
7. Requires the hours worked by an IHSS provider educating other IHSS providers pursuant to the provisions of this bill to be reimbursed by DSS to the employee representative organization.
8. Prohibits the hours of education completed by an IHSS provider pursuant to the provisions of this bill from being included in a recipient's hours of service, and stipulates that the hours worked by a provider educating other providers pursuant to the provisions of this bill do not count toward the provider's workweek limits, as specified.
9. Requires DSS to:
   1. Verify, on a monthly basis, the number of authorized providers conducting training;
   2. Establish, by March 1, 2019, and in collaboration with employee representative organizations, a process by which an employee representative organization shall report the number of peer-to-peer hours submitted by a provider for reimbursement every month.
   3. Ensure, based on the process established with employee representative organizations, as specified by the provisions of this bill, that peer-to-peer hours are reimbursed to the employee representative organization for disbursement to the provider, by the 15th day of the following month.
   4. Increase or decrease, as of January 1, 2020, and each year thereafter, the designated annual peer-to-peer hours per county based on the provider turnover rate in that county from the previous year.

The Senate amendments:

1. Delete language requiring DSS to adopt a peer-to-peer training course for IHSS providers and instead add language that requires DSS to, by July 1, 2019, and in consultation with employee representative organizations, adopt a process for compensating IHSS providers for conducting peer-to-peer training.
2. Delete language that required DSS to ensure that, as of December 31, 2019, every authorized provider in a county has received at least two hours of peer-to-peer training and that, beginning on January 1, 2020, all new providers, or returning providers who have not yet received the training, receive at least two hours of peer-to-peer training within their first year of employment.
3. Add language that requires the peer-to-peer training to supplement, and not supplant, any other training provided by the county, a nonprofit consortium, or a public authority, as specified.
4. Add language that requires attendance at the peer-to-peer training to be voluntary.
5. Delete language requiring DSS to presume that every IHSS provider in the county shall receive at least two hours of peer-to-peer training and instead add language that requires DSS to presume that every provider in the county may receive a maximum of two hours of peer-to-peer training.
6. Add language stipulating that the requirement that providers conducting peer-to-peer training be compensated at the county's prevailing wage rate does not require compensation of attendees of the peer-to-peer training, including, but not limited to, providers and consumers.
7. Clarify that DSS is the party responsible for reimbursing employee representative organizations for hours worked by IHSS providers educating other IHSS providers.
8. Add a deadline of March 1, 2019, to this bill's requirement that DSS establish a process for reporting peer-to-peer hours, and remove the requirement that counties, public authorities, and nonprofit consortia be involved in the development of the process.
9. Revise language pertaining to reimbursements to employee representative organizations for peer-to-peer hours by:
   1. Clarifying that DSS must use the process established by the provisions of this bill for ensuring that hours are reimbursed;
   2. Removing language specifying that a county, nonprofit consortium, or public authority would disburse reimbursements to providers; and
   3. Changing from the 10^th of every month to the 15^th of the following month the date by which disbursement of reimbursements shall take place.
10. Add language that stipulates that the hours worked by a provider educating other providers pursuant to the provisions of this bill do not count toward the provider's workweek limits, as specified.

EXISTING LAW:

1. Establishes the IHSS program to provide supportive services, including domestic, protective supervision, personal care, and paramedical services as specified, to individuals who are aged, blind, or living with disabilities, and who are unable to perform the services themselves or remain safely in their homes without receiving these services. (Welfare and Institutions Code Section (WIC) 12300 et seq.)
2. Authorizes counties to choose to contract with a nonprofit consortium or establish a public authority for the provision of IHSS services. Requires nonprofit consortia and public authorities to, among other things, establish a registry to assist recipients in locating IHSS providers, and to investigate the background and qualifications of potential providers, as specified. (WIC 12301.6)
3. Maintains an IHSS recipient's right to hire, fire, and supervise the work of any IHSS provider, regardless of the employer responsibilities of a public authority or nonprofit consortium, as specified. (WIC 12301.6 (c))
4. Requires all prospective IHSS providers, at the time of enrollment, to complete an orientation developed by DSS in consultation with counties, and stipulates items that must be included in the orientation, including, among other things, a description of the IHSS program and the requirements, rules, regulations, policies, and procedures related to being an IHSS provider. (WIC 12301.24)

FISCAL EFFECT: According to the Senate Appropriations Committee on August 16, 2018, this bill may result in the following costs:

1. Estimated first-year costs to the DSS up to $1.5 million for a peer trainer for every 10 IHSS providers or $14.4 million for a peer trainer for every one IHSS provider. This estimate assumes compensation of $14.21 per hour (the statewide average individual provider cost per hour) for the training applying to the approximately 513,000 providers (or fraction thereof) that would become trainers. The actual costs will vary depending on the local prevailing wages, the actual ratio of trainers to providers, the frequency of training, and the number of authorized trainers, the number of providers who elect to attend trainings, and the total number of hours of training. These costs will also increase as the state minimum wage increases. Ongoing costs will likely be lower assuming that the trainers only provide peer-to-peer training to new providers. (General Fund/federal fund)
2. Ongoing costs to DSS in the low hundreds of thousands of dollars for additional personnel to implement the provisions of the bill including adopting the peer-to-peer training course, verifying the occurrence of training, ensuring accurate reimbursement, and collaborating with relevant stakeholders. (General Fund)
3. Unknown, one-time costs to DSS to develop and adopt a process to compensate trainers.

COMMENTS:

In-Home Supportive Services: The IHSS program assists eligible low-income individuals in California who are at least 65 years old, living with disabilities, or blind, by providing for services that enable them to remain in their own homes. The program pays care providers to assist with personal care services (such as bathing, toileting, and grooming), domestic and related services (meal preparation, housecleaning, and the like), paramedical services, and protective supervision. As of January, there were 570,838 Californians who received IHSS; 98.5% of these individuals received it as a Medicaid benefit.

The IHSS program is overseen by DSS, and administered at the county level. After applying, applicants are assessed by a county social worker for eligibility and need. If determined eligible, an individual is authorized for certain services and number of hours of care. IHSS recipients are responsible for selecting, hiring, firing, directing, and supervising their IHSS workers. These responsibilities also include some administrative duties, such as scheduling and signing timesheets; however, the state handles payroll. As of January, there were 485,411 IHSS providers in California; 69% of these providers were relatives and 53% of these providers lived in the same residence as the recipient. Providers must complete an enrollment process that includes providing fingerprint images and submitting to a criminal background check. Prospective IHSS providers are also required to participate in an on-site orientation developed by DSS and the counties prior to receiving payment for services.

There have been a number of changes in recent years to certain aspects of the IHSS program that can create complications and confusion for providers. For example, the background paper from a November 2016 Senate Human Services Committee hearing on the state's IHSS payroll process noted the following;

Completing an IHSS timesheet is complicated. State-issued provider instructions are very detailed– they include '14 important steps' to avoid payment delays a list of 20 Dos and Don'ts for completing the timesheet. In addition to the complex instructions for filling in a timesheet, providers are required to perform somewhat complicated mathematical calculations to convert recipients' monthly authorized hours into weekly hours and then into decimal equation, and"

Layered on top of the complicated timesheet calculations are new standards that providers must follow in order to claim overtime hours. Repeated violation of these new standards could result in a provider being suspended from the IHSS program for a year, which has created some anxiety among providers and their recipients who are unused to the threat of suspension from the program for timesheet errors.

Need for this bill: According to the author, "Current practice and experience by the provider's employee representative organization(s) has shown a positive impact on provider retention and a reduction in errors when providers explain concepts in their own language. Establishing a compensated peer-to-peer training model in the IHSS program is necessary to minimize the care crisis our state will experience as the aging population continues to grow. [This bill] can provide much-needed assistance in addressing the care crisis in our state as well as the retention challenges experienced by this workforce."

GOVERNOR'S VETO MESSAGE:

This bill would establish a peer-to-peer training course for In-Home Supportive Services providers and require those providers who conduct the training to be compensated.

This bill is unnecessary because IHHS [sic] providers are currently required to attend a training program that covers virtually the same subjects listed in this bill.

Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089 FN: 0005360

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 2872

Author:(Carrillo)

As Amended Ver:August 17, 2018

Majority vote

Original Committee Reference: HUM. S.

SUMMARY: Establishes requirements regarding peer-to-peer training of In-Home Supportive Services (IHSS) providers by IHSS providers.

Specifically, this bill:

1. Requires the Department of Social Services (DSS) to, by July 1, 2019, and in consultation with employee representative organizations, adopt a process for compensating IHSS providers for conducting peer-to-peer training.
2. Requires the subject areas for peer-to-peer training to relate to the IHSS program and include, but not be limited to: how to enroll as a new provider, how to navigate the program, how to avoid making errors on timesheets, how to navigate policy changes to the program, and education on and promotion of other services that may help to lower administrative costs of the program.
3. Requires the peer-to-peer training to supplement, and not supplant, any other training provided by the county, a nonprofit consortium, or a public authority, as specified.
4. Requires attendance at the peer-to-peer training to be voluntary.
5. Requires DSS to designate the hours, per county, to compensate IHSS providers for educating other IHSS providers based on the presumption that every provider in the county may receive a maximum of two hours of peer-to-peer training in a group with no more than 10 total providers.
6. Requires a provider conducting peer-to-peer training to be compensated at the county's prevailing wage rate for IHSS providers, and stipulates that this requirement does not require compensation of attendees of the peer-to-peer training, including, but not limited to, providers and consumers.
7. Requires the hours worked by an IHSS provider educating other IHSS providers pursuant to the provisions of this bill to be reimbursed by DSS to the employee representative organization.
8. Prohibits the hours of education completed by an IHSS provider pursuant to the provisions of this bill from being included in a recipient's hours of service, and stipulates that the hours worked by a provider educating other providers pursuant to the provisions of this bill do not count toward the provider's workweek limits, as specified.
9. Requires DSS to:
   1. Verify, on a monthly basis, the number of authorized providers conducting training;
   2. Establish, by March 1, 2019, and in collaboration with employee representative organizations, a process by which an employee representative organization shall report the number of peer-to-peer hours submitted by a provider for reimbursement every month.
   3. Ensure, based on the process established with employee representative organizations, as specified by the provisions of this bill, that peer-to-peer hours are reimbursed to the employee representative organization for disbursement to the provider, by the 15th day of the following month.
   4. Increase or decrease, as of January 1, 2020, and each year thereafter, the designated annual peer-to-peer hours per county based on the provider turnover rate in that county from the previous year.

The Senate amendments:

1. Delete language requiring DSS to adopt a peer-to-peer training course for IHSS providers and instead add language that requires DSS to, by July 1, 2019, and in consultation with employee representative organizations, adopt a process for compensating IHSS providers for conducting peer-to-peer training.
2. Delete language that required DSS to ensure that, as of December 31, 2019, every authorized provider in a county has received at least two hours of peer-to-peer training and that, beginning on January 1, 2020, all new providers, or returning providers who have not yet received the training, receive at least two hours of peer-to-peer training within their first year of employment.
3. Add language that requires the peer-to-peer training to supplement, and not supplant, any other training provided by the county, a nonprofit consortium, or a public authority, as specified.
4. Add language that requires attendance at the peer-to-peer training to be voluntary.
5. Delete language requiring DSS to presume that every IHSS provider in the county shall receive at least two hours of peer-to-peer training and instead add language that requires DSS to presume that every provider in the county may receive a maximum of two hours of peer-to-peer training.
6. Add language stipulating that the requirement that providers conducting peer-to-peer training be compensated at the county's prevailing wage rate does not require compensation of attendees of the peer-to-peer training, including, but not limited to, providers and consumers.
7. Clarify that DSS is the party responsible for reimbursing employee representative organizations for hours worked by IHSS providers educating other IHSS providers.
8. Add a deadline of March 1, 2019, to this bill's requirement that DSS establish a process for reporting peer-to-peer hours, and remove the requirement that counties, public authorities, and nonprofit consortia be involved in the development of the process.
9. Revise language pertaining to reimbursements to employee representative organizations for peer-to-peer hours by:
   1. Clarifying that DSS must use the process established by the provisions of this bill for ensuring that hours are reimbursed;
   2. Removing language specifying that a county, nonprofit consortium, or public authority would disburse reimbursements to providers; and
   3. Changing from the 10^th of every month to the 15^th of the following month the date by which disbursement of reimbursements shall take place.
10. Add language that stipulates that the hours worked by a provider educating other providers pursuant to the provisions of this bill do not count toward the provider's workweek limits, as specified.

EXISTING LAW:

1. Establishes the IHSS program to provide supportive services, including domestic, protective supervision, personal care, and paramedical services as specified, to individuals who are aged, blind, or living with disabilities, and who are unable to perform the services themselves or remain safely in their homes without receiving these services. (Welfare and Institutions Code Section (WIC) 12300 et seq.)
2. Authorizes counties to choose to contract with a nonprofit consortium or establish a public authority for the provision of IHSS services. Requires nonprofit consortia and public authorities to, among other things, establish a registry to assist recipients in locating IHSS providers, and to investigate the background and qualifications of potential providers, as specified. (WIC 12301.6)
3. Maintains an IHSS recipient's right to hire, fire, and supervise the work of any IHSS provider, regardless of the employer responsibilities of a public authority or nonprofit consortium, as specified. (WIC 12301.6 (c))
4. Requires all prospective IHSS providers, at the time of enrollment, to complete an orientation developed by DSS in consultation with counties, and stipulates items that must be included in the orientation, including, among other things, a description of the IHSS program and the requirements, rules, regulations, policies, and procedures related to being an IHSS provider. (WIC 12301.24)

FISCAL EFFECT: According to the Senate Appropriations Committee on August 16, 2018, this bill may result in the following costs:

1. Estimated first-year costs to the DSS up to $1.5 million for a peer trainer for every 10 IHSS providers or $14.4 million for a peer trainer for every one IHSS provider. This estimate assumes compensation of $14.21 per hour (the statewide average individual provider cost per hour) for the training applying to the approximately 513,000 providers (or fraction thereof) that would become trainers. The actual costs will vary depending on the local prevailing wages, the actual ratio of trainers to providers, the frequency of training, and the number of authorized trainers, the number of providers who elect to attend trainings, and the total number of hours of training. These costs will also increase as the state minimum wage increases. Ongoing costs will likely be lower assuming that the trainers only provide peer-to-peer training to new providers. (General Fund/federal fund)
2. Ongoing costs to DSS in the low hundreds of thousands of dollars for additional personnel to implement the provisions of the bill including adopting the peer-to-peer training course, verifying the occurrence of training, ensuring accurate reimbursement, and collaborating with relevant stakeholders. (General Fund)
3. Unknown, one-time costs to DSS to develop and adopt a process to compensate trainers.

COMMENTS:

In-Home Supportive Services: The IHSS program assists eligible low-income individuals in California who are at least 65 years old, living with disabilities, or blind, by providing for services that enable them to remain in their own homes. The program pays care providers to assist with personal care services (such as bathing, toileting, and grooming), domestic and related services (meal preparation, housecleaning, and the like), paramedical services, and protective supervision. As of January, there were 570,838 Californians who received IHSS; 98.5% of these individuals received it as a Medicaid benefit.

The IHSS program is overseen by DSS, and administered at the county level. After applying, applicants are assessed by a county social worker for eligibility and need. If determined eligible, an individual is authorized for certain services and number of hours of care. IHSS recipients are responsible for selecting, hiring, firing, directing, and supervising their IHSS workers. These responsibilities also include some administrative duties, such as scheduling and signing timesheets; however, the state handles payroll. As of January, there were 485,411 IHSS providers in California; 69% of these providers were relatives and 53% of these providers lived in the same residence as the recipient. Providers must complete an enrollment process that includes providing fingerprint images and submitting to a criminal background check. Prospective IHSS providers are also required to participate in an on-site orientation developed by DSS and the counties prior to receiving payment for services.

There have been a number of changes in recent years to certain aspects of the IHSS program that can create complications and confusion for providers. For example, the background paper from a November 2016 Senate Human Services Committee hearing on the state's IHSS payroll process noted the following;

Completing an IHSS timesheet is complicated. State-issued provider instructions are very detailed– they include '14 important steps' to avoid payment delays a list of 20 Dos and Don'ts for completing the timesheet. In addition to the complex instructions for filling in a timesheet, providers are required to perform somewhat complicated mathematical calculations to convert recipients' monthly authorized hours into weekly hours and then into decimal equation, and"

Layered on top of the complicated timesheet calculations are new standards that providers must follow in order to claim overtime hours. Repeated violation of these new standards could result in a provider being suspended from the IHSS program for a year, which has created some anxiety among providers and their recipients who are unused to the threat of suspension from the program for timesheet errors.

Need for this bill: According to the author, "Current practice and experience by the provider's employee representative organization(s) has shown a positive impact on provider retention and a reduction in errors when providers explain concepts in their own language. Establishing a compensated peer-to-peer training model in the IHSS program is necessary to minimize the care crisis our state will experience as the aging population continues to grow. [This bill] can provide much-needed assistance in addressing the care crisis in our state as well as the retention challenges experienced by this workforce."

Analysis Prepared by FN: 0004620

 THIRD READING  

Bill No: AB 2872

Author:

Amended: 8/17/18 in Senate

Vote:

SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/26/18

AYES: Wiener, Leyva, McGuire, Nguyen, Portantino

NO VOTE RECORDED: Berryhill, Glazer

SENATE APPROPRIATIONS COMMITTEE: 5-2, 8/16/18

AYES: Portantino, Beall, Bradford, Hill, Wiener

NOES: Bates, Nielsen

ASSEMBLY FLOOR: 63-12, 5/30/18 - See last page for vote

SUBJECT:

SOURCE: SEIU California

DIGEST:

This establishes voluntary peer-to-peer training for In-home Supportive Services (IHSS) providers and a process through which IHSS providers who conduct the training will be compensated.

ANALYSIS:

Existing law:

1. Establishes the IHSS program to provide supportive services, including domestic, protective supervision, personal care, and paramedical services as specified, to individuals who are aged, blind, or living with disabilities, and who are unable to perform the services themselves or remain safely in their homes without receiving these services. (WIC 12300 et seq.)
2. Authorizes counties to choose to contract with a nonprofit consortium or establish a public authority for the provision of IHSS services. Requires nonprofit consortia and public authorities to, among other things, establish a registry to assist recipients in locating IHSS providers, and to investigate the background and qualifications of potential providers, as specified. (WIC 12301.6)
3. Maintains an IHSS recipient's right to hire, fire, and supervise the work of any IHSS provider, regardless of the employer responsibilities of a public authority or nonprofit consortium, as specified. (WIC 12301.6 (c))
4. Requires all prospective IHSS providers, at the time of enrollment, to complete an orientation developed by the California Department of Social Services (CDSS) in consultation with counties, and stipulates items that must be included in the orientation, including, among other things, a description of the IHSS program and the requirements, rules, regulations, policies, and procedures related to being an IHSS provider. (WIC 12301.24)
5. Requires that representatives of the recognized employee organization in the county shall be permitted to make a presentation of up to 30 minutes at the orientation. (WIC 12301.24(e)(4)

This bill:

1. Requires CDSS, in consultation with employee representative organizations, to adopt a process, on or before July 1, 2019, to compensate IHSS providers for conducting peer-to-peer training.
2. Requires the subject areas for peer-to-peer training to relate to the IHSS program and include, but not be limited to: how to enroll as a new provider, how to navigate the program, how to avoid making errors on timesheets, how to navigate policy changes to the program, and education on and promotion of other services that may help to lower administrative costs of the program.
3. Requires CDSS to ensure that the peer-to-peer training provided shall be complementary to, and not in place of, any other training provided by the county, a nonprofit consortium, or a public authority, as provided.
4. Requires CDSS to ensure that attendance at peer-to-peer trainings shall be voluntary.
5. Provides that CDSS shall designate the hours, per county, to compensate providers of IHSS for educating other providers of IHSS services based on a presumption that every authorized provider in a county may receive a maximum of two hours of peer-to-peer training in a group with no more than 10 total providers.
6. Requires the provider conducting the training be compensated at the county’s prevailing wage rate for providing IHSS, but does not require compensation to attendees, including, but not limited to, providers and consumers.
7. Requires CDSS to:
8. Verify, on a monthly basis, the number of authorized providers conducting training;
9. Reimburse the employee representative organization for the hours worked by a provider educating other providers;
10. Establish on or before March 1, 2019, in collaboration with employee representative organizations a process by which an employee representative organization shall report the number of peer-to-peer hours submitted by a provider for reimbursement every month.
11. Reimburse the employee representative organization for disbursement to the provider for peer-to-peer hours by no later than the 15th day of the month following their submission of hours to CDSS; and
12. Increase or decrease, as of January 1, 2020, and annually thereafter, the designated annual peer-to-peer hours per county based on the provider turnover rate in that county from the previous year.
13. Excludes the hours of education completed by an IHSS provider pursuant to the provisions of this bill from being included in the recipient’s hours of service, and also excludes the hours worked by a provider educating other providers from counting towards the providers workweek limits.

Background

According to the author, “Current practice and experience by the (IHSS) provider's employee representative organization(s) has shown a positive impact on provider retention and a reduction in errors when providers explain concepts in their own language. Establishing a compensated peer-to-peer training model in the IHSS program is necessary to minimize the care crisis our state will experience as the aging population continues to grow. This bill can provide much-needed assistance in addressing the care crisis in our state as well as the retention challenges experienced by this workforce.”

IHSS Program

The IHSS program provides in-home services for low-income aged, blind and disabled individuals who are unable to perform certain tasks themselves and who cannot safely remain in their homes unless these services are provided. IHSS is administered at the state level by CDSS and at the local level by counties.

The program pays care providers to assist with personal care services (such as bathing, toileting, and grooming), domestic and related services (meal preparation, housecleaning, and the like), paramedical services, and protective supervision. IHSS services also may include accompaniment to medical appointments, protective supervision for mentally-impaired recipients who may place themselves at risk of injury, hazard or accident and paramedical services, when directed by a physician.

Applicants for IHSS services must undergo an initial application and review process, during which a social worker will conduct a home visit and a needs assessment. Upon determining that an individual is eligible for IHSS services, the county social worker will notify the recipient of the monthly maximum authorized hours of care. IHSS recipients are responsible for selecting, hiring, firing, directing, and supervising their IHSS workers. These responsibilities also include some administrative duties, such as scheduling and signing timesheets; however, the state handles payroll. As of January 2018, over 570,000 Californians were receiving in-home care through IHSS; 98.5 percent of these individuals received it as a Medicaid benefit.

Applicants to be IHSS providers must complete an enrollment process, which includes submitting the necessary forms to the county and submitting fingerprint images to the Department of Justice for a criminal background check. Prospective IHSS providers are also required to participate in an on-site orientation developed by CDSS and the counties prior to receiving payment for services. Mandated content for the orientation includes the following:

• Description of the IHSS program;
• Rules, regulations, and provider-related processes and procedures, including timesheets;
• Consequences of committing fraud in the IHSS program;
• Medi-Cal toll-free telephone fraud hotline and Internet Web site for reporting suspected fraud or abuse in the provision or receipt of supportive services; and
• Applicable federal and state requirements regarding minimum wage and overtime pay, including paid travel time and wait time.

Additionally, representatives of the recognized employee organization in the county are required to be permitted to make a presentation of up to 30 minutes at the orientation

As of January 2018, there were over 485,000 IHSS providers in California. Of those, 69 percent were relatives of the IHSS recipients and 53 percent lived in the same residence as the recipient.

The IHSS program has grown from about 400,000 recipients in Fiscal Year (FY) 2007-08 to almost 500,000 in FY 2016-17. As California’s elderly population increases, this trend of increasing demand for IHSS is projected to continue in the coming years.

Changes in IHSS Program

Recent changes in the IHSS program have created complications and confusion for providers, according to the sponsor. For example, implementation of paid overtime continues to be a concern, because it was a major change to the provider’s documentation of hours and instituted penalties if providers did not comply with the new guidelines. Repeated violation of these new standards could result in a provider being suspended from the IHSS program for a year.

The program is also preparing to implement paid sick time and electronic visit verification (EVV). Both of which will likely have significant impact on IHSS providers and the potential to be somewhat complicated.

Beginning July 1, 2018, an IHSS provider who works 30 calendar days within one year from the implementation date or the commencement of employment (whichever is later) as an IHSS provider will earn eight hours of paid sick leave. After July 1, 2018, providers will earn eight hours of sick leave after they have worked for 100 hours. After an IHSS provider has worked 100 hours and earned his or her eight hours of paid sick leave, the provider must work an additional 200 hours, or 60 calendar days must pass after meeting the 100 hour requirement (whichever comes first), in order to use the eight hours of paid sick leave.

Recent changes in federal law (42 U.S.C. 1396b) require all states to implement EVV for Medicaid-funded (Medi-Cal in California) personal care services (IHSS in California) by January 2019 and home health care services by January 2023. EVV is a telephone and computer-based system that electronically verifies service visits occur. There is no prescribed solution from the federal government, so states can select and implement their own EVV design.  However, EVV systems must verify the following:

• type of service performed;
• individual receiving the services;
• date of the service;
• location of service delivery;
• individual providing the service; and
• time the service begins and ends.

The daily start and stop time and the type of service provided are not currently captured in the IHSS program. EVV functionality and policy has not yet been established, but must be in place by January 2019.

Implementing these types of changes for a statewide workforce of 500,000 is a large undertaking, but there are systems in place to administer such statewide changes. CDSS issues advisory notices and maintains a website that provides information for providers and recipients. At the local level, public authorities and county welfare offices have a more direct role in educating IHSS providers of program rules and procedures. Additionally, the labor organizations that represent this workforce provide training and information to their members. However, IHSS providers who conduct such training are not compensated via the IHSS program.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

According an analysis prepared by to the Senate Appropriations Committee, dated August 16, 2019, this bill presents the following costs:

• Estimated first-year costs to the CDSS up to $1.5 million for a peer trainer for every 10 IHSS providers or $14.4 million for a peer trainer for every one IHSS provider. This estimate assumes compensation of $14.21 per hour (the statewide average individual provider cost per hour) for the training applying to the approximately 513,000 providers (or fraction thereof) that would become trainers. The actual costs will vary depending on the local prevailing wages, the actual ratio of trainers to providers, the frequency of training, and the number of authorized trainers, the number of providers who elect to attend trainings, and the total number of hours of training. These costs will also increase as the state minimum wage increases. Ongoing costs will likely be lower assuming that the trainers only provide peer-to-peer training to new providers. (GF/federal fund)
• Ongoing costs to CDSS in the low hundreds of thousands of dollars for additional personnel to implement the provisions of the bill including adopting the peer-to-peer training course, verifying the occurrence of training, ensuring accurate reimbursement, and collaborating with relevant stakeholders. (GF)
• Unknown, one-time costs to CDSS to develop and adopt a process to compensate trainers.

SUPPORT: (Verified 8/17/18)

SEIU California (source)

California Labor Federation

UDW/AFSCME Local 3930

OPPOSITION: (Verified 8/17/18)

Department of Finance

ARGUMENTS IN SUPPORT: SEIU California, the sponsor of AB 2872, writes the following in support of this bill, “Establishing a peer-to-peer training model in the IHSS program is key and necessary to minimize the care crisis our state will experience as the aging population continues to grow. While there are ways established by the Department of Social Services (DSS) to administer IHSS policy changes statewide – mostly through the local public authority and county social workers – the best and most time/cost effective way to educate IHSS providers on changes to the program is to train experienced providers to conduct peer-to-peer learning sessions for new and existing IHSS providers who need assistance.”

ARGUMENTS IN OPPOSITION: The Department of Finance opposes the May 25, 2018 version of this bill because it results in significant ongoing General Fund costs to the state. Additionally, this bill raises an issue of duplicative efforts as current law already requires training similar to subjects outlined in the bill. Currently, IHSS providers are required to complete an orientation that includes training on how to navigate the IHSS program, how to avoid making errors on timesheets, how to navigate policy changes to the IHSS program, and how to enroll in direct deposit.

ASSEMBLY FLOOR: 63-12, 5/30/18

AYES: Acosta, Aguiar-Curry, Arambula, Baker, Berman, Bigelow, Bloom, Bonta, Burke, Caballero, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Chu, Cooley, Cooper, Cunningham, Daly, Eggman, Frazier, Friedman, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Lackey, Levine, Limón, Low, Maienschein, Mathis, McCarty, Medina, Mullin, Muratsuchi, Nazarian, O'Donnell, Quirk, Quirk-Silva, Reyes, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Waldron, Weber, Wood, Rendon

NOES: Travis Allen, Brough, Choi, Dahle, Fong, Gallagher, Harper, Kiley, Melendez, Obernolte, Patterson, Voepel

NO VOTE RECORDED: Chávez, Flora, Mayes

Prepared by:

8/19/18 13:40:21

**** END ****

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2017 - 2018 Regular Session

AB 2872 (Carrillo) - In-home supportive services: peer-to-peer training

Bill Summary:

AB 2872 would establish requirements for peer-to-peer training of In-home Supportive Services (IHSS) providers by IHSS providers.

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on August 16, 2018

Fiscal Impact:

• Estimated first-year costs to the California Department of Social Services (CDSS) up to $1.5 million for a peer trainer for every 10 IHSS providers or $14.4 million for a peer trainer for every one IHSS provider. This estimate assumes compensation of $14.21 per hour (the statewide average individual provider cost per hour) for the training applying to the approximately 513,000 providers (or fraction thereof) that would become trainers. The actual costs will vary depending on the local prevailing wages, the actual ratio of trainers to providers, the frequency of training, and the number of authorized trainers, the number of providers who elect to attend trainings, and the total number of hours of training. These costs will also increase as the state minimum wage increases. Ongoing costs will likely be lower assuming that the trainers only provide peer-to-peer training to new providers. (GF/federal fund)
• Ongoing costs to CDSS in the low hundreds of thousands of dollars for additional personnel to implement the provisions of the bill including adopting the peer-to-peer training course, verifying the occurrence of training, ensuring accurate reimbursement, and collaborating with relevant stakeholders. (GF)
• Unknown, one-time costs to CDSS to develop and adopt a process to compensate trainers.

Author Amendments:

Require CDSS to develop a compensation method for trainers. Specify that the peer-to-peer training is voluntary. Clarify that attendees do not receive compensation and that attendees may receive a maximum of two hours of training.

-- END --

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2017 - 2018 Regular Session

AB 2872 (Carrillo) - In-home supportive services: peer-to-peer training

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

AB 2872 would establish requirements for peer-to-peer training of In-home Supportive Services (IHSS) providers by IHSS providers.

Fiscal Impact:

• Estimated first-year costs to the California Department of Social Services (CDSS) ranging from $1.5 million for a peer trainer for every 10 IHSS providers to $14.4 million for a peer trainer for every one IHSS provider. This estimate assumes compensation of $14.21 per hour (the statewide average individual provider cost per hour) for the training applying to the approximately 513,000 providers (or fraction thereof) that would become trainers. The actual costs will vary depending on the local prevailing wages, the actual ratio of trainers to providers, the frequency of training, and the number of authorized trainers. These costs will also increase as the state minimum wage increases. Ongoing costs will likely be lower assuming that the trainers only provide peer-to-peer training to new providers. (GF/federal fund)
• Ongoing costs to CDSS in the low hundreds of thousands of dollars for additional personnel to implement the provisions of the bill including adopting the peer-to-peer training course, verifying the occurrence of training, ensuring accurate reimbursement, and collaborating with relevant stakeholders. (GF)
• Unknown, potential significant costs to CDSS to update the Case Management, Information and Payrolling System (CMIPS) to accommodate the new payment type.

Background:

The IHSS program provides in-home services for low-income aged, blind and disabled individuals who are unable to perform certain tasks themselves and who cannot safely remain in their homes unless these services are provided. IHSS is administered at the state level by CDSS and at the local level by counties.

Applicants wishing to be IHSS providers must complete an enrollment process, which includes submitting the necessary forms to the county and submitting fingerprint images to the Department of Justice for a criminal background check. Prospective IHSS providers are also required to participate in an on-site orientation developed by CDSS and the counties prior to receiving payment for services. As of January 2018, there were over 485,000 IHSS providers in California. Of those, 69% were relatives of the IHSS recipients and 53% lived in the same residence as the recipient.

Proposed Law:

This bill would:

• Require CDSS to adopt a peer-to-peer training course for providers of IHSS, as specified;
• Require the subject areas for peer-to-peer training to relate to the IHSS program, as specified;
• Require CDSS to ensure that, as of December 31, 2019, every authorized provider in a county has received at least two hours of peer-to-peer training and that, beginning on January 1, 2020, all new providers, or returning providers who have not yet received the training, receive at least two hours of peer-to-peer training within their first year of employment;
• Require CDSS to designate the hours, per county, to compensate IHSS providers for educating other IHSS providers based on the presumption that every provider in the county shall receive at least two hours of peer-to-peer training, as specified, in a group with no more than 10 total providers;
• Require a provider conducting peer-to-peer training to be compensated at the county’s prevailing wage rate for IHSS providers;
• Require the hours worked by an IHSS provider educating other IHSS providers pursuant to the provisions of this bill to be reimbursed to the employee representative organization;
• Prohibit the hours of education completed by an IHSS provider pursuant to the provisions of this bill from being included in a recipient's hours of service;
• Require CDSS to:
  • • Verify, on a monthly basis, the number of authorized providers conducting training;
    • Ensure that peer-to-peer hours are reimbursed to the employee representative organization for disbursement to the provider by the county, nonprofit consortium, or public authority, as specified, by the 10^th day of every month;
    • Establish, in collaboration with counties, public authorities, nonprofit consortia, and employee representative organizations, a process by which an employee representative organization shall report the number of peer-to-peer hours submitted by a provider for reimbursement every month;
    • Increase or decrease, as of January 1, 2020, and annually thereafter, the designated annual peer-to-peer hours per county based on the provider turnover rate in that county from the previous year.

Staff Comments:

It should be noted that any provider can be a trainer or a trainee, depending on the scenario. The fiscal estimate for compensation for trainers assumes that 2 hours of compensation are given to those providers that are educating other providers of in-home supportive services. This estimate does not assume that the IHSS providers who receive the peer-to-peer training will be compensated for their time in training.

Staff notes that CMIPS – the IT system that provides functions for case management for IHSS recipients, payroll for service providers, reporting, and customer support – is not designed to issue provider payments for anything not associated with IHSS authorized service hours. If CMIPS were to be required to issue these types of payments, there would need to be a substantial system change.

-- END --

SENATE COMMITTEE ON HUMAN SERVICES

Senator Wiener, Chair

2017 - 2018 Regular

Bill No: AB 2872

Subject: In-home supportive services: peer-to-peer training.

SUMMARY

This bill establishes requirements for peer-to-peer training of In-home Supportive Services (IHSS) providers by IHSS providers.

ABSTRACT

Existing law:

1. Establishes the IHSS program to provide supportive services, including domestic, protective supervision, personal care, and paramedical services as specified, to individuals who are aged, blind, or living with disabilities, and who are unable to perform the services themselves or remain safely in their homes without receiving these services. (WIC 12300 et seq.)
2. Authorizes counties to choose to contract with a nonprofit consortium or establish a public authority for the provision of IHSS services. Requires nonprofit consortia and public authorities to, among other things, establish a registry to assist recipients in locating IHSS providers, and to investigate the background and qualifications of potential providers, as specified. (WIC 12301.6)
3. Maintains an IHSS recipient's right to hire, fire, and supervise the work of any IHSS provider, regardless of the employer responsibilities of a public authority or nonprofit consortium, as specified. (WIC 12301.6 (c))
4. Requires all prospective IHSS providers, at the time of enrollment, to complete an orientation developed by the California Department of Social Services (CDSS) in consultation with counties, and stipulates items that must be included in the orientation, including, among other things, a description of the IHSS program and the requirements, rules, regulations, policies, and procedures related to being an IHSS provider. (WIC 12301.24)
5. Requires that representatives of the recognized employee organization in the county shall be permitted to make a presentation of up to 30 minutes at the orientation. (WIC 12301.24(e)(4)

This bill:

1. Requires CDSS to adopt a peer-to-peer training course for providers of IHSS, as specified.
2. Requires the subject areas for peer-to-peer training to relate to the IHSS program and include, but not be limited to: how to enroll as a new provider, how to navigate the program, how to avoid making errors on timesheets, how to navigate policy changes to the program, and education on and promotion of other services that may help to lower administrative costs of the program.
3. Requires CDSS to ensure that, as of December 31, 2019, every authorized provider in a county has received at least two hours of peer-to-peer training and that, beginning on January 1, 2020, all new providers, or returning providers who have not yet received the training, receive at least two hours of peer-to-peer training within their first year of employment.
4. Requires CDSS to designate the hours, per county, to compensate IHSS providers for educating other IHSS providers based on the presumption that every provider in the county shall receive at least two hours of peer-to-peer training, as specified, in a group with no more than 10 total providers.
5. Requires a provider conducting peer-to-peer training to be compensated at the county’s prevailing wage rate for IHSS providers.
6. Requires the hours worked by an IHSS provider educating other IHSS providers pursuant to the provisions of this bill to be reimbursed to the employee representative organization.
7. Prohibits the hours of education completed by an IHSS provider pursuant to the provisions of this bill from being included in a recipient's hours of service.
8. Requires CDSS to:
   • 1. Verify, on a monthly basis, the number of authorized providers conducting training;
     2. Ensure that peer-to-peer hours are reimbursed to the employee representative organization for disbursement to the provider by the county, nonprofit consortium, or public authority, as specified, by the 10^th day of every month.
     3. Establish, in collaboration with counties, public authorities, nonprofit consortia, and employee representative organizations, a process by which an employee representative organization shall report the number of peer-to-peer hours submitted by a provider for reimbursement every month.
     4. Increase or decrease, as of January 1, 2020, and annually thereafter, the designated annual peer-to-peer hours per county based on the provider turnover rate in that county from the previous year.

FISCAL IMPACT

According to the Assembly Appropriations Committee on May 25, 2018, this bill may result in the following costs:

1. Ongoing costs to CDSS in the range of $250,000 to $300,000 (General Fund [GF]) annually for three positions to implement and carry out the requirements of the bill;
2. Estimated first-year costs to CDSS of $1 million (federal funds/GF) to compensate the trainers statewide. This assumes one trainer for every ten providers and compensation of $12 per hour. Actual costs will vary depending on local prevailing wages, the frequency of training, and the number of authorized trainers, and will increase as the state minimum wage increases. Ongoing costs will likely be lower assuming the trainers only provide peer-to-peer training to new providers;
3. Unknown costs for training and authorizing the trainers, which this bill does not specify; and
4. This bill does not specify whether the IHSS providers who receive the peer-to-peer training will be compensated for their time in training. If providers are each compensated for two hours, the cost would be in the low millions of dollars (federal funds/GF) for existing providers to receive the peer-to-peer training. Ongoing costs would be substantially lower assuming only new IHSS providers would receive this training.

BACKGROUND AND DISCUSSION

Purpose of the bill:

According to the author, “Current practice and experience by the (IHSS) provider's employee representative organization(s) has shown a positive impact on provider retention and a reduction in errors when providers explain concepts in their own language. Establishing a compensated peer-to-peer training model in the IHSS program is necessary to minimize the care crisis our state will experience as the aging population continues to grow. This bill can provide much-needed assistance in addressing the care crisis in our state as well as the retention challenges experienced by this workforce.”

In-Home Supportive Services (IHSS)

The IHSS program provides in-home services for low-income aged, blind and disabled individuals who are unable to perform certain tasks themselves and who cannot safely remain in their homes unless these services are provided. IHSS is administered at the state level by CDSS and at the local level by counties.

The program pays care providers to assist with personal care services (such as bathing, toileting, and grooming), domestic and related services (meal preparation, housecleaning, and the like), paramedical services, and protective supervision. IHSS services also may include accompaniment to medical appointments, protective supervision for mentally-impaired recipients who may place themselves at risk of injury, hazard or accident and paramedical services, when directed by a physician.

Applicants for IHSS services must undergo an initial application and review process, during which a social worker will conduct a home visit and a needs assessment. Upon determining that an individual is eligible for IHSS services, the county social worker will notify the recipient of the monthly maximum authorized hours of care. IHSS recipients are responsible for selecting, hiring, firing, directing, and supervising their IHSS workers. These responsibilities also include some administrative duties, such as scheduling and signing timesheets; however, the state handles payroll. As of January 2018, over 570,000 Californians were receiving in-home care through IHSS; 98.5 percent of these individuals received it as a Medicaid benefit.

Applicants to be IHSS providers must complete an enrollment process, which includes submitting the necessary forms to the county and submitting fingerprint images to the Department of Justice for a criminal background check. Prospective IHSS providers are also required to participate in an on-site orientation developed by CDSS and the counties prior to receiving payment for services. Mandated content for the orientation includes the following:

• Description of the IHSS program;
• Rules, regulations, and provider-related processes and procedures, including timesheets;
• Consequences of committing fraud in the IHSS program;
• Medi-Cal toll-free telephone fraud hotline and Internet Web site for reporting suspected fraud or abuse in the provision or receipt of supportive services; and
• Applicable federal and state requirements regarding minimum wage and overtime pay, including paid travel time and wait time.

Additionally, representatives of the recognized employee organization in the county are required to be permitted to make a presentation of up to 30 minutes at the orientation

As of January 2018, there were over 485,000 IHSS providers in California. Of those, 69 percent were relatives of the IHSS recipients and 53 percent lived in the same residence as the recipient.

The IHSS program has grown from about 400,000 recipients in Fiscal Year (FY) 2007-08 to almost 500,000 in FY 2016-17. As California’s elderly population increases, this trend of increasing demand for IHSS is projected to continue in the coming years.

Changes in IHSS Program

Recent changes in the IHSS program have created complications and confusion for providers, according to the sponsor. For example, implementation of paid overtime continues to be a concern, because it was a major change to the provider’s documentation of hours and instituted penalties if providers did not comply with the new reporting guidelines. Repeated violation of these new standards could result in a provider being suspended from the IHSS program for a year.

The program is also preparing to implement paid sick time and electronic visit verification (EVV). Both of which will likely have significant impact on IHSS providers.

Beginning July 1, 2018, an IHSS provider who works 30 calendar days within one year from the implementation date or the commencement of employment (whichever is later) as an IHSS provider will earn eight hours of paid sick leave. After July 1, 2018, providers will earn eight hours of sick leave after they have worked for 100 hours. After an IHSS provider has worked 100 hours and earned his or her eight hours of paid sick leave, the provider must work an additional 200 hours, or 60 calendar days must pass after meeting the 100 hour requirement (whichever comes first), in order to use the eight hours of paid sick leave.

Recent changes in federal law (42 U.S.C. 1396b) require all states to implement EVV for Medicaid-funded (Medi-Cal in California) personal care services (IHSS in California) by January 2019 and home health care services by January 2023. EVV is a telephone and computer-based system that electronically verifies service visits occur. There is no prescribed solution from the federal government, so states can select and implement their own EVV design.  However, EVV systems must verify the following:

• type of service performed;
• individual receiving the services;
• date of the service;
• location of service delivery;
• individual providing the service; and
• time the service begins and ends.

The daily start and stop time and the type of service provided are not currently captured in the IHSS program. EVV functionality and policy has not yet been established, but must be in place by January 2019.

Implementing these types of changes for a statewide workforce of 500,000 is a large undertaking, but there are systems in place to administer such statewide changes. CDSS issues advisory notices and maintains a website that provides information for providers and recipients. At the local level, public authorities and county welfare offices have a more direct role in educating IHSS providers of program rules and procedures. Additionally, the labor organizations that represent this workforce provide training and information to their members. However, IHSS providers who conduct such training are not compensated via the IHSS program.

Related legislation:

AB 1909 (Nazarian, 2018) clarifies that CDSS is required to provide translations of written content, as defined, in languages spoken by a substantial number of IHSS providers. This bill is currently in Senate Appropriations Committee.

AB 3082 (Gonzalez Fletcher, 2018) requires the CDSS to establish a policy to address sexual harassment of providers of IHSS and to report a summary of this policy to the Legislature. This bill is scheduled to be heard in this Committee on June 26, 2018.

SB 878 (Senate Committee on Budget and Fiscal Review, Chapter 689, Statutes of 2014) required new components be included in the mandated orientation for prospective IHSS providers and adopted new requirements for the orientation, including, among other things, that oral presentations and written materials be translated into all IHSS threshold languages in a county.

ABX4-19 (Evans, Chapter 17, Statutes of 2009) among other things, required, all prospective IHSS providers to complete a provider orientation covering a number of specified topics at the time of enrollment, as specified.

COMMENTS

As discussed in the analysis by the Assembly Committee on Appropriations, the bill does not specify how authorized trainers will be compensated for the training hours they spend becoming qualified to provide the peer-to-peer training, nor does the bill specify whether the IHSS providers who receive the mandatory peer-to-peer training will be compensated for their time in training. This committee has also identified the following issues that warrant clarification.

1. How will the peer-to-peer training interact with the current mandatory orientation? Will it supplement or supplant it?
2. Will there be a mechanism in place for tracking training compliance, wages earned and payments made?
3. How will the paid hours for training affect overtime rules?
4. What kind of quality assurances will be in place to ensure the training content and the providers of training are meeting the purpose of the program?
5. There is currently no mechanism for paying a third party through the IHSS program. This may be an issue that requires further consultation with CDSS.

Should this bill pass out of this committee, the author has agreed to continue working on these issues as the bill moves forward.

PRIOR VOTES

POSITIONS

Support:

SEIU California (sponsor)

California Labor Federation

UDW/AFSCEM Local 3930

Oppose:

None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 2872

Author:(Carrillo)

As Amended Ver:May 25, 2018

Majority vote

SUMMARY: Establishes requirements regarding peer-to-peer training of In-home Supportive Services (IHSS) providers by IHSS providers.

Specifically, this bill:

1. Requires the Department of Social Services (DSS) to adopt a peer-to-peer training course for providers of IHSS.
2. Requires the subject areas for peer-to-peer training to relate to the IHSS program and include, but not be limited to: how to enroll as a new provider, how to navigate the program, how to avoid making errors on timesheets, how to navigate policy changes to the program, and education on and promotion of other services that may help to lower administrative costs of the program.
3. Requires DSS to ensure that, as of December 31, 2019, every authorized provider in a county has received at least two hours of peer-to-peer training and that, beginning on January 1, 2020, all new providers, or returning providers who have not yet received the training, receive at least two hours of peer-to-peer training within their first year of employment.
4. Requires DSS to designate the hours, per county, to compensate IHSS providers for educating other IHSS providers based on the presumption that every provider in the county shall receive at least two hours of peer-to-peer training, as specified, in a group with no more than 10 total providers.
5. Requires a provider conducting peer-to-peer training to be compensated at the county’s prevailing wage rate for IHSS providers.
6. Requires the hours worked by an IHSS provider educating other IHSS providers pursuant to the provisions of this bill to be reimbursed to the employee representative organization.
7. Prohibits the hours of education completed by an IHSS provider pursuant to the provisions of this bill from being included in a recipient's hours of service.
8. Requires DSS to:
   1. Verify, on a monthly basis, the number of authorized providers conducting training;
   2. Ensure that peer-to-peer hours are reimbursed to the employee representative organization for disbursement to the provider by the county, nonprofit consortium, or public authority, as specified, by the 10^th day of every month.
   3. Establish, in collaboration with counties, public authorities, nonprofit consortia, and employee representative organizations, a process by which an employee representative organization shall report the number of peer-to-peer hours submitted by a provider for reimbursement every month.
   4. Increase or decrease, as of January 1, 2020, and each year thereafter, the designated annual peer-to-peer hours per county based on the provider turnover rate in that county from the previous year.

EXISTING LAW:

1. Establishes the IHSS program to provide supportive services, including domestic, protective supervision, personal care, and paramedical services as specified, to individuals who are aged, blind, or living with disabilities, and who are unable to perform the services themselves or remain safely in their homes without receiving these services. (Welfare and Institutions Code Section (WIC) 12300 et seq.)
2. Authorizes counties to choose to contract with a nonprofit consortium or establish a public authority for the provision of IHSS services. Requires nonprofit consortia and public authorities to, among other things, establish a registry to assist recipients in locating IHSS providers, and to investigate the background and qualifications of potential providers, as specified. (WIC 12301.6)
3. Maintains an IHSS recipient's right to hire, fire, and supervise the work of any IHSS provider, regardless of the employer responsibilities of a public authority or nonprofit consortium, as specified. (WIC 12301.6 (c))
4. Requires all prospective IHSS providers, at the time of enrollment, to complete an orientation developed by DSS in consultation with counties, and stipulates items that must be included in the orientation, including, among other things, a description of the IHSS program and the requirements, rules, regulations, policies, and procedures related to being an IHSS provider. (WIC 12301.24)

FISCAL EFFECT: According to the Assembly Appropriations Committee on May 25, 2018, this bill may result in the following costs:

1. Ongoing costs to DSS in the range of $250,000 to $300,000 (General Fund [GF]) annually for three positions to implement and carry out the requirements of the bill;
2. Estimated first-year costs to DSS of $1 million (federal funds/GF) to compensate the trainers statewide. This assumes one trainer for every ten providers and compensation of $12 per hour. Actual costs will vary depending on local prevailing wages, the frequency of training, and the number of authorized trainers, and will increase as the state minimum wage increases. Ongoing costs will likely be lower assuming the trainers only provide peer-to-peer training to new providers;
3. Unknown costs for training and authorizing the trainers, which this bill does not specify; and
4. This bill does not specify whether the IHSS providers who receive the peer-to-peer training will be compensated for their time in training. If providers are each compensated for two hours, the cost would be in the low millions of dollars (federal funds/GF) for existing providers to receive the peer-to-peer training. Ongoing costs would be substantially lower assuming only new IHSS providers would receive this training.

COMMENTS:

In-Home Supportive Services: The IHSS program assists eligible low-income individuals in California who are at least 65 years old, living with disabilities, or blind, by providing for services that enable them to remain in their own homes. The program pays care providers to assist with personal care services (such as bathing, toileting, and grooming), domestic and related services (meal preparation, housecleaning, and the like), paramedical services, and protective supervision. As of January, there were 570,838 Californians who received IHSS; 98.5% of these individuals received it as a Medicaid benefit.

The IHSS program is overseen by DSS, and administered at the county level. After applying, applicants are assessed by a county social worker for eligibility and need. If determined eligible, an individual is authorized for certain services and number of hours of care. IHSS recipients are responsible for selecting, hiring, firing, directing, and supervising their IHSS workers. These responsibilities also include some administrative duties, such as scheduling and signing timesheets; however, the state handles payroll. As of January, there were 485,411 IHSS providers in California; 69% of these providers were relatives and 53% of these providers lived in the same residence as the recipient. Providers must complete an enrollment process that includes providing fingerprint images and submitting to a criminal background check. Prospective IHSS providers are also required to participate in an on-site orientation developed by DSS and the counties prior to receiving payment for services.

There have been a number of changes in recent years to certain aspects of the IHSS program that can create complications and confusion for providers. For example, the background paper from a November 2016 Senate Human Services Committee hearing on the state's IHSS payroll process noted the following;

Completing an IHSS timesheet is complicated. State-issued provider instructions are very detailed– they include ‘14 important steps’ to avoid payment delays a list of 20 Dos and Don’ts for completing the timesheet. In addition to the complex instructions for filling in a timesheet, providers are required to perform somewhat complicated mathematical calculations to convert recipients’ monthly authorized hours into weekly hours and then into decimal equation, and"

Layered on top of the complicated timesheet calculations are new standards that providers must follow in order to claim overtime hours. Repeated violation of these new standards could result in a provider being suspended from the IHSS program for a year, which has created some anxiety among providers and their recipients who are unused to the threat of suspension from the program for timesheet errors.

Need for this bill: According to the author, “Current practice and experience by the provider's employee representative organization(s) has shown a positive impact on provider retention and a reduction in errors when providers explain concepts in their own language. Establishing a compensated peer-to-peer training model in the IHSS program is necessary to minimize the care crisis our state will experience as the aging population continues to grow. [This bill] can provide much-needed assistance in addressing the care crisis in our state as well as the retention challenges experienced by this workforce.”

Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089 FN: 0003405

Date of Hearing: April 25, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 2872

Author:(Carrillo) – As Amended Ver:April 3, 2018

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

SUMMARY:

This bill establishes requirements for peer-to-peer training of In-Home Supportive Services (IHSS) providers by IHSS providers. Specifically, this bill:

1. Requires DSS to designate the hours, for each county, to compensate IHSS providers for conducting peer-to-peer training assuming that every provider in the county must receive at least two hours of peer-to-peer training in a group with no more than 10 providers.
2. Requires a provider conducting peer-to-peer training to be compensated at the county’s prevailing wage rate for IHSS providers.
3. Requires the hours worked by an IHSS provider training other IHSS providers be reimbursed to the employee representative organization.
4. Prohibits the hours of training completed by an IHSS provider pursuant to the provisions of this bill from being included in a recipient’s hours of service.
5. Requires DSS to:
   1. Verify, on a monthly basis, the number of authorized providers conducting training.
   2. Ensure that peer-to-peer hours are reimbursed to the employee representative organization for disbursement to the provider by the county, nonprofit consortium, or public authority, as specified, by the 10^th day of every month.
   3. Establish, in collaboration with counties, public authorities, nonprofit consortia, and employee representative organizations, a process by which an employee representative organization can report the number of peer-to-peer hours submitted by a provider for reimbursement every month.
   4. Increase or decrease, as of January 1, 2020, and each year thereafter, the designated annual peer-to-peer hours per county based on the provider turnover rate in that county from the previous year.

FISCAL EFFECT:

1. Ongoing costs to DSS in the range of $250,000 to $300,000 (GF) annually for three positions to implement and carry out the requirements of the bill.
2. Estimated first-year costs to DSS of $1 million (federal funds/GF) to compensate the trainers statewide. This assumes one trainer for every ten providers and compensation of $12 per hour. Actual costs will vary depending on local prevailing wages, the frequency of training, and the number of authorized trainers, and will increase as the state minimum wage increases. Ongoing costs will likely be lower assuming the trainers only provide peer-to-peer training to new providers.
3. Unknown costs for training and authorizing the trainers, which this bill does not specify.
4. The bill does not specify whether the IHSS providers who receive the peer-to-peer training will be compensated for their time in training. If providers are each compensated for two hours, the cost would be in the low millions of dollars (federal funds/GF) for existing providers to receive the peer-to-peer training. Ongoing costs would be substantially lower assuming only new IHSS providers would receive this training.

COMMENTS:

1. Purpose. This bill seeks to improve the retention of IHSS providers by establishing a peer-to-peer training program. According to the author:

Current practice and experience by the provider’s employee representative organization(s) has shown a positive impact on provider retention and a reduction in errors when providers explain concepts in their own language. Establishing a compensated peer-to-peer training model in the IHSS program is necessary to minimize the care crisis our state will experience as the aging population continues to grow. [This bill] can provide much-needed assistance in addressing the care crisis in our state as well as the retention challenges experienced by this workforce.

1. Background. The IHSS program assists eligible low-income individuals in California who are at least 65 years old, living with disabilities, or blind, by providing for services that enable them to remain in their own homes. The program pays care providers to assist with personal care services (such as bathing, toileting, and grooming), domestic and related services (meal preparation, housecleaning, and the like), paramedical services, and protective supervision.

The IHSS program is overseen by DSS and administered at the county level. Applicants are assessed by a county social worker for eligibility and need. If determined eligible, an individual is authorized for certain services and number of hours of care. IHSS recipients are responsible for selecting, hiring, firing, directing, and supervising their IHSS workers, including some administrative duties, such as scheduling and signing timesheets. The state handles payroll.

As of January, there were 485,411 IHSS providers in California. Sixty-nine percent of these providers were relatives and 53% lived in the same residence as the recipient. Providers must complete an enrollment process that includes providing fingerprint images and submitting to a criminal background check. Prospective IHSS providers must also participate in an on-site orientation developed by DSS and the counties prior to receiving payment for services.

This bill adds additional training requirements for IHSS providers.

1. Prior Legislation.

SB 878 (Senate Committee on Budget and Fiscal Review), Chapter 689, Statutes of 2014, required new components be included in the mandated orientation for prospective IHSS providers and adopted new requirements for the orientation, including, among other things, that oral presentations and written materials be translated into all IHSS threshold languages in a county.

ABX4-19 (Evans), Chapter 17, Statutes of 2009, among other things, requires, all prospective IHSS providers to complete a provider orientation covering a number of specified topics at the time of enrollment.

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

Date of Hearing: April 10, 2018

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Blanca Rubio, Chair

ABPCA Bill Id:AB 2872 (

Author:Carrillo) – As Amended Ver:April 3, 2018

SUBJECT: In-home supportive services: peer-to-peer training

SUMMARY: Establishes requirements regarding peer-to-peer training of In-home Supportive Services (IHSS) providers by IHSS providers.

Specifically, this bill:

1. Requires the Department of Social Services (DSS) to designate the hours, for each county, to compensate IHSS providers for educating other IHSS providers using peer-to-peer training and requires the designated number of hours to be based on the presumption that every provider in the county shall receive at least two hours of peer-to-peer training in a group with no more than 10 providers.
2. Requires the subject areas for peer-to-peer training to relate to the IHSS program and include, but not be limited to: how to enroll as a new provider, how to navigate the program, how to avoid making errors on timesheets, and how to navigate policy changes to the program.
3. Requires a provider conducting peer-to-peer training to be compensated at the county’s prevailing wage rate for IHSS providers.
4. Requires the hours worked by an IHSS provider educating other IHSS providers pursuant to the provisions of this bill to be reimbursed to the employee representative organization.
5. Prohibits the hours of education completed by an IHSS provider pursuant to the provisions of this bill from being included in a recipient’s hours of service.
6. Requires DSS to:
   1. Verify, on a monthly basis, the number of authorized providers conducting training;
   2. Ensure that peer-to-peer hours are reimbursed to the employee representative organization for disbursement to the provider by the county, nonprofit consortium, or public authority, as specified, by the 10^th day of every month.
   3. Establish, in collaboration with counties, public authorities, nonprofit consortia, and employee representative organizations, a process by which an employee representative organization shall report the number of peer-to-peer hours submitted by a provider for reimbursement every month.
   4. Increase or decrease, as of January 1, 2020, and each year thereafter, the designated annual peer-to-peer hours per county based on the provider turnover rate in that county from the previous year.

EXISTING LAW:

1. Establishes the IHSS program to provide supportive services, including domestic, protective supervision, personal care, and paramedical services as specified, to individuals who are aged, blind, or living with disabilities, and who are unable to perform the services themselves or remain safely in their homes without receiving these services. (WIC 12300 et seq.)
2. Authorizes counties to choose to contract with a nonprofit consortium or establish a public authority for the provision of IHSS services. Requires nonprofit consortia and public authorities to, among other things, establish a registry to assist recipients in locating IHSS providers, and to investigate the background and qualifications of potential providers, as specified. (WIC 12301.6)
3. Maintains an IHSS recipient’s right to hire, fire, and supervise the work of any IHSS provider, regardless of the employer responsibilities of a public authority or nonprofit consortium, as specified. (WIC 12301.6 (c))
4. Requires all prospective IHSS providers, at the time of enrollment, to complete an orientation developed by DSS in consultation with counties, and stipulates items that must be included in the orientation, including, among other things, a description of the IHSS program and the requirements, rules, regulations, policies, and procedures related to being an IHSS provider. (WIC 12301.24)

FISCAL EFFECT: Unknown.

COMMENTS:

In-Home Supportive Services: The IHSS program assists eligible low-income individuals in California who are at least 65 years old, living with disabilities, or blind, by providing for services that enable them to remain in their own homes. The program pays care providers to assist with personal care services (such as bathing, toileting, and grooming), domestic and related services (meal preparation, housecleaning, and the like), paramedical services, and protective supervision. As of January, there were 570,838 Californians who received IHSS; 98.5% of these individuals received it as a Medicaid benefit.

The IHSS program is overseen by DSS, and administered at the county level. After applying, applicants are assessed by a county social worker for eligibility and need. If determined eligible, an individual is authorized for certain services and number of hours of care. IHSS recipients are responsible for selecting, hiring, firing, directing, and supervising their IHSS workers. These responsibilities also include some administrative duties, such as scheduling and signing timesheets; however, the state handles payroll. As of January, there were 485,411 IHSS providers in California; 69% of these providers were relatives and 53% of these providers lived in the same residence as the recipient. Providers must complete an enrollment process that includes providing fingerprint images and submitting to a criminal background check. Prospective IHSS providers are also required to participate in an on-site orientation developed by DSS and the counties prior to receiving payment for services.

There have been a number of changes in recent years to certain aspects of the IHSS program that can create complications and confusion for providers. For example, the background paper from a November 2016 Senate Human Services Committee hearing on the state’s IHSS payroll process noted the following;

“Completing an IHSS timesheet is complicated. State-issued provider instructions are very detailed– they include ‘14 important steps’ to avoid payment delays a list of 20 Dos and Don’ts for completing the timesheet. In addition to the complex instructions for filling in a timesheet, providers are required to perform somewhat complicated mathematical calculations to convert recipients’ monthly authorized hours into weekly hours and then into decimal equation,” and

“Layered on top of the complicated timesheet calculations are new standards that providers must follow in order to claim overtime hours. Repeated violation of these new standards could result in a provider being suspended from the IHSS program for a year, which has created some anxiety among providers and their recipients who are unused to the threat of suspension from the program for timesheet errors.”

Need for this bill: According to the author, “Current practice and experience by the provider’s employee representative organization(s) has shown a positive impact on provider retention and a reduction in errors when providers explain concepts in their own language. Establishing a compensated peer-to-peer training model in the IHSS program is necessary to minimize the care crisis our state will experience as the aging population continues to grow. [This bill] can provide much-needed assistance in addressing the care crisis in our state as well as the retention challenges experienced by this workforce.”

PRIOR LEGISLATION:

SB 878 (Senate Committee on Budget and Fiscal Review), Chapter 689, Statutes of 2014, required new components be included in the mandated orientation for prospective IHSS providers and adopted new requirements for the orientation, including, among other things, that oral presentations and written materials be translated into all IHSS threshold languages in a county.

ABX4-19 (Evans), Chapter 17, Statutes of 2009, among other things, required, all prospective IHSS providers to complete a provider orientation covering a number of specified topics at the time of enrollment, as specified.

REGISTERED SUPPORT / OPPOSITION:

Support

UDW/AFSCME Local 3930

SEIU of California

Opposition

None on file.

Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089