GOVERNOR'S VETO

GV Bill Id:AB 550

Author:(Flora and Berman)

As Enrolled Ver:September 13, 2019

2/3 vote

SUMMARY:

This bill authorizes, as a pilot project until January 1, 2023, a United States Department of Veterans Affairs (USDVA) facility to establish medical foster homes (MFH) for older and medically frail veterans that are not subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act, as specified.

The Senate Amendments:

Require that the USDVA facility establishing a medical foster home verify during monthly checks that home caregivers or other adults living in the home, other than veteran residents, are registered as independent home care aides

Governor’s Veto Message:

This bill would authorize a Medical Foster Home Pilot Program for veterans that would be exempt from state licensure or regulation and subject only to oversight by the federal government.

Other community care facilities in the state are subject to licensure and regulation by the Department of Social Services to ensure safety standards and safeguards.

The state should maintain oversight of the operation of the homes proposed under this bill to ensure that California veterans in these homes do not have fewer safety protections than residents in other community care settings.

Therefore, I am directing the California Health and Human Services Agency and the Department of Social Services to explore a workable regulatory model, including any necessary statutory changes, to allow such a pilot program to move forward. I am committed to working collaboratively on a regulatory model that preserves California's oversight and values while allowing for Medical Foster Homes to operate in our state.

COMMENTS:

The USDVA oversees the MFH program. MFHs are private homes in which a trained caregiver provides services to a few individuals, some, but not all of whom are veterans. An MFH can serve as an alternate to a nursing home. USDVA inspects and approves all MFHs, but does not provide or pay for the homes.

MFHs are distinguished from other typical residential care homes or facilities because an MFH caregiver is required to reside in their own private home while providing 24-hour personal care and supervision to the residents. Currently, in California, MFHs would have to operate as residential care facilities for the elderly (RCFEs), which would require potential MFH caregivers to have their personal home licensed through California State Department of Social Services (CDSS), become a certified administrator, and incur costs associated with training and licensure.

Existing law provides for the licensure of RCFEs, community care facilities, and residential care facilities for persons with chronic, life-threatening illness by CDSS. Traditionally, RCFEs have been used as nonmedical placements for individuals with less acute medical needs than those who qualify for skilled nursing home placement, with some exceptions.

According to the Author:

“AB 550 establishes the Medical Foster Home pilot program and gives veterans options on how and where they would like to age. The integrity of the program and the safety of the participants would be upheld through the strict oversight of the USDVA and the jurisdiction of the California State Auditor.

California families are ready and willing to open their homes to veterans, giving them the option to live out the rest of their days in a family setting rather than that of an institution. They are ready to serve those who have served, and AB 550 will make this possible."

Arguments in Support:

According to AMVETS, Department of California, "MFHs are a model of home-based care which provides assisted living care for eligible veterans who are often older and medically frail. Utilizing an interdisciplinary team of physicians, nurses, aides and others provided by the VHA, these homes care for up to a maximum of three eligible veterans in a private home setting. The homes and volunteer families and individuals participating in the program operate under strict regulations and are closely monitored by the VHA. Currently, conflicting federal and state requirements are creating various licensure and financial barriers to caregivers who want to open their homes to a veteran.”

Arguments in Opposition:

None on file.

FISCAL COMMENTS:

According to the Senate Appropriations Committee, one-time State Auditor costs in the range of $250,000 to $300,000 to evaluate the MFH program and prepare an audit. (GF)

VOTES:

ASM VETERANS AFFAIRS: 11-0-0

YES: Irwin, Voepel, Boerner Horvath, Brough, Daly, Frazier, Gloria, Mathis, Muratsuchi, Petrie-Norris, Salas

ASM APPROPRIATIONS: 18-0-0

YES: Gonzalez, Bigelow, Bloom, Bonta, Brough, Calderon, Carrillo, Chau, Diep, Eggman, Fong, Gabriel, Eduardo Garcia, Maienschein, Obernolte, Petrie-Norris, Quirk, Robert Rivas

ASSEMBLY FLOOR: 78-0-2

YES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, O'Donnell, Obernolte, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

ABS, ABST OR NV: Cooley, Eduardo Garcia

SENATE FLOOR: 40-0-0

YES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dahle, Dodd, Durazo, Galgiani, Glazer, Lena Gonzalez, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Jones, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Stone, Umberg, Wieckowski, Wiener, Wilk

ASSEMBLY FLOOR: 79-0-0

YES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

UPDATED:

VERSION: September 13, 2019

CONSULTANT: Christian Burkin / V.A. / (916) 319-3550 FN: 0002571

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 550

Author:(Flora and Berman)

As Amended Ver:September 5, 2019

Majority vote

SUMMARY:

This bill authorizes, as a pilot project until January 1, 2023, a United States Department of Veterans Affairs (USDVA) facility to establish medical foster homes (MFH) for older and medically frail veterans that are not subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act, as specified.

The Senate Amendments:

Require that the USDVA facility establishing a medical foster home verify during monthly checks that home caregivers or other adults living in the home, other than veteran residents, are registered as independent home care aides

COMMENTS:

Background The USDVA oversees the MFH program. MFHs are private homes in which a trained caregiver provides services to a few individuals, some, but not all of whom are veterans. An MFH can serve as an alternate to a nursing home. USDVA inspects and approves all MFHs, but does not provide or pay for the homes.

MFHs are distinguished from other typical residential care homes or facilities because an MFH caregiver is required to reside in their own private home while providing 24-hour personal care and supervision to the residents. Currently, in California, MFHs would have to operate as residential care facilities for the elderly (RCFEs), which would require potential MFH caregivers to have their personal home licensed through California State Department of Social Services (CDSS), become a certified administrator, and incur costs associated with training and licensure.

Existing law provides for the licensure of RCFEs, community care facilities, and residential care facilities for persons with chronic, life-threatening illness by CDSS. Traditionally, RCFEs have been used as nonmedical placements for individuals with less acute medical needs than those who qualify for skilled nursing home placement, with some exceptions.

According to the Author:

AB 550 establishes the Medical Foster Home pilot program and gives veterans options on how and where they would like to age. The integrity of the program and the safety of the participants would be upheld through the strict oversight of the USDVA and the jurisdiction of the California State Auditor.

California families are ready and willing to open their homes to veterans, giving them the option to live out the rest of their days in a family setting rather than that of an institution. They are ready to serve those who have served, and AB 550 will make this possible."

Arguments in Support:

According AMVETS, Department of California, "MFHs are a model of home-based care which provides assisted living care for eligible veterans who are often older and medically frail. Utilizing an interdisciplinary team of physicians, nurses, aides and others provided by the VHA, these homes care for up to a maximum of three eligible veterans in a private home setting. The homes and volunteer families and individuals participating in the program operate under strict regulations and are closely monitored by the VHA. Currently, conflicting federal and state requirements are creating various licensure and financial barriers to caregivers who want to open their homes to a veteran.

Arguments in Opposition:

None on file.

FISCAL COMMENTS:

According to the Senate Appropriations Committee, one-time State Auditor costs in the range of $250,000 to $300,000 to evaluate the MFH program and prepare an audit. (GF)

VOTES:

ASM VETERANS AFFAIRS: 11-0-0

YES: Irwin, Voepel, Boerner Horvath, Brough, Daly, Frazier, Gloria, Mathis, Muratsuchi, Petrie-Norris, Salas

ASM APPROPRIATIONS: 18-0-0

YES: Gonzalez, Bigelow, Bloom, Bonta, Brough, Calderon, Carrillo, Chau, Diep, Eggman, Fong, Gabriel, Eduardo Garcia, Maienschein, Obernolte, Petrie-Norris, Quirk, Robert Rivas

ASSEMBLY FLOOR: 78-0-2

YES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, O'Donnell, Obernolte, Patterson, Petrie‑Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

ABS, ABST OR NV: Cooley, Eduardo Garcia

SENATE FLOOR: 40-0-0

YES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dahle, Dodd, Durazo, Galgiani, Glazer, Lena Gonzalez, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Jones, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Stone, Umberg, Wieckowski, Wiener, Wilk

UPDATED:

VERSION: September 5, 2019

CONSULTANT: Christian Burkin / V.A. / (916) 319-3550 FN: 0002198

 THIRD READING  

Bill No: AB 550

Author: Flora (R) and Berman (D)

Amended: 9/5/19 in Senate

Vote: 21

SENATE VETERANS AFFAIRS COMMITTEE: 6-0, 6/25/19

AYES: Archuleta, Hurtado, Nielsen, Roth, Umberg, Wilk

NO VOTE RECORDED: Grove

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/30/19

AYES: Portantino, Bates, Bradford, Durazo, Hill, Jones, Wieckowski

ASSEMBLY FLOOR: 78-0, 5/23/19 - See last page for vote

SUBJECT: Veterans: Medical Foster Home Pilot Program

SOURCE: Author

DIGEST:

This bill authorizes, as a pilot project until January 1, 2023, a US Department of Veterans Affairs (USDVA) facility to establish medical foster homes (MFH) for older and medically frail veterans that are not subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act, as specified.

Senate Floor Amendments of 9/5/19 require the USDVA facility establishing a foster home to verify that persons are registered as independent home care aides as part of the facility’s monthly visits, rather than the MFH coordinator.

ANALYSIS:

Existing law:

1. Establishes the Department of Veterans Affairs, which is responsible for administering various programs and services for the benefit of veterans (MVC §63).
2. Provides for the licensure of residential care facilities for the elderly (RCFEs), community care facilities, and residential care facilities for persons with chronic, life-threatening illness by the California State Department of Social Services (CDSS) (HSC §1569.1).
3. Exempts from the application of these provisions specified facilities, including general acute care hospitals and clinics (HSC §1569.145).
4. Authorizes the California State Auditor, upon the request by the Joint Legislative Audit Committee and to the extent funding is available, to audit a state or local governmental agency, as defined, or any other publicly created entity (GOV §8546.1).

This bill:

1. States the intent of the Legislature to expand the USDVA MFH program in California by authorizing the USDVA to establish MFHs that are exempt from state regulation under the Residential Care Facilities for the Elderly Act, the California Community Care Facilities Act, and Chapter 3.01 (commencing with Section 1568.01) of Division 2 of the Health and Safety Code.
2. States that no sooner than June 1, 2020 a USDVA facility may establish in this state a MFH program that is not subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act (Chapter 3.2 (commencing with Section 1569) of Division 2 of the Health and Safety Code), the California Community Care Facilities Act (Chapter 3 (commencing with Section 1500) of Division 2 of the Health and Safety Code), or Chapter 3.01 (commencing with Section 1568.01) of Division 2 of the Health and Safety Code if all of the following requirements are satisfied:
   1. The MFH meets the requirements of Sections 17.73 and 17.74 of Title 38 of the Code of Federal Regulations.
   2. The USDVA facility submits or has submitted a proposal to establish a MFH program to the Director of Home and Community-Based Care in Geriatrics and Extended Care Services in the Central Office of the USDVA and that director authorizes or has authorized the program.
   3. The USDVA facility establishing the foster home agrees to be subject to the jurisdiction of the California State Auditor for the purpose of evaluating the program created under this bill. Consistent with this agreement, the USDVA facility shall provide data, information, and case files as requested by the California State Auditor to perform all of the California State Auditor’s duties in evaluating the program created under this bill.
   4. A MFH caregiver or an individual, other than a veteran resident, who is over 18 years of age and is residing in the MFH shall be a registered independent home care aide, pursuant to Chapter 13 of Division 2 of the Health and Safety Code (commencing with Section 1796.10).
   5. The USDVA facility establishing a foster home shall verify that persons are registered as an independent home care aides, as part of the facility’s monthly visits to the MFH.
3. States the intent of the Legislature that the California State Auditor, upon a request to the Joint Legislative Audit Committee, conduct an audit no sooner than January 1, 2021, that assesses and evaluates the pilot program created in this bill, and that the audit evaluate the success of the pilot program by confirming that the USDVA facilities are meeting their goals and standards, and make recommendations to the Legislature regarding the continuation of the program, including but limited to recommendations regarding changes or reforms needed for improvement of the program.
4. Sunsets on January 1, 2023.

Background

The USDVA oversees the MFH program. MFHs are private homes in which a trained caregiver provides services to a few individuals, some, but not all of whom are veterans. An MFH can serve as an alternate to a nursing home. USDVA inspects and approves all MFHs, but does not provide or pay for the homes.

MFHs are distinguished from other typical residential care homes or facilities because an MFH caregiver is required to reside in their own private home while providing 24-hour personal care and supervision to the residents. Currently, in California, MFHs would have to operate as RCFEs, which would require potential MFH caregivers to have their personal home licensed through CDSS, become a certified administrator, and incur costs associated with training and licensure.

Existing law provides for the licensure of RCFEs, community care facilities, and residential care facilities for persons with chronic, life-threatening illness by CDSS. Traditionally, RCFEs have been used as nonmedical placements for individuals with less acute medical needs than those who qualify for skilled nursing home placement, with some exceptions.

Related/Prior Legislation

AB 2607 (Berman, 2018) was nearly identical to this bill. The bill was held in the Assembly Appropriations Committee.

AB 1821 (Gordon, Chapter 650, Statutes of 2014) established the Medical Foster Home Pilot Program until January 1, 2018.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, one-time State Auditor costs in the range of $250,000 to $300,000 to evaluate the MFH program and prepare an audit. (GF)

SUPPORT: (Verified 9/5/19)

AARP California

American G.I. Forum of California

American Legion, Department of California

AMVETS, Department of California

California Association for Health Services at Home

California Association of County Veterans Service Officers

California Association of Veteran Service Agencies

California Commission on Aging

California State Commanders Veterans Council

Military Officers Association of America

Public Law Center

OPPOSITION: (Verified 9/5/19)

None received

ARGUMENTS IN SUPPORT: According AMVETS, Department of California, “MFHs are a model of home-based care which provides assisted living care for eligible veterans who are often older and medically frail. Utilizing an interdisciplinary team of physicians, nurses, aides and others provided by the VHA, these homes care for up to a maximum of three eligible veterans in a private home setting. The homes and volunteer families and individuals participating in the program operate under strict regulations and are closely monitored by the VHA. Currently, conflicting federal and state requirements are creating various licensure and financial barriers to caregivers who want to open their homes to a veteran.

“California families are ready and willing to open their homes to veterans, giving them the option to live out the rest of their days in a family setting rather than that of an institution. They are ready to serve those who have served, and AB 550 will make this possible.”

The California Association for Health Services at Home states, “Medical Foster Homes pilot projects have been successfully implemented in other states and allow veterans to receive care in a private home-like setting in which a trained caregiver provides services to a limited number of veterans. The Veteran’s Affairs Department inspects and approves all Medical Foster Homes which serve as an alternative to a nursing home. These homes have a trained caregiver on duty 24 hours a day, 7 days a week who can assist the veteran with the activities of daily living, such as bathing and getting dressed. CAHSAH has long been an advocate for aging in place and providing care in the least restrictive setting. AB 550 is an important step in improving the quality of care for California’s veterans.”

ASSEMBLY FLOOR: 78-0, 5/23/19

AYES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

NO VOTE RECORDED: Cooley, Eduardo Garcia

Prepared by: Veronica Badillo / V.A. / (916) 651-1503

9/6/19 13:30:00

**** END ****

 THIRD READING  

Bill No: AB 550

Author: Flora (R) and Berman (D)

Amended: 8/30/19 in Senate

Vote: 21

SENATE VETERANS AFFAIRS COMMITTEE: 6-0, 6/25/19

AYES: Archuleta, Hurtado, Nielsen, Roth, Umberg, Wilk

NO VOTE RECORDED: Grove

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/30/19

AYES: Portantino, Bates, Bradford, Durazo, Hill, Jones, Wieckowski

ASSEMBLY FLOOR: 78-0, 5/23/19 - See last page for vote

SUBJECT: Veterans: Medical Foster Home Pilot Program

SOURCE: Author

DIGEST:

This bill authorizes, as a pilot project until January 1, 2023, a US Department of Veterans Affairs (USDVA) facility to establish medical foster homes (MFH) for older and medically frail veterans that are not subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act, as specified.

ANALYSIS:

Existing law:

1. Establishes the Department of Veterans Affairs, which is responsible for administering various programs and services for the benefit of veterans (MVC §63).
2. Provides for the licensure of residential care facilities for the elderly (RCFEs), community care facilities, and residential care facilities for persons with chronic, life-threatening illness by the California State Department of Social Services (CDSS) (HSC §1569.1).
3. Exempts from the application of these provisions specified facilities, including general acute care hospitals and clinics (HSC §1569.145).
4. Authorizes the California State Auditor, upon the request by the Joint Legislative Audit Committee and to the extent funding is available, to audit a state or local governmental agency, as defined, or any other publicly created entity (GOV §8546.1).

This bill:

1. States the intent of the Legislature to expand the USDVA MFH program in California by authorizing the USDVA to establish MFHs that are exempt from state regulation under the Residential Care Facilities for the Elderly Act, the California Community Care Facilities Act, and Chapter 3.01 (commencing with Section 1568.01) of Division 2 of the Health and Safety Code.
2. States that no sooner than June 1, 2020 a USDVA facility may establish in this state a MFH program that is not subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act (Chapter 3.2 (commencing with Section 1569) of Division 2 of the Health and Safety Code), the California Community Care Facilities Act (Chapter 3 (commencing with Section 1500) of Division 2 of the Health and Safety Code), or Chapter 3.01 (commencing with Section 1568.01) of Division 2 of the Health and Safety Code if all of the following requirements are satisfied:
   1. The MFH meets the requirements of Sections 17.73 and 17.74 of Title 38 of the Code of Federal Regulations.
   2. The USDVA facility submits or has submitted a proposal to establish a MFH program to the Director of Home and Community-Based Care in Geriatrics and Extended Care Services in the Central Office of the USDVA and that director authorizes or has authorized the program.
   3. The USDVA facility establishing the foster home agrees to be subject to the jurisdiction of the California State Auditor for the purpose of evaluating the program created under this bill. Consistent with this agreement, the USDVA facility shall provide data, information, and case files as requested by the California State Auditor to perform all of the California State Auditor’s duties in evaluating the program created under this bill.
   4. A MFH caregiver or an individual, other than a veteran resident, who is over 18 years of age and is residing in the MFH shall be a registered independent home care aide, pursuant to Chapter 13 of Division 2 of the Health and Safety Code (commencing with Section 1796.10).
   5. The MFH coordinator shall verify that persons are registered as an independent home care aids, as part of the coordinator’s monthly home visits to the MFH.
3. States the intent of the Legislature that the California State Auditor, upon a request to the Joint Legislative Audit Committee, conduct an audit no sooner than January 1, 2021 that assesses and evaluates the pilot program created in this bill, and that the audit evaluate the success of the pilot program by confirming that the USDVA facilities are meeting their goals and standards, and make recommendations to the Legislature regarding the continuation of the program, including but limited to recommendations regarding changes or reforms needed for improvement of the program.
4. Sunsets on January 1, 2023.

Background

The USDVA oversees the MFH program. MFHs are private homes in which a trained caregiver provides services to a few individuals, some, but not all of whom are veterans. An MFH can serve as an alternate to a nursing home. USDVA inspects and approves all MFHs, but does not provide or pay for the homes.

MFHs are distinguished from other typical residential care homes or facilities because an MFH caregiver is required to reside in their own private home while providing 24-hour personal care and supervision to the residents. Currently, in California, MFHs would have to operate as RCFEs, which would require potential MFH caregivers to have their personal home licensed through CDSS, become a certified administrator, and incur costs associated with training and licensure.

Existing law provides for the licensure of RCFEs, community care facilities, and residential care facilities for persons with chronic, life-threatening illness by CDSS. Traditionally, RCFEs have been used as nonmedical placements for individuals with less acute medical needs than those who qualify for skilled nursing home placement, with some exceptions.

Related/Prior Legislation

AB 2607 (Berman, 2018) was nearly identical to this bill. The bill was held in the Assembly Appropriations Committee.

AB 1821 (Gordon, Chapter 650, Statutes of 2014) established the Medical Foster Home Pilot Program until January 1, 2018.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, one-time State Auditor costs in the range of $250,000 to $300,000 to evaluate the MFH program and prepare an audit. (GF)

SUPPORT: (Verified 8/30/19)

AARP California

American G.I. Forum of California

American Legion, Department of California

AMVETS, Department of California

California Association for Health Services at Home

California Association of County Veterans Service Officers

California Association of Veteran Service Agencies

California Commission on Aging

California State Commanders Veterans Council

Military Officers Association of America

Public Law Center

OPPOSITION: (Verified 8/30/19)

None received

ARGUMENTS IN SUPPORT: According AMVETS, Department of California, “MFHs are a model of home-based care which provides assisted living care for eligible veterans who are often older and medically frail. Utilizing an interdisciplinary team of physicians, nurses, aides and others provided by the VHA, these homes care for up to a maximum of three eligible veterans in a private home setting. The homes and volunteer families and individuals participating in the program operate under strict regulations and are closely monitored by the VHA. Currently, conflicting federal and state requirements are creating various licensure and financial barriers to caregivers who want to open their homes to a veteran.

“California families are ready and willing to open their homes to veterans, giving them the option to live out the rest of their days in a family setting rather than that of an institution. They are ready to serve those who have served, and AB 550 will make this possible.”

The California Association for Health Services at Home states, “Medical Foster Homes pilot projects have been successfully implemented in other states and allow veterans to receive care in a private home-like setting in which a trained caregiver provides services to a limited number of veterans. The Veteran’s Affairs Department inspects and approves all Medical Foster Homes which serve as an alternative to a nursing home. These homes have a trained caregiver on duty 24 hours a day, 7 days a week who can assist the veteran with the activities of daily living, such as bathing and getting dressed. CAHSAH has long been an advocate for aging in place and providing care in the least restrictive setting. AB 550 is an important step in improving the quality of care for California’s veterans.”

ASSEMBLY FLOOR: 78-0, 5/23/19

AYES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

NO VOTE RECORDED: Cooley, Eduardo Garcia

Prepared by: Veronica Badillo / V.A. / (916) 651-1503

9/3/19 11:22:03

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2019 - 2020 Regular Session

AB 550 (Flora) - Veterans: Medical Foster Home Pilot Program

Bill Summary:

AB 550 would authorize, as a pilot project until January 1, 2023, a US Department of Veterans Affairs (USDVA) facility to establish medical foster homes (MFH) for older and medically frail veterans that are not subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act, as specified.

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

The following information is revised to reflect amendments

adopted by the committee on August 30, 2019

Fiscal Impact:

One-time State Auditor costs in the range of $250,000 to $300,000 to evaluate the MFH program and prepare an audit. (GF)

Author Amendments:

Require the medical foster home coordinator, at their monthly home visit, to verify that persons are registered as independent home care aids.

-- END --

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2019 - 2020 Regular Session

AB 550 (Flora) - Veterans: Medical Foster Home Pilot Program

Bill Summary:

AB 550 would authorize, as a pilot project until January 1, 2023, a US Department of Veterans Affairs (USDVA) facility to establish medical foster homes (MFH) for older and medically frail veterans that are not subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act, as specified.

Fiscal Impact:

One-time State Auditor costs in the range of $250,000 to $300,000 to evaluate the MFH program and prepare an audit. (GF)

Background:

The USDVA oversees the MFH program. MFHs are private homes in which a trained caregiver provides services to a few individuals, some, but not all of whom are veterans. An MFH can serve as an alternate to a nursing home. USDVA inspects and approves all MFHs, but does not provide or pay for the homes.

MFHs are distinguished from other typical residential care homes or facilities because an MFH caregiver is required to reside in their own private home while providing 24-hour personal care and supervision to the residents. Currently, in California, MFHs would have to operate as Residential Care Facilities for the Elderly (RCFEs), which would require potential MFH caregivers to have their personal home licensed through the California Department of Social Services, become a certified administrator, and incur costs associated with training and licensure.

Existing law provides for the licensure of RCFEs, community care facilities, and residential care facilities for persons with chronic, life-threatening illness by the California State Department of Social Services (CDSS). Traditionally, RCFEs have been used as nonmedical placements for individuals with less acute medical needs than those who qualify for skilled nursing home placement, with some exceptions.

Proposed Law:

This bill would:

• Authorize a USDVA facility to establish a medical foster home program in California starting June 1, 2020;
• Provide that the medical foster home would not be subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act, the California Community Care Facilities Act, or the Residential Care Facilities for Persons With Chronic Life-Threatening Illness if the following requirements are met:
  • The medical foster home meets the federal medical foster home standards and requirements;
  • The facility submits or has submitted a proposal to establish a medical foster home program to the Director of Home and Community-Based Care in Geriatrics and Extended Care Services in the Central Office of the USDVA and that director authorizes or has authorized the program;
  • The facility establishing the foster home agrees to be subject to the jurisdiction of the California State Auditor for the purpose of evaluating the program;
  • A medical foster home caregiver or an individual, other than a veteran resident, who is over 18 years of age and is residing in the medical foster home shall be a registered independent home care aid;
• State Legislative intent that the California State Auditor, in response to a request to the Joint Legislative Audit Committee, conduct an audit, no sooner than January 1, 2021, that assesses and evaluates the pilot program and makes recommendations to the Legislature regarding the continuation of the program;
• Sunset on January 1, 2023.

Related Legislation:

AB 2607 (Berman, 2018) was nearly identical to this bill. The measure was held in the Assembly Appropriations Committee.

AB 1821 (Gordon, Chapter 650, Statutes of 2014) established the Medical Foster Home Pilot Program until January 1, 2018.

Staff Comments:

AB 1821 (Gordon, Chapter 650, Statutes of 2014) established a pilot program to start in 2015, but that pilot was never launched, in part because of complications at the federal level relating to the background check process. The provisions in AB 2607 (Berman, 2018) governing background checks were therefore different from those in AB 1821 by using existing independent home care aide background check and registration provisions for MFH caregivers to be registered independent home care aides rather than requiring the USDVA to collect fingerprints from MFH caregivers and other non-veteran residents living in the home, and submit them to the Department of Justice for background checks.

Staff notes that traditionally, CDSS’s Community Care Licensing Division, not the State Auditor, provides regulatory oversight for the health and safety of RCFEs, community care facilities, and residential care facilities for persons with chronic, life-threatening illness. This oversight ensures that community care facilities operate according to applicable laws and regulations and that corrective action is taken when a licensee fails to protect the health, safety, and personal rights of individuals in care. The author may wish to incorporate CDSS’s Community Care Licensing Division’s oversight into the provisions of the bill.

-- END --

SENATE COMMITTEE ON

Senator Bob Archuleta, Chair

2019 - 2020 Regular

Bill No: Hearing Date: 6/25/19

Subject:

DESCRIPTION

Summary:

This bill authorizes, as a pilot project until January 1, 2023, a U.S. Department of Veterans Affairs (USDVA) facility to establish medical foster homes (MFH) for older and medically frail veterans that are not subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act, under specified provisions.

Existing law:

1) Establishes the Department of Veterans Affairs, which is responsible for administering various programs and services for the benefit of veterans (MVC §63).

2) Provides for the licensure of residential care facilities for the elderly (RCFEs), community care facilities, and residential care facilities for persons with chronic, life-threatening illness by the California State Department of Social Services (HSC §1569.1).

3) Exempts from the application of these provisions specified facilities, including general acute care hospitals and clinics (HSC §1569.145).

4) Authorizes the California State Auditor, upon the request by the Joint Legislative Audit Committee and to the extent funding is available, to audit a state or local governmental agency, as defined, or any other publicly created entity (GOV §8546.1).

This bill:

1) States the intent of the Legislature to expand the United States Department of Veterans Affairs (USDVA) medical foster home program in California by authorizing the USDVA to establish medical foster homes that are exempt from state regulation under the Residential Care Facilities for the Elderly Act, the California Community Care Facilities Act, and Chapter 3.01 (commencing with Section 1568.01) of Division 2 of the Health and Safety Code;

2) Defines “medical foster home” to have the same meaning as it is defined in Section 17.73 of Title 38 of the Code of Federal Regulations;

3) Defines “medical foster home caregiver” as the primary person who provides care to a veteran resident in a medical foster home;

4) Defines “USDVA facility” as a United States Department of Veterans Affairs facility;

5) States that no sooner than June 1, 2020 a USDVA facility may establish in this state a medical foster home program that is not subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act (Chapter 3.2 (commencing with Section 1569) of Division 2 of the Health and Safety Code), the California Community Care Facilities Act (Chapter 3 (commencing with Section 1500) of Division 2 of the Health and Safety Code), or Chapter 3.01 (commencing with Section 1568.01) of Division 2 of the Health and Safety Code if all of the following requirements are satisfied:

1. The medical foster home meets the requirements of Sections 17.73 and 17.74 of Title 38 of the Code of Federal Regulations.
2. The USDVA facility submits or has submitted a proposal to establish a medical foster home program to the Director of Home and Community-Based Care in Geriatrics and Extended Care Services in the Central Office of the USDVA and that director authorizes or has authorized the program.
3. The USDVA facility establishing the foster home agrees to be subject to the jurisdiction of the California State Auditor for the purpose of evaluating the program created under this chapter. Consistent with this agreement, the USDVA facility shall provide data, information, and case files as requested by the California State Auditor to perform all of the California State Auditor’s duties in evaluating the program created under this chapter.
4. A medical foster home caregiver or an individual, other than a veteran resident, who is over 18 years of age and is residing in the medical foster home shall be a registered independent home care aide, pursuant to Chapter 13 of Division 2 of the Health and Safety Code (commencing with Section 1796.10).

6) States the intent of the legislature that the California State Auditor, upon a request to the Joint Legislative Audit Committee, conduct an audit no sooner than January 1, 2021 that assesses and evaluates the pilot program created in this bill, and that the audit evaluate the success of the pilot program by confirming that the USDVA facilities are meeting their goals and standards, and make recommendations to the legislature regarding the continuation of the program, including but limited to recommendations regarding changes or reforms needed for improvement of the program.

7) Is repealed as of January 1, 2023.

BACKGROUND

The U.S. Department of Veterans Affairs oversees the Medical Foster Home (MFH) program. According to the USDVA, MFHs are private homes in which a trained caregiver provides services to a few individuals. Some, but not all residents are veterans. USDVA inspects and approves all MFHs, but does not provide funding.

To be eligible for a MFH, a veteran must be enrolled in Home Based Primary Care, a USDVA program through which health care services are provided to veterans in their homes. Veterans must pay for the MFH themselves or rely on other insurance. However, the Veterans Aid and Attendance benefit and Social Security benefits generally cover these costs. The charge for a MFH is between $1500 to $3000 each month based on income level and level of care required.

MFHs often serve as an alternative to a nursing home. They may be appropriate for veterans who require nursing home care but prefer a non-institutional setting with fewer residents. MFHs have a trained caregiver on duty 24/7, who can help the veteran carry out activities of daily living (e.g., bathing and getting dressed). The USDVA ensures that the caregiver is well-trained to provide USDVA planned care.

MFHs are only able to operate in California as Residential Care Facilities for the Elderly, which would require potential MFH caregivers to have their personal home licensed, become a certified administrator and incur costs associated with training and licensure.

The authority to establish a Medical Foster Home Pilot Program in California allowing MFHs to be operated as intended was created under previous legislation, but was never used, and the program sunset. Legislative attempts have been made to reauthorize the program, citing "complications at the federal level relating to the background check process" as a principle reason for the programs failure to launch. This bill has changed those requirements in an attempt to streamline the process under existing California law, by allowing the MFH program to operate under federal rules, outside of California regulations.

COMMENT

Author’s Statement. According to the author, “AB 550 establishes the Medical Foster Home pilot program and gives veterans options on how and where they would like to age. The integrity of the program and the safety of the participants would be upheld through the strict oversight of the USDVA and the jurisdiction of the California State Auditor. California families are ready and willing to open their homes to veterans, giving them the option to live out the rest of their days in a family setting rather than that of an institution. They are ready to serve those who have served, and AB 550 will make this possible.”

Related/Previous Legislation. AB 2607 (Berman), of the 2017-18 Legislative Session, was substantially similar to this bill. Held in Assembly Veterans Affairs Committee.

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

POSITIONS

Sponsor: Author.

Support: AARP

American GI Forum of California

American Legion – Department of California

AMVETS – Department of California

California Association of County Veterans Service Officers

California Association for Health Services at Home

California Association of Veteran Service Agencies

California Commission on Aging

California State Commanders Veterans Council

Military Officers Association of America – California Council of Chapters

Stanislaus Military Advisory Commissioner

Public Law Center

Oppose: None on file.

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 550

Author:(Flora and Berman)

As Introduced Ver:February 13, 2019

Majority vote

SUMMARY:

This bill authorizes, as a pilot project until January 1, 2023, a U.S. Department of Veterans Affairs (USDVA) facility to establish medical foster homes (MFH) for older and medically frail veterans that are not subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act, under specified provisions.

Major Provisions

1. States the intent of the Legislature to expand the United States Department of Veterans Affairs (USDVA) medical foster home program in California by authorizing the USDVA to establish medical foster homes that are exempt from state regulation;
2. States that no sooner than June 1, 2020 a USDVA facility may establish in this state a medical foster home program that is not subject to licensure or regulation under California law;
3. States the intent of the legislature that the California State Auditor, upon a request to the Joint Legislative Audit Committee, conduct an audit no sooner than January 1, 2021 that evaluates the pilot program created in this bill, and makes recommendations to the legislature regarding the continuation of the program, including but not limited to recommendations regarding changes or reforms needed for improvement of the program.
4. Is repealed as of January 1, 2023.

COMMENTS:

The U.S. Department of Veterans Affairs oversees the Medical Foster Home (MFH) program. According to the USDVA, MFHs are private homes in which a trained caregiver provides services to a few individuals. Some, but not all residents are veterans. USDVA inspects and approves all MFHs, but does not actually provide or pay for the homes.

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

MFHs have a trained caregiver on duty 24/7. This caregiver can help the veteran carry out activities of daily living (e.g., bathing and getting dressed). The USDVA ensures that the caregiver is well-trained to provide USDVA-planned care.

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

MFHs are now only able to operate in California as Residential Care Facilities for the Elderly.

The authority to establish a Medical Foster Home Pilot Program in California allowing MFHs to be operated as intended was created under previous legislation, but was never used, and the program sunset. Legislative attempts have been made to reauthorize the program, citing "complications at the federal level relating to the background check process" as a principle reason for the program's failure to launch. This bill has changed those requirements in an attempt to streamline the process under existing California law.

According to the Author:

"AB 550 establishes the Medical Foster Home pilot program and gives veterans options on how and where they would like to age. The integrity of the program and the safety of the participants would be upheld through the strict oversight of the USDVA and the jurisdiction of the California State Auditor.

California families are ready and willing to open their homes to veterans, giving them the option to live out the rest of their days in a family setting rather than that of an institution. They are ready to serve those who have served, and AB 550 will make this possible."

Arguments in Support:

Supporters argue that Medical Foster Homes pilot projects have been successfully implemented in other states, and allow veterans to receive care in a private home-like setting in which a trained caregiver provides services to a limited number of veterans.

Arguments in Opposition:

None on file.

FISCAL COMMENTS:

According to the Assembly Appropriations Committee

1. Onetime State Auditor costs in the range of $250,000 to $300,000 (GF) to evaluate the MFH program and prepare an audit.
2. Unknown out-year cost-avoidance to the extent the MFH concept is successful in California without the cost of DSS licensing, regulations and review.

VOTES:

ASM VETERANS AFFAIRS: 11-0-0

YES: Irwin, Voepel, Boerner Horvath, Brough, Daly, Frazier, Gloria, Mathis, Muratsuchi, Petrie-Norris, Salas

ASM APPROPRIATIONS: 18-0-0

YES: Gonzalez, Bigelow, Bloom, Bonta, Brough, Calderon, Carrillo, Chau, Diep, Eggman, Fong, Gabriel, Eduardo Garcia, Maienschein, Obernolte, Petrie-Norris, Quirk, Robert Rivas

UPDATED:

VERSION: February 13, 2019

CONSULTANT: Christian Burkin / V.A. / (916) 319-3550 FN: 0000802

Date of Hearing: April 3, 2019

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 550

Author:(Flora and Berman) – As Introduced Ver:February 13, 2019

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

SUMMARY:

This bill authorizes, as a pilot project until January 1, 2023, a U.S. Department of Veterans Affairs (USDVA) facility to establish medical foster homes (MFH) for older and medically frail veterans that are not subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act, provided that:

1. Specified federal requirements are satisfied.
2. The USDVA facility establishing the home agrees to be subject to the jurisdiction of the California State Auditor.
3. Caregivers and specified individuals residing in the home register as independent home care aides and submit fingerprints and related information to the Department of Justice (DOJ) for background checks as well as a signed declaration regarding any prior criminal convictions to the Department of Social Services (DSS).

This bill states legislative intent that the California State Auditor, through a request to the Joint Legislative Audit Committee, conduct an audit evaluating the pilot program created by this bill.

FISCAL EFFECT:

1. Onetime State Auditor costs in the range of $250,000 to $300,000 (GF) to evaluate the MFH program and prepare an audit.
2. Unknown out-year cost-avoidance to the extent the MFH concept is successful in California without the cost of DSS licensing, regulations and review.

COMMENTS:

1. Purpose. This bill seeks to provide an additional housing option for elderly and frail veterans by authorizing MFHs that provide 24-hour care for up to three veterans in private homes.

The Medical Foster Home Pilot Program was established as a pilot by previous legislation under substantially similar requirements, but was never used.

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

Veterans must pay for the MFH themselves or rely on insurance. However, the Veterans Aid and Attendance benefit and Social Security benefits generally cover these costs. The charge for an MFH is about $1,500 to $3,000 each month based on income level and level of care required.

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

In California, an MFH would have to operate as a Residential Care Facility for the Elderly (RCFE), which would require potential MFH caregivers to have their personal home licensed, become a certified administrator and incur costs associated with training and licensure. This bill allows the MFH program to operate under federal rules, outside of California regulations.

The original pilot was never used, in part because of complications at the federal level relating to the background check process. Accordingly, the provisions in this bill governing background checks are different from those in the original pilot. Rather than requiring the USDVA to collect fingerprints and submit them to the DOJ for background checks, this bill uses California’s existing home care aide background check and registration process, eliminating the role of the USDVA in facilitating background checks.

1. Prior Legislation.

AB 2607 (Berman), of the 2017-18 Legislative Session, was substantially similar to this bill. That bill was held on this committee’s suspense file.

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

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

Date of Hearing: March 26, 2019

ASSEMBLY COMMITTEE ON VETERANS AFFAIRS

Jacqui Irwin, Chair

ABPCA Bill Id:AB 550 (

Author:Flora) – As Introduced Ver:February 13, 2019

SUBJECT: Veterans: Medical Foster Home Pilot Program

SUMMARY: Re-establishes the Medical Foster Home Pilot Program, under substantially similar requirements as a pilot program established under previous legislation, which has since expired. Specifically, this bill:

1. States the intent of the Legislature to expand the United States Department of Veterans Affairs (USDVA) medical foster home program in California by authorizing the USDVA to establish medical foster homes that are exempt from state regulation under the Residential Care Facilities for the Elderly Act, the California Community Care Facilities Act, and Chapter 3.01 (commencing with Section 1568.01) of Division 2 of the Health and Safety Code;
2. Defines “medical foster home” to have the same meaning as it is defined in Section 17.73 of Title 38 of the Code of Federal Regulations;
3. Defines “medical foster home caregiver” as the primary person who provides care to a veteran resident in a medical foster home;
4. Defines “USDVA facility” as a United States Department of Veterans Affairs facility;
5. States that no sooner than June 1, 2020 a USDVA facility may establish in this state a medical foster home program that is not subject to licensure or regulation under the California Residential Care Facilities for the Elderly Act (Chapter 3.2 (commencing with Section 1569) of Division 2 of the Health and Safety Code), the California Community Care Facilities Act (Chapter 3 (commencing with Section 1500) of Division 2 of the Health and Safety Code), or Chapter 3.01 (commencing with Section 1568.01) of Division 2 of the Health and Safety Code if all of the following requirements are satisfied:
6. The medical foster home meets the requirements of Sections 17.73 and 17.74 of Title 38 of the Code of Federal Regulations.
7. The USDVA facility submits or has submitted a proposal to establish a medical foster home program to the Director of Home and Community-Based Care in Geriatrics and Extended Care Services in the Central Office of the USDVA and that director authorizes or has authorized the program.
8. The USDVA facility establishing the foster home agrees to be subject to the jurisdiction of the California State Auditor for the purpose of evaluating the program created under this chapter. Consistent with this agreement, the USDVA facility shall provide data, information, and case files as requested by the California State Auditor to perform all of the California State Auditor’s duties in evaluating the program created under this chapter.
9. A medical foster home caregiver or an individual, other than a veteran resident, who is over 18 years of age and is residing in the medical foster home shall be a registered independent home care aide, pursuant to Chapter 13 of Division 2 of the Health and Safety Code (commencing with Section 1796.10).
10. States the intent of the legislature that the California State Auditor, upon a request to the Joint Legislative Audit Committee, conduct an audit no sooner than January 1, 2021 that assesses and evaluates the pilot program created in this bill, and that the audit evaluate the success of the pilot program by confirming that the USDVA facilities are meeting their goals and standards, and make recommendations to the legislature regarding the continuation of the program, including but limited to recommendations regarding changes or reforms needed for improvement of the program.
11. Is repealed as of January 1, 2023.

EXISTING LAW:

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

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

COMMENTS:

According to the author:

“AB 550 establishes the Medical Foster Home pilot program and gives veterans options on how and where they would like to age. The integrity of the program and the safety of the participants would be upheld through the strict oversight of the USDVA and the jurisdiction of the California State Auditor.

California families are ready and willing to open their homes to veterans, giving them the option to live out the rest of their days in a family setting rather than that of an institution. They are ready to serve those who have served, and AB 550 will make this possible.”

Background:

The U.S. Department of Veterans Affairs oversees the Medical Foster Home (MFH) program. According to the USDVA, MFHs are private homes in which a trained caregiver provides services to a few individuals. Some, but not all residents are veterans. USDVA inspects and approves all MFHs, but does not actually provide or pay for the homes.

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

MFHs have a trained caregiver on duty 24/7. This caregiver can help the veteran carry out activities of daily living (e.g., bathing and getting dressed). The USDVA ensures that the caregiver is well-trained to provide USDVA planned care.

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

MFHs are only able to operate in California as Residential Care Facilities for the Elderly.

Residential Care Facilities for the Elderly:

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

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

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

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

Previous legislation:

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

The authority granted by AB 1821 was never exercised, however, and so no audit was conducted. Assembly Bill 2607 (Berman), 2018, would have re-authorized the Medical Foster Home Pilot Program. In background materials, Berman cited “complications at the federal level relating to the background check process” as a principle reason for the program’s failure to launch. The provisions in AB 2607 governing background checks were therefore different from those in its predecessor legislation. Rather than requiring the USDVA to collect fingerprints from MFH caregivers and other non-veteran residents living in the home, and submit them to the Department of Justice for background checks, this bill piggybacked on the existing independent home care aide background check and registration provisions in Division 2 Chapter 13 Article 4 of the Health and Safety Code, by requiring MFH caregivers to be registered independent home care aides. This eliminated the role of the U.S. Department of Veterans Affairs in processing background checks. However, AB 2607 died in the Assembly Committee on Appropriations.

REGISTERED SUPPORT / OPPOSITION:

Support

California Association for Health Services at Home

Opposition

None on file.

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