BILL NUMBER: SB 547INTRODUCED BILL TEXT INTRODUCED BY Senator Liu (Principal coauthor: Assembly Member Brown) FEBRUARY 26, 2015 An act to amend Section 12803 of the Government Code, and to add Division 121 (commencing with Section 152000) to the Health and Safety Code, relating to long-term care. LEGISLATIVE COUNSEL'S DIGEST SB 547, as introduced, Liu. Long-term care: Assistant Secretary of Aging and Long-term Care: Department of Community Living. Existing law establishes the California Health and Human Services Agency consisting of the Departments of Aging, Child Support services, Community Services and Development, Developmental Services, Health Care Services, Managed Health Care, Public Health, Rehabilitation, Social Services, and State Hospitals. Existing law sets forth legislative findings and declarations regarding long-term care services, including that consumers of those services experience great differences in service levels, eligibility criteria, and service availability that often result in inappropriate and expensive care that is not responsive to individual needs. Those findings and declarations also state that the laws governing long-term care facilities have established an uncoordinated array of long-term care services that are funded and administered by a state structure that lacks necessary integration and focus. This bill would establish the Department of Community Living within the agency. The department would, among other duties, serve as the single state-level contact on issues of aging and long-term care, oversee statewide long-term care service delivery, promote coordinated long-term care service delivery and access to home and community-based services at the local and regional level, and serve as the organizational unit designated to oversee all long-term care programs in the state and to consolidate all long-term care programs administered throughout all departments of the agency. The bill would also create the office of Assistant Secretary of Aging and Long-term Care Coordination within the agency, who would be appointed by the Governor and confirmed by the Senate. The bill would require the Assistant Secretary to develop a systemwide long-term care plan that would, among other things, address the expansion of managed care and the changes to, and differences in, access to health care for older and disabled adults in counties throughout the state, propose a support network for unpaid family caregivers, and include an analysis of workforce needs, including the training and education requirements of a long-term care workforce, and a strategy for aligning the available resources to meet those needs. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 12803 of the Government Code is amended to read: 12803. (a) The California Health and Human Services Agency consists of the following departments: Aging; Community Services and Development; Developmental Services; Health Care Services; Managed Health Care; Public Health; Rehabilitation; Social Services; and State Hospitals. (b) The agency also includes the Emergency Medical Services Authority, the Managed Risk Medical Insurance Board, the Office of Health Information Integrity, the Office of Patient Advocate, the Office of Statewide Health Planning and Development, the Office of Systems Integration, the Office of Law Enforcement Support, and the State Council on Developmental Disabilities. (c) The Department of Child Support Services is hereby created within the agency commencing January 1, 2000, and shall be the single organizational unit designated as the state's Title IV-D agency with the responsibility for administering the state plan and providing services relating to the establishment of paternity or the establishment, modification, or enforcement of child support obligations as required by Section 654 of Title 42 of the United States Code. State plan functions shall be performed by other agencies as required by law, by delegation of the department, or by cooperative agreements. (d) There shall be an Assistant Secretary of Aging and Long-term Care Coordination within the agency who shall be appointed by the Governor and confirmed by the Senate. The person appointed shall have an appropriate background in and knowledge of long-term care. (e) The Department of Community Living is hereby created within the agency. SEC. 2. Division 121 (commencing with Section 152000) is added to the Health and Safety Code, to read: DIVISION 121. Department of Community Living 152000. There is in the California Health and Human Services Agency the Department of Community Living. 152001. The Assistant Secretary of Aging and Long-term Care Coordination shall serve as liaison to the federal Administration for Community Living and shall be responsible for ensuring that the state maximizes the use of available federal funding opportunities. The Assistant Secretary of Aging and Long-term Care Coordination shall do all of the following: (a) Consolidate data and programs regarding long-term care from all departments and programs in the agency. (b) Coordinate and direct the establishment of the Department of Community Living. (c) Lead the development and implementation of a statewide long-term care strategic plan. (d) Oversee and coordinate the integration of health care and long-term care services. (e) Work with rural and urban communities to identify infrastructure capacity issues and lead in the development of access standards for home and community-based services. (f) Facilitate the coordination of long-term care services at the local level. (g) Report on an annual basis to the legislative and fiscal policy committees regarding the current status of long-term care in the state, the level of state spending on long-term care programs, federal funding received, progress in improving the continuum of services, and policy recommendations to enhance the coordination and delivery of long-term care services. 152002. The department shall be aligned, to the extent practicable, with the federal Administration for Community Living. The department shall serve as the single state-level contact on issues of aging and long-term care, oversee statewide long-term care service delivery, promote coordinated long-term care service delivery and access to home and community-based services at the local and regional level, and provide leadership and information to local agencies on best practices. The department shall also serve as the organizational unit designated to oversee all long-term care programs in the state and to consolidate all long-term care programs administered throughout all departments of the agency, including programs serving older adults and those serving persons with disabilities. The department may develop statewide standards for the delivery of long-term care services to ensure consistent access to those services throughout the state, but shall provide sufficient flexibility to local agencies to meet the specific needs of the local population. 152003. The Assistant Secretary of Aging and Long-term Care Coordination shall develop a system-wide long-term care plan. The plan shall establish the priorities of the state, maximize the use of limited resources, engage a range of stakeholders representing the population of aging and disabled persons who need long-term care services, and incorporate clear benchmarks and timelines for achieving the goals set forth in the plan. The plan shall do all of the following: (a) The plan shall address the expansion of managed care in Coordinated Care Initiative counties, as defined in Section 14182,16 of the Welfare and Institutions Code, and the changes to, and differences in, access to health care for older and disabled adults in counties throughout the state. The plan shall include a strategy for integrating the health care system statewide, including recommended budgeting practices and incentives to make home and community-based services more accessible regardless of where persons in need of long-term care reside. (b) The plan shall propose a support network for unpaid family caregivers in this state. The plan would review and analyze existing programs, services, and deficiencies. The plan shall also consider employment-related policies and offer proposals to improve the support network, such as increasing the length of protected leave. (c) The plan shall develop principles and standards for person-centered planning in an integrated system of care to ensure that individuals and families have the opportunity to engage in service planning across the health and long-term care continuum in a manner that reflects their needs, desires, and preferences. (d) The plan shall include an analysis of workforce needs, including the training and education requirements of a long-term care workforce, and a strategy for aligning the available resources to meet those needs. (e) The plan shall include directives for ensuring that the integrated long-term care system screens individuals prior to placement in a "nursing home" or similar long-term care facility, to avoid unnecessary admissions to those facilities. The plan shall also examine how a preadmission screening program may be integrated into a managed care system and shall include a discussion of best practices in other states, such as Oregon, that are used to determine whether an individual is appropriate for community-based care as opposed to institutional placement. The plan shall specify the minimum levels of functional limitations that an individual must have in order for a facility to receive Medi-Cal reimbursement. (f) The plan shall include a strategy for developing a public/private partnership to raise Californians' awareness of, and engagement in, long-term care planning. The plan shall consult advocates, private foundations, and other stakeholders in developing a strategy to engage the general population on long-term care issues. (g) The plan shall include guidance on enhancing decision-making capacity for impaired individuals, as well as options for supported and surrogate decision-making that are appropriate for various levels of impairment and risk. The plan shall also specify measures to evaluate a consumer's capacity to provide or oversee self-care and consent to or refuse services. The plan shall also address how to educate long-term care consumers and providers, the legal system, and the public about "safe" advance directives, limited conservatorships, and affordable access to conservators. (h) The plan shall address end-of-life planning issues emphasizing a consumer's rights to make decisions about options to die with dignity. The plan shall also address improvements to end-of-life care, while promoting access to quality health and long-term care services, including palliative care, for consumers and their families. (i) The plan shall consider how to expand local and state-level innovations designed to address the challenges related to long-term care services delivery. The plan shall examine model programs in various cities and counties.