CSAC Bulletin Article

Health and Human Services 08/12/2011

IHSS Fraud Prevention Funding On Hold Pending Potential Trigger Cuts

The Department of Social Services notified counties in July that the $10 million included in the Budget Act of 2011 for county investigation and program integrity efforts related to In-Home Supportive Services is subject to the Act’s “trigger cuts” mechanism.

What this means is that the $10 million will not be released to counties if the state’s revenues fall $1 billion below revenue projections included in the Budget Act. Should the state’s revenue track with projections, the “trigger cuts” will not materialize and counties would receive funding for the IHSS fraud program in January 2012. Under that scenario, counties would be permitted to claim expenses retroactive to July 1, 2011. However, should the trigger cuts occur, no funding will be available for county costs after June 30, 2011. 

Counties are encouraged to continue to prepare, approve, and submit fraud prevention proposals to the Adult Programs Division of the Department of Social Services no later than October 28, 2011. 

Governor Brown Vetoes Adult Day Health Care Look-A-Like Bill

Governor Jerry Brown vetoed AB 96, a budget bill that would have recreated the Adult Day Health Care program under the name of “Keeping Adults Free from Institutions”, or KAFI, on July 25. 

The Adult Day Health Care (ADHC) program was eliminated by the Governor through his line-item veto authority in June, when he deleted budget language that required expenditure of $85 million to transition Adult Day Health Care enrollees to other Medi-Cal services and to a new federal waiver program. 

Proponents of the ADHC program then moved AB 96 through the Legislature, which would have created KAFI based on the ADHC model. AB 96 landed on the Governor’s desk on July 14 and he vetoed it on July 25. 

The Governor noted that the state cannot afford the ADHC program at this time, but that his Department of Health Care Services (DHCS) recently extended the ADHC benefit through administrative action until December 1, 2011, with federal funding approval. He also signed SB 91, which will allow adult day health centers to continue to operate after the fee-for-services payments under Medi-Cal expire. 

The Governor has directed DHCS to work with the Legislature, stakeholders, managed care plans, and home- and community-based service providers to ensure a smooth transition to appropriate services for beneficiaries. The first stakeholder meeting was held this week, on August 9, and is supposed to be the first in a series of meetings on the topic. However, additional meetings have not yet been scheduled at the time of this writing. 
Resources: 
Read the DHCS transition plan for ADHC.
Read Governor Brown’s AB 96 veto message.

Emergency Medical Services

AB 210 (Solorio) – Pending
As Proposed to be Amended 

AB 210, by Assembly Member Jose Solorio, would amend what is commonly known as Section 201 (Health and Safety Code Section 1797.201-224) of the Emergency Medical Services (EMS) System and the Pre-Hospital Emergency Medical Care Personnel Act (EMS Act) to require grandfathered EMS transportation providers to enter into a written agreement with their respective Local Emergency Medical Services Agency (LEMSA) by 2014. 

AB 210 is intended to address Section 201 issues surrounding regulatory authority, local control, and operational control in local EMS systems. The bill also includes an attempt to create a standard set of definitions for Section 201. 

AB 210 was originally envisioned as a vehicle for the recommendations of a state Emergency Medical Services Commission subcommittee, but that committee has not fully reached consensus on its provisions. However, a stakeholder group comprised of the California Professional Firefighters, ambulance services, fire chiefs, cities and local EMS administrators has continued to meet as the bill moves through the legislative process. CSAC is maintaining a pending position while stakeholders continue their work on reaching a consensus. 

The counties of San Joaquin and Tulare have opposed earlier versions of the bill, and it is proposed to be amended next when the Legislature returns to Sacramento. Mono County is seeking an amendment to exempt counties smaller than 50,000 residents from the bill’s provisions, and the Emergency Medical Services Administrators’ Association of California (EMSAAC) has recommended that it be made a two-year bill, which will give stakeholders more time to work on the language. CSAC has maintained a “pending” position on AB 210 and will closely review the recent proposed amendments once they appear in print. 

AB 210 is scheduled to be heard by the Senate Appropriations Committee on August 15. 

AB 717 (Ammiano) – Support
As Amended June 29, 2011

AB 717, by Assembly Member Tom Ammiano, would improve the use and operation of the Child Abuse Central Index (CACI).

The CACI is a tool used by county child welfare agencies when conducting investigations and hiring of staff. However, because of the sensitive information within the system, CACI has been the target of litigation throughout the years. A result of some of that litigation is a due process structure for persons listed on the CACI. AB 717, as amended, will improve due process by, among other things, affording all persons listed in CACI the right to request a due process hearing if they have not already had the opportunity to do so. AB 717 would also help streamline the system by permitting “inconclusive” reports to be purged. Also, AB 717 would allow the Department of Justice to purge all reports in CACI where the person listed has reached 100 years of age. 

CSAC has changed our position to support due to the recent amendments clarifying the due process and “inconclusive” report process. The Senate Appropriations Committee will hear AB 717 on August 15.

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