BILL NUMBER: SB 547	INTRODUCED
	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.