California Bill Seeks to Increase Home Care Regulation
September 18, 2013 03:55 PM
The California legislature continues to work out language for the Home Care Services Consumer Protection Act (A.B. 1217), which would increase regulation for home care organizations and home care aides. If enacted, the legislative change would affect both Medicaid and non-Medicaid home care services. The National Council on Medicaid Home Care – a NAHC Affiliate discusses the most pertinent provisions.
Currently, California requires certification of home health aides and background checks are required for In-Home Supportive Services workers. California requires licensure of its home health agencies, and 93 percent of them are also certified by either CMS or other organizations like the Joint Commission.
However, providers of non-skilled home care services are not as regulated. In California, there are currently no licensing requirements for agencies or individuals providing home care aide (HCA) services, i.e. those that provide care not related to health, such as cooking, homemaking, or shopping. Currently, 24 other states requiring licensure of these types of home care organizations (HCOs).
To see more information on the current status of regulation, click here for an article, and here for a recent UCLA study.
Summary. A.B. 1217 requires: 1) the licensure and regulation of HCOs, and 2) the registration of HCAs. The bill excludes certain entities from the definition of HCOs, as well as certain individuals from the definition of HCAs.
Exclusions. HCOs do not include home health agencies, hospices, or a county providing in-home supportive services. Similarly, HCAs do not include those providing home care services through a licensed home health agency, a licensed hospice, or via in-home supportive services (IHSS).
Licensure of HCOs. If the owner of the HCO is an individual or individuals, the owner must submit a valid identification card and consent to a background examination. If the owner is a corporation, association, joint venture, limited liability company, or another entity, an individual with at least a 10 percent interest must consent to a background examination.
Unauthorized Representation and Provision of Care. A person or organization cannot represent themselves as being an HCO or providing home care until they have been licensed. Provision of home care services prior to licensure is deemed “unlicensed home care services,” subject to civil monetary penalties and cease and desist orders.
Renewal. Once registered, an HCO must renew his or her registration every two years. This is contingent on submitting a renewal application form and paying renewal fees prior to the license’s expiration. Further, a renewal is contingent on the HCO “continuing to satisfy the requirements set forth in this chapter, and cooperating with the department in the completion of the home care organization licenses renewal process.”
Operating Requirements. The HCO is required to do several things, including: posting its license, abiding by worker’s compensation laws, maintaining an employee dishonesty bond, and reporting suspected or known adult abuse.
Operating Requirements Regarding HCAs: The HCOs must ensure that its employed HCAs are properly registered before allowing them to have direct contact with patients. Also, the HCOs must ensure that all employees, staff, or volunteer interacting with clients, prospective clients, or confidential client information has met the requirements of obtaining a background clearance as required in this bill. HCOs must also ensure that their HCAs have completed the required training as specified in this bill. Also, HCOs are required to have their HCAs demonstrate they are free from active tuberculosis, and to keep this certificate on file. Finally, HCOs must notify the State Department of Social Services immediately when the HCO no longer employs one of its HCAs.
HCA Registry. A.B. 1217 mandates the establishment of a HCA registry, which would provide specific information on both registered HCAs and HCA applicants.
Background Clearances. HCAs must undergo background clearances, including a signed declaration regarding any prior criminal convictions, as well as a declaration that they are free of active tuberculosis.
Registry and Exemptions. Those individuals not employed by an HCO may be listed on the registry if they provide home care services. HCAs employed by an HCO to provide home care services shall be listed on the registry before they can provide home care services to a client.
Renewal. Once registered, an HCA must renew his or her registration every two years to stay registered.
To see A.B. 1217, click here.
The Council’s Take
The Council supports minimum standards for home care agencies, licensing being one such standard, but opposes standards that are overly burdensome. The Council therefore supports more balanced bills like A.B. 322, of which the California Association for Health Services at Home (CAHSAH) is a sponsor, and also joins CAHSAH in opposing A.B. 1217.
A.B. 322, in establishing minimum licensure requirements for private home care agencies providing non-medical care in the home, balances oversight and consumer protection concerns. To see CAHSAH’s position on A.B. 322, click here. To see A.B. 322 itself, click here.
Some home care providers have expressed concerns that the licensure requirements of A.B. 1217 will drive up prices. As Nadereh Pourat, the director of research at the UCLA Center for Health Policy Research stated: “[t]he concerns have validity. Licensure can impact price. You’re asking people for additional paperwork and effort.” For her full comments on the legislation, click here. CAHSAH echoed cost concerns as well. CAHSAH stated in its 2013 Legislative Priorities that “[t]he provisions regulating the use of home care aides in A.B. 1217 are burdensome and will increase the cost of services purchased by working and middle class families. As the cost of care increases, families will be forced to make tough decisions in order to receive care.” For a link to CAHSAH’s 2013 Legislative Priorities, click here. In fact, in a one-pager on A.B. 1217, CAHSAH maintained that home care agencies will bear the entire cost of licensure. The Council echoes these concerns and stands with CAHSAH in its opposition to this bill.
Home care companies should anticipate future regulatory and legislative action to regulate home care, especially in the states that currently do not require licensure of HCOs and/or HCAs. A movement is also afoot to require background checks for caregivers.
As regulators react to fraud and abuse, believing that all problems can be solved through another layer of rules, stakeholders should remain actively engaged in these processes through the forums or state advocacy. To the extent that there is a need for reforms, it is important to craft sound legislation/regulation that protects patients while putting the fewest restrictions on honest caregivers. Home care companies are encouraged to keep abreast of home care legislative and regulatory initiatives in their states, and to contact the Council with any questions or concerns.