HomeMy WebLinkAboutMINUTES - 01121993 - FC.1 TO: BOARD OF SUPERVISORS
;-/ _IJ
` • Contra
FROM: Supervisor Gayle Bishop o'. - ,;� _ - ,off Costa
Supervisor Tom Powers
County
Finance Committee - - •'�~
�CST'4COUt�'CZ
DATE: January 12, 1993
SUBJECT: Social Service Department Budget Reduction Plan
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
RECOMMENDATION(S):
1. ACCEPT the report on current efforts to modify the existing Child Welfare Services (CWS)
allocation formula and to ensure allocation of the current CWS State Reserve Fund to counties
which received CWS reductions.
2. AUTHORIZE the Chair, Board of Supervisors, to sign letters to Assemblyman Bob Campbell and
Assemblyman Tom Bates expressing our appreciation for their willingness to work with us on the
CWS Reserve Fund allocation.
3. ACCEPT the status report on the Social Service Department's work group in restructuring and
prioritizing Children's Protective Services.
4. DIRECT the County Administrator's Office, Social Service Department and Health Services
Department to establish an ad hoc committee to review Title XIX Personal Care Option
regulations as they are promulgated and to analyze the fiscal impact of the new regulations on
Contra Costa County and to develop an action plan for program implementation and, in doing to,
informally involve special interest groups, employee organizations and the public in the process
and consult with other Bay Area counties on program planning and implementation issues.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR_RECOMMENDATION OF BOARD COMMITTEE
APPROVE _OTHER
SIGNATURE(S): / v
Gayle Bishop Tom Powers
ACTION OF BOARD ON qlS APPROVED AS RECOMMENDED_(OTHER
fi_ IT
APPROVED recommendations as listed and requested Social
Services Director to send a letter to Russ Gould, State
Secretary of Health & Welfare, and John Wilson, Financial Branch
Management Chief, relating to State regulations on caseload
standards and the financial impact on the County; and a letter
to the Social Security Administration, requesting whether U. S .
Department of Health & Human Services funds will come directly
to the County or does the State have latitude with these funds .
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A
J, UNANIMOUS(ABSENT ) TRUE AND CORRECT COPY OF AND
AYES: NOES: ACTION TAKEN AND ENTERED
ABSENT: ABSTAIN: ON MINUTES OF THE BOARD OF
SUPERVISORS ON THE DATE SHOWN.
Contact: Sara Hoffman,646-1390
ATTESTED ,4
PHI BATCHE R,CLERK OF
THFJBOARD OF SUPERVISORS
AND COUNTY ADMINISTRATOR
cc: CAO
BY DEPUTY
5. DIRECT the County Administrator's Office, Social Service Director and Health Services
Director to report back to the Board on the status of the Personal Care Option program within
60 days.
6. REFER the proposed resolution on Attendant Services for People with Disabilities and
Alternatives to Institutionalization to the Social Service Director and County Administrator.
Background/Reasons for Recommendation
At its December 22, 1992 Board Meeting, the Board of Supervisors referred the issues of Child
Welfare Services (CWS) funding allocations and the prospective Title XIX Personal Care Option
funding to the Finance Committee for their review and report back to the Board on January 12, 1993.
Restructuring and Prioritizing Children's Protective Services
The Social Service Department lost $1.6 million in its FY 92-93 CWS allocation from the State. This
funding loss, received five months into our fiscal year, necessitated a reduction of staff, approved by
the Board of Supervisors on December 22, 1992. (The reduction brought staffing levels down to
State allocations.)
The Social Service Department is preparing to simplify and streamline its CWS operations as a
result of the reductions. Areas of focus include the court process, paper work requirements and
elimination of tasks not mandated by state or federal regulation. The streamlining/restructuring is
being done in close consultation with employee organizations. Meetings have been/will be held as
follows:
Tuesday, January 5, 11 :00 a.m to 12:00 p.m.
Thursday, January 7, 8:30 a.m. to 5:00 p.m.
Friday, January 8, 1 :30 p.m. to 5:00 p.m.
Monday, January 11, 1 :30 p.m. to 5:00 p.m.
Thursday, January 14, 8:30 a.m. to 12:00 p.m.
In addition, meetings have been scheduled with the Juvenile Court Judge, Public Defender, Alternate
Defender and County Counsel (Many of the activities in CWS are directed by the Juvenile Court
Judge). In addition, a meeting has been set up with the president of the Foster Parent Association
(who volunteered to explore ways that foster parents could assist the County).
CWS Allocation Formula and Distribution of Reserve Funds
The current CWS allocation formula allows for considerable variation in yearly funding. This year,
Contra Costa received a $1.6 million allocation reduction, while other counties received allocation
increases which they may not be able to spend (due to the late notice and timing on staffing
increases). Over the past month, considerable progress has been made towards rectifying the
current allocation inequities:
• California Welfare Directors' Association (CWDA) has established an Allocation
Formula Task Force. Perfecto Villarreal, Director of Social Service, is a member of the
task force. The first meeting was held on Friday, January 8, 1993 for the purpose of
developing guiding principles to present to the State at the next meeting, scheduled for
January 13, 1993.
• The County Administrators' Association of California is meeting with CWDA and the
State Department of Social Services on Monday, January 11, 1993 to discuss the
revision of the allocation formula as well as distribution of the CWS Reserve Fund.
• At the December meeting with the employee organizations, the Social Service
Department requested the employee organizations to work with their state lobbyists on
the future allocation issues as well as distribution of the reserve fund.
• In addition to letters sent to each of Contra Costa's legislative delegation, personal
contacts were made to Bob Campbell's office and Tom Bates' office. Both offices
expressed their concern and willingness to work with the County. It may be
appropriate for the Chair, Board of Supervisors, to send a letter expressing
appreciation for the interest of Assemblymen Campbell and Bates in helping Contra
Costa County on this issue.
2
• On Wednesday, January 6, 1993, the County Administrator's Office and Social Service
Department met with the Chief of the Budget Bureau for the State Department of Social
Services (DSS). DSS concurs that the current allocation formula is not equitable and
expressed willingness to work with CWDA on revising the formula. For the current
allocation period, however, the DSS was not flexible. In fact, the DSS's position is that
the reserve funds will not be distributed to the counties who received allocation
reductions, but would be made available to all counties who expressed interest on a
loan basis only. This position was reiterated on Friday, January 8, 1993 in a meeting
with John Healy, Chief Deputy Director, DSS.
Title XIX Personal Care Option Funding
The State Department of Social Services has set April as the statewide implementation date for
Personal Care Option (PCO) funding. However, the steps necessary to ensure that implementation
date have already slipped behind. The State Departments of Health and Social Service were
scheduled to disseminate draft regulations to counties on December 22, 1992. On Friday, January
8, 1993, we personally picked up (after 4:00 p.m.) the draft program regulations; however, the
program regulations will be subject to review by the CWDA/PCO work group. The financial
regulations were not available.
With only draft program regulations and no fiscal regulations, it is not possible at this time to fully
evaluate the effect of the Title XIX Personal Care Option on Contra Costa County. For example, the
draft program regulations contain caseload standards for both assessment workers and nurses.
Yet, state staff assured us that there would be no caseload standards. There will be a dramatic
difference in the fiscal and staffing requirements of this program depending on the language of the
final regulations.
We do know that Personal Care Option will require involvement of nursing and medical staff through
our Health Services Department or through other arrangements. Consequently, it would be prudent
at this time to establish an ad hoc Personal Care Option committee composed of representatives of
the Social Service Department, Health Services Department and County Administrator's Office to
review the regulations as they become available and to address new organizational relationships
and staffing requirements.
Status of Social Service Budget
In its December 15, 1992 report to the Board of Supervisors, staff outlined the current status of the
Social Service budget as follows:
Shortfall (in millions)
Child Welfare Services $1.604
County Services Block Grant (IHSS) $ .787
Foster Care Licensing $ .143
Adoptions $ .246
Food Stamps $ .225
General Assistance Administration* .054
TOTAL $3—.173"
* Does not include delay of centralization.
"*Does not include a potentially significant audit adjustment for audit exceptions dating back to fiscal
year 1983-84.
3
The Department proposed and the Board accepted its Phase III Reduction Plan to address the
shortfall as follows:
In Millions
Recognition of Restored CWS Funding $.210
Application of Categorical Aids Surplus $.950
Staffing Reductions .800
TOTAL 1.960
This left a shortfall of $1.213 million to be solved through additional actions. It now appears the
shortfall is even greater than anticipated. At the Wednesday, January 6, 1993 meeting with the
State Department of Social Services, their Budget Bureau Chief announced that the DSS had made
an accounting error in their CSBG allocation to Contra Costa County in FY 1990-91. Consequently,
they will be deducting $1.018 million from their payments to Contra Costa County in FY 1992-93.
In addition, the Department faces two significant risks: 1) that the CWS reserve will be not available
to Contra Costa County as anticipated; and 2) that the audit exceptions dating back to FY 1983-84
will be applied in this fiscal year. The State maintains the audit exception is $820,000; however,
Social Service fiscal staff believes that it could be demonstrated that the exception should be as
little as $300,000.
In summary, the Department's shortfall currently appears as follows:
Shortfall (in millions)
Following Phase III Reductions $1.213
CSBG Allocation Reduction $1.018
Possible CWS Reserve Fund Loss $ .210
Possible Audit Exception .300
TOTAL $Z.741
Proposed Resolution
During the Finance Committee meeting, Maggie Dee-Dowling, representing Democrats with
Disabilities, presented a resolution Attendant Services for People with Disabilities and Alternatives to
Institutionalization to the Committee. She requested that the Board adopt the resolution. The
Committee suggests that this resolution be referred to the Social Service Director and County
Administrator for their review.
4
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PCO IMPLEMENTATION
Proposed
State Actions Required to Implement PCO Completion Date Status
Department of Finance approval of State
Plan Unknown Unknown
Develop administrative allocation December No draft as of 1/8/93
Obtain CWDA approval of allocation December CWDA/PCO work
(Work Group met 12/11 & again 12/22) group meets 1/14/93
Develop & distribute fiscal instructions 1/15/93 Same
to counties
Provide training to 58 counties 1/30/93 Same
Draft & file emergency State Department of 2/1/93 Draft regulations
Health and Department of Social Services distributed to
regulations counties 1/8/93
Design, test & implement new programming 4/1/93 Same
for State automated system (CMIPS)
County Actions Required to Implement PCO: Completion Date
• Develop and submit revised IHSS/PCO plan to SDSS Required by 30 days after
receipt of allocation
• Review cases and identify PCO eligible clients unknown
• Obtain physician's statement of need for personal
care on 1500 cases (remainder of cases have
medical statement dated within the last 12 months) unknown
• Obtain certification (by recipient) of provider's ability
to provide service on eligible cases. unknown
• Make arrangements for RN supervision of unknown
PCO cases
• Implement new fiscal claiming process unknown
DRAFT
118193
DSS DRAFT PCO REGULATIONS
30-700 . 1 PROGRAM DEFINITION
The In-Home Supportive Services (IHSS) Program provides assistance to
those eligible aged, blind and disabled individuals who are unable to
remain safely in their own homes without this assistance. IHSS is an
alternative to out-of-home care. Personal Care Option (PCO) is a Medi-
Cal funded portion of the IHSS Program. All regulations contained
herein apply equally to the PCO portion and to the non-PCO portion of
the IHSS Program unless regulations specifically state otherwise.
Eligibility and services for the non-PCO portion of the IHSS Program are
limited by the availability of funds.
30-753 Special Definitions
(a) (1) Administrative costs for IHSS are those costs necessary for the
proper and efficient administration of the county IHSS program as
defined below. Activities considered administrative in nature
include, but are not limited to:
(A) Determineing eligibility;
(B) Conducting needs assessments;
(C) Giveing information and referrals;
(D) Establishing case files;
(E) Processing Notices of Action;
(F) Arrangeing for services
(G) Computeing shares of cost;
(H) Monitoring and evaluateinq contractor performance;
(I) Responding to inquiries;
(J) Auditing recipient and individual provider timesheets;
(K) Entering case a-nd payroll and service delivery information into
the CMIPS;
(L) Recruiting and 6screeniing potential providers and maintaining a
registry;
Providing necessary support to recipients in responsibilities as
employers of individual providers ;
SNS Supervising county homemakers who provide direct services.
(a) (2) Administrative costs for PCO are those costs necessary for the
proper and efficient administration of the county PCO program. In
addition to all activities listed under (a) (1) above as
administrative costs for IHSS, the following activities are
considered administrative in nature, subject to PCO funding:
Nursing supervision;
(B) Clerical staff directly supporting nursing supervision of PCO
cases ;
Physician certification of medical necessity when such
certification is completed by a licensed health care professional
who is a county employee.
DRAFT
118113
DSS DRAFT PCO REGULATIONS
30-700. 1 PROGRAM DEFINITION
The In-Home Supportive Services (IHSS) Program provides assistance to
those eligible aged, blind and disabled individuals who are unable to
remain safely in their own homes without this assistance. IHSS is an
alternative to out-of-home care. Personal Care Option (PCO) is a Medi-
Cal funded portion of the IHSS Program. All regulations contained
herein apply equally to the PCO portion and to the non-PCO portion of
the IHSS Program unless regulations specifically state otherwise.
Eligibility and services for the non-PCO portion of the IHSS Program are
limited by the availability of funds.
30-753 Special Definitions
(a) (1) Administrative costs for IHSS are those costs necessary for the
proper and efficient administration of the county IHSS program as
defined below. Activities considered administrative in nature
include, but are not limited to:
(A) Determineinq eligibility;
(B) Conducting needs assessments;
(C) Giveing information and referrals;
(D) Establishing case files;
(E) Processing Notices of Action;
(F) Arrangeing for services
(G) Computeing shares of cost;
(H) Monitoring and evaluateing contractor performance;
(I) Responding to inquiries ;
(J) Auditing recipient and individual provider timesheets;
(K) Entering caseL a-ftd payroll and service delivery information into
the CMIPS;
(L) Recruiting and -Gscreeninq potential providers and maintaining a
registry;
(M)_ Providing necessary support to recipients in responsibilities as
employers of individual providers;
(N) Supervising county homemakers who provide direct services.
(a) (2) Administrative costs for PCO are those costs necessary for the
proper and efficient administration of the county PCO program. In
addition to all activities listed under (a) (1) above as
administrative costs for IHSS the following activities are
considered administrative in nature, subject to PCO funding:
(A)_ Nursing supervision;
(B) Clerical staff directly supporting nursing supervision of PCO
cases;
_(C) Physician certification of medical necessity when such
certification is completed by a licensed health care professional
who is a county employee.
'DRAFT
(a)+2 _C21 Allocation means federal, state and county monies which are
identified for a county by the Department for the purchase of
services in the IHSS 'and PCO Programs and for the administration
of the IHSS and PCO Programs.
(b) (2) Base a" 11 -e-eatien means all federa!, -state and eeidnt
identified fer eeunties by the Depaiatment fer the ;-�-h%Ase ef
serv±ees in the 1-HSS Pregram, exelusive ef any previ-der-e—
alleeatien, but ineluding reelpient GGLA.
(c) (1) County plan means the annual plan and the midyear update submitted
to the State Department of Social Services specifying the methed ef
111SS delivery to fneet prografft e'--ee'-*.---, -eenditlens, and f1sea!
j
limitations how the county will provide IHSS and PCO.
(s) (4) Spouse means, as used in 30-763 . 241 for determining restrictions *in
service payment when the recipient has an able and available spouse,
a member of a married couple or a person considered to be a member
of a married couple for SSI/SSP purposes because they hold
themselves out to the community as a married couple as defined in
20CFR416. 1806 . Legal spouse means, as used in 30-780.4 for
determining PCO eligibilitvlegally married under the laws of the
State of the couple' s permanent home at the time they lived
together.
30-761 Needs Assessment Standards (continued)
. 13 County social services staff has had a face-to-face contact with the
recipient in the recipient' s home at least once within the past 12
months, and has determined that h� i-e the recipient would not be
able to remain safely in his/her own home without IHSS. If the
face-to-face contact is due but the recipient is absent from the
state but still eligible to receive IHSS pursuant to the
requirements stated in Section 30-770. 4 , Residency, the face-to-face
requirement is suspended until such a time as the recipient returns
to the state.
(Continued)
. 15 Home visit assessments with the recipient are required for all
initial assessments, annual reassessments and determinations of need
for recipients who allege a change in need because of deteriorated
functioning
(Continued)
. 3 IHSS staff shall be county social service staff or staff of a county
department of- long term care
2
DRAFT
. 31 Classification of IHSS assessment workers shall be at the discretion
of the County
. 32 IHSS assessment workers shall be trained in the Uniformity
Assessment system
. 33 On a case-by-case basis the county may arrange for the recipient's
functioning to be assessed by a staff member in another long term
care program so long as:
. 331 The staff performing the assessment has been trained in the
Uniformity Assessment system, and
. 332 The staff does not work for an agency which provides IHSS under
contract in the County or otherwise conflicts with the
independence of the assessment process.
30-766 Pregram eentrels County Plans
. 1 Each county welfare department shall develop and submit a county plan to
SDSS no later than 30 days following receipt of its allocation, which
specifies the means by which IHSS and PCO will be provided in order to
meet the objectives and conditions of the program within its allocation.
. 11 The plan shall be submitted to SDSS and shall be based upon relevant
information, as specified in Welfare and Institutions Code Section
12301 and 14132 . 95 , including but not limited to the information
specified below:
. 111 Projected caseload, hours paid, and costs per month/quarter by
mode.
. 112 the modes of IHSS and PCO service delivery the county intends to
use;
. 113 the estimated program and administrative costs for both the IHSS
and PCO programs ;
. 114 the methods the county utilizes to control IHSS program costs to
comply with required fiscal limitations ; and
. 115 the staffing structure intended to meet PCO requirements.
i TTI.TTIBe GK BEGINS
HERE
. 112 S cetr6-131-239r-oz—the--Welfare—and I-Rst rzutr6-HSG6u"
utilized 15y the eeunty regarding the availability ef se. ..' ---
uncr
11'!!ANE)BGGK DADS HER
(Continued)
3
DRAFT
. 13 SDSS shall review each county plan for compliance with Welfare and
, Institutions Code' Section 12300, et seq. and 14132 . 95, departfftental
regulations of SDSS and DHS, and when appropriate, issue
departmental approval.
(Continued)
30-768 Overpayments/Underpayments
DHS regs to be put . into handbook and added to this section
30-769 . 3 -- The County Has The Sole Responsibility For Determining And
Investigating Fraud And Forgery
DHS regs to be put into handbook and added to this section
30-769 . 93 Provider Fraud or Forgery
DHS reqs to be put into handbook and added to this section
30-770 . 4 Residency
DHS reqs to be put into handbook and added to this section
30-780 Personal Care Option (PCO) Eligibility
A person is eligible for PCO who meets the following criteria:
_1 Is status eligible (a current categorical assistance recipient)
. 2 Has a disabling condition that is permanent or chronic in nature and
which is expected to persist for at least twelve months or end in death
before that time.
. 21 Recipients who receive SSI/SSP shall be presumed to meet the
criteria specified in Section 30-780 . 2 .
. 22 For individuals who do not receive SSI/SSP a qualifying disabling
condition is a verified medical or psychiatric diagnosis which has
lasted at least 12 months or is expected to last at least 12 months
or end in death and is severe enough to create a mental impairment
in memory, orientation and/or judgment such that the sum of the
mental function scores equals or exceeds 7 or functional impairment
rank of 3 or more in at least one of the following:
221 mobility inside
222 bathing and grooming
. 223 dressing
4
DRAFT
. 224 bowel , bladder and menstrual
. 225 transfer
. 226 eating
. 227 respiration
. 23 The physician or, at County option, the nurse, shall have the
authority to certify that the disabling condition is expected. to
last at least twelve months.
. 3 Receives at least one of the following:
. 31 Any personal care service listed in MPP 30-757 . 14
. 32 Protective supervision as defined MPP 30-757 . 17
. 33 Paramedical services as defined in MPP 30-757 . 19
. 4 Does not have a provider who is a legally responsible- relative
. 41 When the recipient is legally married, the recipient's spouse is a
legally responsible relative
. 42 When the recipient is an unemancipated minor (under the age of 18)
the recipient' s parent (by birth or adoption) is a legally
responsible relative
30-786 PCO Funding Standards
. 1 Physician certification
. 11 The recipient' s medical necessity for personal care shall be signed
by a licensed health care professional . County staff shall ensure
that the certification is in the recipient' s case record. within 60
days from the date PCO services begin.
. 12 Physician recertification shall occur annually
. 13 At County option, the certification may be done by the recipient's
treating physician or another physician who has reviewed the
necessary documentation.
. 2 Nursing supervision
. 21 Nurses shall at a minimum, visit each PCO recipient at least once
every 12 months.
. 22 Nurses shall monitor the recipient's condition and the effectiveness
of PCO services
5
DRAFT
. 3 Delivery Modes
. 31 Counties shall provide PCO services from one or a combination olf: the
following modes of service delivery he
. 311 County employees as defined in MPP 30-767 . 11
. 312 Contract with an agency as defined in MPP 30-767. 12
. 313 Individual providers as defined in MPP 30-767 . 13
. 4 Provider Enrollment
All providers shall be enrolled as Medi-Cal providers. As a condition
of enrollment, the provider shall sign a statement of vendor compliance
which acknowledges that the provider is subject to federal audit. All
providers providing IHSS at the time of conversion to PCO or within
hin the
past 30 days shall be considered _..grandfathered-in_as providers capable
ofprovidingPCO services .
. 41 Within the first 30 days of PCO serviceprovisionthe Provider
shall be enrolled as a provider eligible for -pa�mentt
.42 At a minimum, IPs shall demonstrate competence to perform authorized
PCO services to be eligible for enrollment- as a PCO-IP
. 421 The recipient may attest to the IP's competence
. 422 The County shall intervene in the event that the recipient has
been neglected or abused by the action or inaction of the
provider
. 5 Third party liability
. 51 (Reserved in case counties will be required to participate in this
process. )
30-784 PCO Administrative Requirements
. 1 In order to complete the new mandates required for, PCO, the. county shall
assure PCO average staffing ratio of I assessment workerper127 cases
. 2 Counties may hire or contract or otherwise make available a licensed
health care professional (s) to certify the medical necessity of PCO
. 3 The County shall assure that registered nurses be available at a
staffing ratio of no more than 350 cases per nurse
6
DRAFT
. 31 The nurse may be an employee of a County department, an employee of
an agency under contract with the County to provide PCO nursing
sup.-�rvislon as defined in 30-786 above, or be available to the
County as an independent contractor.
7
C It
WP = STATUTES-PC; BGRONLUND, MCAREY, CMILLER; 1/7/93
CCR DIVISION 3 HEALTH CARE SERVICES
CHAPTER 3. HEALTH CAPE SERVICES
ARTICLE 2. ADMINISTRATION
S 50101. County Department Responsibilities:
Add: -8) Assist Medi-Cal applicants or beneficiaries, as needed, in
establishing their eligibility and assessing their need for
Personal Care services."
Add: 50112. Case Records and confidentiality for Personal Care
(a) The county Department shall adhere to the requirements in Divisions 19 and
23, Manual of Policies and Procedures, Department of Social Services,
governing:
(1) Maintenance of case records.
(2) Confidentiality of case records.
(3) Safeguarding federal tax information.
(4) Access to case records.
(b) The board of supervisors of a county may authorize the destruction of:
(1) Narrative portions of a case record which are over three years old in
any case file, active or inactive, after audit by the county department.
(2) Case files which have remained inactive for a period of three years
providing the Department has not notified the county department that
unresolved issues or pending civil or criminal actions exist."
Add: "S 51003.1 Prior Authorization of Personal Care Benefits.
a) "Prior Authorization", "reauthorization," or "approval" of a recipient of
Medi-Cal personal care benefits shall follow all the rules set forth in S
51003 above and the County social worker shall be considered to be the
designated Medi-Cal consultant for purposes of these rules."
S 51011 Identification of Beneficiary
(Add "with the exception of personal care services". )
a) "All out-of-hospital and inpatient services with the exception of
personal care services may be provided subject to limitations
specified in the , scope of benefits, and subject to the Medical
Assistance classification of the beneficiary upon presentation by
a beneficiary of a valid medical care eligibility card issued by
a local welfare department, except where these regulations specify
that prior authorization for a specific service is required, and
evidence of such authorization is presented or furnished, such
card shall be deemed adequate authorization to provide services up
to the expiration date specified on the card. Limitations to
personal care services are specified in Section 51350 of this
Division."
Add: "S 51015.2 Providers of Personal Care Services Grievance and Complaints
All grievances or complaints concerning payment for personal care services shall be made
to the employer (recipient) . After following this procedure, a provider who is not
satisfied may seek appropriate remedy from the county welfare department."
[cJA rl t=
ARTICLE 2 - DEFINITIONS FOR: iA E3 MY
I
S 51051 Provider of Services for Personal Care
Add: (b) "Personal Care Services Provider" to listing
Add: "$ 51145.1 Home
For purposes of providing personal care services, home means that place in which the
recipient chooses to reside. The beneficiary's home does not include a facility
licensed by the California State Department of Health Services nor a community care
facility or a residential care facility licensed by the California State Department
of Social Services Community Care Licensing Division."
Add: "S 51181 Personal Care Services Provider
A personal care services provider is that individual, county employee, county
contracted agency, county authority or consortia authorized by the Department to
provide personal care services to eligible beneficiaries. The individual provider
shall not be a family member, which for purposes of this section means a spouse or
the parent of a minor child under the age of eighteen.0
Add: "S 51182 Personal Care Services
Personal Care services as defined in Section 14132.95 of the Welfare and Institutions
Code include a) primary and b) ancillary services prescribed in accordance with a
plan of treatment.
a) Primary personal care services mean:
1) assistance with ambulation;
2) bathing, oral hygiene and grooming;
3) dressing;
4) care and assistance with prosthetic devices;
5) bowel, bladder, and menstrual care;
6) skin care;
7) repositioning; range of motion exercises, and transfers;
8) feeding and assurance of adequate fluid intake;
9) respiration;
10) paramedical services are defined as those activities which persons would
normally perform for themselves but for their functional limitations
and, which due to the recipients, mental or physical condition, are
necessary to maintain the recipients' health;
11) protective supervision; and,
12) assistance with self-administration of medications.
b) Ancillary services including meal preparation and cleanup, routine laundry,
shopping for food and other necessities, and domestic services may also be
provided as long as these ancillary services are subordinate to personal care
services.
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c) A beneficiary who receives only domestic services is not considered eligible
for personal care reimbursement and is to receive services in the IHSS
program. il
ARTICLE 3. STANDARDS FOR PARTICIPATION
Add: "$ 51204. Personal Care Services Provider.
All providers of personal care must be approved by Department of Health Services and
must sign a document designated by the Department agreeing to comply with all
applicable laws and regulations governing Medi-Cal and personal care service.
(a) Independent providers will be selected by the applicant/recipient and
will be trained by the applicant/recipient, his/her conservator, or in
the case of a minor, the legal parent or guardian. The recipient will
co-sign the provider enrollment document certifying that the provider is
qualified to provide personal care.
(b) Contract agency personal care providers must be selected in accordance
with requirements imposed by Welfare and Institutions Code 12302.1.
When a contract agency is used in lieu of an independent provider, the
recipient shall be given the choice of agency employees to act as
his/her attendant. The recipient or designee will train the person in
the care of the recipient and will co-sign the provider enrollment
document certifying that the person is qualified to provide the care.
(c) County employed homemaker providers will be trained by the county in the
care of recipients.
(d) Other county authorities or consortia empowered to provide personal care
will, to the extent possible, allow the recipient to choose the
attendant who will provide the care and the recipient or designee will
train the person to provide care and will co-sign the provider
enrollment agreement certifying that the person is qualified to provide
the care. "
ARTICLE 4 - SCOPE AND DURATION OF BENEFITS
Add: "$ 51350 Personal Care Services
(a) Personal care services as specified in Section 51182 are provided when
authorized by a local welfare department designated social worker based on the
state approved Uniformity Assessment tool.
(b) For purposes of Personal Care Services, all personal. care services may be
provided to a categorically needy beneficiary who has a chronic, disabling
condition that causes functional impairment that is expected to last at least
12 consecutive months or that is expected to result in death within 12 months
and who is unable to remain safely at home without the services. These
services must be prescribed by a physician and be provided in accordance with
a plan of treatment that is under the supervision of a registered nurse. The
services must be provided in the home of the beneficiary. Personal .care
services authorized shall not exceed 283 hours in a given month.
(c) Paramedical services when included in the personal care plan of treatment must
be ordered by a licensed health professional lawfully authorized by the State.
The services shall be provided under the direction of the prescribing health
care professional and supervised by the registered nurse provided by the
county. Paramedical services shall include no services which are included
within the scope of practice of practitioners of the healing arts licensed
under authority of the California Business and Professions Code. "
-
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ARTICLE 6 •- ELIGIBILITY FOR PAYMENT p. 459
Add: "§ 51454.1 Provider of Personal Care Services Defined
For purposes of Personal Care Services, providers include counties, agencies
contracting with the counties to provide the needed care, and individual providers
of care. A relative may not provide personal care services. A "relative" is a
spouse or parent of a minor child; a "spouse" is a member of a married couple or a
person considered to be a member of a married couple; and, a "minor" is any person
under the age of eighteen."
Add: "§ 51476.2 Personal Care Services Records
Each county shall keep, maintain, and have readily retrievable,such records as are
necessary to fully disclose the type and extent of personal care services provided
to a Medi-Cal beneficiary. Records shall be made at or near the time the service is
rendered or the assessment or other activity is performed. Such records shall
include, but not be limited to the following:
(1) Billings
(2) Assessment forms and notes
(3) All service records, care plans, and orders/prescriptions ordering
personal care.
(4) Any other such records that might be prescribed by Department of Health
Services or Department of Social Services."
[§51483.1 Provider Requirements]
ARTICLE 7 PAYMENT FOR SERVICES & SUPPLIES
Add: "§ 51545?? Reimbursement Rates for Personal Care Services
Reimbursement rates for personal care services shall be equal to the 1991-1992 rates
in each county for the same mode of services in the IHHS program pursuant to Article
7 (commencing with Section 12300) of Chapter 3, plus any increase provided in the
annual Budget Act for personal care services rates."
Claiming -
The current IHSS claims payment system, Case Management Information and Payrolling
System (CMIPS) , will be modified to meet federal Medicaid Management Information
Systems (MMIS) requirements. Claims will be processOd by the current IHSS
contractor, Electronic Data Systems, Incorporated.
State of California-Health and Welfare Agency Department of Social Services
PHYSICIAN'S CERTIFICATION OF MEDICAL NECESSITY
DATE:
This form must be completed for Personal Care
Option eligibility and annually for recertification.
After completion, return this form to the agency
L J address indicated below.
PATIENTS NAME DATE OF BIRTH CASE NUMBER
Dear Doctor:
The Personal Care Option provides assistance through In-Home Supportive Services, to those eligible aged, blind,
and disabled indivduals who are limited in their ability to care for themselves and would be unable to remain
safely in their own homes without this service.
Your patient has requested help with one or more of the following personal care services: assistance with
ambulation; bathing; oral hygiene; grooming; dressing; care and assistance with prosthetic devices; protective
supervision; bowel, bladder and menstrual care; repositioning,skin care, range of motion exercises and transfers;
feeding and assurance of adequate fluid intake; respiration; or assistance with self-administration of medications.
Your examination of this patient is reimbursable through Medi-Cal as an office visit provided that all other
applicable Medi-Cal requirements are met.
AGENCY SERVICE WORKER SERVICE WORKER NUMBER
AGENCY ADDRESS(Street,City,Zip) PHONE
SERVICE WORKER'S SIGNATURE DATE
::;;:>:;::;; ::<::::::i:::::5::i::::5::r::ri::3:: :::::;»:::;i�:i3:::;i;:'r:;:r:::: ::::r;:i::.r.:;;i:;i:: ::i:i:::i:::;..
.:�.: :::::: :;::r ::::': :: ::::::::':::'?: ::;`::::::::::::::::::::::::2?!;: ::$::;:;:;:;:;:::::::;:;::': fir: :::::::::: :
.::.::.;:.:;:::::-;:;;;>:.<;:»>.::>«::::>:;;>::>::>::>:<:>::>:::::>::>:::<:»>:.;;>:.;:.;::<.;:.>:.;:;>; >:::>>:: «:»>::>:;:: ::: » IJ:>tiQ.R ZATI.O.N..................:.................
I hereby authorize the release of information,to the above named agency,pertaining to my medical neccesity for personal care services
which will enable me to remain safely at home.
PATIENTS SIGNATURE(Or Authorized Representative) DATE
......:::::::::::::::::::::F.OR.PH.YSICIAN S;.:USE. . LY...:...... : ::,,..:..... .. .
PHYSICIAN'S NAME LICENSE NUMBER PHONE
OFFICE ADDRESS(Street,City,Zip)
DATE LAST SEEN BY PHYSICIAN LENGTH OF DISABILITY (Dale disability began/expected duration,Le.,6 months,2 years,permanent)
DIAGNOSIS
PROGNOSIS
I recommend one or more of the above listed personal care services as part of this patient's treatment plan. Yes No
PHYSICIANS SIGNTURE PROVIDER NUMBER DATE
SOC Temp. A(1/93) -
State of California-Health and Welfare Agency Department of Social Services
PERSONAL CARE OPTION
PROVIDER/ENROLLME:NT AGREEMENT
Instructions:
• This form is to be completed in duplicate.
• This form must be completed for each provider/recipient relationship prior to enrollment.
• Part 1 is to be completed by the provider.
• Part 11 is to be completed by the recipient.
• Part 111 is to be completed by the county.
• The original form is to be maintained by the county and a copy given to the provider.
PART I - PROVIDER
PROVIDER NAME SOCIAL SECURITY NUMBER
ADDRESS(Street,City.Zip)
PHONE
CERTIFICATION STATEMENT
• I certify that all claims, whcih I submit, for services to recipients of the Personal Care Option,
provided through the In-Home Supportive Services program, will be provided as authorized for the
recipient.
• I certify that all information submitted to the county will be accurate and complete to the best of my
knowledge.
• I understand that any false statement, claim, or concealment of information may be prosecuted
under federal and/or state laws.
• I agree that services will be provided without discrimination based on race, religion, color, national or
ethnic origin, sex, age, or physical or mental disability.
PROVIDER'S SIGNATURE DATE
PART 11 - RECIPIENT CERTIFICATION
I certify that the provider named above is qualified to provide personal care services for me as
authorized by the county.
RECIPIENTS NAME CASE NUMBER
RECIPIENTS SIGNATURE(Or Authorized Representative) •DATE
PART III - RECORD RETENTION
On behalf of the proivder, the county shall keep all records which are necessary to fully disclose the
extent of services to the recipient for a minimum of three years from the date of service; and on request
shall furnish the records for audit to the State of California or the U.S. Department of Health and
Human Services or their duly authorized representatives.
AUTHORIZED COUNTY REPRESENTATIVE'S SIGNATURE DATE
SOC Temp. B (179 3)
PROPOSED RESOLUTION
Re: Attendant Services for People With Disabilities and
Alternatives to Institutionalization
WHEREAS, the Contra Costa Board of Supervisors and most
major advocacy groups representing older and disabled
Americans has recommended that individuals and their
families should have self-directed community based
attendant service options and alternatives to
institutional and nursing home services.
WHEREAS, the number of older and /or disabled Americans
who want and need these self-directed, community-based,
non-medical attendant services is growing every year,
WHEREAS, historical and current funding patterns of our
State and Federal governments have put substantially more
dollars into institutional and nursing home services than
into self-directed community-based attendant services
alternatives,
THEREFORE, BE IT RESOLVED, that Contra Costa County will
adopt policies and programs that will promote the:
- redirection of current Federal and State institutional
and nursing home dollars to self-directed
community-based attendant service alternatives,
- allocation of all new Federal and State dollars in a
way that lowers the ratio between institutional and
nursing home program dollars and self-directed,
community-based attendant services options,
- removal of all regulations, funding incentives and
legislative initiatives that promote an environment
which encourages institutional and nursing home
programs over self-directed community-based
attendant service alternatives,
- to establish the Individual Provider mode (IP) as the
primary In-Home support model,
- work with other County and State agencies to provide
case management services under the IP mode. It would
serve our communities of seniors/disabled better, to
house case management in other agencies,
-more-
t.
Page, 2-3
- work to end "local option" in IHSS and return to a
state-run program. It is evident that, "Local Option,"
generates greater problems resulting in time consuming
litigation and costly mistakes due to inconsistencies
of interpretation and management . Transportation and
voting are primary examples of this.
- establishment of a permanent advisory commission to
the Board of Supervisors during the planning,
development, implementation and operation phases of
a, "Managed Care Program," and to advise on the
Title XIX monies when they become available to the
State of California, thereby to Contra Costa County,
acting as a review panel for grievances to be heard,
(as an option to a recipient) , prior to a request for
a State of California Hearing and to act as
advisors to the Board of Supervisors, County
personnel and to be comprised of, three recipients,
(2 Medi-Cal recipients, 1 Contra Costa Health Plan
recipient, non-Medi-Cal) , one agency to represent
the senior population, one agency to represent the
disabled and three recipients, ( 1 Medi-Cal; 1 IHSS
recipient, 1 SSI/AFDC recipient) , 1 public interest
attorney representative, 1 Social Worker from each
Dept. of Social Services (no Supervisors or
Mangement) ; the Director of Health Services, the
Director Social Services or their single appointed
representative.
BE IT FURTHER RESOLVED, that Contra Costa County will work
with local advocacy groups for the implementation of new
Federal policies that will change our long term care system
from one that promotes the institutional and nursing home
model to one that provides incentives for the development of
self-directed, community-based attendant services.
BE IT FURTHER RESOLVED, that Contra Costa County will make
this position known to the current Secretary of Health and
Human Services, Louis Sullivan and the newly appointed and
confirmed, In-coming Secretary; Pete Wilson, Governor of
California; the California State Legislature and the
American Health Care Association among others.
-30-
Respectfully submitted by:
C. C. Central Committee's, Democrats With Disabilities Club,
A quorum vote:
Executive Board, Co-Chairs, Richard Stickney, Maggie
-more-
Page 3-3
Dowling; Secretary/Treasure, Tamarah Lucio; Members : Evers,
Hoffart, Fowble, Scott, Ludwig, Gilmore, Guy, Peterson, C.
Huff, J. Huff, Pejovich, Spenser
Revision: Page 2 and add, page 3, January 9, 1993
IN THE BOARD OF SUPERVISORS
OF
CONTRA COSTA COUNTY, STATE OF CALIFORNIA
In the Matter of )
Support of the East Bay )
Regional Park District's )
Regional Trails Program )
)
The Board of Supervisors of Contra Costa County RESOLVES THAT:
WHEREAS, East Bay Regional Park District (EBRPD) has developed an extensive
multi-use regional trails program which is highly regarded and consistently utilized by the
citizens of our county;
WHEREAS, EBRPD, similar to all local government agencies, is confronting a
current problem of limited financial resources, a problem which likely will continue for
many years;
WHEREAS, it is important that EBRPD be in a position to sustain its important
regional trails program, at a consistently high standard of service;
WHEREAS, Contra Costa County has organized work crews to provide training
opportunities for General Assistance recipients which could provide cost-effective trail
maintenance for the Parks District; and
WHEREAS, the District is initiating an exploratory effort, with the involvement and
representation of citizen support groups, to determine the appropriateness of formation
of a two-county Landscaping and Lighting District at a nominal assessment rate
approximating $5.00 per parcel.
NOW THEREFORE, the Contra Costa County Board of Supervisors:
Encourages the EBRPD to make every effort possible to insure that the regional
trails program be continued at is high level of effectiveness and citizen satisfaction,
Encourages the EBRPD to collaborate with the County in providing work training
opportunities for General Assistance recipients through use of the County's work
crews to improve trail maintenance;
Supports EBRPD's efforts to explore the feasibility of forming a Landscaping and
Lighting District in order to insure availability of a reliable funding source for the
trails program; and
Endorses the EBRPD intent to involve a representative citizens' group to review the
proposals and to determine their validity.
PASSED by the following vote of the Board of Supervisors on this 12th day of January
1993.
AYES: Supervisors Smith, Bishop, .McPeak, and Torlakson
NOES: None
ABSENT: Supervisor Powers
ABSTAIN: None
I hereby certify that the foregoing is a true and correct copy of an order entered on
the minutes of the Board of Supervisors of the date aforesaid.
Witness my hand and Seal of the Board of
Supervisors affixed on this 12th day of January
1993.
Phil Batchelor, Clerk of the Board of Supervisors
and County Administrator
By
Deputy Clerk
cc: EBRPD
h28:ebrpd.res
RECEIVED
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