IHSS Quality Assurance & Hourly Task Guidelines Talking Points
Senate Budget Subcommittee #3 hearing of April 23, 2008
Background: The IHSS Quality Assurance Program was enacted with SB 1104 (Chapter 229, Statutes
of 2004) as a companion to the federal IHSS Plus Waiver which secured enhanced federal funding to
preserve essential services to IHSS consumers.
In the FY 03-04 state budget proposal, Governor
Schwarzenegger proposed to repeal the IHSS Residual program which would have resulted in 75,000
consumers being eliminated from the IHSS program. In order to continue to provide those services, the
State of California sought federal approval to implement the IHSS Plus Waiver. The Centers for Medicare
and Medicaid Services (CMS) approval was received effective August 1, 2004. Under the IHSS Plus
Waiver, the State receives federal matching funds. This five year federal waiver is slated to expire on
July 31, 2009.
We are opposed to the following provisions of the IHSS Quality Assurance trailer bill language:




Repeal of the stakeholder statutes and process (except for input on waiver regulations)
Repeal of the requirement for CDSS to develop protocols on QA monitoring
Repeal of the authorization for counties to consult with CDSS
Amend current law to provide counties with the sole authority to establish policies, procedures, and
timelines for QA activities by deleting state role.
We respectfully urge that the proposed trailer bill language be rejected.
Talking Points:
#1 – the Trailer Bill language could jeopardize federal funding.
The federal CMS required and the state agreed on specific Quality Assurance components as a
condition of receiving the enhanced federal funding under the IHSS Plus Waiver. The federal QA
requirements include:




providing mechanisms to assure that the care needs of vulnerable populations participating in
this demonstration (i.e., the elderly and disabled) are satisfied;
assuring that funds provided to these consumers are used appropriately;
providing for case management staff for purposes of monitoring participant health and
welfare with quality monitoring surveys to be conducted, and the monitoring and corrective
action plans to be triggered by the surveys;
procedures for insuring against duplication of payment between the demonstration, fee for
service and Home and Community-Based Services programs; and fraud control provisions
and monitoring.
The proposed IHSS Quality Assurance trailer bill language appears to violate California’s
agreement with the federal government and could jeopardize our ability to receive enhanced
federal funding.
#2 – The trailer bill language contradicts legislative action taken to protect federal funding.
The legislature reinforced its support to continue the IHSS Plus Waiver with the passage of AJR
11 in 2007; in fact, this resolution was passed without a single “no” vote. The proposed trailer
bill undermines the legislature resolution to ensure that the IHSS Plus Waiver program is
renewed and protected.
#3 – It is premature to end the stakeholder process. There were several components of the
Quality Assurance project that were very controversial (such as the Hourly Task Guidelines) and
the stakeholder process has been extremely important to consumers and providers to ensure that
essential services would not be eroded. The waiver is currently slated to expire next year and
voice of stakeholders will continue to be important to insure continuation of the waiver.
#4 – The Hourly Task Guidelines Quality Assurance are not completed. While a great deal
of work has been accomplished under the Quality Assurance plan, there are several projects that
have not been finalized. CDSS released a survey to obtain feedback from IHSS consumers
about their service authorizations to obtain additional data about the impact of the HTGs. The
January 2008 report from CDSS indicated that an analysis was conducted on data collected
through a survey of a randomly selected sample of consumers statewide. We have requested
the data from the consumer survey and have not received it.
#5 – The Quality Assurance statute required the state to update IHSS regulations and the
regulatory revisions are not complete. The CDSS has committed to update regulations
pertaining to collective bargaining, Advisory Committees, Public Authorities and other issues that
have arisen out of the enactment of AB 1682 (Chapter 90, Statutes of 1999). The last
stakeholder meeting to update these regulations was September 20, 2007. CDSS indicated that
we would receive a revised draft in October 2007. We have not received any update since
September 20, 2007 and no further meetings of this workgroup have been convened.
#6 – We are opposed to the trailer bill language to repeal the state’s role in developing
Quality Assurance protocols. This proposal contradicts the goal of establishing uniformity
between the counties.
#7 Request to adopt Quality Assurance language: In 2006 and 2007, the Legislature adopted
Supplemental Report Language requiring DSS to report to the Legislature quarterly on IHSS
utilization data by county, task, and client level. The data was also to report the number of
exceptions by county, task and client level. Budget Bill Language was also adopted to require
DSS to report at budget hearings on the impact of the IHSS QA regulations. The IHSS Coalition
respectfully requests that the same language be adopted for FY 2008-09.
###