Health and human services.

Existing law requires the State Department of Developmental Services, in consultation with stakeholders, to develop an alternative service delivery model that provides an Individual Choice Budget for obtaining quality services and supports that provides choice and flexibility within a finite budget that, in the aggregate, reduces regional center purchase of service expenditures, reduces reliance on the General Fund, and maximizes federal financial participation. Existing law places certain restrictions on the purchase of respite services, based on need and duration, until implementation of the Individual Choice Budget, as specified. AB 107 of the 2017–18 Regular Session would repeal the provision that places restrictions on the purchase of those services. This bill would delay the repeal of that provision until January 1, 2018. The bill would appropriate $100,000 from the Federal Trust Fund to the department for purposes of implementation. Existing law provides for the county-administered In-Home Supportive Services (IHSS) program, administered by the State Department of Social Services and counties, and under which qualified aged, blind, and disabled persons are provided with supportive services. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing federal law provides for various home- and community-based services waivers, such as the In-Home Operations Waiver and the Nursing Facility/Acute Hospital Transition and Diversion Waiver (NF/AH waiver) , that promote coverage and services that enable an individual who would otherwise be institutionalized to live at home or in the community. Under the NF/AH waiver, a home- and community-based services waiver authorized under this federal law until March 31, 2016, home- and community-based services, such as case management and coordination, habilitation services, and community transition services, are provided to eligible Medi-Cal beneficiaries with long-term medical conditions who would otherwise receive care in a skilled nursing facility. AB 113 and SB 97 of the 2017–18 Regular Session would authorize the Director of Health Care Services, when renewing the NF/AH waiver, to seek additional increases in the scope of the home- and community-based NF/AH waiver and would make conforming changes. This bill would make those conforming changes to the NF/AH waiver provisions. Existing law prohibits a provider of in-home supportive services or waiver personal care services, or both, from working a total number of hours within a workweek that exceeds 66 hours, as specified. Existing law prohibits the provision of services by the provider to an individual recipient from exceeding the total weekly hours of the services authorized to that recipient, except as specified. This bill, notwithstanding the 66-hour workweek limit and subject to receipt of any necessary federal approvals and federal financial participation, would require the State Department of Health Care Services to grant an exemption to a provider of an applicant or participant of the NF/AH waiver or the In-Home Operations Waiver, or their successors, whose medical or behavioral needs require that the services be provided by the requested provider, if one of specified circumstances exists. For a waiver participant who is enrolled in either waiver after January 31, 2016, the bill would require the department to grant a provider an exemption on a case-by-case basis, as specified. The bill would authorize a provider of in-home supportive services or waiver personal care services who is granted an exemption to work up to a total of 12 hours per day, and up to 360 hours per month, as specified. The bill would require the department to record the number of requests for exemptions, as specified. This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.