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		<ns0:Id>20250AB__034697AMD</ns0:Id>
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			<ns0:Action>
				<ns0:ActionText>INTRODUCED</ns0:ActionText>
				<ns0:ActionDate>2025-01-29</ns0:ActionDate>
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				<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
				<ns0:ActionDate>2025-05-23</ns0:ActionDate>
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				<ns0:ActionText>AMENDED_SENATE</ns0:ActionText>
				<ns0:ActionDate>2025-07-09</ns0:ActionDate>
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			<ns0:SessionYear>2025</ns0:SessionYear>
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			<ns0:MeasureNum>346</ns0:MeasureNum>
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		<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Nguyen</ns0:AuthorText>
		<ns0:Authors>
			<ns0:Legislator>
				<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
				<ns0:House>ASSEMBLY</ns0:House>
				<ns0:Name>Nguyen</ns0:Name>
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		<ns0:Title> An act to amend Sections 12300.1 and 12309.1 of the Welfare and Institutions Code, relating to in-home supportive services. </ns0:Title>
		<ns0:RelatingClause>in-home supportive services</ns0:RelatingClause>
		<ns0:GeneralSubject>
			<ns0:Subject>In-home supportive services: licensed health care professional certification.</ns0:Subject>
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		<ns0:DigestText>
			<html:p>Existing law provides for the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons are provided with specified services in order to permit them to remain in their own homes and avoid institutionalization. Existing law defines supportive services for purposes of the IHSS program to include those necessary paramedical services that are ordered by a licensed health care professional, which persons could provide for themselves, but for their functional limitations. Existing law requires an applicant for, or recipient of, in-home supportive services, as a condition of receiving these services, to obtain a certification from a licensed health care professional declaring that the applicant or recipient is unable to perform some activities of daily living independently, and that without services to assist the applicant or
			 recipient with activities of daily living, the applicant or recipient is at risk of placement in out-of-home care, and defines a licensed health care professional for this purpose to mean an individual licensed in California by the appropriate California regulatory agency, acting within the scope of their license or certificate as defined in the Business and Professions Code.</html:p>
			<html:p>This bill would use the above-described definition of “licensed health care professional” for purposes of the provisions relating to paramedical services, and would, for purposes of the certification requirement, add to the above-described definition of “licensed health care professional” that the licensed individual has primary responsibilities to diagnose or provide treatment and
			 care for physical or mental impairments that cause or contribute to an individual’s functional limitations.</html:p>
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	<ns0:Bill id="bill">
		<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
		<ns0:BillSection id="id_05EDAF76-BD22-407A-A78A-DFED46909AF7">
			<ns0:Num>SECTION 1.</ns0:Num>
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				Section 12300.1 of the 
				<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
				 is amended to read:
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					<ns0:Num>12300.1.</ns0:Num>
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								(a)
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								As used in Section 12300 and in this article, “supportive services” include those necessary paramedical services that are ordered by a licensed health care professional who is lawfully authorized to do so, which persons could provide for themselves, but for their functional limitations. Paramedical services include the administration of medications, puncturing the skin or inserting a medical device into a body orifice, activities requiring sterile procedures, or other activities requiring judgment based on training given by a licensed health care professional. These necessary services shall be rendered by a provider under the direction of a licensed health care professional, subject to the informed consent
						of the recipient obtained as a part of the order for service. Any and all references to Section 12300 in any statute heretofore or hereafter enacted shall be deemed to be references to this section. All statutory references to the supportive services specified in Section 12300 shall be deemed to include paramedical services.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								For purposes of this section, “licensed health care professional” means an individual licensed in California by the appropriate California regulatory agency, acting within the scope of their license or certificate, as defined in the Business and Professions Code, including a physician or surgeon, physician assistant, podiatrist, dentist, or nurse practitioner.
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			<ns0:Num>SEC. 2.</ns0:Num>
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				Section 12309.1 of the 
				<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
				 is amended to read:
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					<ns0:Num>12309.1.</ns0:Num>
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							<html:p>
								(a)
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								(1)
								<html:span class="EnSpace"/>
								As a condition of receiving services under this article, or Section 14132.95 or 14132.952, an applicant for or recipient of services shall obtain a certification from a licensed health care professional declaring that the applicant or recipient is unable to perform some activities of daily living independently, and that without services to assist the applicant or recipient with activities of daily living, the applicant or recipient is at risk of placement in out-of-home care.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								For purposes of this section, “licensed health care professional”
						means an individual licensed in California by the appropriate California regulatory agency, acting within the scope of their license or certificate, as defined in the Business and Professions Code, and whose primary responsibilities are to diagnose or provide treatment and care for physical or mental impairments that cause or contribute to an individual’s functional limitations.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Except as provided in subparagraph (A) or (B), or subdivision
						(c), the certification shall be received prior to service authorization, and services shall not be authorized in the absence of the certification.
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								Services may be authorized prior to receipt of the certification when the services have been requested on behalf of an individual being discharged from a hospital or nursing home and services are needed to enable the individual to return safely to their home or into the community.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								Services may be authorized temporarily pending receipt of the certification when the county determines that there is a risk of out-of-home placement.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								The county shall consider the certification as one indicator of the need for in-home supportive services, but the certification shall
						not be the sole determining factor.
							</html:p>
							<html:p>
								(5)
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								The licensed health care professional’s certification shall include, at a minimum, both of the following:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								A statement by the licensed health care professional that the individual is unable to independently perform one or more activities of daily living, and that one or more of the services available under the IHSS program is recommended for the applicant or recipient, in order to prevent the need for out-of-home care.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								A description of any condition or functional limitation that has resulted in, or contributed to, the applicant’s or recipient’s need for assistance.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								The department, in consultation with the
						State Department of Health Care Services and with stakeholders, including, but not limited to, representatives of program recipients, providers, and counties, shall develop a standard certification form for use in all counties that includes, but is not limited to, all of the conditions in paragraph (5) of subdivision (a). The form shall include a description of the In-Home Supportive Services program and the services the program can provide when authorized after a social worker’s assessment of eligibility. The form shall not, however, require licensed health care professionals to certify the applicant’s or recipient’s need for each individual service.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								The department, in consultation with the State Department of Health Care Services and stakeholders, as described in subdivision (b), shall identify alternative documentation that shall be
						accepted by counties to meet the requirements of this section, including, but not limited to, hospital or nursing facility discharge plans, minimum data set forms, individual program plans, or other documentation that contains the necessary information, consistent with the requirements specified in subdivision (a).
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								The department shall develop a letter for use by counties to
						inform recipients of the requirements of subdivision (a). The letter shall be understandable to the recipient, and shall be translated into all languages spoken by a substantial number of the public served by the In-Home Supportive Services program, in accordance with Section 7295.2 of the Government Code.
							</html:p>
							<html:p>
								(e)
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								This section does not apply to a recipient who is receiving services in accordance with this article or Section 14132.95 or 14132.952 on the operative date of this section until the date of the recipient’s first reassessment following the operative date of this section, as provided in subdivision (g).
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								The recipient shall be notified of the certification requirement before or at the time of the reassessment, and shall submit the certification within 45 days
						following the reassessment in order to continue to be authorized for receipt of services.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								A county may extend the 45-day period for a recipient to submit the medical certification on a case-by-case basis, if the county determines that good cause for the delay exists.
							</html:p>
							<html:p>
								(f)
								<html:span class="EnSpace"/>
								<html:span class="EnSpace"/>
								A licensed health care professional shall not charge a fee for the completion of the certification form.
							</html:p>
							<html:p>
								(g)
								<html:span class="EnSpace"/>
								This section shall become operative on the first day of the first month following 90 days after the effective date of Chapter 8 of the Statutes of 2011, or July 1, 2011, whichever is later.
							</html:p>
							<html:p>
								(h)
								<html:span class="EnSpace"/>
								The State Department of Health Care Services shall provide notice to all
						Medi-Cal managed care plans, directing the plans to assess all Medi-Cal recipients applying for or receiving in-home supportive services, in order to make the certifications required by this section.
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								If the Director of Health Care Services determines that a Medicaid State Plan amendment is necessary to implement subdivision (b) of Section 14132.95, this section shall not be implemented until federal approval is received.
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