BILL NUMBER: ABX4 9 CHAPTERED
BILL TEXT
CHAPTER 9
FILED WITH SECRETARY OF STATE JULY 28, 2009
APPROVED BY GOVERNOR JULY 28, 2009
PASSED THE SENATE JULY 23, 2009
PASSED THE ASSEMBLY JULY 23, 2009
AMENDED IN SENATE JULY 23, 2009
INTRODUCED BY Assembly Member Evans
JULY 2, 2009
An act to amend Sections 95004, 95014, and 95020 of, and to add
Section 95021 to, the Government Code, to amend Sections 4648,
4648.1, 4659, 4677, 4685, 4686, 4689, 4784, and 7502.5 of, to amend
the heading of Chapter 4 (commencing with Section 4570) of Division
4.5 of, to amend and repeal Sections 4418.1 and 4570 of, and to add
Sections 4435, 4571, 4648.35, 4648.5, 4648.6, 4686.2, 4686.5, 4688.1,
4688.2, 4688.3, 4689.05, and 4692 to, the Welfare and Institutions
Code, relating to public social services, and declaring the urgency
thereof, to take effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
AB 9, Evans. Developmental services.
Existing law, the California Early Intervention Services Act,
provides a statewide system of coordinated, comprehensive,
family-centered, multidisciplinary, and interagency programs that are
responsible for providing appropriate early intervention services
and support to all eligible infants and toddlers, as defined, and
their families. The act requires these services to be provided
pursuant to the existing regional center system under the Lanterman
Developmental Disabilities Service Act, and further requires the
regional centers to comply with that act and its implementing
regulations, as specified.
This bill additionally would require a family's private insurance
for medical services or a health care service plan identified in the
individualized family service plan to be used in compliance with
applicable state law and regulation, except for specified purposes.
The California Early Intervention Services Act requires an
eligible infant or toddler receiving services under the act to have
an individualized family service plan (IFSP). The plan is required to
be in writing and to address specified issues, including a statement
of the specific early intervention services needed to meet the
unique needs of the infant or toddler.
This bill would revise the definition of an eligible infant or
toddler for purposes of eligibility for services. The bill would also
revise the contents of the individualized family service plan,
including, commencing July 1, 2009, requiring the development,
review, or modification of an individualized family service plan to
consider certain group training and preschool activities and would
make related changes. The bill would prohibit regional centers from
purchasing nonrequired services, as defined, except durable medical
equipment.
This bill would, effective July 1, 2009, require any vendor of
applied behavioral analysis services or intensive behavioral
intervention services, as defined, under either the California Early
Intervention Services Act or the Lanterman Developmental Disabilities
Services Act to conduct a behavioral assessment of each infant or
toddler to whom the vendor provides these services and design an
intervention plan for the child. The regional center would be
required to purchase these services, subject to prescribed
limitations.
This bill would also require the State Department of Developmental
Services to establish a prevention program for at-risk babies, as
defined, under which intake, assessment, case management, and
referral to generic agencies, as defined, would be provided. Each
regional center would purchase or provide services under the program
pursuant to its allocation from the department.
Under existing law, the Lanterman Developmental Disabilities
Services Act, the State Department of Developmental Services is
responsible for providing various services and supports to
individuals with developmental disabilities, and for ensuring the
appropriateness and quality of those services and supports. Existing
law requires that life quality assessments be conducted with
consumers served by private nonprofit regional centers, pursuant to
specified criteria.
This bill would, instead, require the State Department of
Developmental Services to implement an improved, unified quality
assessment system, on or before January 1, 2010. It would require the
department to identify a valid and reliable quality assurance
instrument that includes assessments of consumer and family
satisfaction, provision of services, and personal outcomes. The bill
would require the department to contract with an independent agency
or organization for this purpose. Implementation of these provisions
would be subject to an annual appropriation of funds in the Budget
Act.
Under existing law, the department contracts with the regional
centers to provide services and supports to persons with
developmental disabilities. The services and supports to be provided
to a regional center consumer are contained in an individual program
plan (IPP), developed in accordance with prescribed requirements.
These services and supports may include transportation services.
This bill, effective July 1, 2009, would impose various
requirements relating to the funding of transportation services, at
the time of the development, review, or modification of a consumer's
IFSP or IPP, as specified.
Existing law permits a regional center to purchase, pursuant to
vendorization or contract, services and supports for the consumer
from any individual or agency that the regional center and the
consumer or, where appropriate, his or her parents, legal guardian,
conservator, or authorized representative determine will best
accomplish all or any part of the consumer's IPP. Under existing law,
the regional center and the consumer or, where appropriate, his or
her parents, legal guardian, conservator, or authorized
representative are required, pursuant to the IPP, to consider
specified factors when selecting a provider of services and supports,
including the cost of providing services and supports of comparable
quality by different providers, if available.
This bill would, except as prescribed, require the least costly
available provider of comparable services that is able to accomplish
all or part of the consumer's IPP, consistent with the particular
needs of the consumer and family, as identified in the IPP, to be
selected.
The bill would also prohibit, effective July 1, 2009, a regional
center from purchasing experimental treatments, therapeutic services,
or devices that have not been clinically determined or
scientifically proven to be effective or safe or for which risks and
complications are unknown. It would delay application of this
prohibition for persons receiving these services on July 1, 2009,
until August 1, 2009.
The bill would require a regional center to annually provide to
the consumer and his or her parents, legal guardian, conservator, or
legal representative a statement of services and supports that the
regional center purchased, for the purpose of ensuring that they are
delivered.
Existing law contains various requirements pertaining to the
responsibilities of the department and regional centers concerning
the monitoring of consumers in health and residential care
facilities.
This bill would, effective July 1, 2009, provide that a regional
center shall not be required to perform triennial evaluations of
specified community care facilities.
This bill would, effective July 1, 2009, with specified
exceptions, prohibit a regional center from newly vendoring a 24-hour
residential care facility licensed by the State Department of Social
Services with a licensed capacity of 16 or more beds.
Existing law requires a regional center to identify and pursue all
possible sources of funding for consumers, including governmental or
other entities or programs required to provide or pay the costs of
providing services.
This bill would require that the department, in consultation with
stakeholders, 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. The bill would, effective
July 1, 2009, prohibit a regional center from purchasing specified
services pending implementation of the Individual Choice Budget,
except that an exemption from this prohibition may be granted under
prescribed circumstances.
The bill would also, effective July 1, 2009, impose restrictions
on the amount of respite services that may be purchased for a
consumer, except that a regional center may grant an exemption from
these restrictions under prescribed circumstances. This respite
service provision would be repealed upon the occurrence of prescribed
conditions relating to the implementation of the Individual Choice
Budget.
This bill would, effective July 1, 2009, and except as prescribed,
provide that a regional center shall not purchase any service that
would otherwise be available from prescribed publicly funded program,
private insurance, or a health care service plan when the consumer
or family meets the criteria of that coverage but chooses not to
pursue that coverage.
The bill would also, effective July 1, 2009, and except as
prescribed, prohibit a regional center from purchasing medical or
dental services for a consumer 3 years of age or older from the
Medi-Cal program private insurance, or health care service plan
unless the regional center is provided documentation of a Medi-Cal,
private insurance, or health care service plan denial appeal is being
pursued, and the regional center makes a specified determination
regarding the appeal.
Existing law requires the Director of Developmental Services to
establish, annually review, and adjust as needed, a schedule of
parental fees for services received through the regional centers.
Under existing law, adjustment of the parental fees by the department
is subject to the approval of the State Council on Developmental
Disabilities.
This bill would revise the provisions relating to parental fees,
by, among other things, exempting the July 1, 2009, parental fee
adjustment from approval by the State Council on Developmental
Disabilities and providing for additional factors to be used in
determining the fee adjustment.
Existing law authorizes an in-home respite worker, as defined, to
perform gastrostomy care and feeding of regional center clients,
after completing designated training.
This bill would expand these provisions to include colostomy,
ileostomy, and urinary catheter care, and would refer to these
services collectively as incidental medical services. The bill would
revise applicable training requirements, and would provide for
specified wage increases for in-home respite agencies and staff
providing incidental medical services.
Existing law requires the department and regional centers to
ensure that supported living arrangements for adults with
developmental disabilities are made available, as specified.
This bill would revise the provisions relating to supported living
arrangements by, among other things, setting forth the circumstances
under which a regional center would make rent, mortgage, or lease
payments or household expenses, as defined, for a consumer.
Existing law provides for the In-Home Supportive Services (IHSS)
program, under which qualified aged, blind, and disabled persons
receive services enabling them to remain in their own homes.
This bill would prohibit a regional center from purchasing
supportive services under the IHSS program for a consumer who meets
the criteria for the program, but declines to apply for those
services, unless the regional center director waives this provision,
as specified, and documents this waiver in an addendum to the
consumer's IPP.
This bill would require the department and the State Department of
Health Care Services, jointly, to seek a Medi-Cal program state plan
amendment from the federal government to expand federal financial
participation for services to persons with developmental disabilities
provided by regional centers.
Existing law requires the Director of Developmental Services to
establish, maintain, and revise, as necessary, an equitable process
for setting rates of state payment for nonresidential services
purchased by regional centers, and authorizes the director to
promulgate implementing regulations.
This bill, effective July 1, 2009, would prohibit regional centers
from compensating designated nonresidential service programs for
providing any service to a consumer on any of a list of holidays
specified in the bill, with the department authorized to adjust these
holidays through a program directive.
Existing law prohibits the total number of developmental center
residents in the secure treatment facility at Porterville
Developmental Center from exceeding 297.
This bill would include residents receiving services in the center'
s transition treatment program for purposes of this limit.
This bill would require the department to provide information to
the Assembly Committee on Budget and Senate Committee on Budget and
Fiscal Review during budget hearings for the 2010-11 fiscal year
about the effect on the developmental service system of the specific
cost containment measures implemented to achieve designated General
Fund reductions for the 2009-10 fiscal year pursuant to a specified
item of the Budget Act of 2009.
The bill also would require the department to continue to convene,
as appropriate, a stakeholder review process to obtain information
and comments about implementation of these cost containment measures
and their effect on the developmental service system.
The California Constitution authorizes the Governor to declare a
fiscal emergency and to call the Legislature into special session for
that purpose. The Governor issued a proclamation declaring a fiscal
emergency, and calling a special session for this purpose, on July 1,
2009.
This bill would state that it addresses the fiscal emergency
declared by the Governor by proclamation issued on July 1, 2009,
pursuant to the California Constitution.
This bill would declare that it is to take effect immediately as
an urgency statute.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 95004 of the Government Code, as amended by
Section 1 of Chapter 3 of the 3rd Extraordinary Session of the
Statutes of 2008, is amended to read:
95004. The early intervention services specified in this title
shall be provided as follows:
(a) Direct services for eligible infants and toddlers and their
families shall be provided pursuant to the existing regional center
system under the Lanterman Developmental Disabilities Services Act
(Division 4.5 (commencing with Section 4500) of the Welfare and
Institutions Code) and the existing local education agency system
under appropriate sections of Part 30 (commencing with Section 56000)
of the Education Code and regulations adopted pursuant thereto, and
Part C of the Individuals with Disabilities Education Act (20 U.S.C.
Sec. 1431 et seq.).
(b) (1) In providing services under this title, regional centers
shall comply with the Lanterman Developmental Disabilities Services
Act (Division 4.5 (commencing with Section 4500) of the Welfare and
Institutions Code, and its implementing regulations (Division 2
(commencing with Section 50201) of Title 17 of the California Code of
Regulations) including, but not limited to, those provisions
relating to vendorization and ratesetting, and the Family Cost
Participation Program, except where compliance with those provisions
would result in any delays in, the provision of early intervention,
or otherwise conflict with this title and the regulations
implementing this title (Chapter 2 (commencing with Section 52000) of
Division 2 of Title 17 of the California Code of Regulations), or
Part C of the Individuals with Disabilities Education Act (20 U.S.C.
Sec. 1431 et seq.), and applicable federal regulations contained in
Part 303 (commencing with Section 303.1) of Title 34 of the Code of
Federal Regulations. Notwithstanding any other law or regulation to
the contrary, a family's private insurance for medical services or a
health care service plan identified in the individualized family
service plan, other than for evaluation and assessment, shall be used
in compliance with applicable federal and state law and regulation.
(2) When compliance with this subdivision would result in any
delays in the provision of early intervention services for the
provision of any of these services, the department may authorize a
regional center to use a special service code that allows immediate
procurement of the service.
(c) Services shall be provided by family resource centers that
provide, but are not limited to, parent-to-parent support,
information dissemination and referral, public awareness, family
professional collaboration activities, and transition assistance for
families.
(d) Existing obligations of the state to provide these services at
state expense shall not be expanded.
(e) It is the intent of the Legislature that services be provided
in accordance with Sections 303.124, 303.126, and 303.527 of Title 34
of the Code of Federal Regulations.
SEC. 2. Section 95014 of the Government Code is amended to read:
95014. (a) The term "eligible infant or toddler" for the purposes
of this title means infants and toddlers from birth through two
years of age, for whom a need for early intervention services, as
specified in the federal Individuals with Disabilities Education Act
(20 U.S.C. Sec. 1431 et seq.) and applicable regulations, is
documented by means of assessment and evaluation as required in
Sections 95016 and 95018 and who meet one of the following criteria:
(1) Infants and toddlers with a developmental delay in one or more
of the following five areas: cognitive development; physical and
motor development, including vision and hearing; communication
development; social or emotional development; or adaptive
development. Developmentally delayed infants and toddlers are those
who are determined to have a significant difference between the
expected level of development for their age and their current level
of functioning. This determination shall be made by qualified
personnel who are recognized by, or part of, a multidisciplinary
team, including the parents. A significant difference is defined as a
33-percent delay in one developmental area before 24 months of age,
or, at 24 months of age or older, either a delay of 50 percent in one
developmental area or a 33-percent delay in two or more
developmental areas. The age for use in determination of eligibility
for the Early Intervention Program shall be the age of the infant or
toddler on the date of the initial referral to the Early Intervention
Program.
(2) Infants and toddlers with established risk conditions, who are
infants and toddlers with conditions of known etiology or conditions
with established harmful developmental consequences. The conditions
shall be diagnosed by a qualified personnel recognized by, or part
of, a multidisciplinary team, including the parents. The condition
shall be certified as having a high probability of leading to
developmental delay if the delay is not evident at the time of
diagnosis.
(b) Regional centers and local educational agencies shall be
responsible for ensuring that eligible infants and toddlers are
served as follows:
(1) The State Department of Developmental Services and regional
centers shall be responsible for the provision of appropriate early
intervention services that are required for California's
participation in Part C of the federal Individuals with Disabilities
Education Act (20 U.S.C. Sec. 1431 et seq.) for all infants eligible
under Section 95014, except for those infants with solely a visual,
hearing, or severe orthopedic impairment, or any combination of those
impairments, who meet the criteria in Sections 56026 and 56026.5 of
the Education Code, and in Section 3030(a), (b), (d), or (e) of, and
Section 3031 of, Title 5 of the California Code of Regulations.
(2) The State Department of Education and local educational
agencies shall be responsible for the provision of appropriate early
intervention services in accordance with Part C of the federal
Individuals with Disabilities Education Act (20 U.S.C. Sec. 1431 et
seq.) for infants with solely a visual, hearing, or severe orthopedic
impairment, or any combination of those impairments, who meet the
criteria in Sections 56026 and 56026.5 of the Education Code, and in
Section 3030(a), (b), (d), or (e) of, and Section 3031 of, Title 5 of
the California Code of Regulations, and who are not eligible for
services under the Lanterman Developmental Disabilities Services Act
(Division 4.5 (commencing with Section 4500) of the Welfare and
Institutions Code).
(c) For infants and toddlers and their families who are eligible
to receive services from both a regional center and a local
educational agency, the regional center shall be the agency
responsible for providing or purchasing appropriate early
intervention services that are beyond the mandated responsibilities
of local educational agencies and that are required for California's
participation in Part C of the federal Individuals with Disabilities
Education Act (20 U.S.C. Sec. 1431 et seq.). The local educational
agency shall provide special education services up to its funded
program capacity as established annually by the State Department of
Education in consultation with the State Department of Developmental
Services and the Department of Finance.
(d) No agency or multidisciplinary team, including any agency
listed in Section 95012, shall presume or determine eligibility,
including eligibility for medical services, for any other agency.
However, regional centers and local educational agencies shall
coordinate intake, evaluation, assessment, and individualized family
service plans for infants and toddlers and their families who are
served by an agency.
(e) Upon termination of the program pursuant to Section 95003, the
State Department of Developmental Services shall be responsible for
the payment of services pursuant to this title.
SEC. 3. Section 95020 of the Government Code is amended to read:
95020. (a) An eligible infant or toddler shall have an
individualized family service plan. The individualized family service
plan shall be used in place of an individualized education program
required pursuant to Sections 4646 and 4646.5 of the Welfare and
Institutions Code, the individualized program plan required pursuant
to Section 56340 of the Education Code, or any other applicable
service plan.
(b) For an infant or toddler who has been evaluated for the first
time, a meeting to share the results of the evaluation, to determine
eligibility and, for children who are eligible, to develop the
initial individualized family service plan shall be conducted within
45 calendar days of receipt of the written referral. Evaluation
results and determination of eligibility may be shared in a meeting
with the family prior to the individualized family service plan.
Written parent consent to evaluate and assess shall be obtained
within the 45-day timeline. A regional center, local educational
agency, or the designee of one of those entities shall initiate and
conduct this meeting. Families shall be afforded the opportunity to
participate in all decisions regarding eligibility and services.
(c) Parents shall be fully informed of their rights, including the
right to invite another person, including a family member or an
advocate or peer parent, or any or all of them, to accompany them to
any or all individualized family service plan meetings. With parental
consent, a referral shall be made to the local family resource
center or network.
(d) The individualized family service plan shall be in writing and
shall address all of the following:
(1) A statement of the infant's or toddler's present levels of
physical development including vision, hearing, and health status,
cognitive development, communication development, social and
emotional development, and adaptive developments.
(2) With the concurrence of the family, a statement of the family'
s concerns, priorities, and resources related to meeting the special
developmental needs of the eligible infant or toddler.
(3) A statement of the major outcomes expected to be achieved for
the infant or toddler and family where services for the family are
related to meeting the special developmental needs of the eligible
infant or toddler.
(4) The criteria, procedures, and timelines used to determine the
degree to which progress toward achieving the outcomes is being made
and whether modifications or revisions are necessary.
(5) (A) A statement of the specific early intervention services
necessary to meet the unique needs of the infant or toddler as
identified in paragraph (3), including, but not limited to, the
frequency, intensity, location, duration, and method of delivering
the services, and ways of providing services in natural generic
environments, including group training for parents on behavioral
intervention techniques in lieu of some or all of the in-home parent
training component of the behavior intervention services, and
purchase of neighborhood preschool services and needed qualified
personnel in lieu of infant development programs.
(B) Effective July 1, 2009, at the time of development, review, or
modification of an infant's or toddler's individualized family
service plan, the regional center shall consider both of the
following:
(i) The use of group training for parents on behavior intervention
techniques, in lieu of some or all of the in-home parent training
component of the behavior intervention services.
(ii) The purchase of neighborhood preschool services and needed
qualified personnel, in lieu of infant development programs.
(6) A statement of the agency responsible for providing the
identified services.
(7) The name of the service coordinator who shall be responsible
for facilitating implementation of the plan and coordinating with
other agencies and persons.
(8) The steps to be taken to ensure transition of the infant or
toddler upon reaching three years of age to other appropriate
services. These may include, as appropriate, special education or
other services offered in natural environments.
(9) The projected dates for the initiation of services in
paragraph (5) and the anticipated duration of those services.
(e) Each service identified on the individualized family service
plan shall be designated as one of three types:
(1) An early intervention service, as defined in subsection (4) of
Section 1432 of Title 20 of the United States Code, and applicable
regulations, that is provided or purchased through the regional
center, local educational agency, or other participating agency. The
State Department of Health Care Services, State Department of Social
Services, State Department of Mental Health, and State Department of
Alcohol and Drug Programs shall provide services in accordance with
state and federal law and applicable regulations, and up to the level
of funding as appropriated by the Legislature. Early intervention
services identified on an individualized family service plan that
exceed the funding, statutory, and regulatory requirements of these
departments shall be provided or purchased by regional centers or
local educational agencies under subdivisions (b) and (c) of Section
95014. The State Department of Health Care Services, State Department
of Social Services, State Department of Mental Health, and State
Department of Alcohol and Drug Programs shall not be required to
provide early intervention services over their existing funding,
statutory, and regulatory requirements.
(2) Another service, other than those specified in paragraph (1),
which the eligible infant or toddler or his or her family may receive
from other state programs, subject to the eligibility standards of
those programs.
(3) A referral to a nonrequired service that may be provided to an
eligible infant or toddler or his or her family. Nonrequired
services are those services that are not defined as early
intervention services or do not relate to meeting the special
developmental needs of an eligible infant or toddler related to the
disability, but that may be helpful to the family. The granting or
denial of nonrequired services by a public or private agency is not
subject to appeal under this title. Notwithstanding any other
provision of law or regulation to the contrary, effective July 1,
2009, with the exception of durable medical equipment, regional
centers shall not purchase nonrequired services, but may refer a
family to a nonrequired service that may be available to an eligible
infant or toddler or his or her family.
(f) An annual review, and other periodic reviews, of the
individualized family service plan for an infant or toddler and the
infant's or toddler's family shall be conducted to determine the
degree of progress that is being made in achieving the outcomes
specified in the plan and whether modification or revision of the
outcomes or services is necessary. The frequency, participants,
purpose, and required processes for annual and periodic reviews shall
be consistent with the statutes and regulations under Part C of the
federal Individuals with Disabilities Education Act (20 U.S.C. Sec.
1431 et seq.) and this title, and shall be specified in regulations
adopted pursuant to Section 95028.
SEC. 4. Section 95021 is added to the Government Code, to read:
95021. (a) Effective July 1, 2009, notwithstanding any other
provision of law or regulation to the contrary, any vendor who
provides applied behavioral analysis (ABA) services or intensive
behavioral intervention services, or both, as defined in subdivision
(d), shall:
(1) Conduct a behavioral assessment of each infant or toddler to
whom the vendor provides these services.
(2) Design an intervention plan that shall include the service
type, number of hours, and parent participation needed to achieve the
goals and objectives of the infant or toddler, as set forth in his
or her individualized family service plan (IFSP). The intervention
plan shall also set forth the frequency at which the progress of the
infant or toddler shall be evaluated and reported.
(3) Provide a copy of the intervention plan to the regional center
for review and consideration by the planning team members.
(b) Effective July 1, 2009, notwithstanding any other provision of
law or regulation to the contrary, regional centers shall:
(1) Only purchase ABA services or intensive behavioral
intervention services that reflect evidence-based practices, promote
positive social behaviors, and ameliorate behaviors that interfere
with learning and social interactions.
(2) Only purchase ABA or intensive behavioral intervention
services when the parent or parents of an infant or toddler receiving
services participate in the intervention plan for the infant or
toddler, given the critical nature of parent participation to the
success of the intervention plan.
(3) Not purchase either ABA or intensive behavioral intervention
services for purposes of providing respite, day care, or school
services.
(4) Discontinue purchasing ABA or intensive behavioral
intervention services for an infant or toddler when his or her
treatment goals and objectives, as described under subdivision (a),
are achieved. ABA or intensive behavioral intervention services shall
not be discontinued until the goals and objectives are reviewed and
updated as required in paragraph (5) and shall be discontinued only
if those updated treatment goals and objectives do not require ABA or
intensive behavioral intervention services.
(5) For each infant or toddler, evaluate the vendor's intervention
plan and number of service hours for ABA or intensive behavioral
intervention no less than every six months, consistent with
evidence-based practices. If necessary, the intervention plan's
treatment goals and objectives shall be updated and revised.
(6) Not reimburse a parent for participating in a behavioral
services treatment program.
(c) For infants and toddlers receiving ABA or behavioral
intervention services on July 1, 2009, as part of their IFSP,
subdivision (b) shall apply on August 1, 2009.
(d) For purposes of this section the following definitions shall
apply:
(1) "Applied behavioral analysis" means the design,
implementation, and evaluation of systematic instructional and
environmental modifications to promote positive social behaviors and
reduce or ameliorate behaviors which interfere with learning and
social interaction.
(2) "Intensive behavioral intervention" means any form of applied
behavioral analysis that is comprehensive, designed to address all
domains of functioning, and provided in multiple settings for no more
than 40 hours per week, across all settings, depending on the
individual's needs and progress. Interventions can be delivered in a
one-to-one ratio or small group format, as appropriate.
(3) "Evidence-based practice" means a decisionmaking process which
integrates the best available scientifically rigorous research,
clinical expertise, and individual's characteristics. Evidence-based
practice is an approach to treatment rather than a specific
treatment. Evidence-based practice promotes the collection,
interpretation, integration, and continuous evaluation of valid,
important, and applicable individual- or family-reported,
clinically-observed, and research-supported evidence. The best
available evidence, matched to infant or toddler circumstances and
preferences, is applied to ensure the quality of clinical judgments
and facilitates the most cost-effective care.
(4) "Parent" has the same meaning as defined in paragraph (15) of
subdivision (b) of Section 52000 of Title 17 of the California Code
of Regulations.
(5) "Parent participation" shall include, but shall not be limited
to, the following meanings:
(A) Completion of group instruction on the basics of behavior
intervention.
(B) Implementation of intervention strategies according to the
intervention plan.
(C) If needed, collection of data on behavioral strategies and
submission of that data to the provider for incorporation into
progress reports.
(D) Participation in any needed clinical meetings.
(E) Purchase of suggested behavior modification materials or
community involvement if a reward system is used.
SEC. 5. Section 4418.1 of the Welfare and Institutions Code is
amended to read:
4418.1. (a) The Legislature recognizes that it has a special
obligation to ensure the well-being of persons with developmental
disabilities who are moved from state hospitals to the community.
(b) To ensure that persons with developmental disabilities who are
moved from state hospitals to the community are receiving necessary
services and supports, the department shall contract with an
independent agency or organization for the tracking and monitoring of
those persons, including all persons moved as a result of the
Coffelt v. State Department of Developmental Services settlement
agreement and any persons moved after the terms of that agreement
have been met.
(c) The contractor shall be experienced in all of the following:
(1) Designing valid tracking instruments.
(2) Tracking the quality of community programs, including
outcome-based measures such as health and safety, quality of life,
integration, choice, and consumer satisfaction.
(3) Tracking the quality and appropriateness of community
placements for persons moving from large institutions into community
settings.
(4) Developing data systems.
(5) Data analysis and report preparation.
(d) The contractor shall measure consumer and family satisfaction
with services provided, including case management and quality of
life, including, but not limited to, health and safety, independence,
productivity, integration, opportunities for choice, and delivery of
needed services.
(e) The information maintained for each person shall include the
person's name, address, nature of disability, medical condition,
scope of community-based services and supports, and the annual data
collected by the contractor.
(f) The contractor shall meet with each person, and the person's
family, legal guardian, or conservator, when appropriate, no less
than once a year to discuss quality of life and observe the person's
services and supports. In cases where the consumer is not capable of
communicating his or her responses and where there is no family
member, guardian, or conservator involved, the contractor shall meet
with no less than two persons familiar with the consumer.
Additionally, the contractor shall interview staff and friends who
know the consumer best and review records, as appropriate.
(g) If the contractor identifies any suspected violation of the
legal, civil, or service rights of an individual, or if the
contractor determines that the health and welfare of the individual
is at risk, that information shall be provided immediately to the
regional center providing case management services, the client rights
advocate, and to the department.
(h) The department shall monitor the corrective actions taken by
the regional center and maintain a report in the person's file. The
consumer and, when appropriate, his or her parents, legal guardian,
or conservator, shall be provided with access to the person's file
and be provided with copies of all reports filed with the regional
center or department relative to them.
(i) The department shall establish a task force, including
representatives from stakeholder organizations, to annually review
the findings of the contractor and make recommendations regarding
additional or differing criteria for information to be gathered by
the contractor in future interviews.
(j) As of July 1, 1998, and annually thereafter, the contractor
shall provide a report to the Governor, the Legislature, and the
department outlining the activities and findings of this process. The
reports shall be public and shall contain no personally identifying
information about the persons being monitored.
(k) It is the intent of the Legislature to ensure the well-being
of consumers, taking into account their informed and expressed
choices. It is further the intent of the Legislature to support the
satisfaction and success of consumers through the delivery of quality
services and supports. Evaluation of the services that consumers
receive is a key aspect to the service system. Utilizing the
information that consumers, including those who have moved from state
developmental centers to the community, and their families provide
about those services in a reliable and meaningful way is also
critical to enabling the department to assess the performance of the
state's developmental services system and to improve services for
consumers in the future. To that end, pursuant to Section 4571, the
department shall implement, not later than January 1, 2010, an
improved unified quality assessment system.
(l) This section shall remain in effect only until July 1, 2009,
and as of that date is repealed, unless a later enacted statute, that
is enacted before July 1, 2009, deletes or extends that date.
SEC. 6. Section 4435 is added to the Welfare and Institutions
Code, to read:
4435. (a) The department shall establish a prevention program for
at-risk babies. For purposes of this section, "at-risk baby" means a
child under 36 months of age who is otherwise not eligible for the
California Early Intervention Program pursuant to Title 14
(commencing with Section 95000) of the Government Code or services
provided under the Lanterman Developmental Disabilities Services Act
(Division 4.5 (commencing with Section 4500)) and whose genetic,
medical, developmental, or environmental history is predictive of a
substantially greater risk for developmental disability than that for
the general population, the presence of which is diagnosed by
qualified clinicians.
(b) This program shall provide intake, assessment, case
management, and referral to generic agencies. For purposes of this
section, "generic agency" means any agency that has a legal
responsibility to serve the general public and that is receiving
public funds for providing these services.
(c) The department shall allocate to each regional center, subject
to appropriation, specific funding for this program. A regional
center's total expenditures for purchasing or providing services
under the prevention program shall not exceed the funding allocated
in its contract for this purpose.
(d) The department shall establish policies and procedures for
implementation of the prevention program by regional centers. These
policies and procedures shall define other services included in this
program and the process for appealing denial of eligibility for the
prevention program.
SEC. 7. Section 4570 of the Welfare and Institutions Code is
amended to read:
4570. (a) In order to remain informed regarding the quality of
services in the area and to protect the legal, civil, and service
rights of persons with developmental disabilities, the Legislature
finds that it is necessary to conduct life quality assessments with
consumers served by the regional centers.
(b) The department shall enter into an interagency agreement with
the state council, on behalf of the area boards, to conduct the life
quality assessments described in this section. This interagency
agreement shall include assurances that the state council shall not
direct the area boards in their conduct of these assessments or in
the content or format of the annual reports submitted to the council
by the area boards.
(c) Consistent with the responsibilities described in this
chapter, the area board, with the consent of the consumer and, when
appropriate, a family member, shall conduct life quality assessments
with consumers living in out-of-home placements, supported living
arrangements, or independent living arrangements no less than once
every three years or more frequently upon the request of a consumer,
or, when appropriate, a family member. If a consumer who is eligible
to receive a life quality assessment is a dependent of a juvenile
court pursuant to Section 300, 601, or 602, the assessment may be
conducted with the consent of the court or social services agency. A
regional center or the department shall annually provide the local
area board with a list, including, but not limited to, the name,
address, and telephone number of each consumer, and, when
appropriate, a family member, the consumer's date of birth, and the
consumer's case manager, for all consumers living in out-of-home
placements, supported living arrangements, or independent living
arrangements, in order to facilitate area board contact with
consumers and, when appropriate, family members, for the purpose of
conducting life quality assessments.
(d) The life quality assessments shall be conducted by utilizing
the "Looking at Life Quality Handbook" or subsequent revisions
developed by the department.
(e) The assessments shall be conducted by consumers, families,
providers, and others, including volunteer surveyors. Each area board
shall recruit, train, supervise, and coordinate surveyors. Upon
request, and if feasible, the area board shall respect the request of
a consumer and, when appropriate, family member, for a specific
surveyor to conduct the life quality assessment. An area board may
provide stipends to surveyors.
(f) A life quality assessment shall be conducted within 90 days
prior to a consumer's triennial individual program plan meeting, so
that the consumer and regional center may use this information as
part of the planning process.
(g) Prior to conducting a life quality assessment, the area board
shall meet with the regional center to coordinate the exchange of
appropriate information necessary to conduct the assessment and
ensure timely followup to identified violations of any legal, civil,
or service rights.
(h) Following the completion of each life quality assessment, the
area board shall develop a report of its findings and provide a copy
of the report to the consumer, when appropriate, family members, and
the regional center providing case management services to the
consumer. A copy of the life quality assessment of a consumer who is
a dependent of a juvenile court pursuant to Section 300, 601, or 602
shall be provided, upon request, to the court or social services
agency. In the event that a report identifies alleged violations of
any legal, civil, or service right, the area board shall notify the
regional center and the department of the alleged violation. The
department shall monitor the regional center to ensure that
violations are addressed and resolved in a timely manner.
(i) Regional centers shall review information from the life
quality assessments on a systemic basis in order to identify training
and resource development needs.
(j) (1) On an annual basis, each area board shall prepare and
submit a report to the state council describing its activities and
accomplishments related to the implementation of this section. The
report shall include, but not be limited to, the number of life
quality assessments conducted, the number of surveyors, including
those provided stipends, a description of the surveyor recruitment
process and training program, including any barriers to recruitment,
the number, nature, and outcome of any identified violations of
legal, civil, or service rights reported to regional centers, and
recommendations for improvement in the life quality assessment
process.
(2) By September 15 of each year, the state council shall compile
these reports and forward to the Governor, the Legislature, and the
department.
(k) Implementation of this section shall be subject to an annual
appropriation of funds in the Budget Act for this purpose.
(l) It is the intent of the Legislature to ensure the well-being
of consumers, taking into account their informed and expressed
choices. It is further the intent of the Legislature to support the
satisfaction and success of consumers through the delivery of quality
services and supports. Evaluation of the services that consumers
receive is a key aspect to the service system. Utilizing the
information that consumers, including those who have moved from state
developmental centers to the community, and their families provide
about those services in a reliable and meaningful way is also
critical to enabling the department to assess the performance of the
state's developmental services system and to improve services for
consumers in the future. To that end, pursuant to Section 4571, the
department shall implement, not later than January 1, 2010, an
improved unified quality assessment system.
(m) This section shall remain in effect only until January 1,
2010, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2010, deletes or extends
that date.
SEC. 8. The heading of Chapter 4 (commencing with Section 4570) of
Division 4.5 of the Welfare and Institutions Code is amended to
read:
CHAPTER 4. QUALITY ASSESSMENTS
SEC. 9. Section 4571 is added to the Welfare and Institutions
Code, to read:
4571. (a) It is the intent of the Legislature to ensure the
well-being of consumers, taking into account their informed and
expressed choices. It is further the intent of the Legislature to
support the satisfaction and success of consumers through the
delivery of quality services and supports. Evaluation of the services
that consumers receive is a key aspect to the service system.
Utilizing the information that consumers and their families provide
about such services in a reliable and meaningful way is also critical
to enable the department to assess the performance of the state's
developmental services system and to improve services for consumers
in the future. To that end, the State Department of Developmental
Services, on or before January 1, 2010, shall implement an improved,
unified quality assessment system, in accordance with this section.
(b) The department, in consultation with stakeholders, shall
identify a valid and reliable quality assurance instrument that
includes assessments of consumer and family satisfaction, provision
of services, and personal outcomes. The instrument shall do all of
the following:
(1) Provide nationally validated, benchmarked, consistent,
reliable, and measurable data for the department's Quality Management
System.
(2) Enable the department and regional centers to compare the
performance of California's developmental services system against
other states' developmental services systems and to assess quality
and performance among all of the regional centers.
(3) Include outcome-based measures such as health, safety,
well-being, relationships, interactions with people who do not have a
disability, employment, quality of life, integration, choice,
service, and consumer satisfaction.
(c) To the extent that funding is available, the instrument
identified in subdivision (b) may be expanded to collect additional
data requested by the State Council on Developmental Disabilities.
(d) The department shall contract with an independent agency or
organization to implement by January 1, 2010, the quality assurance
instrument described in subdivision (b). The contractor shall be
experienced in all of the following:
(1) Designing valid quality assurance instruments for
developmental service systems.
(2) Tracking outcome-based measures such as health, safety,
well-being, relationships, interactions with people who do not have a
disability, employment, quality of life, integration, choice,
service, and consumer satisfaction.
(3) Developing data systems.
(4) Data analysis and report preparation.
(5) Assessments of the services received by consumers who are
moved from developmental centers to the community, given the
Legislature's historic recognition of a special obligation to ensure
the well-being of these persons.
(e) The department, in consultation with the contractor described
in subdivision (d), shall establish the methodology by which the
quality assurance instrument shall be administered, including, but
not limited to, how often and to whom the quality assurance will be
administered, and the design of a stratified, random sample among the
entire population of consumers served by regional centers. The
contractor shall provide aggregate information for all regional
centers and the state as a whole. At the request of a consumer or the
family member of a consumer, the survey shall be conducted in the
primary language of the consumer or family member surveyed.
(f) The department shall contract with the state council to
collect data for the quality assurance instrument described in
subdivision (b). If, during the data collection process, the state
council identifies any suspected violation of the legal, civil, or
service rights of a consumer, or if it determines that the health and
welfare of a consumer is at risk, that information shall be provided
immediately to the regional center providing case management
services to the consumer. At the request of the consumer, or family,
when appropriate, a copy of the completed survey shall be provided to
the regional center providing case management services to improve
the consumer's quality of services through the individual planning
process.
(g) The department, in consultation with stakeholders, shall
annually review the data collected from and the findings of the
quality assurance instrument described in subdivision (b) and accept
recommendations regarding additional or different criteria for the
quality assurance instrument in order to assess the performance of
the state's developmental services system and improve services for
consumers.
(h) All reports generated pursuant to this section shall be made
publicly available, but shall not contain any personal identifying
information about any person assessed.
(i) All data collected pursuant to subdivision (c) shall be
provided to the state council, but shall contain no personal
identifying information about the persons being surveyed.
(j) Implementation of this section shall be subject to an annual
appropriation of funds in the Budget Act for this purpose.
SEC. 10. Section 4648 of the Welfare and Institutions Code is
amended to read:
4648. In order to achieve the stated objectives of a consumer's
individual program plan, the regional center shall conduct
activities, including, but not limited to, all of the following:
(a) Securing needed services and supports.
(1) It is the intent of the Legislature that services and supports
assist individuals with developmental disabilities in achieving the
greatest self-sufficiency possible and in exercising personal
choices. The regional center shall secure services and supports that
meet the needs of the consumer, as determined in the consumer's
individual program plan, and within the context of the individual
program plan, the planning team shall give highest preference to
those services and supports which would allow minors with
developmental disabilities to live with their families, adult persons
with developmental disabilities to live as independently as possible
in the community, and that allow all consumers to interact with
persons without disabilities in positive, meaningful ways.
(2) In implementing individual program plans, regional centers,
through the planning team, shall first consider services and supports
in natural community, home, work, and recreational settings.
Services and supports shall be flexible and individually tailored to
the consumer and, where appropriate, his or her family.
(3) A regional center may, pursuant to vendorization or a
contract, purchase services or supports for a consumer from any
individual or agency which the regional center and consumer or, where
appropriate, his or her parents, legal guardian, or conservator, or
authorized representatives, determines will best accomplish all or
any part of that consumer's program plan.
(A) Vendorization or contracting is the process for
identification, selection, and utilization of service vendors or
contractors, based on the qualifications and other requirements
necessary in order to provide the service.
(B) A regional center may reimburse an individual or agency for
services or supports provided to a regional center consumer if the
individual or agency has a rate of payment for vendored or contracted
services established by the department, pursuant to this division,
and is providing services pursuant to an emergency vendorization or
has completed the vendorization procedures or has entered into a
contract with the regional center and continues to comply with the
vendorization or contracting requirements. The director shall adopt
regulations governing the vendorization process to be utilized by the
department, regional centers, vendors and the individual or agency
requesting vendorization.
(C) Regulations shall include, but not be limited to: the vendor
application process, and the basis for accepting or denying an
application; the qualification and requirements for each category of
services that may be provided to a regional center consumer through a
vendor; requirements for emergency vendorization; procedures for
termination of vendorization; the procedure for an individual or an
agency to appeal any vendorization decision made by the department or
regional center.
(D) A regional center may vendorize a licensed facility for
exclusive services to persons with developmental disabilities at a
capacity equal to or less than the facility's licensed capacity. A
facility already licensed on January 1, 1999, shall continue to be
vendorized at their full licensed capacity until the facility agrees
to vendorization at a reduced capacity.
(E) Effective July 1, 2009, notwithstanding any other provision of
law or regulation to the contrary, a regional center shall not newly
vendor a State Department of Social Services licensed 24-hour
residential care facility with a licensed capacity of 16 or more
beds, unless the facility qualifies for receipt of federal funds
under the Medicaid Program.
(4) Notwithstanding subparagraph (B), a regional center may
contract or issue a voucher for services and supports provided to a
consumer or family at a cost not to exceed the maximum rate of
payment for that service or support established by the department. If
a rate has not been established by the department, the regional
center may, for an interim period, contract for a specified service
or support with, and establish a rate of payment for, any provider of
the service or support necessary to implement a consumer's
individual program plan. Contracts may be negotiated for a period of
up to three years, with annual review and subject to the availability
of funds.
(5) In order to ensure the maximum flexibility and availability of
appropriate services and supports for persons with developmental
disabilities, the department shall establish and maintain an
equitable system of payment to providers of services and supports
identified as necessary to the implementation of a consumers'
individual program plan. The system of payment shall include
provision for a rate to ensure that the provider can meet the special
needs of consumers and provide quality services and supports in the
least restrictive setting as required by law.
(6) The regional center and the consumer, or where appropriate,
his or her parents, legal guardian, conservator, or authorized
representative, including those appointed pursuant to subdivision (d)
of Section 4548 or subdivision (e) of Section 4705, shall, pursuant
to the individual program plan, consider all of the following when
selecting a provider of consumer services and supports:
(A) A provider's ability to deliver quality services or supports
which can accomplish all or part of the consumer's individual program
plan.
(B) A provider's success in achieving the objectives set forth in
the individual program plan.
(C) Where appropriate, the existence of licensing, accreditation,
or professional certification.
(D) The cost of providing services or supports of comparable
quality by different providers, if available, shall be reviewed, and
the least costly available provider of comparable service, including
the cost of transportation, who is able to accomplish all or part of
the consumer's individual program plan, consistent with the
particular needs of the consumer and family as identified in the
individual program plan, shall be selected. In determining the least
costly provider, the availability of federal financial participation
shall be considered. The consumer shall not be required to use the
least costly provider if it will result in the consumer moving from
an existing provider of services or supports to more restrictive or
less integrated services or supports.
(E) The consumer's or, where appropriate, the parents, legal
guardian, or conservator of a consumer's choice of providers.
(7) No service or support provided by any agency or individual
shall be continued unless the consumer or, where appropriate, his or
her parents, legal guardian, or conservator, or authorized
representative, including those appointed pursuant to subdivision (d)
of Section 4548 or subdivision (e) of Section 4705, is satisfied and
the regional center and the consumer or, when appropriate, the
person's parents or legal guardian or conservator agree that planned
services and supports have been provided, and reasonable progress
toward objectives have been made.
(8) Regional center funds shall not be used to supplant the budget
of any agency which has a legal responsibility to serve all members
of the general public and is receiving public funds for providing
those services.
(9) (A) A regional center may, directly or through an agency
acting on behalf of the center, provide placement in, purchase of, or
follow-along services to persons with developmental disabilities in,
appropriate community living arrangements, including, but not
limited to, support service for consumers in homes they own or lease,
foster family placements, health care facilities, and licensed
community care facilities. In considering appropriate placement
alternatives for children with developmental disabilities, approval
by the child's parent or guardian shall be obtained before placement
is made.
(B) Effective July 1, 2012, notwithstanding any other provision of
law or regulation to the contrary, a regional center shall not
purchase residential services from a State Department of Social
Services licensed 24-hour residential care facility with a licensed
capacity of 16 or more beds. This prohibition on regional center
purchase of residential services shall not apply to either of the
following:
(i) A residential facility with a licensed capacity of 16 or more
beds that has been approved to participate in the department's Home
and Community Based Services Waiver or another existing waiver
program or certified to participate in the Medi-Cal program.
(ii) A residential facility service provider that has a written
agreement and specific plan prior to July 1, 2012, with the vendoring
regional center to downsize the existing facility by transitioning
its residential services to living arrangements of 15 beds or less or
restructure the large facility to meet federal Medicaid eligibility
requirements on or before June 30, 2013.
(C) Each person with developmental disabilities placed by the
regional center in a community living arrangement shall have the
rights specified in this division. These rights shall be brought to
the person's attention by any means necessary to reasonably
communicate these rights to each resident, provided that, at a
minimum, the Director of Developmental Services prepare, provide, and
require to be clearly posted in all residential facilities and day
programs a poster using simplified language and pictures that is
designed to be more understandable by persons with cognitive
disabilities and that the rights information shall also be available
through the regional center to each residential facility and day
program in alternative formats, including, but not limited to, other
languages, braille, and audio tapes, when necessary to meet the
communication needs of consumers.
(D) Consumers are eligible to receive supplemental services
including, but not limited to, additional staffing, pursuant to the
process described in subdivision (d) of Section 4646. Necessary
additional staffing that is not specifically included in the rates
paid to the service provider may be purchased by the regional center
if the additional staff are in excess of the amount required by
regulation and the individual's planning team determines the
additional services are consistent with the provisions of the
individual program plan. Additional staff should be periodically
reviewed by the planning team for consistency with the individual
program plan objectives in order to determine if continued use of the
additional staff is necessary and appropriate and if the service is
producing outcomes consistent with the individual program plan.
Regional centers shall monitor programs to ensure that the additional
staff is being provided and utilized appropriately.
(10) Emergency and crisis intervention services including, but not
limited to, mental health services and behavior modification
services, may be provided, as needed, to maintain persons with
developmental disabilities in the living arrangement of their own
choice. Crisis services shall first be provided without disrupting a
person's living arrangement. If crisis intervention services are
unsuccessful, emergency housing shall be available in the person's
home community. If dislocation cannot be avoided, every effort shall
be made to return the person to his or her living arrangement of
choice, with all necessary supports, as soon as possible.
(11) Among other service and support options, planning teams shall
consider the use of paid roommates or neighbors, personal
assistance, technical and financial assistance, and all other service
and support options which would result in greater self-sufficiency
for the consumer and cost-effectiveness to the state.
(12) When facilitation as specified in an individual program plan
requires the services of an individual, the facilitator shall be of
the consumer's choosing.
(13) The community support may be provided to assist individuals
with developmental disabilities to fully participate in community and
civic life, including, but not limited to, programs, services, work
opportunities, business, and activities available to persons without
disabilities. This facilitation shall include, but not be limited to,
any of the following:
(A) Outreach and education to programs and services within the
community.
(B) Direct support to individuals which would enable them to more
fully participate in their community.
(C) Developing unpaid natural supports when possible.
(14) Other services and supports may be provided as set forth in
Sections 4685, 4686, 4687, 4688, and 4689, when necessary.
(15) Notwithstanding any other provision of law or regulation to
the contrary, effective July 1, 2009, regional centers shall not
purchase experimental treatments, therapeutic services, or devices
that have not been clinically determined or scientifically proven to
be effective or safe or for which risks and complications are
unknown. Experimental treatments or therapeutic services include
experimental medical or nutritional therapy when the use of the
product for that purpose is not a general physician practice. For
regional center consumers receiving these services as part of their
individual program plan (IPP) or individualized family service plan
(IFSP) on July 1, 2009, this prohibition shall apply on August 1,
2009.
(b) (1) Advocacy for, and protection of, the civil, legal, and
service rights of persons with developmental disabilities as
established in this division.
(2) Whenever the advocacy efforts of a regional center to secure
or protect the civil, legal, or service rights of any of its
consumers prove ineffective, the regional center or the person with
developmental disabilities or his or her parents, legal guardian, or
other representative may request the area board to initiate action
under the provisions defining area board advocacy functions
established in this division.
(c) The regional center may assist consumers and families
directly, or through a provider, in identifying and building circles
of support within the community.
(d) In order to increase the quality of community services and
protect consumers, the regional center shall, when appropriate, take
either of the following actions:
(1) Identify services and supports that are ineffective or of poor
quality and provide or secure consultation, training, or technical
assistance services for any agency or individual provider to assist
that agency or individual provider in upgrading the quality of
services or supports.
(2) Identify providers of services or supports that may not be in
compliance with local, state, and federal statutes and regulations
and notify the appropriate licensing or regulatory authority, or
request the area board to investigate the possible noncompliance.
(e) When necessary to expand the availability of needed services
of good quality, a regional center may take actions that include, but
are not limited to,
the following:
(1) Soliciting an individual or agency by requests for proposals
or other means, to provide needed services or supports not presently
available.
(2) Requesting funds from the Program Development Fund, pursuant
to Section 4677, or community placement plan funds designated from
that fund, to reimburse the startup costs needed to initiate a new
program of services and supports.
(3) Using creative and innovative service delivery models,
including, but not limited to, natural supports.
(f) Except in emergency situations, a regional center shall not
provide direct treatment and therapeutic services, but shall utilize
appropriate public and private community agencies and service
providers to obtain those services for its consumers.
(g) Where there are identified gaps in the system of services and
supports or where there are identified consumers for whom no provider
will provide services and supports contained in his or her
individual program plan, the department may provide the services and
supports directly.
(h) At least annually, regional centers shall provide the
consumer, his or her parents, legal guardian, conservator, or
authorized representative a statement of services and supports the
regional center purchased for the purpose of ensuring that they are
delivered. The statement shall include the type, unit, month, and
cost of services and supports purchased.
SEC. 11. Section 4648.1 of the Welfare and Institutions Code is
amended to read:
4648.1. (a) The State Department of Developmental Services and
regional centers may monitor services and supports purchased for
regional center consumers with or without prior notice. Not less than
two monitoring visits to a licensed long-term health care or
community care facility or family home agency home each year shall be
unannounced. The department may conduct fiscal reviews and audits of
the service providers' records.
(b) Department and regional center staff involved in monitoring or
auditing services provided to the regional centers' consumers by a
service provider shall have access to the provider's grounds,
buildings, and service program, and to all related records, including
books, papers, computerized data, accounting records, and related
documentation. All persons connected with the service provider's
program, including, but not limited to, program administrators,
staff, consultants, and accountants, shall provide information and
access to facilities as required by the department or regional
center.
(c) The department, in cooperation with regional centers, shall
ensure that all providers of services and supports purchased by
regional centers for their consumers are informed of all of the
following:
(1) The provisions of this section.
(2) The responsibility of providers to comply with laws and
regulations governing both their service program and the provision of
services and supports to people with developmental disabilities.
(3) The responsibility of providers to comply with conditions of
any contract or agreement between the regional center and the
provider, and between the provider and the department.
(4) The rights of providers established in regulations adopted
pursuant to Sections 4648.2, 4748, and 4780.5, to appeal actions
taken by regional centers or the department as a result of their
monitoring and auditing findings.
(d) A regional center may terminate payments for services, and may
terminate its contract or authorization for the purchase of consumer
services if it determines that the provider has not complied with
provisions of its contract or authorization with the regional center
or with applicable state laws and regulations. When terminating
payments for services or its contract or authorization for the
purchase of consumer services, a regional center shall make
reasonable efforts to avoid unnecessary disruptions of consumer
services.
(e) A regional center or the department may recover from the
provider funds paid for services when the department or the regional
center determines that either of the following has occurred:
(1) The services were not provided in accordance with the regional
center's contract or authorization with the provider, or with
applicable state laws or regulations.
(2) The rate paid is based on inaccurate data submitted by the
provider on a provider cost statement.
Any funds so recovered shall be remitted to the department.
(f) Any evidence of suspected licensing violations found by
department or regional center personnel shall be reported immediately
to the appropriate state licensing agency.
(g) Regional centers may establish volunteer teams, made up of
consumers, parents, other family members, and advocates to conduct
the monitoring activities described in this section.
(h) In meeting its responsibility to provide technical assistance
to providers of community living arrangements for persons with
developmental disabilities, including, but not limited to, licensed
residential facilities, family home agencies, and supported or
independent living arrangements, a regional center shall utilize the
"Looking at Service Quality-Provider's Handbook" developed by the
department or subsequent revisions developed by the department.
(i) Effective July 1, 2009, a regional center shall not be
required to perform triennial evaluations of community care
facilities, as described in Sections 56046, 56049, 56050, 56051, and
56052 of Title 17 of the California Code of Regulations.
SEC. 12. Section 4648.35 is added to the Welfare and Institutions
Code, to read:
4648.35. Effective July 1, 2009, at the time of development,
review, or modification of a consumer's individual program plan (IPP)
or individualized family service plan (IFSP), all of the following
shall apply to a regional center:
(a) A regional center shall not fund private specialized
transportation services for an adult consumer who can safely access
and utilize public transportation, when that transportation is
available.
(b) A regional center shall fund the least expensive
transportation modality that meets the consumer's needs, as set forth
in the consumer's IPP or IFSP.
(c) A regional center shall fund transportation, when required,
from the consumer's residence to the lowest-cost vendor that provides
the service that meets the consumer's needs, as set forth in the
consumer's IPP or IFSP. For purposes of this subdivision, the cost of
a vendor shall be determined by combining the vendor's program costs
and the costs to transport a consumer from the consumer's residence
to the vendor.
(d) A regional center shall fund transportation services for a
minor child living in the family residence, only if the family of the
child provides sufficient written documentation to the regional
center to demonstrate that it is unable to provide transportation for
the child.
SEC. 13. Section 4648.5 is added to the Welfare and Institutions
Code, to read:
4648.5. (a) Notwithstanding any other provision of law or
regulations to the contrary, effective July 1, 2009, a regional
centers' authority to purchase the following services shall be
suspended pending implementation of the Individual Choice Budget and
certification by the Director of Developmental Services that the
Individual Choice Budget has been implemented and will result in
state budget savings sufficient to offset the costs of providing the
following services:
(1) Camping services and associated travel expenses.
(2) Social recreation activities, except for those activities
vendored as community-based day programs.
(3) Educational services for children three to 17, inclusive,
years of age.
(4) Nonmedical therapies, including, but not limited to,
specialized recreation, art, dance, and music.
(b) For regional center consumers receiving services described in
subdivision (a) as part of their individual program plan (IPP) or
individualized family service plan (IFSP), the prohibition in
subdivision (a) shall take effect on August 1, 2009.
(c) An exemption may be granted on an individual basis in
extraordinary circumstances to permit purchase of a service
identified in subdivision (a) when the regional center determines
that the service is a primary or critical means for ameliorating the
physical, cognitive, or psychosocial effects of the consumer's
developmental disability, or the service is necessary to enable the
consumer to remain in his or her home and no alternative service is
available to meet the consumer's needs.
SEC. 14. Section 4648.6 is added to the Welfare and Institutions
Code, to read:
4648.6. The department, in consultation with stakeholders, shall
develop an alternative service delivery model that provides an
Individual Choice Budget for obtaining quality services and supports
which provides choice and flexibility within a finite budget that in
the aggregate reduces regional center purchase of service
expenditures, reduces reliance on the state general fund, and
maximizes federal financial participation in the delivery of
services. The individual budget will be determined using a fair,
equitable, transparent standardized process.
SEC. 15. Section 4659 of the Welfare and Institutions Code is
amended to read:
4659. (a) Except as otherwise provided in subdivision (b) or (e),
the regional center shall identify and pursue all possible sources
of funding for consumers receiving regional center services. These
sources shall include, but not be limited to, both of the following:
(1) Governmental or other entities or programs required to provide
or pay the cost of providing services, including Medi-Cal, Medicare,
the Civilian Health and Medical Program for Uniform Services, school
districts, and federal supplemental security income and the state
supplementary program.
(2) Private entities, to the maximum extent they are liable for
the cost of services, aid, insurance, or medical assistance to the
consumer.
(b) Any revenues collected by a regional center pursuant to this
section shall be applied against the cost of services prior to use of
regional center funds for those services. This revenue shall not
result in a reduction in the regional center's purchase of services
budget, except as it relates to federal supplemental security income
and the state supplementary program.
(c) Effective July 1, 2009, notwithstanding any other provision of
law or regulation to the contrary, regional centers shall not
purchase any service that would otherwise be available from Medi-Cal,
Medicare, the Civilian Health and Medical Program for Uniform
Services, In-Home Support Services, California Children's Services,
private insurance, or a health care service plan when a consumer or a
family meets the criteria of this coverage but chooses not to pursue
that coverage. If, on July 1, 2009, a regional center is purchasing
that service as part of a consumer's individual program plan (IPP),
the prohibition shall take effect on October 1, 2009.
(d) (1) Effective July 1, 2009, notwithstanding any other
provision of law or regulation to the contrary, a regional center
shall not purchase medical or dental services for a consumer three
years of age or older unless the regional center is provided with
documentation of a Medi-Cal, private insurance, or a health care
service plan denial and the regional center determines that an appeal
by the consumer or family of the denial does not have merit. If, on
July 1, 2009, a regional center is purchasing the service as part of
a consumer's IPP, this provision shall take effect on August 1, 2009.
Regional centers may pay for medical or dental services during the
following periods:
(A) While coverage is being pursued, but before a denial is made.
(B) Pending a final administrative decision on the administrative
appeal if the family has provided to the regional center a
verification that an administrative appeal is being pursued.
(C) Until the commencement of services by Medi-Cal, private
insurance, or a health care service plan.
(2) When necessary, the consumer or family may receive assistance
from the regional center, the Clients' Rights Advocate funded by the
department, or area boards on developmental disabilities in pursuing
these appeals.
(e) This section shall not be construed to impose any additional
liability on the parents of children with developmental disabilities,
or to restrict eligibility for, or deny services to, any individual
who qualifies for regional center services but is unable to pay.
(f) In order to best utilize generic resources, federally funded
programs, and private insurance programs for individuals with
developmental disabilities, the department and regional centers shall
engage in the following activities:
(1) Within existing resources, the department shall provide
training to regional centers, no less than once every two years, in
the availability and requirements of generic, federally funded and
private programs available to persons with developmental
disabilities, including, but not limited to, eligibility
requirements, the application process and covered services, and the
appeal process.
(2) Regional centers shall disseminate information and training to
all service coordinators regarding the availability and requirements
of generic, federally funded and private insurance programs on the
local level.
SEC. 16. Section 4677 of the Welfare and Institutions Code is
amended to read:
4677. (a) (1) All parental fees collected by or for regional
centers shall be remitted to the State Treasury to be deposited in
the Developmental Disabilities Program Development Fund, which is
hereby created and hereinafter called the Program Development Fund.
The purpose of the Program Development Fund shall be to provide
resources needed to initiate new programs, and to expand or convert
existing programs. Within the context of, and consistent with,
approved priorities for program development in the state plan,
program development funds shall promote integrated residential, work,
instructional, social, civic, volunteer, and recreational services
and supports that increase opportunities for self-determination and
maximum independence of persons with developmental disabilities.
Notwithstanding any other provision of law or regulation to the
contrary, commencing July 1, 2009, parental fees remitted to the
State Treasury shall be deposited in accordance with Section 4784.
(2) In no event shall an allocation from the Program Development
Fund be granted for more than 24 months.
(b) (1) The State Council on Developmental Disabilities shall, at
least once every five years, request from all regional centers
information on the types and amounts of services and supports needed,
but currently unavailable.
(2) The state council shall work collaboratively with the
department and the Association of Regional Center Agencies to develop
standardized forms and protocols that shall be used by all regional
centers and area boards in collecting and reporting this information.
In addition to identifying services and supports that are needed,
but currently unavailable, the forms and protocols shall also solicit
input and suggestions on alternative and innovative service delivery
models that would address consumer needs.
(3) In addition to the information provided pursuant to paragraph
(2), the state council may utilize information from other sources,
including, but not limited to, public hearings, quality assurance
assessments conducted pursuant to Section 4571, regional center
reports on alternative service delivery submitted to the department
pursuant to Section 4669.2, and the annual report on self-directed
services produced pursuant to Section 4685.7.
(4) The department shall provide additional information, as
requested by the state council.
(5) Based on the information provided by the regional centers and
other agencies, the state council shall develop an assessment of the
need for new, expanded, or converted community services and support,
and make that assessment available to the public. The assessment
shall include a discussion of the type and amount of services and
supports necessary but currently unavailable including the impact on
consumers with common characteristics, including, but not limited to,
disability, specified geographic regions, age, and ethnicity, face
distinct challenges. The assessment shall highlight alternative and
innovative service delivery models identified through their
assessment process.
(6) This needs assessment shall be conducted at least once every
five years and updated annually. The assessment shall be included in
the state plan and shall be provided to the department and to the
appropriate committees of the Legislature. The assessment and annual
updates shall be made available to the public. The State Council on
Developmental Disabilities, in consultation with the department,
shall make a recommendation to the Department of Finance as to the
level of funding for program development to be included in the
Governor's Budget, based upon this needs assessment.
(c) Parental fee schedules shall be evaluated pursuant to Section
4784 and adjusted annually, as needed, by the department, with the
approval of the state council. The July 1, 2009, parental fee
adjustment shall be exempt from this approval requirement. Fees for
out-of-home care shall bear an equitable relationship to the cost of
the care and the ability of the family to pay.
(d) In addition to parental fees and General Fund appropriations,
the Program Development Fund may be augmented by federal funds
available to the state for program development purposes, when these
funds are allotted to the Program Development Fund in the state plan.
The Program Development Fund is hereby appropriated to the
department, and subject to any allocations that may be made in the
annual Budget Act. In no event shall any of these funds revert to the
General Fund.
(e) The department may allocate funds from the Program Development
Fund for any legal purpose, provided that requests for proposals and
allocations are approved by the state council in consultation with
the department, and are consistent with the priorities for program
development in the state plan. Allocations from the Program
Development Fund shall take into consideration the following factors:
(1) The future fiscal impact of the allocations on other state
supported services and supports for persons with developmental
disabilities.
(2) The information on priority services and supports needed, but
currently unavailable, submitted by the regional centers.
Consistent with the level of need as determined in the state plan,
excess parental fees may be used for purposes other than programs
specified in subdivision (a) only when specifically appropriated to
the State Department of Developmental Services for those purposes.
(f) Under no circumstances shall the deposit of federal moneys
into the Program Development Fund be construed as requiring the State
Department of Developmental Services to comply with a definition of
"developmental disabilities" and "services for persons with
developmental disabilities" other than as specified in subdivisions
(a) and (b) of Section 4512 for the purposes of determining
eligibility for developmental services or for allocating parental
fees and state general funds deposited in the Program Development
Fund.
SEC. 17. Section 4685 of the Welfare and Institutions Code is
amended to read:
4685. (a) Consistent with state and federal law, the Legislature
finds and declares that children with developmental disabilities most
often have greater opportunities for educational and social growth
when they live with their families. The Legislature further finds and
declares that the cost of providing necessary services and supports
which enable a child with developmental disabilities to live at home
is typically equal to or lower than the cost of providing out-of-home
placement. The Legislature places a high priority on providing
opportunities for children with developmental disabilities to live
with their families, when living at home is the preferred objective
in the child's individual program plan.
(b) It is the intent of the Legislature that regional centers
provide or secure family support services that do all of the
following:
(1) Respect and support the decisionmaking authority of the
family.
(2) Be flexible and creative in meeting the unique and individual
needs of families as they evolve over time.
(3) Recognize and build on family strengths, natural supports, and
existing community resources.
(4) Be designed to meet the cultural preferences, values, and
lifestyles of families.
(5) Focus on the entire family and promote the inclusion of
children with disabilities in all aspects of school and community.
(c) In order to provide opportunities for children to live with
their families, the following procedures shall be adopted:
(1) The department and regional centers shall give a very high
priority to the development and expansion of services and supports
designed to assist families that are caring for their children at
home, when that is the preferred objective in the individual program
plan. This assistance may include, but is not limited to specialized
medical and dental care, special training for parents, infant
stimulation programs, respite for parents, homemaker services,
camping, day care, short-term out-of-home care, child care,
counseling, mental health services, behavior modification programs,
special adaptive equipment such as wheelchairs, hospital beds,
communication devices, and other necessary appliances and supplies,
and advocacy to assist persons in securing income maintenance,
educational services, and other benefits to which they are entitled.
(2) When children with developmental disabilities live with their
families, the individual program plan shall include a family plan
component which describes those services and supports necessary to
successfully maintain the child at home. Regional centers shall
consider every possible way to assist families in maintaining their
children at home, when living at home will be in the best interest of
the child, before considering out-of-home placement alternatives.
When the regional center first becomes aware that a family may
consider an out-of-home placement, or is in need of additional
specialized services to assist in caring for the child in the home,
the regional center shall meet with the family to discuss the
situation and the family's current needs, solicit from the family
what supports would be necessary to maintain the child in the home,
and utilize creative and innovative ways of meeting the family's
needs and providing adequate supports to keep the family together, if
possible.
(3) (A) To ensure that these services and supports are provided in
the most cost-effective and beneficial manner, regional centers may
utilize innovative service-delivery mechanisms, including, but not
limited to, vouchers; alternative respite options such as foster
families, vacant community facility beds, crisis child care
facilities; group training for parents on behavioral intervention
techniques in lieu of some or all of the in-home parent training
component of the behavioral intervention services; purchase of
neighborhood preschool services and needed qualified personnel in
lieu of infant development programs; and alternative child care
options such as supplemental support to generic child care facilities
and parent child care cooperatives.
(B) Effective July 1, 2009, at the time of development, review, or
modification of a child's individualized family service plan or
individual program plan, the regional center shall consider both of
the following:
(i) The use of group training for parents on behavioral
intervention techniques in lieu of some or all of the in-home parent
training component of the behavioral intervention services.
(ii) The purchase of neighborhood preschool services and needed
qualified personnel in lieu of infant development programs.
(4) If the parent of any child receiving services and supports
from a regional center believes that the regional center is not
offering adequate assistance to enable the family to keep the child
at home, the parent may initiate a request for fair hearing as
established in this division. A family shall not be required to start
a placement process or to commit to placing a child in order to
receive requested services.
(5) Nothing in this section shall be construed to encourage the
continued residency of adult children in the home of their parents
when that residency is not in the best interests of the person.
(6) When purchasing or providing a voucher for day care services
for parents who are caring for children at home, the regional center
may pay only the cost of the day care service that exceeds the cost
of providing day care services to a child without disabilities. The
regional center may pay in excess of this amount when a family can
demonstrate a financial need and when doing so will enable the child
to remain in the family home.
(7) A regional center may purchase or provide a voucher for
diapers for children three years of age or older. A regional center
may purchase or provide vouchers for diapers under three years of age
when a family can demonstrate a financial need and when doing so
will enable the child to remain in the family home.
SEC. 18. Section 4686 of the Welfare and Institutions Code is
amended to read:
4686. (a) Notwithstanding any other provision of law or
regulation to the contrary, an in-home respite worker who is not a
licensed health care professional but who is trained by a licensed
health care professional may perform incidental medical services for
consumers of regional centers with stable conditions, after
successful completion of training as provided in this section.
Incidental medical services provided by trained in-home respite
workers shall be limited to the following:
(1) Colostomy and ileostomy: changing bags and cleaning stoma.
(2) Urinary catheter: emptying and changing bags and care of
catheter site.
(3) Gastrostomy: feeding, hydration, cleaning stoma, and adding
medication per physician's or nurse practitioner's orders for the
routine medication of patients with stable conditions.
(b) In order to be eligible to receive training for purposes of
this section, an in-home respite worker shall submit to the trainer
proof of successful completion of a first aid course and successful
completion of a cardiopulmonary resuscitation course within the
preceding year.
(c) The training in
incidental medical services required under this section shall be
provided by physicians or registered nurses. Training in gastrostomy
services shall be provided by a physician or registered nurse, or
through a gastroenterology or surgical center in an acute care
hospital, as defined in subdivision (a) of Section 1250 of the Health
and Safety Code, which meets California Children Services' Program
standards for centers for children with congenital gastrointestinal
disorders, or comparable standards for adults, or by a physician or
registered nurse who has been certified to provide training by the
center.
(d) The in-home respite agency providing the training shall
develop a training protocol which shall be submitted for approval to
the State Department of Developmental Services. The department shall
approve those protocols that specifically address both of the
following:
(1) A description of the incidental medical services to be
provided by trained in-home respite workers.
(2) A description of the protocols by which the training will be
provided. Protocols shall include a demonstration of the following
skills by the trainee:
(A) Care of the gastrostomy, colostomy, ileostomy, or urinary
catheter site.
(B) Performance of gastrostomy tube feeding, changing bags and
cleaning stoma of colostomy or ileostomy sites, and emptying and
changing urinary catheter bags.
(C) Identification of, and appropriate response to, problems and
complications associated with gastrostomy care and feeding, colostomy
and ileostomy care, and care of urinary catheter sites.
(D) Continuing education requirements.
(e) Training by the gastroenterology or surgical center, or the
certified physician or registered nurse, shall be done in accordance
with the approved training protocol. Training of in-home respite
workers shall be specific to the individual needs of the regional
center consumer receiving the incidental medical service and shall be
in accordance with orders from the consumer's treating physician or
surgeon.
(f) The treating physician or surgeon shall give assurances to the
regional center that the patient's condition is stable prior to the
regional center's purchasing incidental medical services for the
consumer through an appropriately trained respite worker.
(g) Prior to the purchase of incidental medical services through a
trained respite worker, the regional center shall do all of the
following:
(1) Ensure that a nursing assessment of the consumer, performed by
a registered nurse, is conducted to determine whether an in-home
respite worker, licensed vocational nurse, or registered nurse may
perform the services.
(2) Ensure that a nursing assessment of the home has been
conducted to determine whether incidental medical services can
appropriately be provided in that setting.
(h) The agency providing in-home respite services shall do all of
the following:
(1) Ensure adequate training of the in-home respite worker.
(2) Ensure that telephone backup and emergency consultation by a
registered nurse or physician is available.
(3) Develop a plan for care specific to the incidental medical
services provided to be carried out by the respite worker.
(4) Ensure that the in-home respite worker and the incidental
medical services provided by the respite worker are adequately
supervised by a registered nurse.
(i) Notwithstanding any other provision of law or regulation to
the contrary, the hourly rate for an in-home respite agency shall be
increased to provide a fifty cent ($.50) per hour wage increase and
an eight-cent ($.08) per hour benefit increase for the hours the
in-home respite agency is providing incidental medical services.
(j) To expand the availability of trained in-home respite agency
staff, a regional center may reimburse the in-home respite agency up
to two hundred dollars ($200) semiannually, for the provision of
training pursuant to subdivision (c).
(k) For purposes of this section, "in-home respite worker" means
an individual employed by an agency which is vendored by a regional
center to provide in-home respite services. These agencies include,
but are not limited to, in-home respite services agencies, home
health agencies, or other agencies providing these services.
SEC. 19. Section 4686.2 is added to the Welfare and Institutions
Code, to read:
4686.2. (a) Effective July 1, 2009, notwithstanding any other
provision of law or regulation to the contrary, any vendor who
provides applied behavioral analysis (ABA) services, or intensive
behavioral intervention services or both, as defined in subdivision
(d), shall:
(1) Conduct a behavioral assessment of each consumer to whom the
vendor provides these services.
(2) Design an intervention plan that shall include the service
type, number of hours and parent participation needed to achieve the
consumer's goals and objectives, as set forth in the consumer's
individual program plan (IPP) or individualized family service plan
(IFSP). The intervention plan shall also set forth the frequency at
which the consumer's progress shall be evaluated and reported.
(3) Provide a copy of the intervention plan to the regional center
for review and consideration by the planning team members.
(b) Effective July 1, 2009, notwithstanding any other provision of
law or regulation to the contrary, regional centers shall:
(1) Only purchase ABA services or intensive behavioral
intervention services that reflect evidence-based practices, promote
positive social behaviors, and ameliorate behaviors that interfere
with learning and social interactions.
(2) Only purchase ABA or intensive behavioral intervention
services when the parent or parents of minor consumers receiving
services participate in the intervention plan for the consumers,
given the critical nature of parent participation to the success of
the intervention plan.
(3) Not purchase either ABA or intensive behavioral intervention
services for purposes of providing respite, day care, or school
services.
(4) Discontinue purchasing ABA or intensive behavioral
intervention services for a consumer when the consumer's treatment
goals and objectives, as described under subdivision (a), are
achieved. ABA or intensive behavioral intervention services shall not
be discontinued until the goals and objectives are reviewed and
updated as required in paragraph (5) and shall be discontinued only
if those updated treatment goals and objectives do not require ABA or
intensive behavioral intervention services.
(5) For each consumer, evaluate the vendor's intervention plan and
number of service hours for ABA or intensive behavioral intervention
no less than every six months, consistent with evidence-based
practices. If necessary, the intervention plan's treatment goals and
objectives shall be updated and revised.
(6) Not reimburse a parent for participating in a behavioral
services treatment program.
(c) For consumers receiving ABA or behavioral intervention
services on July 1, 2009, as part of their IPP or IFSP, subdivision
(b) shall apply on August 1, 2009.
(d) For purposes of this section the following definitions shall
apply:
(1) "Applied behavioral analysis" means the design,
implementation, and evaluation of systematic instructional and
environmental modifications to promote positive social behaviors and
reduce or ameliorate behaviors which interfere with learning and
social interaction.
(2) "Intensive behavioral intervention" means any form of applied
behavioral analysis that is comprehensive, designed to address all
domains of functioning, and provided in multiple settings for no more
than 40 hours per week, across all settings, depending on the
individual's needs and progress. Interventions can be delivered in a
one-to-one ratio or small group format, as appropriate.
(3) "Evidence-based practice" means a decisionmaking process that
integrates the best available scientifically rigorous research,
clinical expertise, and individual's characteristics. Evidence-based
practice is an approach to treatment rather than a specific
treatment. Evidence-based practice promotes the collection,
interpretation, integration, and continuous evaluation of valid,
important, and applicable individual- or family-reported,
clinically-observed, and research-supported evidence. The best
available evidence, matched to consumer circumstances and
preferences, is applied to ensure the quality of clinical judgments
and facilitates the most cost-effective care.
(4) "Parent participation" shall include, but shall not be limited
to, the following meanings:
(A) Completion of group instruction on the basics of behavior
intervention.
(B) Implementation of intervention strategies, according to the
intervention plan.
(C) If needed, collection of data on behavioral strategies and
submission of that data to the provider for incorporation into
progress reports.
(D) Participation in any needed clinical meetings.
(E) Purchase of suggested behavior modification materials or
community involvement if a reward system is used.
SEC. 20. Section 4686.5 is added to the Welfare and Institutions
Code, to read:
4686.5. (a) Effective July 1, 2009, notwithstanding any other
provision of law or regulation to the contrary, all of the following
shall apply:
(1) A regional center may only purchase respite services when the
care and supervision needs of a consumer exceed that of an individual
of the same age without developmental disabilities.
(2) A regional center shall not purchase more than 21 days of
out-of-home respite services in a fiscal year nor more than 90 hours
of in-home respite services in a quarter, for a consumer.
(3) (A) A regional center may grant an exemption to the
requirements set forth in paragraphs (1) and (2) if it is
demonstrated that the intensity of the consumer's care and
supervision needs are such that additional respite is necessary to
maintain the consumer in the family home, or there is an
extraordinary event that impacts the family member's ability to meet
the care and supervision needs of the consumer.
(B) For purposes of this section, "family member" means an
individual who:
(i) Has a consumer residing with him or her.
(ii) Is responsible for the 24-hour care and supervision of the
consumer.
(iii) Is not a licensed or certified residential care facility or
foster family home receiving funds from any public agency or regional
center for the care and supervision provided. Notwithstanding this
provision, a relative who receives foster care funds shall not be
precluded from receiving respite.
(4) A regional center shall not purchase day care services to
replace or supplant respite services. For purposes of this section,
"day care" is defined as regularly provided care, protection, and
supervision of a consumer living in the home of his or her parents,
for periods of less than 24 hours per day, while the parents are
engaged in employment outside of the home or educational activities
leading to employment, or both.
(5) A regional center shall only consider in-home supportive
services a generic resource when the approved in-home supportive
services meets the respite need as identified in the consumer's
individual program plan (IPP) or individualized family service plan
(IFSP).
(b) For consumers receiving respite services on July 1, 2009, as
part of their IPP or IFSP, subdivision (a) shall apply on August 1,
2009.
(c) This section shall remain in effect until implementation of
the individual choice budget pursuant to Section 4648.6 and
certification by the Director of the Department of Developmental
Services that the individual choice budget has been implemented and
will result in state budget savings sufficient to offset the costs
associated with the repeal of this section. This section shall be
repealed on the date of certification.
SEC. 21. Section 4688.1 is added to the Welfare and Institutions
Code, to read:
4688.1. (a) Notwithstanding any other provision of law or
regulation to the contrary, vendors of behavior management, activity
center, and adult development center day programs, social recreation
programs, socialization training programs, community integration
training programs, community activities support programs, creative
art programs, and work activity programs shall offer an alternative
senior program component focused on the needs of individuals with
developmental disabilities who are over 50 years of age, at a rate
not to exceed the lesser of thirty-five dollars ($35) per day or the
vendor's existing daily rate.
(1) The alternative senior program component shall be provided at
a ratio of no more than eight consumers to one staff member.
(2) Consistent with the intent of the Lanterman Developmental
Disabilities Services Act, the alternative senior program component
shall be offered within the provider's existing vendored capacity as
reflected in its program design or licensed capacity.
(b) Effective July 1, 2009, at the time of development, review, or
modification of an eligible consumer's individual program plan,
regional centers, as appropriate, shall provide information about and
offer an alternative senior program. The alternative senior program
shall be offered to eligible consumers who want to transition to a
program component focused on the needs and interests of seniors.
SEC. 22. Section 4688.2 is added to the Welfare and Institutions
Code, to read:
4688.2. (a) Notwithstanding any other provision of law or
regulation to the contrary, vendors of behavior management, activity
center, and adult development center adult day programs, community
integration training programs, and community activities support
services programs shall offer an alternative customized program
component with an appropriate staffing component to meet
individualized consumer needs.
(1) The alternative customized program component shall be offered
within the provider's existing vendored capacity, as reflected in its
program design or licensed capacity.
(2) The regional center shall fund customized programs based on
the vendor's existing rate and only fund those hours provided.
(b) Effective July 1, 2009, at the time of development, review, or
modification of a consumer's individual program plan, regional
centers, as appropriate, shall provide information about and make
available the customized program option.
(1) The alternative customized program component shall be offered
to individuals with developmental disabilities who want a program
focused on their individualized needs and interests to develop or
maintain employment or volunteer activities in lieu of their current
program.
(2) Total hours of service for this alternative customized program
shall range between 20 and 80 hours per month, per person, depending
on the support needs of the individual.
SEC. 23. Section 4688.3 is added to the Welfare and Institutions
Code, to read:
4688.3. (a) The State Department of Health Care Services and the
department shall jointly seek a federal Centers for Medicare and
Medicaid Services' (CMS) approved 1915(i) state plan amendment to
expand federal financial participation for services to persons with
developmental disabilities provided by regional centers pursuant to
Division 4.5 (commencing with Section 4500).
(b) Services provided pursuant to this section shall be rendered
under the administrative direction of the department. The department
may issue program directives to regional centers for implementing the
approved state plan amendment.
(c) If CMS approves the state plan amendment pursuant to Section
1915(i) of the Social Security Act, the Director of Health Care
Services shall execute a declaration stating that this approval has
been granted. The director shall retain the declaration and this
section shall be implemented commencing on the date that the director
executes a declaration pursuant to this subdivision.
(d) The department may adopt regulations to implement this section
and any sections in Division 4.5 (commencing with Section 4500)
necessary to implement the terms of the 1915(i) state plan amendment.
The adoption, amendment, repeal, or readoption of a regulation
authorized by this section is deemed to be necessary for the
immediate preservation of the public peace, health and safety, or
general welfare, for purposes of Sections 11346.1 and 11349.9 of the
Government Code, and the department is hereby exempted from that
requirement. For purposes of subdivision (e) of Section 11346.1 of
the Government Code, the 120-day period, as applicable to the
effective period of an emergency regulatory action and submission of
specified materials to the Office of Administrative Law, is hereby
extended to 180 days.
(e) The department shall adopt regulations to implement the terms
of the 1915(i) state plan amendment though the regular rulemaking
process pursuant to Sections 11346 and 11349.1 of the Government Code
within 18 months of the adoption of emergency regulations pursuant
to subdivision (d).
(f) The department shall consult with stakeholders, as defined in
subdivision (k) of Section 4512.
(g) The State Department of Health Care Services shall post a copy
of, or a link to, the approved state plan amendment and any State
Department of Developmental Services regulations or program
directives, or both, issued pursuant to this section on its Internet
Web site.
SEC. 24. Section 4689 of the Welfare and Institutions Code is
amended to read:
4689. Consistent with state and federal law, the Legislature
places a high priority on providing opportunities for adults with
developmental disabilities, regardless of the degree of disability,
to live in homes that they own or lease with support available as
often and for as long as it is needed, when that is the preferred
objective in the individual program plan. In order to provide
opportunities for adults to live in their own homes, the following
procedures shall be adopted:
(a) The department and regional centers shall ensure that
supported living arrangements adhere to the following principles:
(1) Consumers shall be supported in living arrangements which are
typical of those in which persons without disabilities reside.
(2) The services or supports that a consumer receives shall change
as his or her needs change without the consumer having to move
elsewhere.
(3) The consumer's preference shall guide decisions concerning
where and with whom he or she lives.
(4) Consumers shall have control over the environment within their
own home.
(5) The purpose of furnishing services and supports to a consumer
shall be to assist that individual to exercise choice in his or her
life while building critical and durable relationships with other
individuals.
(6) The services or supports shall be flexible and tailored to a
consumer's needs and preferences.
(7) Services and supports are most effective when furnished where
a person lives and within the context of his or her day-to-day
activities.
(8) Consumers shall not be excluded from supported living
arrangements based solely on the nature and severity of their
disabilities.
(b) Regional centers may contract with agencies or individuals to
assist consumers in securing their own homes and to provide consumers
with the supports needed to live in their own homes.
(c) The range of supported living services and supports available
include, but are not limited to, assessment of consumer needs;
assistance in finding, modifying and maintaining a home; facilitating
circles of support to encourage the development of unpaid and
natural supports in the community; advocacy and self-advocacy
facilitation; development of employment goals; social, behavioral,
and daily living skills training and support; development and
provision of 24-hour emergency response systems; securing and
maintaining adaptive equipment and supplies; recruiting, training,
and hiring individuals to provide personal care and other assistance,
including in-home supportive services workers, paid neighbors, and
paid roommates; providing respite and emergency relief for personal
care attendants; and facilitating community participation. Assessment
of consumer needs may begin before 18 years of age to enable the
consumer to move to his or her own home when he or she reaches 18
years of age.
(d) Regional centers shall provide information and education to
consumers and their families about supported living principles and
services.
(e) Regional centers shall monitor and ensure the quality of
services and supports provided to individuals living in homes that
they own or lease. Monitoring shall take into account all of the
following:
(1) Adherence to the principles set forth in this section.
(2) Whether the services and supports outlined in the consumer's
individual program plan are congruent with the choices and needs of
the individual.
(3) Whether services and supports described in the consumer's
individual program plan are being delivered.
(4) Whether services and supports are having the desired effects.
(5) Whether the consumer is satisfied with the services and
supports.
(f) The planning team, established pursuant to subdivision (j) of
Section 4512, for a consumer receiving supported living services
shall confirm that all appropriate and available sources of natural
and generic supports have been utilized to the fullest extent
possible for that consumer.
(g) Regional centers shall utilize the same supported living
provider for consumers who reside in the same domicile, provided that
each individual consumer's particular needs can still be met
pursuant to his or her individual program plans.
(h) Rent, mortgage, and lease payments of a supported living home
and household expenses shall be the responsibility of the consumer
and any roommate who resides with the consumer.
(i) A regional center shall not make rent, mortgage, or lease
payments on a supported living home, or pay for household expenses of
consumers receiving supported living services, except under the
following circumstances:
(1) If all of the following conditions are met, a regional center
may make rent, mortgage, or lease payments as follows:
(A) The regional center executive director verifies in writing
that making the rent, mortgage, or lease payments or paying for
household expenses is required to meet the specific care needs unique
to the individual consumer as set forth in an addendum to the
consumer's individual program plan, and is required when a consumer's
demonstrated medical, behavioral, or psychiatric condition presents
a health and safety risk to himself or herself, or another.
(B) During the time period that a regional center is making rent,
mortgage, or lease payments, or paying for household expenses, the
supported living services vendor shall assist the consumer in
accessing all sources of generic and natural supports consistent with
the needs of the consumer.
(C) The regional center shall not make rent, mortgage, or lease
payments on a supported living home or pay for household expenses for
more than six months, unless the regional center finds that it is
necessary to meet the individual consumer's particular needs pursuant
to the consumer's individual program plan. The regional center shall
review a finding of necessity on a quarterly basis and the regional
center executive director shall annually verify in an addendum to the
consumer's individual program plan that the requirements set forth
in subparagraph (A) continue to be met.
(2) A regional center that has been contributing to rent,
mortgage, or lease payments or paying for household expenses prior to
July 1, 2009, shall at the time of development, review, or
modification of a consumer's individual program plan determine if the
conditions in paragraph (1) are met. If the planning team determines
that these contributions are no longer appropriate under this
section, a reasonable time for transition, not to exceed six months,
shall be permitted.
(j) All paid roommates and live-in support staff in supported
living arrangements in which regional centers have made rent,
mortgage, or lease payments, or have paid for household expenses
pursuant to subdivision (i) shall pay their share of the rent,
mortgage, or lease payments or household expenses for the supported
living home, subject to the requirements of Industrial Welfare
Commission Order No. 15-2001 and the Housing Choice Voucher Program,
as set forth in Section 1437f of Title 42 of the United States Code.
(k) Regional centers shall ensure that the supported living
services vendors' administrative costs are necessary and reasonable,
given the particular services that they are providing and the number
of consumers to whom the vendor provides services. Administrative
costs shall be limited to allowable costs for community-based day
programs, as defined in Section 57434 of Title 17 of the California
Code of Regulations, or its successor.
(l) Regional centers shall ensure that the most cost-effective of
the rate methodologies is utilized to determine the negotiated rate
for vendors of supported living services, consistent with Section
4689.8 and Title 17 of the California Code of Regulations.
(m) For purposes of this section, "household expenses" means
general living expenses and includes, but is not limited to,
utilities paid and food consumed within the home.
(n) A supported living services provider shall provide assistance
to a consumer who is a Medi-Cal beneficiary in applying for in-home
supportive services, as set forth in Section 12300, within five days
of the consumer moving into a supported living services arrangement.
SEC. 25. Section 4689.05 is added to the Welfare and Institutions
Code, to read:
4689.05. (a) A regional center shall not purchase supportive
services, as defined in Section 12300, for a consumer who meets the
criteria to receive, but declines to apply for, in-home supportive
services (IHSS) benefits, as set forth in Section 12300, except as
set forth in subdivision (d).
(b) Consistent with Section 4648, a regional center shall not
purchase supported living services for a consumer to supplant IHSS.
(c) Between the date that a consumer applies for IHSS and the date
that a consumer's application for IHSS is approved, a regional
center shall not purchase supportive services for the consumer at a
rate that exceeds the IHSS hourly rate, which includes the IHSS
provider hourly wage, the provider's hourly payroll taxes, and the
hourly administrative costs, for the county in which the consumer
resides.
(d) A regional center executive
director may waive the requirements set forth in subdivision (a) if
the executive director finds that extraordinary circumstances warrant
the waiver, and that a finding is documented in an addendum to the
consumer's individual program plan.
SEC. 26. Section 4692 is added to the Welfare and Institutions
Code, to read:
4692. (a) Effective August 1, 2009, subject to subdivisions (c)
and (e), regional centers shall not compensate a work activity
program, activity center, adult development center, behavior
management program, social recreation program, adaptive skills
trainer, infant development program, program support group (day
service), socialization training program, client/parent support
behavior intervention training program, community integration
training program, community activities support service, or creative
arts program, as defined in Title 17 of the California Code of
Regulations, for providing any service to a consumer on any of the
following holidays:
(1) January 1.
(2) The third Monday in January.
(3) The third Monday in February.
(4) March 31.
(5) The last Monday in May.
(6) July 4.
(7) The first Monday in September.
(8) November 11.
(9) Thanksgiving Day.
(10) December 25.
(11) The four business days between December 25 and January 1.
(b) Effective August 1, 2009, subject to subdivisions (c) and (e),
regional centers shall not compensate a transportation vendor/family
member, transportation company, transportation/additional component
vendor, transportation broker, transportation assistant/vendor,
transportation vendor/auto driver, or transportation vendor/public or
rental car agency or taxi, in accordance with Title 17 of the
California Code of Regulations, for transporting any consumer to
receive services from any of the vendors specified in subdivision (a)
for any of the holidays set forth in paragraphs (1) to (11),
inclusive, of subdivision (a).
(c) If a holiday listed in this section falls on a Saturday or a
Sunday, the following Monday shall be deemed to be the holiday in
lieu of the day observed.
(d) Contracts between the vendors described in this section and
regional centers shall reflect the holiday closures set forth in this
section and shall be renegotiated accordingly, as necessary.
(e) The department may adjust the holidays set forth in
subdivision (a) through a program directive. This directive shall be
provided to the regional centers and posted on the department's
Internet Web site at least 60 days prior to the effective date of the
change in holiday.
SEC. 27. Section 4784 of the Welfare and Institutions Code is
amended to read:
4784. (a) The Director of Developmental Services shall establish,
annually review, and adjust as needed, a schedule of parental fees
for services received through the regional centers. Effective July 1,
2009, this schedule shall be revised to reflect changes in economic
conditions that affect parents' ability to pay the fee, but not to
exceed an inflationary factor as determined by the department.
(b) The parental fee schedule established pursuant to this section
shall be exempt from Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code.
(c) In establishing the amount parents shall pay, the director
shall take into account all of the following factors:
(1) The current cost of caring for a child at home, as determined
by the most recent data available from the United States Department
of Agriculture's survey on the cost of raising a child in California,
adjusted for the Consumer Price Index (CPI) from the survey date to
the date of payment adjustment.
(2) Medical expenses incurred prior to regional center care.
(3) Whether the child is living at home.
(4) Parental payments for medical expenses, clothing, incidentals,
and other items considered necessary for the normal rearing of a
child.
(5) Transportation expenses incurred in visiting a child.
(d) The parental fee schedule shall exempt families with an income
below the federal poverty level from assessment and payment of the
parental fee.
(e) (1) The adjusted fee shall be assessed in full for children,
when the out-of-home placement commences on or after July 1, 2009.
(2) For children placed out-of-home prior to July 1, 2009, the
department shall determine the increase in the parental fee above the
amount assessed using the fee schedule in effect on June 30, 2009.
This fee increase shall be implemented over three years, with
one-third of the increase added to the fee on July 1, 2009, one-third
of the increase added to the fee on July 1, 2010, and the final
third added to the fee on July 1, 2011.
(f) Notwithstanding any other provision of law or regulation to
the contrary, commencing July 1, 2009, all fees collected shall be
remitted to the State Treasury to be deposited as follows:
(1) Fees collected up to the amount that would be assessed using
the fee schedule in effect on June 30, 2009, shall be deposited into
the Program Development Fund established in Chapter 6 (commencing
with Section 4670) to provide resources needed to initiate new
programs, consistent with approved priorities for program development
in the state plan.
(2) Fees collected using the July 1, 2009, schedule that are
greater than the amount that would have been assessed using the fee
schedule in effect on June 30, 2009, shall be deposited into the
Program Development Fund and shall be available for expenditure by
the department to offset General Fund costs.
SEC. 28. Section 7502.5 of the Welfare and Institutions Code is
amended to read:
7502.5. The total number of developmental center residents in the
secure treatment facility at Porterville Developmental Center,
including those residents receiving services in the Porterville
Developmental Center transition treatment program, shall not exceed
297.
SEC. 29. (a) The State Department of Developmental Services shall
provide information to the Assembly Committee on Budget and the
Senate Committee on Budget and Fiscal Review during budget hearings
for the 2010-11 fiscal year regarding the effect on the developmental
service system of the specific cost containment measures implemented
to achieve up to three hundred thirty-four million dollars
($334,000,000) in General Fund reductions for the 2009-10 fiscal year
pursuant to Item 4300-101-0001 of Section 2.00 of the Budget Act of
2009.
(b) The department shall continue to convene, as appropriate, a
stakeholder review process to obtain information and comments about
implementation of the cost containment measures and their effect on
the developmental service system. The stakeholder review process
shall include statewide organizations representing the interests of
consumers, family members, service providers, and statewide advocacy
organizations, as well as policy and fiscal staff of the Legislature.
SEC. 30. This act addresses the fiscal emergency declared by the
Governor by proclamation on July 1, 2009, pursuant to subdivision (f)
of Section 10 of Article IV of the California Constitution.
SEC. 31. This act is an urgency statute necessary for the
immediate preservation of the public peace, health, or safety within
the meaning of Article IV of the Constitution and shall go into
immediate effect. The facts constituting the necessity are:
In order to make the necessary statutory changes to implement the
Budget Act of 2009 at the earliest possible time, it is necessary
that this act take effect immediately.