BILL ANALYSIS
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: AB 1260
A
AUTHOR: Huffman
B
VERSION: September 4, 2009
HEARING DATE: September 10, 2009
1
FISCAL: Yes; two-thirds vote required (urgency)
2
6
CONSULTANT:
0
Hailey/Park
SUBJECT
Developmental services: regional centers
SUMMARY
Revises the maximum purchase by a regional center of
respite services for consumers, from a maximum number of
days per year and hours per quarter, to a percentage of the
annualized volume of respite services utilized by a
consumer who received those services in the 2008-09 fiscal
year. Revises the requirement for specified vendors to
offer an alternative senior program component to be
permissive, and revises the requirement for regional
centers to provide information and offer an alternative
senior program to be permissive.
ABSTRACT
Current law
1)Provides that certain persons with developmental
disabilities have the right to receive treatment and
services to meet their needs regardless of age or degree
of handicap, at each stage of life: the disability must
Continued---
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begin before the consumer's 18th birthday, be expected to
continue indefinitely, present a significant disability,
and be attributable to certain medical conditions, such
as mental retardation, autism, epilepsy, and cerebral
palsy.
2)Requires that the state pay for these services through
contracts with regional centers, and requires regional
centers to arrange and contract for services in the
community.
3)Requires regional centers to develop an individual
program plan (IPP) for each consumer that sets forth the
treatment and services to be provided to each consumer,
which include, among other things, respite services,
alternative senior programs, and alternative customized
programs.
4)Requires regional centers to develop, where appropriate
for children three years of age and younger, to develop
individual family service plans (IFSP).
Respite services
5)Restricts the amount of respite services that may be
purchased for a client and their family. Specifically:
a) a regional center may only purchase respite
services when the care and supervision needs of a
client exceed that of an individual of the same age
without developmental disabilities;
b) 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.
c) Effects these restrictions on August 1, 2009, for
consumers receiving respite services on July 1, 2009,
as part of their IPP or individual family service plan
(IFSP).
6)Allows a regional center to grant an exemption from these
restrictions under prescribed circumstances.
7)Repeals these restrictions upon implementation of the
individual choice budget.
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Alternative Senior Programs
8)Requires 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 to offer an alternative senior
program component focused on the needs of individuals
with developmental disabilities who are over 50 years of
age.
9)Requires the alternative senior program component to be
provided at a ratio of no more than eight consumers to
one staff member, at a rate not to exceed the lesser of
thirty-five dollars ($35) per day or the vendor's
existing daily rate.
10)Requires that the alternative senior program component
be offered within the provider's existing vendored
capacity as reflected in its program design or licensed
capacity, consistent with the intent of the Lanterman
Developmental Disabilities Services Act.
11)Effective July 1, 2009, requires, regional centers to
provide, as appropriate, information about and offer an
alternative senior program at the time of development,
review, or modification of an eligible consumer's
individual program plan, to eligible consumers who want
to transition to a program component focused on the needs
and interests of seniors.
This bill
1)Eliminates the maximum purchase by a regional center of
21-days of out-of-home respite services in a fiscal year,
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and 90 hours of in-home respite services in a quarter,
for a consumer; and, instead, prohibits regional centers
from purchasing more than 98 percent of the annualized
volume of in-home and out-of-home respite services
utilized by a consumer who received those services in the
2008-09 fiscal year.
2)Revises the requirement for specified vendors to offer an
alternative senior program component to be permissive,
and revises the requirement for regional centers to
provide information and offer an alternative senior
program to be permissive.
3)Allows vendors to formulate agreements to meet the
objectives of the requirements above, in order to meet
consumer demand for these alternative senior programs.
4)Requires regional centers to take appropriate steps to
make sure that sufficient program capacity exists to meet
the individual needs of consumers wishing to enroll in
alternative senior programs that are consistent with the
individual's IPP.
5)Contains an urgency clause.
FISCAL IMPACT
Unknown. There is some debate about the fiscal impact.
Based upon information from the Senate Budget Committee,
this legislation will result in General Fund costs of at
least $5.8 million. The savings associated with the
seniors program would be eroded ($1 million General Fund),
as would the savings from the respite cap ($4.8 million
General Fund). The proponents believe that AB 1260 would
provide at least the amount of savings that the Legislature
intended be generated by provisions in ABx4 9 (Evans),
Chapter 9, Statutes of 2009; however, with the provisions
of AB 1260, the savings would not exceed the budget target.
BACKGROUND AND DISCUSSION
Background
As part of the July 2009 package of bills signed into law
to address the budget shortfall, ABx4 9 (Evans), Chapter 9,
Statutes of 2009, became law. This developmental services
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trailer bill, which became effective on July 28, 2009, made
specified changes to achieve budget savings of more than
$200 million. All of the proposed changes occur, unless
otherwise specified, at the time of the development,
scheduled review, or modification of a client's individual
program plan -- IPP or IFSP. Among the changes were new
restrictions for respite services, expected to yield
savings of $5.3 million annually, and a requirement for
specified vendors to offer less costly alternative senior
program options, for an expected savings of $1 million.
Specifically, the new restrictions on respite services
include a maximum of 21 days of out-of-home respite
services in a fiscal year, and 90 hours of in-home respite
services in a quarter, in addition to other restrictions.
For existing consumers, these new restrictions go into
effect on August 1, 2009.
The trailer bill also required all 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 to offer an
alternative senior program component focused on the needs
of individuals with developmental disabilities who are over
50 years of age, and do so within their existing licensed
capacity. It is estimated that hundreds of vendors would be
subject to this requirement.
The budget set a goal of enrolling approximately 5 percent
of eligible seniors in these alternative programs.
Additionally, the bill required vendors to meet a
staff-to-consumer ratio of no more than 1 to 8, and receive
the lesser of $35 a day or their current daily rate.
According to advocates, the average day program
reimbursement has been approximately $45 per person, per
day.
Author's case
According to the author, respite agencies around the state
believe the current cap on respite services would result in
an estimated 20 percent reduction in services, rather than
the 2 percent savings that was projected when the bill
passed. Instead of saving $5.3 million, the author
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believes that the budget trailer bill will result in
reductions of approximately $60 million in respite services
- 20 percent of $314 million in the current year.
Similarly, the author believes that the goal and expected
savings of the trailer bill regarding the alternative
senior program component can be achieved, without the
requirement for all vendors of specified services to offer
it. The author believes that current law will lead to
excessive capacity and unnecessarily force organizations to
offer a program that they may be unable to offer.
The stakeholder process
The Department of Developmental Services is unique in the
health and human services in that statute directs it to
convene a "stakeholder group" to make recommendations to
the department and the Legislature on how best to meet
targets for budget reductions. Representatives of
professional organizations, service organizations, the
regional centers, and advocacy groups participated in the
stakeholder meetings. Legislative staff were also
involved. The results of those meetings were forwarded to
the Legislature and adopted as part of budget trailer
bills.
Previous votes
Not applicable.
Arguments in support
For the senior program, advocates point out that to meet
the budget goal of enrolling 5 percent of 23,000 eligible
individuals over the age of 50, only 1,150 consumers would
need to participate in these programs statewide, or an
average of 55 participants per regional center catchment
area. If a ratio of 1 staff to 8 consumers was used, fewer
than 150 programs statewide or an average of seven programs
per regional center would need to be offered to meet the 5
percent target, far fewer than the hundreds of vendors
which the law requires to offer such programs. Advocates
emphasize it may be difficult for some vendors to meet the
requirements of offering this program within their current
limited capacity (example: if a vendor has only 4 open
slots, it may have to operate the program at a loss), and
allowing greater flexibility through joint agreements may
enhance vendors' ability to meet consumer demand.
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Advocates state that programs tailored to seniors are
already offered informally and believe that a regional
center, which already has the responsibility to find
appropriate services for consumers to meet their Individual
Program Plan, will be capable of finding programs willing
to offer the senior option, without a requirement that all
vendors offer it. Additionally, advocates believe that
because of the difference in the average rate for a day
program and the statutorily set maximum rate for the
alternative senior option (estimated to be approximately
$10), the goal of 5 percent participation would
significantly exceed the estimated savings associated with
this option. Advocates believe that program savings could
be achieved with only 569 participants, rather than 1,150,
enrolled in about 75 programs statewide.
QUESTIONS AND COMMENTS
Respite care: is there evidence the budget trailer bill
requires program reductions greater than $5.3 million?
The rationale for this section of the bill (Section 1, pp.
9-10) is that the language of ABx4 9 (Evans) imposes
program reductions in excess of the Legislature's intent to
reduce respite services by $5.3 million. Can the
Department of Developmental Services provide information on
implementation of respite services budget changes?
Does the language of ABx4 9 generate savings
greater than $5.3 million?
Is there a disagreement about the meaning of the
language - such that the department is interpreting it
in ways that generate more savings than the
Legislature intended?
Are individual regional centers differing in their
interpretation of the language such that the savings
generated are projected to be greater than necessary?
Respite care: is there evidence that the substitute
language of AB 1260 will generate the necessary savings of
$5.3 million in the current year's respite services budget?
The committee should ask the department to comment on this
language and its budget impact.
Senior programs: is there evidence that the substitute
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language of AB 1260 will generate the necessary savings of
$1 million in the current year's senior services budget?
The committee should ask the department to comment on this
language and its budget impact.
Is this evidence sufficient to act now to alter the
recently-passed budget trailer language, or is it
preferable to study the implementation of the budget-act
provisions during the next four months for review in
January?
POSITIONS
Support: Arc of California
California Association for Health Services
at Home
California Disability Services Organization
California Respite Association
California Supported Living Network
Californians for Disability Rights
Easter Seals
Family Resource Center Network of California
People First of California
United Association of California Care
Providers
Oppose: None received
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