BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 1232
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          Date of Hearing:   April 16, 2013

                        ASSEMBLY COMMITTEE ON HUMAN SERVICES
                                  Mark Stone, Chair
            AB 1232 (V. Manuel Pérez) - As Introduced:  February 22, 2013
           
          SUBJECT  :  Developmental services:  quality assessment system

           SUMMARY  :  Includes linguistic and cultural competency among the  
          outcomes measured with the State Department of Developmental  
          Services (DDS) quality assurance instrument.  

          Specifically,  this bill  :  

          1)Makes the following legislative findings:

             a)   The Lanterman Developmental Disabilities Services Act  
               requires that regional centers provide services to  
               consumers in a manner that is determined by the individual  
               program plan (IPP) or the individual family service plan  
               (IFSP);

             b)   The Act requires the active participation of the  
               consumer, and his or her family, in the planning and  
               implementation of the IPP and the IFSP;

             c)   The IPP and the IFSP and all regional center services  
               must be provided in a linguistically and culturally  
               competent manner for the consumer;

             d)   Existing law requires DDS to establish a quality  
               assessment system to provide evaluation and oversight for  
               regional center services;

             e)   The department has established a contractual  
               relationship with the National Core Indicators to meet  
               these statutory requirements with an annual expenditure of  
               $3,235,000 for the 2012-13 fiscal year; and

             f)   The current quality assessment system does not require  
               evaluation or oversight on issues of equity and diversity  
               to ensure that regional center services are provided in a  
               linguistically and culturally competent manner.

          1)Changes the scope of the existing quality assurance instrument  








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            identified by DDS, which includes an assessment of the  
            provision of services, to include an assessment of whether  
            services are provided in a linguistically and culturally  
            competent manner.

          2)Requires that the quality assurance instrument include  
            outcome-based measures on issues of equity and diversity to  
            evaluate the linguistic and cultural competency of regional  
            center services provided to consumers across their lifetime.

          3)Requires the independent agency or organization that DDS  
            contracts with to implement the quality assurance assessment  
            to have experience with issues related to linguistic and  
            cultural competency.
           

          EXISTING LAW  
           
           1)Establishes the Lanterman Developmental Disabilities Services  
            Act (Lanterman Act), under which the Department of  
            Developmental Services (DDS) is authorized to contract with  
            private non-profit regional centers to provide case management  
            services and arrange for, or purchase, services that meet the  
            individual needs and choices of each person with developmental  
            disabilities, regardless of age or degree of disability, and  
            at each stage of life and to support their integration into  
            the mainstream life of the community.

          2)Grants all individuals with developmental disabilities, among  
            all other rights and responsibilities established for any  
            individual by the United States Constitution and laws and the  
            California Constitution and laws, the right to services and  
            supports in the least restrictive environment.

          3)Requires the development of an Individual Program Plan (IPP)  
            for each regional center consumer, which specifies services to  
            be provided to the consumer, based on his or her  
            individualized needs determination and preferences, and  
            defines that planning process as the vehicle to ensure that  
            services and supports are customized to meet the needs of  
            consumers who are served by regional centers.

          4)Requires that the planning processes to create an IPP include:

             a)   A statement of the individual's goals and objectives, a  








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               schedule of the type and nature of services to be provided  
               and other information and considerations, as specified;

             b)   Review and modification, as necessary, by the regional  
               center's planning team no less frequently than every three  
               years; and

             c)   Statewide training and review of the IPP plan creation,  
               as specified.

          1)Establishes that an infant or toddler under age 3 who is  
            eligible for regional center services shall have an  
            individualized family service plan (IFSP) to direct services,  
            as specified, and defines the types of services, supports and  
            staffing that should be considered when creating the plan.
           
           2)Requires all regional centers to notify consumers and families  
            of the availability of services in English and such other  
            languages as may be appropriate to the service area, provide  
            outreach services in areas with a high incidence of  
            developmental disabilities, and identify persons who may need  
            services. 

          3)Requires that every state agency which serves a substantial  
            number of non-English-speaking people and which provides  
            materials in English explaining services shall also provide  
            the same type of materials in any non-English language spoken  
            by a substantial number of the public served by the agency, as  
            specified. 

          4) Defines a "substantial number of non-English-speaking people"  
            as members of a group who either do not speak English, or who  
            are unable to effectively communicate in English because it is  
            not their native language, and who comprise 5 percent or more  
            of the people served by any local office or facility of a  
            state agency.

          5)Declares that evaluation of the services consumers receive is  
            a key aspect to the service system.

          6)Requires DDS in consultation with stakeholders, to identify a  
            valid and reliable quality assurance instrument that measures  
            consumer and family satisfaction, provision of services and  
            personal outcomes, as specified.









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          7)Allows the quality assurance instrument to be expanded to  
            collect additional data requested by the State Council on  
            Developmental Disabilities, to the extent funding is  
            available.

          8)Requires DDS, as of January 1, 2010, to contract with an  
            independent agency or organization to implement an improved,  
            unified quality assessment system and establishes criteria for  
            the contract agency or organization's required experience.

          9)Requires DDS to do the following with respect to the quality  
            assurance instrument:

             a)   Establish the methodology used to administer the quality  
               assurance instrument;

             b)   Contract with the State Council on Developmental  
               Disabilities to collect data for the quality assurance  
               instrument; and

             c)   In consultation with stakeholders, undergo an annual  
               review of the quality assurance instrument data and  
               findings and accept recommendations regarding additional or  
               different criteria for the instrument to improve assessment  
               and services.

          1)Requires reports related to the data and findings of the  
            quality assurance instrument to be publicly available and  
            subjects implementation of the instrument and process to an  
            annual budget appropriation.

           FISCAL EFFECT  :  Unknown.

           Background
           The Lanterman Developmental Disabilities Services Act (Welfare &  
          Institutions Code § 4500 et seq.) guides the provision of  
          services and supports for Californians with developmental  
          disabilities.  Each individual under the Act, typically referred  
          to as a "consumer," is legally entitled to treatment and  
          habilitation services and supports in the least restrictive  
          environment.  Lanterman Act services are designed to enable all  
          consumers to live more independent and productive lives in the  
          community. 

          Direct responsibility for implementation of the Lanterman Act  








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          service system is shared by the Department of Developmental  
          Services (DDS) and 21 regional centers, which are private  
          nonprofit entities, established pursuant to the Lanterman Act,  
          that contract with DDS to carry out many of the state's  
          responsibilities under the Act.  The principal roles of regional  
          centers include intake and assessment, individualized program  
          plan development, case management, and securing services through  
          generic agencies or purchasing services provided by vendors.   
          Regional centers also share primary responsibility with local  
          education agencies for provision of early intervention services  
          under the California Early Intervention Services Act (e.g.,  
          Early Start Program).  The regional center caseload includes  
          over 250,000 consumers who receive services such as residential  
          placements, supported living services, respite care,  
          transportation, day treatment programs, work support programs,  
          and various social and therapeutic programs.  Approximately  
          1,600 consumers reside at one of California's four Developmental  
          Centers-and one state-operated, specialized community  
          facility-that provide 24-hour habilitation and medical and  
          social treatment services.  According to March DDS data that  
          shows the ethnic breakdown of consumers served by regional  
          centers, 34.87% are identified as Hispanic and 37.40% as White,  
          whereas 10% are identified as Black/African-American and 6.36%  
          are identified as Asian.

          Services provided to people with developmental disabilities are  
          determined through an individual planning process.  Under this  
          process, planning teams-which include, among others, the  
          consumer, his or her legally authorized representative, and one  
          or more regional center representatives-jointly prepare an  
          Individual Program Plan (IPP) based on the consumer's needs and  
          choices.  The Lanterman Act requires that the IPP promote  
          community integration and maximize opportunities for each  
          consumer to develop relationships, be part of community life,  
          increase control over his or her life, and acquire increasingly  
          positive roles in the community.  The IPP must give the highest  
          preference to those services and supports that allow minors to  
          live with their families and adults to live as independently as  
          possible in the community. 

           Quality Assessment Services project
           ABX4 9 (Evans) Chapter 9, Statutes of 2009, was a Budget Act DDS  
          trailer bill and the vehicle that was used to consolidate two  
          data collection efforts.  The Evaluation of People with  
          Developmental Disabilities Moving from Developmental Centers  








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          into the Community, and the Life Quality Assessments were  
          consolidated into the Quality Assessment Services project, for  
          which DDS uses a nationally validated instrument that allows for  
          the collection of statewide and regional center data needed to  
          assess consumer satisfaction and success.  DDS established  
          membership with the National Core Indicators (NCI) program, of  
          which 33 other states' developmental services systems are  
          members.  Using the NCI survey instruments, DDS collects data on  
          consumer satisfaction, provision of services, and personal  
          outcomes, which provide the Department with the information it  
          needs to evaluate the quality of the DDS service delivery  
          system.  The State Council on Developmental Disabilities (SCDD)  
          uses the NCI instrument to collect the data for this project,  
          similar to SCDD's involvement in collecting data for the Life  
          Quality Assessments that were conducted prior to development of  
          the new quality assessment system.  The data that the SCDD  
          gathers, including information about consumers' employment  
          status, perceptions of their own safety, and interactions with  
          their regional centers, for example, give the state the  
          opportunity learn a great deal about the quality of services and  
          the impacts they have on consumers' quality of life within the  
          DDS system.

           COMMENTS  :   

          The Senate Select Committee on Autism and Related Disorders held  
          an informational hearing on April 30, 2012, to discuss questions  
          surrounding equal access to regional center services for  
          consumers with autism spectrum disorders (ASD).  An outcome  
          hearing was creation of a 20-member Taskforce on Equity and  
          Diversity for Regional Center Autism Services, which was charged  
          with developing recommendations to ensure that consumers of  
          regional center services receive appropriate and timely supports  
          regardless of race, ethnicity, educational background and other  
          socio-economic factors.  The report, "A Preliminary Report by  
          the Taskforce on Equity and Diversity for Regional Center Autism  
          Services," was published on March 18, 2013, and identified a  
          number of recommendations for changes to current practice within  
          the Developmental Services system based on the work of five  
          subcommittees.  Among them were recommendations to include  
          issues of equity and diversity within the quality assurance  
          instrument, in addition to using the instrument to measure  
          consumers across their lifetime, not just as adults. (P.53)   
          Both of these recommendations are reflected in this legislation.  









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          According to the author, this bill "simply stipulates that  
          future contracts by DDS for the quality assessment of regional  
          center services, already mandated by current law, must also  
          include outcome measures related to cultural and linguistic  
          competency."  Current statute regarding the quality assessments  
          system allows the State Council on Developmental Disabilities to  
          expand the quality assessment instrument to collect additional  
          data.  While the author's attempt to require cultural and  
          linguistic competency to be measured with respect to regional  
          center service delivery is not an effort put forth by the SCDD  
          under their statutory authority, SCDD supports the bill's goals.

           RELATED LEGISLATION

           SB 208 (Lara) requires that a request for proposal prepared by  
          DDS or a regional center that relates to consumer services and  
          supports include a section on equity and diversity. 

          SB 319 (Price) Requires DDS to ensure that the regional centers  
          collect, analyze, and report data in a way that allows for  
          comparisons across regional centers, and requires regional  
          centers to identify plans to reduce disparities that are  
          identified. 

          SB 321 (Price) would require DDS to establish performance  
          contract guidelines and measures relating to issues of cultural  
          and linguistic competency. 

          SB 367 (Block) would require Regional Centers to develop a  
          Regional Center Study and Planning Process for Equity and  
          Cultural and Linguistic Competency (RESPECT) to oversee issues  
          related to regional center staff and vendor cultural and  
          linguistic competency. 
           
          PRIOR LEGISLATION
           
          ABX4 9 (Evans) Chapter 9, Statutes of 2009 added Section 4571 to  
          the Welfare and Institutions Code, which directed the Department  
          of Development Services (DDS) to "implement an improved,  
          unified, quality assessment system."  
           
           REGISTERED SUPPORT / OPPOSITION  :   

           Support 








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          Fiesta Educativa, Inc.

           Opposition 
           
          None on file
           
          Analysis Prepared by  :    Myesha Jackson / HUM. S. / (916)  
          319-2089