BILL ANALYSIS �
SENATE HUMAN
SERVICES COMMITTEE
Senator Leland Y. Yee, Chair
BILL NO: SB 321
S
AUTHOR: Price
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VERSION: April 2, 2013
HEARING DATE: April 9, 2013
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FISCAL: Yes
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CONSULTANT: Mareva Brown
SUBJECT
Developmental services: regional centers: performance
contracts
SUMMARY
This bill requires the Department of Developmental Services
to establish performance contract guidelines and measures
relating to issues of cultural and linguistic competency.
ABSTRACT
Existing law
1) Establishes the Lanterman Developmental
Disabilities Services Act, which states that
California is responsible for providing an array of
services and supports sufficiently complete to meet
the 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 (WIC 4500, et al)
2) Establishes a system of nonprofit Regional Centers
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to provide fixed points of contact in the community
for all persons with developmental disabilities and
their families, to coordinate services and supports
best suited to them throughout their lifetime. (WIC
4620)
3) Requires each Regional Center to enter into a
five-year contract with DDS with continued funding
contingent upon meeting specified annual performance
objectives. (WIC 4269)
4) Requires DDS to monitor each regional center's
objectives annually, as specified, and to review each
contract to ensure compliance with the provisions, as
specified. (WIC 4269 (e))
This bill
1) Establishes a number of requirements for DDS to
include in contract guidelines and performance
measurements, including:
a) That the development of services and supports
identified as necessary to meet identified needs
include culturally and linguistically appropriate
services and supports.
b) That information is provided in appropriate
languages for consumers and their families.
c) That when regional centers conduct public
meetings, focus groups and surveys to collect
information from the community that they take into
consideration the linguistic and ethnic diversity of
the community.
d) That DDS monitor each regional center's
performance objectives for compliance with the
guidelines and measures established by the
department relating to cultural and linguistic
competency.
1) Requires that when DDS considers identifying in a
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regional center's performance contract areas of
service and support that need development, it includes
consideration of any racial or ethnic disparities in
the distribution of services and supports.
2) Requires DDS to establish performance contract
guidelines and measures relating to issues of cultural
and linguistic competency
3) Requires that for the contract year beginning July
1, 2014, DDS specify in the performance contract any
areas that require improvement by the regional center
to reduce racial and ethnic disparities identified, as
specified.
4) Adds to the activities that DDS must monitor to
determine contract compliance, the requirement of
regional centers to reduce identified racial and
ethnic disparities, as specified.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the bill
This bill is one of a package that resulted from an April
2012 Senate hearing on cultural competency within the
Regional Center system, and a subsequent report
recommending changes.
The author states that health care systems have recently
recognized that attentiveness to cultural competency result
in "significant organizational and consumer benefits," and
that numerous health care providers have undertaken
intensive assessments to ensure that appropriate cultural
and linguistic competence programs are embedded as an
integral component of their health care delivery system.
Citing a national report prepared by the US Department of
Health and Human Services, identifying goals for better
competency among health organizations, the author also
states that California's Developmental Services system
should be included in such conversations.
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While Regional Centers are required to adhere to a series
of performance measures, and the DDS is required to review
whether the regional centers are fulfilling that
requirement, the author states that there is no performance
outcome measurement related to issues of cultural
competency, equity or diversity.
Regional Centers
Regional Centers are part of a system of care overseen by
the Department of Developmental Services (DDS). With a
proposed budget of $4.3 billion for community-based
services in 2013-2014, DDS is responsible for coordinating
care and providing services for more than 250,000 people
with developmental disabilities who receive services and
supports to live in their communities, as well as
approximately 1,560 people who resided in developmental
centers as of March 6, 2013. California's 21 regional
centers are non-profit organizations that provide local
services and supports to individuals through contracts with
DDS.
Historically, the regional centers have been praised for
providing services that are tailored to local needs and
responsive to individuals in communities, and criticized
for their inconsistency across the state. While DDS sets
some common rates, there are variations in services and
historic rate variations across the regional center system.
The regional centers, as nonprofits, also are not subject
to the same degree of public disclosure as state agencies,
and have faced criticism for a lack of transparency in
expenditures and business practices.
Senate Hearing
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). The hearing was prompted by a series of articles in
2011 in the Los Angeles Times, which explored the
differences that families of children with autism had in
accessing services. "Warrior Parents Fare Best in Securing
Autism Services" states that people of color, low income,
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and socio-economically disadvantaged communities receive
fewer services compared to their white counterparts, and
found that DDS spent an average of $11,723 per child on
whites; $11,063 on Asians; $7,634 on Latinos, and $6,593 on
blacks.
A key point of the series was that parents who fought more
for their children gained more services. Often, these
parents are wealthier, more sophisticated in navigating
bureaucratic systems, fluent in English, and able to devote
significant time to providing for their children. In
contrast, the article states, parents who work multiple
jobs, single parents, immigrants, those who can't speak
English, and those who have multiple children don't have
the time and/or ability to fight for the services that
their children are legally entitled to receive.
Non-English speaking families also are less likely to seek
regional center services and tend to be more comfortable
going to health clinics or providers who are culturally and
linguistically sensitive to their own race/ethnicity.
Often times, families of individuals who are eligible for
regional center services are engaged with community-based
organizations, which provide services and support to
communities with cultural and linguistic barriers as well
as socio-economic barriers.
Though all regional centers are supposed to follow the same
criteria, average spending per child varies widely from
place to place and race to race," according to data
obtained by The Times under the California Public Records
Act. The articles also noted that in 2010, the system
served 16,367 autistic children between the ages of 3 and
6, spending an average of $9,751 per case statewide. But
spending ranged from an average of $1,991 per child at the
regional center in South Los Angeles to $18,356 at the one
in Orange County.
An outcome of the select committee's hearing was a
20-member Taskforce on Equity and Diversity for Regional
Center Autism Services, appointed by Senate President pro
Tempore Darrell Steinberg. The group was charged with
finding recommendations to ensure that consumers of
regional center services receive appropriate and timely
supports regardless of race, ethnicity, educational
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background and other socio-economic factors. A 119-page
report, "A Preliminary Report by the Taskforce on Equity
and Diversity for Regional Center Autism Services," was
published on March 18, 2013, and identified 19 recommended
changes to practice within the Developmental Services
system based on the work of five subcommittees.
Among the findings was a recommendation to establish
performance contract outcome measures to provide oversight
on issues of equity and diversity. (P 62)
"DDS is empowered ? to specify in the performance
contract additional areas of service and support that
require development or enhancement by the regional
center. To date there do not appear to be any
performance or outcome measures that relate to issues
of cultural competency, equity or diversity." (P 63).
Access to Health Care Services
The U.S. Department of Health and Human Services Office of
Minority Health has issued 14 standards for health
organizations to ensure Culturally and Linguistically
Appropriate Services. In 2001, the Office of Minority
Health released a report<1> which stands as its document of
record.
The report identified adoption CLAS standards as a way to
correct inequities that currently exist in the provision of
health services and to make these services more responsive
to the individual needs of all patients/consumers.
Standards are intended to be inclusive of all cultures and
not limited to any particular population group or sets of
groups. However, they are especially designed to address
the needs of racial, ethnic, and linguistic population
groups that experience unequal access to health services.
"The CLAS standards serve several purposes. They
provide a common understanding and consistent
definitions of culturally and linguistically
appropriate services in health care. They offer a
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<1>
http://minorityhealth.hhs.gov/assets/pdf/checked/executive.p
df
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practical framework for the implementation of services
and organizational structures that can help health
care organizations and providers be responsive to the
cultural and linguistic issues presented by diverse
populations."<2>
The report identified 14 standards of care for medical
practitioners, organized by themes. It said that additional
cost-benefit work needed to be done to draw a link between
improved cultural competency and better outcomes for
patients and highlighted a number of large health care
organizations, including Kaiser Permanente, that have
addressed diversity issues for several reasons.
Related Legislation
This bill is part of a package of legislation drafted from
recommendations in the Taskforce's report. Other bills in
this 2013 package include:
SB 158 (Correa) Establishes a demonstration program, the
Regional Center Excellence in Community Autism Partnerships
(RE CAP), coordinated by a University of California or
California State University campus which defines
underserved communities in Regional Center catchment areas
and establishes guidelines to improve services, as
specified.
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
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<2> US Department of Health and Human Services, Office of
Minority Health, "National Standards for Culturally and
Linguistically Appropriate Services in Health Care," March
2001, page ix.
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requires regional centers to identify plans to reduce
disparities that are identified.
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.
SB 555 (Correa) would require that communication about
assessment, individual program plans and other critical
documents and processes be done in a consumer or family
member's native language and other culturally and
linguistically competent manners.
AB 1232 (V. Manuel Perez) would require the existing DDS
quality assurance instrument to assess the provision of
services in a linguistically and culturally competent
manner and include an outcome-based measure on issues of
equity and diversity.
POSITIONS
Support: Special Needs Network (sponsor)
National Association of Social Workers
Oppose: None received
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