Amended in Senate April 15, 2013

Senate Bill No. 468

Introduced by Senators Emmerson and Beall

(Coauthor: Assembly Member Blumenfield)

February 21, 2013

An act to add Section 4685.8 to the Welfare and Institutions Code, relating to developmental services.

LEGISLATIVE COUNSEL’S DIGEST

SB 468, as amended, Emmerson. Developmental services: statewide begin delete self-determination project. end delete begin insert Self-Determination Program. end insert

Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services contracts with regional centers to provide support and services to individuals with developmental disabilities. Under existing law, the regional centers purchase needed services and supports for individuals with developmental disabilities through approved service providers, or arrange for their provision through other publicly funded agencies. 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. Existing law establishes, contingent upon approval of a federal waiver, the Self-Directed Services Program, and requires the program to be available in every regional center catchment area to provide participants, within an individual budget, greater control over needed services and supports.

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This bill would require the department, contingent upon approval of federal funding, to establish and implement a state Self-Determination Program, as defined, that would be available in every regional center catchment area to provide participants and their families, within an individual budget, increased flexibility and choice, and greater control over decisions, resources, and needed and desired services and supports to implement their IPP, in accordance with prescribed requirements. The statewide program would be phased in over 3 years, initially serving up to 2,500 regional center consumers, and thereafter would be available on a voluntary basis to all regional center consumers. The bill would require the department to, among other things, apply for federal funding for the program by March 1, 2014.

end insert begin insert

Under the bill, program participants would receive an individual budget, as prescribed, to be used for the purchase of services and supports necessary to implement the participant’s IPP. The bill would require program participants to agree to, among other things, manage self-determination services within the individual budget amount. Under the bill, the individual budget amount would be available to the participant each year for the purchase of services and supports under the program until a new individual budget has been determined. The bill would, among other things, require each regional center to be responsible for implementing the program as a term of its contract, and to establish a local advisory committee to provide oversight of the project. The bill would require the State Council on Developmental Disabilities to issue to the Legislature a report regarding the status of the program and recommendations to the program, as specified, and would require the department, beginning January 10, 2016, to provide to the appropriate policy and fiscal committees of the Legislature prescribed information relating to the program.

end insert begin delete

This bill would require the department to implement a statewide self-determination project under which funds from regional center budgets are allocated for local self-determination projects that will enhance the ability of a consumer and his or her family to control the decisions and resources required to meet the objectives in his or her individual program plan. The statewide project would be phased in over 3 years, and serve up to 2500 regional center consumers. The bill would require the department to ensure, among other things, that self-determination is available as a choice and participants in the project reflect the disability, ethnic, and geographic diversity of the state. The bill would require self-determination projects to include, among other things, increased consumer and family control over which services best meet their needs and the IPP objectives and comprehensive person-centered planning. This bill would require a self-determination project to establish a local advisory committee, as prescribed, to provide oversight of the project and to submit, by September 1, 2016, specified recommendations to the department regarding the effectiveness of the project.

end delete begin delete

This bill would require the department to report to the Legislature, as provided, by January 1, 2017, regarding the status of each project established under the bill, and would render this reporting requirement inoperative on January 1, 2021.

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Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

The Legislature finds and declares all of the
following:

(a) In 1998, the Legislature expanded the Lanterman
Developmental Disabilities Services Act to include a
self-determination pilot program. That pilot program was continued
by the Legislature in 2002 and 2003. However, the pilot program
was only available at five regional centers and the number of
individuals served by the self-determination pilot program remains
small, about 200 regional center consumers.

(b) As reflected in the State Department of Developmental
Services 2002 Report to the Legislature, the pilot program remains
an innovative, cost effective and successful way of providing
services to regional center consumers and their families. The
findings in the report show that self-determination pilot program
participants were happy and experienced more freedom and
responsibility in controlling the direction of their services and life
choices, and the program was cost neutral in the aggregate. The
report also found that good self-determination requires intensive
person-centered planning, collaboration, and follow-along services
and supports.

(c) Most other states have self-directed begin insert or self-determination end insert
services as a model for providing services. Many California
consumers and families have asked for a statewide expansion of
the pilot program believing it will do the following: increase
innovative and effective services, eliminate bureaucracy, and
increase choices for consumers and parents, thereby allowing them
to increase their control of services and supports by easily
navigating increasingly complex service systems.

(d) The intent of this act is to allow for voluntary participation
in the begin delete self-determination projects end delete begin insert Self-Determination Program end insert
while ensuring that the begin delete project end delete begin insert program end insert is available to all
consumers regardless of geographic location, economic or
educational background, or race or ethnicity, and ensuring a
consistent statewide method of administration and comparable
services. To ensure these outcomes are achieved, it is the intent of
the Legislature that the State Department of Developmental
Services and local advisory boards be responsible for oversight
and monitoring of funds used for begin delete self-determination projects end delete begin insert the
Self-Determination Program end insert and the achievement of consumer
outcomes.

(e) In addition, the intent of this act is that the begin delete self-determination
project end delete begin insert Self-Determination Program end insert be phased in over a three-year
period and that the begin delete project end delete begin insert program end insert will continue to be available
to all consumers as an option after the initial phase-in period ends.

SEC. 2.  

Section 4685.8 is added to the Welfare and Institutions
Code, to read:

4685.8.  

(a)  begin delete Notwithstanding any other provision of law, the end delete
begin insert The end insert department shall implement a statewide begin delete self-determination
project under which funds from regional center budgets shall be
allocated for local self-determination projects that will enhance
the ability of a consumer and his or her family to control the
decisions and resources required to meet the objectives in his or
her individual program plan. end delete begin insert Self-Determination Program. The
Self-Determination Program shall be available in every regional
center catchment area to provide participants and their families,
within an individual budget, increased flexibility and choice, and
greater control over decisions, resources, and needed and desired
services and supports to implement their IPP. end insert The statewide begin delete project end delete
begin insert Self-Determination Program end insert shall be phased in over three years,
begin delete and serve end delete begin insert initially serving end insert up to begin delete 2500 end delete begin insert 2,500 end insert regional center
begin delete consumers. end delete begin insert consumers, and thereafter shall be available on a
voluntary basis to all regional center consumers. end insert

(b) The department in establishing the statewide begin delete project end delete begin insert program end insert
shall ensure the following:

(1) That self-determination is available as a choice for up to
2500 regional center consumers.

begin delete

(2) That participants

end delete

begin insert (1) end insert begin insert   end insert begin insert Participants end insert in the begin delete project end delete begin insert program end insert reflect the disability,
ethnic, and geographic diversity of the state.

begin delete

(3) That the project

end delete

begin insert (2) end insert begin insert   end insert begin insert The program end insert is cost neutral in the aggregate.

begin delete

(4)

end delete

begin insert (3) end insert  A statewide method of administration and determining
comparable services.

begin delete

(5)

end delete

begin insert (4) end insert  Oversight of expenditure of begin delete self-directed end delete begin insert self-determined end insert
funds and the achievement of consumer outcomes over time.

begin delete

(c) Self-determination projects funded shall include, but not be
limited to, all of the following:

end delete begin delete

(1)

end delete

begin insert (5) end insert  Increased consumer and family control over which services
best meet their needs and the begin delete individual program plan end delete begin insert IPP end insert
objectives.

begin delete

(2)

end delete

begin insert (6) end insert  Comprehensive person-centered planning, including an
individual budget and services that are outcome based.

begin delete

(3)

end delete

begin insert (7) end insert  Consumer and family training to ensure understanding of
the planning process and management of budgets, services, and
staff.

begin delete

(4)

end delete

begin insert (8) end insert  Choice of independent facilitators who can assist with the
person-centered planning process and begin delete fiscal intermediaries end delete begin insert financial
management service end insert begin insert s providers end insert who can assist with payments and
provide employee-related services.

begin delete

(5)

end delete

begin insert (9) end insert  Innovation that will more effectively allow consumers to
achieve their goals.

begin delete

(6) Programs that provide for the utilization of parent vendors,
direct pay options, individual budgets for the procurement of
services and supports, alternative case management, and vouchers.

end delete begin insert

(c) For purposes of this section, the following definitions shall
apply:

end insert begin insert

(1) “Financial management services” means services or
functions that assists the participant to manage and direct the
distribution of funds contained in the individual budget. These
may include, but are not limited to, bill paying services and
activities that facilitate the employment of service and support
workers by the participant, including, but not limited to, fiscal
accounting, tax withholding, and expenditure reports. The
department shall establish specific qualifications that shall be
required of a financial management services provider.

end insert begin insert

(2) “Independent facilitator” means a person, selected and
directed by the participant, who may assist the participant in
making informed decisions about the individual budget, and in
locating, accessing, and coordinating services consistent with the
participant’s IPP. He or she is available to assist in identifying
immediate and long-term needs, developing options to meet those
needs, leading or participating in the person-centered planning
process and development of the IPP, and obtaining identified
services and supports.

end insert begin insert

(3) “Individual budget” means the amount of funding available
to the participant for the purchase of services and supports
necessary to implement the IPP. The individual budget shall be
constructed using a fair, equitable, and transparent methodology.

end insert begin insert

(4) “IPP” means individual program plan.

end insert begin insert

(5) “Participant” means an individual, and when appropriate,
his or her parents, legal guardian or conservator, or authorized
representative, who has been deemed eligible for, and has
voluntarily agreed to participate in, the Self-Determination
Program.

end insert begin insert

(6) “Self-determination” means a voluntary delivery system
consisting of a defined and comprehensive mix of services and
supports, selected and directed by a participant through
person-centered planning, in order to meet all or some of the
objectives in his or her IPP. Self-determination services and
supports are designed to assist the participant to achieve
personally defined outcomes in community settings that promote
inclusion. The Self-Determination Program shall only fund services
and supports that are approved by the federal Center for Medicare
and Medicaid Services.

end insert begin insert

(d) Participation in the Self-Determination Program is fully
voluntary. A consumer may choose to participate in, and may
choose to leave, the Self-Determination Program at any time. A
regional center may not require or prohibit participation in the
Self-Determination Program as a condition of eligibility for, or
the delivery of, services and supports otherwise available under
this division. Participation in the Self-Determination Program
shall be available to any regional center consumer who meets the
following eligibility requirements:

end insert begin insert

(1) The participant is three years of age or older.

end insert begin insert

(2) The participant has a developmental disability, as defined
in Section 4512.

end insert begin insert

(3) The participant does not live in a licensed long-term health
care facility, as defined in paragraph (44) of subdivision (a) of
Section 54302 of Title 17 of the California Code of Regulations.
An individual, and when appropriate his or her parent, legal
guardian or conservator, or authorized representative, who is not
eligible to participate in the Self-Determination Program pursuant
to this paragraph may request that the regional center provide
person-centered planning services in order to make arrangements
for transition to the Self-Determination Program. In that case, the
regional center shall initiate person-centered planning services
within 60 days of that request.

end insert begin insert

(4) The participant agrees to all of the following terms and
conditions:

end insert begin insert

(A) The participant shall receive an orientation to the
Self-Determination Program prior to enrollment.

end insert begin insert

(B) The participant shall agree to utilize the services and
supports available within the Self-Determination Program only
when generic services and supports cannot be accessed.

end insert begin insert

(C) The participant shall only use services and supports
necessary to implement his or her IPP and shall agree to comply
with any and all other terms and conditions for participation in
the Self-Determination Program described in this section.

end insert begin insert

(D) The participant shall manage Self-Determination Program
services and supports within the individual budget amount.

end insert begin insert

(E) The participant shall utilize the services of the
conflict-of-interest-free financial management services provider
of his or her own choosing.

end insert begin insert

(F) The participant may utilize the services of a
conflict-of-interest-free independent facilitator of his or her own
choosing for the purpose of providing services and functions as
described in paragraph (2) of subdivision (c). The financial
management services provider shall determine that the independent
facilitator is adequately trained and otherwise qualified.

end insert begin insert

(e) A participant who is not Medi-Cal eligible may participate
in the Self-Determination Program and receive self-determination
services and supports if all other program eligibility requirements
are met.

end insert begin insert

(f) An individual receiving services and supports under the
self-determination projects authorized pursuant to Section 13 of
Chapter 80 of the Statutes of 1998, as amended, may elect to
continue to receive self-determination services and supports
pursuant to this section. An individual who participates in the
Self-Determination Program may elect to continue to receive
self-determination services and supports if he or she transfers to
another regional center catchment area.

end insert begin insert

(g) If at any time during participation in the Self-Determination
Program a regional center determines that a participant is no
longer eligible to continue in, or a participant voluntarily chooses
to exit, the Self-Determination Program, the regional center shall
provide for the participant’s transition from the Self-Determination
Program to other services and supports. This transition shall
include the development of a new IPP that reflects the services
and supports necessary to meet the individual’s needs. The regional
center shall ensure that there is no gap in services and supports
during the transition period.

end insert begin insert

(h) An individual determined to be ineligible for or who
voluntarily exits the Self-Determination Program shall be permitted
to return to the Self-Determination Program upon meeting all
applicable eligibility criteria and upon approval of the
participant’s IPP team, as described in subdivision (j) of Section
4512.

end insert begin insert

(i) The IPP team shall utilize the person-centered planning
process to develop the IPP for a participant. The IPP shall detail
the goals and objectives of the participant that are to be met
through the purchase of participant-selected services and supports.
The IPP team shall determine the individual budget to ensure the
budget assists the participant to achieve the outcomes set forth in
his or her IPP and ensures his or her health and safety. The
completed individual budget shall be attached to the IPP.

end insert begin insert

(j) The participant shall implement his or her IPP, including
choosing the services and supports allowable under this section
necessary to implement the plan. A participant is exempt from
Section 4783, the Family Cost Participation Program, and cost
control restrictions, including, but not limited to, purchases of
services and supports pursuant to Sections 4648.35, 4648.5, and
4659, subparagraph (B) of paragraph (3) of subdivision (c) of
Section 4685, Sections 4648.55, 4686.2, 4686.5, and 4689, and
purchase of services best practices enacted pursuant to Section
4620.3. A regional center shall not prohibit the purchase of any
service or support that is otherwise allowable under this section.

end insert begin insert

(k) A participant shall have all the rights established in Chapter
7 (commencing with Section 4700).

end insert begin insert

(l) The department, in consultation with stakeholders, shall
develop a methodology for individual budgets that ensures the
budgets are computed in a fair, transparent, and equitable manner
and are based on consumer characteristics and needs, and a
method for adjusting individual budgets to address a participant’s
unanticipated needs. In developing this methodology, the
department shall ensure that budgets of all participants are cost
neutral in the aggregate.

end insert begin insert

(m) The IPP team, using the methodology developed in
subdivision (l), shall determine the individual budget for the
participant. That individual budget amount shall be available to
the participant each year for the purchase of program services
and supports until a new individual budget has been determined.
An individual budget shall be calculated no more than once in a
12-month period, unless revised to reflect the unanticipated needs
of the participant. The individual budget shall be distributed among
uniform budget categories developed by the department in
consultation with stakeholders.

end insert begin insert

(n) Annually, participants may transfer up to 20 percent of the
funds originally distributed to any budget category set forth in
subdivision (m), to another budget category or categories.
Transfers in excess of 20 percent of the original amount allocated
to any budget category may be made upon the approval of the
regional center or the participant’s IPP team. Regional centers
or the IPP team may only deny a transfer if necessary to protect
the health and safety of the participant.

end insert begin insert

(o) Consistent with the implementation date of the IPP, the IPP
team shall annually ascertain from the participant whether there
are any circumstances that require a change to the annual
individual budget. Based on that review, the IPP team shall
calculate a new individual budget consistent with the methodology
identified in subdivision (l).

end insert begin insert

(p) On or before March 1, 2014, the department shall apply for
federal Medicaid funding for the Self-Determination Program by
applying for a state plan amendment, an amendment to a current
home- and community-based waiver for individuals with
developmental disabilities, for a new waiver, or by seeking to
maximize federal financial participation through other means.
Contingent upon approval of federal funding, the
Self-Determination Program shall be established. The department
shall adopt regulations to implement the procedures set forth in
this section.

end insert begin insert

(q) The department, in consultation with stakeholders, shall
develop informational materials about the Self-Determination
Program. The department shall ensure that regional centers are
trained in the principles of self-determination, the mechanics of
the Self-Determination Program, and the rights of consumers and
families as candidates for, and participants in, the
Self-Determination Program.

end insert begin insert

(r) Each regional center shall be responsible for implementing
the Self-Determination Program as a term of its contract under
Section 4629. As part of implementing the program, the regional
center shall do all of the following:

end insert begin insert

(1) Contract with local or family-run consumer organizations
to conduct outreach and training through local meetings or forums
to provide regional center consumers and their families with
information about the Self-Determination Program and to help
ensure that the program is available to a diverse group of
participants, with special outreach to underserved communities.

end insert begin insert

(2) Advance funds to a financial management services provider
to facilitate participation in the Self-Determination Program, as
determined necessary by a participant’s IPP team.

end insert begin insert

(s) The financial management services provider shall provide
the participant, or his or her authorized representative, and the
regional center service coordinator with a monthly individual
budget statement that describes the amount of funds allocated by
budget category, the amount spent in the previous 30-day period,
and the amount of funding that remains available under the
participant’s individual budget.

end insert begin insert

(t) Only the financial management services provider is required
to apply for vendorization in accordance with Subchapter 2
(commencing with Section 54300) of Chapter 3 of Title 17 of the
California Code of Regulations, for the Self-Determination
Program. All other service providers shall have applicable state
licenses, certifications, or other state required documentation, but
are exempt from the vendorization requirements set forth in Title
17 of the California Code of Regulations. The financial
management services provider shall ensure and document that all
service providers meet specified requirements for any service that
may be delivered to the participant.

end insert begin insert

(u) A participant may request, at no charge to the participant
or the regional center, criminal history background checks for
persons seeking employment as a provider of services and supports
and providing direct care services and supports to the participant.

end insert begin insert

(1) Criminal history record checks pursuant to this subdivision
shall be performed and administered as described in subdivision
(b) and subdivisions (d) to (h), inclusive, of Section 4689.2, and
Sections 4689.4 to 4689.6, inclusive, and shall apply to
vendorization of providers and hiring of employees to provide
services and supports for family home agencies and family homes.

end insert begin insert

(2) The department may enter into a written agreement with the
Department of Justice to implement this subdivision.

end insert begin delete

(d)

end delete

begin insert (v) end insert  Each begin delete self-determination project end delete begin insert regional center end insert shall
establish a local advisory committee to provide oversight of the
begin delete self-determination project. end delete begin insert Self-Determination Program. end insert The
regional center, area board, and the Office of Clients’ Rights
Advocacy of Disability Rights California shall each appoint
one-third of the membership of the committee, which shall consist
of consumers, family members, clients’ rights advocates and other
advocates, and community leaders. begin insert A majority of the committee
shall be consumers and their family members. end insert The committee shall
reflect the multicultural diversity and geographic profile of the
catchment area. The committee shall review the development and
ongoing progress of the begin delete self-determination project end delete
begin insert Self-Determination Program end insert , including whether the begin delete project end delete
begin insert program end insert is operating consistent with the requirements of
begin delete subdivisions (a) and (b) end delete begin insert this section end insert , and may make ongoing
recommendations for improvement to the regional center and the
department. begin delete By September 1, 2016, the local advisory committee
shall submit to the department recommendations regarding the
effectiveness of the project and the continuation and expansion of
self-determined services. end delete

begin insert

(w) Commencing January 10, 2016, the department shall
annually provide the following information to the appropriate
policy and fiscal committees of the Legislature:

end insert begin insert

(1) Number and characteristics of participants, by regional
center.

end insert begin insert

(2) Types and ranking of services and supports purchased under
the Self-Determination Program, by regional center.

end insert begin insert

(3) Range and average of individual budgets, by regional center,
including adjustments to the budget to address unanticipated need.

end insert begin insert

(4) Information regarding participant satisfaction under the
Self-Determination Program and, when data is available, the
traditional service delivery system, by regional center.

end insert begin insert

(5) The proportion of participants who report that their choices
and decisions are respected and supported.

end insert begin insert

(6) The proportion of participants who report that they are able
to recruit and hire qualified service providers.

end insert begin insert

(7) The number and outcome of individual budget appeals, by
regional center.

end insert begin insert

(8) The number and outcome of fair hearing appeals, by regional
center.

end insert begin insert

(9) The number of participants who voluntarily withdraw from
the Self-Determination Program and a summary of the reasons
why, by regional center.

end insert begin insert

(10) The number of participants who are subsequently
determined to no longer be eligible for the Self-Determination
Program and a summary of the reasons why, by regional center.

end insert begin insert

(11) Identification of barriers to participation and
recommendations for program improvements.

end insert begin insert

(12) A comparison of average annual expenditures for
individuals with similar characteristics not participating in the
Self-Determination Program.

end insert begin delete

(e)

end delete

begin insert (x) end insert  The begin delete department end delete begin insert State Council on Developmental Disabilities,
in collaboration with the protection and advocacy agency identified
in Section 4900 and the federally funded University Centers for
Excellence in Developmental Disabilities Education, Research,
and Service, end insert shall issue a report to the Legislature no later than
begin delete January 1, 2017, end delete begin insert three years following the approval of the federal
funding end insert on the status of begin delete each self-determination project end delete begin insert the
Self-Determination Program end insert authorized by this section, and provide
recommendations begin delete with respect to continuation and expansion. end delete begin insert to
enhance the effectiveness of the program. end insert

begin delete

(f) (1) The requirement for submitting a report imposed under
subdivision (e) is inoperative on January 1, 2021, pursuant to
Section 10231.5 of the Government Code.

(2) A report to be submitted pursuant to subdivision (e) shall
be submitted in compliance with Section 9797 of the Government
Code.

end delete