BILL ANALYSIS Ó
-----------------------------------------------------------------
|SENATE RULES COMMITTEE | SB 468|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
-----------------------------------------------------------------
THIRD READING
Bill No: SB 468
Author: Emmerson (R)
Amended: 5/28/13
Vote: 21
SENATE HUMAN SERVICES COMMITTEE : 6-0, 4/23/13
AYES: Yee, Berryhill, Emmerson, Evans, Liu, Wright
SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/23/13
AYES: De León, Walters, Gaines, Hill, Lara, Padilla, Steinberg
SUBJECT : Developmental services: statewide
Self-Determination Program
SOURCE : Autism Society of Los Angeles
Disability Rights California
The Arc and United Cerebral Palsy California
Collaboration
DIGEST : This bill requires the Department of Developmental
Disabilities (DDS) to establish a Self-Determination Program,
which allows regional center consumers to use an individual
budget to purchase services and supports at the consumer's
direction.
ANALYSIS :
Existing law:
1.Establishes the Lanterman Developmental Disabilities Services
CONTINUED
SB 468
Page
2
Act, which declares California's responsibility for providing
an array of services and supports to meet the needs of each
person with developmental disabilities in the least
restrictive environment, regardless of age or degree of
disability, and to support their integration into the
mainstream life of the community.
2.Establishes a system of nonprofit regional centers 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.
3.Establishes an Individual Program Plan (IPP) 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.Establishes, contingent upon approval of a federal waiver, the
Self-Directed Services Program (SDS Program) statewide to
provide participants, within an individual budget, greater
control over needed services and supports.
5.Defines the duties of a financial services manager, and other
support personnel; provides a definition of the types of
services available through an individual budget; identifies
the purpose and formula for funding a risk pool to cover
unanticipated expenses, and other elements of the program, as
specified.
6.Establishes that a consumer may choose between one of two
individual budget amounts and requires that methodologies for
determining those two budgets amounts be detailed in
departmental regulations, as specified.
7.Defines the categories of services that an individual may fund
through the individual budget to include community living,
health and clinical services, employment, training and
education, environmental and medical supports and
transportation.
8.Provides that an individual who is determined to be
ineligible, or who voluntarily exits the SDS Program, shall be
permitted to return to the SDS Program upon meeting all
applicable eligibility criteria and after a minimum of 12
CONTINUED
SB 468
Page
3
months' time has elapsed.
9.Creates other requirements and guidelines, as specified, for
the program.
This bill:
1.Makes a series of legislative findings and declarations about
the efficacy of and need for self-determination services and
the intent that the program will continue after the initial
three-year phase-in of the program.
2.Requires DDS to implement a statewide Self-Determination
Program to provide participants and their families with an
individualized budget that provides increased flexibility and
choice, greater control over decisions, resources and desired
services, as specified.
3.Requires that the program be phased-in over three years,
initially serving up to 2,500 regional center consumers and
thereafter to be available on a voluntary basis to all
regional center consumers.
4.Requires DDS to ensure the following:
A. Participants reflect the diversity of disability,
ethnicity and geography of the state.
B. The program is cost-neutral in the aggregate.
C. A statewide method of administration and of determining
comparable services.
D. Oversight of the self-determined funds and achievement
of consumer outcomes over time.
E. Increased consumer and family control over which
services best meet their needs and the IPP objectives.
F. Comprehensive person-centered planning, including an
individual budget and services that are outcome-based.
G. Consumer and family training to ensure understanding of
the planning process and management of budgets, services
CONTINUED
SB 468
Page
4
and staff.
H. A choice of independent facilitators who can assist with
the person-centered planning process and financial
management services providers who can assist with payments
and provide employee-related services.
I. Innovation that will more effectively allow consumers to
achieve their goals.
1.Defines terms related to Self-Determination Services.
2.Establishes that the Self-Determination Program shall only
fund services and supports that are approved by the federal
Center for Medicare and Medicaid Services.
3.Requires that participation in the Self-Determination Program
be fully voluntary and be available to any eligible regional
center consumer.
4.Defines eligibility criteria for the program.
5.Requires a participant to agree to specified terms and
conditions.
6. Requires that 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.
7. Requires that individuals who are participating in the 1998
self-directed pilot project be included in the new
Self-Determination Program, and that a consumer who elects to
participate in the Self-Determination Program may transfer to
another regional center without losing the right to
participate in the program.
8. Requires that when a participant exits the program, either
voluntarily or because a regional center determines that a
participant is no longer eligible to continue, the regional
center shall provide for the participant's transition from
the Self-Determination Program to other services and
supports, including developing a new IPP.
CONTINUED
SB 468
Page
5
9. Requires that if a participant exits the program, the
regional center ensures that there is no gap in services and
supports during the transition period.
10.Requires that a participant who exits the program for any
reason be permitted to return upon meeting eligibility
criteria and approval of the IPP team, as specified.
11.Requires that a consumer's IPP team detail the goals and
objectives that are to be met through participant-selected
services and design the individual budget to ensure it helps
participants achieve the outcomes set forth the IPP, as
specified. The completed individual budget shall be attached
to the IPP.
12.Requires that the participant shall implement his/her IPP,
including choosing the services and supports, as specified.
13.Requires DDS to apply on or before December 31, 2014, 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.
14.Provides that the establishment of the Self-Determination
Program shall be contingent upon federal funding.
15.Requires DDS, in consultation with stakeholders, to develop
informational materials about the Self-Determination Program,
as specified.
16.Requires the financial management services provider to give
the participant and regional center, as specified, with a
monthly individual budget statement describing the funds
allocated by budget category, the amount spent in the
previous 30-day period, and the amount of funding that
remains available.
17.Requires that only the financial management services
provider must apply for vendorization, as specified. All
other service providers shall have applicable state licenses,
certifications, or other state required documentation, but
are exempt from the vendorization requirements.
CONTINUED
SB 468
Page
6
18.Requires the financial management services provider to
ensure and document that all service providers meet specified
requirements for any service that may be delivered to the
participant.
19.Requires that if a participant chooses to request a 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 that the check be
provided cost-free and according to existing law, as
specified.
20.Requires each regional center to establish a local advisory
committee to provide oversight of the Self-Determination
Program, as specified.
21.Requires DDS to annually provide data to the Legislature
beginning January 10, 2016, as specified.
22.Requires the State Council on Developmental Disabilities, in
collaboration with others, as specified, to issue a report to
the Legislature no later than three years following the
approval of the federal funding on the status of the
Self-Determination Program, and provide recommendations to
enhance the effectiveness of the program.
Background
Regional Center system. California's 21 nonprofit regional
centers are part of a system of care for individuals with
developmental disabilities overseen by DDS. DDS is responsible
for coordinating care and providing services for more than
250,000 people who receive services and supports to live in
their communities.
Regional centers provide diagnosis and assessment of eligibility
and help plan, access, coordinate and monitor the services and
supports that are needed because of an individual's
developmental disability. Services for consumers are determined
through an IPP.
Self-Determination . The concept of facilitating a way for
individuals with developmental disabilities to choose their own
CONTINUED
SB 468
Page
7
services and supports, rather than be prescribed a list of
customized services began in the mid-1990s. According to a 2007
Robert Wood Johnson Foundation report, the growing move toward
de-institutionalization and the home and community based waivers
associated with that move allowed states to serve more people.
However, most states did not have the resources to meet the
long-term care needs of everyone who sought help.
Self-determination in California . In 1998 the Legislature
passed a Self-Determination Pilot Project that was conducted in
five regional centers and included about 200 participants. A
subsequent report to the Legislature showed that the
participants were happy and had experienced more freedom and
responsibility in controlling the direction of their services
and their life choices. The report also indicated that good
self-determination practices required intensive person-centered
planning, collaboration, and follow-along support.
Prior Legislation
AB 1244 (Chesbro, 2011), would have created a self-determination
program to provide individuals with a single, capitated funding
allocation to purchase services that support goals identified in
the IPP. This bill would have replaced the existing statutory
language creating a statewide self-directed services program,
which required a federal waiver for implementation. This bill
died in the Senate Human Services Committee.
AB 131 (Omnibus health trailer bill, Chapter 80, Statutes of
2005), creates a statewide self-directed services project
contingent upon approval of a waiver for federal funding by the
Centers for Medicaid and Medicare Services. The waiver
application remains pending.
SB 1038 (Thompson, Chapter 1043 Statutes of 1998), created a
3-year pilot project for local Self-Determination Programs and
re-appropriated $750,000 to DDS from specified funds
appropriated pursuant to the Budget Act of 1998 for these
programs.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
CONTINUED
SB 468
Page
8
One-time costs likely in the hundreds of thousands for
the DDS to establish program requirements and apply for
federal approval to draw down federal matching funds
(General Fund).
Ongoing administrative costs by the regional centers of
about $6 million per year (General Fund). Because the bill
requires the program to be cost-neutral, eventually these
administrative costs may be offset by reduced
administrative costs or proportional reductions in
participating consumers' individual budgets.
Because the bill requires the program to be implemented
in a manner that is cost-neutral to the state, the overall
demand for services and supports under the program is not
expected to increase.
Potential ongoing state savings of about $2.8 million
per year from additional federal funding for current
services (General Fund).
SUPPORT : (Verified 5/28/13)
Autism Society Los Angeles (co-source)
Disability Rights California (co-source)
The Arc and United Cerebral Palsy California Collaboration
(co-source)
Easter Seals California
State Council on Developmental Disabilities
ARGUMENTS IN SUPPORT : Disability Rights California, a
co-source of this bill is supportive of this measure because "it
provides participants and their families, within an individual
budget, increased flexibility, choice, and greater control over
decisions, resources, and needed services and supports to
implement their IPP."
The Arc and United Cerebral Palsy California Collaboration, a
co-source of this bill, writes in support that "this bill
provides an alternative to the traditional method of providing
CONTINUED
SB 468
Page
9
regional center services to consumers. It allows individuals
with developmental disabilities, with the support of family,
friends, and professionals, to take charge of their future by
gaining control over the services, supports and resources that
they need. Based on a successful pilot project in existence
since 1998, SB 468 ensures that the self-determination program
will be offered to consumers as a voluntary choice in every
regional center throughout California."
JL:ej 5/28/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****
CONTINUED