BILL ANALYSIS Ó
SB 468
Page 1
Date of Hearing: August 13, 2013
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
SB 468 (Emmerson and Beall) - As Amended: August 6, 2013
SENATE VOTE : 38-0
SUBJECT : Developmental services: statewide Self-Determination
Program
SUMMARY : Establishes a statewide Self-Determination Program for
individuals with developmental disabilities and makes the
program available in every regional center catchment area.
Specifically, this bill :
1)Declares a number of legislative findings related to the
establishment of the Self-Determination Program, including a
declaration of legislative intent that participation in the
Self-Determination Program be available to all regional center
consumers, on a voluntary basis, regardless of geographic
location, economic or educational background, or race or
ethnicity.
2)Requires the Department of Developmental Services (DDS) to
implement a statewide Self-Determination Program that would
provide a participant and his or her family an individual
budget to maximize choice and flexibility in services provided
to implement the participant's individual program plan (IPP).
3)Phases in the statewide Self-Determination Program over three
years, initially serving up to 2,500 regional center
consumers, which includes the remaining participants in the
self-determination pilot project authorized pursuant to
Section 13 of Chapter 1043 of the Statutes of 1998, as
amended.
4)Makes participation in the Self-Determination Program
voluntary and requires the program to be available to
individuals who reflect the disability, ethnic and geographic
diversity of the state.
5)Requires DDS to ensure that the Self-Determination Program is
cost neutral in the aggregate and improves consumer outcomes
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over time through increasing consumer and family control over
services, comprehensive person-centered planning, consumer and
family training on the principle of self-determination,
consumer choice of independent facilitators and financial
management services providers, and overall innovation that
will allow consumers to achieve their goals, as specified.
6)Defines self-determination as 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 and promote inclusion in the
community, as specified.
7)Requires the Self-Determination Program to fund only those
services and supports that are deemed eligible for federal
financial participation by the federal Centers for Medicare
and Medicaid Services.
8)Provides that the Self-Determination Program is fully
voluntary and bars a regional center from requiring or
prohibiting participation in the program as a condition of
receiving services and supports otherwise available through
the regional center.
9)Grants eligibility for participation in the Self-Determination
Program for any regional center consumer who meets the
following requirements:
a) Is three years of age or older;
b) Has a developmental disability, as defined in WIC
Section 4512;
c) Does not live in a licensed long-term health care
facility, as specified; and
d) Agrees to meet the requirements of the
Self-Determination program, as specified.
1)Authorizes participation in the Self-Determination Program for
consumers who are not eligible for Medi-Cal, provided that
they meet all other program eligibility requirements and the
services and supports they receive are otherwise eligible for
federal financial participation.
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2)Allows an individual receiving services and supports under the
self-determination pilot programs established pursuant to
Section 13 of Chapter 1043 of the Statutes of 1998, as
amended, to either continue to receive services and supports
under the Self-Determination Program or transition to other
services and supports within the regional center system, as
specified.
3)Requires additional federal financial participation funds
generated by individuals participating in the
Self-Determination Program to be used to offset the
administrative costs of the program, including training for
consumers, family members and regional center staff; regional
center caseload ratio improvement; and costs associated with
the initial person-centered planning meeting and development
of the initial budget amount for individual participants.
4)Requires a regional center to provide for a participant's
transition from the Self-Determination Program to other
services and supports, as specified, provided that the
participant is determined to no longer be eligible for the
program or voluntarily chooses to exit.
5)Allows a participant who transitions out of the
Self-Determination Program to return to the program upon
meeting all applicable eligibility requirements and receiving
approval of his or her planning team, except that a
participant that exits the program voluntarily cannot return
to the program for at least 12 months.
6)Allows a Self-Determination Program participant to continue to
receive self-determination services and supports if he or she
transfers to another regional center catchment area.
7)Requires a Self-Determination Program participant's IPP team
to utilize the person-centered planning process to develop his
or her IPP and requires the IPP team to determine the
participant's individual budget amount to ensure it will help
the participant achieve the goals established in his or her
IPP.
8)Requires a participant to choose and purchase the services and
supports necessary to implement his or her IPP, and authorizes
the purchase certain services, as specified, that were
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suspended as a result of budget cost control restrictions.
9)Provides that the individual budget amount shall equal 98% of
individual participants' annual purchase of service costs, as
specified, during the first two years of the
Self-Determination Program, and requires DDS, in consultation
with stakeholders, to develop one or more additional
methodologies for calculating individual budget amounts prior
to the end of the second year of the program.
10)Requires the IPP team, using any of the authorized
methodologies, to determine a participant's individual budget
amount, which shall be available to the participant each year
for the purchase of program services and supports and
distributed among uniform budget categories, as specified,
until a new individual budget amount is determined.
11)Authorizes participants to annually transfer up to 10% of the
funds originally distributed to any budget category to another
budget category or categories, and allows transfers in excess
of 10% provided the transfer is approved by the regional
center or the participant's IPP team.
12)Allows the IPP team to adjust a participant's individual
budget amount to address a change in the participant's
circumstances, but otherwise prohibits an individual budget
amount from being calculated more than once in a 12-month
period.
13)Requires the IPP team to annually ascertain any changes in a
participant's circumstances in order to make necessary changes
to the participant's individual budget amount.
14)Requires DDS to apply for federal Medicaid funding for the
Self-Determination Program by December 31, 2014, as specified,
makes establishment of the program contingent upon approval of
federal funding, and requires DDS to develop regulations to
implement the program.
15)Requires DDS, in consultation with stakeholders, to develop
informational materials about the Self-Determination Program
and ensure that regional centers are trained in all aspects of
the program, as specified.
16)Requires each regional center to implement the
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Self-Determination Program as a term of its contract with DDS
and do all of the following:
a) Contract with local consumer or family-run organizations
to conduct outreach to consumers and families to provide
information about the Self-Determination Program and help
ensure that the program is available to a diverse group of
participants and underserved communities;
b) Collaborate with the local consumer or family-run
organizations to jointly conduct training on the
Self-Determination Program; and
c) Advance funds to a financial management service
provider, not to exceed 15% of the individual budget amount
at any one time, to facilitate participation in the
Self-Determination Program when a participant's IPP team
determines the advance is necessary to enable participation
in the program.
1)Defines financial management services as functions that assist
the participant to manage and direct the distribution of funds
contained in the individual budget, to ensure the participant
has the financial resources to implement his or her IPP
throughout the year, and requires the costs of financial
management services to be paid by a participant out of his or
her individual budget. Requires a participant to utilize the
services of a conflict-of-interest-free financial management
services provider of his or her own choosing.
2)Requires the financial management services provider to provide
the participant and the regional center service coordinator
with a monthly individual budget statement with detailed
information about how funds within the budget are allocated,
as specified.
3)Requires only the financial management services providers to
meet DDS vendorization requirements and requires all other
service providers within the Self-Determination Program to
have applicable state licenses, certifications, or other
state-required documentation but exempts them from the
vendorization requirement for purposes of the program.
4)Defines independent facilitator as a conflict-of-interest-free
person, selected by the participant and paid by the
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participant out of his or her individual budget, who may
assist the participant in making informed decisions about his
or her individual budget and in locating and coordinating
services and supports, as specified. Allows the participant
to choose not to use an independent facilitator and instead
seek these services and functions from a regional center
service coordinator of his or her choosing.
5)Allows a participant to request criminal history background
check information for a person seeking employment as a service
provider for that participant, at no charge to the participant
or the regional center, and describes the process for
providing that information to a participant.
6)Requires the establishment of local volunteer advisory
committees at each regional center and a volunteer statewide
advisory committee, as specified, to ensure the effective
implementation of the Self-Determination Program and to
facilitate the sharing of best practices and related training
materials.
7)Requires DDS, commencing January 10, 2016, to annually provide
data pertaining to the Self-Determination Program, as
specified, to the appropriate policy and fiscal committees of
the Legislature.
8)Authorizes the State Council on Developmental Disabilities
(SCDD), in collaboration with the state protection and
advocacy agency and the federally-funded University Centers
for Excellence in Developmental Disabilities Education,
Research and Service, to work with regional centers to survey
participants regarding their satisfaction with the
Self-Determination Program, and requires the SCDD to issue a
report to the Legislature on the status of the
Self-Determination Program, no later than three years
following the implementation of the program, as specified.
EXISTING LAW :
1)Establishes an entitlement to services for individuals with
developmental disabilities under the Lanterman Developmental
Disabilities Services Act (Lanterman Act). (WIC 4500 et seq.)
2)Grants all individuals with developmental disabilities, among
all other rights and responsibilities established for any
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individual by the United States Constitution and laws and the
California Constitution and laws, the right to treatment and
habilitation services and supports in the least restrictive
environment. (WIC 4502)
3)Establishes a system of 21 nonprofit regional centers
throughout the state to identify needs and coordinate services
for eligible individuals with developmental disabilities and
requires the Department of Developmental Services (DDS) to
contract with those regional centers to provide case
management services and arrange for or purchase services that
meet the needs of individuals with developmental disabilities,
as defined. (WIC 4620 et seq.)
4)Requires public and private agencies serving regional center
consumers under the Lanterman Act to provide consumers
relevant information in an understandable form to aid them in
making decisions about their own day-to-day lives. (WIC
4502.1)
5)Requires the development of an 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. (WIC 4512)
6)Requires the IPP planning processes to include:
a) A statement of the individual's goals and objectives, a
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. (WIC 4646.5)
1)Creates a process by which regional centers may "vendorize"
service providers, thereby providing a path to contract for
services with that provider. (WIC 4648 (a)(3))
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2)Authorizes regional centers to solicit an individual or agency
through a request for proposals or other means to provide
needed services or supports not presently available, provided
it is necessary to expand the availability of needed services
of good quality. (WIC 4648(e)(1))
3)Requires regional centers to provide the consumer, his or her
parent, legal guardian, or other appropriate authorized
representative, as specified, at least annually, a statement
of services and supports the regional center purchased, for
the purpose of ensuring that the services are delivered. (WIC
4648(h))
4)Requires DDS, in cooperation with the regional centers, to
ensure that all providers of services and supports are
informed about their responsibility to comply with conditions
of any contract between the regional center and the provider
or the provider and DDS. (WIC 4648.1 (c))
5)Prohibits discrimination against individuals in protected
classes, including national origin and ethnic group
identification, for purposes of providing full and equal
access to benefits or programs that are operated or funded by
the state. (GOV 11135 et seq.)
6)Suspends the availability of specified services for purchase
by the regional center in order to implement cost containment
provisions included in the 2009-2010 State Budget Act. (WIC
4648.5, 4686.5)
7)Creates a self-directed services program, contingent upon
federal funding approval, under which consumers of regional
center services can opt for a set individual budget that
allows them to choose from a menu of service options rather
than having services coordinated through a regional center
case manager. (WIC 4685.7)
FISCAL EFFECT : According to the Senate Appropriations
Committee:
1)One-time costs likely in the hundreds of thousands for the
Department of Developmental Services to establish program
requirements and apply for federal approval to draw down
federal matching funds (General Fund).
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2)Administrative costs to the regional centers in the low
millions (General Fund), which are likely to increase
initially then decline as consumers shift to using a
self-directed budget.
3)No anticipated increase in the overall demand for services and
supports under the program because the bill requires the
program to be implemented in a manner that is cost-neutral to
the state.
4)Potential ongoing state savings of about $2.8 million per year
from additional federal funding for current services (General
Fund).
COMMENTS : This bill establishes a statewide Self-Determination
Program within California's regional center system for
individuals with developmental disabilities, contingent on
federal funding approval. With implementation of this new
program, the authors of this bill seek to ensure person-centered
planning for participants' services, as well as increase the
ability of regional center consumers and their families to
choose and direct the services and support they receive through
their regional centers. Furthermore, participants will have the
flexibility to purchase preferred services and relinquish
services that aren't successful in helping them achieve the
desired outcomes and goals outlined in their IPPs. The
Self-Determination Program will be available to up to 2,500
regional center consumers, on a voluntary basis, for the first
three years of implementation, after which the program will be
available to all eligible regional center consumers throughout
the state. This bill further requires that the program be
implemented and administered consistently throughout the state,
and provides for extensive oversight to ensure positive
participant outcomes are achieved and funds are being allocated
and spent appropriately.
Background : The Lanterman Act 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.
The term "developmental disability" means a disability that
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originates before an individual attains 18 years of age, is
expected to continue indefinitely, and constitutes a substantial
disability for that individual. It includes intellectual
disabilities, cerebral palsy, epilepsy, and autism spectrum
disorders (ASD). Other developmental disabilities are those
disabling conditions similar to an intellectual disability that
require treatment (i.e., care and management) similar to that
required by individuals with intellectual disabilities. This
does not include conditions that are solely psychiatric or
physical in nature, and the conditions must occur before age 18,
result in a substantial disability, be likely to continue
indefinitely, and involve brain damage or dysfunction. Examples
of conditions might include intracranial neoplasms, degenerative
brain disease or brain damage associated with accidents.
Direct responsibility for implementation of the Lanterman Act
service system is shared by the Department of Developmental
Services 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 serve roughly 260,000 consumers statewide.
Most consumers live and receive services in the community, and
approximately 1,500 regional center consumers reside at one of
California's four Developmental Centers-and one state-operated,
specialized community facility-which provide 24-hour
habilitation and medical and social treatment services.
Regional center service delivery : The state's 21 regional
centers plan, coordinate, and pay for services and supports for
people with developmental disabilities 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 planning process for developmental services
promotes community integration and maximizes 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.
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Services and supports coordinated through California's regional
centers include, but are not limited to: residential placements
and affordable housing; supported living services; respite care;
transportation services; day programs; supported employment,
work activity and work support programs; dental services; and
various social and therapeutic programs.
Suspended services : The 2009-2010 Budget Act trailer bill for
developmental services (Fourth Extraordinary Session, Chapter 9,
Statutes of 2009) enacted a number of provisions intended to
achieve a $200 million cut in the developmental services budget.
The bill included a requirement to maximize the use of generic
services (e.g., In-Home Supportive Services and other existing
services used by individuals outside of the regional center
system), as well as a suspension of educational services for
children ages 3 to 17 years and various nonmedical therapies and
services. The suspended services included camping, horseback
riding, art, dance, music, and other specialized recreation
services. While some exceptions were made to allow consumers to
continue to access these services under special circumstances,
including cases in which the service is the primary or critical
means of ameliorating the consumer's condition, access was
eliminated for the vast majority of consumers.
The recent history of self-determination in California : The
state's efforts to provide a self-determination option to
consumers in the developmental services system began with what
were intended to be three-year pilot projects launched at five
regional centers in January 1999, which were subsequently
reauthorized by the Legislature through 2004. Although the
statute establishing the pilots was repealed, they continue to
successfully operate and currently serve approximately 200
individuals.
The 2005-2006 Budget Act included a new Self-Directed Services
Program, which was intended to expand the original pilot program
statewide, contingent upon approval of a federal waiver for
self-directed services. The waiver application was submitted in
2008, but was subsequently stalled when the Centers for Medicare
and Medicaid Services (CMS) invoked rules that would have
required a redesign of the state's payment structure for
developmental services; DDS would have had to assume
responsibility for paying providers directly rather than
allowing the regional centers to serve as fiscal intermediaries.
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Consequently, CMS never approved the Self-Directed Services
waiver, and the program was never implemented. With the renewal
of California's principal Home and Community Based Services
(HCBS) waiver in 2012, CMS redefined DDS as an Organized Health
Care System, thereby allowing the state to continue to pay
approved service providers through the regional centers rather
than requiring direct payment from DDS.
As part of the 2009-2010 Budget Act, which included the
suspension of various non-medical regional center services, the
Legislature approved the development of an Individual Choice
Budget; another attempt to provide individual consumers and
their families increased flexibility in access to services,
including those that had been suspended. Although DDS convened
a budget advisory group to discuss what the Individual Choice
Budget would entail, it was never implemented, as DDS was not
able to certify that the Individual Choice Budget would result
in the savings target proposed in the law.
Self-determination principles : The five principles of
self-determination, as written and defined in this bill, are as
follows:
1)Freedom, which includes the ability of adults with
developmental disabilities to exercise the same rights as all
citizens; to establish, with freely chosen supporters, family
and friends, where they want to live, with whom they want to
live, how their time will be occupied, and who supports them;
and, for families, to have the freedom to receive unbiased
assistance of their own choosing when developing a plan and to
select all personnel and supports to further the life goals of
a minor child;
2)Authority, which includes the ability of a person with a
disability, or family, to control a certain sum of dollars in
order to purchase services and supports of their choosing;
3)Support, which includes the ability to arrange resources and
personnel, both formal and informal, that will assist a person
with a disability to live a life in his or her community that
is rich in community participation and contributions;
4)Responsibility, which includes the ability of participants to
take responsibility for decisions in their own lives and to be
accountable for the use of public dollars, and to accept a
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valued role in their community through, for example,
competitive employment, organizational affiliations, spiritual
development, and general caring of others in their community;
and
5)Confirmation, which includes confirmation of the critical role
of participants and their families in making decisions in
their own lives and designing and operating the system that
they rely on.
These five principles are explicitly included in the provisions
of this bill as a means of protecting the rights and
responsibilities of participants, as well as guiding training
and other practices included in the implementation of the
Self-Determination Program.
Need for the bill : The Self-Determination Program established
in this bill is different from the inactive Self-Directed
Services program in current law in several key ways, including
that it:
1)Allows more flexibility in seeking federal reimbursement;
2)Expands eligibility to consumers living in facilities licensed
by DSS (non-medical community facilities), which increases
flexibility and choice for those participants with respect to
their day programs and work activities;
3)Generates additional financial participation by requiring
individuals in the current self-determination pilot program,
for whom federal funding is not currently drawn down, to
either continue in the new Self-Determination Program or
return to the traditional regional center system;
4)Requires the use of a financial management services providers
to meet new federal requirements;
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5)Requires that there be a uniform methodology to calculate the
individual budgets during the phase-in period; and
6)Authorizes the IPP team to adjust a participant's individual
budget amount to address a change in the participant's
circumstances.
The traditional system for delivering regional center services
requires regional centers to pay providers directly for the
services identified in a consumer's IPP. Conversely, because
the Self-Determination Program is built on the concept of
increased control over providers and services, and flexibility
for consumers and their family members, participants in the
program will be provided an individual budget amount based on
their IPP, which they will then use to choose and purchase the
services and supports they need.
This bill requires a participant to use the services of a
conflict-of-interest free financial management services
provider, which the participant will pay for out of his or her
individual budget amount. The financial management services
provider will help the participant manage and direct the
distribution of funds while making sure the individual budget
lasts throughout the year and is not exhausted before a new
individual budget amount is authorized. In addition to a
financial management services provider, the Self-Determination
Program allows a participant to utilize the services of a
conflict-of-interest-free independent facilitator to help the
participant locate and coordinate services and supports that are
in line with the participant's IPP. If a participant desires
these services but chooses not to locate and hire an independent
facilitator, the participant can seek these services from a
regional center services coordinator.
For the first two years after implementation of the
Self-Determination Program, the individual budget amount
provided to participants will be equal to 98% of their
individual annual purchase of service costs, which is intended
to ensure the program is cost neutral in the aggregate. This
bill requires DDS to work with stakeholders to develop
additional budget methodologies prior to the end of the second
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year. Regardless of which authorized budget methodology is
applied, the Self-Determination Program will allow a
participant's IPP team to adjust his or her individual budget
amount to address a change in the participant's circumstances.
In addition to granting participants more say in deciding how
and by whom their services and supports are delivered,
supporters of this legislation indicate that one of the draws of
the Self-Determination Program, despite the 98% individual
budget amount cap, is that it renews participants' access to the
educational, recreational and non-medical therapeutic services
that were suspended as a result of cost-control restrictions in
the 2009-2010 Budget Act.
Arguments in support : According to the authors of this bill,
the Self-Determination Program is an innovative approach to
regional center service delivery that will allow consumers and
their families to "think outside the box" when choosing and
planning services and will help them meet their life goals. The
authors go on to say that bureaucracy will be limited through
the program, thereby allowing consumers and their family members
to easily navigate the system.
In support, the Special Needs Network states, "The [current]
complicated labyrinth of care systems has been one of the
primary barriers to vital therapies and services for these
families. Self-Determination will free these families to freely
access services based on the best outcomes and individual needs
for their special needs."
The Self-Advocacy Board of Los Angeles County further states,
"For more than a decade, the self-determination pilot project
has proved that it is both cost effective and produces positive
outcomes for the people who have utilized it to purchase their
own services. People should have the option to have greater
control over the monies that will be spent on supporting them to
live typical lives. This is in line with the intent of the
Lanterman Act that puts the decision-making authority in the
hands of the person receiving the supports. We believe it is
time to allow this forward-thinking approach to service
provision to operate across the state in every regional center
catchment area."
Arguments in opposition : The Association of Regional Center
Agencies (ARCA) has indicated that it supports the concept of
self-determined services and believes that, when properly
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implemented, it empowers individuals with developmental
disabilities and can be a powerful tool to address historical
funding differences between different demographic groups.
However, ARCA opposes this bill, citing a number of areas in
which the organization thinks amendments are necessary. ARCA
states, "While [self-determined services] has great potential to
provide individuals and their families with increased
flexibility and control over their services, if not carefully
administered, it can make existing service and access inequities
more pronounced. Providing some individuals significant
opportunities and others with comparable needs with very little
is not an acceptable outcome to any proposed system change. Any
effort to bring widespread expansion of [self-determined
services] to California without adequate planning runs the risk
of limiting rather than promoting access to services for
individuals with developmental disabilities."
Committee staff recommendations : Should this bill pass, the
authors should continue to work on language in the bill
pertaining to the following details:
1)The budget methodology for the phase-in period : The language
should ensure that the methodology addresses opportunities for
new regional center consumers to participate and does not
further disparities in services for underserved communities.
2)Criminal background checks : The current language specifies
that neither participants nor regional centers are required to
pay for criminal background checks, but there is no person or
entity identified to pay. Procedures for handling and
releasing the criminal background check once it is received
should also be explained in greater detail to ensure a
meaningful background check process.
3)Oversight and monitoring of provider qualifications : There is
no structure in the current language to ensure that
non-vendorized providers meet the required qualifications
prior to serving participants and continue to meet those
requirements while they are serving participants.
PRIOR LEGISLATION :
AB 1244 (Chesbro), created a self-determination program to
provide individuals with a single, capitated funding allocation
they may use to purchase services that support goals identified
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in their individual program plan. Died in the Senate Human
Services Committee.
AB 9 X4 (Evans), Chapter 9, Statutes of 2009, 4th Extraordinary
Session, created an option for the individual choice budget,
which allowed for the purchase of otherwise suspended services
but required savings of $35.1 million. It has not been
implemented.
AB 131 (Assembly Budget Committee), Chapter 80 Statutes of 2005,
established a self-directed services option statewide,
contingent upon approval of a federal waiver. A waiver was
never obtained, and it has not been implemented.
SB 1038 (Thompson), Chapter 1043, Statutes of 1998, authorized
the creation of pilot projects for self-determination at three
regional centers. Two other regional centers also created
independent self-determination pilots under an alternative
service delivery model, bringing to five the number of regional
centers engaged in the pilot. These pilots continue today.
REGISTERED SUPPORT / OPPOSITION :
Support
BETTZEDEK
Cal TASH
California State Council on Developmental Disabilities
CASHPCR
Creative Solutions for Hope
Developmental Disabilities Area Board 10
Disabilities Rights California
Disabled Sports Eastern Sierra
Easter Seals California
Educate. Advocate.
Greenhouse Therapy Center
North Los Angeles County Regional Center
Pasadena Child Development Associates
Self-Advocacy Board of Los Angeles County
Special Needs Network (SNN)
20 individuals
Opposition
Association of Regional Center Agencies (ARCA)
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Analysis Prepared by : Myesha Jackson / HUM. S. / (916)
319-2089