BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  SB 468
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          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