BILL ANALYSIS Ó
SB 468
Page 1
SENATE THIRD READING
SB 468 (Emmerson and Beall)
As Amended August 21, 2013
Majority vote
SENATE VOTE :38-0
HUMAN SERVICES 7-0 APPROPRIATIONS 17-0
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|Ayes:|Stone, Maienschein, |Ayes:|Gatto, Harkey, Bigelow, |
| |Ammiano, | |Bocanegra, Bradford, Ian |
| |Ian Calderon, Garcia, | |Calderon, Campos, |
| |Grove, Hall | |Donnelly, Eggman, Gomez, |
| | | |Hall, Holden, Linder, |
| | | |Pan, Quirk, Wagner, Weber |
| | | | |
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SUMMARY : Establishes a statewide Self-Determination Program for
individuals with developmental disabilities and makes the
program available in every regional center catchment area,
contingent on federal funding approval. 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
previously authorizes self-determination pilot projects, as
specified.
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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 program is available on an
equitable basis to participants in all regional center
catchment areas for the first three years, as specified, and
that the Self-Determination Program improves consumer outcomes
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 participants 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)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.
10)Allows an individual receiving services and supports under
the previously authorized self-determination pilot project, as
specified, to either continue to receive services and supports
under the Self-Determination Program or transition to other
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services and supports within the regional center system, as
specified.
11)Requires additional federal financial participation funds
generated by former participants of the self-determination
pilot projects, as specified, to be used to offset costs to
DDS for administering the criminal background check process
for nonvendored providers of services under the
Self-Determination Program. Requires any remaining funds to
be used to offset administrative costs to the regional centers
in implementing the Self-Determination Program, training for
consumers, family members, and regional center staff, costs
associated with the participant's initial person-centered
planning meeting, and the development of the participant's
initial individual budget.
12)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.
13)Allows a participant who transitions out of the
Self-Determination Program to return to the program upon
meeting all applicable eligibility requirements, as specified,
and upon 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.
14)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,
provided that he or she remains eligible for the program, and
requires the balance of the participant's individual budget to
be reallocated to the receiving regional center.
15)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 to ensure it will help the
participant achieve the goals established in his or her IPP.
16)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
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were suspended as a result of budget cost control
restrictions.
17)Establishes methodologies for calculating annual budgets for
participants based on their status as current or new regional
center consumers, as specified.
18)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
from being calculated more than once in a 12-month period.
19)Requires the individual budget to be assigned to uniform
budget categories developed by DDS, in consultation with
stakeholders, and distributed according to the timing of the
anticipated expenditures in the IPP and in a manner that
ensures that the participant has the financial resources to
implement his or her IPP.
20)Authorizes DDS, in consultation with stakeholders, to develop
alternative methodologies for individual budgets that are
computed in a fair, transparent, and equitable manner and are
based on consumer characteristics and needs, and that include
a method for adjusting individual budgets to address a
participant's change in circumstances or needs.
21)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.
22)Requires the IPP team to annually ascertain any changes in a
participant's circumstances or needs in order to make
necessary changes to the participant's individual budget.
23)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 issue program
directives or similar instructions to implement the program
until regulations are developed.
24)Requires DDS, in consultation with stakeholders, to develop
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informational materials about the Self-Determination Program
and ensure that regional centers are trained in all aspects of
the program, as specified.
25)Requires each regional center to implement the
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; and
b) Collaborate with the local consumer or family-run
organizations to jointly conduct training on the
Self-Determination 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, as specified. Requires a participant
to utilize the services of a 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, to not be on the federal
debarment list, and exempts them from the vendorization
requirement for purposes of the program.
4)Defines independent facilitator as a person, selected by the
participant and paid by the participant out of his or her
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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.
Prohibits the independent facilitator from being someone who
is otherwise providing services to the participant pursuant to
his or her IPP or who is employed by a person providing
services to the participant. Allows the participant to choose
not to use an independent facilitator and instead seek these
services and functions from his or her regional center service
coordinator.
5)Establishes criminal background check requirements for
providers of services and supports under the
Self-Determination Program, as specified, and requires DDS to
issue a program directive identifying the nonvendored
providers that must submit to a criminal background check,
which shall include but not be limited to individuals who
provide direct personal care services to a participant and
other nonvendored providers for whom a criminal background
check is requested by a participant or his or her financial
management service.
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, 2017, 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.
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FISCAL EFFECT : According to the Assembly Appropriations
Committee, this bill will have the following fiscal impact:
1)One-time General Fund (GF) costs potentially in excess of
several hundred thousand dollars for the workload associated
with creating the new Self-Determination Program.
2)On-going costs of $1.3 million for DDS to administer and
process the required background checks for providers.
3)On-going costs of up to $2 million for the Regional Centers
for outreach, training, and administration of the
Self-Determination Program.
4)Annual savings of approximately $2.75 million GF from shifting
the current pilot project participants to the new statewide
program which is eligible for 50% federal funding. The
current pilot project costs over $5 million GF per year.
5)Language in the bill requires that the program be implemented
in a way that is cost-neutral to the state.
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 Individual Program
Plans (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.
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Background : The Lanterman Act (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.
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 state's 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 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.
Regional centers serve roughly 260,000 consumers statewide.
Most consumers live and receive services in the community, and
approximately 1,400 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.
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
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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 three
regional centers in January 1999, to which two additional
regional center pilots were added. 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.
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
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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.
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;
5)Requires that there be a uniform methodology to calculate the
individual budgets during the phase-in period; and
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6)Authorizes the IPP team to adjust a participant's individual
budget 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 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. 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 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.
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.
Analysis Prepared by : Myesha Jackson / HUM. S. / (916)
319-2089
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FN: 0002182