BILL ANALYSIS �
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UNFINISHED BUSINESS
Bill No: SB 468
Author: Emmerson (R) and Beall (D), et al.
Amended: 9/6/13
Vote: 21
SENATE HUMAN SERVICES COMMITTEE : 6-0, 4/23/13
AYES: Yee, Berryhill, Emmerson, Evans, Liu, Wright
SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/23/13
AYES: De Le�n, Walters, Gaines, Hill, Lara, Padilla, Steinberg
SENATE FLOOR : 38-0, 5/30/13
AYES: Anderson, Beall, Berryhill, Block, Calderon, Cannella,
Corbett, Correa, De Le�n, DeSaulnier, Emmerson, Evans, Fuller,
Gaines, Galgiani, Hancock, Hernandez, Hill, Hueso, Huff,
Jackson, Knight, Lara, Leno, Lieu, Liu, Monning, Nielsen,
Padilla, Pavley, Price, Roth, Steinberg, Torres, Walters,
Wolk, Wyland, Yee
NO VOTE RECORDED: Wright, Vacancy
ASSEMBLY FLOOR : Not available
SUBJECT : Developmental services: statewide
Self-Determination Program
SOURCE : Autism Society of Los Angeles
Disability Rights California
DIGEST : This bill establishes a statewide Self-Determination
Program for individuals with developmental disabilities and
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makes the program available in every regional center catchment
area, contingent on federal funding approval.
Assembly Amendments make numerous technical and substantive
changes including (1) the addition of co-authors; (2) the
creation of the State Council on Developmental Disabilities as a
volunteer committee, to be known as the Statewide
Self-Determination Advisory Committee; (3) revise and add to
definitions that apply to this bill; (4) add a requirement that
nonvendored providers of services and supports submit to a
background check prior to employment; (5) specify that with
respect to this background check, fingerprint images and related
information are required to be submitted to the Department of
Justice (DOJ) and require DOJ to provide specified responses and
charge a fee sufficient to cover the cost of processing the
requests; (6) clarify the entities the State Council on
Developmental Disabilities is required to collaborate with in
order to meet the Council's requirement to submit a report to
the Legislature on the Self-Determination Program; and (7)
revise the date the reporting requirement commences from January
10, 2016, to January 10, 2017.
ANALYSIS :
Existing law:
1.Establishes the Lanterman Developmental Disabilities Services
Act, which declares California's responsibility for providing
an array of services and supports to meet the needs of each
person with developmental disabilities in the least
restrictive environment, regardless of age or degree of
disability, and to support their integration into the
mainstream life of the community.
2.Establishes a system of nonprofit regional centers to provide
fixed points of contact in the community for all persons with
developmental disabilities and their families, to coordinate
services and supports best suited to them throughout their
lifetime.
3.Establishes an Individual Program Plan (IPP) and defines that
planning process as the vehicle to ensure that services and
supports are customized to meet the needs of consumers who are
served by regional centers.
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4.Establishes, contingent upon approval of a federal waiver, the
Self-Directed Services Program (SDS Program) statewide to
provide participants, within an individual budget, greater
control over needed services and supports.
5.Defines the duties of a financial services manager, and other
support personnel; provides a definition of the types of
services available through an individual budget; identifies
the purpose and formula for funding a risk pool to cover
unanticipated expenses, and other elements of the program, as
specified.
6.Establishes that a consumer may choose between one of two
individual budget amounts and requires that methodologies for
determining those two budgets amounts be detailed in
departmental regulations, as specified.
7.Defines the categories of services that an individual may fund
through the individual budget to include community living,
health and clinical services, employment, training and
education, environmental and medical supports and
transportation.
8.Provides that an individual who is determined to be
ineligible, or who voluntarily exits the SDS Program, shall be
permitted to return to the SDS Program upon meeting all
applicable eligibility criteria and after a minimum of 12
months' time has elapsed.
9.Creates other requirements and guidelines, as specified, for
the program.
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
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implement a statewide Self-Determination Program that
provides a participant and his/her family an individual
budget to maximize choice and flexibility in services
provided to implement the participant's 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 authorized self-determination pilot projects, as
specified.
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/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
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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 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 the remaining funds to
be used to offset operations costs for caseload ratio
enhancement, training for regional center staff, costs
associated with the participant's initial person-centered
planning meeting, the development of the participant's
initial individual budget and consumer and family member
training.
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/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
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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/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/her IPP.
16.Requires a participant to choose and purchase the services
and supports necessary to implement his/her IPP, and
authorizes the purchase certain services, as specified, that
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/her IPP throughout the year.
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
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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 issue
program directives or similar instructions to implement the
program until regulations are developed.
24.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.
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.
26.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/her
IPP throughout the year, and requires the costs of financial
management services to be paid by a participant out of
his/her individual budget, as specified. Requires a
participant to utilize the services of a financial management
services provider of his/her own choosing.
27.Requires the financial management services provider to
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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.
28.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.
29.Defines independent facilitator as a person, selected by the
participant and paid by the participant out of his/her
individual budget, who may assist the participant in making
informed decisions about his/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/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/her
regional center service coordinator.
30.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/her financial
management service.
31.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.
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32.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.
33.Authorizes the State Council on Developmental Disabilities,
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 State Council on
Developmental Disabilities, in collaboration with the
aforementioned entities, 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.
Background
Regional Center system. California's 21 nonprofit regional
centers are part of a system of care for individuals with
developmental disabilities overseen by DDS. DDS is responsible
for coordinating care and providing services for more than
250,000 people who receive services and supports to live in
their communities.
Regional centers provide diagnosis and assessment of eligibility
and help plan, access, coordinate and monitor the services and
supports that are needed because of an individual's
developmental disability. Services for consumers are determined
through an IPP.
Self-Determination . The concept of facilitating a way for
individuals with developmental disabilities to choose their own
services and supports, rather than be prescribed a list of
customized services began in the mid-1990s. According to a 2007
Robert Wood Johnson Foundation report, the growing move toward
de-institutionalization and the home and community based waivers
associated with that move allowed states to serve more people.
However, most states did not have the resources to meet the
long-term care needs of everyone who sought help.
Self-determination in California . In 1998 the Legislature
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passed a Self-Determination Pilot Project that was conducted in
five regional centers and included about 200 participants. A
subsequent report to the Legislature showed that the
participants were happy and had experienced more freedom and
responsibility in controlling the direction of their services
and their life choices. The report also indicated that good
self-determination practices required intensive person-centered
planning, collaboration, and follow-along support.
Prior Legislation
AB 1244 (Chesbro, 2011), would have created a self-determination
program to provide individuals with a single, capitated funding
allocation to purchase services that support goals identified in
the IPP. This bill would have replaced the existing statutory
language creating a statewide SDS program, which required a
federal waiver for implementation. This bill died in the Senate
Human Services Committee.
AB 131 (Omnibus health trailer bill, Chapter 80, Statutes of
2005), creates a statewide self-directed services project
contingent upon approval of a waiver for federal funding by the
Centers for Medicaid and Medicare Services. The waiver
application remains pending.
SB 1038 (Thompson, Chapter 1043 Statutes of 1998), created a
3-year pilot project for local Self-Determination Programs and
re-appropriated $750,000 to DDS from specified funds
appropriated pursuant to the Budget Act of 1998 for these
programs.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Assembly Appropriations Committee:
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.
On-going costs of $1.3 million for DDS to administer and
process the required background checks for providers.
On-going costs of up to $2 million for the Regional Centers
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for outreach, training, and administration of the
Self-Determination Program.
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.
Language in the bill requires that the program be implemented
in a way that is cost-neutral to the state.
SUPPORT : (Verified 9/10/13)
Autism Society Los Angeles (co-source)
Disability Rights California (co-source)
Area 10 Developmental Disabilities Board
Area 4 Developmental Disabilities Board
Association of Regional Center Agencies
California Supported Living Network
CASH/PCR
Center for Autism and Related Disorders
Collaboration
Easter Seals California
Educate.Advocate
North Los Angeles County Regional Center
Self Advocacy Board of Los Angeles County
State Council on Developmental Disabilities
The Alliance
The Arc and United Cerebral Palsy California Collaboration
ARGUMENTS IN SUPPORT : Disability Rights California, a
co-source of this bill is supportive of this measure because "it
provides participants and their families, within an individual
budget, increased flexibility, choice, and greater control over
decisions, resources, and needed services and supports to
implement their IPP."
The Arc and United Cerebral Palsy California Collaboration,
writes in support that "this bill provides an alternative to the
traditional method of providing regional center services to
consumers. It allows individuals with developmental
disabilities, with the support of family, friends, and
professionals, to take charge of their future by gaining control
over the services, supports and resources that they need. Based
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on a successful pilot project in existence since 1998, SB 468
ensures that the self-determination program will be offered to
consumers as a voluntary choice in every regional center
throughout California."
JL:ej:d 9/11/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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