Amended in Senate April 9, 2013

Senate Bill No. 579

Introduced by Senator Berryhill

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(Coauthor: Senator Emmerson)

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February 22, 2013

An act to begin delete amend Section 12306.1 of end delete begin insert add Section 4751 to end insert the Welfare and Institutions Code, relating to begin delete public social end delete begin insert developmental end insert services.

LEGISLATIVE COUNSEL’S DIGEST

SB 579, as amended, Berryhill. begin delete In-home supportive services. end delete begin insert Developmental services: Oversight Efficiency and Quality Enhancement Model. end insert

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The Lanterman Developmental Disabilities Services Act authorizes the State Department of Developmental Services to contract with regional centers to provide services and supports to individuals with developmental disabilities. The services and supports to be provided to a regional center consumer are contained in an individual program plan, developed in accordance with prescribed requirements.

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This bill would, commencing January 1, 2014, and to the extent that funds are made available, establish a 41⁄2 year Oversight Efficiency and Quality Enhancement Model pilot project in specified regional center catchment areas to implement a unified oversight and quality enhancement process, as specified, shifting the oversight of the service providers from the Community Care Licensing Division of the State Department of Social Services and the Licensing and Certification Division of the State Department of Public Health to the department and the pilot regional centers.

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This bill would require the Legislative Analyst’s Office to conduct a study identifying all of the financial and human resources expended in relation to current quality assurance activities for the licensed programs identified in the pilot project and to determine the amount of current quality assurance costs that are covered by federal dollars and what could be federally funded if the system and waiver were changed. The bill, by October 1, 2016, would also require the department to contract with an independent agency or organization to evaluate the pilot project and prepare a written report of its findings.

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Existing law provides for the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons are provided with services in order to permit them to remain in their own homes and avoid institutionalization. Existing law requires, except as provided, a county to use county-only funds to fund both the county share and the state share when any increase in IHSS provider wages or benefits is negotiated or agreed to by a public authority or nonprofit consortium, as specified.

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This bill would make a technical, nonsubstantive change to that provision.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

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begin insert Section 4751 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

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begin insert 4751. end insert   

(a) The Legislature finds and declares all of the
following:

(1) Evaluation of the services that people with developmental
disabilities receive from both service providers and regional
centers is a critical component of the service system.

(2) The current system of having three state entities, the State
Department of Developmental Services with the regional centers,
the Community Care Licensing Division of the State Department
of Social Services, and the Licensing and Certification Division
of the State Department of Public Health, all charged with
monitoring and maintaining quality services and supports for
people with developmental disabilities, is duplicative and wasteful
of limited state dollars and resources and fails to obtain optimal
results.

(3) The efficiency and efficacy of the oversight and quality
review processes can be significantly enhanced by unifying the
current duplicative quality review system, thus conserving limited
state fiscal resources and reducing the wasteful use of state staff
and service providers’ time while simultaneously improving the
lives of people with developmental disabilities in California.

(b) Notwithstanding any other law, commencing January 1,
2014, a four-and one-half year Oversight Efficiency and Quality
Enhancement Model pilot project shall be established to shift the
authority and resources to the State Department of Developmental
Services, in conjunction with the pilot regional centers, to
implement a unified oversight and quality enhancement process.
This process shall ensure the welfare, community participation,
health, and safety of all those with developmental disabilities who
are served in programs currently licensed by the Community Care
Licensing Division of the State Department of Social Services and
the Licensing and Certification Division of the State Department
of Public Health. The project shall also enhance accountability
and quality review processes for the services directly provided by
regional centers. At the conclusion of the pilot project, it is the
intent of the Legislature that if, based upon the analysis and
recommendations of an independent evaluation, as well as
experience in each of the pilot regional centers, the pilot project
has sufficiently met the goals and standards of the Oversignt
Efficiency and Quality Enhancement Model set forth in subdivision
(f), the creation of an Oversight Efficiency and Quality
Enhancement Model shall be extended statewide.

(c) The pilot project shall be conducted in the catchment areas
of the Golden Gate Regional Center, the Tri-Counties Regional
Center, and the San Diego Regional Center. On or before February
1, 2014, the State Department of Developmental Services may
select two additional regional centers to participate in the pilot
project on a voluntary basis. Additional regional centers shall be
selected according to criteria developed by the department in
consultation with the Association of Regional Center Agencies. In
selecting additional pilot regional centers, the department shall
promote diversity among participating regional centers in terms
of size and geographical location. An agreement shall be
negotiated between each pilot regional center and the department
regarding the scope of activities, project milestones, and resources
available to each pilot regional center.

(d) By February 1, 2014, each pilot regional center shall
establish a local Quality Enhancement Advisory Committee,
including consumers, family members, service providers, and
advocates, to provide input and feedback in the design,
implementation, and evaluation of the Oversight Efficiency and
Quality Enhancement Model. The local advisory committee shall
review pilot project data, including, but not limited to, baselines
and outcomes of quality reviews of providers’ services and the
individuals served by these providers and baselines and outcomes
of the quality reviews of the services the regional center directly
provides.

(e) From January 1, 2014, to April 1, 2014, inclusive, the
department, working with representatives from the pilot regional
centers, shall, consistent with the parameters set forth in this
section, develop the structure for transfer of responsibilities from
the Community Care Licensing Division of the State Department
of Social Services and the Licensing and Certification Division of
the State Department of Public Health, including the systems and
procedures for certification and decertification, quality reviews,
oversight, and complaint investigation of all programs currently
licensed by those agencies that serve people with developmental
disabilities in the pilot regional center catchment areas. The
Community Care Licensing Division of the State Department of
Social Services and the Licensing and Certification Division of
the State Department of Public Health shall provide staff to consult
with the State Department of Developmental Services and regional
centers during this process.

(f) The Oversight Efficiency and Quality Enhancement Model
shall focus on the impact of services on consumers’ lives, support
the continuous investigation and enhancement of the quality and
impact of services, and be informed by reliable data on service
effectiveness and consumer outcomes. The model shall do all of
the following:

(1) Be lean, simple, efficient, and understood by the people it
serves.

(2) Avoid unnecessary redundancies of process, permissions,
oversight, and enforcement.

(3) Base reviews on quality standards that, in accordance with
Lanterman Developmental Disabilities Services Act principles,
address individual outcomes, including, but not limited to, health,
safety, independence, choice, empowerment, inclusion, and
participation in community life.

(4) Recognize that service outcomes and effectiveness, the
impact of services on consumers’ lives, and satisfaction data will
be key to ensuring quality.

(5) Shift the focus of quality efforts to a service enhancement
model that encourages and recognizes service provider and
regional center improvements.

(6) Include multiple options for proactive consumer protections,
including screening for qualified providers, an emphasis on an
evolving improvement system of coaching and mentoring service
providers toward quality, and an immediate response capacity to
address people in imminent danger.

(7) Report aggregate service and individual outcomes to
highlight excellence, innovation, and satisfaction in the services
provided and in the lives of individuals with developmental
disabilities.

(8) Enhance transparency, accountability, quality standards,
and measurement processes for the services directly provided by
regional centers.

(9) Provide consumers, families, service providers, and regional
center staff the opportunity to participate in system evaluation.

(10) Ensure that the results of oversight, quality enhancement,
and assurance review activities are available to people with
developmental disabilities and their families in plain language so
they can be informed consumers of the services that they receive.

(g) On or before July 1, 2014, the department and pilot regional
centers, in consultation with stakeholder organizations, shall do
all of the following:

(1) Establish model certification requirements that shall be
applied in certifying new service providers and service provider
performance standards that shall be used in conducting ongoing
quality reviews and enhancement activities. Certification
requirements and performance standards shall be consistent and
shall include standards for health, safety, and welfare, as well as
quality of life outcomes, including, but not limited to, community
inclusion and participation, choice, friendship, and empowerment.
The principles set forth in subdivision (f), current regulatory and
statutory requirements, as well as nationally accepted quality of
life standards shall be considered in developing the model
certification requirements and performance standards. The model
performance standards shall replace current standards from Titles
17 and 22 of the California Code of Regulations for the specific
services subject to the pilot project in the pilot regional center
areas. The model certification requirements and performance
standards shall support the development, maintenance, and
continuous improvement of innovative, cost-effective services.

(2) Establish pilot regional center performance standards for
use during the pilot project, including, but not limited to, quality
expectations for customer service, resource development,
conducting quality assurance of service providers, accounting,
and intake, outreach, and service coordination, including
individual program plan development and implementation. The
regional center performance standards shall work in concert with
the service provider performance standards and be aligned with
the values of the Lanterman Developmental Disabilities Services
Act and the principles set forth in subdivision (f). The standards
shall address how the regional center’s services have resulted in
consumer or family empowerment and in more independent,
productive, and normal lives for the persons served.

(3) Develop a uniform data collection system that provides
reliable, valid, and actionable data from multiple stakeholder
perspectives and is consistently deployed at each pilot regional
center. The data system shall include information on service
provider and pilot regional center performance, as well as the
quality-of-life outcomes and individual program plan goals of the
individuals served in the project. The data system shall be flexible,
have the capacity to allow field-based data entry and analysis,
and to document, measure, and analyze the implementation of the
model. To the extent possible, data currently being collected by
regional centers or the department shall be utilized in the data
system.

(4) Consider the experience and outcomes from the Agnews
Developmental Center, Bay Area Quality Management System
and from current quality reviews of unlicensed Lanterman
Developmental Disabilities Services Act support models, including
family home agencies and supported living, in developing the
structure, standards, and data collection methodologies for the
model.

(h) From January 1, 2014, to June 30, 2014, inclusive, pilot
regional centers shall collect baseline data on existing service
quality and quality assurance processes in programs and services
for people with developmental disabilities that have been covered
by licensing requirements through the Community Care Licensing
Division of the State Department of Social Services or the Licensing
and Certification Division of the State Department of Public
Health. Baseline data shall meet all of the following requirements:

(1) Be collected by an independent third party surveying a
statistically significant sample of regional center employees,
service provider staff, and individuals and families providing or
receiving those services.

(2) Address all of the following:

(A) The satisfaction of regional center employees, service
provider staff, individuals, and families with the current quality
assurance system.

(B) The impact of services on consumers’ lives, including, but
not limited to, the areas of health, safety, community participation,
friendship, empowerment, and choice.

(C) The effectiveness and efficiency of existing quality assurance
processes, including training and related service provider support,
as well as the quality and efficacy of regional center-service
provider relationships.

(3) Be made available to the pilot project’s independent
evaluator for comparison with pilot project data as described in
subdivision (k).

(i) The Legislative Analyst’s Office shall conduct a study
identifying all of the financial and human resources expended by
the Community Care Licensing Division of the State Department
of Social Services, the Licensing and Certification Division of the
State Department of Public Health, the State Department of
Developmental Services, regional centers, and service providers
in relation to current quality assurance activities for the licensed
programs identified in the pilot project. The study shall also
determine the amount of current quality assurance costs that are
covered by federal funds, primarily through the home-and
community-based service waiver program, and what could be
federally funded if the system and waiver were changed. Based on
this study, the Legislative Analyst’s Office shall make
recommendations on amounts of, and the best possible means for,
reallocation of funding to augment current quality review and
monitoring staff at the State Department of Developmental Services
and regional centers and provide the resources necessary to
implement the Oversight Efficiency and Quality Enhancement
Model.

(j) Full implementation of the pilot project and transfer of
responsibilities will begin on July 1, 2014. Commencing on that
date and for the remainder of the pilot project period, quality
review and oversight functions in the pilot regional center areas
shall be accomplished as follows:

(1) The State Department of Developmental Services shall
certify, rather than license, new programs and services for people
with developmental disabilities that would previously have been
subject to licensing requirements through the Community Care
Licensing Division of the State Department of Social Services or
the Licensing and Certification Division of the State Department
of Public Health. A service provider seeking to start a new program
or service shall first be selected by the regional center through a
request for proposal process and then obtain certification. The
certification process shall include submission of a program design
that reflects the model standards and certification requirements
developed pursuant to paragraph (1) of subdivision (g). The
potential service provider shall complete an initial application for
certification with the local pilot regional center. The application
shall then be submitted to the department for issuance of a
certificate.

(2) The State Department of Developmental Services shall deem
certified all programs in the pilot regional center areas that are
licensed prior to July 1, 2014, either by the Community Care
Licensing Division of the State Department of Social Services or
the Licensing and Certification Division of the State Department
of Public Health and these programs shall no longer be monitored
by those licensing agencies. All of these programs shall be deemed
certified by the State Department of Developmental Services
without the certification process requirements developed pursuant
to paragraph (1) of subdivision (g), and shall be subject to quality
monitoring and decertification processes as if they had been issued
a certificate.

(3) All certified programs shall have an annual quality review
conducted by pilot regional center staff. Additionally, a
comprehensive quality enhancement and performance evaluation
shall be scheduled, as needed, depending on the findings of the
annual quality reviews. Quality reviews and monitoring visits shall
be effective and efficient and be based upon the performance
standards developed pursuant to paragraph (1) of subdivision (g).

(4) Training is central to the Oversight Efficiency and Quality
Enhancement Model, and all certified service providers shall
submit a training plan to all pilot regional centers for which they
provide services. The training program shall be subject to the
approval of the pilot regional center. Training shall emphasize
continuous improvement and be proactive and responsive to the
findings of quality reviews. Service providers shall be utilized as
training resources for their own programs as well as to assist other
providers and self-assessment tools shall be developed.

(5) Complaints regarding service provider performance shall
be addressed by the State Department of Developmental Services
and pilot regional centers, as determined during the development
of the structure of the pilot project pursuant to subdivision (e).
The pilot regional center shall initiate investigations of serious
complaints within 24 hours of receipt, or sooner if imminent danger
is alleged. A “serious complaint” is one which, upon investigation,
has identified a condition of “immediate danger,” as defined in
paragraph (18) of subdivision (a) of Section 56002 of Title 17 of
the California Code of Regulations. In cases of immediate danger
to a consumer, the pilot regional center shall plan for relocation
of the consumer. The complainant, if known, shall be advised of
the outcome of the investigation and of any corrective actions
required of the service provider.

(6) The department and pilot regional centers shall have the
right and responsibility to decertify a provider based upon a
substantiated serious complaint; a serious, life threatening,
preventable occurrence at the program; or a documented,
established pattern of substandard performance that continues
after notice and opportunity for corrective action.

(7) The department and pilot regional centers shall conduct a
transparent annual quality service review for the continuous
investigation and improvement of the quality of the services a pilot
regional center directly provides, based on the regional center
performance standards developed pursuant to paragraph (2) of
subdivision (g). The department shall monitor pilot regional center
service quality and outcomes, hold pilot regional centers
accountable for their performance, and use a service enhancement
approach to encourage and recognize regional center
improvements. Regional center annual quality service reviews
shall include, but not be limited to, all of the following:

(A) The existing performance contract with department pursuant
to Section 4629.

(B) An annual survey by an independent third party of a
statistically significant sample of consumers and families that
addresses both service provider and pilot regional center services
and includes, but is not limited to, improvements in consumer life
outcomes, the delivery and outcomes of services specified in the
individual program plan, and consumer satisfaction with service
coordination, including individual program plan development and
implementation and satisfaction with the consumer’s service
provider. Each pilot regional center shall select an independent
third-party entity, with advice from others outside the regional
center, to complete the annual survey described in this
subparagraph.

(C) An annual survey by an independent third party of a
statistically significant sample of service providers that addresses
their satisfaction with the pilot regional center’s customer service
to the provider and support of the provider’s service quality
performance. Data shall include, but not be limited to, provider
evaluation of regional center quality assurance, training, and
resource development processes, including the effectiveness,
efficiency, and timeliness of those functions. The independent
third-party entity selected to complete the annual survey described
in this subparagraph will be the same entity as the one selected to
complete the annual survey described in subparagraph (B).

(D) Additional components, as determined by the pilot regional
centers and the department.

(8) The Community Care Licensing Division of the State
Department of Social Services and the Licensing and Certification
Division of the State Department of Public Health shall continue
to be responsible for criminal background checks, as required by
law, for service provider staff.

(9) The State Department of Developmental Services and the
pilot regional centers shall implement, test, and verify the
Oversight Efficiency and Quality Enhancement Model data
collection system described in paragraph (3) of subdivision (g).

(10) The department and pilot regional centers shall share with
local advisory committees and statewide stakeholder organizations
the aggregate service provider quality review information and
analysis and regional center annual quality service reviews,
including the information described in paragraph (7). Pilot
regional centers shall make available for review by consumers,
families, advocates, and other interested persons the annual quality
reviews and quality enhancement and performance evaluation
reviews of service providers described in paragraph (3). These
reviews shall not contain personally identifiable consumer
information.

(k) (1) On or before October 1, 2016, the State Department of
Developmental Services shall contract with an independent agency
or organization to evaluate the pilot project and prepare a written
report of its findings. The scope of services for the contractor shall
be prepared by the department, in consultation with the State
Department of Social Services, the State Department of Public
Health, the Association of Regional Center Agencies, and
stakeholder organizations, including representatives of service
provider organizations. The evaluation shall, at a minimum,
address all of the following:

(A) A description of the structure and process of implementation
of the Oversight Efficiency and Quality Enhancement Model.

(B) The number and characteristics of the service providers
and programs subject to the pilot project, and the number of
consumers served under the pilot project.

(C) The overall impact of the model on consumers, including,
but not limited to, the extent to which consumers’ quality of life
outcomes improve, especially in the areas of health, safety,
community inclusion and participation, friendship, empowerment,
choice, and satisfaction.

(D) The overall impact of the model on service providers,
including, but not limited to, changes in the quality of services
provided, their ability to support people with developmental
disabilities, the cost of quality assurance-related activities,
including use of all resources, and the effectiveness and efficiency
of the model on their internal operations, business model, and
relationships with the regional centers.

(E) The overall impact of the model on pilot regional centers,
including, but not limited to, changes in the quality of services
directly provided by pilot regional centers, effectiveness and
efficiency of pilot regional centers’ quality oversight, and
enhancement efforts with service providers, their ability to support
people with developmental disabilities, the cost of quality
assurance-related activities, and the effectiveness and efficiency
of the model on their internal operations, business model, and
relationships between the service providers, pilot regional centers,
and the department.

(F) The overall impact of the model on the State Department of
Developmental Services, including, but not limited to, the
department’s role in monitoring pilot regional center service
quality and outcomes, in holding pilot regional centers accountable
for their performance, in ensuring that pilot regional centers are
aligned with Lanterman Developmental Disabilities Services Act
values, and in supporting evaluation enhancement of the quality
of services directly provided by pilot regional centers. The
department shall also consider the cost of quality assurance-related
activities, and the effectiveness and efficiency of the model on the
department’s internal operations and relationships with pilot
regional centers.

(G) The overall impressions, including, but not limited to, pilot
project strengths, weaknesses, and recommendations for
improvement of the model by employees of the department, pilot
regional center participants, service provider organizations and
their staff, state licensing and monitoring personnel, and consumers
and families, including, but not limited to, improvements and
innovations demonstrated, problems encountered, regulatory,
statutory, and programmatic barriers identified, and corrective
responses employed.

(H) The satisfaction with the model by department employees,
pilot regional center participants, provider organizations and their
staff, state licensing and monitoring personnel, consumers, and
families.

(I) Identification of the model’s strongest performance standard
areas, those most in need of improvement, and those with the
greatest quality improvement for both service providers and pilot
regional centers, as documented during the pilot project period.

(J) Aggregate and comparison data regarding service provider
certification attainment and losses of certification.

(K) The types, amounts, qualifications, and sufficiency of staffing
at the department and pilot regional centers to effectively
implement the model.

(L) The costs and cost-effectiveness of the model as compared
with the multiagency, statewide quality systems involved in services
to people with developmental disabilities, as measured and
described by the Legislative Analyst’s Office study of the current
system, as described in subdivision (i).

(M) An analysis and summary findings of all pilot project
consumers’ special incident reports and unusual occurrences
reported during the evaluation period, in comparison to special
incident reports under the current quality assurance systems.

(N) Recommendations for statewide application and expansion
of the Oversight Efficiency and Quality Enhancement Model.

(2) The evaluation by the independent agency or organization
shall include, at a minimum, the following approaches and
methodologies in the investigation of the evaluation parameters
pursuant to paragraph (1).

(A) Interviews, surveys, focus groups, and other assessments of
the pilot project participant groups, specifically, State Department
of Developmental Services employees, state licensing and
monitoring personnel, pilot regional center participants, service
provider organizations and their staff, and consumers and families,
by the independent evaluator or another independent third-party
agency or organization.

(B) Analysis of the Oversight Efficiency and Quality
Enhancement Model data system information.

(C) A comparison of consumers’ quality of life outcomes under
the model to baseline consumer outcome data collected at the start
of the pilot pursuant to subdivision (h). This data shall be made
available both as an aggregate of all pilot regional centers, as
well as by individual pilot regional center.

(D) A comparison, both historically and between regional
centers, of data collected pursuant to Section 4571 regarding
consumer and family satisfaction, provision of services, and
individual consumer outcomes, between and among those served
in the pilot project and those served using traditional quality
assurance systems.

(E) A review of selected service provider annual quality reviews
and a comprehensive quality enhancement and performance
evaluation review from each pilot regional center.

(F) A review of the pilot regional centers’ annual quality service
reviews and a comparison of that data to the baseline data
collected pursuant to subdivision (h). This data shall be made
available both as an aggregate of all pilot regional centers, as
well as by individual pilot regional center.

(G) A comparison of the impact of the model on regional center
accountability and quality of services compared to the impact of
the current performance contract processes under Section 4629
at both pilot and nonpilot regional centers.

(3) The written report by the independent agency or organization
shall be submitted to the State Department of Developmental
Services. The department shall circulate the report to the
Community Care Licensing Division of the State Department of
Social Services, the Licensing and Certification Division of the
State Department of Public Health, and the Association of Regional
Center Agencies. The department shall also submit the report to
the appropriate fiscal and policy committees of the Legislature by
July 1, 2017, and make it readily available to the public.

(l) The department may administer the pilot project through the
issuance of written directives that shall have the same force and
effect as regulations. Any directive affecting Article 1 (commencing
with Section 700) of Chapter 7 of Title 11 of the California Code
of Regulations shall be approved by the Department of Justice.
The directives shall be exempt from the rulemaking provisions of
the Administrative Procedure Act (Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code).

(m) The department may adopt emergency regulations to
implement this section. The adoption, amendment, repeal, or
readoption of a regulation authorized by this section is deemed to
be necessary for the immediate preservation of the public peace,
health and safety, or general welfare, for purposes of Sections
11346.1 and 11349.6 of the Government Code, and the State
Department of Developmental Services is hereby exempted from
the requirement that it describe specific facts showing the need
for immediate action. A certificate of compliance for these
implementing regulations shall be filed within 24 months following
the adoption of the first emergency regulations filed pursuant to
this section.

(n) The department may waive regulations that pose a barrier
to implementation and operation of this pilot project. The waiver
of regulations by the department pursuant to this section shall
apply to only those counties participating in the pilot project and
only for the duration of the pilot project.

(o) All aggregate and system-level reports generated pursuant
to this section shall be made publicly available, but shall not
contain the personal identifying information of any consumer or
other individual.

(p) This section shall only be implemented to the extent that
funds are made available through an appropriation in the annual
Budget Act.

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All matter omitted in this version of the bill appears in the bill as introduced in the Senate, February 22, 2013. (JR11)