BILL ANALYSIS Ó
SENATE HUMAN
SERVICES COMMITTEE
Senator Leland Y. Yee, Chair
BILL NO: SB 579
S
AUTHOR: Berryhill
B
VERSION: April 9, 2013
HEARING DATE: April 23, 2013
5
FISCAL: Yes
7
9
CONSULTANT: Mareva Brown
SUBJECT
Developmental services: Oversight Efficiency and Quality
Enhancement Model
SUMMARY
This bill shifts oversight of regional center service
providers from the Community Care Licensing division of the
state Department of Social Services (DSS) and the Licensing
and Certification Division of the state Department of
Public Health (CDPH) to specified regional centers under a
4-year pilot project, the Oversight Efficiency and Quality
Enhancement Model. Requires the Legislative Analyst's
Office to identify all of the financial and human resources
directed to current quality assurance activities for
specified licensed programs, to identify which costs are
federally funded and to determine which costs could be
federally funded under the oversight shift. Requires an
evaluation of the project, as specified.
ABSTRACT
Existing law:
Continued---
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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1) Establishes the California Community Care
Facilities Act and declares Legislative intent to
assure that all people who require services in the
community are provided with the appropriate range of
social rehabilitative, habilitative and treatment
services, including residential and nonresidential
programs tailored to their needs; to protect the legal
and human rights of a person in or receiving services
from a community care facility; to ensure the quality
of community care facilities by evaluating the care
and services provided, as specified, and other
provisions. (HSC 1500 et seq.)
2) Establishes within the DSS a branch to license and
certify community care facilities and defines
community care facilities, as specified. (HSC 1500 et
seq.)
3) Defines the type of care and services that may be
provided in a licensed community care facility, as
well as the staffing requirements necessary to hold a
license. (HSC 1502 et seq.)
4) Defines criteria necessary to become licensed,
including requirements for staffing levels and staff
background checks, licensure fees, the requirement to
share information with other agencies about employees
who have been the subject of disciplinary action, and
other specified requirements. (HSC 1520 et seq.)
5) Requires that every DSS-licensed facility be
subject to unannounced visits "as often as necessary
to ensure the quality of care provided" and no less
than once every five years, as specified. (HSC 1534)
6) Establishes within CDPH a branch to license and
oversee residential care facilities for the elderly,
which includes "health facilities" including
Intermediate Care Facilities for the Developmental
Disabled. (HSC 1569 et seq.) (HSC 1250 et seq.)
7) Provides in the California Code of Regulations
specific requirements for licensing, oversight and
monitoring of community facilities. (CCR Title 17, 22)
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This bill:
1) Declares Legislative findings that:
a. Evaluation of services by regional center
providers is a critical component of the service
system.
b. It is duplicative and wasteful of state
dollars and resources to have three state
entities - DSS, DPH and the Department of
Developmental Services (DDS) with its regional
centers - charged with monitoring and maintaining
quality services and supports.
c. 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.
2) Creates an Oversight Efficiency and Quality
Enhancement Model pilot project for 4 years,
beginning January 1, 2014, that shifts the authority
and resources to the DDS, in conjunction with the
pilot regional centers, to implement a unified
oversight and quality enhancement process, as
specified.
3) Requires that the unified oversight and quality
enhancement model ensure the welfare, community
participation, health and safety of individuals with
developmental disabilities who are served in programs
licensed by DSS's division of community care licensing
(CCL) and DPH.
4) Requires that the process enhance accountability
and quality review for services directly provided by
regional centers.
5) Establishes legislative intent that if, at the
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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conclusion of the pilot project, the pilot has
sufficiently met its goals and standards, as
specified, it shall be extended statewide.
6) Specifies that the Golden Gate Regional Center, the
Tri-Counties Regional Center, the San Diego Regional
Center, and two additional regional centers are to
participate in the pilot project on a voluntary basis,
as specified.
7) Requires each participating regional center by
February 1, 2014, to 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
committee shall review pilot project data, as
specified.
8) Requires DDS and the pilot regional centers to
develop the structure for transfer of responsibilities
from the licensing branches of Social Services and
Public Health by April 1, 2014, as specified. The
licensing branches of DSS and DPH are required provide
staff to consult with DDS and the pilot regional
centers during this process.
9) Requires that the Oversight Efficiency and Quality
Enhancement Model 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.
10) Requires that the model do all of the following:
a) Be lean, simple, efficient, and understood by
the people it serves and avoid unnecessary
redundancies of process, permissions, oversight, and
enforcement.
b) Base reviews on quality standards that, in
accordance with Lanterman Developmental Disabilities
Services Act principles, address individual
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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outcomes, including, but not limited to, health,
safety, independence, choice, empowerment,
inclusion, and participation in community life.
c) Recognize that service outcomes and
effectiveness, the impact of services on consumers'
lives, and satisfaction data will be key to ensuring
quality.
d) Shift the focus of quality efforts to a service
enhancement model that encourages and recognizes
service provider and regional center improvements.
e) Include multiple options for proactive consumer
protections, including screening for qualified
providers, an emphasis on an evolving quality
improvement system of coaching and mentoring service
providers toward quality, and an immediate response
capacity to address people in imminent danger.
f) 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.
g) Enhance transparency, accountability, quality
standards, and measurement processes for the
services directly provided by regional centers.
h) Provide consumers, families, service providers,
and regional center staff the opportunity to
participate in system evaluation.
i) Ensure that the results of oversight, quality
enhancement, and quality 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.
1) Requires that by July 1, 2014, DDS and its
stakeholders do the following:
a. Establish certification requirements for
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new service providers and standards for provider
quality reviews, as specified, including for
health, safety, quality of life outcomes,
including community inclusion and participation,
choice, friendship, and empowerment. Requires the
requirements and stakeholders consider the
principles identified (in Item 10, above),
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.
b. 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) with
these new standards, as specified.
c. Establish performance standards for the
regional centers piloting the project and ensure
that these performance standards work in concert
with the service provider standards and be
aligned with the values of the Lanterman
Developmental Disabilities Services Act and other
principles, as specified. These 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.
d. Develop a uniform data collection system
that is consistently deployed at each pilot
regional center, as specified.
e. Consider the experience and outcomes from
the Agnews Developmental Center, Bay Area Quality
Management System and current quality reviews of
unlicensed Lanterman Developmental Disabilities
Services Act support models, in developing the
structure, standards, and data collection
methodologies for the model.
2) Requires that between January 1 and June 30, 2014,
participating regional centers collect baseline data
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on existing quality assurance processes currently
covered by DSS and CDPH. Baseline data shall meet all
of the following requirements:
a. 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.
b. Address the satisfaction of regional
center employees, service provider staff,
individuals, and families with the current
quality assurance system.
c. Address the impact of services on
consumers' lives, including, but not limited to,
the areas of health, safety, community
participation, friendship, empowerment, and
choice.
d. Address 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.
e. Be made available to the pilot project's
independent evaluator for comparison with pilot
project data, as specified.
1) Requires the Legislative Analyst's Office conduct
to a study to identify all of the financial and human
resources expended by the licensing divisions of DSS
and CDPH, and by DDS, the regional centers, and
service providers in conducting quality assurance
activities for the licensed programs identified in the
pilot project. The study shall determine quality
assurance costs that are covered by federal funds, and
recommend a means to reallocate funding through the
pilot model, as specified.
2) Requires that full implementation of the pilot
project and transfer of responsibilities begin on July
1, 2014 and defines quality review and oversight
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functions in the pilot regional center areas as
follows:
a. Requires that DDS certify new programs
and services for regional center consumers
through a request for proposal process, instead
of licensing them, as would be done under
existing regulations and law.
b. Requires a potential service provider to
complete an initial application for certification
with the local pilot regional center. The
application shall then be submitted to DSS for
issuance of a certificate, as specified.
c. Requires DDS to certify all existing
vendor programs in the pilot regional centers
that are licensed either by DSS or CDPH prior to
July 1, 2014, and prohibits those agencies from
monitoring those vendors.
d. Requires that each certified program have
an annual quality review conducted by pilot
regional center staff and, depending on the
findings of the annual quality reviews, a
comprehensive quality enhancement and performance
evaluation, as specified.
e. Requires that quality reviews and
monitoring visits to be effective and efficient
and be based upon performance standards, as
specified.
f. Requires all certified service providers
to submit a training plan to all pilot regional
centers for which they provide services, subject
to approval by the regional center(s). 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 to assist other providers and develop
self-assessment tools.
g. Requires that complaints regarding
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service provider performance be addressed by DDS
and the pilot regional centers, as determined by
DDS and the regional centers.
h. Requires pilot centers to investigate
serious complaints, as defined, within 24 hours
of receipt, or sooner if imminent danger is
alleged. In cases of immediate danger to a
consumer, the pilot regional center shall plan
for relocation of the consumer. Requires that the
complainant, if known, shall be advised of the
outcome of the investigation and of any
corrective actions required of the service
provider.
i. Establishes the right of DDS and the
pilot regional centers 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 have been provided.
j. Requires DDS to 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 existing
performance contracts with DDS, an annual survey
by an independent third-party evaluator, as
specified, and additional components as
determined by the pilot regional centers and the
department.
aa. Requires the licensing divisions of DSS
and CDPH to continue to be responsible for
criminal background checks, as required by law,
for service provider staff.
bb. Requires DDS and the pilot regional
centers to implement, test, and verify the
Oversight Efficiency and Quality Enhancement
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Model data collection system.
cc. Requires DDS and the pilot regional
centers to share with local advisory committees
and statewide stakeholder organizations data and
analysis service provider and regional center
reviews. Pilot regional centers shall make
available for review the service provider's
quality reviews and quality enhancement and
performance evaluation reviews. Prohibits reviews
from containing identifiable consumer
information.
3) Requires DDS to contract with an independent agency
by October 1, 2016, to evaluate the pilot project and
prepare a written report of its findings. In preparing
the contract, DDS is required to consult with DDS,
CDPH, the Association of Regional Center Agencies, and
stakeholder organizations, as specified. At minimum
the evaluation shall include:
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.
c. The overall impact of the model on
consumers, service providers, pilot regional
centers, DDS, as specified.
d. Consideration by DDS of 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.
e. 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
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organizations and their staff, state licensing
and monitoring personnel, and consumers and
families, as specified.
f. Satisfaction with the model by DDS
employees, pilot regional center participants,
provider organizations and their staff, state
licensing and monitoring personnel, consumers,
and families.
g. 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.
h. Aggregate and comparison data regarding
service provider certification attainment and
losses of certification.
i. Identification of the types, amounts,
qualifications, and sufficiency of staffing at
the department and pilot regional centers to
effectively implement the model.
j. Costs and cost-effectiveness of the model
as compared with the multiagency, statewide
quality systems involved in services to people
with developmental disabilities, as defined in
the LAO report required by this bill.
aa. 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.
bb. Recommendations for statewide application
and expansion of the Oversight Efficiency and
Quality Enhancement Model.
4) Requires the independent evaluator to utilize data
provided by the new model system, interviews, surveys,
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focus groups, and other assessments of the pilot
project participant groups, as well as a comparison of
consumers' quality of life outcomes under the model to
baseline, and other specified measurements.
5) Requires that the independent evaluator's written
report be submitted to DDS which shall then circulate
it to licensing and certification divisions of DSS and
CDPH, and to the Association of Regional Center
Agencies. DDS also must 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.
6) Permits DDS to administer the pilot project through
the issuance of written directives that shall have the
same force and effect as regulations, as specified,
and be exempt from the rulemaking provisions of the
Administrative Procedures Act.
7) Permits DDS to adopt emergency regulations to
implement this section, as is deemed to be necessary
for the immediate preservation of the public peace,
health and safety, or general welfare, per government
code, as specified. Also permits DDS to waive
regulations that pose a barrier to implementation of
the pilot project, as specified.
8) Requires that 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.
9) Requires that the pilot project be implemented only
to the extent that funds are made available through an
appropriation in the annual Budget Act.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
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BACKGROUND AND DISCUSSION
Purpose of the bill
The author states that SB 579 would create a clearer
regulatory framework for those who provide services to
people with developmental disabilities. The author also
states that "while this bill serves to eliminate wasted
state funds from having duplicative agencies reviewing
programs, and the unnecessary costs to service providers in
staffing the redundant and sometimes contradictory, quality
reviews; the primary goal of this bill is increased safety
and efficiency through clarity."
This bill would eliminate state oversight by the Community
Care Licensing Division of the Department of Social
Services and the Licensing and Certification Division of
the Department of Public Health for consumers who receive
services within the five regional centers piloting the
project. It would replace that oversight with a model, run
by the regional centers, with data collection and oversight
responsibilities by the Department of Developmental
Services.
Current Oversight activities
Community Care Licensing, Department of Social Services
Currently, consumers who live or spend time in facilities
such as day programs or group residential homes are subject
to licensing oversight by DSS, similar to the oversight of
foster youth in group homes and others who live in
out-of-home non-medical group care, as well as children in
day care and adults in adult day care programs. The
services provided in these facilities vary according to the
needs of the individual, but typically include help with
medications and assistance with personal hygiene, dressing
and grooming.
According to data from DSS, in 2013 there were more than
77,000 licensed community care facilities with a capacity
to serve 1.4 million residents. Prior to 2003, DSS was
required to visit most licensed facilities once per year
and family child care homes once every three years.
However, due to the state's ongoing budget deficit, the
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state eliminated these requirements in the 2003-04 budget
and limited visits to ten percent of facilities per year
based upon poor performance history.
Concerns about the lack of oversight by DSS led the
department to explore a program indicators project, which
would result in more frequent visits but of shorter
duration. This would allow licensing staff to view more
facilities each year, and perform the traditional longer
inspections only if inspectors found indications that
facilities had problems that warranted a more thorough
look. In 2012-13, DSS reported that it had conducted 30
percent more random visits, 15 percent more total
inspections and issued 13 percent more citations than the
prior year.
Licensing and Certification Division, Department of Public
Health
Consumers who live in facilities whose needs necessitate a
certain level of medical care are subject to license and
certification oversight by CDPH. These facilities include
intermediate care facilities for the developmentally
disabled, specialized nursing homes, and approximately 30
other types of health care facilities. CDPH conducts
approximately 27,000 complaint investigations annually.<1>
The Licensing and Certification program is housed within
CDPH's Center for Health Care Quality, which includes about
1,200 staff located in 14 District offices. It is the
largest division within CDPH. Among its duties is to act as
the "state survey agency" for the federal Centers for
Medicare and Medicaid (CMS). In that role, CDPH is
responsible for certifying to the federal government that
the health care facilities are eligible for payments under
CMS programs. CDPH makes a certification recommendation
after surveying the health care facilities and establishing
that they are in compliance with all federal Conditions of
Participation.
-------------------------
<1>
http://www.cdph.ca.gov/programs/LnC/Documents/LCSenateBudget
SubCommittee3Report.pdf
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Among the concerns that CDPH addressed recently before the
Legislature were questions about whether there were
inconsistencies across surveys and whether investigators
were using too much discretion in issuing citations. CDPH
responded with additional training for its survey teams.
Sonoma Developmental Center's recent federal
decertification also focused on the role of CDPH. The
department was criticized in an Oct. 23, 2012 joint hearing
before the Senate Human Services Committee and Subcommittee
#3 of the Senate Budget and Fiscal Review Committee for not
taking stronger action sooner against the Sonoma
Developmental Center, which had substandard care in its
Intermediate Care Facility (ICF) units. Prior and
subsequent to that hearing, CDPH and the federal Centers
for Medicare and Medicaid Services issued a number of
citations and findings of immediate jeopardy at the
facility and currently Sonoma Developmental Center is
operating without federal certification and reimbursement
for four of its 10 ICF units. Among the findings were
improper training by Developmental Center staff in the use
of catheters, improper tracking of Benadryl's use and other
medical practice issues.
Department of Developmental Services
The Lanterman Act and certain federal provisions require
DDS to oversee the state's 21 nonprofit regional centers
through its monitoring of each regional center's
contractual performance. To ensure that the regional
centers comply with requirements of the federal Medicaid
Home and Community-Based Services Waiver, DDS conducts
on-site program reviews and fiscal audits of the regional
centers. However, under a 1985 California Supreme Court
decision, there are limitations to the types of directives
Developmental Services can issue to the regional centers.
Federal licensing and certification requirements
Most of the service providers that would fall into this
consolidated oversight model receive federal matching funds
for services provided by DDS and the regional centers. To
qualify for that funding, the federal government requires a
number of licensing oversight activities.
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Consolidating oversight
There have been many discussions over the past decade about
consolidating the licensing and certification
responsibilities of DSS and CDPH into a single agency,
including a proposal in Gov. Arnold Schwarzenegger's 2005
California Performance Review. That document suggested that
licensing and certification functions within California's
Health and Human Services agencies be consolidated with the
Department of Consumer Affairs (DCA), which houses 16
boards that oversee licensure or certification of 35
categories of health care professionals.<2>
In total, the departments, agencies and boards oversee
approximately 58 different types of facilities and
programs, as well as more than 50 categories of health
and human services professionals. For some departments
and boards, the workload is enormous. For example, DSS
is currently responsible for licensure of
approximately 92,000 community care facilities, while
DHS licenses and monitors nearly 1,400 skilled nursing
facilities. The Medical Board of California is
responsible for licensure of more than 115,000
physicians, and the Board of Registered Nursing is
responsible for licensure of nearly 300,000 registered
nurses. Other departments and boards have somewhat
less daunting workloads. California Performance
Review.
Even if oversight were consolidated, the requirements of
each type of licensing entity is so unique and complex that
there still would likely need to be specialists within a
single oversight entity. CDPH, for example, functions as
the state-designated survey agency for the Centers for
Medicaid and Medicare Services which requires federally
certified training. Within the licensing and certification
division are specialists in licensing of nursing homes,
intermediate care facilities for the developmentally
disabled, and other medically involved facilities. So
specialized are the licensing protocols that a single
facility, such as a Developmental Center, may require
separate specialists to perform federal licensure surveys
-------------------------
<2>
http://cpr.ca.gov/CPR_Report/Issues_and_Recommendations/Chap
ter_2_Health_and_Human_Services/HHS21.html
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on, for example, the licensed General Acute Care Hospital,
or the Intermediate Care Facility for the Developmentally
Disabled. CDPH reports that it may take as long as three
years to get a new licensing specialist through the federal
training in order for them to be able to perform surveys
for the Centers for Medicaid and Medicare Services.
Regional Center oversight
Regional Centers are part of a system of care overseen by
the Department of Developmental Services (DDS). With a
proposed budget of $4.3 billion for community-based
services in 2013-2014, DDS is responsible for coordinating
care and providing services for nearly 260,000 people with
developmental disabilities who receive services and
supports to live in their communities, as well as
approximately 1,560 people who resided in developmental
centers as of March 6, 2013. California's 21 regional
centers are non-profit organizations that provide local
services and supports to individuals through contracts with
DDS.
Historically, the regional centers have been praised for
providing services that are tailored to local needs and
responsive to individuals in communities, and criticized
for their inconsistency across the state. While DDS sets
some common rates, there are variations in services and
historic rate variations across the regional center system.
Oversight of the state's 21 nonprofit regional centers was
the subject of a Legislative hearing in 2011, following
publication of a Bureau of State Audits report that
outlined concerns about contracting irregularities. In
response to those findings, a number of bills were
introduced and passed that required regional centers to
post information on their websites to provide more
transparency in their transactions with vendors. One issue
in obtaining transparency is that regional centers, as
nonprofits, are not subject to the same degree of public
scrutiny as state agencies.
Bureau of State Audit report
In August 2010, the Bureau of State Audits (BSA) released a
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report, "Department of Developmental Services: A More
Uniform and Transparent Procurement and RateSetting Process
Would Improve the CostEffectiveness of Regional Centers.
Among the findings was that while DDS performed its
required monitoring functions as specified, there still was
little oversight of regional center practices or of the
regional center oversight of its vendoring process.
The law and regulations do not prescribe the format,
content, or quality of rate negotiations between
vendors and regional centers, nor do they require the
regional centers to document the negotiation process.
Given the problems we found at the regional centers we
visited ? increased oversight of these rate
determinations appears to be warranted. (BSA p. 21)
Among the specific findings by the BSA were a lack of
documentation of procedures for approving and processing
invoices for services at two of the six audited regional
centers, one vendor's deliberate submission of inaccurate
transportation billing spreadsheets and the regional
center's failure to catch these inconsistencies and another
regional center's apparent awarding of a contract based
upon the amount of money it had to allocate rather than
service provision. The final example, which involved a
$950,000 contract to a transportation broker that the
regional center also was negotiating with for a service
contract, resulted in that regional center being sanctioned
by DDS after the BSA revealed the information.
Developmental Services provided little direct
oversight through existing monitoring efforts of how
regional centers establish rates. Within this
framework, we found-based on our review of a sample of
regional-center-established rates-that the regional
centers often do not retain support demonstrating that
they established rates using an appropriate level of
analysis. We also found that they sometimes
established rates using inappropriate processes that
gave the appearance of favoritism toward certain
vendors or fiscal irresponsibility. (BSA, p. 28)
Comments
This bill eliminates all oversight of regional center
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vendors by the state licensing and certification entities
charged with protecting consumer health and safety in the
five pilot regional centers. Instead it vests this
oversight with the regional centers, with certification
responsibility and some high-level oversight by DDS. As
noted by the BSA in 2010 and in legislation dating to the
current session, there are ongoing concerns about the
transparency of some regional center interactions with
vendors.
Fiscal timeline
This bill establishes July 1, 2014 as the start date for
the regional centers and DDS to begin certifying providers
in lieu of DSS or DPH licensure. It also establishes
funding beginning on that date. While at least one pilot
regional center has said that they can perform any
preparation activities within the existing budget, it is
unclear that DDS will be able to assemble stakeholders and
establish a new oversight system within the time allotted
and within existing budgetary resources.
In establishing certification and decertification
requirements for vendors along with input from
stakeholders, this bill requires DDS to replace all current
standards from Titles 17 and 22 of the California Code of
Regulations and to develop requirements and performance
standards that support the development, maintenance, and
continuous improvement of innovative, cost-effective
services. It also requires DDS to establish monitoring
standards for DDS and the regional centers as well as
requirements for emergency relocation of consumers, if
warranted. And it requires DDS to develop a uniform data
collection system that is consistently deployed at each
pilot regional center.
Staff recommends moving the implementation date to July 1,
2016.
LAO request
This bill requires the Legislative Analyst's Office to
conduct a study to identify all of the financial and human
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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resources expended by the licensing divisions of DSS and
CDPH, and by DDS, the regional centers, and service
providers, to determine quality assurance costs that are
covered by federal funds, and to recommend a means to
reallocate funding through the pilot model, as specified.
This language is unnecessary as the LAO is responsive to
member requests.
Staff recommends removing the LAO requirement and instead
having the member make this request directly.
Concerns about removing outside oversight
While there has been concern about potential conflicting
licensing requirements and program guidelines for
individuals with developmental disabilities, the solution
may not be to remove outside oversight, as this bill does,
nor to revise all existing licensing statutes. Furthermore,
it is unclear whether the federal Centers for Medicaid and
Medicare Services would permit a nonprofit entity to
perform the federal certification role that DPH currently
has. Without federally approved certification, the
providers would not be eligible for federal matching funds.
This bill would remove the role of DPH automatically,
without consideration of the federal funding implications.
Additionally, this bill would vest the pilot regional
centers with oversight of DDS consumers in an acute care
hospital, nursing home, or intermediate care facility for
the developmentally disabled, including those residing at
the state's Developmental Centers, such as Sonoma. Given
the current licensing and certification issues with Sonoma
Developmental Center, a change in oversight could delay the
recertification process with the federal government, which
is anticipated to be completed in 2014.
Staff recommends the bill be amended to use the existing
DDS and stakeholder workgroup process to review overlapping
oversight and licensure issues and to consider the best
process to address this, including whether placing this
responsibility with the nonprofit regional centers is the
best method to address consolidation of oversight.
Related legislation
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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AB 364 (Ian Calderon) 2013 Requires the DSS to visit a
community care facility and a residential care facility for
the elderly once every two years, instead of the current
requirement that they be visited no less than once every
five years.
POSITIONS
Support: Association of Regional Center Agencies
(sponsor)
Cal-TASH
Partnerships With Industry
San Diego Regional Center
7 individuals
Oppose: None received
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