BILL ANALYSIS Ó
SENATE HUMAN
SERVICES COMMITTEE
Senator Leland Y. Yee, Chair
BILL NO: SB 579
S
AUTHOR: Berryhill
B
VERSION: January 6, 2014
HEARING DATE: January 14, 2014
5
FISCAL: Yes
7
9
CONSULTANT: Mareva Brown
SUBJECT
Developmental services: Commission on Oversight Efficiency
and Quality Enhancement
Models.
SUMMARY
This bill creates a 12-member commission to investigate
methods of streamlining oversight of programs that are
licensed by the Department of Social Services (DSS) and
vendorized by the Department of Developmental Services
(DDS). Additionally the bill states legislative intent that
DDS identify regional center catchment areas for voluntary
participation in a pilot project consistent with the
recommendations of the commission, and requires that
regional centers which are interested in participating in
the voluntary pilot project must collect baseline data on
existing processes, as specified. It requires that the
commission recommend a strategy for creation of a uniform
data collection system, and establishes other requirements,
as specified.
ABSTRACT
Continued---
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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Existing law:
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) Defines the types 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.)
3) 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.)
4) 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)
5) Provides in the California Code of Regulations
specific requirements for licensing, oversight and
monitoring of community facilities. (CCR Title 17, 22)
6) Provides in the California Code of Regulations
specific processes and requirements for becoming a
vendor of services for clients of the state's 21
nonprofit Regional Centers. (CCR Title 17, Division 2)
7) Establishes a contractual relationship between DDS
and the Regional Centers and specifies the
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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requirements for the Regional Centers to be able to
continue contracting with the state. (WIC 4620, et
seq.)
This bill:
1) Declares legislative findings that:
a. Evaluation of services by Regional Center
providers is a critical component of the service
system.
b. There is evidence that it is duplicative,
confusing, and fails to produce data essential
for service improvement to have three
state-funded entities - DSS, DDS and the
Department of Public Health (DPH) - charged with
monitoring and maintaining quality services and
supports for people with developmental
disabilities.
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) Establishes a Commission on Oversight Efficiency
and Quality Enhancement Models to investigate methods
of implementing a unified and consistent oversight and
quality enhancement process.
3) Requires that the process 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 DSS.
4) Directs the commission to give the utmost attention
to ensuring that the results of its work do not reduce
the quality of oversight and monitoring of the health
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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and safety of persons with developmental disabilities.
5) Requires that the process enhance accountability
and quality review processes for the services directly
provided by regional centers.
6) States legislative intent that based upon
information analysis and recommendations of the
commission, DDS shall identify regional center
catchment areas for voluntary participation in a pilot
project consistent with the recommendations of the
commission.
7) Establishes that the commission be composed of not
more than 12 members including:
a. Nine members - three each to be appointed
to be appointed by the Governor, Senate Rules
Committee and Speaker of the Assembly -- with the
following qualifications:
i. Each member must represent
statewide organizations and have
professional experience in quality assurance
within the developmental disabilities field,
and
ii. Each appointing authority must
appoint members who represent, as broadly as
possible, each of the following areas:
1. The service provider
community
2. The advocacy and
consumer services community
3. Regional centers
b. A representative may be appointed by each
of the state departments of Developmental
Services, Social Services and the California
Health and Human Services Agency.
8) Permits the commission to appoint advisory groups
to provide specialized input to assist the commission
in its work.
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9) Requires the commission to examine existing
regulations and statutes, and recommend changes to the
DDS, as specified.
10) Requires the commission to recommend, and include
in its final report, a strategy for uniform data
collection that provides reliable, valid and
actionable data from multiple stakeholder perspectives
and that may be consistently deployed at regional
centers.
11) This data strategy shall address to the fullest
extent possible all of the following:
a. Service provider and regional performance
b. Outcomes consistent with individual
program plan goals
c. Flexibility and implementation
d. Field-based data entry and analysis
e. Documentation, measurement and analysis
of the strategy's implementation
f. Usage of data currently being collected
by regional centers and DDS
g. Regional center and service provider
resources needed to implement the strategy
12) Requires the commission to consider, but not be
limited to, the experience, outcomes and data provided
by the National Core Indicators project, the Agnews
Developmental Center and the 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
strategy's structure, standards and data collection
methodologies.
13) Requires the commission to review current sections
in Titles 17 and 22 of the California Code of
Regulations and relevant statutes to better focus on
reliable data to measure outcomes for individuals
served and the impact of services on the lives of
individuals and their families.
14) Requires that recommendations for the strategy and
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regulatory change reflect the following
characteristics:
a) Be lean, simple, efficient, and understood by
the people it serves and those who serve them
b) Avoid unnecessary redundancies of process,
permissions, oversight, and enforcement
c) Base objective 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
d) Require that outcome measures be consistent
with performance measures for regional centers
e) Base subjective reviews of the impact on
individuals and families on satisfaction data
collected by an independent third party that surveys
a statistically significant sample of service
providers and individuals and families providing or
receiving those services
f) Shift the focus of quality efforts to a service
enhancement model that encourages and recognizes
service provider and regional center improvements
g) 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
h) 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
i) Enhance transparency, accountability, quality
standards, and measurement processes for the
services directly provided by regional centers
consistent with regional center performance
contracts
j) Provide consumers, families, service providers
and regional center staff the opportunity to
participate in system evaluation
aa) Ensure that the results of oversight, quality
enhancement and assurance review activities are
available in plain language to people with
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developmental disabilities and their families so
they can be informed consumers of the services that
they receive.
1) Requires that the commission determine no later
than June 30, 2015 the best methods of collecting
input on relevant statutes and sections of Titles 17
and 22 of the California Code of Regulations (CCR),
including but not limited to:
a. Holding at least two public meetings,
with one held in southern California and one held
in northern California
b. The electronic submission of comments
2) Requires the commission to request public input
concerning the revision, retention or removal of
relevant statutes and sections of Titles 17 and 22 of
the California Code of Regulations affecting only
programs meeting both of the following:
a. Are under the partial or exclusive
oversight of the Community Care Licensing
Division of DSS, and
b. Provide services and supports exclusively
or primarily to persons with developmental
disabilities.
3) Requires the commission to solicit comment on issue
areas including, but not limited to the following:
a. Certification and vendorization processes
b. Complaints
c. Quality oversight and monitoring
requirements
d. Decertification and de-vendorization
processes
e. Conflict and duplication in statutes and
regulations
4) Requires that the commission review and compile the
input received based on its relevance to the criteria
described above in (14) by Sept. 30, 2016.
5) Requires the commission to submit a report to the
Legislature and DDS by December 31, 2016 with
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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recommended changes to Titles 17 and 22 of the CCR and
any recommended statutory changes, as specified. The
report must also propose a process by which relevant
regulations and statutes governing the Licensing and
Certification Division at the State Department of
Public Health may be reviewed by a future commission,
if one is established.
6) Requires that regional centers that wish to be
considered for participation in any program to pilot
new quality enhancement systems must collect baseline
data, as determined by the commission on existing
service quality and quality assurances processes in
programs and services that are licensed by DSS's
Community Care Licensing Division. This data must be
collected between January 1, 2016 and December 31,
2016.
7) Establishes a sunset date of January 1, 2018.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
Bill history
SB 579 originally was heard by this committee on April 23,
2013, but was not voted upon due to concerns about various
provisions.
That version of the bill would have eliminated oversight of
service providers by the Community Care Licensing Division
within DSS and the Licensing and Certification Division
within the CDPH for five regional centers piloting the
project. That oversight would have been replaced with a new
model, run by the five pilot regional centers, with
oversight and data collection responsibilities by
Developmental Services. It mandated a shift of funds from
DSS and DPH to Developmental Services to pay for the
oversight. Additionally, it required the Legislative
Analyst's Office to identify all of the financial and human
resources directed to current quality assurance activities
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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for specified licensed programs, to identify which costs
are federally funded and to determine which costs could be
federally funded under the oversight shift. An evaluation
of the project was required.
Since that hearing, the author has amended the bill twice.
The current version removes the transfer of licensing
oversight from DSS and DPH to the Regional Centers. It
deletes the required LAO study, which has instead been
requested directly by the author. Instead, it creates a
12-member commission appointed by the Legislature and
Administration to review overlapping licensing and
regulatory schemes and requires the commission to submit a
report with recommended changes to the Legislature and to
DDS no later than September 30, 2016. It also mandates that
the commission hold at least two public meetings, in
Southern and Northern California, as well as provide a
mechanism to accept public comments electronically.
While the current version of the bill deletes the elaborate
provisions of the pilot project, it states legislative
intent that DDS identify regional center catchment areas
for voluntary participation in a pilot project consistent
with the recommendations of the commission. It requires
that the regional centers interested in participating in
the voluntary pilot project must collect baseline data - to
be specified by the commission - from January to December
2016 on existing service quality and quality assurance
processes.
It also requires that the commission recommend a strategy
for creation of a uniform data collection system, as
specified. The current version of the bill additionally
links outcome measurements of the new oversight model with
Regional Center performance contracts.
This version of the bill maintains the original language
that would create a new regulatory system based on 10
characteristics including shifting the focus of quality
efforts to a service enhancement model that encourages and
recognizes service provider and regional center
improvements.
Purpose of the bill
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The author states that it is very important to examine the
redundant and duplicative structure for the evaluation of
services and supports that individuals with developmental
disabilities receive from the Regional Centers. He states
that this redundancy is a wasteful use of limited state
resources and not effective at improving the quality of
services.
Current oversight activities
Community Care Licensing, Department of Social Services
Facilities serving consumers with developmental
disabilities such as day programs or group residential
homes are subject to licensing oversight by DSS. The
services provided in these facilities vary according to the
needs of the individual, but typically include help with
personal hygiene, dressing and grooming, and medication
assistance but exclude medical care provided by licensed
health care providers.
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
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 Key Indicators Tool, which resulted
in more frequent visits but of shorter duration. This
allows licensing staff to view more facilities each year,
and perform the traditional longer inspections only if
inspectors find indications that facilities have 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
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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Consumers who live in facilities whose needs necessitate a
certain level of medical care are subject to licensure 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.
Department of Developmental Services
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 1,350 people
who resided in developmental centers as of January 1, 2014.
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 (HCBS) 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.
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<1>
http://www.cdph.ca.gov/programs/LnC/Documents/LCSenateBudget
SubCommittee3Report.pdf
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Regional Centers
California's 21 regional centers are non-profit
organizations that provide local services and supports to
individuals through contracts with individual vendors.
Oversight of the regional center system 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 and
oversight of 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.
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. A
proposal in Gov. Arnold Schwarzenegger's 2005 California
Performance Review 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>
Even if oversight were consolidated, the requirements of
each type of licensing entity are so unique and complex
that there still would need to be specialists. CDPH, for
example, functions as the state-designated survey agency
for the Centers for Medicaid and Medicare Services, a role
which requires the staff to receive 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. CDPH reports that it may
take as long as three years to get a new licensing
specialist to complete the federal training in order for
them to be able to perform surveys for the Centers for
-------------------------
<2>
http://cpr.ca.gov/CPR_Report/Issues_and_Recommendations/Chap
ter_2_Health_and_Human_Services/HHS21.html
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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Medicaid and Medicare Services.
Comments
Concerns about contradictory regulations for facilities
that provide services to individuals with developmental
disabilities have been discussed for many years, however
without a thorough review of the overlapping and
contradictory regulations and statutes, it has been
difficult to evaluate the issue or determine a solution.
This bill would create a structure to facilitate that
evaluation, led by advocates and providers with expertise
in this area. Although this study is timely and
appropriate, this bill does not address several structural
problems with the commission.
Funding and staffing
This bill requires the 12-member commission to produce a
number of products, including a report to the Department,
to the Legislature that evaluates and recommends changes in
regulations and statute. It requires the commission hold
two public meetings, and collect public comment
electronically. It requires the commission to evaluate and
recommend a data system for use statewide. However, the
bill provides no staff to conduct research, produce reports
or perform administrative functions necessary for this
commission. Furthermore it requires commissioners to travel
to both ends of the state but does not address whether
commissioners receive travel compensation or per diem pay.
1. Staff recommends the author identify a department
or agency that will provide staff and other
administrative tasks to the commission. Staff also
recommends the author consider the language that
established the Disability Access Commission,<3> and
other commissions to establish an administrative
structure, specify reimbursement and per diem
expenses, acknowledge Bagley-Keene open meeting
regulations and address other commission structural
necessities.
2. Staff recommends identifying appointees to be
appointed by the specific entities. Specifically:
-----------------------
<3> California Government Code Sections 8299-8299.11
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WIC 4751 (c) The commission shall be composed of not
more than 12 members.
(1) The Governor, the Senate Committee on Rules, and
the Speaker of the Assembly shall each appoint three
members to serve on the commission consistent with
subparagraphs (A) and (B).
(A) The appointed members shall meet both of the
following requirements:
(i) Have professional experience in quality assurance
within the developmental disabilities field.
(ii) Represent statewide organizations.
(B) Each appointing authority shall appoint a member
representing, as broadly as possible, each of the
following areas:
(i) The service provider community.
(ii) The advocacy and consumer services community.
(iii) Regional centers.
(a) Three public members appointed by the Senate
Committee on Rules, with one appointee from the
advocacy community, one appointee who is a provider of
day program services, and one appointee representing
the Regional Centers.
(b) Three public members appointed by the Speaker of
the Assembly, with one appointee being a consumer or
family member, one appointee who is a provider of
residential services, and one appointee representing
the Regional Centers.
(c) Three public members appointed by the Governor,
with the consent of the Senate. The Governor shall
request and consider nominations from the advocacy
community, the provider community, the regional center
system, consumers and family members, and subject
experts in data collection and licensing oversight for
these appointments.
(2) The State Department of Developmental Services,
the State Department of Social Services, and the
California Health and Human Services Agency may each
select a representative to participate on the
commission.
(d) The commission may appoint advisory groups to
provide specialized input to assist the commission in
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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its work.
Pilot project assumes commission's conclusion
This bill requires the commission to "investigate methods
of implementing a unified and consistent oversight and
quality enhancement process" that will ensure the welfare,
community participation, health, and safety of all those
with developmental disabilities who are served in programs
currently licensed by DSS, while giving utmost attention to
not reducing the quality of oversight. It directs the
Commission to look at specific regulations, and at statute,
in evaluating redundancy and conflicting language. It
directs the commission to identify a strategy for data
collection and regulatory change that upholds 10
characteristics of oversight. However, it leaves open the
question of whether that can be accomplished within the
existing oversight structure and how far-reaching the
changes will need to be. The report is due to the
Legislature and DDS on September 30, 2016.
By establishing legislative intent to create a pilot
project from the recommendations, and by requiring
interested regional centers to begin collecting baseline
data on January 1, 2016, this presumes an outcome before
the Commission has finished its work. Furthermore, it
requires collection of baseline data, to be determined by
the commission, nine months before the commission
recommends a strategy. This directive may cause confusion
and unrealistic expectations among regional centers.
3. Should the bill move forward, staff recommends the
author consider striking language relating to the
pilot program until it is clear that a pilot is
appropriate.
POSITIONS
Support: Association of Regional Center Agencies
(sponsor)
Autistry Studios
California Disability Services Association
Center for Autism and Related Disorders
STAFF ANALYSIS OF SENATE BILL 579 (Berryhill)
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Community Gatepath
Dominican University of California
Golden Gate Regional Center
Lifehouse
Opportunity for Independence
Premier Healthcare Services
San Diego Regional Center
The Arc/United Cerebral Palsy California
Collaboration
The Alliance
The Cedars of Marin
United Cerebral Palsy/WORK, Inc.
34 Individuals
Oppose: None
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