BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 579|
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THIRD READING
Bill No: SB 579
Author: Berryhill (R)
Amended: 1/27/14
Vote: 21
SENATE HUMAN SERVICES COMMITTEE : 4-0, 1/14/14
AYES: Yee, Berryhill, Evans, Liu
NO VOTE RECORDED: Wright, Vacancy
SENATE APPROPRIATIONS COMMITTEE : 6-0, 1/23/14
AYES: De León, Gaines, Hill, Lara, Padilla, Steinberg
NO VOTE RECORDED: Walters
SUBJECT : Developmental services: Commission on Oversight
Efficiency and Quality Enhancement Models
SOURCE : Association of Regional Center Agencies
DIGEST : This bill creates a 12-member Commission on Oversight
Efficiency and Quality Enhancement Models (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).
Requires the Commission to recommend a strategy for creation of
a uniform data collection system, and establishes other
requirements, as specified.
ANALYSIS :
Existing law:
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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.
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.
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.
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.
5. Provides in the California Code of Regulations (CCR)
specific requirements for licensing, oversight and monitoring
of community facilities.
6. Provides in the CCR specific processes and requirements for
becoming a vendor of services for clients of the state's 21
nonprofit Regional Centers.
7. Establishes a contractual relationship between DDS and the
Regional Centers and specifies the requirements for the
Regional Centers to be able to continue contracting with the
state.
This bill:
1. Makes legislative findings and declarations that:
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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.
1. Establishes the Commission to investigate methods of
implementing a unified and consistent oversight and quality
enhancement process.
2. 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.
3. 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 and safety
of persons with developmental disabilities.
4. Requires that the process enhance accountability and quality
review processes for the services directly provided by
Regional Centers.
5. Establishes that the Commission be composed of not more than
12 members, as specified.
6. Requires DSS to provide staff support to the Commission.
7. Permits the Commission to appoint advisory groups to provide
specialized input to assist the Commission in its work.
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8. Requires the Commission to examine existing regulations and
statutes, and recommend changes to the DDS, as specified.
9. 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.
10.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.
11.Requires the Commission to review current sections in Titles
17 and 22 of the CCR 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.
12.Requires that recommendations for the strategy and
regulatory change reflect specific characteristics, as
defined.
13.Requires the Commission to 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 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.
1. 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 CCR affecting only
programs meeting both of the following:
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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.
1. 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
1. Requires the Commission to review and compile the input
received based on its relevance to the criteria described
above in #11 by Sept. 30, 2016.
2. Requires the Commission to submit a report to the
Legislature and DDS by December 31, 2016, with recommended
changes to Titles 17 and 22 of the CCR and any recommended
statutory changes, as specified.
3. Establishes a sunset date of January 1, 2018.
Comments
Community Care Licensing, Department of Social Services .
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 10% of facilities
per year based upon poor performance history.
Concerns about the lack of oversight by DSS led the department
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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% more random visits, 15% more total inspections and issued
13% more citations than the prior year.
Licensing and Certification Division, DPH . Consumers who live
in facilities whose needs necessitate a certain level of medical
care are subject to licensure and certification oversight by
DPH. These facilities include intermediate care facilities for
the developmentally disabled, specialized nursing homes, and
approximately 30 other types of health care facilities. DPH
conducts approximately 27,000 complaint investigations annually.
The Licensing and Certification program is housed within DPH's
Center for Health Care Quality, which includes about 1,200 staff
located in 14 District offices. It is the largest division
within DPH. Among its duties is to act as the "state survey
agency" for the federal Centers for Medicare and Medicaid (CMS).
In that role, DPH is responsible for certifying to the federal
government that the health care facilities are eligible for
payments under CMS programs. DPH makes a certification
recommendation after surveying the health care facilities and
establishing that they are in compliance with all federal
Conditions of Participation.
DDS . 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 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
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Developmental Services can issue to the Regional Centers.
Consolidating oversight . There have been many discussions over
the past decade about consolidating the licensing and
certification responsibilities of DSS and DPH into a single
agency. A proposal in Governor 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, which
houses 16 boards that oversee licensure or certification of 35
categories of health care professionals.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee, likely costs
of about $500,000 over two years to support the Commission
(General Fund). This estimate includes state staff to provide
administrative support to the Commission as well as travel and
other costs associated with the Commission.
SUPPORT : (Verified 1/23/14)
Association of Regional Center Agencies (source)
Autistry Studios
California Disability Services Association
Center for Autism and Related Disorders
Community Gatepath
Dominican University of California
Golden Gate Regional Center
Lifehouse
Opportunity for Independence
Premier Healthcare Services
San Diego Regional Center
The Alliance
The Arc/United Cerebral Palsy California Collaboration
The Cedars of Marin
United Cerebral Palsy/WORK, Inc.
ARGUMENTS IN SUPPORT : 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
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state resources and not effective at improving the quality of
services.
JL:k 1/27/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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