BILL ANALYSIS                                                                                                                                                                                                    






                                                                     AB 563


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          Date of Hearing:   April 14, 2015


                        ASSEMBLY COMMITTEE ON HUMAN SERVICES


                                  Kansen Chu, Chair


          AB 563  
          (Lopez) - As Introduced February 24, 2015


          SUBJECT:  Developmental services


          SUMMARY:  Establishes a pilot program to address the needs of  
          aging individuals with developmental and intellectual  
          disabilities.


          Specifically, this bill:


          1)Requires the Department of Developmental Services (DDS) and  
            the California Department of Aging to develop guidelines and  
            protocols establishing best practices for providing services  
            and supports to aging consumers with developmental and  
            intellectual disabilities by January 1, 2017.


          2)Requires DDS to conduct a two-year pilot program that  
            implements those guidelines and protocols in three regional  
            centers, and requires DDS to submit a report to the  
            Legislature evaluating the pilot program by January 1, 2020,  
            as specified.


          3)Establishes a January 1, 2021 sunset date for the pilot  











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            program.


          EXISTING LAW:  


          1)Establishes an entitlement to services for individuals with  
            developmental disabilities under the Lanterman Developmental  
            Disabilities Services Act (Lanterman Act).  (WIC 4500 et seq.)



          2)Grants all individuals with developmental disabilities, among  
            all other rights and responsibilities established for any  
            individual by the United States Constitution and laws and the  
            California Constitution and laws, the right to treatment and  
            habilitation services and supports in the least restrictive  
            environment.  (WIC 4502)



          3)Establishes a system of 21 nonprofit regional centers  
            throughout the state to identify needs and coordinate services  
            for eligible individuals with developmental disabilities and  
            requires the DDS to contract with regional centers to provide  
            case management services and arrange for or purchase services  
            that meet the needs of individuals with developmental  
            disabilities, as defined.  (WIC 4620 et seq.)

          4)Requires the development of an individual program plan (IPP)  
            for each regional center consumer, which specifies services to  
            be provided to the consumer, based on his or her  
            individualized needs determination and preferences, and  
            defines that planning process as the vehicle to ensure that  
            services and supports are customized to meet the needs of  
            consumers who are served by regional centers.  (WIC 4512)














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          5)Requires the IPP planning processes to include:



             a)   A statement of the individual's goals and objectives, a  
               schedule of the type and nature of services to be provided  
               and other information and considerations, as specified;

             b)   Review and modification, as necessary, by the regional  
               center's planning team no less frequently than every three  
               years; and



             c)   Statewide training and review of the IPP plan creation,  
               as specified.  (WIC 4646.5)



          1)Establishes the federal Older American's Act, under which a  
            national network of state agencies on aging and area agencies  
            on aging (AAAs) provide home- and community-based services  
            that help older adults remain healthy and independent.   
            Programs include nutrition, job training, senior centers,  
            caregiver support, transportation, health promotion, benefits  
            enrollment, and elder abuse prevention.  (42 U.S.C. 3001 et  
            seq.)

          2)Establishes the Mello-Granlund Older Californians Act, which  
            reflects the federal Older Americans Act and provides  
            state-funded programs and services for older adults and people  
            with disabilities.  (WIC 9000 et seq.) 

          3)Establishes the California Department of Aging (CDA) within  
            the California Health and Human Services Agency for the  
            purpose of providing leadership to the AAAs in developing  
            systems of home- and community-based services that maintain  
            individuals in their own homes or least restrictive, homelike  
            environments.  (WIC 9100)











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          FISCAL EFFECT:  Unknown


          COMMENTS:  





          Developmental services:  The Lanterman Act (WIC  4500 et seq.)  
          guides the provision of services and supports for Californians  
          with developmental disabilities.  Each individual under the Act,  
          typically referred to as a "consumer," is legally entitled to  
          treatment and habilitation services and supports in the least  
          restrictive environment.  Lanterman Act services are designed to  
          enable all consumers to live more independent and productive  
          lives in the community. 


          The term "developmental disability" means a disability that  
          originates before an individual attains 18 years of age, is  
          expected to continue indefinitely, and constitutes a substantial  
          disability for that individual.  It includes intellectual  
          disabilities, cerebral palsy, epilepsy, and autism spectrum  
          disorders (ASD).  Other developmental disabilities are those  
          disabling conditions similar to an intellectual disability that  
          require treatment (i.e., care and management) similar to that  
          required by individuals with an intellectual disability.  





          Direct responsibility for implementation of the Lanterman Act  
          service system is shared by DDS and 21 regional centers, which  
          are private nonprofit entities, established pursuant to the  
          Lanterman Act, that contract with DDS to carry out many of the  
          state's responsibilities under the Act.  The 21 regional centers  











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          serve 279,000 consumers, providing services such as residential  
          placements, supported living services, respite care,  
          transportation, day treatment programs, work support programs,  
          and various social and therapeutic activities.  Approximately  
          1,100 consumers reside at one of California's three  
          Developmental Centers-and one state-operated, specialized  
          community facility-which provide 24-hour habilitation and  
          medical and social treatment services.  





          Services provided to people with developmental disabilities are  
          outlined in an IPP, which is developed by the IPP  
          team-including, among others, the consumer, his or her legally  
          authorized representative, and one or more regional center  
          representatives-and is based on the consumer's needs and  
          choices.  The Lanterman Act requires that the IPP promote  
          community integration and maximize opportunities for each  
          consumer to develop relationships, be part of community life,  
          increase control over his or her life, and acquire increasingly  
          positive roles in the community.  The IPP must give the highest  
          preference to those services and supports that allow minors to  
          live with their families and adults to live as independently as  
          possible in the community. 





          Department of Aging and Area Agencies on Aging:  The California  
          Department of Aging (CDA) administers programs that serve older  
          and disabled adults, as well as family caregivers and residents  
          in long-term care facilities.  These include basic nutrition  
          assistance, transportation services, in-home assistance,  
          caregiver support, health promotion, elder abuse prevention,  
          services that help older adults find employment, and other  
          services that help older and disabled individuals live  











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          independently in the community.  CDA's programs are administered  
          using funds allocated under the federal Older Americans Act, the  
          Older Californians Act, the Medi-Cal program, and public and  
          private grants.  


          CDA contracts with 33 AAAs throughout California, which are  
          responsible for planning, coordinating and directly managing  
          programs and services CDA oversees.  CDA also contracts directly  
          with agencies that operate the Multipurpose Senior Services  
          Program, which provides social and health care management  
          services to help frail individuals avoid or delay  
          institutionalization.  Approximately 80% of the money for AAA  
          programs is appropriated to the state from the federal  
          government.  


          Aging and developmental disabilities:  According to the U.S.  
          Census Bureau, the nation's population is expected to grow from  
          314 million in 2012 to 400 million in 2050 (a 27% increase),  
          while the population of individuals age 65 and older is expected  
          to increase by 94% during that same period of time, and is  
          expected to make up more than 20% of the projected US population  
          by 2050.  


          Regional centers are also experiencing an increase in the number  
          of older individuals they serve.  As of December 2014, 17,600  
          regional center consumers were between 52 and 61 years of age,  
          and 10,069 were 62 years of age and older, accounting for 7.25%  
          and 4.15% of the total regional center caseload, respectively.   
          By way of comparison, the number of regional center consumers  
          between 52 and 61 years of age in 2004 was 10,614, and there  
          were 4,845 individuals age 62 and older.  Compared to 2004, the  
          2014 figure for consumers age 62 and older represents an  
          increase of 5,224 consumers and an additional 1.4% of the  
          overall caseload. 













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          The University of Illinois at Chicago's Institute on Disability  
          and Human Development released a report in 2012, Bridging the  
          aging and developmental disabilities service networks:   
          Challenges and best practices, which outlines the unique service  
          needs of aging individuals with developmental disabilities.   
          Within the report, the authors estimate that the number of  
          individuals over age 60 living in the community with  
          developmental disabilities will increase considerably in the  
          coming decades, reaching 1.4 million by 2030.  They go on to  
          state that increased life expectancy is one of the major factors  
          contributing to the growing number of older individuals with  
          developmental disabilities, with the mean age of death being 66  
          years in 1993, compared to 59 years in the 1970s and 33 years in  
          the 1930s. <1> 





          Down Syndrome:  According to the National Down Syndrome Society,  
          6,000 babies born in the U.S. each year have Down Syndrome.   
          Because it is included in the etiology of intellectual  
          disability, over 18,000 individuals with Down Syndrome are  
          currently served by California's regional centers.  

          While data shows that, overall, individuals with intellectual  
          and developmental disabilities are experiencing increasingly  
          longer average lifespans, the needs of regional center consumers  
          with Down Syndrome have a particular connection to the needs of  
          many older adults without developmental disabilities.  This is  
          because Down Syndrome is the result of a person having a whole  
          or partial extra copy of chromosome 21, one of the chromosomes  
          ---------------------------
          <1> Factor, A., Heller, T., & Janicki, M. (2012). Bridging the  
          aging and developmental disabilities service networks:  
          Challenges and best practices. Chicago: Institute on Disability  
          and Human Development, University of Illinois at Chicago. 













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          associated with Alzheimer's disease.  According to the  
          Alzheimer's Association, the percentage of individuals with  
          Alzheimer's age 65 and older is nearly six times higher among  
          individuals with Down Syndrome than the percentage of people of  
          the same age group without Down Syndrome.

          Need for this bill:  According to the author, "Under existing  
          law, the Department of Developmental services is required to  
          contract with the Regional Centers to provide needed services to  
          individuals with developmental disabilities through all stages  
          of their lives. Currently the Regional Center system provides  
          specific services for infants, children, adolescents and adults.  
           There is no specific Regional Center unit that addresses the  
          unique needs of older adults.  Within the developmental  
          disability system, several individuals and programs have  
          independently attempted to fill the service gap that is not met  
          by the current DDS/Regional Center system.  This is indicative  
          of the significant needs of older adults with intellectual and  
          developmental disabilities, as the population continues to  
          increase."


          Recommended amendments:  While the increasing number of older  
          individuals served by regional centers does call for greater  
          attention to be focused on their changing needs, this bill is  
          not entirely clear as to whether the best practices that are  
          developed will dictate new services that will be sought from  
          providers that contract with the regional centers or new  
          practices the regional centers will execute as they interact  
          with consumers and their families.


          Additionally, this bill establishes a pilot program in three  
          regional centers, but there is no indication as to how the  
          regional centers will be chosen for the pilot.  This bill also  
          does not include language regarding the potential expansion of  
          the pilot so that aging consumers in other regional centers  
          throughout the state might benefit from implementation of the  
          identified best practices.  











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          Committee staff recommends the bill be amended to do the  
          following:


          1)Clarify whether the best practices to be implemented pertain  
            to actual services that will be included in a consumer's IPP,  
            when appropriate, or the general practices of the regional  
            centers when they interact with aging consumers, or both.

          2)Identify a process for selection of the three regional centers  
            to be included in the initial pilot program.

          3)Indicate when and how the identified best practices will be  
            implemented in other regional centers.

           DOUBLE REFERRAL  .  This bill has been double-referred.  Should  
          this bill pass out of this committee, it will be referred to the  
          Assembly Committee on Aging and Long-Term Care. 
          


          REGISTERED SUPPORT / OPPOSITION:




          Support


          New Horizons


          The Adult Skills Center (TASC)


          United Cerebral Palsy of Los Angeles












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          Valley Village




          Opposition


          None on file.




          Analysis Prepared by:Myesha Jackson / HUM. S. / (916) 319-2089