BILL ANALYSIS Ó AB 564 Page 1 Date of Hearing: April 28, 2015 ASSEMBLY COMMITTEE ON HUMAN SERVICES Kansen Chu, Chair AB 564 (Eggman) - As Amended April 22, 2015 SUBJECT: Regional centers: parental fees SUMMARY: Eliminates inconsistency in Parental Fee Program determinations and appeals processes for families with children receiving 24-hour out-of-home care through a regional center. Specifically, this bill: 1)Adds major unusual expenses, including, but not limited to, expenses caused by a natural disaster, catastrophic uninsured loss, or significant recent medical expenses to the factors that must be taken into account in establishing the parental fee amount. 2)Requires the parental fee schedule to be adjusted for the level of annual gross income and the number of persons living in the family home. 3)Codifies the ability for a parent to appeal the department's determination of the amount of the parental fee, which is currently allowed through state regulations. AB 564 Page 2 4)Requires the Department of Developmental Services to consider the same information regarding a parent's gross income and the factors required to be taken into account when determining a parental fee and when considering an appeal of a parental fee determination. 5)Requires a parental fee amount that is adjusted as the result of an appeal to be determined in accordance with the parental fee schedule. 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 Department of Developmental Services 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 AB 564 Page 3 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) 5)Establishes that an infant or toddler under age 3 who is eligible for regional center services shall have an individualized family service plan (IFSP) to direct services, as specified, and defines the types of services, supports and staffing that should be considered when creating the plan. (GOV 95020) 6)Requires regional centers to provide the consumer, his or her parent, legal guardian, or other appropriate authorized representative, as specified, at least annually, a statement of services and supports the regional center purchased, for the purpose of ensuring that the services are delivered. (WIC 4648(h)) 7)Requires regional centers to identify and pursue all possible sources of funding for consumers receiving regional center services, as specified. (WIC 4659 (a) and (b)) 8)Requires parents of children who are under age 18 and receiving 24-hour out-of-home-care services through a regional center to pay a parental fee, as specified. (WIC 4782) 9)Requires DDS to annually review and adjust, as needed, a AB 564 Page 4 schedule of parental fees for services provided through regional centers, as specified, and exempts families with income below the federal poverty level from assessment and payment of a parental fee. (WIC 4784) 10)Authorizes parents to appeal the determination of their ability to pay a parental fee or the amount of the parental fee within 30 days of receiving a parental fee confirmation letter, as specified. Requires DDS to review the appeal and provide written notice of the decision to the appellant and the appropriate regional center within 30 days after receipt of the appeal and related pertinent information, as specified. (CCR Title 17, Section 50241) FISCAL EFFECT: Unknown COMMENTS: Developmental services: The Lanterman Act 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 individuals served 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. AB 564 Page 5 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 serve 280,000 consumers and contract with providers, on their behalf, to deliver services such as residential placements, supported living services, respite care, transportation, day treatment programs, work support programs, and various social and therapeutic activities. Around 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. AB 564 Page 6 Out-of-home care: Residence types available to regional center consumers who are not able to remain safely at home vary based on the level of services needed, which dictate criteria such as staffing levels, the physical aspects of a facility, and programming. These residence types include community care homes, such as adult residential facilities, foster family homes, independent living and supported living settings, skilled nursing facilities (SNF) and intermediate care facilities (ICF), developmental centers, and community treatment facilities, among others. According to April 2015 data, nearly 77% of individuals served by regional centers live with their parents or in their own homes, while 96.76% of children (ages 0 to 17) live with their parents. The other 3.24% (or 4,295 children) live in out-of-home, primarily community care settings. There aren't any children living in independent living or supported living settings, nor are there any children living in the state's developmental centers. Parental Fee Program: Established in the early years of the Lanterman Act, the Parental Fee Program was put into statute to require parents of children who are under 18 years of age and receive 24-hour out-of-home care, paid for by a regional center, to pay a share of cost based on their ability to pay. The money DDS receives from the Parental Fee Program is required by law to be remitted to the State Treasury for deposit into the Program Development Fund, which is used to initiate new programs AB 564 Page 7 consistent with the California Developmental Disabilities State Plan. Parental fees are established for families with income at or above 100% of the Federal Poverty Level, and they range from $59 to $1,877 per month, based on family size and income. Today, there are 559 children in the Parental Fee Program. If parents are unhappy with the determination that they are required to pay a parental fee, or if they wish to dispute the actual monthly amount, they must submit a written request to appeal the determination or the amount within 30 days of receiving notification from DDS stating that they are to pay a parental fee. Within 30 days of receiving the appeal and all pertinent financial information from a family, DDS is required to review the appeal and provide written notice of the decision to the appellant and the appropriate regional center. A January 2015 California State Auditor report called into question whether implementation of the Parental Fee Program was effective and equitable. The Auditor found that DDS was using gross income and annual expenses when first determining a parent's ability to pay, and then using net income and monthly household expenses in the appeal process. This resulted in a recommendation that DDS eliminate inconsistencies between the information used for initial fee determinations and the information used when an appeal is filed. AB 564 Page 8 Current law requires the parental fee schedule to exempt families with income below 100% of poverty from assessment and payment of a parental fee and establishes a number of factors that DDS must consider when determining the parental fee amount parents are required to pay. These factors include: a)The current cost of caring for a child at home, as determined by the most recent data available from the United States Department of Agriculture's survey on the cost of raising a child in California, adjusted for the Consumer Price Index (CPI) from the survey date to the date of payment adjustment; b)Medical expenses incurred prior to regional center care; c)Whether the child is living at home; d)Parental payments for medical expenses, clothing, incidentals, and other items considered necessary for the normal rearing of a child; and e)Transportation expenses incurred in visiting a child. Additionally, Parental Fee Program regulations permit DDS to AB 564 Page 9 allow claims for major unusual expenses that limit a family's available resources, which can be used to adjust the family's gross income used to determine a parent's ability to pay and the amount of the fee. These expense allowances include expenditures that consume a substantial portion of the family's gross income, as well as expenditures over which parents have no control (e.g., natural disaster, catastrophic uninsured casualty loss, death of an immediate family member, extreme medical expense). Need for this bill: With this bill, the author hopes to provide more consistency in the implementation of the Parental Fee Program for families with children in out-of-home care. In addition to clarifying the factors to be considered when determining the amount of a parental fee, and codifying a parent's right to an appeal of a parental fee determination, this bill requires the same type of information to be used when making parental fee determinations and when considering appeals. Staff comments: The Department of Developmental Services responded to the recommendations provided in the State Auditor's report, stating that the recommendations were consistent with recent efforts the Department was making to review and update the numerous components of its Parental Fee Program. In response to the recommendation that DDS should eliminate inconsistency between the information analyzed for making parental fee determinations and the information considered for appeals, DDS stated that it will determine whether implementation of the recommendation is possible within current statutory and regulatory authority, and it will consider revisions to the Parental Fee Program regulations to promote a more transparent appeals process, if necessary. AB 564 Page 10 Recommended amendment: Whereas current appeals procedures within the Parental Fee Program are established in regulations, this bill codifies a parent's ability to appeal DDS' determination of the amount a parent is required to pay. While the ability to appeal should be clear, the requirement included in this bill does not spell out any of the responsibilities for either party involved in the appeal or the timeline for the appeals process. Considering DDS' response to the Auditor's recommendation, which may result in changes to the regulations that outline the appeals process, this bill should be consistent with the developing regulations pertaining to appeals. In order to clarify the process for an appeal in the Parental Fee Program, committee staff recommends this bill be amended to cross-reference Section 50241 of Title 17 of the California Code of Regulations, which describes the appeals process. REGISTERED SUPPORT / OPPOSITION: Support None on file. Opposition AB 564 Page 11 None on file. Analysis Prepared by:Myesha Jackson / HUM. S. / (916) 319-2089