BILL ANALYSIS                                                                                                                                                                                                    Ó



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          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.








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          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  








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            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  








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            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.  








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          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. 










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          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  








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          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.








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          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  








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          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.









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          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










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          None on file.





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