BILL ANALYSIS Ó
AB 564
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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