Amended in Assembly May 4, 2016

Amended in Assembly March 18, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 2809

Introduced by Assembly Member Rodriguez

February 19, 2016

An act to amend Sections 4646.5, 4648, begin delete 4648.35, 4648.5, 4648.55, 4659, 4686.2, and 4686.5 of end delete begin insert and 4686.2 of, and to add Section 4646.45 to, end insert the Welfare and Institutions Code, relating to developmental services.

LEGISLATIVE COUNSEL’S DIGEST

AB 2809, as amended, Rodriguez. Developmental services: regional centers.

Existing law, the California Early Intervention Services Act, provides a statewide system of coordinated, comprehensive, family-centered, multidisciplinary, and interagency programs that are responsible for providing appropriate early intervention services and support to all eligible infants and toddlers, as defined, and their families and requires an eligible infant or toddler receiving services under the act to have an individualized family service plan (IFSP). The act requires these services to be provided pursuant to the existing regional center system under the Lanterman Developmental Disabilities Service Act.

Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services is responsible for providing various services and supports to individuals with developmental disabilities, and for ensuring the appropriateness and quality of those services and supports. Under existing law, the department contracts with regional centers to provide services and supports to persons with developmental disabilities. The services and supports to be provided to a regional center consumer are contained in an individual program plan (IPP), developed in accordance with prescribed requirements.

This bill would require regional centers to give certain information and materials to a consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, at the time of development, scheduled review, or modification of a consumer’s IPP or IFSP and would require that information and those materials to be begin delete in his, her, or their native language. end delete begin insert made available in threshold languages, as defined. end insert

begin delete

Existing law generally provides, beginning July 1, 2009 that a regional center shall not purchase medical or dental services for a consumer 3 years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center determines that an appeal of the denial by the consumer or family does not have merit. Existing law authorizes regional centers to pay for medical or dental services during certain periods, including, among others, while coverage is being pursued, but before a denial is made.

end delete begin delete

This bill would instead require regional centers to pay for medical or dental services during those periods.

end delete

Existing law also requires a regional center to only purchase applied behavioral analysis (ABA) services or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers.

This bill would require the regional center, when determining the extent of parent participation to consider any relevant hardships suffered by a parent or parents that may constitute a barrier to the consumer accessing those services. The bill would require the hardships to be documented in the IPP or IFSP and reviewed annually to determine if there has been a change in circumstances.

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 4646.45 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , end insert immediately following Section 4646.4 begin insert , to read: end insert

begin insert

begin insert 4646.45. end insert   

At the time of development, scheduled review, or
modification of a consumer’s individual program plan or
individualized family service plan, the regional center shall make
available, in a nontechnical, understandable form and in threshold
languages, as defined in paragraph (3) of subdivision (a) of Section
1810.410 of Title 9 of the California Code of Regulations, as
appropriate, to the consumer or his or her parents, legal guardian,
conservator, or authorized representative, or both, a document
describing all of the following and the process for obtaining each
exception or exemption:

(a) The exception described in subdivision (d) of Section
4648.35.

(b) The exemption described in subdivision (c) of Section 4648.5.

(c) The exemption described in subdivision (d) of Section
4648.55.

(d) The exemption described in subparagraph (A) of paragraph
(3) of subdivision (a) of Section 4686.5.

end insert

begin delete SECTION 1. end delete

begin insert SEC. 2. end insert   

Section 4646.5 of the Welfare and Institutions Code
is amended to read:

4646.5.  

(a) The planning process for the individual program
plan described in Section 4646 shall include all of the following:

(1) Gathering information and conducting assessments to
determine the life goals, capabilities and strengths, preferences,
barriers, and concerns or problems of the person with
developmental disabilities. For children with developmental
disabilities, this process should include a review of the strengths,
preferences, and needs of the child and the family unit as a whole.
Assessments shall be conducted by qualified individuals and
performed in natural environments whenever possible. Information
shall be taken from the consumer, his or her parents and other
family members, his or her friends, advocates, authorized
representative, if applicable, providers of services and supports,
and other agencies. The assessment process shall reflect awareness
of, and sensitivity to, the lifestyle and cultural background of the
consumer and the family.

(2) A statement of goals, based on the needs, preferences, and
life choices of the individual with developmental disabilities, and
a statement of specific, time-limited objectives for implementing
the person’s goals and addressing his or her needs. These objectives
shall be stated in terms that allow measurement of progress or
monitoring of service delivery. These goals and objectives should
maximize opportunities for the consumer to develop relationships,
be part of community life in the areas of community participation,
housing, work, school, and leisure, increase control over his or her
life, acquire increasingly positive roles in community life, and
develop competencies to help accomplish these goals.

(3) When developing individual program plans for children,
regional centers shall be guided by the principles, process, and
services and support parameters set forth in Section 4685.

(4) When developing an individual program plan for a transition
age youth or working age adult, the planning team shall consider
the Employment First Policy described in Chapter 14 (commencing
with Section 4868).

(5) A schedule of the type and amount of services and supports
to be purchased by the regional center or obtained from generic
agencies or other resources in order to achieve the individual
program plan goals and objectives, and identification of the
provider or providers of service responsible for attaining each
objective, including, but not limited to, vendors, contracted
providers, generic service agencies, and natural supports. The
individual program plan shall specify the approximate scheduled
start date for services and supports and shall contain timelines for
actions necessary to begin services and supports, including generic
services. In addition to the requirements of subdivision (h) of
Section 4646, each regional center shall offer, and upon request
provide, a written copy of the individual program plan to the
consumer, and, when appropriate, his or her parents, legal guardian
or conservator, or authorized representative within 45 days of their
request in a threshold language, as defined by paragraph (3) of
subdivision (a) of Section 1810.410 of Title 9 of the California
Code of Regulations.

(6) At the beginning of each individual program plan meeting,
the regional center shall provide a consumer and, when appropriate,
his or her parents, legal guardian, conservator, or authorized
representative begin delete a list of services provided by the regional center
and end delete information about the appeal and complaint process in begin delete his or
her native language. end delete begin insert threshold languages, as defined in paragraph
(3) of subdivision (a) of Section 1810.410 of Title 9 of the
California Code of Regulations, as appropriate. end insert

begin delete

(7) At the end of the individual program plan meeting, the
regional center shall provide a consumer and, when appropriate,
his or her parents, legal guardian, conservator, or authorized
representative a written list of agreed-upon services and supports,
including the amount and anticipated start date, and a list of any
services and supports for which final agreement has not yet been
reached and for which there will be a subsequent program plan
meeting pursuant to subdivision (f) of Section 4646.

end delete begin delete

(8)

end delete

begin insert (7) end insert  When agreed to by the consumer, the parents, legally
appointed guardian, or authorized representative of a minor
consumer, or the legally appointed conservator of an adult
consumer or the authorized representative, including those
appointed pursuant to subdivision (a) of Section 4541, subdivision
(b) of Section 4701.6, and subdivision (e) of Section 4705, a review
of the general health status of the adult or child, including medical,
dental, and mental health needs, shall be conducted. This review
shall include a discussion of current medications, any observed
side effects, and the date of the last review of the medication.
Service providers shall cooperate with the planning team to provide
any information necessary to complete the health status review. If
any concerns are noted during the review, referrals shall be made
to regional center clinicians or to the consumer’s physician, as
appropriate. Documentation of health status and referrals shall be
made in the consumer’s record by the service coordinator.

begin delete

(9)

end delete

begin insert (8) end insert  (A) The development of a transportation access plan for a
consumer when all of the following conditions are met:

(i) The regional center is purchasing private, specialized
transportation services or services from a residential, day, or other
provider, excluding vouchered service providers, to transport the
consumer to and from day or work services.

(ii) The planning team has determined that a consumer’s
community integration and participation could be safe and
enhanced through the use of public transportation services.

(iii) The planning team has determined that generic
transportation services are available and accessible.

(B) To maximize independence and community integration and
participation, the transportation access plan shall identify the
services and supports necessary to assist the consumer in accessing
public transportation and shall comply with Section 4648.35. These
services and supports may include, but are not limited to, mobility
training services and the use of transportation aides. Regional
centers are encouraged to coordinate with local public
transportation agencies.

begin delete

(10)

end delete

begin insert (9) end insert  A schedule of regular periodic review and reevaluation to
ascertain that planned services have been provided, that objectives
have been fulfilled within the times specified, and that consumers
and families are satisfied with the individual program plan and its
implementation.

(b) For all active cases, individual program plans shall be
reviewed and modified by the planning team, through the process
described in Section 4646, as necessary, in response to the person’s
achievement or changing needs, and no less often than once every
three years. If the consumer or, where appropriate, the consumer’s
parents, legal guardian, authorized representative, or conservator
requests an individual program plan review, the individual program
shall be reviewed within 30 days after the request is submitted.

(c) (1) The department, with the participation of representatives
of a statewide consumer organization, the Association of Regional
Center Agencies, an organized labor organization representing
service coordination staff, and the state council shall prepare
training material and a standard format and instructions for the
preparation of individual program plans, which embody an
approach centered on the person and family.

(2) Each regional center shall use the training materials and
format prepared by the department pursuant to paragraph (1).

(3) The department shall biennially review a random sample of
individual program plans at each regional center to ensure that
these plans are being developed and modified in compliance with
Section 4646 and this section.

begin delete SEC. 2. end delete

begin insert SEC. 3. end insert   

Section 4648 of the Welfare and Institutions Code is
amended to read:

4648.  

In order to achieve the stated objectives of a consumer’s
individual program plan, the regional center shall conduct activities,
including, but not limited to, all of the following:

(a) Securing needed services and supports.

(1) It is the intent of the Legislature that services and supports
assist individuals with developmental disabilities in achieving the
greatest self-sufficiency possible and in exercising personal
choices. The regional center shall secure services and supports
that meet the needs of the consumer, as determined in the
consumer’s individual program plan, and within the context of the
individual program plan, the planning team shall give highest
preference to those services and supports which would allow
minors with developmental disabilities to live with their families,
adult persons with developmental disabilities to live as
independently as possible in the community, and that allow all
consumers to interact with persons without disabilities in positive,
meaningful ways.

(2) In implementing individual program plans, regional centers,
through the planning team, shall first consider services and supports
in natural community, home, work, and recreational settings.
Services and supports shall be flexible and individually tailored
to the consumer and, where appropriate, his or her family.

(3) A regional center may, pursuant to vendorization or a
contract, purchase services or supports for a consumer from any
individual or agency that the regional center and consumer or,
when appropriate, his or her parents, legal guardian, or conservator,
or authorized representatives, determines will best accomplish all
or any part of that consumer’s program plan.

(A) Vendorization or contracting is the process for identification,
selection, and utilization of service vendors or contractors, based
on the qualifications and other requirements necessary in order to
provide the service.

(B) A regional center may reimburse an individual or agency
for services or supports provided to a regional center consumer if
the individual or agency has a rate of payment for vendored or
contracted services established by the department, pursuant to this
division, and is providing services pursuant to an emergency
vendorization or has completed the vendorization procedures or
has entered into a contract with the regional center and continues
to comply with the vendorization or contracting requirements. The
director shall adopt regulations governing the vendorization process
to be utilized by the department, regional centers, vendors, and
the individual or agency requesting vendorization.

(C) Regulations shall include, but not be limited to: the vendor
application process, and the basis for accepting or denying an
application; the qualification and requirements for each category
of services that may be provided to a regional center consumer
through a vendor; requirements for emergency vendorization;
procedures for termination of vendorization; begin insert and end insert the procedure
for an individual or an agency to appeal any vendorization decision
made by the department or regional center.

(D) A regional center may vendorize a licensed facility for
exclusive services to persons with developmental disabilities at a
capacity equal to or less than the facility’s licensed capacity. A
facility already licensed on January 1, 1999, shall continue to be
vendorized at their full licensed capacity until the facility agrees
to vendorization at a reduced capacity.

(E) Effective July 1, 2009, notwithstanding any other law or
regulation, a regional center shall not newly vendor a State
Department of Social Services licensed 24-hour residential care
facility with a licensed capacity of 16 or more beds, unless the
facility qualifies for receipt of federal funds under the Medicaid
Program.

(4) Notwithstanding subparagraph (B) of paragraph (3), a
regional center may contract or issue a voucher for services and
supports provided to a consumer or family at a cost not to exceed
the maximum rate of payment for that service or support
established by the department. If a rate has not been established
by the department, the regional center may, for an interim period,
contract for a specified service or support with, and establish a
rate of payment for, any provider of the service or support
necessary to implement a consumer’s individual program plan.
Contracts may be negotiated for a period of up to three years, with
annual review and subject to the availability of funds.

(5) In order to ensure the maximum flexibility and availability
of appropriate services and supports for persons with
developmental disabilities, the department shall establish and
maintain an equitable system of payment to providers of services
and supports identified as necessary to the implementation of a
begin delete consumers’ end delete begin insert consumer’s end insert individual program plan. The system of
payment shall include a provision for a rate to ensure that the
provider can meet the special needs of consumers and provide
quality services and supports in the least restrictive setting as
required by law.

(6) The regional center and the consumer, or when appropriate,
his or her parents, legal guardian, conservator, or authorized
representative, including those appointed pursuant to subdivision
(a) of Section 4541, subdivision (b) of Section 4701.6, or
subdivision (e) of Section 4705, shall, pursuant to the individual
program plan, consider all of the following when selecting a
provider of consumer services and supports:

(A) A provider’s ability to deliver quality services or supports
that can accomplish all or part of the consumer’s individual
program plan.

(B) A provider’s success in achieving the objectives set forth
in the individual program plan.

(C) Where appropriate, the existence of licensing, accreditation,
or professional certification.

(D) The cost of providing services or supports of comparable
quality by different providers, if available, shall be reviewed, and
the least costly available provider of comparable service, including
the cost of transportation, who is able to accomplish all or part of
the consumer’s individual program plan, consistent with the
particular needs of the consumer and family as identified in the
individual program plan, shall be selected. In determining the least
costly provider, the availability of federal financial participation
shall be considered. The consumer shall not be required to use the
least costly provider if it will result in the consumer moving from
an existing provider of services or supports to more restrictive or
less integrated services or supports.

(E) The consumer’s choice of providers, or, when appropriate,
the consumer’s parent’s, legal guardian’s, authorized
representative’s, or conservator’s choice of providers.

(7) No service or support provided by any agency or individual
shall be continued unless the consumer or, when appropriate, his
or her parents, legal guardian, or conservator, or authorized
representative, including those appointed pursuant to subdivision
(a) of Section 4541, subdivision (b) of Section 4701.6, or
subdivision (e) of Section 4705, is satisfied and the regional center
and the consumer or, when appropriate, the person’s parents or
legal guardian or conservator agree that planned services and
supports have been provided, and reasonable progress toward
objectives have been made.

(8) Regional center funds shall not be used to supplant the
budget of any agency that has a legal responsibility to serve all
members of the general public and is receiving public funds for
providing those services.

(9) (A) A regional center may, directly or through an agency
acting on behalf of the center, provide placement in, purchase of,
or follow-along services to persons with developmental disabilities
in, appropriate community living arrangements, including, but not
limited to, support service for consumers in homes they own or
lease, foster family placements, health care facilities, and licensed
community care facilities. In considering appropriate placement
alternatives for children with developmental disabilities, approval
by the child’s parent or guardian shall be obtained before placement
is made.

(B) Effective July 1, 2012, notwithstanding any other law or
regulation, a regional center shall not purchase residential services
from a State Department of Social Services licensed 24-hour
residential care facility with a licensed capacity of 16 or more
beds. This prohibition on regional center purchase of residential
services shall not apply to any of the following:

(i) A residential facility with a licensed capacity of 16 or more
beds that has been approved to participate in the department’s
Home and Community Based Services Waiver or another existing
waiver program or certified to participate in the Medi-Cal program.

(ii) A residential facility service provider that has a written
agreement and specific plan prior to July 1, 2012, with the
vendoring regional center to downsize the existing facility by
transitioning its residential services to living arrangements of 15
beds or less or restructure the large facility to meet federal
Medicaid eligibility requirements on or before June 30, 2013.

(iii) A residential facility licensed as a mental health
rehabilitation center by the State Department of Mental Health or
successor agency under any of the following circumstances:

(I) The facility is eligible for Medicaid reimbursement.

(II) The facility has a department-approved plan in place by
June 30, 2013, to transition to a program structure eligible for
federal Medicaid funding, and this transition will be completed by
June 30, 2014. The department may grant an extension for the date
by which the transition will be completed if the facility
demonstrates that it has made significant progress toward transition,
and states with specificity the timeframe by which the transition
will be completed and the specified steps that will be taken to
accomplish the transition. A regional center may pay for the costs
of care and treatment of a consumer residing in the facility on June
30, 2012, until June 30, 2013, inclusive, and, if the facility has a
department-approved plan in place by June 30, 2013, may continue
to pay the costs under this subparagraph until June 30, 2014, or
until the end of any period during which the department has granted
an extension.

(III) There is an emergency circumstance in which the regional
center determines that it cannot locate alternate federally eligible
services to meet the consumer’s needs. Under such an emergency
circumstance, an assessment shall be completed by the regional
center as soon as possible and within 30 days of admission. An
individual program plan meeting shall be convened immediately
following the assessment to determine the services and supports
needed for stabilization and to develop a plan to transition the
consumer from the facility into the community. If transition is not
expected within 90 days of admission, an individual program plan
meeting shall be held to discuss the status of transition and to
determine if the consumer is still in need of placement in the
facility. Commencing October 1, 2012, this determination shall
be made after also considering resource options identified by the
statewide specialized resource service. If it is determined that
emergency services continue to be necessary, the regional center
shall submit an updated transition plan that can cover a period of
up to 90 days. In no event shall placements under these emergency
circumstances exceed 180 days.

(C) (i) Effective July 1, 2012, notwithstanding any other law
or regulation, a regional center shall not purchase new residential
services from, or place a consumer in, institutions for mental
disease, as described in Part 5 (commencing with Section 5900)
of Division 5, for which federal Medicaid funding is not available.
Effective July 1, 2013, this prohibition applies regardless of the
availability of federal funding.

(ii) The prohibition described in clause (i) shall not apply to
emergencies, as determined by the regional center, when a regional
center cannot locate alternate services to meet the consumer’s
needs. As soon as possible within 30 days of admission due to an
emergency, an assessment shall be completed by the regional
center. An individual program plan meeting shall be convened
immediately following the assessment, to determine the services
and supports needed for stabilization and to develop a plan to
transition the consumer from the facility to the community. If
transition is not expected within 90 days of admission, an
emergency program plan meeting shall be held to discuss the status
of the transition and to determine if the consumer is still in need
of placement in the facility. If emergency services continue to be
necessary, the regional center shall submit an updated transition
plan to the department for an extension of up to 90 days. Placement
shall not exceed 180 days.

(iii) To the extent feasible, prior to any admission, the regional
center shall consider resource options identified by the statewide
specialized resource service established pursuant to subdivision
(b) of Section 4418.25.

(iv) The clients’ rights advocate shall be notified of each
admission and individual program begin delete planning end delete begin insert plan end insert meeting pursuant
to this subparagraph and may participate in all individual program
begin delete planning end delete begin insert plan end insert meetings unless the consumer objects on his or her
own behalf. For purposes of this clause, notification to the clients’
rights advocate shall include a copy of the most recent
comprehensive assessment or updated assessment and the time,
date, and location of the meeting, and shall be provided as soon
as practicable, but not less than seven calendar days prior to the
meeting.

(v) If a consumer is placed in an institution for mental disease
by another entity, the institution for mental disease shall inform
the regional center of the placement within five days of the date
the consumer is admitted. If an individual’s records indicate that
he or she is a regional center consumer, the institution for mental
disease shall make every effort to contact the local regional center
or department to determine which regional center to provide notice.
As soon as possible within 30 days of admission to an institution
for mental disease due to an emergency pursuant to clause (ii), or
within 30 days of notification of admission to an institution for
mental disease by an entity other than a regional center, an
assessment shall be completed by the regional center.

(vi) Regional centers shall complete a comprehensive assessment
of any consumer residing in an institution for mental disease as of
July 1, 2012, for which federal Medicaid funding is not available,
and for any consumer residing in an institution for mental disease
as of July 1, 2013, without regard to federal funding. The
comprehensive assessment shall be completed prior to the
consumer’s next scheduled individual program plan meeting and
shall include identification of the services and supports needed
and the timeline for identifying or developing those services needed
to transition the consumer back to the community. Effective
October 1, 2012, the regional center shall also consider resource
options identified by the statewide specialized resource service.
For each individual program plan meeting convened pursuant to
this subparagraph, the clients’ rights advocate for the regional
center shall be notified of the meeting and may participate in the
meeting unless the consumer objects on his or her own behalf. For
purposes of this clause, notification to the clients’ rights advocate
shall include the time, date, and location of the meeting, and shall
be provided as soon as practicable, but not less than seven calendar
days prior to the meeting.

(D) A person with developmental disabilities placed by the
regional center in a community living arrangement shall have the
rights specified in this division. These rights shall be brought to
the person’s attention by any means necessary to reasonably
communicate these rights to each resident, provided that, at a
minimum, the Director of Developmental Services prepare,
provide, and require to be clearly posted in all residential facilities
and day programs a poster using simplified language and pictures
that is designed to be more understandable by persons with
intellectual disabilities and that the rights information shall also
be available through the regional center to each residential facility
and day program in alternative formats, including, but not limited
to, other languages, braille, and audiotapes, when necessary to
meet the communication needs of consumers.

(E) Consumers are eligible to receive supplemental services
including, but not limited to, additional staffing, pursuant to the
process described in subdivision (d) of Section 4646. Necessary
additional staffing that is not specifically included in the rates paid
to the service provider may be purchased by the regional center if
the additional staff are in excess of the amount required by
regulation and the individual’s planning team determines the
additional services are consistent with the provisions of the
individual program plan. Additional staff should be periodically
reviewed by the planning team for consistency with the individual
program plan objectives in order to determine if continued use of
the additional staff is necessary and appropriate and if the service
is producing outcomes consistent with the individual program plan.
Regional centers shall monitor programs to ensure that the
additional staff is being provided and utilized appropriately.

(10) Emergency and crisis intervention services including, but
not limited to, mental health services and behavior modification
services, may be provided, as needed, to maintain persons with
developmental disabilities in the living arrangement of their own
choice. Crisis services shall first be provided without disrupting a
person’s living arrangement. If crisis intervention services are
unsuccessful, emergency housing shall be available in the person’s
home community. If dislocation cannot be avoided, every effort
shall be made to return the person to his or her living arrangement
of choice, with all necessary supports, as soon as possible.

(11) Among other service and support options, planning teams
shall consider the use of paid roommates or neighbors, personal
assistance, technical and financial assistance, and all other service
and support options which would result in greater self-sufficiency
for the consumer and cost-effectiveness to the state.

(12) When facilitation as specified in an individual program
plan requires the services of an individual, the facilitator shall be
of the consumer’s choosing.

(13) The community support may be provided to assist
individuals with developmental disabilities to fully participate in
community and civic life, including, but not limited to, programs,
services, work opportunities, business, and activities available to
persons without disabilities. This facilitation shall include, but not
be limited to, any of the following:

(A) Outreach and education to programs and services within
the community.

(B) Direct support to individuals that would enable them to
more fully participate in their community.

(C) Developing unpaid natural supports when possible.

(14) When feasible and recommended by the individual program
planning team, for purposes of facilitating better and cost-effective
services for consumers or family members, technology, including
telecommunication technology, may be used in conjunction with
other services and supports. Technology in lieu of a consumer’s
in-person appearances at judicial proceedings or administrative
due process hearings may be used only if the consumer or, when
appropriate, the consumer’s parent, legal guardian, conservator,
or authorized representative, gives informed consent. Technology
may be used in lieu of, or in conjunction with, in-person training
for providers, as appropriate.

(15) Other services and supports may be provided as set forth
in Sections 4685, 4686, 4687, 4688, and 4689, when necessary.

(16) Notwithstanding any other law or regulation, effective July
1, 2009, regional centers shall not purchase experimental
treatments, therapeutic services, or devices that have not been
clinically determined or scientifically proven to be effective or
safe or for which risks and complications are unknown.
Experimental treatments or therapeutic services include
experimental medical or nutritional therapy when the use of the
product for that purpose is not a general physician practice. For
regional center consumers receiving these services as part of their
individual program plan (IPP) or individualized family service
plan (IFSP) on July 1, 2009, this prohibition shall apply on August
1, 2009.

(b) (1) Advocacy for, and protection of, the civil, legal, and
service rights of persons with developmental disabilities as
established in this division.

(2) Whenever the advocacy efforts of a regional center to secure
or protect the civil, legal, or service rights of any of its consumers
prove ineffective, the regional center or the person with
developmental disabilities or his or her parents, legal guardian, or
other representative may request advocacy assistance from the
state council.

(c) The regional center may assist consumers and families
directly, or through a provider, in identifying and building circles
of support within the community.

(d) In order to increase the quality of community services and
protect consumers, the regional center shall, when appropriate,
take either of the following actions:

(1) Identify services and supports that are ineffective or of poor
quality and provide or secure consultation, training, or technical
assistance services for any agency or individual provider to assist
that agency or individual provider in upgrading the quality of
services or supports.

(2) Identify providers of services or supports that may not be
in compliance with local, state, and federal statutes and regulations
and notify the appropriate licensing or regulatory authority to
investigate the possible noncompliance.

(e) When necessary to expand the availability of needed services
of good quality, a regional center may take actions that include,
but are not limited to, the following:

(1) Soliciting an individual or agency by requests for proposals
or other means, to provide needed services or supports not presently
available.

(2) Requesting funds from the Program Development Fund,
pursuant to Section 4677, or community placement plan funds
designated from that fund, to reimburse the startup costs needed
to initiate a new program of services and supports.

(3) Using creative and innovative service delivery models,
including, but not limited to, natural supports.

(f) Except in emergency situations, a regional center shall not
provide direct treatment and therapeutic services, but shall utilize
appropriate public and private community agencies and service
providers to obtain those services for its consumers.

(g) When there are identified gaps in the system of services and
supports or when there are identified consumers for whom no
provider will provide services and supports contained in his or her
individual program plan, the department may provide the services
and supports directly.

(h) At least annually, begin delete and at the time of development, scheduled
review, or modification of a consumer’s individual program plan
or individualized family service plan, end delete regional centers shall provide
the consumer, his or her parents, legal guardian, conservator, or
authorized representative a statement of services and supports the
regional center purchased for the purpose of ensuring that they are
delivered. The statement shall include the type, unit, month, and
cost of services and supports purchased. The regional center shall
begin delete provide that statement in the native language of the end delete begin insert make that
statement available in threshold languages, as defined in
paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of
the California Code of Regulations, as appropriate, to the end insert
consumer or his or her parents, legal guardian, conservator, or
authorized representative, or both.

begin delete

SEC. 3.  

Section 4648.35 of the Welfare and Institutions Code
is amended to read:

4648.35.  

At the time of development, review, or modification
of a consumer’s individual program plan (IPP) or individualized
family service plan (IFSP), all of the following shall apply to a
regional center:

(a) A regional center shall not fund private specialized
transportation services for an adult consumer who can safely access
and utilize public transportation, when that transportation is
available.

(b) A regional center shall fund the least expensive
transportation modality that meets the consumer’s needs, as set
forth in the consumer’s IPP or IFSP.

(c) A regional center shall fund transportation, when required,
from the consumer’s residence to the lowest-cost vendor that
provides the service that meets the consumer’s needs, as set forth
in the consumer’s IPP or IFSP. For purposes of this subdivision,
the cost of a vendor shall be determined by combining the vendor’s
program costs and the costs to transport a consumer from the
consumer’s residence to the vendor.

(d) A regional center shall fund transportation services for a
minor child living in the family residence, only if the family of
the child provides sufficient written documentation to the regional
center to demonstrate that it is unable to provide transportation for
the child. At the time of development, scheduled review, or
modification of a consumer’s individual program plan or
individualized family service plan, the regional center shall provide,
in a non-technical, understandable form and in the native language
of the consumer or his or her parents, legal guardian, conservator,
or authorized representative, or both, a written statement of the
requirement described in this subdivision and examples of
sufficient written documentation that may be submitted. The
regional center shall accept documentation submitted pursuant to
this subdivision in any written form, including in the native
language of the consumer or his or her parents, legal guardian,
conservator, or authorized representative.

SEC. 4.  

Section 4648.5 of the Welfare and Institutions Code
is amended to read:

4648.5.  

(a) Notwithstanding any other law or regulations to
the contrary, effective July 1, 2009, a regional centers’ authority
to purchase the following services shall be suspended pending
implementation of the Individual Choice Budget and certification
by the Director of Developmental Services that the Individual
Choice Budget has been implemented and will result in state budget
savings sufficient to offset the costs of providing the following
services:

(1) Camping services and associated travel expenses.

(2) Social recreation activities, except for those activities
vendored as community-based day programs.

(3) Educational services for children three to 17, inclusive, years
of age.

(4) Nonmedical therapies, including, but not limited to,
specialized recreation, art, dance, and music.

(b) For regional center consumers receiving services described
in subdivision (a) as part of their individual program plan (IPP) or
individualized family service plan (IFSP), the prohibition in
subdivision (a) shall take effect on August 1, 2009.

(c) An exemption may be granted on an individual basis in
extraordinary circumstances to permit purchase of a service
identified in subdivision (a) when the regional center determines
that the service is a primary or critical means for ameliorating the
physical, cognitive, or psychosocial effects of the consumer’s
developmental disability, or the service is necessary to enable the
consumer to remain in his or her home and no alternative service
is available to meet the consumer’s needs.

(d) At the time of development, scheduled review, or
modification of a consumer’s individual program plan or
individualized family service plan, the regional center shall provide,
in a non-technical, understandable form and in the native language
of the consumer or his or her parents, legal guardian, conservator,
or authorized representative, or both, a written statement describing
the exemption in subdivision (c) and examples of documentation
that may be submitted to demonstrate qualification for the
exemption.

SEC. 5.  

Section 4648.55 of the Welfare and Institutions Code
is amended to read:

4648.55.  

(a) A regional center shall not purchase day program,
vocational education, work services, independent living program,
or mobility training and related transportation services for a
consumer who is 18 to 22 years of age, inclusive, if that consumer
is eligible for special education and related education services and
has not received a diploma or certificate of completion, unless the
individual program plan (IPP) planning team determines that the
consumer’s needs cannot be met in the educational system or grants
an exemption pursuant to subdivision (d). If the planning team
determines that generic services can meet the consumer’s day,
vocational education, work services, independent living, or mobility
training and related transportation needs, the regional center shall
assist the consumer in accessing those services. To ensure that
consumers receive appropriate educational services and an effective
transition from services provided by educational agencies to
services provided by regional centers, the regional center service
coordinator, at the request of the consumer or, where appropriate,
the consumer’s parent, legal guardian, or conservator, may attend
the individualized education program (IEP) planning team meeting.

(b) For consumers who are 18 to 22 years of age, inclusive, who
have left the public school system, and who are receiving regional
center purchased services identified in subdivision (a) on or before
the effective date of this section, a determination shall be made
through the IPP as to whether the return to the educational system
can be achieved while meeting the consumer’s needs. If the
planning team determines that the consumer’s needs cannot be
met in the educational system, the regional center may continue
to purchase the services identified in subdivision (a). If the planning
team determines that generic services can meet the consumer’s
day, vocational education, work services, independent living, or
mobility training and related transportation needs, the regional
center shall assist the consumer in accessing those services.

(c) For consumers who are 18 to 22 years of age, inclusive, who
have left school prior to enactment of this section, but who are not
receiving any of the regional center purchased services identified
in subdivision (a), the regional center shall use generic education
services to meet the consumer’s day, vocational education, work
services, independent living, or mobility training and related
transportation needs if those needs are subsequently identified in
the IPP unless the consumer is eligible for an exemption as set
forth in subdivision (d). If the planning team determines that
generic services can meet the consumer’s day, vocational
education, work services, independent living, or mobility training
and related transportation needs, the regional center shall assist
the consumer in accessing those services.

(d) (1) An exemption to the provisions of this section may be
granted on an individual basis in extraordinary circumstances to
permit purchase of a service identified in subdivision (a). An
exemption shall be granted through the IPP process and shall be
based on a determination that the generic service is not appropriate
to meet the consumer’s need.

(2) At the time of development, scheduled review, or
modification of a consumer’s individual program plan, the regional
center shall provide, in a non-technical, understandable form and
in the native language of the consumer or his or her parents, legal
guardian, conservator, or authorized representative, or both, a
written statement describing the exemption in paragraph (1) and
examples of documentation that may be submitted to demonstrate
qualification for the exemption.

(3) The IPP planning team shall consider the standard set forth
in Section 4688.05 when determining whether the consumer
qualifies for an exemption under this subdivision for the purpose
of meeting his or her independent living needs.

(e) A school district may contract with regional center vendors
to meet the needs of consumers pursuant to this section.

SEC. 6.  

Section 4659 of the Welfare and Institutions Code is
amended to read:

4659.  

(a) Except as otherwise provided in subdivision (b) or
(e), the regional center shall identify and pursue all possible sources
of funding for consumers receiving regional center services. These
sources shall include, but not be limited to, both of the following:

(1) Governmental or other entities or programs required to
provide or pay the cost of providing services, including Medi-Cal,
Medicare, the Civilian Health and Medical Program for Uniform
Services, school districts, and federal supplemental security income
and the state supplementary program.

(2) Private entities, to the maximum extent they are liable for
the cost of services, aid, insurance, or medical assistance to the
consumer.

(b) Any revenues collected by a regional center pursuant to this
section shall be applied against the cost of services prior to use of
regional center funds for those services. This revenue shall not
result in a reduction in the regional center’s purchase of services
budget, except as it relates to federal supplemental security income
and the state supplementary program.

(c) Effective July 1, 2009, notwithstanding any other law or
regulation, regional centers shall not purchase any service that
would otherwise be available from Medi-Cal, Medicare, the
Civilian Health and Medical Program for Uniform Services,
In-Home Support Services, California Children’s Services, private
insurance, or a health care service plan when a consumer or a
family meets the criteria of this coverage but chooses not to pursue
that coverage. If, on July 1, 2009, a regional center is purchasing
that service as part of a consumer’s individual program plan (IPP),
the prohibition shall take effect on October 1, 2009.

(d) (1) Effective July 1, 2009, notwithstanding any other law
or regulation, a regional center shall not purchase medical or dental
services for a consumer three years of age or older unless the
regional center is provided with documentation of a Medi-Cal,
private insurance, or a health care service plan denial and the
regional center determines that an appeal by the consumer or family
of the denial does not have merit. If, on July 1, 2009, a regional
center is purchasing the service as part of a consumer’s IPP, this
provision shall take effect on August 1, 2009. At the time of
development, scheduled review, or modification of a consumer’s
individual program plan or individualized family service plan, the
regional center shall provide, in a non-technical, understandable
form and in the native language of the consumer or his or her
parents, legal guardian, conservator, or authorized representative,
or both, a written statement describing the documentation required
pursuant to this paragraph. Regional centers shall pay for medical
or dental services during the following periods:

(A) While coverage is being pursued, but before a denial is
made.

(B) Pending a final administrative decision on the administrative
appeal if the family has provided to the regional center a
verification that an administrative appeal is being pursued.

(C) Until the commencement of services by Medi-Cal, private
insurance, or a health care service plan.

(2) When necessary, the consumer or family may receive
assistance from the regional center, the Clients’ Rights Advocate
funded by the department, or the state council in pursuing these
appeals.

(e) This section shall not impose any additional liability on the
parents of children with developmental disabilities, or to restrict
eligibility for, or deny services to, any individual who qualifies
for regional center services but is unable to pay.

(f) In order to best utilize generic resources, federally funded
programs, and private insurance programs for individuals with
developmental disabilities, the department and regional centers
shall engage in the following activities:

(1) Within existing resources, the department shall provide
training to regional centers, no less than once every two years, in
the availability and requirements of generic, federally funded and
private programs available to persons with developmental
disabilities, including, but not limited to, eligibility requirements,
the application process and covered services, and the appeal
process.

(2) Regional centers shall disseminate information and training
to all service coordinators regarding the availability and
requirements of generic, federally funded, and private insurance
programs on the local level.

end delete

begin delete SEC. 7. end delete

begin insert SEC. 4. end insert   

Section 4686.2 of the Welfare and Institutions Code
is amended to read:

4686.2.  

(a) Effective July 1, 2009, notwithstanding any other
law or regulation to the contrary, any vendor who provides applied
behavioral analysis (ABA) services, or intensive behavioral
intervention services or both, as defined in subdivision (d), shall:

(1) Conduct a behavioral assessment of each consumer to whom
the vendor provides these services.

(2) Design an intervention plan that shall include the service
type, number of begin delete hours end delete begin insert hours, end insert and parent participation needed to
achieve the consumer’s goals and objectives, as set forth in the
consumer’s individual program plan (IPP) or individualized family
service plan (IFSP). The intervention plan shall also set forth the
frequency at which the consumer’s progress shall be evaluated
and reported.

(3) Provide a copy of the intervention plan to the regional center
for review and consideration by the planning team members.

(b) Effective July 1, 2009, notwithstanding any other law or
regulation to the contrary, regional centers shall:

(1) Only purchase ABA services or intensive behavioral
intervention services that reflect evidence-based practices, promote
positive social behaviors, and ameliorate behaviors that interfere
with learning and social interactions.

(2) (A) Only purchase ABA or intensive behavioral intervention
services when the parent or parents of minor consumers receiving
services participate in the intervention plan for the consumers,
given the critical nature of parent participation to the success of
the intervention plan.

(B) In determining the extent of parent participation required
for the provision of ABA or intensive behavioral intervention
services, the IPP or IFSP planning team shall consider any relevant
hardships suffered by a parent or parents that may constitute a
barrier to the consumer accessing those services, including, but
not limited to, availability of group instruction courses, conflicts
with employment, vocational training, or educational demands,
financial hardship, or lack of transportation or child or other family
member care, and language barriers. Any hardships shall be
documented in the IPP or IFSP and reviewed annually to determine
if there has been a change in circumstances. If the regional center
determines that the extent of parent participation should be adjusted
due to a change in circumstances, the regional center shall provide
adequate notice pursuant to subdivision (a) of Section 4710.

begin delete

(C) At the time of development, scheduled review, or
modification of a consumer’s IPP or IFSP, the regional center shall
provide, in a non-technical, understandable form and in the native
language of the consumer or his or her parents, legal guardian,
conservator, or authorized representative, or both, a written
statement describing the process for determining the extent of
parent participation pursuant to this paragraph and examples of
documentation that may be submitted to demonstrate hardships.

end delete

(3) Not purchase either ABA or intensive behavioral intervention
services for purposes of providing respite, day care, or school
services.

(4) Discontinue purchasing ABA or intensive behavioral
intervention services for a consumer when the consumer’s
treatment goals and objectives, as described under subdivision (a),
are achieved. ABA or intensive behavioral intervention services
shall not be discontinued until the goals and objectives are reviewed
and updated as required in paragraph (5) and shall be discontinued
only if those updated treatment goals and objectives do not require
ABA or intensive behavioral intervention services.

(5) For each consumer, evaluate the vendor’s intervention plan
and number of service hours for ABA or intensive behavioral
intervention no less than every six months, consistent with
evidence-based practices. If necessary, the intervention plan’s
treatment goals and objectives shall be updated and revised.

(6) Not reimburse a parent for participating in a behavioral
services treatment program.

(c) For consumers receiving ABA or behavioral intervention
services on July 1, 2009, as part of their IPP or IFSP, subdivision
(b) shall apply on August 1, 2009.

(d) For purposes of this section the following definitions shall
apply:

(1) “Applied behavioral analysis” means the design,
implementation, and evaluation of systematic instructional and
environmental modifications to promote positive social behaviors
and reduce or ameliorate behaviors which interfere with learning
and social interaction.

(2) “Intensive behavioral intervention” means any form of
applied behavioral analysis that is comprehensive, designed to
address all domains of functioning, and provided in multiple
settings for no more than 40 hours per week, across all settings,
depending on the individual’s needs and progress. Interventions
can be delivered in a one-to-one ratio or small group format, as
appropriate.

(3) “Evidence-based practice” means a decisionmaking process
that integrates the best available scientifically rigorous research,
clinical expertise, and individual’s characteristics. Evidence-based
practice is an approach to treatment rather than a specific treatment.
Evidence-based practice promotes the collection, interpretation,
integration, and continuous evaluation of valid, important, and
applicable individual- or family-reported, clinically-observed, and
research-supported evidence. The best available evidence, matched
to consumer circumstances and preferences, is applied to ensure
the quality of clinical judgments and facilitates the most
cost-effective care.

(4) “Parent participation” shall include, but shall not be limited
to, the following meanings:

(A) Completion of group instruction on the basics of behavior
intervention.

(B) Implementation of intervention strategies, according to the
intervention plan.

(C) If needed, collection of data on behavioral strategies and
submission of that data to the provider for incorporation into
progress reports.

(D) Participation in any needed clinical meetings.

(E) Purchase of suggested behavior modification materials or
community involvement if a reward system is used.

begin delete

SEC. 8.  

Section 4686.5 of the Welfare and Institutions Code
is amended to read:

4686.5.  

(a) Effective July 1, 2009, notwithstanding any other
provision of law or regulation to the contrary, all of the following
shall apply:

(1) A regional center may only purchase respite services when
the care and supervision needs of a consumer exceed that of an
individual of the same age without developmental disabilities.

(2) A regional center shall not purchase more than 21 days of
out-of-home respite services in a fiscal year nor more than 90 hours
of in-home respite services in a quarter, for a consumer.

(3) (A) A regional center may grant an exemption to the
requirements set forth in paragraphs (1) and (2) if it is demonstrated
that the intensity of the consumer’s care and supervision needs are
such that additional respite is necessary to maintain the consumer
in the family home, or there is an extraordinary event that impacts
the family member’s ability to meet the care and supervision needs
of the consumer.

(B) At the time of development, scheduled review, or
modification of a consumer’s individual program plan or
individualized family service plan, the regional center shall provide,
in a non-technical, understandable form and in the native language
of the consumer or his or her parents, legal guardian, conservator,
or authorized representative, or both, a written statement describing
the exemption in subparagraph (A) and examples of documentation
that may be submitted to demonstrate qualification for the
exemption.

(C) For purposes of this section, “family member” means an
individual who:

(i) Has a consumer residing with him or her.

(ii) Is responsible for the 24-hour care and supervision of the
consumer.

(iii) Is not a licensed or certified residential care facility or foster
family home receiving funds from any public agency or regional
center for the care and supervision provided. Notwithstanding this
provision, a relative who receives foster care funds shall not be
precluded from receiving respite.

(4) A regional center shall not purchase day care services to
replace or supplant respite services. For purposes of this section,
“day care” is defined as regularly provided care, protection, and
supervision of a consumer living in the home of his or her parents,
for periods of less than 24 hours per day, while the parents are
engaged in employment outside of the home or educational
activities leading to employment, or both.

(5) A regional center shall only consider in-home supportive
services a generic resource when the approved in-home supportive
services meets the respite need as identified in the consumer’s
individual program plan (IPP) or individualized family service
plan (IFSP).

(b) For consumers receiving respite services on July 1, 2009,
as part of their IPP or IFSP, subdivision (a) shall apply on August
1, 2009.

(c) This section shall remain in effect until implementation of
the individual choice budget pursuant to Section 4648.6 and
certification by the Director of the Department of Developmental
Services that the individual choice budget has been implemented
and will result in state budget savings sufficient to offset the costs
associated with the repeal of this section. This section shall be
repealed on the date of certification.

end delete