BILL ANALYSIS Ó
AB 2809
Page 1
Date of Hearing: April 26, 2016
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Susan Bonilla, Chair
AB 2809
(Rodriguez) - As Amended March 18, 2016
SUBJECT: Developmental services: regional centers
SUMMARY: Requires regional centers to pay for medical and
dental services during specified periods and to provide certain
information in the native language of consumers and other
designated individuals and further, requires that parental
hardships be considered when determining the extent of parent
participation for certain services.
Specifically, this bill:
1)Requires a regional center, at the beginning of each
individual program plan (IPP) meeting, to provide a consumer
and, when appropriate, other specified individuals, a list of
services provided by the regional center and information about
the appeal and complaint process in his or her native
language.
2)Requires a regional center, at the end of an IPP meeting, to
provide a consumer and, when appropriate, other specified
individuals, a written list of agreed-upon services and
supports, including the amount and anticipated start date, and
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a list of any services and supports for which final agreement
has not been reached and for which there will be a subsequent
program plan meeting, as specified.
3)Requires a regional center to provide the statement of
services and supports purchased for a consumer, as specified,
in the native language of the consumer and/or his or her
parents, legal guardian, conservator, or authorized
representative, and further requires this statement to be
provided, in addition to the currently-required annual notice,
at the time of development, scheduled review, or modification
of a consumer's IPP or individualized family service plan
(IFSP).
4)Requires a regional center, at the time of development,
scheduled review, or modification of a consumer's IPP or IFSP,
to provide the consumer and/or other individuals with a
written statement and examples of pertinent documentation in
an understandable form and in the appropriate native
language(s), as specified, regarding each of the following:
a) Acquisition of transportation services for a minor
child, as specified;
b) Exemptions to the limitations on purchase of camping
services, social recreation activities, educational
services, and nonmedical therapies, as specified;
c) Exemptions to the limitations on purchase of certain
services for consumers ages 18 to 22 years old, as
specified; and
d) Exemptions to the limitations on purchase of respite
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services, as specified.
5)Requires the regional center to accept documentation
demonstrating that the family of a child is unable to provide
transportation for that child in any written form, including
in the native language of the consumer or other individuals,
as specified.
6)Requires an IPP planning team to, when making a determination
regarding exemptions for the purchase of certain services for
consumers ages 18 to 22, consider the standard requiring
regional centers to provide independent living skills services
to an adult consumer, consistent with his or her IPP, that
provide the consumer with functional skills training that
enables him or her to acquire or maintain skills to live
independently or achieve greater independence, as specified.
7)Requires regional centers to pay for medical or dental
services during the following periods:
a) While insurance coverage is being pursued, but before a
denial is made;
b) Pending final decision on an administrative appeal, as
specified; and
c) Until the commencement of Medi-Cal, private insurance,
or a health care service plan.
8)Requires a regional center, at the time of development,
scheduled review, or modification of a consumer's IPP or IFSP,
to provide the consumer and/or other individuals with a
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written statement and examples of pertinent documentation in
an understandable form and in the appropriate native
language(s), as specified, regarding acquisition of coverage
of medical and dental services during certain periods, as
specified.
9)Requires the IPP or IFSP planning team, 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 applied behavioral
analysis (ABA) or intensive behavioral intervention services
and that such hardships be documented in the IPP or IFSP and
be reviewed annually, as specified. Further, requires the
regional center, if it determines that the extent of parent
participation should be adjusted due to a change in
circumstances, to provide adequate notice, as specified.
10)Requires a regional center, at the time of development,
scheduled review, or modification of a consumer's IPP or IFSP,
to provide the consumer and/or other individuals with a
written statement and examples of pertinent documentation in
an understandable form and in the appropriate native
language(s), as specified, regarding the process for
determining the extent of parent participation and
demonstration of hardships.
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
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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 (DDS) to
contract with regional centers to provide case management
services and arrange for or purchase services that meet the
needs of individuals with developmental disabilities, as
defined. (WIC 4620 et seq.)
4)Requires the development of an 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)Requires the IPP planning processes to include:
a) A statement of the individual's goals and objectives, a
schedule of the type and nature of services to be provided
and other information and considerations, as specified;
b) Review and modification, as necessary, by the regional
center's planning team no less frequently than every three
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years; and
c) Statewide training and review of the IPP plan creation,
as specified. (WIC 4646.5)
1)Prohibits discrimination against individuals in protected
classes, including national origin and ethnic group
identification, for purposes of providing full and equal
access to benefits or programs that are operated or funded by
the state. (GOV 11135 et seq.)
2)Places various requirements on regional centers to communicate
and provide certain written materials in a consumer's and/or
family's or other designated individual's native language, as
specified. (GOV 95020 (g); WIC 4642 (b), 4643 (d), 4646 (h))
3)Defines "threshold language" to mean a language that has been
identified as the primary language, as specified, of 3,000
beneficiaries or 5% of the beneficiary population, whichever
is lower, in an identified geographic area. (9 CCR § 1810.410
(a)(3))
4)Requires each regional center to offer, and upon request
provide, a written copy of the IPP to the consumer and, when
appropriate, to his or her parents, legal guardian or
conservator, or authorized representative within 45 days of
his, her, or 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. (WIC 4646.5
(a)(5))
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5) Provides for exemptions to certain service limitations, as
specified, related to: transportation for minors; camping
services, social recreation activities, educational services,
and nonmedical therapies; certain services for consumers ages
18 to 22 years old; and respite services. (WIC 4648.35,
4648.5, 4648.55, 4686.5)
6)Authorizes regional centers to pay for medical or dental
services pending pursuit or appeal with Medi-Cal, private
insurance, or other health care plan. (WIC 4659 (d))
7)Defines "parent participation" for purposes of ABA or
intensive behavioral intervention services to include, but not
be limited to: completion of group instruction on the basics
of behavior intervention; implementation of intervention
strategies, according to the intervention plan; collection of
data on behavioral strategies and submission of that data, as
specified; and participation in any needed clinical meetings.
(WIC 4686.2 (d)(4))
8)Requires any vendor who provides ABA or intensive behavioral
intervention services to design an intervention plan that
includes, among other things, the parent participation needed
to achieve the consumer's goals and objectives as set forth in
the IPP. (WIC 4686.2 (a)(2))
9)Requires regional centers to only purchase ABA or intensive
behavioral intervention services when the parent(s) of minor
consumers receiving services participate in the intervention
plan for the consumers. (WIC 4686.2 (b)(2))
FISCAL EFFECT: Unknown.
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COMMENTS:
Developmental services: The Lanterman Act (WIC § 4500 et seq.)
guides the provision of services and supports for Californians
with developmental disabilities. Each individual under the Act,
typically referred to as a "consumer," is legally entitled to
treatment and habilitation services and supports in the least
restrictive environment. Lanterman Act services are designed to
enable all consumers to live more independent and productive
lives in the community.
The term "developmental disability" means a disability that
originates before an individual attains 18 years of age, is
expected to continue indefinitely, and constitutes a substantial
disability for that individual. It includes intellectual
disabilities, cerebral palsy, epilepsy, and autism spectrum
disorders (ASD). Other developmental disabilities are those
disabling conditions similar to an intellectual disability that
require treatment (i.e., care and management) similar to that
required by individuals with an intellectual disability.
Direct responsibility for implementation of the Lanterman Act
service system is shared by the Department of Developmental
Services (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
approximately 290,000 consumers, providing services such as
residential placements, supported living services, respite care,
transportation, day treatment programs, work support programs,
and various social and therapeutic activities. Approximately
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1,005 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.
In July of 2009, a number of state budget cuts were adopted in
response to the budget shortfall resulting in large part from
the national economic crisis. DDS had to make a number of cuts
at this time; the department worked with stakeholders to
identify over $300 million in General Fund savings. Examples of
some of the many actions taken include: limiting transportation
for minor children to when the family provides documentation
that they cannot provide transportation themselves; suspending
the purchase of camping services, certain social recreation
activities, educational services, and non-medical therapies,
except in cases where exemptions are granted; restricting the
amount of respite services that may be purchased, except in
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cases where exemptions are granted; and providing for a standard
that parent participation is critical to the success of the
intervention plan and requiring regional centers to purchase ABA
or intensive behavioral intervention services only when the
parent agrees to participate in the intervention plan.
Threshold languages: Including English, 207 languages are
spoken in the state. The California Code of Regulations (9
CCR § 1810.410 (a)(3)) defines "threshold language" to mean a
language that has been identified as the primary language, as
specified, of 3,000 beneficiaries or 5% of the beneficiary
population, whichever is lower, in an identified geographic
area. A 2015 Budget Trailer bill (SB 82 (Senate Committee on
Budget and Fiscal Review), Chapter 23, Statutes of 2015), among
other things, required each regional center to offer, and upon
request provide, a written copy of the IPP to the consumer and,
when appropriate, his or her parents, legal guardian or
conservator, or authorized representative within 45 days of the
request in a threshold language.
For each regional center catchment area, the threshold
languages are defined by the county or counties served by
that regional center. Below are the threshold languages (and
the percentage of the population speaking that language as
their primary language) for a sample of California counties,
as of May 2014:
Alameda County: Spanish (24.5%), Cantonese (5.8%), Vietnamese
(2.7%), Mandarin (1.5%)
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Contra Costa County: Spanish (29.1%)
Kern County: Spanish (34%)
Los Angeles County: Spanish (42%), Armenian (2.3%), Cantonese
(1.1%), Korean (1%),
Vietnamese (0.9%), Mandarin (0.9%), Farsi (0.5%), Tagalog
(0.4%), Russian (0.4%), Cambodian (0.3%), Other Chinese
(0.3%), Arabic (0.2%)
Monterey County: Spanish (58.5%)
San Diego County: Spanish (32.3%), Arabic (2.8%), Vietnamese
(1.9%), Tagalog (1.2%)
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Santa Cruz County: Spanish (48.8%)
Solano County: Spanish (22.7%)
Recent special session actions: The Governor convened a special
legislative session in June 2015 to address, among other things,
funding rate increases for community service providers of
services for individuals with developmental disabilities. One
result of that special session was the passage of ABX2 1
(Thurmond), Chapter 3, Statutes of 2016, signed by the Governor
on March 1 of this year, which appropriated $287 million General
Fund to regional centers and community services providers in
2016-17 in additional to leveraging an estimated $186 million in
federal funding. Approximately 60% of the General Fund spending
is marked for rate increases to go towards salaries and benefits
for staff that provide direct care to consumers. Among other
spending augmentations, ABX2 1 also included a fixed
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appropriation of $11 million to promote equity and reduce
disparities in the purchase of services, to be used for
activities such as cultural competency training, parent
education, and supporting bilingual regional center staff.
Need for this bill: According to the author, "For people with
developmental disabilities, health disparities can result in
significant health, social, and economic consequences.
California's diverse language and ethnic communities account for
about 60% of its population. In recent years, access to
developmental services has been significantly limited due to
severe budget cuts, with minority populations particularly
adversely affected. In 2011, a Los Angeles Times series
reported significant disparities in the funding of developmental
services based on race, ethnicity, and language. Consumers and
family members who are limited English proficient have the right
to culturally and linguistically competent information about
accessing developmental services available through regional
centers, including information on the process for obtaining
certain services through statutory exemptions and meeting other
affirmative requirements. Additionally, the level of parent
participation required to access intensive behavioral
intervention services is often too burdensome to meet for some
families who are low-income and/or who are limited English
proficient, and the law should provide for some flexibility in
authorizing for these services by accounting for hardship
factors."
Staff comments: Ensuring that consumers of services for
individuals with developmental disabilities receive
communications in the appropriate languages is an important
goal. Steps in recent years - including the passage SB 555
(Correa), Chapter 685, Statutes of 2013 and SB 82 (Senate
Committee on Budget and Fiscal Review), Chapter 23, Statutes of
2015 - have made headway toward this goal. This bill seeks to
provide additional materials in consumers', and their families'
and other designated individuals', native languages. With 206
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languages currently spoken in California in addition to English,
this could place significant strain on resources and
substantially heighten related administrative duties for
regional centers - all at a time when, in the wake the passage
of the special session bill (ABX2 1 (Thurmond), Chapter 3,
Statutes of 2016), attention is being directed towards how to
best use augmented funds to the greatest benefit for consumers.
Additionally, requiring regional centers to pay for medical and
dental services pending pursuit or appeal with Medi-Cal, private
insurance, or other health care plan, would only place further
strain on regional centers. From both a policy and fiscal
standpoint, it is important to judiciously weigh any new
requirements and obligations placed on the regional center
system as the state prepares for rate increases and other
changes.
Recommended amendments: In order to address the issues raised
above, committee staff recommends: 1) striking provisions of
this bill that require regional centers to pay for medical or
dental services pending pursuit or appeal with Medi-Cal, private
insurance, or other health care plan, and 2) narrowing the
requirements this bill places on regional centers to provide
certain documents in native languages to instead require the
provision of the following in threshold languages, as
appropriate: information on appeals and complaints, the
consumer's annual statement of services and supports, and a
document providing information on exceptions/exemptions to
certain service limitations and how to pursue those
exceptions/exemptions. Therefore, committee staff recommends
the following amendments:
1)Strike the following: lines 23 through 30 on page 4; lines 4
through 12 on page 18; lines 27 through 38 on page 19; lines 3
through 10 on page 23; and lines 8 through 16 on page 25.
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2)Make the following amendments starting on line 17 of page 4 of
the bill:
17
(6)At the beginning of each individual program plan meeting,
18
the regional center shall provide a consumer and, when
19
appropriate, his or her parents, legal guardian, conservator, or
20
authorized representative a list of services provided by the
regional
21
center and information about the appeal and complaint process
22
in threshold languages, as appropriate, and as defined by
paragraph (3) of subdivision (a) of Section 1810.410 of Title 9
of the California Code of Regulations. his or her native
language.
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3)Make the following amendments starting on line 8 of page 16 of
the bill:
8
(h)At least annually, and at the time of development,
scheduled
9
review, or modification of a consumers individual program plan
10
or individualized family service plan, regional centers shall
provide
11
the consumer, his or her parents, legal guardian, conservator,
or
12
authorized representative a statement of services and supports
the
13
regional center purchased for the purpose of ensuring that they
are
14
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delivered. The statement shall include the type, unit, month,
and
15
cost of services and supports purchased. The regional center
shall
16
provide that statement in the native language of the make that
statement available in threshold languages, as appropriate, and
as defined by paragraph (3) of subdivision (a) of Section
1810.410 of Title 9 of the California Code of Regulations, to
the consumer or
17
his or her parents, legal guardian, conservator, or authorized
18
representative, or both.
4)Make the following amendments starting on line 3 of page 17 of
the bill:
3
the child. At the time of development, scheduled review, or
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4
modification of a consumer's individual program plan or
5
individualized family service plan, the regional center shall
6
provide, in a non-technical, understandable form and in the
native
7
language of the consumer or his or her parents, legal guardian,
8
conservator, or authorized representative, or both, a written
9
statement of the requirement described in this subdivision and
10
examples of sufficient written documentation that may be
submitted.
11
The regional center shall accept documentation submitted
pursuant
12
to this subdivision in any written form, including in the native
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13
language of the consumer or his or her parents, legal guardian,
14
conservator, or authorized representative.
5)Make the following amendments starting on line 25 of page 19
of the bill:
25
to meet the consumer's need. The consumer shall be informed of
26
the exemption and the process for obtaining an exemption. The
consumer shall be informed of the exemption and the process for
obtaining an exemption.
6)Make the following amendments starting on line 39 of page 20
of the bill:
31
(d)(1)Effective July 1, 2009, notwithstanding any other law
32
or regulation, a regional center shall not purchase medical or
dental
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33
services for a consumer three years of age or older unless the
34
regional center is provided with documentation of a Medi-Cal,
35
private insurance, or a health care service plan denial and the
36
regional center determines that an appeal by the consumer or
family
37
of the denial does not have merit. If, on July 1, 2009, a
regional
38
center is purchasing the service as part of a consumer's IPP,
this
39
provision shall take effect on August 1, 2009. At the time of
40
development, scheduled review, or modification of a consumer's
P21
1
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individual program plan or individualized family service plan,
the
2
regional center shall provide, in a non-technical,
understandable
3
form and in the native language of the consumer or his or her
4
parents, legal guardian, conservator, or authorized
representative,
5
or both, a written statement describing the documentation
required
6
pursuant to this paragraph. Regional centers may may shall pay
for
7
medical or dental services during the following periods:
8
(A)While coverage is being pursued, but before a denial is
9
made.
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10
(B)Pending a final administrative decision on the
administrative
11
appeal if the family has provided to the regional center a
12
verification that an administrative appeal is being pursued.
13
(C)Until the commencement of services by Medi-Cal, private
14
insurance, or a health care service plan.
7)Insert the following language into the bill:
At the time of development, scheduled review, or modification of
a consumers individual program plan or individualized family
service plan, the regional center shall make available, in a
non-technical, understandable form and in threshold languages,
as appropriate, and as defined by paragraph (3) of subdivision
(a) of Section 1810.410 of Title 9 of the California Code of
Regulations, for the consumer or his or her parents, legal
guardian, conservator, or authorized representative, or both, a
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document describing all of the following exceptions and
exemptions to service limitations and the process for obtaining
each exception and exemption:
1) The exception described in subdivision (d) of Section
4648.35
2) The exemption described in subdivision (c) of Section
4648.5
3) The exemption described in subdivision (d) of Section
4648.55
4) The exemption described in subparagraph (A) of paragraph
(3) of subdivision (a) of Section 4686.5.
RELATED AND PRIOR LEGISLATION
SB 1034 (Mitchell), among other things, would prohibit lack of
parent or caregiver participation from being used to deny or
reduce medically necessary behavioral health treatment, as
specified. This bill was heard in the Senate Health Committee
on April 20th.
ABX2 1 (Thurmond), Chapter 3, Statutes of 2016, among other
things, implemented targeted rate increases for the
community-based developmental services system.
SB 82 (Senate Committee on Budget and Fiscal Review), Chapter
23, Statutes of 2015, among other things, required each regional
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center to offer, and upon request provide, a written copy of the
IPP to the consumer and, when appropriate, his or her parents,
legal guardian or conservator, or authorized representative
within 45 days of his, her, or their request in a threshold
language, as defined, and further required the department and
regional centers to annually collaborate to compile data on the
number of instances in which an IPP was provided in this manner.
SB 555 (Correa), Chapter 685, Statutes of 2013, placed various
requirements on regional centers to communicate and provide
certain written materials in a consumer's and/or family's or
other designated individual's native language, as specified.
AB 9 X4 (Evans), Chapter 9, Statutes of 2009, contained
necessary changes to enact modifications to the 2009 Budget Act,
including, but not limited to, suspending and limiting certain
services for regional center consumers.
REGISTERED SUPPORT / OPPOSITION:
Support
Crystal Stairs, Inc.
Disability Rights California
Public Counsel - co-sponsor
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Special Needs Network - co sponsor
State Council on Developmental Disabilities
Opposition
Association of Regional Center Agencies (ARCA)
Analysis Prepared by:Daphne Hunt / HUM. S. / (916) 319-2089