BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 982|
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THIRD READING
Bill No: SB 982
Author: McGuire (D)
Amended: 5/31/16
Vote: 21
SENATE HUMAN SERVICES COMMITTEE: 4-0, 4/12/16
AYES: McGuire, Berryhill, Hancock, Liu
NO VOTE RECORDED: Nguyen
SENATE APPROPRIATIONS COMMITTEE: 6-0, 5/27/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza
NO VOTE RECORDED: Nielsen
SUBJECT: State Department of Developmental Services:
developmental centers
SOURCE: Author
DIGEST: This bill requires the Department of Developmental
Services (DDS) to contract for a longitudinal study, as
specified, to assess the quality of life and outcomes of
residents that relocate from the Sonoma and Fairview
developmental centers, and the general treatment of Porterville
Developmental Center as a result of the closure of those
centers. This bill specifies qualifications and duties of the
contractor and requires DDS to submit interim and final reports
to the Legislature.
ANALYSIS:
Existing law:
1) Establishes the Lanterman Developmental Disabilities
Services Act, which declares California's responsibility to
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provide an array of services and supports to meet the needs
of each person with developmental disabilities in the least
restrictive environment, and to support their integration
into the mainstream life of the community. (WIC 4500, et
seq.)
2) Establishes the jurisdiction of DDS over including Sonoma,
Fairview and Porterville developmental centers and the
responsibility of each facility to create bylaws and rules,
as specified. (WIC 4440)
3) Requires DDS to submit a detailed plan to the Legislature
when it proposes closure of a developmental center no later
than April 1 immediately prior to the fiscal year in which
the plan is to be implemented, and as a part of the
Governor's proposed budget. (WIC 4474.1. (a))
4) Establishes a system of nonprofit regional centers to
provide fixed points of contact in the community for all
persons with developmental disabilities and their families,
to coordinate services and supports best suited to them
throughout their lifetime. (WIC 4620)
5) Requires DDS to implement a unified quality assessment
system, and expresses Legislative intent that this system
will ensure the well-being of consumers, taking into account
their informed and expressed choices. Requires DDS with its
stakeholders to identify a valid and reliable quality
assurance instrument, as specified, and to contract with an
entity with experience in tracking outcomes and developing
data systems. (WIC 4571)
6) Requires DDS, in consultation with the contractor, to
establish the methodology by which the quality assurance
instrument shall be administered, including, but not limited
to, how often and to whom the quality assurance will be
administered, and the design of a stratified, random sample
among the entire population of consumers served by regional
centers. Requires the contractor to provide aggregate
information for regional centers and the state as a whole.
(WIC 4571 (e))
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This bill:
1) Declares Legislative intent to measure the unique needs of
people transitioning from developmental centers, including
specified outcomes, in order to ensure the appropriate
transition of consumers currently living in developmental
centers to the community living arrangements as a result of
the closure of the state's three remaining developmental
centers.
2) Adds a new section, WIC 4474.12, requiring DDS to contract
with an independent agency or organization for a longitudinal
study, commencing July 1, 2017, to assess the quality of life
and outcomes of developmental center residents who relocate
from the Sonoma Developmental Center, the Fairview
Developmental Center, and the general treatment area of the
Porterville Developmental Center, as a result of the closure
of those centers, in order to ensure that persons with
developmental disabilities who are moved from developmental
centers to the community are receiving necessary services and
supports.
3) Requires the study to supplement the quality assessment
system, as defined, and to make recommendations about
improving health and safety, choice, integration and other
similar factors based on the data collected. The study shall
be conducted each year concerning residents who move from the
developmental centers until two years after the last resident
moves from the developmental centers.
4) Requires that the contractor be experienced in all of the
following:
a) Designing valid tracking instruments.
b) Tracking the quality of community programs, including
outcome-based measures such as health and safety, quality
of life, integration, choice, and consumer satisfaction.
c) Tracking the quality and appropriateness of community
placements for persons moving from large institutions into
community settings.
d) Developing data systems.
e) Data analysis and report preparation.
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5) Requires that the contractor measure consumer and family
satisfaction with services provided, including case
management and quality of life, including, but not limited
to, health and safety, independence, productivity,
integration, opportunities for choice, and delivery of needed
services.
6) Requires the contractor to meet with each person, and the
person's family, or legal guardian or conservator, when
appropriate, no less than once per year to discuss quality of
life and observe the person's services and supports.
7) Requires that in cases in which the consumer is not capable
of communicating his or her responses, and in which a family
member, or legal guardian or conservator, is not involved,
the contractor shall meet with no fewer than two persons
familiar with the consumer. Additionally, requires the
contractor to interview staff and friends who know the
consumer best and review records, as appropriate, and to use
any data concerning the consumer collected through the
quality assurance instrument, as specified.
8) Permits the contract, if appropriate, to be satisfied by the
same contractor used by DDS to implement the quality
assurance instrument pursuant to Section 4571, which is the
National Core Indicator survey.
9) Requires DDS to maintain and update the addresses of, and
contact information for, former residents of the centers who
relocated as a result of the closure of the centers to
facilitate the survey, and requires DDS to ensure that
researchers conducting the study have access to data and
other information necessary to conduct the study, as defined
and to the extent permitted by law.
10)Requires DDS to submit interim reports to the Legislature
regarding the study at the end of the first and second years
of the study, as specified, and to submit the study to the
Legislature, upon completion.
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Background
Purpose. The author has modeled the longitudinal study
described in this bill after one conducted as part of the
Stockton Developmental Center closure, which measured movers'
quality of life, satisfaction with services, and other factors.
The author states that requiring a comprehensive longitudinal
study would ensure families that their loved ones are receiving
quality care, enable the state to learn from and correct any
challenges that may arise and improve accountability.
Developmental Centers. DDS operates three state developmental
centers - Sonoma, Fairview and Porterville - and one smaller
facility in Cathedral City that is often used as a step-down
placement for individuals with developmental disabilities and
challenging behavioral needs. Each developmental center has
three levels of care - a skilled nursing facility, an
intermediate care facility for individuals with intellectual
disabilities (ICF/IID), and a small acute care hospital.
In April of 2015, the Administration submitted a proposed plan
of closure for the Sonoma Developmental Center. This plan is
currently under review of legislative budget committees and must
be approved prior to implementation. On April 1, 2016, the
Administration submitted proposed closure plans for Fairview
Developmental Center and the general treatment program at
Porterville Developmental Center. These plans must also be
approved by the Legislature.
The developmental centers once were considered the placement of
preference for individuals with significant needs. At its peak
in 1968, the developmental center system housed more than 13,400
individuals in seven facilities. Since then a series of federal
and state legal decisions began the movement to provide services
for individuals with developmental disabilities in their
communities. Of the three remaining facilities, the oldest is
Sonoma Developmental Center (1891) and the newest is Fairview
Developmental Center (1959).
As of May 25, 2016, the four state-run facilities collectively
served 980 individuals with significant physical or behavioral
developmental disabilities. Of these, 195 individuals were in
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the secure treatment program at Porterville Developmental
Center, and 155 were in the general treatment program. Another
229 individuals lived at Fairview Developmental Center and 353
were at Sonoma. The remaining 48 were at Canyon Springs, a
smaller state-run facility in Riverside County, which is not
slated for closure.
Licensing and Certification concerns. In January 2013, four of
the 10 ICF units at Sonoma DC were withdrawn from federal
certification by DDS, in response to notice that the federal
government was moving to decertify, and defund, all the ICF
units at the facility. The actions came on the heels of widely
reported revelations of multiple instances of abuse, neglect,
and other lapses in caregiving at the institution. In March
2013, DDS entered into a Program Improvement Plan agreement,
which was accepted by the federal Centers for Medicare and
Medicaid Services (CMS). As a condition of the Program
Improvement Plan, DDS contracted with a consultant to develop an
action plan ensuring compliance with federal and state licensing
and certification requirements.
The Administration assumed these corrective actions would result
in the restoration of certification and federal funding by July
1, 2014. However, this did not occur. A survey of the seven
certified ICF units at Sonoma DC in May 2014 resulted in their
decertification. Over the next 14 months, CMS and the
Administration negotiated terms of a settlement, as DDS
simultaneously began moving to close Sonoma Developmental
Center, with the intent to have most residents moved before
losing federal funding. On June 30, 2015, DDS and the federal
government agreed to extend the federal funding to July 1, 2016
with the potential for one or more extensions, as long as DDS
continued to make improvements in the care at Sonoma. However,
on May 13, CMS notified DDS that it had not made sufficient
progress and that approximately $26.4 million in annual federal
funding for the ICF units would cease July 1.
Similar concerns and CMS findings followed at the other two
developmental centers and on April 1, 2016, DDS revealed plans
for closure of Fairview Developmental Center and the general
treatment area at Porterville DC. An agreement with CMS is still
pending, and anticipated this week.
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Community based services. California's 21 nonprofit regional
centers are part of a system of care for individuals with
developmental disabilities overseen by DDS. DDS is responsible
for coordinating care and providing services for nearly 290,000
people who receive services and supports to live in their
communities, as of March 2016. Regional centers provide
diagnosis and assessment of eligibility and case managers help
to plan, access, coordinate and monitor the services and
supports that are needed because of an individual's
developmental disability. Services for consumers are determined
through an individual program plan (IPP).
Quality Assessments. DDS has used a variety of quality
assessment measurements, beginning in 1993 with the Coffelt
settlement Quality Tracking Project, which focused on
individuals who were placed in the community from a
developmental center as a result of the lawsuit. According to
DDS, the study assessed consumer and family satisfaction, case
management activities, independence, productivity, integration,
choice and self-determination, service delivery patterns,
health, safety, psychoactive medication usage, qualities of home
settings, and costs of services. Using six different research
designs and more than 4,000 visits, the survey ultimately was
reported in 19 separate reports and found that movers had
improvements in self-care abilities, social behaviors,
opportunities for choice making and consumer satisfaction, among
other domains. Negative outcomes included fewer individuals with
paid jobs and making less money than they did in the DCs. Use of
sedatives and psychotropic medications had increased.
As part of the plan to close Stockton Developmental Center, DDS
agreed to complete a three-year longitudinal study in three
phases to track consumer outcomes and the quality of life of
individuals upon its closure in 1996. California State
University, Sacramento was chosen to conduct the study.
A year later, responding to parent concerns, the Legislature
codified the state's responsibility to track and evaluate the
well-being of individuals moving from DCs, (SB 391, Chapter 294,
Statutes of 1997). The obligation was fulfilled by a variety of
contracts with researchers. In 2009, as part of the budget
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process, this section of statute was deleted and replaced by
language directing DDS to complete a single survey, the Quality
Assessment Project, (WIC 4571) which was intended to provide
more appropriate information. To satisfy this requirement, DDS
chose to use the National Core Indicator survey.
National Core Indicator survey (NCI). The NCI is a collaborative
effort between the National Association of State Directors of
Developmental Disabilities Services (NASDDDS) and the Human
Services Research Institute. The program began in 1997 to
support NASDDDS member agencies to gather a standard set of
performance and outcome measures to track their own performance,
compare results across states, and to establish national
benchmarks. Indicators address such key areas as employment,
rights, service planning, community inclusion, choice,
loneliness, and health and safety. In California, the NCI
Quality Assessment Project operates on a three-year cycle,
alternating data collection among three groups of people served
by regional centers: adult consumers, guardians and family
members, and family members of children receiving services.
DDS also is conducting a longitudinal study of movers and their
families during the first two years post transition into the
community. This longitudinal study will survey the first 100
people transitioning from a developmental center into the
community and their families beginning in January 2016. Study
participants will be surveyed using the NCI tools at 3 months, 6
months, 1 year, and 2 years.
Related/Prior Legislation
AB 9 (Evans, Chapter 9, Statutes of 2009, 4th Extraordinary
Session) established a requirement in statute for DDS to track
outcomes of consumers in the system.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to an analysis by the Senate Committee on
Appropriations, this bill will cost around $500,000 per year for
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several years, for an independent contractor to undertake the
required study (General Fund and federal funds).
SUPPORT: (Verified 5/31/16)
California Association of Psychiatric Technicians
Disability Rights California
Parent Hospital Association
Sonoma County Board of Supervisors
Sonoma Land Trust
OPPOSITION: (Verified5/31/16)
None received
ARGUMENTS IN SUPPORT: The (Sonoma) Parent Hospital
Association writes that this bill provides a mechanism for the
state Legislature to receive regular status reports on the SDC
closure and the quality of life for residents to ensure all
commitments to care are being met and are on target.
Prepared by:Mareva Brown / HUMAN S. / (916) 651-1524
5/31/16 20:45:27
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