BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 982|
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UNFINISHED BUSINESS
Bill No: SB 982
Author: McGuire (D)
Amended: 8/15/16
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
SENATE FLOOR: 38-0, 6/1/16
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,
Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson,
Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning,
Moorlach, Morrell, Nguyen, Pan, Pavley, Roth, Stone, Vidak,
Wieckowski, Wolk
NO VOTE RECORDED: Nielsen, Runner
ASSEMBLY FLOOR: 79-0, 8/23/16 - See last page for vote
SUBJECT: State Department of Developmental Services:
developmental centers
SOURCE: Author
DIGEST: This bill requires the state Department of
Developmental Services (DDS) to seek to modify an existing
contract to conduct a movers' longitudinal study of individuals
who are moving from one of the state's developmental centers to
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a community setting. The bill requires that at least 250
individuals who meet certain criteria participate in the study,
among other criteria. The bill requires DDS to annually submit
interim reports to the Legislature and to submit a final report
upon conclusion of the study, as specified.
Assembly Amendments clarify that the requirements of the bill be
added to an existing longitudinal study, specify the size and
composition of study participants, delete the requirement to
interview family members and require annual reporting to the
Legislature, as specified.
ANALYSIS:
Existing law:
1)Establishes the Lanterman Developmental Disabilities Services
Act, which declares California's responsibility to 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
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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))
This bill:
1)Declares Legislative intent to ensure the appropriate
transition of consumers currently living in developmental
centers from those centers to community living arrangements as
a result of the closure of the state's three remaining DCs. It
is the further intent of the Legislature to measure the unique
needs of people transitioning from developmental centers,
including providing information about the quality of life,
satisfaction with services, the degree to which the
individuals achieve their goals.
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2)Requires DDS to seek to modify a contract in existence on
January 1, 2017, to conduct a movers longitudinal study to
include at least 250 voluntary participants who were
proportionately selected from among individuals who have moved
into the community from each of the three developmental
centers and who have moved into the community at different
stages of the closure process.
3)Requires that the study follow the sample of individuals for a
two-year period after the individual moves into the community
from the developmental center.
4)Requires that the study include individuals who move into the
community from a developmental center during the first year of
the study, and during each subsequent year of the study, until
the developmental centers close.
5)Requires that researchers meet with each individual
participating in the study at intervals of three months, six
months, one year, and two years following the person's move
into the community from the developmental center to discuss
the individual's quality of life and services and supports.
6)Establishes that the movers longitudinal study is one element
of the quality assurance instrument required under current
law.
7)Requires DDS to maintain and update the addresses of, and
contact information for, former residents who relocated as a
result of the closure of the centers.
8)Requires DDS to ensure, to the extent permitted by law, that
researchers conducting the study have access to data and other
information necessary to conduct the study, including contact
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information for former residents who relocated due to the
closure of the centers, as specified.
9)Requires DDS to annually submit interim reports about the
study to the Legislature, as specified, and requires the
reports to include information about consumer and family
satisfaction and adequacy of community services. Requires DDS
to submit the completed study to the Legislature, as
specified.
Background
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.
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 August 10, 2016, the four state-run facilities
collectively served 957 individuals with significant physical or
behavioral developmental disabilities. Of these, 206 individuals
were in the secure treatment program at Porterville
Developmental Center, which is not slated for closure. Another
145 were in the general treatment program. Some 217 individuals
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lived at Fairview Developmental Center and 344 were at Sonoma.
The remaining 45 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
ultimate 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, 2016, 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 on July 1.
Similar concerns and CMS findings were mirrored 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.
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A July 1, 2016 agreement with the CMS outlines annual extensions
of federal funding for the ICF units at Fairview and Porterville
providing the state adheres to its plans to transition residents
to community settings, maintains appropriate staffing levels and
does not violate other terms of the agreement. Funding cannot be
extended for Fairview Developmental Center beyond Dec. 31, 2019
and beyond Oct. 31, 2021 for the general treatment area
Porterville Developmental Center. The secure treatment area of
Porterville DC is not included in closure plans.
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 300,000
people who receive services and supports to live in their
communities, as of August 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 tools, beginning in 1993 with the Quality Tracking
Project, which focused on individuals who were placed in the
community from a developmental center as a result of the Coffelt
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.
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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 process, this
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. 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 125
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.
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This bill seeks to broaden that study by doubling its size and
including a sample of movers over the duration of the closure
process, to more accurately capture the experiences of all
movers.
Related Legislation
AB 9 (Evans, Chapter 9, 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 Assembly floor analysis, the Assembly
Appropriations Committee notes this bill may result in onetime
costs of up to $100,000 to incorporate provisions of this bill
into an ongoing DDS study.
SUPPORT: (Verified 8/23/16)
California Association of Psychiatric Technicians
Disability Rights California
Parent Hospital Association
Sonoma County Board of Supervisors
Sonoma Land Trust
The Service Employees International Union, Local 1000
OPPOSITION: (Verified8/23/16)
None received
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ARGUMENTS IN SUPPORT: Disability Rights California writes
that a similar study of individuals who moved from Agnews
Developmental Center provided important information and a means
to help assure the quality of life and outcomes for those
individuals as they transitioned to the community. This bill
"ensures and objective analysis of developmental center mover
satisfaction by looking at meaningful outcome measures," writes
DRC.
ARGUMENTS IN OPPOSITION: The California Department of
Finance writes in opposition to this bill that it would require
General Fund expenditures not already in the budget and that the
study may be duplicative of existing efforts. Recent amendments
to this bill have resulted in DDS removing its opposition.
ASSEMBLY FLOOR: 79-0, 8/23/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,
Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley,
Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth
Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto,
Gipson, Gomez, Gonzalez, Gordon, Grove, Hadley, Harper, Roger
Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey,
Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes,
McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte,
O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon
NO VOTE RECORDED: Gray
Prepared by:Mareva Brown / HUMAN S. / (916) 651-1524
8/23/16 19:54:32
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