BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: SB 1427
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|Author: |Pavley |
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|Version: |March 28, 2016 |Hearing | |
| | |Date: | |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Mareva Brown |
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Subject: Workforce development: developmentally disabled
individuals
SUMMARY
This bill requires the Department of Developmental Services
(DDS) to establish a Work Transition Project, as specified, for
regional centers to allow blended or braided forms of integrated
services, as specified, and to assist in the state's efforts to
reach compliance with the federal Home and Community-Based
Services Waiver regulations. The bill authorizes the department
to waive regulatory requirements that inhibit the provision of
services in competitive integrated settings. It also requires
DDS to assess the decrease in time that it takes a consumer
under these provisions to become job ready and to transition
into an integrated work setting, and to report that information
to the Legislature, as specified.
ABSTRACT
Existing law:
1) Establishes the Lanterman Developmental Disabilities
Services Act, which declares California's responsibility
for providing an array of services and supports to meet the
needs of each person with developmental disabilities in the
least restrictive environment, regardless of age or degree
of disability, and to support their integration into the
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mainstream life of the community. (WIC 4500, et seq.)
2) 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)
3) Establishes an Individual Program Plan (IPP) 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)
4) Defines habilitation services as activities purchased
for regional center consumers, including services provided
under the Work Activity and Supported Employment programs
to prepare and maintain consumers at their highest level of
vocation functioning or to prepare them for referral to
vocational rehabilitation services. (WIC 4851)
5) Establishes an individual habilitation services plan and
specifies areas in which consumers must meet individual
employment goals. (WIC 4853, WIC 4854)
6) Requires a regional center to authorize appropriate
services for a consumer while he or she is on a waiting
list for services from the Department of Rehabilitation
(DOR), as specified. (WIC 4855)
7) Establishes fees and hourly rates for service providers
who work with consumers in various job development and
support activities. (WIC 4860)
8) Establishes in federal law state reimbursements for
achieving work outcomes for individuals with disabilities,
as specified. (CFR 411.582)
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9) Establishes an Employment First Policy in California to
prioritize opportunities for integrated, competitive
employment for individuals with developmental disabilities,
regardless of the severity of their disabilities, as
specified. (WIC 4869)
This bill:
1) Makes various findings and declarations, including:
a. It is the intent of the Legislature to ensure
that individuals with developmental disabilities who
are earning income do not lose their vocational
opportunities and earning power as a result of changes
related to the home- and community-based services
settings (HCBS) rule due to the implementation of the
Workforce Innovation and Opportunity Act.
b. There are thousands of consumers today earning
some income in existing employment programs, who are
complying with current rules and deserve specific
attention during this transition period to ensure they
have the opportunity for, and access to, more
integrated work settings of their choice.
c. In order to increase the self-sufficiency of
adults with developmental disabilities, as specified,
it is important that the state implement a program to
provide opportunities for individuals to engage in job
discovery and job readiness training to assist their
transition to more competitive integrated employment
and to ensure employment success.
2) Requires that on or before July 1, 2017, DDS shall
establish a Work Transition Project with guidelines and an
approved process for regional centers to allow blended or
braided forms of integrated services using allowable
services under existing state and federal law.
3) Requires that the project assist in the state's efforts
to reach compliance with the federal Home and
Community-Based Services waiver regulations by March 31,
2019.
4) Permits a maximum of 75 hours per quarter, at no more
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than an equivalent of $40 per hour to be authorized for
vendors to provide needed job readiness and support
services aimed at individualized transition services for
consumers currently placed in segregated work settings who
choose to move toward competitive integrated employment.
5) Defines "blended or braided forms of integrated
services" to mean services for a single consumer that are
funded by multiple agencies or entities and that work as a
single program.
6) Requires DDS to permit regional centers to customize
skill development and job readiness programs for consumers,
as appropriate, by partnering with work activity programs
and group supported employment vendors to transition those
consumers who choose to move towards integrated competitive
employment.
7) Permits DDS to waive, until March 31, 2019, regulatory
requirements that inhibit the provision of services in
competitive integrated settings.
8) Requires DDS to assess the decrease in time that it
takes a consumer under these provisions to become job ready
and to transition into an integrated work setting.
9) Requires DDS to report to the budget committee of each
house of the Legislature during the annual budget process
regarding the use of these provisions and the measurable
outcomes, as specified.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the bill:
The author states that this bill will help individuals with
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developmental disabilities who are working in group employment
or work activity programs to move toward competitive integrated
employment, which will be required by new federal regulations in
2019. "Currently, there are thousands of consumers who are
earning income in settings that are compliant with current
rules, whose employment will be threatened under the forthcoming
requirements," the author states. "These consumers deserve
specific attention during this transition period to ensure that
they have a reasonable opportunity for, and access to, more
integrated work settings of their choice." The author further
states that many of these programs do not provide job discovery
or soft skills training needed to transition the consumers into
competitive, integrated employment and that existing models are
inflexible. "If this population is left without purposefully
designed pathways into more competitive, integrated employment,
these adults will be at higher risk of losing income and
increasing public dependency throughout the course of their
lives."
Regional centers
California's 21 nonprofit regional centers are part of a system
of care for individuals with developmental disabilities overseen
by DDS. The department is responsible for coordinating care and
providing services for nearly 290,000 people who live in their
communities, and about 1,000 people who lived in developmental
centers as of March 2016. Regional centers provide diagnosis and
assessment of eligibility and, if consumers qualify for
services, case management to help to plan, access, coordinate
and monitor the services and supports that are needed. Services
for consumers are determined through an individual program plan
(IPP).
Employment
AB 287 (Beall, Chapter 231, Statutes of 2009) required that the
State Council on Developmental Disabilities establish a standing
Employment First Committee to identify strategies, best
practices, and incentives, and to develop an Employment First
Policy. The goal of the policy was to increase the number of
people with developmental disabilities who are employed in
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integrated work, self-employment, and microenterprises, and the
number earning wages at or above minimum wage.
A subsequent report, released in 2011, found that 26.5 percent
of working-age adults with developmental disabilities live below
the federal poverty line compared with 13 percent of adults in
the general population. Other findings included a need for
additional supports for individuals to prepare for and maintain
employment. That report, and a subsequent report in 2012,<1>
prompted a number of legislative efforts, including SB 577
(Pavley, Chapter 431, Statutes of 2014) which established a
four-year pilot project to create community-based vocational
development services to teach "softer" interpersonal skills to
consumers, and to evaluate whether those skills are important to
succeed in supported employment. The pilot was not enacted.
Individual and Group Employment
There are a variety of ways for consumers to be supported in a
work environment. Typically, regional centers contract with
employment services programs and providers to address the
employment needs of individuals with developmental disabilities.
Consumers are placed in jobs according to their individual
skills, needs and choices, and provided support services on an
individual basis or in a group.
Work Activity Programs are employment services programs in a
sheltered work environment for consumers who have acquired basic
vocational and independent living skills. Consumers are paid at
a daily per capita rate based on productivity. As of May 2015,
there were 108 Work Activity Program vendors and about 9,600
consumers in the program, according to DDS data.
Supported Employment Programs are community-based rehabilitation
programs that focus on helping consumers obtain, retain or
maintain employment in integrated settings either individually
or in groups. Often supported employment includes a job coach
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<1>http://www.scdd.ca.gov/res/docs/pdf/Employment_First/2012%20EF
C%20Annual%20Report%20Jan%2016%202013.pdf
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that provides on-the-job services and training, and wages paid
directly to the consumer by the employer. Supported employment
can either be tailored to an individual, or performed with a
group. According to data from DDS, as of May 2015, there were
167 group employment vendors and approximately 5,900 consumers.
Individual supported employment, which is not the focus of this
bill, employed about 188 vendors and nearly, 4,400 individual
participants.
Home and Community-Based Services waiver changes
On January 10, 2014, the federal Centers for Medicare and
Medicaid Services (CMS) released a new "final rule" summarizing
key changes in its requirements for states' home and
community-based services waivers. The rule affects three types
of waivers, all of which are applied in California to serve
populations including individuals with developmental
disabilities. Elements of the new requirements include that an
individual has a lease or other legally enforceable agreement
providing similar protections, has privacy in their living unit
including lockable doors and a choice of roommates, controls his
or her own schedule and can access food at any time, among other
practices. Experts believe that group work paid at sub-minimum
wages will not be supported under the new HCBS rule but that
consumers will need to be employed in integrated settings and
with a full salary.
According to CMS:
"In this final rule, CMS is moving away from defining home
and community-based settings by "what they are not," and
toward defining them by the nature and quality of
individuals' experiences. The home and community-based
setting provisions in this final rule establish a more
outcome-oriented definition of home and community-based
settings, rather than one based solely on a setting's
location, geography, or physical characteristics. The
changes related to clarification of home and
community-based settings will maximize the opportunities
for participants in HCBS programs to have access to the
benefits of community living and to receive services in the
most integrated setting and will effectuate the law's
intention for Medicaid HCBS to provide alternatives to
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services provided in institutions."<2>
CMS requires states to submit a plan for changes to its service
delivery system to comply with the final rule. California's
Department of Health Care Services (DHCS) is coordinating the
state's response, with input from DDS and other affected
departments. On August 14, 2015, DHCS, submitted the Statewide
Transition Plan for home and community-based settings to CMS for
approval. The state is currently negotiating elements of its
plan with CMS. The state must be in full compliance with the new
HCBS guidelines in order to receive federal funding by March
2019.
Related legislation:
SB 577 (Pavley, Chapter 431, Statutes of 2014) established a
four-year pilot project to create and evaluate whether
community-based vocational development services are determined
to be a necessary step to achieve a supported employment
outcome. The pilot has not been enacted.
AB 1041 (Chesbro, Chapter 677, Statutes of 2013) expanded the
definition of competitive integrated employment and required
regional centers to ensure that consumers, beginning at 16 years
of age, are provided with information about options for
integrated competitive employment and other services, including
postsecondary education.
AB 287 (Beall, Chapter 231, Statutes of 2009) established an
"Employment First" effort for the State to undertake, which has
led to the State Council on Developmental Disabilities to put
together an "Employment First" policy and several attempts to
get that policy passed into law.
COMMENTS
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<2>
https://www.medicaid.gov/medicaid-chip-program-information/by-top
ics/long-term-services-and-supports/home-and-community-based-serv
ices/downloads/hcbs-setting-fact-sheet.pdf
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This bill seeks to move a group of consumers who currently are
in group employment activities into competitive integrated
employment, as is preferred by the new HCBS ruling, by creating
a transition program for individuals to learn social and other
necessary job skills. The bill would create a time-limited
opportunity to braid funding from various state departments and
regional center vendors to support consumers in obtaining
independent employment. Per the author, this is intended to move
the state toward solutions that can be incorporated into the new
HCBS state plan during the period when the state is formulating
then plan.
The bill is similar in concept to SB 577, a four-year pilot
project which was contingent upon federal funding and
established the same rate structure and similar job skills
training. SB 577 was signed and chaptered, however it has been
stalled by a lack of federal approval while the state's HCBS
waiver is pending. All new services or waivers must be approved
by the federal government to receive matching funding. The
sponsors of this bill hope that by removing the federal funding
requirement and permitting instead braided and blended funding
for existing categories of services, that these programs will be
established prior to the HCBS waiver process completion and the
enactment of SB 577.
Should this bill be passed from the Senate Human Services
Committee, the author may want to provide additional definition
of blended and braided funding and how these services would be
structured to provide the required training.
POSITIONS
Support:
California Disability Services Association
Arc and United Cerebral Palsy California Collaboration
Oppose:
None received.
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