BILL ANALYSIS
SENATE HEALTH AND HUMAN SERVICES
COMMITTEE ANALYSIS
Senator Deborah V. Ortiz, Chair
BILL NO: AB 1191
A
AUTHOR: Longville
B
AMENDED: April 19, 2001
HEARING DATE: June 27, 2001
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FISCAL: Appropriations
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CONSULTANT:
1
McCarthy / ak
SUBJECT
Developmental disabilities
SUMMARY
Establishes a process for resolving disputes between
regional centers and local public agencies.
ABSTRACT
Existing law:
1.Establishes the Lanterman Developmental Disabilities
Services Act, under which the Department of Developmental
Services (DDS) contracts with 21 private non-profit
regional centers to provide case management services and
arrange for, or purchase, other services that meet the
needs of individuals with developmental disabilities.
Some of the services are sought from another
publicly-funded agency.
2.Prohibits regional centers from using funds to supplant
the budget of any agency that has a legal responsibility
and is funded to provide services to the general public;
however, the regional center is the payer of last resort
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for services the regional center has determined necessary
for an individual.
3.Requires that regional centers develop an individualized
program plan (IPP) to be developed for every child over
the age of 36 months who is determined by a regional
center to be eligible for DDS system services. Requires
the IPP to identify the services and supports to be
purchased by the regional center or obtained from other
agencies.
4.Establishes the California Early Intervention Services
Act (Early Start Program), in addition to regular
development disabilities (DD) system service, funded
through Part C of the federal Individuals with
Disabilities Education Act (IDEA), to promote a
coordinated family service system for children from birth
to 36 months who have a developmental delay or are at
risk of developing a disability. Eligibility for Early
Start is broader than eligibility for regular DD system
services.
5.Requires regional centers to share primary responsibility
for provision of Early Start early intervention services
with local education agencies. Requires that the
regional centers develop an individualized family service
plan (IFSP) for each child in Early Start, delineating
the child's levels of development, desired outcomes,
services to be provided, and methods to be used to
determine the child's progress.
This bill:
1.Establishes a dispute resolution process that applies to
disputes regarding which local agency is responsible for
delivering or paying for a specific type, duration, or
frequency of service contained in either an Early Start
IFSP or a regular DD System IPP of a child, aged 0 - 5.
2.Prohibits the dispute resolution process from being used
to determine eligibility for a service, resolve disputes
between a consumer and a regional center, or take up
issues that have been decided through a state fair
hearing process or a proceeding under the California
Early Intervention Act, or for which a consumer has
requested mediation or a fair hearing.
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3.Specifies that the provisions of the bill do not modify
the mandated responsibility of a regional center or local
education agency to fund services identified in the Early
Start IFSP, and do not modify the responsibilities of a
regional center under the Lanterman Developmental
Services Act (regular DD system).
4.Authorizes a regional center to submit to another local
agency (e.g., local education agency, county health
department, county mental health department) a written
notification of the failure to provide a service, and a
request for dispute resolution, to the agency that the
regional center believes is responsible for providing the
service. Requires the regional center also to provide
written notification of this request to the consumer's
parent, legal guardian, or authorized representative.
5.Permits the regional center to withdraw its request for
dispute resolution at any time during the process.
6.Upon receipt of the written notification, requires the
local agency to meet with the regional center and resolve
the dispute within 15 calendar days. If the dispute is
resolved, requires the agency to mail a written copy of
the resolution to the parent, guardian, or authorized
representative within 10 calendar days of the meeting.
7.If the dispute cannot be resolved within 10 calendar days
of the meeting, requires the parties to submit their
contentions to the Office of Administrative Hearings
(OAH).
8.Requires OAH to review the dispute and issue a binding
written decision within 30 calendar days of receipt of
the case, specifying the type, frequency and duration of
the disputed service to be provided, as specified in the
IFSP or IPP developed by the regional center, and which
entity is responsible for the service.
9.Requires OAH to send a written copy of the resolution to
the parent, guardian, or authorized representative, the
Director of Developmental Services, and the regional
center or local agency involved in the dispute resolution
process.
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10.Permits the local agency and the regional center to
arrange for the provision of services in the child's IFSP
or IPP on an interim basis, until the dispute is
resolved.
11.Once the dispute resolution process is completed,
requires the agency determined to be responsible for the
service to reimburse the agency that provided the
service, if one did.
12.Specifies that nothing in the inter-agency dispute
resolution process shall prevent a consumer from filing
for a due process hearing or pursuing a remedy through a
civil action.
13.Requires DDS to pay for the services of the OAH.
14.Specifies that no resolution reached through this
process shall set a precedent for the resolution of any
other matter.
15.Sunsets the program December 31, 2004.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, there would be minor costs of about $123,000
General Fund annually for DDS to pay for the Office of
Administrative Hearing (OAH) services. This assumes 70
cases a year will require OAH review and decision, at a
cost of $1,750 per case. (However, there may be other
costs to other local county agencies, especially local
education agencies, related to their participation in the
dispute resolution process.)
BACKGROUND AND DISCUSSION
Early Start Program - ages 0-3
DDS and the regional centers administer early intervention
services for children who are developmentally delayed or at
risk of developmental disability. However, the regional
centers are required to share program responsibility with
local school districts and, if the child has health care
needs, programs administered by the Department of Health
Services, (including Medi-Cal and California Children's
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Services) and programs administered by county mental
health departments. It is not uncommon for disagreements to
occur among these various agencies regarding which agency
is responsible for paying for a particular service. When
such disagreements arise, the result is that the child may
go without the service until the agencies resolve their
differences or one of the agencies agrees to provide it.
Such disagreements can cause stress on families, interfere
with the provision of early intervention services, and,
regional centers believe, cause regional centers to absorb
more costs.
This bill, sponsored by the Association of Regional Center
Agencies (ARCA), is nearly identical to one introduced last
year by the Assembly Human Services Committee, AB 2918. AB
2918 passed out of the Assembly, but failed passage in the
Senate Appropriations Committee. According to ARCA, the
bill was re-introduced this year because the need still
exists. Families often face great frustration when a
regional center refers it to another local agency for
services, but the agency is reluctant to provide them.
This bill is intended to assure a timely resolution of
inter-agency disputes, and encourage services to be
provided while the resolution process is underway.
In its 1999 monitoring report of California's Early Start
program, the federal Office of Special Education Programs
(OSEP) found, that "[p]rovision of early intervention
services to some children and families is inappropriately
delayed because the State lacks a reimbursement procedure
to ensure that needed services can begin in a timely manner
without disputes about agency fiscal responsibility." The
Continuous Improvement Plan, submitted in response by DDS
to OSEP, includes training for regional center service
coordinators and other staff, instructions that the "payer
of last resort" has an obligation to purchase services
specified in the IFSP, and responsibility for the
Department of Education and the Department of Health
Services to develop reimbursement agreements. Subsequent
to the OSEP report, DDS has developed memoranda of
understanding with the Departments of Health Services,
Education, Mental Health, and Alcohol and Drug Programs,
specifying procedures for resolving disputes at the state
level.
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Nonetheless, according to ARCA, at the local level the
impasse over who is the responsible agency continues to
occur. This bill, ARCA argues, establishes procedures to
definitively resolve local disputes. Because it is based on
a statutory process and includes the OAH, ARCA believes it
will be more enforceable than the current memoranda of
understanding among state departments.
QUESTIONS AND COMMENTS
1.Initiation of dispute resolution process
AB 1191 allows only the regional center to initiate the
dispute resolution process outlined in the bill. This
provision could result in a one-sided process, in which
regional centers can start the process to require other
local agencies to provide services to a regional center
client, but does not provide a process for other local
agencies to require the regional centers to provide
services to a child not currently being served by a
regional center. For example, if a county mental health
agency is serving a young child and believes the child
qualifies for, and should be receiving services through,
the local regional center, no remedy is available to the
mental health agency through the proposed dispute
resolution process. Should this bill be amended to
allow other local agencies to also initiate the dispute
resolution process required by this bill?
2.IFSP and IPP required services
The regional centers develop for each eligible consumer
an Early Start IFSP or a regular DD system IPP; these
are the service plans that describe the type, frequency
and duration of services the child needs. Other local
agencies may not have been involved in determining the
contents of a child's IFSP or IPP and, thus, may disagree
with the regional center regarding the type, duration and
frequency of services outlined in those service plans,
but still be expected to provide those services by the
regional center. Also, as the other local agencies have
different eligibility criteria under state and federal
law, there may be different opinions as to the child's
eligibility for services. For example, mental health
services provided by county mental health are generally
limited to children who meet the criteria of "severely
emotionally disturbed" (SED); if a child's IPP requires
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mental health services, but the county mental health
department does not agree the particular child meets the
SED criteria, a dispute may arise regarding payment for
mental health services. This bill requires that the
decision of OAH must "specify the type, frequency, and
duration of the service or services to be provided as
specified in the consumer's individualized program plan
[IPP] or individualized family service plan [IFSP]".
Thus, the bill requires the OAH to accept the regional
center plan for services and only focus on which local
agency should pay for it.
At the state level, state agencies have developed
memoranda of understanding regarding how to resolve these
disputes. The author may want to consider an amendment
to require that the four major local agencies involved,
the local education agencies, county health and county
mental health and the regional centers develop similar
memoranda of understanding.
3.Technical amendment
This bill requires a technical amendment to insure
notification of the OAH decision is required to be
provided to any local agency involved, in addition to the
regional center.
4.Interim payment
Protection and Advocacy, Inc. opposed this bill on the
basis that it appeared to weaken requirements in current
law that regional centers must provide and pay for
services that are specified in a child's service plan
until or unless another local agency provides them. This
bill states that regional centers and other public
agencies may enter into written agreements regarding
which local agency shall provide the services on an
interim basis. Protection and Advocacy requested more
explicit language in the bill that, after submitting a
request for dispute resolution, a regional center is
still legally responsible, as payor of last resort, for
provision of the services pending the outcome of the
dispute resolution process. The author believes that
recent amendments to the bill have eliminated PAI's
concerns.
PRIOR ACTIONS
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Assembly Floor: 75 - 0 Pass on Consent
Assembly Appropriations: 21 - 0 Do Pass to Consent
Assembly Human Services: 6 - 0 Do Pass to Consent
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POSITIONS
Support: Association of Regional Center Agencies
(sponsor)
Alta California Regional Center
Developmental Disabilities Area Board 10
San Gabriel/Pomona
Tri-Counties Association for the
Developmentally disabled, Inc.
Oppose: Protection and Advocacy, Inc. (opposition may be
withdrawn due
to recent amendments)
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