BILL ANALYSIS
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: SB 1129
S
AUTHOR: Wiggins
B
VERSION: April 6, 2010
HEARING DATE: April 13, 2010
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FISCAL: Health; Appropriations
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CONSULTANT:
9
Hailey
SUBJECT
Health services: Sonoma Developmental Center
SUMMARY
Directs the Department of Developmental Services (DDS) to
provide intensive behavioral treatment services to
individuals residing in the community surrounding the
Sonoma Development Center.
ABSTRACT
Current law
1) Establishes developmental centers, administered by the
Department of Developmental Services (DDS), to provide
housing and services to persons with developmental
disabilities.
2) Establishes the Medi-Cal program to provide health care
coverage to persons who qualify by dint of age, economic
status, or disability.
Continued---
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3) Directs DDS to operate the Agnews Outpatient Clinic on
the property where the Agnews Developmental Center was
located.
This bill
1) Makes findings and declarations about developmental
centers, the high-quality intensive behavioral treatment
services they provide, and the difficulty that persons with
developmental disabilities have finding intensive
behavioral treatment services in their communities.
2) Requires the director of DDS to provide intensive
behavioral treatment services at the Sonoma Developmental
Center to persons residing in the surrounding area.
2) Permits DDS to obtain Medi-Cal provider status in order
to be reimbursed for services provided to persons who do
not reside at the developmental center.
3) Directs DDS to pursue other funds to minimize the
bill's impact on the General Fund; notes that other sources
may include the establishment of a certified public
expenditure program or procurement of a waiver under
federal Medicaid provisions.
4) Provides that the services to persons who are not
residents of the developmental center shall be contingent
on the department obtaining either sufficient outside funds
or status as a Medi-Cal provider.
5) Provides that the administration of these community
services be funded through the department's existing
resources and that no additional General Fund monies be
appropriated for new administrative duties.
FISCAL IMPACT
Unknown.
BACKGROUND AND DISCUSSION
Over the past fifty years, there have been extensive
changes in the social and legal approach to housing and
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providing services to persons with developmental
disabilities. In 1969, the Lanterman Act established
regional centers to provide case management and the
purchase of services necessary for persons with specific
developmental disabilities to live outside of institutional
settings. One at a time, as social mores and federal law
have changed, the state's developmental centers - large
institutional settings where persons with developmental
disabilities can live and receive needed health care and
other services - have closed or have served fewer
residents. These closures are unsettling for developmental
center residents and their families, and regardless of the
housing that is established or found for former
developmental-center residents, the needs of these
individuals for health care services remains high.
Developmental centers provide health care services to their
residents, using personnel who develop extensive experience
and expertise treating individuals with developmental
disabilities, who may have health challenges, fragile
conditions, and behavioral profiles distinct from the
general populations.
As the populations of developmental centers decrease,
residents, family members, professionals, and their labor
unions have sought ways to keep specialists working within
the regions where developmental centers operate. This bill
represents one approach to that goal.
Outpatient clinic at Agnews
As the state went through the process of closing Agnews
Developmental Center, in the San Jose area, the residents
there, their families, and the providers of health-care
services at the center worked to find ways to maintain
those services in the region by making them available to
area residents on an outpatient basis.
DDS sought and received a license for an outpatient clinic
as part of its licensed acute care hospital at Agnews
Developmental Center. In 2007, as part of budget trailer
legislation, the Legislature gave statutory direction to
DDS to continue operation of the Agnews Outpatient Clinic
until such time as DDS is no longer responsible for the
property where the developmental center sits. (Section
4474.8 of the Welfare and Institutions Code; part of AB
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203, Chapter 188, Statutes of 2007.)
DDS's experience opening the outpatient clinic on the
Agnews grounds may be instructive. Because a clinic bills
for Medi-Cal services separately from how medical services
are funded at a developmental center, DDS was unable to
establish a viable way to bill for services provided to
non-residents by developmental center staff. The
outpatient clinic was able to bill Medi-Cal for services
only after the developmental center closed its residential
program.
Further, according to DDS, while enthusiasm for the clinic
was high when it opened, within less than two years, more
than half the clinic staff had been laid off due to
decreasing demand. The San Jose area (Santa Clara and San
Mateo Counties and portions of southern Alameda County)
contained an estimated 3 million people in 2009, while the
counties surrounding Sonoma Developmental Center were home
to about 1 million people (Napa, Solano, and Sonoma
Counties).
Definition of "intensive behavioral treatment service"
California statute does not define "intensive behavioral
treatment service." Welfare and Institutions Code Section
4686.2 -- part of the Lanterman Act which establishes the
regional center system -- does define "intensive behavioral
intervention" as
any form of applied behavioral analysis that is
comprehensive, designed to address all domains of
functioning, and provided in multiple settings for
no more than 40 hours per week, depending on the
individual's needs and progress. Interventions can
be delivered in a one-to-one ration or small group
format, as appropriate.
Previous legislation
SB 1183 (Wiggins), in 2008, contained language directing
DDS to open an outpatient clinic providing medical and
dental services as well as ancillary services such as
wheelchair repair and orthotics. The Senate Human Services
Committee passed the bill on a 3-2 vote, the Senate sent
the bill to the lower house on a 25-14 vote, and the
Assembly Appropriations Committee held the bill.
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COMMENTS AND QUESTIONS
Would services to developmental center residents be
compromised if center personnel also care for persons who
are not center residents?
The budget for personnel and operations at the
developmental center is based upon the number of residents
at the center and their needs. The committee may want the
author to comment on whether there are unused resources at
the center that can be redirected to nonresidents who are
in need of intensive behavioral treatment services?
Can DDS bill Medi-Cal for services provided to
non-residents by developmental center employees?
As noted above, DDS reports that it was unable to bill
Medi-Cal for outpatient services provided by personnel at
the Agnews Developmental Center. The outpatient clinic
opened only after the last resident left Agnews. The
committee may want to ask the author and DDS if the
department has found ways to operate a developmental center
and serve non-residents simultaneously using the same
personnel. If personnel at the Sonoma Developmental Center
are in place to care for the residents, is it possible to
tease out the cost of their providing services to persons
from the area and then possible to subtract those costs
from the developmental center's budget and recoup an equal
amount from Medi-Cal?
Population to be served
As written, the bill would make intensive behavioral
treatment services to any person who comes to Sonoma
Developmental Center in need to these services. The author
may want to consider amending the bill to provide these
community services only to clients of the regional center
system. Those clients have case managers through their
local regional center and the regional centers have some
available for purchase of services that are not covered by
other state or federal funds.
Definition of services to be provided
Should the bill be amended to replace "intensive behavioral
treatment service" with "intensive behavioral
intervention," which is a phrase defined in statutes
addressing services to persons with developmental
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disabilities who are clients of the regional center system?
Note: all residents of Sonoma Developmental Center are, by
definition, regional center clients.
Note about double referral
The Rules Committee referred this bill to both the Human
Services Committee and the Committee on Health. In order
to meet legislative timelines, any amendments agreed to
during the Human Services Committee should be presented and
adopted in the Health Committee if a motion and sufficient
votes move the bill.
POSITIONS
Support: California Association of Psychiatric
Technicians
California Association for the Retarded
Developmental Services Network
Mayor of Sonoma
Service Employees International Union -
California State Council
Sonoma County Board of Supervisors
Oppose: None received
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