BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 104|
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THIRD READING
Bill No: AB 104
Author: Assembly Budget Committee
Amended: 6/8/11 in Senate
Vote: 21
PRIOR VOTES NOT RELEVANT
SUBJECT : Budget Act of 2011: Developmental Services
SOURCE : Author
DIGEST : This bill contains necessary changes in the area
of Developmental Services to enact the Budget Bill for
2011-12.
Senate Floor Amendments of 6/8/11 delete the prior version
of the bill and make various changes to statutes related to
the provision of developmental services and supports to
provide more uniformity and consistency in administrative
practices for Regional Centers and best practices for the
purchase of services by Regional Centers.
ANALYSIS : This bill makes the following changes:
1. Copy of Benefit Cards . This bill requires the
individual, or where appropriate, the parents, legal
guardian, or conservator, to provide copies of any
health benefit cards under which the consumer is
eligible to receive health care benefits, as specified,
at the time of the Individual Program Plan (IPP) or
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Individual Family Service Plan (IFSP). The purpose of
this change is to ensure appropriate access to the
receipt of federal funds and to maximize other
third-party resources as appropriate. If there are no
such benefits, the Regional Center shall not use that
fact to negatively impact the services that the consumer
may or may not receive from the Regional Center.
2. Electronic Billing . This bill requires Regional Centers
to begin transitioning providers to use of electronic
billing for services purchased through the Regional
Centers as specified. The Budget Bill reflects savings
of $900,000 (General Fund) from this action.
3. Changes to Porterville Developmental Center . This bill
caps admissions in the Secured Treatment Program at
Porterville Developmental Center. The Budget Bill
reflects savings of $5.1 million (General Fund) and 71
State positions for this action. The current cap is 297
residents. This legislation lowers that to a total of
230 residents which includes those individuals receiving
services in the Porterville transition treatment
program.
4. Prevention Program Transition and the Family Resource
Centers . The Prevention Program was established in
October 2009 after changes in eligibility to achieve
savings in the Early Start Program. The Prevention
Program provides services in the form of intake,
assessment, case management, and referral to generic
agencies for those infants and toddlers, 0 to 2 years of
age, who are not eligible for Early Start services but
who are at risk for developmental delay.
This bill decreases the required functions of the
Prevention Program to information, resource, outreach,
and referral, and transfers responsibilities for these
functions to the Family Resource Centers. The Budget
Bill reflects a reduction of $7.5 million (General Fund)
from this action.
Specifically, this bill amends statute to specify that
babies identified as being "at-risk" who are in the
Prevention Program as of June 30, 2011, shall continue
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in the Prevention Program until the child reaches the
age of 36 months, or the Regional Center has determined
the child is eligible for services under the Early Start
Intervention Program pursuant to Title 14, or June 30,
2012, whichever date is earlier. This bill phases out
the existing Prevention Program by July 1, 2012. In
addition, this bill provides for the Department of
Developmental Services (DDS) to contract with Family
Resource Centers to provide outreach, information and
referral services for families.
5. Development of Transportation Access Plans . Current law
provides that Regional Centers will not fund private,
specialized transportation services for an adult
consumer who can safely access and utilize public
transportation when that transportation modality is
available and will purchase the least expensive
transportation modality that meets a consumer's needs as
set forth in the IPP or IFSP.
To maximize consumer community integration and to
address barriers to the most integrated transportation
services, a Transportation Access Plan would be
developed at the time of the IPP, for consumers for whom
the Regional Center is purchasing specialized
transportation services or vendored transportation
services. The Transportation Plan would address
services needed to assist the consumer in developing
skills to access the most inclusive transportation
option that can meet the consumer's needs.
This bill requires the review of transportation needs of
a consumer through a Transportation Access Plan as
specified. Changes to the consumer's transportation
needs will be completed through the IPP and will address
a consumer's community integration and participation
through the use of public transportation services. The
planning team will consider safety, availability,
accessibility, and future services and supports which
include mobility training services and transportation
aides.
The Budget Bill reflects a reduction of $1.1 million
(General Fund) from this action.
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6. Use of Generic Education Resources . The Lanterman Act
requires the use of generic services to meet the needs
of consumers, as applicable, and public school services
are a generic resource to be utilized. Publicly funded
school services are available to regional center
consumers until age 22. The Education Code lists
services provided by the school system, including
orientation and mobility services, school transition
services, specialized driver training instruction,
specifically designed vocational education and career
development, and transportation.
This bill requires Regional Centers to access public
schools services where appropriate, in lieu of
purchasing Day Program, work/ employment, independent
living, and associated transportation services, as
feasible for consumers who remain eligible for services
through the public school system. This determination
would be based on the IPP and other factors as
specified.
The Budget Bill reflects a reduction of $10.2 million
(General Fund) from this action.
7. Maintaining Consumer's Home of Choice: Mixed Payment
Rates . Current regulations for Alternative Residential
Model (ARM) facilities (Title 17, Section 56902) allow
Regional Centers to negotiate a level of payment for its
consumers that is lower than the vendored rate
established by DDS. However, the vendor must still
provide the same level of service (i.e., staffing ratios
and hours, and consultant services) for which they are
vendored.
This bill allows, pursuant to the consumer's IPP, and a
contract between the Regional Center and Residential
Provider, a lower payment rate for a consumer whose
needs have changed but wants to maintain their residency
in their home, without impacting the facility's ARM
service level designation.
The Budget Bill assumes a reduction of $1.4 million
(General Fund) from this action. This reduction assumes
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that 450 consumers residing in service level 4 ARM
facilities that are determined through their IPP to no
longer need the level of service provided by that
facility through its assessed rate, but want to remain
in their home, are provided services at a lower rate.
The lower level of payment (within the existing ARM rate
structure) would be negotiated and established in
contract. Any change in the level of residential
services would be done through the IPP process, and
subsequently through a contract between the regional
center and residential service provider.
8. Maximizing Resources for Behavioral Services .
Behavioral Services are services that provide
instruction and environmental modifications to promote
positive behaviors and reduce behaviors that interfere
with learning and social interaction. These include
designing, implementing and evaluating teaching methods,
consultation with specialists, and behavioral
interventions; and training for consumers and/or parents
on the use of behavioral intervention techniques and
home-based behavioral intervention programs. DDS
regulations establish the qualifications for the various
professionals delivering these services.
This bill makes two changes regarding the receipt of
Behavioral Services which are purchased by Regional
Centers. First, it authorizes DDS to promulgate
emergency regulations to establish a new service to
enable Regional Centers to contract with
paraprofessionals with certain educational or
experiential qualifications and acting under
professional supervision (i.e., group practice), to
provide behavioral intervention services. The Budget
Bill reflects a reduction of $2.5 million ($1.9 million
General Fund) from this action. This reduction level
assumes that 25 percent of Behavioral Management
Assistant services are provided by a paraprofessional
and that the rate paid to the paraprofessional is 75
percent of the current rate.
Second, it requires parents to verify receipt of
Behavioral Services provided to their child to reduce
the unintended occurrence of incorrect billings. The
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Budget Bill reflects a reduction of $2.7 million ($2
million General Fund) from this action. This reduction
level reflects a one percent savings level based upon
projected expenditures of $265.7 million (total funds)
for Behavioral Services (ages 0 to 17 years).
9. Sunsets the Alternative Senior Program . The Budget Act
of 2009 and accompanying trailer legislation provided
for a new Alternative Senior Program as an alternative
for individuals desiring less programming in their Day
Program choices. However, this program was never fully
implemented. This bill sunsets this program as of July
1, 2011.
10. Individual Choice Day Service - Three Components . This
bill makes three changes to Day Program services.
First, it provides for a "Tailored Day Program Services
Option." In this option, through the IPP process, the
consumer, vendor, and Regional Center can create a
program tailored to the consumer's needs. Once the type
and amount of service desired by the consumer is
determined, the Regional Center and vendor can negotiate
the appropriate hourly or daily rate. Staffing may be
adjusted but must meet all health and safety
requirements for the consumer and meet the consumer's
tailored needs. The Budget Bill reflects a reduction of
$5.3 million (General Fund) in 2011-12 and annualized
savings of $7 million General Fund from implementation
of the Tailored Day Program Service Option.
Second, this bill provides for a "Vouchered
Community-Based Training Service Option." In this
option, consumers and/or parents can choose to directly
hire a support worker to develop functional skills to
achieve community integration, pursue post-secondary
education, employment, or participate in volunteer
activities. A Financial Management Services entity
would be available to assist the consumer in payroll
activities and up to 150 hours of services are available
each quarter. The Budget Bill reflects a reduction of
$2.9 million (General Fund) in 2011and annualized
savings of $3.9 million (General Fund).
Third, this bill provides for a modified full and
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half-day Day Program attendance billing. This bill
defines a full day of service at least 65 percent of the
declared and approved programed day, and a half-day of
service is any attendance less than a full-day of
service. Presently, regulations governing the provision
of Day Programs are silent on what constitutes a full or
half-day for billing purposes. This proposal would
ensure the consumer is receiving the level of services
purchased. The Budget Bill reflects a reduction of $1.4
million (General Fund) in 2011-12 and annualized savings
of the same amount.
These three changes result in annualized savings of
$16.5 million ($12.3 million General Fund).
11. Supported Living Services: Maximize Resources .
Supported Living Services (SLS) is a community living
option that supports adult consumers who live in homes
they control through ownership, lease, or rental
agreement. In supported living, a consumer pays for
living expenses (e.g., rent, utilities, food, and
entertainment) out of Social Security Income, work
earnings or other personal resources. Regional Centers
pay the vendor to provide the SLS. The Budget Bill
reflects a reduction of $9.9 million ($5.5 million
General Fund) in 2011-12 based on two changes.
First, this bill requires Regional Centers to assess,
during IPP meetings, whether there are tasks that can be
shared by consumers who live with roommates. DDS states
that 40 percent of consumers receiving SLS share living
arrangements with another adult. It is assumed that 10
percent of these households will choose to share equally
in tasks. A reduction of $3.8 million ($2.1 million
General Fund) is reflected in the Budget Bill from this
action.
Second, this bill requires an independent needs
assessment for all consumers who have Supported Living
Services costs that exceed 125 percent of their annual
statewide average cost of providing supported living
service. The independent needs assessment, as
specified, will be provided to the IPP team who will
make final determinations of needs.
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A reduction of $6.1 million ($3.4 million General Fund)
is assumed in the Budget Bill for this component. This
calculation assumes a reduction of five percent due to
the independent assessments of those individuals above,
or expected to be above the 125 percent of the annual
statewide average (mean), or $15.2 million (total
funds). This reduction is offset by the cost of the
independent assessment, at about $1,000 per assessment,
or $3 million (total funds). Annual savings from this
component are anticipated to be $12.2 million ($6.7
million General Fund).
12. Annual Family Program Fee . As contained in the
Governor's May Revision, this bill assumes
implementation of an Annual Family Program Fee for
certain income groups, effective as of July 1, 2011.
The fee would be phased-in at the time of in-take, or at
the time of development, scheduled review, or
modification of a consumer's Individual Program Plan
(IPP), but no later than June 30, 2012.
The Budget Bill reflects a reduction of $3.6 million
(General Fund) for 2011-12 by requiring certain families
of consumers to pay an annual family program fee in the
amount of $150 or $200 depending on family income.
Annual savings from this action are estimated to be $7.2
million (General Fund).
This annual fee would be assessed for families of
consumers receiving services from the Regional Centers
who meet the following criteria:
Family's income is at or above 400 percent of
poverty based upon family size;
Child lives at home, is under 18 years of age,
and is not eligible for Medi-Cal; and
Child or family receives services beyond
eligibility determination, needs assessment, and case
management.
Families of consumers who only receive respite,
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day care, and/or camping services are also excluded
under the Annual Fee Program if assessed separately
in the Family Cost Participation Program (no double
payment).
It is estimated that there will be a total of 46,900
families responsible for paying this Fee. It is assumed
that five percent of these families will be exempt from
paying for various reasons. Of the remaining 42,400
families, about 18,800 families will have incomes
between 400 percent and 800 percent of poverty and would
be assessed an annual Fee of $150, generating $2.8
million in savings. The remaining 23,600 families will
have incomes in excess of 800 percent of poverty and
would be assessed a family fee of $200, generating $4.8
million in savings.
It should be noted that this bill provides for an
exemption from paying the fee if the parents can
demonstrate that (a) exemption from the Fee is necessary
to maintain the child in the family home; (b) the
existence of an extraordinary event as specified; or (c)
the existence of a catastrophic loss that temporarily
limits the ability of the parents to pay as specified.
13. Rate Equity and Negotiated Rate Control . The rate
setting methodologies for services funded by Regional
Centers are specified in law. These methodologies
include (a) negotiations resulting in a rate that does
not exceed the Regional Center's median rate for that
service, or the statewide median, whichever is lower;
and (b) the provider's "Usual and Customary" rate, which
means the rate they charge the members of the general
public to whom they are providing services.
The 4.25 percent payment reduction for the Purchase of
Services went into effect July 1, 2010 but did not apply
to service providers with a "Usual and Customary" rate.
The intent of the "Usual and Customary" exemption was
for businesses that serve the general public without
specialty in services for persons with developmental
disabilities.
This bill clarifies that the exemption to the 4.25
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percent payment reductions does not apply to providers
specializing in services to persons with developmental
disabilities. This bill also requires DDS to update the
calculation of the Regional Center and statewide median
rates, established as part of the 2008-09 budget
reductions, applicable to new vendors providing services
for which rates are set through negotiation. The
proposal impacts providers who were not previously
impacted by the 4.25 percent payment reduction and new
providers of negotiated rate services.
The Budget Bill reflects a reduction of $4.6 million
($3.4 million General Fund) for 2011-12 for this action.
Annual savings are $13 million ($9.6 million General
Fund).
14. Technical Adjustment for Retroactive Billing to Claim
Federal Funds . The Budget Act of 2008 provided for the
receipt of additional federal funds by reconfiguring the
billing mechanism related to Intermediate Care
Facilities for the Developmentally Disabled (ICF-DD) as
it pertains to transportation. The federal Centers for
Medicare and Medicaid (CMS) allows for retroactive
billing which would enable California to receive the
full amount of federal funding available.
This bill provides for a reappropriation to capture
federal funds starting as of July 1, 2007. This will
enable California to appropriately retroactively claim
federal funds.
15. Review by the Office of Statewide Audits and
Evaluations . This bill requires the DDS to reimburse
the Office of Statewide Audits and Evaluations (OSAE) to
conduct a review and analysis of the budget methodology,
including relevant data, formulas, and cost assumptions,
used in determining the annual state budget for the
Developmental Centers. It is the Legislature's intent
for the DDS to notify the OSAE and to proceed with this
analysis during the fall of 2011.
16. Appropriation and Proposition 25 Language . This bill
appropriates $1,000 to DDS for state administration. It
is a bill that meets the meaning of subdivision (e) of
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Section 12 of Article IV of the California Constitution,
and has been identified as related to the budget in the
Budget Bill and shall take effect immediately.
FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes
Local: No
CTW:mw 6/8/11 Senate Floor Analyses
SUPPORT/OPPOSITION: NONE RECEIVED
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