BILL ANALYSIS �
AB 1244
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ASSEMBLY THIRD READING
AB 1244 (Chesbro)
As Amended May 27, 2011
Majority vote
HUMAN SERVICES 4-2 APPROPRIATIONS 12-5
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|Ayes:|Beall, Ammiano, Hall, |Ayes:|Fuentes, Blumenfield, |
| |Portantino | |Bradford, Charles |
| | | |Calderon, Campos, Davis, |
| | | |Gatto, Hall, Hill, Lara, |
| | | |Mitchell, Solorio |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Jones, Grove |Nays:|Harkey, Donnelly, |
| | | |Nielsen, Norby, Wagner |
| | | | |
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SUMMARY : Establishes the Self-Determination Program providing
individuals with developmental disabilities with an individual
funding allocation to give them greater control over the
purchase of services and supports needed to implement their
individual program plans. Specifically, this bill :
1)Strikes existing statutory provisions establishing the
Self-Directed Services Program (SDS Program) (Welfare &
Institutions (W&I) Code Section 4685.7) and, instead,
contingent upon the approval of federal Medicaid matching
funding, establishes the Self-Determination Program (SD
Program), which makes available to individuals with
developmental disabilities receiving services under the
Lanterman Developmental Disabilities Services Act (Lanterman
Act) a capitated individual funding allocation, computed in a
fair, transparent, and equitable manner based on the
individual's characteristics and need, to enable them to
exercise their rights to make choices in their lives and
access services and supports they choose to implement their
individual program plans (IPPs).
2)Provides that participation in the SD Program is voluntary,
that a participant may choose to participate or leave at any
time, and that participation may not be a condition placed on
the receipt of services and supports otherwise available under
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the Lanterman Act.
3)Provides that, in its first year, the SD Program shall be
available only in the five regional centers (RCs) that are
part of an existing self-determination pilot program and that,
in the second year, all RCs shall be required to implement an
SD Program as a term of their contract.
4)Provides that the individual allocation shall equal 90% of the
annual per capita purchase of service costs for the previous
fiscal year for consumers with similar characteristics who do
not receive services through the SD Program;
5)Prohibits the use of individual allocations to purchase
services from the following:
a) A licensed long-term health facility, or a residential
facility;
b) A day program or habilitation services program, except
for:
i) Specific periodic or one time services; and,
ii) Job development and job coaching services for
Individual Placement Supported Employment.
6)Provides that an RC may not prohibit the purchase of any
service or support otherwise allowable under the SD Program in
order to implement an individual's IPP.
7)Requires the Department of Developmental Services (DDS) to
establish and administer a risk pool to meet the unanticipated
needs of participants in the SD Program.
8)Requires the risk pool to be funded at the equivalent of 2.5%
of the historical annual purchase of service costs for
consumers participating in the SD Program, as determined for
consumers of similar characteristics.
9)Requires DDS to use 7.5% of the historical annual purchased of
service costs for consumers in the SD Program toward
offsetting SD Program state costs, with the remainder to be
returned as savings to the General Fund (GF).
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10)Exempts SD Program participants from the Family Cost
Participation Program, and recent cost savings measures
placing restrictions on purchases of services enacted through
the budget process.
11)Provides that SD Program participants have the right to
employ, supervise, direct, schedule, evaluate, train and
terminate SD Support Workers, who are with limited exceptions
not deemed to be State employees, of their choice;
12)Requires the state to establish a base compensation package
to ensure decent pay standards for SD Support Workers, and
authorizes individuals to pay SD Support Workers above the
base established by the state, to develop job descriptions,
and otherwise organize and incentivize their SD Support
Workers;
13)Authorizes SD Support Workers to form, join, and participate
in labor organizations in order to engage in collective
negotiations with DDS;
14)Prohibits the designated negotiating representative for SD
Support Workers from calling or directing a strike or other
form of work stoppage.
15)Requires DDS to establish a statewide SD Program Advisory
Committee and,
commencing January 10, 2013, to annually provide specified
information and data on implementation of the SD Program to
the Advisory Committee and to the policy and fiscal committees
of the Legislature.
16)States the intent of the Legislature that the purchase of
services and supports through the SD Program be eligible for
federal Medicaid match funds, and requires that DDS:
a) Take all steps necessary to ensure the availability of
federal matching funds for the SD Program by applying for
amendments to the current home and community-based waiver
for people with developmental disabilities or for a new
Medicaid waiver; and,
b) Apply for an enhanced federal match through the federal
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Community First Choice Option.
EXISTING LAW
1)Establishes, contingent upon approval of a federal waiver, the
SDS Program, which, when implemented, provides participants,
within a set individual budget amount, greater control over
needed services and supports, consistent with the requirements
set forth in the statute (W&I Code Section 4685.7).
2)Requires DDS, in consultation with stakeholders, to develop an
alternative service delivery model that provides an Individual
Choice Budget (ICB) for obtaining quality services and
supports which provides choice and flexibility within a finite
budget that in the aggregate reduces regional center purchase
of service expenditures, reduces reliance on the state general
fund, and maximizes federal financial participation in the
delivery of services. Requires the individual budget to be
determined using a fair, equitable, transparent standardized
process (W&I Code Section 4648.6).
FISCAL EFFECT : According to the Assembly Appropriations
Committee, one-time costs potentially in excess of several
hundred thousand dollars GF for the workload associated with
creating the new SD Program.
COMMENTS : "Self-determination," or "self-directed services,"
represents an alternative model of service delivery, whereby
individuals who are eligible for state developmental
disabilities services are empowered to gain control over the
selection of services and supports that meet their own needs.
It is an alternative to the standard service model of the
Lanterman Act in which regional centers purchase services
directly from approved "vendors" or obtain services from other
agencies. Self-determination is intended to enhance the ability
of a consumer and his or her family to control the decisions and
resources required to meet all or some of the objectives in the
consumer's IPP. According to DDS' Web site, self-directed
service programs are implemented nationwide and have garnered
international and bi-partisan support.
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Prior self-determination/self-directed services initiatives .
Self-Determination Pilot Projects : SB 1038 (Thompson), Chapter
1043, Statutes of 1998, authorizes the planning and
implementation of self-determination pilot projects at three
RCs: East Los Angeles Regional Center, Tri-Counties Regional
Center, and Redwood Coast Regional Center. Two other regional
centers (Kern Regional Center and San Diego Regional Center)
also created independent self-determination pilots through
approval of alternative service delivery models pursuant to W&I
Code Section 4669.2. The pilot programs, which vary somewhat
among the five participating RCs, were limited to a total of
approximately 140 consumers. These self-determination pilot
programs are ongoing and, reportedly, successful, with a high
level of participant satisfaction.
Self-Directed Services Program (SDS Program) : AB 131 (Assembly
Budget Committee), Chapter 80, Statutes of 2005 (Budget Act
2005, omnibus health trailer bill), repeals the statutory
section establishing the self-determination pilot projects and
added W&I Code Section 4685.7 to establish, contingent upon
approval of a federal waiver, self-directed services statewide.
DDS filed an SDS Waiver application with the federal Centers for
Medicare & Medicaid Services (CMS) on April 2, 2008; however, it
has still not been approved. Therefore, the SDS Program has
never been implemented.
Individual choice budgets (ICB) : As part of the 2008-09 and
2009-10 budget process, DDS was charged with identifying $334
million in GF savings in the developmental disabilities service
system. Those cost savings measures included the suspension of
RCs' authority to purchase certain services, including
social/recreation activities, camping services, educational
services for minor, school-aged children, and non-medical
therapies. The services will be made available once DDS
develops and implements an ICB service delivery model and the
director of DDS certifies that the ICB has been implemented and
will result in state budget savings sufficient to offset the
costs of providing those services. AB 9 X4 (Evans), Chapter 9,
Statutes of 2009 4th Extraordinary Session. The ICB service
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delivery model is to provide consumers and families with an
"Individual Choice Budget" that gives them the resources to
obtain quality services and supports within a defined budget
while providing choice and flexibility that, in total, saves
money in purchase of service expenditures. AB 9 X4 requires DDS
to develop the ICB model in consultation with stakeholders. To
date, no consensus among stakeholders has been reached on the
ICB model and it has not been developed or implemented.
Cost savings : A key feature of the existing SDS Program
statute, the ICB model, and the SD Program established by this
bill is that individual budget allocations are required to
result in a cost savings compared to the current purchase of
service model. This bill requires that the individual
allocation amount "shall equal 90% of the annual per capita
purchase of service costs for the previous fiscal year for
consumers with similar characteristics who do not receive
services through the SD Program." In exchange for the reduced
expenditure, consumers would gain far more flexibility and
control over the services and supports they receive.
The most recent amendments to this bill, taken in the Assembly
Appropriations Committee, are intended to ensure cost
neutrality. Among other things, these amendments make
implementation of the program contingent on the receipt of
federal Medicaid matching funding, and increase from 2.5% to
7.5% of historical purchase of service costs the amount that DDS
is to set aside to cover the costs to the state to administer
the SD Program.
Please see policy committee analysis for more comprehensive
comments and additional details on the provisions of this bill.
Analysis Prepared by : Eric Gelber / HUM. S. / (916) 319-2089
FN: 0001119
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