BILL ANALYSIS �
SENATE COMMITTEE ON BUDGET AND FISCAL REVIEW
Mark Leno, Chair
Bill No: AB 1472
Author: Committee on Budget
As Amended: June 13, 2012
Consultant: Jennifer Troia
Fiscal: Yes
Hearing Date: June 14, 2012
Subject: Budget Act of 2012: Developmental Services
Summary: Contains necessary statutory and technical
changes to implement to the Developmental Services
provisions of the Budget Act of 2012.
Background: The Department of Developmental Services (DDS)
administers services for persons with developmental
disabilities. The services are provided in the community
through 21 Regional Centers and also in state-run
Developmental Center institutions (DCs). Services and
supports provided range from day programs to transportation
or residential care. Determination of which services an
individual consumer needs is made through the process of
developing an Individualized Program Plan (IPP) (or
Individual Family Service Plan if the consumer is an
infant/toddler three years of age or younger).
Individuals with developmental disabilities have a number
of residential options. Ninety-nine percent of DDS
consumers receive community-based services and live with
parents or other relatives, in their own houses or
apartments, or in group homes (of various models) designed
to meet their medical or behavioral needs. Another
approximately 1,800 individuals reside in four
state-operated DCs and one state-operated community
facility. Consistent with national trends that support
integrated services and reduced reliance on state
institutions, California has been reducing its use of DCs
as a placement for individuals with developmental
disabilities for several decades.
Due to lower than anticipated revenue projections, the
Department of Finance announced in December 2011, that
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DDS's 2011-12 budget would be reduced by $100 million
General Fund (GF) in accordance with A.B. 121, Chapter 41,
(Statutes of 2011). The proposed budget for 2012-13
includes the full year impact of the revenue trigger
reduction for DDS of $200 million GF. Several of the
policy changes necessary to implement this reduction are
included in the provisions of this bill.
Proposed Law:
This bill includes the following provisions:
1)Consistent with federal requirements, provides that the
use of private health insurance to pay for early
intervention services for infants and toddlers with
disabilities under the California Early Intervention
Services Act and Part C of the federal Individuals with
Disabilities Education Act may not result in the loss of
benefits due to an annual or lifetime health insurance
cap, may not negatively affect the availability of health
insurance for the individual or family, and may not be
the basis for increasing health insurance premiums for
the individual or family.
2) Decreases reliance on developmental centers (DCs),
residential facilities for which federal Medicaid funding
is not available, and out-of-state placements through
several measures, including those detailed below, which
are intended to redesign services for individuals with
challenging service needs. This redesign is anticipated
to result in savings of $20 million GF annually.
a) Establishes a statewide resource service to track
specialty services and coordinate with regional
centers, and prioritizes the development of specialty
resources, including regional community crisis homes,
when allocating community placement plan funding.
b) Requires regional centers to complete, by December
31, 2015, comprehensive assessments of specified
developmental center residents residing in a DC on
July 1, 2012, and provides that the assessments shall
be shared with IPP teams to assist in determining the
least restrictive environment for the consumer.
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c) Expands the availability of adult residential
facilities for persons with special health care needs
to consumers of any regional center moving from a DC;
and, with prior DDS authorization, to consumers of any
regional center not residing in a DC who meet the
requirements for admission if: i) there is a vacancy;
ii) no DC resident from any regional center meets the
requirements for admission; and iii) the placement is
necessary to protect the consumer's health or safety.
d) Establishes new restrictions on admissions to DCs
by limiting them to individuals with developmental
disabilities who are:
i) Committed by a court to Porterville DC for
secure treatment:
(1) For the attainment of mental competence,
pursuant to Penal Code provisions pertaining to
persons determined to be incompetent to stand
trial for criminal offenses;
(2) After involvement with the criminal
justice system, a determination of incompetence
to stand trial, and a finding that the individual
is dangerous to himself, herself, or others; or,
(3) For the attainment of mental competence
pursuant to Welfare and Institutions Code
provisions pertaining to juvenile offenders;
ii) Committed by a court to Fairview DC due to an
acute crisis, as defined; or,
iii) Released from a DC on a provisional placement
of up to 12 months and have an automatic right of
return to the DC during the period of provisional
placement.
e) Requires regional resource development program
determinations that admittance to a DC is necessary
due to an acute crisis, as defined, to include a
regional center report detailing all considered
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community-based options, excluding out-of-state
placements and specified placements that are
ineligible for federal Medicaid funding, and an
explanation of why those options cannot meet the
consumer's needs at the time of the determination.
f) Establishes assessment and transition planning
requirements, including timelines, following
court-ordered DC admissions due to an acute crisis.
g) Limits court-ordered DC admissions due to an acute
crisis to six months unless specified conditions are
met and the committing court extends the commitment
for an additional period, not to exceed a total
commitment period of one year. Permits an additional
30-day extension only if the regional center
demonstrates significant progress toward implementing
the consumer's transition plan and extraordinary
circumstances exist beyond the regional center's
control preventing the regional center from obtaining
the identified services and supports within the
timeline specified in the plan.
h) Revises provisions governing court-ordered DC
placements and stays of individuals with developmental
disabilities (pursuant to Welfare and Institutions
Code Section 6500 et seq.), to conform to the
admission criteria and time limits for placements at
Fairview DC due to an acute crisis, or Porterville DC
secure treatment program based on a determination of
dangerousness to self or others.
i) Prohibits regional centers from purchasing
out-of-state services without prior DDS authorization,
and limits authorization to six months, with a
possible six-month extension based on a determination
that the consumer's needs cannot be met in California.
Requires regional centers to submit, by December 31,
2012, a transition plan for all consumers residing out
of state as of June 20, 2012, for whom the regional
center is purchasing services.
j) Prohibits regional centers from purchasing
residential services from a mental health
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rehabilitation center unless the facility is eligible
for federal Medicaid funding; or has an approved plan
in place to transition to a Medicaid-eligible program
structure within specified timeframes; or, in the
event of an emergency when alternative, federally
eligible services cannot be located, for no longer
than six months.
aa) Prohibits regional centers from purchasing
residential services from an institution for mental
disease (IMD) for which federal Medicaid funding is
not available, except in emergencies, subject to
specified assessment and transition planning
requirements. Requires comprehensive assessments
prior to the consumer's next scheduled IPP meeting for
any consumer residing in an IMD as of July 1, 2012.
bb) Authorizes certain facilities, with residents no
younger than 10 years of age, to utilize delayed
egress devices in combination with secured perimeters
under specified conditions when approved by a state
department and in accord with emergency regulations
promulgated by the Department of Developmental
Services (DDS).
cc) Requires annual reporting to the Legislature by
DDS, with input provided by regional centers, on the
outcomes of various measures to reduce reliance on
DCs, residential facilities for which federal funding
is not available, and out-of-state placements.
3)Authorizes the use of technology, including
telecommunication, when feasible and recommended by the
IPP team to facilitate better and cost-effective
services. Restricts the use of technology in lieu of a
consumer's in-person appearance at judicial proceedings
or administrative hearings to only circumstances in which
the consumer (or, when appropriate, the consumer's
legally authorized representative) has provided informed
consent. These provisions are anticipated to result in
savings of $2.0 million GF.
4)Deletes provisions of current law requiring independent
assessments of consumers receiving supported living
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services who have supported living costs, or an initial
recommendation for service costs, that exceed 125% of the
annual statewide average cost. Instead, requires that
IPP teams complete a standardized assessment
questionnaire at specified times to assist in determining
whether the supported living services provided or
recommended are necessary, sufficient, and
cost-effective. Requires the questionnaire to be
developed with input from regional centers and other
stakeholders and posted on the DDS Web site by June 30,
2012. These provisions are anticipated to result in net
savings of $4.2 million GF.
5)Reduces, from July 1, 2012, until June 30, 2013, payments
to Regional Centers and providers of specified services
by 1.25 percent. A payment reduction of three percent was
initiated in 2009. It was increased to 4.25 percent on
July 1, 2012 and is scheduled to sunset June 30, 2012.
This bill would instead extend the reduction for one
additional year, but at a lower amount. This provision
is anticipated to result in savings of $30.7 million GF.
Correspondingly, this bill extends authorization for
temporary modifications of personnel requirements,
functions, or qualifications, or staff training
requirements, as well as prescribed annual review and
reporting requirements for affected providers, until June
30, 2013. Also suspends specified regional center
staffing level and staff expertise requirements until
June 30, 2013.
6)Requires DDS and each regional center to annually report
and post on its Web site purchase-of-service
authorization, utilization, and expenditure data, by
regional center, with respect to race or ethnicity, age,
primary language, and disability, and requires each
regional center to meet with stakeholders in a public
meeting regarding this data.
7)Establishes the intent of the Legislature that if a
reduction of $50 million to the developmental services
system is triggered by a specified provision of the
Budget Act during the 2012-13 fiscal year, the impacts of
that reduction should be kept as far away as possible
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from the direct services and needs of DDS consumers. To
that end, the bill identifies a variety of strategies
that might assist the Department in carrying out that
intent. Additionally, this bill requires the Department
to consider input from prescribed stakeholders as
necessary to develop savings proposals related to this
trigger.
Support: Unknown
Opposed: Unknown
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