California Legislature—2013–14 Regular Session

Assembly Bill No. 1753

Introduced by Assembly Member Holden

February 14, 2014

An act to amend Sections 4629.5 and 4648 of the Welfare and Institutions Code, relating to developmental services.

LEGISLATIVE COUNSEL’S DIGEST

AB 1753, as introduced, Holden. Developmental services: regional centers: vendorization.

Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services is required to contract with regional centers to provide services and supports to individuals with developmental disabilities and their families. The services and supports to be provided by a regional center to a consumer are contained in an individual program plan (IPP) or individual family service plan (IFSP), developed in accordance with prescribed requirements. Existing law authorizes a regional center to purchase, pursuant to vendorization or a contract, services or supports for a consumer from an individual or agency that the regional center and consumer, or when appropriate, other specified persons, determines will best accomplish all or any part of that consumer’s program plan.

This bill would, if a consumer, or his or her parents, legal guardian, conservator, or authorized representative, requests that a service specified in the consumer’s individual program plan be provided by a service vendor that has been vendored by another regional center, authorize the service vendor to provide services to the consumer under the same contractual terms as the vendoring regional center if certain requirements are satisfied, including that the service vendor is in good standing with the vendoring regional center and that the service provider provides services at no additional costs to the consumer or the consumer’s regional center.

Existing law requires a regional center to include specified information on its Internet Web site for the purpose of promoting transparency and access to public information.

This bill would require that information to include a list of the services that are provided directly to consumers by the regional center or through service vendors or contractors. The bill would require the list to be in a standardized form, as prescribed by the department, and to be updated at least quarterly.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 4629.5 of the Welfare and Institutions
Code is amended to read:

4629.5.  

(a) In addition to the requirements set forth in Section
4629, the department’s contract with a regional center shall require
the regional center to adopt, maintain, and post on its Internet Web
site a board-approved policy regarding transparency and access to
public information. The transparency and public information policy
shall provide for timely public access to information, including,
but not limited to, information regarding requests for proposals
and contract awards, service provider rates, documentation related
to establishment of negotiated rates, audits, and IRS Form 990.
The transparency and public information policy shall be in
compliance with applicable law relating to the confidentiality of
consumer service information and records, including, but not
limited to, Section 4514.

(b) To promote transparency, each regional center shall include
on its Internet Web site, as expeditiously as possible, at least all
of the following:

(1) Regional center annual independent audits.

(2) Biannual fiscal audits conducted by the department.

(3) Regional center annual reports pursuant to Section 4639.5.

(4) Contract awards, including the organization or entity
awarded the contract, and the amount and purpose of the award.

(5) Purchase of service policies.

(6) The names, types of service, and contact information of all
vendors, except consumers or family members of consumers.

(7) Board meeting agendas and approved minutes of open
meetings of the board and all committees of the board.

(8) Bylaws of the regional center governing board.

(9) The annual performance contract and year-end performance
contract entered into with the department pursuant to this division.

(10) The biannual Home and Community-based Services Waiver
program review conducted by the department and the State
Department of Health Care Services.

(11) The board-approved transparency and public information
policy.

(12) The board-approved conflict-of-interest policy.

begin delete

(13) Reports required pursuant to Section 4639.5.

end delete begin insert

(13) A list of the services that are provided directly to consumers
by the regional center or through service vendors or contractors.
The list shall be in a standardized format prescribed by the
department and shall be updated at least quarterly.

end insert

(c) The department shall establish and maintain a transparency
portal on its Internet Web site that allows consumers, families,
advocates, and others to access provider and regional center
information. Posted information on the department’s Internet Web
site transparency portal shall include, but need not be limited to,
all of the following:

(1) A link to each regional center’s Internet Web site information
referenced in subdivision (b).

(2) Biannual fiscal audits conducted by the department.

(3) Vendor audits.

(4) Biannual Home and Community-based Services Waiver
program reviews conducted by the department and the State
Department of Health Care Services.

(5) Biannual targeted case management program and federal
nursing home reform program reviews conducted by the
department.

(6) Early Start Program reviews conducted by the department.

(7) Annual performance contract and year-end performance
contract reports.

SEC. 2.  

Section 4648 of the Welfare and Institutions Code is
amended to read:

4648.  

In order to achieve the stated objectives of a consumer’s
individual program plan, the regional center shall conduct activities,
including, but not limited to, all of the following:

(a) Securing needed services and supports.

(1) It is the intent of the Legislature that services and supports
assist individuals with developmental disabilities in achieving the
greatest self-sufficiency possible and in exercising personal
choices. The regional center shall secure services and supports
that meet the needs of the consumer, as determined in the
consumer’s individual program plan, and within the context of the
individual program plan, the planning team shall give highest
preference to those services and supports which would allow
minors with developmental disabilities to live with their families,
adult persons with developmental disabilities to live as
independently as possible in the community, and that allow all
consumers to interact with persons without disabilities in positive,
meaningful ways.

(2) In implementing individual program plans, regional centers,
through the planning team, shall first consider services and supports
in natural community, home, work, and recreational settings.
Services and supports shall be flexible and individually tailored
to the consumer and, where appropriate, his or her family.

(3) A regional center may, pursuant to vendorization or a
contract, purchase services or supports for a consumer from any
individual or agency begin delete which end delete begin insert that end insert the regional center and consumer
or, begin delete where end delete begin insert when end insert appropriate, his or her parents, legal guardian, or
conservator, or authorized representatives, determines will best
accomplish all or any part of that consumer’s program plan.

(A) Vendorization or contracting is the process for identification,
selection, and utilization of service vendors or contractors, based
on the qualifications and other requirements necessary in order to
provide the service.

(B) A regional center may reimburse an individual or agency
for services or supports provided to a regional center consumer if
the individual or agency has a rate of payment for vendored or
contracted services established by the department, pursuant to this
division, and is providing services pursuant to an emergency
vendorization or has completed the vendorization procedures or
has entered into a contract with the regional center and continues
to comply with the vendorization or contracting requirements. The
director shall adopt regulations governing the vendorization process
to be utilized by the department, regional centers, vendors and the
individual or agency requesting vendorization.

(C) Regulations shall include, but not be limited to: the vendor
application process, and the basis for accepting or denying an
application; the qualification and requirements for each category
of services that may be provided to a regional center consumer
through a vendor; requirements for emergency vendorization;
procedures for termination of vendorization; the procedure for an
individual or an agency to appeal begin delete any end delete begin insert a end insert vendorization decision
made by the department or regional center.

(D) A regional center may vendorize a licensed facility for
exclusive services to persons with developmental disabilities at a
capacity equal to or less than the facility’s licensed capacity. A
facility already licensed on January 1, 1999, shall continue to be
vendorized at their full licensed capacity until the facility agrees
to vendorization at a reduced capacity.

(E) Effective July 1, 2009, notwithstanding any other begin delete provision
of end delete law or regulation to the contrary, a regional center shall not
newly vendor a State Department of Social Services licensed
24-hour residential care facility with a licensed capacity of 16 or
more beds, unless the facility qualifies for receipt of federal funds
under the Medicaid Program.

begin insert

(F) (i) If a consumer, or his or her parents, legal guardian,
conservator, or authorized representative, requests that a service
specified in the consumer’s individual program plan be provided
by a service vendor that has been vendored by another regional
center, the service vendor is authorized to provide services to the
consumer in accordance with paragraph (6) of this subdivision,
and under the same contractual terms as the vendoring regional
center, if all of the following requirements are satisfied:

end insert begin insert

(I) The service vendor is in good standing with the vendoring
regional center.

end insert begin insert

(II) The service vendor provides services at no additional cost
to the consumer or the consumer’s regional center.

end insert begin insert

(III) The services provided by the service vendor are consistent
with, and provided at the same level of care and professionalism
as, the vendoring regional center’s vendorization.

end insert begin insert

(ii) For purposes of this subparagraph, “vendoring regional
center” means the regional center that has vendored the service
vendor.

end insert

(4) Notwithstanding subparagraph (B) of paragraph (3), a
regional center may contract or issue a voucher for services and
supports provided to a consumer or family at a cost not to exceed
the maximum rate of payment for that service or support
established by the department. If a rate has not been established
by the department, the regional center may, for an interim period,
contract for a specified service or support with, and establish a
rate of payment for, any provider of the service or support
necessary to implement a consumer’s individual program plan.
Contracts may be negotiated for a period of up to three years, with
annual review and subject to the availability of funds.

(5) In order to ensure the maximum flexibility and availability
of appropriate services and supports for persons with
developmental disabilities, the department shall establish and
maintain an equitable system of payment to providers of services
and supports identified as necessary to the implementation of a
consumers’ individual program plan. The system of payment shall
include provision for a rate to ensure that the provider can meet
the special needs of consumers and provide quality services and
supports in the least restrictive setting as required by law.

(6) The regional center and the consumer, or begin delete where end delete begin insert when end insert
appropriate, his or her parents, legal guardian, conservator, or
authorized representative, including those appointed pursuant to
subdivision (d) of Section 4548, subdivision (b) of Section 4701.6,
or subdivision (e) of Section 4705, shall, pursuant to the individual
program plan, consider all of the following when selecting a
provider of consumer services and supports:

(A) A provider’s ability to deliver quality services or supports
begin delete which end delete begin insert that end insert can accomplish all or part of the consumer’s individual
program plan.

(B) A provider’s success in achieving the objectives set forth
in the individual program plan.

(C)  begin delete Where end delete begin insert When end insert appropriate, the existence of licensing,
accreditation, or professional certification.

(D) The cost of providing services or supports of comparable
quality by different providers, if available, shall be reviewed, and
the least costly available provider of comparable service, including
the cost of transportation, who is able to accomplish all or part of
the consumer’s individual program plan, consistent with the
particular needs of the consumer and family as identified in the
individual program plan, shall be selected. In determining the least
costly provider, the availability of federal financial participation
shall be considered. The consumer shall not be required to use the
least costly provider if it will result in the consumer moving from
an existing provider of services or supports to more restrictive or
less integrated services or supports.

(E) The consumer’s choice of providers, or, begin delete where end delete begin insert when end insert
appropriate, the consumer’s parent’s, legal guardian’s, authorized
representative’s, or conservator’s choice of providers.

(7) No service or support provided by any agency or individual
shall be continued unless the consumer or, begin delete where end delete begin insert when end insert appropriate,
his or her parents, legal guardian, or conservator, or authorized
representative, including those appointed pursuant to subdivision
(d) of Section 4548, subdivision (b) of Section 4701.6, or
subdivision (e) of Section 4705, is satisfied and the regional center
and the consumer or, when appropriate, the person’s parents or
legal guardian or conservator agree that planned services and
supports have been provided, and reasonable progress toward
objectives have been made.

(8) Regional center funds shall not be used to supplant the
budget of any agency that has a legal responsibility to serve all
members of the general public and is receiving public funds for
providing those services.

(9) (A) A regional center may, directly or through an agency
acting on behalf of the center, provide placement in, purchase of,
or follow-along services to persons with developmental disabilities
in, appropriate community living arrangements, including, but not
limited to, support service for consumers in homes they own or
lease, foster family placements, health care facilities, and licensed
community care facilities. In considering appropriate placement
alternatives for children with developmental disabilities, approval
by the child’s parent or guardian shall be obtained before placement
is made.

(B) Effective July 1, 2012, notwithstanding any other law or
regulation begin delete to the contrary end delete , a regional center shall not purchase
residential services from a State Department of Social Services
licensed 24-hour residential care facility with a licensed capacity
of 16 or more beds. This prohibition on regional center purchase
of residential services shall not apply to any of the following:

(i) A residential facility with a licensed capacity of 16 or more
beds that has been approved to participate in the department’s
Home and Community Based Services Waiver or another existing
waiver program or certified to participate in the Medi-Cal program.

(ii) A residential facility service provider that has a written
agreement and specific plan prior to July 1, 2012, with the
vendoring regional center to downsize the existing facility by
transitioning its residential services to living arrangements of 15
beds or less or restructure the large facility to meet federal
Medicaid eligibility requirements on or before June 30, 2013.

(iii) A residential facility licensed as a mental health
rehabilitation center by the State Department of Mental Health or
successor agency under any of the following circumstances:

(I) The facility is eligible for Medicaid reimbursement.

(II) The facility has a department-approved plan in place by
June 30, 2013, to transition to a program structure eligible for
federal Medicaid funding, and this transition will be completed by
June 30, 2014. The department may grant an extension for the date
by which the transition will be completed if the facility
demonstrates that it has made significant progress toward transition,
and states with specificity the timeframe by which the transition
will be completed and the specified steps that will be taken to
accomplish the transition. A regional center may pay for the costs
of care and treatment of a consumer residing in the facility on June
30, 2012, until June 30, 2013, inclusive, and, if the facility has a
department-approved plan in place by June 30, 2013, may continue
to pay the costs under this subparagraph until June 30, 2014, or
until the end of any period during which the department has granted
an extension.

(III) There is an emergency circumstance in which the regional
center determines that it cannot locate alternate federally eligible
services to meet the consumer’s needs. Under such an emergency
circumstance, an assessment shall be completed by the regional
center as soon as possible and within 30 days of admission. An
individual program plan meeting shall be convened immediately
following the assessment to determine the services and supports
needed for stabilization and to develop a plan to transition the
consumer from the facility into the community. If transition is not
expected within 90 days of admission, an individual program plan
meeting shall be held to discuss the status of transition and to
determine if the consumer is still in need of placement in the
facility. Commencing October 1, 2012, this determination shall
be made after also considering resource options identified by the
statewide specialized resource service. If it is determined that
emergency services continue to be necessary, the regional center
shall submit an updated transition plan that can cover a period of
up to 90 days. In no event shall placements under these emergency
circumstances exceed 180 days.

(C) (i) Effective July 1, 2012, notwithstanding any other law
or regulation begin delete to the contrary end delete , a regional center shall not purchase
new residential services from, or place a consumer in, institutions
for mental disease, as described in Part 5 (commencing with
Section 5900) of Division 5, for which federal Medicaid funding
is not available. Effective July 1, 2013, this prohibition applies
regardless of the availability of federal funding.

(ii) The prohibition described in clause (i) shall not apply to
emergencies, as determined by the regional center, when a regional
center cannot locate alternate services to meet the consumer’s
needs. As soon as possible within 30 days of admission due to an
emergency, an assessment shall be completed by the regional
center. An individual program plan meeting shall be convened
immediately following the assessment, to determine the services
and supports needed for stabilization and to develop a plan to
transition the consumer from the facility to the community. If
transition is not expected within 90 days of admission, an
emergency program plan meeting shall be held to discuss the status
of the transition and to determine if the consumer is still in need
of placement in the facility. If emergency services continue to be
necessary, the regional center shall submit an updated transition
plan to the department for an extension of up to 90 days. Placement
shall not exceed 180 days.

(iii) To the extent feasible, prior to any admission, the regional
center shall consider resource options identified by the statewide
specialized resource service established pursuant to subdivision
(b) of Section 4418.25.

(iv) The clients’ rights advocate shall be notified of each
admission and individual program planning meeting pursuant to
this subparagraph and may participate in all individual program
planning meetings unless the consumer objects on his or her own
behalf.

(v) Regional centers shall complete a comprehensive assessment
of any consumer residing in an institution for mental disease as of
July 1, 2012, for which federal Medicaid funding is not available,
and for any consumer residing in an institution for mental disease
as of July 1, 2013, without regard to federal funding. The
comprehensive assessment shall be completed prior to the
consumer’s next scheduled individual program plan meeting and
shall include identification of the services and supports needed
and the timeline for identifying or developing those services needed
to transition the consumer back to the community. Effective
October 1, 2012, the regional center shall also consider resource
options identified by the statewide specialized resource service.
For each individual program plan meeting convened pursuant to
this subparagraph, the clients’ rights advocate for the regional
center shall be notified of the meeting and may participate in the
meeting unless the consumer objects on his or her own behalf.

(D)  begin delete Each end delete begin insert A end insert person with developmental disabilities placed by
the regional center in a community living arrangement shall have
the rights specified in this division. These rights shall be brought
to the person’s attention by any means necessary to reasonably
communicate these rights to each resident, provided that, at a
minimum, the Director of Developmental Services prepare,
provide, and require to be clearly posted in all residential facilities
and day programs a poster using simplified language and pictures
that is designed to be more understandable by persons with
cognitive disabilities and that the rights information shall also be
available through the regional center to each residential facility
and day program in alternative formats, including, but not limited
to, other languages, braille, and audio tapes, when necessary to
meet the communication needs of consumers.

(E) Consumers are eligible to receive supplemental services
including, but not limited to, additional staffing, pursuant to the
process described in subdivision (d) of Section 4646. Necessary
additional staffing that is not specifically included in the rates paid
to the service provider may be purchased by the regional center if
the additional staff are in excess of the amount required by
regulation and the individual’s planning team determines the
additional services are consistent with the provisions of the
individual program plan. Additional staff should be periodically
reviewed by the planning team for consistency with the individual
program plan objectives in order to determine if continued use of
the additional staff is necessary and appropriate and if the service
is producing outcomes consistent with the individual program plan.
Regional centers shall monitor programs to ensure that the
additional staff is being provided and utilized appropriately.

(10) Emergency and crisis intervention services including, but
not limited to, mental health services and behavior modification
services, may be provided, as needed, to maintain persons with
developmental disabilities in the living arrangement of their own
choice. Crisis services shall first be provided without disrupting a
person’s living arrangement. If crisis intervention services are
unsuccessful, emergency housing shall be available in the person’s
home community. If dislocation cannot be avoided, every effort
shall be made to return the person to his or her living arrangement
of choice, with all necessary supports, as soon as possible.

(11) Among other service and support options, planning teams
shall consider the use of paid roommates or neighbors, personal
assistance, technical and financial assistance, and all other service
and support options which would result in greater self-sufficiency
for the consumer and cost-effectiveness to the state.

(12) When facilitation as specified in an individual program
plan requires the services of an individual, the facilitator shall be
of the consumer’s choosing.

(13) The community support may be provided to assist
individuals with developmental disabilities to fully participate in
community and civic life, including, but not limited to, programs,
services, work opportunities, business, and activities available to
persons without disabilities. This facilitation shall include, but not
be limited to, any of the following:

(A) Outreach and education to programs and services within
the community.

(B) Direct support to individuals begin delete which end delete begin insert that end insert would enable them
to more fully participate in their community.

(C) Developing unpaid natural supports when possible.

(14) When feasible and recommended by the individual program
planning team, for purposes of facilitating better and cost-effective
services for consumers or family members, technology, including
telecommunication technology, may be used in conjunction with
other services and supports. Technology in lieu of a consumer’s
in-person appearances at judicial proceedings or administrative
due process hearings may be used only if the consumer or, when
appropriate, the consumer’s parent, legal guardian, conservator,
or authorized representative, gives informed consent. Technology
may be used in lieu of, or in conjunction with, in-person training
for providers, as appropriate.

(15) Other services and supports may be provided as set forth
in Sections 4685, 4686, 4687, 4688, and 4689, when necessary.

(16) Notwithstanding any other begin delete provision of end delete law or regulation
begin delete to the contrary end delete , effective July 1, 2009, regional centers shall not
purchase experimental treatments, therapeutic services, or devices
that have not been clinically determined or scientifically proven
to be effective or safe or for which risks and complications are
unknown. Experimental treatments or therapeutic services include
experimental medical or nutritional therapy when the use of the
product for that purpose is not a general physician practice. For
regional center consumers receiving these services as part of their
individual program plan (IPP) or individualized family service
plan (IFSP) on July 1, 2009, this prohibition shall apply on August
1, 2009.

(b) (1) Advocacy for, and protection of, the civil, legal, and
service rights of persons with developmental disabilities as
established in this division.

(2) Whenever the advocacy efforts of a regional center to secure
or protect the civil, legal, or service rights of any of its consumers
prove ineffective, the regional center or the person with
developmental disabilities or his or her parents, legal guardian, or
other representative may request the area board to initiate action
under the provisions defining area board advocacy functions
established in this division.

(c) The regional center may assist consumers and families
directly, or through a provider, in identifying and building circles
of support within the community.

(d) In order to increase the quality of community services and
protect consumers, the regional center shall, when appropriate,
take either of the following actions:

(1) Identify services and supports that are ineffective or of poor
quality and provide or secure consultation, training, or technical
assistance services for any agency or individual provider to assist
that agency or individual provider in upgrading the quality of
services or supports.

(2) Identify providers of services or supports that may not be
in compliance with local, state, and federal statutes and regulations
and notify the appropriate licensing or regulatory authority, or
request the area board to investigate the possible noncompliance.

(e) When necessary to expand the availability of needed services
of good quality, a regional center may take actions that include,
but are not limited to, the following:

(1) Soliciting an individual or agency by requests for proposals
or other means, to provide needed services or supports not presently
available.

(2) Requesting funds from the Program Development Fund,
pursuant to Section 4677, or community placement plan funds
designated from that fund, to reimburse the startup costs needed
to initiate a new program of services and supports.

(3) Using creative and innovative service delivery models,
including, but not limited to, natural supports.

(f) Except in emergency situations, a regional center shall not
provide direct treatment and therapeutic services, but shall utilize
appropriate public and private community agencies and service
providers to obtain those services for its consumers.

(g)  begin delete Where end delete begin insert When end insert there are identified gaps in the system of
services and supports or begin delete where end delete begin insert when end insert there are identified consumers
for whom no provider will provide services and supports contained
in his or her individual program plan, the department may provide
the services and supports directly.

(h) At least annually, regional centers shall provide the
consumer, his or her parents, legal guardian, conservator, or
authorized representative a statement of services and supports the
regional center purchased for the purpose of ensuring that they are
delivered. The statement shall include the type, unit, month, and
cost of services and supports purchased.