BILL ANALYSIS �
AB 1753
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Date of Hearing: April 8, 2014
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
AB 1753 (Holden) - As Introduced: February 14, 2014
SUBJECT : Developmental services: regional centers:
vendorization
SUMMARY : Increases regional center consumer access to vendors
not included in a consumer's regional center catchment area.
Specifically, this bill :
1)Adds to the information a regional center must provide on its
Internet Web site a list of services provided directly to
consumers by the regional center or through service vendors or
contractors that adheres to a statewide formatting standard
and is updated at least quarterly.
2)Authorizes a service vendor to provide services specified in a
consumer's individual program plan upon the request of a
consumer or his or her representative, as specified, if the
service vendor is not vendorized by the regional center
serving the consumer but is vendorized by another regional
center and meets other specified criteria.
EXISTING LAW
1)Establishes an entitlement to services for individuals with
developmental disabilities under the Lanterman Developmental
Disabilities Services Act (Lanterman Act). (WIC 4500 et seq.)
2)Grants all individuals with developmental disabilities, among
all other rights and responsibilities established for any
individual by the United States Constitution and laws and the
California Constitution and laws, the right to treatment and
habilitation services and supports in the least restrictive
environment. (WIC 4502)
3)Establishes a system of 21 nonprofit regional centers
throughout the state to identify needs and coordinate services
for eligible individuals with developmental disabilities and
requires the Department of Developmental Services (DDS) to
contract with regional centers to provide case management
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services and arrange for or purchase services that meet the
needs of individuals with developmental disabilities, as
defined. (WIC 4620 et seq.)
4)Requires the development of an IPP for each regional center
consumer, which specifies services to be provided to the
consumer, based on his or her individualized needs
determination and preferences, and defines that planning
process as the vehicle to ensure that services and supports
are customized to meet the needs of consumers who are served
by regional centers. (WIC 4512)
5)Requires the IPP planning processes to include:
a) A statement of the individual's goals and objectives, a
schedule of the type and nature of services to be provided
and other information and considerations, as specified;
b) Review and modification, as necessary, by the regional
center's planning team no less frequently than every three
years; and
c) Statewide training and review of the IPP plan creation,
as specified. (WIC 4646.5)
1)Provides that a consumer who is or has been determined to be
eligible for services by a regional center shall also be
considered eligible by any other regional center if he or she
has moved to another location within the state. (WIC 4643.5
(a))
2)Requires the level and types of services and supports
specified in a consumer's IPP to be authorized and secured, if
available, pending the development of a new IPP, whenever a
consumer transfers from one regional center catchment area to
another. Requires a regional center in a catchment area to
which a consumer has transferred to convene a meeting to
develop a new IPP within 30 days if the services and supports
in the consumer's existing IPP are not available, and prior to
approval of a new IPP, requires the regional center to provide
alternative services and supports to the consumer that best
meet his or her IPP objectives in the least restrictive
setting. (WIC 4643.5 (c))
3)Creates a process by which regional centers may "vendorize"
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service providers, thereby providing a path to contract for
services with that provider and ensuring maximum flexibility
and availability of appropriate services and support for
persons with developmental disabilities. (WIC 4648)
4)Authorizes regional centers to solicit an individual or agency
through a request for proposals or other means to provide
needed services or supports not presently available, provided
it is necessary to expand the availability of needed services
of good quality. (WIC 4648(e)(1))
5)Prohibits a regional center from providing direct treatment
and therapeutic services to a consumer and instead requires
the utilization of appropriate public and private community
agencies and service providers to obtain those services for
its consumers, except in emergency situations. (WIC 4648 (f))
6)Requires regional centers to provide the consumer, his or her
parent, legal guardian, or other appropriate authorized
representative, as specified, at least annually, a statement
of services and supports the regional center purchased, for
the purpose of ensuring that the services are delivered. (WIC
4648(h))
7)Sets forth specific requirements and annual performance
objectives for contracts between DDS and regional centers.
(WIC 4629)
8)Provides that each contract between DDS and a regional center
must include a requirement that the regional center adopt,
maintain, and post on its Internet Web site a board-approved
policy regarding transparency and access to public
information, and requires that policy to provide, at a
minimum, information regarding requests for proposals, service
provider rates, documentation related to establishment of
negotiated rates, audits, and other forms, as specified. (WIC
4629.5)
FISCAL EFFECT : Unknown.
COMMENTS : While the current regional center system is intended
to ensure people with developmental disabilities have access to
necessary services and supports, there is no requirement for
identical services to be available across all regional center
catchment areas. This bill seeks to ensure continuity of
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services and increase access to desired and appropriate services
for regional center consumers by easing vendorization
requirements for vendors providing services across catchment
area lines.
Background : The Lanterman Act guides the provision of services
and supports for Californians with developmental disabilities.
Each individual under the Act, typically referred to as a
"consumer," is legally entitled to treatment and habilitation
services and supports in the least restrictive environment.
Lanterman Act services are designed to enable all consumers to
live more independent and productive lives in the community.
The term "developmental disability" means a disability that
originates before an individual attains 18 years of age, is
expected to continue indefinitely, and constitutes a substantial
disability for that individual. It includes intellectual
disabilities, cerebral palsy, epilepsy, and autism spectrum
disorders (ASD). Other developmental disabilities are those
disabling conditions similar to an intellectual disability that
require treatment (i.e., care and management) similar to that
required by individuals with an intellectual disability. This
does not include conditions that are solely psychiatric or
physical in nature, and the conditions must occur before age 18,
result in a substantial disability, be likely to continue
indefinitely, and involve brain damage or dysfunction. Examples
of conditions might include intracranial neoplasms, degenerative
brain disease or brain damage associated with accidents.
Direct responsibility for implementation of the Lanterman Act
service system is shared by the Department of Developmental
Services (DDS) and 21 regional centers, which are private
nonprofit entities, established pursuant to the Lanterman Act,
that contract with DDS to carry out many of the state's
responsibilities under the Act. The principal roles of regional
centers include intake and assessment, individualized program
plan development, case management, and securing services through
generic agencies or purchasing services provided by vendors.
Regional centers also share primary responsibility with local
education agencies for provision of early intervention services
under the California Early Intervention Services Act.
Regional centers : The 21 regional centers throughout the state
serve over 260,000 consumers who receive services such as
residential placements, supported living services, respite care,
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transportation, day treatment programs, work support programs,
and various social and therapeutic activities. Approximately
1,300 consumers reside at one of California's four Developmental
Centers-and one state-operated, specialized community
facility-which provide 24-hour habilitation and medical and
social treatment services.
Services provided to people with developmental disabilities are
determined through an individual planning process. Under this
process, planning teams-which include, among others, the
consumer, his or her parent(s) or other legally authorized
representative, and one or more regional center
representatives-jointly prepare an Individual Program Plan (IPP)
based on the consumer's needs and choices. The Lanterman Act
requires that the IPP promote community integration and maximize
opportunities for each consumer to develop relationships, be
part of community life, increase control over his or her life,
and acquire increasingly positive roles in the community. The
IPP must give the highest preference to those services and
supports that allow minors to live with their families and
adults to live as independently as possible in the community.
While some regional center catchment areas are geographically
expansive, others provide services alongside many other regional
centers, often due to higher, more concentrated populations.
For example, Inland Regional Center, which covers San Bernardino
and Riverside Counties, serves around 28,300 consumers, whereas
neighboring Los Angeles County includes seven regional center
catchment areas, which together serve over 82,600 consumers.
Relative to this example and other similar examples throughout
the state, this bill seeks to better facilitate a consumer's
ability to receive services from providers across nearby county
lines, as well as access services from providers whose
reasonable reach goes across many catchment areas, as is the
case with Los Angeles County and the Bay Area.
The vendorization process : Prior to being approved to receive
funding from a regional center for providing services to a
consumer, a service provider must become vendored by the
regional center that oversees the catchment area in which the
provider is located. This "vendorization" process includes
verifying that the provider is qualified to provide the planned
services and meets all other regulatory standards and
requirements. It is important to note that vendorization makes
a provider eligible to provide services paid for by the regional
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center, but does not guarantee the regional center will refer
consumers. Furthermore, there is nothing precluding a vendor
from being vendorized by more than one regional center. There
are over 45,000 vendors that provide services paid for by
regional centers in California.
A regional center must approve the vendorization of a provider
within 45 days, provided that the applicant provider has
satisfied all application and program requirements. This
includes meeting staffing ratio requirements, based on the level
and types of services, and obtaining from the appropriate agency
or department any required license, registration, credential,
certificate or permit necessary to lawfully provide the
anticipated services. If an applicant provider fails to comply
with these vendorization requirements, the regional center must
also act to deny vendorization within 45 days of receiving the
vendor applicant's completed application. The written
notification of denial must include a statement of the
applicant's right to appeal the decision within 30 days and
other information pertaining to the appeals process.
Regional center rates : Current statute and regulations set
forth rate requirements for regional centers to adhere to when
contracting with vendors to provide services to consumers.
There are different types of rates for services provided in
different settings, many of which are negotiated between
regional centers and vendors and are subject to a cap as a
result of the state's cost-containment efforts over the last six
years. July 1, 2008 marked the original implementation date for
statewide and regional center median rates, with a requirement
that regional centers do not negotiate rates higher than the
lower of the two median rates for services. Each regional
center is required to annually certify to DDS its median rate
for each negotiated rate service, which DDS verifies during its
biennial fiscal audit of the regional center. Despite the
median rate cap, a regional center can obtain a rate increase
from DDS under health and safety exemptions if the regional
center can demonstrate the exemption is necessary for the health
and safety of consumers.
Need for the bill : Each regional center is charged with seeking
out and contracting with service providers that meet the needs
identified in a consumer's IPP. However, a consumer's transfer
from one catchment area to another, status as a child in foster
care, location with respect to necessary services, language
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needs, and variation in types of services provided for a
diagnosis like autism spectrum disorder (ASD) are all factors
that may result in a consumer necessitating the services of a
provider that is not vendorized by the consumer's regional
center.
According to the author, "The Lanterman Act created the regional
center system to provide services to Californians with
developmental disabilities designed to enable them to live
within their own communities. The consumer's reasons for
selecting a service provider from outside of the regional center
may be due to a variety of reasons including a desire for
continuity of care, the need for a type of service unavailable
within the consumer's regional center or the geographic
proximity of the service provider."
With respect to children with ASD, in particular, the author
states, "In the case of children with Autism, continuity of
services is particularly important. Children may suffer
setbacks in their course of treatment which will entail
additional long-term expense for the State and, equally
important, a loss of progress for the individual. The approved
resources available in one regional center may not be available
in another or may not be geographically convenient in the other
regional center. For example, some evidence-based behavioral
treatment options may be vendored in one regional center but not
in an adjacent regional center catchment area. This
unnecessarily limits the choice of providers and services the
consumer or their family can select."
Arguments in opposition : The Association of Regional Center
Agencies (ARCA) rebuts the expressed need for this bill, stating
that the current vendorization process is a more viable option
for ensuring access to providers across catchment areas.
According to ARCA, "When a regional center vendorizes a program,
it is responsible for [quality assurance (QA)] oversight and
monitoring of that program. If a vendor could provide services
outside of their catchment area in the fashion described by this
bill, that work would be invisible to the vendoring regional
center - and its QA requirements. Additionally, by not having
an office in the catchment area in which a service provider
works, oversight would be further impacted. With employees
working at a distance, it would be difficult for the provider to
ensure staff oversight for maintenance of quality. In short,
there is no mechanism to either track the number of individuals
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receiving those services, or provide oversight. Creating such a
mechanism would require significant investments in statewide IT
upgrades."
Staff comments : Current law does not prohibit a regional center
from referring a consumer to, and paying for, a provider that is
vendorized by another regional center without needing to
vendorize the provider itself. This practice is often referred
to as a "courtesy vendorization," and the regional center paying
for the services of the provider coming from another regional
center catchment area is the "user regional center." However,
supporters of this bill claim that this option is not always
guaranteed, putting some consumers seeking timely and more
appropriate services or continuity of services at a
disadvantage.
Rather than relying on regional center discretion to determine
when a courtesy vendorization is appropriate, this bill places a
requirement on regional centers to pay for services provided by
an outside vendor if a consumer or authorized representative
requests the services of the provider to meet needs established
in the consumer's IPP and the provider meets the following
requirements:
1) The provider is in good standing with its vendoring regional
center;
2)Services are provided at no additional charge to the consumer
or the consumer's regional center; and
3)The services provided are consistent with, and provided at the
same level of care and professionalism as, those indicated in
the provider's vendorization contract with the vendoring
regional center.
While these requirements are intended to ensure integrity in the
provision of and payment for services outside of the
vendorization process, the current language may not provide
adequate safeguards.
With respect to rates paid for services under current law and in
this bill, the rate paid by the vendoring regional center
prevails for vendors that provide services across catchment area
lines. Although this bill requires a vendor to provide services
at no additional charge to the user regional center or the
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consumer, it allows a vendor to receive the same rate from the
user regional center as it receives from the vendoring regional
center, despite whether that rate exceeds the user regional
center's median rate. The end result of this could be a user
regional center paying higher rates for the same services to
providers it has not vendorized than it pays to providers it has
vendorized with a decreased capacity for oversight of the
providers from other catchment areas. Conversely, if a vendor
becomes vendorized by a second regional center, the service
rates would be consistent with the median rate requirements at
the new regional center.
Additionally, the requirement that a vendor providing services
under this bill is in good standing with its vendoring regional
center may provide a false sense of oversight. Section 54326 of
Title 17 of the California Code of Regulations requires regional
centers to "take routine action" to ensure vendors have no
convictions and have not been found liable for fraud or abuse,
and to ensure vendors are serving consumers with the valid
licenses, certificates and credentials required. However, the
current regional center system is not built for the information
resulting from this review to be freely shared between regional
centers, and there is no mechanism for oversight by the
vendoring regional center of the provider's services and
comportment outside of the catchment area, further raising the
issue of a lack of accountability and a reduced capacity for
oversight on the part of the vendoring regional center and the
user regional center. Should this bill move forward, the author
may want to address the ability of either the vendoring regional
center or the user regional center to be able to have greater
oversight over vendors providing services across catchment area
lines to ensure the needs of consumers are being met.
PROPOSED TECHNICAL AMENDMENT : For infants and toddlers under 3
years of age within the regional center system, the plan
generated for provision of services is called an individualized
family service plan (IFSP). Similar to the IPP, the IFSP
dictates the services to be provided to a child to meet his or
her developmental and early intervention needs. This bill
mentions a consumer or specified representative's ability to
request services from a provider outside of his or her regional
center catchment area to provide services indicated in the IPP,
but makes no mention of an IFSP. Staff recommends the following
amendment to clarify broad application of the provisions of this
bill for all individuals served by a regional center:
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1)On page 5, line 26, after "plan" insert:
or individualized family service plan
PRIOR LEGISLATION :
AB 1089 (Calderon) 2013, established timelines for the transfer
of files and provision of services to children in foster care
who are also receiving early intervention services and other
developmental services through a regional center or local
education agency. This bill died in Senate Human Services
Committee.
SB 468 (Emmerson and Beall) Chapter 683, Statutes of 2013,
requires DDS, upon approval of federal funding, to establish and
implement a state Self-Determination Program for regional center
consumers that grants program participants and their families an
individual budget and increased flexibility, choice, and greater
control over decisions, resources, and services and supports to
implement their IPP.
REGISTERED SUPPORT / OPPOSITION :
Support
The Interdisciplinary Council on Development and Learning
Professional Child Development Associates
California Association for Health Services at Home (CAHSAH)
Child Development Institute
Performing Arts Studio West
Greenhouse Therapy Center
146 Individuals
Opposition
Association of Regional Center Agencies (ARCA)
Analysis Prepared by : Myesha Jackson / HUM. S. / (916)
319-2089