AB 2809: Developmental services: regional centers.
- Session Year: 2015-2016
- House: Assembly
- Latest Version Date: 2016-08-16
Existing law, the California Early Intervention Services Act, provides a statewide system of coordinated, comprehensive, family-centered, multidisciplinary, and interagency programs that are responsible for providing appropriate early intervention services and support to all eligible infants and toddlers, as defined, and their families and requires an eligible infant or toddler receiving services under the act to have an individualized family service plan (IFSP). The act requires these services to be provided pursuant to the existing regional center system under the Lanterman Developmental Disabilities Service Act.
Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services is responsible for providing various services and supports to individuals with developmental disabilities, and for ensuring the appropriateness and quality of those services and supports. Under existing law, the department contracts with regional centers to provide services and supports to persons with developmental disabilities. The services and supports to be provided to a regional center consumer are contained in an individual program plan (IPP), developed in accordance with prescribed requirements.
This bill would require regional centers to provide certain information information, including a statement of services and supports purchased and information about the appeal and complaint process, to a consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, in threshold languages, as defined.
Existing law also requires a regional center to only purchase applied behavioral analysis (ABA) services or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers. Existing law includes completion of group instruction on the basics of behavior intervention within the definition of parent participation.
This bill would prohibit a parents or caregivers noncompletion of group instruction on the basics of behavior intervention from being used to deny, delay, or reduce ABA or intensive behavioral intervention services if the parent or caregiver demonstrates hardship in accessing or attending group instruction classes. The bill would require the IPP or IFSP team to review the parents or caregivers demonstration of hardship every 6 months.
Existing law, the California Early Intervention Services Act, provides a statewide system of coordinated, comprehensive, family-centered, multidisciplinary, and interagency programs that are responsible for providing appropriate early intervention services and support to all eligible infants and toddlers, as defined, and their families and requires an eligible infant or toddler receiving services under the act to have an individualized family service plan (IFSP). The act requires these services to be provided pursuant to the existing regional center system under the Lanterman Developmental Disabilities Service Act.
Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services is responsible for providing various services and supports to individuals with developmental disabilities, and for ensuring the appropriateness and quality of those services and supports. Under existing law, the department contracts with regional centers to provide services and supports to persons with developmental disabilities. The services and supports to be provided to a regional center consumer are contained in an individual program plan (IPP), developed in accordance with prescribed requirements.
This bill would require regional centers to give certain information and materials provide certain information to a consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, at the time of development, scheduled review, or modification of a consumers IPP or IFSP and would require that information and those materials to be made available in threshold languages, as defined.
Existing law also requires a regional center to only purchase applied behavioral analysis (ABA) services or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers. Existing law includes completion of group instruction on the basics of behavior intervention within the definition of parent participation.
This bill would require the regional center, when determining the extent of parent participation to consider any relevant hardships suffered by a parent or parents that may constitute a barrier to the consumer accessing those services. The bill would require the hardships to be documented in the IPP or IFSP and reviewed every six months to determine if there has been a change in circumstances. prohibit a parents or caregivers noncompletion of group instruction on the basics of behavior intervention from being used to deny, delay, or reduce ABA or intensive behavioral intervention services if the parent or caregiver demonstrates hardship in accessing or attending group instruction classes. The bill would require the IPP or IFSP team to review the parents or caregivers demonstration of hardship every 6 months.
Existing law, the California Early Intervention Services Act, provides a statewide system of coordinated, comprehensive, family-centered, multidisciplinary, and interagency programs that are responsible for providing appropriate early intervention services and support to all eligible infants and toddlers, as defined, and their families and requires an eligible infant or toddler receiving services under the act to have an individualized family service plan (IFSP). The act requires these services to be provided pursuant to the existing regional center system under the Lanterman Developmental Disabilities Service Act.
Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services is responsible for providing various services and supports to individuals with developmental disabilities, and for ensuring the appropriateness and quality of those services and supports. Under existing law, the department contracts with regional centers to provide services and supports to persons with developmental disabilities. The services and supports to be provided to a regional center consumer are contained in an individual program plan (IPP), developed in accordance with prescribed requirements.
This bill would require regional centers to give certain information and materials to a consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, at the time of development, scheduled review, or modification of a consumers IPP or IFSP and would require that information and those materials to be made available in threshold languages, as defined.
Existing law also requires a regional center to only purchase applied behavioral analysis (ABA) services or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers.
This bill would require the regional center, when determining the extent of parent participation to consider any relevant hardships suffered by a parent or parents that may constitute a barrier to the consumer accessing those services. The bill would require the hardships to be documented in the IPP or IFSP and reviewed annually every six months to determine if there has been a change in circumstances.
Existing law, the California Early Intervention Services Act, provides a statewide system of coordinated, comprehensive, family-centered, multidisciplinary, and interagency programs that are responsible for providing appropriate early intervention services and support to all eligible infants and toddlers, as defined, and their families and requires an eligible infant or toddler receiving services under the act to have an individualized family service plan (IFSP). The act requires these services to be provided pursuant to the existing regional center system under the Lanterman Developmental Disabilities Service Act.
Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services is responsible for providing various services and supports to individuals with developmental disabilities, and for ensuring the appropriateness and quality of those services and supports. Under existing law, the department contracts with regional centers to provide services and supports to persons with developmental disabilities. The services and supports to be provided to a regional center consumer are contained in an individual program plan (IPP), developed in accordance with prescribed requirements.
This bill would require regional centers to give certain information and materials to a consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, at the time of development, scheduled review, or modification of a consumers IPP or IFSP and would require that information and those materials to be in his, her, or their native language. made available in threshold languages, as defined.
Existing law generally provides, beginning July 1, 2009 that a regional center shall not purchase medical or dental services for a consumer 3 years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center determines that an appeal of the denial by the consumer or family does not have merit. Existing law authorizes regional centers to pay for medical or dental services during certain periods, including, among others, while coverage is being pursued, but before a denial is made.
This bill would instead require regional centers to pay for medical or dental services during those periods.
Existing law also requires a regional center to only purchase applied behavioral analysis (ABA) services or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers.
This bill would require the regional center, when determining the extent of parent participation to consider any relevant hardships suffered by a parent or parents that may constitute a barrier to the consumer accessing those services. The bill would require the hardships to be documented in the IPP or IFSP and reviewed annually to determine if there has been a change in circumstances.
Existing law, the California Early Intervention Services Act, provides a statewide system of coordinated, comprehensive, family-centered, multidisciplinary, and interagency programs that are responsible for providing appropriate early intervention services and support to all eligible infants and toddlers, as defined, and their families and requires an eligible infant or toddler receiving services under the act to have an individualized family service plan (IFSP). The act requires these services to be provided pursuant to the existing regional center system under the Lanterman Developmental Disabilities Service Act.
Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services is responsible for providing various services and supports to individuals with developmental disabilities, and for ensuring the appropriateness and quality of those services and supports. Under existing law, the department contracts with regional centers to provide services and supports to persons with developmental disabilities. The services and supports to be provided to a regional center consumer are contained in an individual program plan (IPP), developed in accordance with prescribed requirements.
This bill would require regional centers to give certain information and materials to a consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, at the time of development, scheduled review, or modification of a consumers IPP or IFSP and would require that information and those materials to be in his, her, or their native language.
Existing law generally provides, beginning July 1, 2009 that a regional center shall not purchase medical or dental services for a consumer 3 years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center determines that an appeal of the denial by the consumer or family does not have merit. Existing law authorizes regional centers to pay for medical or dental services during certain periods, including, among others, while coverage is being pursued, but before a denial is made.
This bill would instead require regional centers to pay for medical or dental services during those periods.
Existing law also requires a regional center to only purchase applied behavioral analysis (ABA) services or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers.
This bill would require the regional center, when determining the extent of parent participation to consider any relevant hardships suffered by a parent or parents that may constitute a barrier to the consumer accessing those services. The bill would require the hardships to be documented in the IPP or IFSP and reviewed annually to determine if there has been a change in circumstances.
Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services to enter into contracts with private nonprofit corporations to operate regional centers to provide community services and supports for persons with developmental disabilities and their families.
This bill would state the intent of the Legislature to enact legislation to require regional centers to provide nontechnical, understandable information in a consumers native language regarding the complex process of obtaining regional center services.
Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services to enter into contracts with private nonprofit corporations to operate regional centers to provide community services and supports for persons with developmental disabilities and their families.
This bill would state the intent of the Legislature to enact legislation to require regional centers to provide nontechnical, understandable information in a consumers native language regarding the complex process of obtaining regional center services.
(a)The planning process for the individual program plan described in Section 4646 shall include all of the following:
(1)Gathering information and conducting assessments to determine the life goals, capabilities and strengths, preferences, barriers, and concerns or problems of the person with developmental disabilities. For children with developmental disabilities, this process should include a review of the strengths, preferences, and needs of the child and the family unit as a whole. Assessments shall be conducted by qualified individuals and performed in natural environments whenever possible. Information shall be taken from the consumer, his or her parents and other family members, his or her friends, advocates, authorized representative, if applicable, providers of services and supports, and other agencies. The assessment process shall reflect awareness of, and sensitivity to, the lifestyle and cultural background of the consumer and the family.
(2)A statement of goals, based on the needs, preferences, and life choices of the individual with developmental disabilities, and a statement of specific, time-limited objectives for implementing the persons goals and addressing his or her needs. These objectives shall be stated in terms that allow measurement of progress or monitoring of service delivery. These goals and objectives should maximize opportunities for the consumer to develop relationships, be part of community life in the areas of community participation, housing, work, school, and leisure, increase control over his or her life, acquire increasingly positive roles in community life, and develop competencies to help accomplish these goals.
(3)When developing individual program plans for children, regional centers shall be guided by the principles, process, and services and support parameters set forth in Section 4685.
(4)When developing an individual program plan for a transition age youth or working age adult, the planning team shall consider the Employment First Policy described in Chapter 14 (commencing with Section 4868).
(5)A schedule of the type and amount of services and supports to be purchased by the regional center or obtained from generic agencies or other resources in order to achieve the individual program plan goals and objectives, and identification of the provider or providers of service responsible for attaining each objective, including, but not limited to, vendors, contracted providers, generic service agencies, and natural supports. The individual program plan shall specify the approximate scheduled start date for services and supports and shall contain timelines for actions necessary to begin services and supports, including generic services. In addition to the requirements of subdivision (h) of Section 4646, each regional center shall offer, and upon request provide, a written copy of the individual program plan to the consumer, and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of their request in a threshold language, as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations.
(6)At the beginning of each individual program plan meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative information about the appeal and complaint process in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate. This paragraph is in addition to, and independent of, any other rights, remedies, or procedures under any other law and shall not be construed to alter, limit, or negate any other rights, remedies, or procedures provided for by law.
(7)When agreed to by the consumer, the parents, legally appointed guardian, or authorized representative of a minor consumer, or the legally appointed conservator of an adult consumer or the authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, and subdivision (e) of Section 4705, a review of the general health status of the adult or child, including medical, dental, and mental health needs, shall be conducted. This review shall include a discussion of current medications, any observed side effects, and the date of the last review of the medication. Service providers shall cooperate with the planning team to provide any information necessary to complete the health status review. If any concerns are noted during the review, referrals shall be made to regional center clinicians or to the consumers physician, as appropriate. Documentation of health status and referrals shall be made in the consumers record by the service coordinator.
(8)(A)The development of a transportation access plan for a consumer when all of the following conditions are met:
(i)The regional center is purchasing private, specialized transportation services or services from a residential, day, or other provider, excluding vouchered service providers, to transport the consumer to and from day or work services.
(ii)The planning team has determined that a consumers community integration and participation could be safe and enhanced through the use of public transportation services.
(iii)The planning team has determined that generic transportation services are available and accessible.
(B)To maximize independence and community integration and participation, the transportation access plan shall identify the services and supports necessary to assist the consumer in accessing public transportation and shall comply with Section 4648.35. These services and supports may include, but are not limited to, mobility training services and the use of transportation aides. Regional centers are encouraged to coordinate with local public transportation agencies.
(9)A schedule of regular periodic review and reevaluation to ascertain that planned services have been provided, that objectives have been fulfilled within the times specified, and that consumers and families are satisfied with the individual program plan and its implementation.
(b)For all active cases, individual program plans shall be reviewed and modified by the planning team, through the process described in Section 4646, as necessary, in response to the persons achievement or changing needs, and no less often than once every three years. If the consumer or, where appropriate, the consumers parents, legal guardian, authorized representative, or conservator requests an individual program plan review, the individual program shall be reviewed within 30 days after the request is submitted.
(c)(1)The department, with the participation of representatives of a statewide consumer organization, the Association of Regional Center Agencies, an organized labor organization representing service coordination staff, and the state council shall prepare training material and a standard format and instructions for the preparation of individual program plans, which embody an approach centered on the person and family.
(2)Each regional center shall use the training materials and format prepared by the department pursuant to paragraph (1).
(3)The department shall biennially review a random sample of individual program plans at each regional center to ensure that these plans are being developed and modified in compliance with Section 4646 and this section.
SEC. 2.Section 4648 of the Welfare and Institutions Code is amended to read:4648.In order to achieve the stated objectives of a consumers 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 consumers 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 that the regional center and consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representatives, determines will best accomplish all or any part of that consumers 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; and the procedure for an individual or an agency to appeal any 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 facilitys 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 law or regulation, 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.
(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 consumers 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 a 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 when appropriate, his or her parents, legal guardian, conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, 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 providers ability to deliver quality services or supports that can accomplish all or part of the consumers individual program plan.
(B)A providers success in achieving the objectives set forth in the individual program plan.
(C)Where 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 consumers 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 consumers choice of providers, or, when appropriate, the consumers parents, legal guardians, authorized representatives, or conservators choice of providers.
(7)No service or support provided by any agency or individual shall be continued unless the consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, 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 persons 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 childs parent or guardian shall be obtained before placement is made.
(B)Effective July 1, 2012, notwithstanding any other law or regulation, 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 departments 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 Health Care Services 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 consumers 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, 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 consumers 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 plan meeting pursuant to this subparagraph and may participate in all individual program plan meetings unless the consumer objects on his or her own behalf. For purposes of this clause, notification to the clients rights advocate shall include a copy of the most recent comprehensive assessment or updated assessment and the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.
(v)If a consumer is placed in an institution for mental disease by another entity, the institution for mental disease shall inform the regional center of the placement within five days of the date the consumer is admitted. If an individuals records indicate that he or she is a regional center consumer, the institution for mental disease shall make every effort to contact the local regional center or department to determine which regional center to provide notice. As soon as possible within 30 days of admission to an institution for mental disease due to an emergency pursuant to clause (ii), or within 30 days of notification of admission to an institution for mental disease by an entity other than a regional center, an assessment shall be completed by the regional center.
(vi)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 consumers 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. For purposes of this clause, notification to the clients rights advocate shall include the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.
(D)A 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 persons 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 intellectual 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 audiotapes, 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 individuals 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 persons living arrangement. If crisis intervention services are unsuccessful, emergency housing shall be available in the persons 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 consumers 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 that 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 consumers in-person appearances at judicial proceedings or administrative due process hearings may be used only if the consumer or, when appropriate, the consumers 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 law or regulation, 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 advocacy assistance from the state council.
(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 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)When there are identified gaps in the system of services and supports or when 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)(1)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.
(2)Upon request of the consumer, or his or her legal guardian, the regional center shall make the statement described in paragraph (1) available in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate, to the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both. This paragraph is in addition to, and independent of, any other rights, remedies, or procedures under any other law and shall not be construed to alter, limit, or negate any other rights, remedies, or procedures provided for by law.
SEC. 3.Section 4686.2 of the Welfare and Institutions Code is amended to read:4686.2.(a)Effective July 1, 2009, notwithstanding any other law or regulation to the contrary, any vendor who provides applied behavioral analysis (ABA) services, or intensive behavioral intervention services or both, as defined in subdivision (d), shall:
(1)Conduct a behavioral assessment of each consumer to whom the vendor provides these services.
(2)Design an intervention plan that shall include the service type, number of hours, and parent participation needed to achieve the consumers goals and objectives, as set forth in the consumers individual program plan (IPP) or individualized family service plan (IFSP). The intervention plan shall also set forth the frequency at which the consumers progress shall be evaluated and reported.
(3)Provide a copy of the intervention plan to the regional center for review and consideration by the planning team members.
(b)Effective July 1, 2009, notwithstanding any other law or regulation to the contrary, regional centers shall:
(1)Only purchase ABA services or intensive behavioral intervention services that reflect evidence-based practices, promote positive social behaviors, and ameliorate behaviors that interfere with learning and social interactions.
(2)(A)Only purchase ABA or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers, given the critical nature of parent participation to the success of the intervention plan.
(B)A parents or caregivers noncompletion of group instruction on the basics of behavior intervention shall not be used to deny, delay, or reduce ABA or intensive behavioral intervention services if the parent or caregiver demonstrates hardship in accessing or attending group instruction classes. The parents or caregivers demonstration of hardship shall be reviewed by the IPP or IFSP team every six months.
(3)Not purchase either ABA or intensive behavioral intervention services for purposes of providing respite, day care, or school services.
(4)Discontinue purchasing ABA or intensive behavioral intervention services for a consumer when the consumers treatment goals and objectives, as described under subdivision (a), are achieved. ABA or intensive behavioral intervention services shall not be discontinued until the goals and objectives are reviewed and updated as required in paragraph (5) and shall be discontinued only if those updated treatment goals and objectives do not require ABA or intensive behavioral intervention services.
(5)For each consumer, evaluate the vendors intervention plan and number of service hours for ABA or intensive behavioral intervention no less than every six months, consistent with evidence-based practices. If necessary, the intervention plans treatment goals and objectives shall be updated and revised.
(6)Not reimburse a parent for participating in a behavioral services treatment program.
(c)For consumers receiving ABA or behavioral intervention services on July 1, 2009, as part of their IPP or IFSP, subdivision (b) shall apply on August 1, 2009.
(d)For purposes of this section the following definitions shall apply:
(1)Applied behavioral analysis means the design, implementation, and evaluation of systematic instructional and environmental modifications to promote positive social behaviors and reduce or ameliorate behaviors which interfere with learning and social interaction.
(2)Intensive behavioral intervention means any form of applied behavioral analysis that is comprehensive, designed to address all domains of functioning, and provided in multiple settings for no more than 40 hours per week, across all settings, depending on the individuals needs and progress. Interventions can be delivered in a one-to-one ratio or small group format, as appropriate.
(3)Evidence-based practice means a decisionmaking process that integrates the best available scientifically rigorous research, clinical expertise, and individuals characteristics. Evidence-based practice is an approach to treatment rather than a specific treatment. Evidence-based practice promotes the collection, interpretation, integration, and continuous evaluation of valid, important, and applicable individual- or family-reported, clinically-observed, and research-supported evidence. The best available evidence, matched to consumer circumstances and preferences, is applied to ensure the quality of clinical judgments and facilitates the most cost-effective care.
(4)Parent participation shall include, but shall not be limited to, the following meanings:
(A)Completion of group instruction on the basics of behavior intervention.
(B)Implementation of intervention strategies, according to the intervention plan.
(C)If needed, collection of data on behavioral strategies and submission of that data to the provider for incorporation into progress reports.
(D)Participation in any needed clinical meetings.
(E)Purchase of suggested behavior modification materials or community involvement if a reward system is used.
At the time of development, scheduled review, or modification of a consumers individual program plan or individualized family service plan, the regional center shall make available, in a nontechnical, understandable form and in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate, to the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a document describing all of the following and the process for obtaining each exception or exemption:
(a)The exception described in subdivision (d) of Section 4648.35.
(b)The exemption described in subdivision (c) of Section 4648.5.
(c)The exemption described in subdivision (d) of Section 4648.55.
(d)The exemption described in subparagraph (A) of paragraph (3) of subdivision (a) of Section 4686.5.
SEC. 2.SECTION 1.Section 4646.5 of the Welfare and Institutions Code is amended to read:4646.5.(a)The planning process for the individual program plan described in Section 4646 shall include all of the following:
(1)Gathering information and conducting assessments to determine the life goals, capabilities and strengths, preferences, barriers, and concerns or problems of the person with developmental disabilities. For children with developmental disabilities, this process should include a review of the strengths, preferences, and needs of the child and the family unit as a whole. Assessments shall be conducted by qualified individuals and performed in natural environments whenever possible. Information shall be taken from the consumer, his or her parents and other family members, his or her friends, advocates, authorized representative, if applicable, providers of services and supports, and other agencies. The assessment process shall reflect awareness of, and sensitivity to, the lifestyle and cultural background of the consumer and the family.
(2)A statement of goals, based on the needs, preferences, and life choices of the individual with developmental disabilities, and a statement of specific, time-limited objectives for implementing the persons goals and addressing his or her needs. These objectives shall be stated in terms that allow measurement of progress or monitoring of service delivery. These goals and objectives should maximize opportunities for the consumer to develop relationships, be part of community life in the areas of community participation, housing, work, school, and leisure, increase control over his or her life, acquire increasingly positive roles in community life, and develop competencies to help accomplish these goals.
(3)When developing individual program plans for children, regional centers shall be guided by the principles, process, and services and support parameters set forth in Section 4685.
(4)When developing an individual program plan for a transition age youth or working age adult, the planning team shall consider the Employment First Policy described in Chapter 14 (commencing with Section 4868).
(5)A schedule of the type and amount of services and supports to be purchased by the regional center or obtained from generic agencies or other resources in order to achieve the individual program plan goals and objectives, and identification of the provider or providers of service responsible for attaining each objective, including, but not limited to, vendors, contracted providers, generic service agencies, and natural supports. The individual program plan shall specify the approximate scheduled start date for services and supports and shall contain timelines for actions necessary to begin services and supports, including generic services. In addition to the requirements of subdivision (h) of Section 4646, each regional center shall offer, and upon request provide, a written copy of the individual program plan to the consumer, and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of their request in a threshold language, as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations.
(6)At the beginning of each individual program plan meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative information about the appeal and complaint process in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate. This paragraph is in addition to, and independent of, any other rights, remedies, or procedures under any other law and shall not be construed to alter, limit, or negate any other rights, remedies, or procedures provided for by law.
(7)When agreed to by the consumer, the parents, legally appointed guardian, or authorized representative of a minor consumer, or the legally appointed conservator of an adult consumer or the authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, and subdivision (e) of Section 4705, a review of the general health status of the adult or child, including medical, dental, and mental health needs, shall be conducted. This review shall include a discussion of current medications, any observed side effects, and the date of the last review of the medication. Service providers shall cooperate with the planning team to provide any information necessary to complete the health status review. If any concerns are noted during the review, referrals shall be made to regional center clinicians or to the consumers physician, as appropriate. Documentation of health status and referrals shall be made in the consumers record by the service coordinator.
(8)(A)The development of a transportation access plan for a consumer when all of the following conditions are met:
(i)The regional center is purchasing private, specialized transportation services or services from a residential, day, or other provider, excluding vouchered service providers, to transport the consumer to and from day or work services.
(ii)The planning team has determined that a consumers community integration and participation could be safe and enhanced through the use of public transportation services.
(iii)The planning team has determined that generic transportation services are available and accessible.
(B)To maximize independence and community integration and participation, the transportation access plan shall identify the services and supports necessary to assist the consumer in accessing public transportation and shall comply with Section 4648.35. These services and supports may include, but are not limited to, mobility training services and the use of transportation aides. Regional centers are encouraged to coordinate with local public transportation agencies.
(9)A schedule of regular periodic review and reevaluation to ascertain that planned services have been provided, that objectives have been fulfilled within the times specified, and that consumers and families are satisfied with the individual program plan and its implementation.
(b)For all active cases, individual program plans shall be reviewed and modified by the planning team, through the process described in Section 4646, as necessary, in response to the persons achievement or changing needs, and no less often than once every three years. If the consumer or, where appropriate, the consumers parents, legal guardian, authorized representative, or conservator requests an individual program plan review, the individual program shall be reviewed within 30 days after the request is submitted.
(c)(1)The department, with the participation of representatives of a statewide consumer organization, the Association of Regional Center Agencies, an organized labor organization representing service coordination staff, and the state council shall prepare training material and a standard format and instructions for the preparation of individual program plans, which embody an approach centered on the person and family.
(2)Each regional center shall use the training materials and format prepared by the department pursuant to paragraph (1).
(3)The department shall biennially review a random sample of individual program plans at each regional center to ensure that these plans are being developed and modified in compliance with Section 4646 and this section.
SEC. 3.SEC. 2.Section 4648 of the Welfare and Institutions Code is amended to read:4648.In order to achieve the stated objectives of a consumers 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 consumers 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 that the regional center and consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representatives, determines will best accomplish all or any part of that consumers 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; and the procedure for an individual or an agency to appeal any 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 facilitys 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 law or regulation, 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.
(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 consumers 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 a 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 when appropriate, his or her parents, legal guardian, conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, 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 providers ability to deliver quality services or supports that can accomplish all or part of the consumers individual program plan.
(B)A providers success in achieving the objectives set forth in the individual program plan.
(C)Where 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 consumers 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 consumers choice of providers, or, when appropriate, the consumers parents, legal guardians, authorized representatives, or conservators choice of providers.
(7)No service or support provided by any agency or individual shall be continued unless the consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, 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 persons 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 childs parent or guardian shall be obtained before placement is made.
(B)Effective July 1, 2012, notwithstanding any other law or regulation, 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 departments 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 Health Care Services 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 consumers 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, 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 consumers 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 plan meeting pursuant to this subparagraph and may participate in all individual program plan meetings unless the consumer objects on his or her own behalf. For purposes of this clause, notification to the clients rights advocate shall include a copy of the most recent comprehensive assessment or updated assessment and the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.
(v)If a consumer is placed in an institution for mental disease by another entity, the institution for mental disease shall inform the regional center of the placement within five days of the date the consumer is admitted. If an individuals records indicate that he or she is a regional center consumer, the institution for mental disease shall make every effort to contact the local regional center or department to determine which regional center to provide notice. As soon as possible within 30 days of admission to an institution for mental disease due to an emergency pursuant to clause (ii), or within 30 days of notification of admission to an institution for mental disease by an entity other than a regional center, an assessment shall be completed by the regional center.
(vi)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 consumers 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. For purposes of this clause, notification to the clients rights advocate shall include the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.
(D)A 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 persons 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 intellectual 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 audiotapes, 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 individuals 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 persons living arrangement. If crisis intervention services are unsuccessful, emergency housing shall be available in the persons 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 consumers 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 that 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 consumers in-person appearances at judicial proceedings or administrative due process hearings may be used only if the consumer or, when appropriate, the consumers 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 law or regulation, 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 advocacy assistance from the state council.
(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 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)When there are identified gaps in the system of services and supports or when 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)(1)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. The
(2)Upon request of the consumer, or his or her legal guardian, the regional center shall make that statement the statement described in paragraph (1) available in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate, to the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both. This paragraph is in addition to, and independent of, any other rights, remedies, or procedures under any other law and shall not be construed to alter, limit, or negate any other rights, remedies, or procedures provided for by law.
SEC. 4.SEC. 3.Section 4686.2 of the Welfare and Institutions Code is amended to read:4686.2.(a)Effective July 1, 2009, notwithstanding any other law or regulation to the contrary, any vendor who provides applied behavioral analysis (ABA) services, or intensive behavioral intervention services or both, as defined in subdivision (d), shall:
(1)Conduct a behavioral assessment of each consumer to whom the vendor provides these services.
(2)Design an intervention plan that shall include the service type, number of hours, and parent participation needed to achieve the consumers goals and objectives, as set forth in the consumers individual program plan (IPP) or individualized family service plan (IFSP). The intervention plan shall also set forth the frequency at which the consumers progress shall be evaluated and reported.
(3)Provide a copy of the intervention plan to the regional center for review and consideration by the planning team members.
(b)Effective July 1, 2009, notwithstanding any other law or regulation to the contrary, regional centers shall:
(1)Only purchase ABA services or intensive behavioral intervention services that reflect evidence-based practices, promote positive social behaviors, and ameliorate behaviors that interfere with learning and social interactions.
(2)(A)Only purchase ABA or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers, given the critical nature of parent participation to the success of the intervention plan.
(B)In determining the extent of parent participation required for the provision of ABA or intensive behavioral intervention services, the IPP or IFSP planning team shall consider any relevant hardships suffered by a parent or parents that may constitute a barrier to the consumer accessing those services, including, but not limited to, availability of group instruction courses, conflicts with employment, vocational training, or educational demands, financial hardship, or lack of transportation or child or other family member care, and language barriers. Any hardships shall be documented in the IPP or IFSP and reviewed every six months to determine if there has been a change in circumstances. If the regional center determines that the extent of parent participation should be adjusted due to a change in circumstances, the regional center shall provide adequate notice pursuant to subdivision (a) of Section 4710.
(B)A parents or caregivers noncompletion of group instruction on the basics of behavior intervention shall not be used to deny, delay, or reduce ABA or intensive behavioral intervention services if the parent or caregiver demonstrates hardship in accessing or attending group instruction classes. The parents or caregivers demonstration of hardship shall be reviewed by the IPP or IFSP team every six months.
(3)Not purchase either ABA or intensive behavioral intervention services for purposes of providing respite, day care, or school services.
(4)Discontinue purchasing ABA or intensive behavioral intervention services for a consumer when the consumers treatment goals and objectives, as described under subdivision (a), are achieved. ABA or intensive behavioral intervention services shall not be discontinued until the goals and objectives are reviewed and updated as required in paragraph (5) and shall be discontinued only if those updated treatment goals and objectives do not require ABA or intensive behavioral intervention services.
(5)For each consumer, evaluate the vendors intervention plan and number of service hours for ABA or intensive behavioral intervention no less than every six months, consistent with evidence-based practices. If necessary, the intervention plans treatment goals and objectives shall be updated and revised.
(6)Not reimburse a parent for participating in a behavioral services treatment program.
(c)For consumers receiving ABA or behavioral intervention services on July 1, 2009, as part of their IPP or IFSP, subdivision (b) shall apply on August 1, 2009.
(d)For purposes of this section the following definitions shall apply:
(1)Applied behavioral analysis means the design, implementation, and evaluation of systematic instructional and environmental modifications to promote positive social behaviors and reduce or ameliorate behaviors which interfere with learning and social interaction.
(2)Intensive behavioral intervention means any form of applied behavioral analysis that is comprehensive, designed to address all domains of functioning, and provided in multiple settings for no more than 40 hours per week, across all settings, depending on the individuals needs and progress. Interventions can be delivered in a one-to-one ratio or small group format, as appropriate.
(3)Evidence-based practice means a decisionmaking process that integrates the best available scientifically rigorous research, clinical expertise, and individuals characteristics. Evidence-based practice is an approach to treatment rather than a specific treatment. Evidence-based practice promotes the collection, interpretation, integration, and continuous evaluation of valid, important, and applicable individual- or family-reported, clinically-observed, and research-supported evidence. The best available evidence, matched to consumer circumstances and preferences, is applied to ensure the quality of clinical judgments and facilitates the most cost-effective care.
(4)Parent participation shall include, but shall not be limited to, the following meanings:
(A)Completion of group instruction on the basics of behavior intervention.
(B)Implementation of intervention strategies, according to the intervention plan.
(C)If needed, collection of data on behavioral strategies and submission of that data to the provider for incorporation into progress reports.
(D)Participation in any needed clinical meetings.
(E)Purchase of suggested behavior modification materials or community involvement if a reward system is used.
At the time of development, scheduled review, or modification of a consumers individual program plan or individualized family service plan, the regional center shall make available, in a nontechnical, understandable form and in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate, to the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a document describing all of the following and the process for obtaining each exception or exemption:
(a)The exception described in subdivision (d) of Section 4648.35.
(b)The exemption described in subdivision (c) of Section 4648.5.
(c)The exemption described in subdivision (d) of Section 4648.55.
(d)The exemption described in subparagraph (A) of paragraph (3) of subdivision (a) of Section 4686.5.
SEC. 2.Section 4646.5 of the Welfare and Institutions Code is amended to read:4646.5.(a)The planning process for the individual program plan described in Section 4646 shall include all of the following:
(1)Gathering information and conducting assessments to determine the life goals, capabilities and strengths, preferences, barriers, and concerns or problems of the person with developmental disabilities. For children with developmental disabilities, this process should include a review of the strengths, preferences, and needs of the child and the family unit as a whole. Assessments shall be conducted by qualified individuals and performed in natural environments whenever possible. Information shall be taken from the consumer, his or her parents and other family members, his or her friends, advocates, authorized representative, if applicable, providers of services and supports, and other agencies. The assessment process shall reflect awareness of, and sensitivity to, the lifestyle and cultural background of the consumer and the family.
(2)A statement of goals, based on the needs, preferences, and life choices of the individual with developmental disabilities, and a statement of specific, time-limited objectives for implementing the persons goals and addressing his or her needs. These objectives shall be stated in terms that allow measurement of progress or monitoring of service delivery. These goals and objectives should maximize opportunities for the consumer to develop relationships, be part of community life in the areas of community participation, housing, work, school, and leisure, increase control over his or her life, acquire increasingly positive roles in community life, and develop competencies to help accomplish these goals.
(3)When developing individual program plans for children, regional centers shall be guided by the principles, process, and services and support parameters set forth in Section 4685.
(4)When developing an individual program plan for a transition age youth or working age adult, the planning team shall consider the Employment First Policy described in Chapter 14 (commencing with Section 4868).
(5)A schedule of the type and amount of services and supports to be purchased by the regional center or obtained from generic agencies or other resources in order to achieve the individual program plan goals and objectives, and identification of the provider or providers of service responsible for attaining each objective, including, but not limited to, vendors, contracted providers, generic service agencies, and natural supports. The individual program plan shall specify the approximate scheduled start date for services and supports and shall contain timelines for actions necessary to begin services and supports, including generic services. In addition to the requirements of subdivision (h) of Section 4646, each regional center shall offer, and upon request provide, a written copy of the individual program plan to the consumer, and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of their request in a threshold language, as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations.
(6)At the beginning of each individual program plan meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative information about the appeal and complaint process in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate.
(7)When agreed to by the consumer, the parents, legally appointed guardian, or authorized representative of a minor consumer, or the legally appointed conservator of an adult consumer or the authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, and subdivision (e) of Section 4705, a review of the general health status of the adult or child, including medical, dental, and mental health needs, shall be conducted. This review shall include a discussion of current medications, any observed side effects, and the date of the last review of the medication. Service providers shall cooperate with the planning team to provide any information necessary to complete the health status review. If any concerns are noted during the review, referrals shall be made to regional center clinicians or to the consumers physician, as appropriate. Documentation of health status and referrals shall be made in the consumers record by the service coordinator.
(8)(A)The development of a transportation access plan for a consumer when all of the following conditions are met:
(i)The regional center is purchasing private, specialized transportation services or services from a residential, day, or other provider, excluding vouchered service providers, to transport the consumer to and from day or work services.
(ii)The planning team has determined that a consumers community integration and participation could be safe and enhanced through the use of public transportation services.
(iii)The planning team has determined that generic transportation services are available and accessible.
(B)To maximize independence and community integration and participation, the transportation access plan shall identify the services and supports necessary to assist the consumer in accessing public transportation and shall comply with Section 4648.35. These services and supports may include, but are not limited to, mobility training services and the use of transportation aides. Regional centers are encouraged to coordinate with local public transportation agencies.
(9)A schedule of regular periodic review and reevaluation to ascertain that planned services have been provided, that objectives have been fulfilled within the times specified, and that consumers and families are satisfied with the individual program plan and its implementation.
(b)For all active cases, individual program plans shall be reviewed and modified by the planning team, through the process described in Section 4646, as necessary, in response to the persons achievement or changing needs, and no less often than once every three years. If the consumer or, where appropriate, the consumers parents, legal guardian, authorized representative, or conservator requests an individual program plan review, the individual program shall be reviewed within 30 days after the request is submitted.
(c)(1)The department, with the participation of representatives of a statewide consumer organization, the Association of Regional Center Agencies, an organized labor organization representing service coordination staff, and the state council shall prepare training material and a standard format and instructions for the preparation of individual program plans, which embody an approach centered on the person and family.
(2)Each regional center shall use the training materials and format prepared by the department pursuant to paragraph (1).
(3)The department shall biennially review a random sample of individual program plans at each regional center to ensure that these plans are being developed and modified in compliance with Section 4646 and this section.
SEC. 3.Section 4648 of the Welfare and Institutions Code is amended to read:4648.In order to achieve the stated objectives of a consumers 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 consumers 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 that the regional center and consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representatives, determines will best accomplish all or any part of that consumers 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; and the procedure for an individual or an agency to appeal any 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 facilitys 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 law or regulation, 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.
(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 consumers 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 a 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 when appropriate, his or her parents, legal guardian, conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, 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 providers ability to deliver quality services or supports that can accomplish all or part of the consumers individual program plan.
(B)A providers success in achieving the objectives set forth in the individual program plan.
(C)Where 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 consumers 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 consumers choice of providers, or, when appropriate, the consumers parents, legal guardians, authorized representatives, or conservators choice of providers.
(7)No service or support provided by any agency or individual shall be continued unless the consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, 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 persons 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 childs parent or guardian shall be obtained before placement is made.
(B)Effective July 1, 2012, notwithstanding any other law or regulation, 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 departments 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 Health Care Services 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 consumers 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, 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 consumers 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 plan meeting pursuant to this subparagraph and may participate in all individual program plan meetings unless the consumer objects on his or her own behalf. For purposes of this clause, notification to the clients rights advocate shall include a copy of the most recent comprehensive assessment or updated assessment and the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.
(v)If a consumer is placed in an institution for mental disease by another entity, the institution for mental disease shall inform the regional center of the placement within five days of the date the consumer is admitted. If an individuals records indicate that he or she is a regional center consumer, the institution for mental disease shall make every effort to contact the local regional center or department to determine which regional center to provide notice. As soon as possible within 30 days of admission to an institution for mental disease due to an emergency pursuant to clause (ii), or within 30 days of notification of admission to an institution for mental disease by an entity other than a regional center, an assessment shall be completed by the regional center.
(vi)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 consumers 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. For purposes of this clause, notification to the clients rights advocate shall include the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.
(D)A 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 persons 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 intellectual 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 audiotapes, 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 individuals 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 persons living arrangement. If crisis intervention services are unsuccessful, emergency housing shall be available in the persons 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 consumers 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 that 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 consumers in-person appearances at judicial proceedings or administrative due process hearings may be used only if the consumer or, when appropriate, the consumers 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 law or regulation, 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 advocacy assistance from the state council.
(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 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)When there are identified gaps in the system of services and supports or when 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. The regional center shall make that statement available in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate, to the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both.
SEC. 4.Section 4686.2 of the Welfare and Institutions Code is amended to read:4686.2.(a)Effective July 1, 2009, notwithstanding any other law or regulation to the contrary, any vendor who provides applied behavioral analysis (ABA) services, or intensive behavioral intervention services or both, as defined in subdivision (d), shall:
(1)Conduct a behavioral assessment of each consumer to whom the vendor provides these services.
(2)Design an intervention plan that shall include the service type, number of hours, and parent participation needed to achieve the consumers goals and objectives, as set forth in the consumers individual program plan (IPP) or individualized family service plan (IFSP). The intervention plan shall also set forth the frequency at which the consumers progress shall be evaluated and reported.
(3)Provide a copy of the intervention plan to the regional center for review and consideration by the planning team members.
(b)Effective July 1, 2009, notwithstanding any other law or regulation to the contrary, regional centers shall:
(1)Only purchase ABA services or intensive behavioral intervention services that reflect evidence-based practices, promote positive social behaviors, and ameliorate behaviors that interfere with learning and social interactions.
(2)(A)Only purchase ABA or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers, given the critical nature of parent participation to the success of the intervention plan.
(B)In determining the extent of parent participation required for the provision of ABA or intensive behavioral intervention services, the IPP or IFSP planning team shall consider any relevant hardships suffered by a parent or parents that may constitute a barrier to the consumer accessing those services, including, but not limited to, availability of group instruction courses, conflicts with employment, vocational training, or educational demands, financial hardship, or lack of transportation or child or other family member care, and language barriers. Any hardships shall be documented in the IPP or IFSP and reviewed annually every six months to determine if there has been a change in circumstances. If the regional center determines that the extent of parent participation should be adjusted due to a change in circumstances, the regional center shall provide adequate notice pursuant to subdivision (a) of Section 4710.
(3)Not purchase either ABA or intensive behavioral intervention services for purposes of providing respite, day care, or school services.
(4)Discontinue purchasing ABA or intensive behavioral intervention services for a consumer when the consumers treatment goals and objectives, as described under subdivision (a), are achieved. ABA or intensive behavioral intervention services shall not be discontinued until the goals and objectives are reviewed and updated as required in paragraph (5) and shall be discontinued only if those updated treatment goals and objectives do not require ABA or intensive behavioral intervention services.
(5)For each consumer, evaluate the vendors intervention plan and number of service hours for ABA or intensive behavioral intervention no less than every six months, consistent with evidence-based practices. If necessary, the intervention plans treatment goals and objectives shall be updated and revised.
(6)Not reimburse a parent for participating in a behavioral services treatment program.
(c)For consumers receiving ABA or behavioral intervention services on July 1, 2009, as part of their IPP or IFSP, subdivision (b) shall apply on August 1, 2009.
(d)For purposes of this section the following definitions shall apply:
(1)Applied behavioral analysis means the design, implementation, and evaluation of systematic instructional and environmental modifications to promote positive social behaviors and reduce or ameliorate behaviors which interfere with learning and social interaction.
(2)Intensive behavioral intervention means any form of applied behavioral analysis that is comprehensive, designed to address all domains of functioning, and provided in multiple settings for no more than 40 hours per week, across all settings, depending on the individuals needs and progress. Interventions can be delivered in a one-to-one ratio or small group format, as appropriate.
(3)Evidence-based practice means a decisionmaking process that integrates the best available scientifically rigorous research, clinical expertise, and individuals characteristics. Evidence-based practice is an approach to treatment rather than a specific treatment. Evidence-based practice promotes the collection, interpretation, integration, and continuous evaluation of valid, important, and applicable individual- or family-reported, clinically-observed, and research-supported evidence. The best available evidence, matched to consumer circumstances and preferences, is applied to ensure the quality of clinical judgments and facilitates the most cost-effective care.
(4)Parent participation shall include, but shall not be limited to, the following meanings:
(A)Completion of group instruction on the basics of behavior intervention.
(B)Implementation of intervention strategies, according to the intervention plan.
(C)If needed, collection of data on behavioral strategies and submission of that data to the provider for incorporation into progress reports.
(D)Participation in any needed clinical meetings.
(E)Purchase of suggested behavior modification materials or community involvement if a reward system is used.
At the time of development, scheduled review, or modification of a consumers individual program plan or individualized family service plan, the regional center shall make available, in a nontechnical, understandable form and in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate, to the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a document describing all of the following and the process for obtaining each exception or exemption:
(a)The exception described in subdivision (d) of Section 4648.35.
(b)The exemption described in subdivision (c) of Section 4648.5.
(c)The exemption described in subdivision (d) of Section 4648.55.
(d)The exemption described in subparagraph (A) of paragraph (3) of subdivision (a) of Section 4686.5.
SECTION 1.SEC. 2.Section 4646.5 of the Welfare and Institutions Code is amended to read:4646.5.(a)The planning process for the individual program plan described in Section 4646 shall include all of the following:
(1)Gathering information and conducting assessments to determine the life goals, capabilities and strengths, preferences, barriers, and concerns or problems of the person with developmental disabilities. For children with developmental disabilities, this process should include a review of the strengths, preferences, and needs of the child and the family unit as a whole. Assessments shall be conducted by qualified individuals and performed in natural environments whenever possible. Information shall be taken from the consumer, his or her parents and other family members, his or her friends, advocates, authorized representative, if applicable, providers of services and supports, and other agencies. The assessment process shall reflect awareness of, and sensitivity to, the lifestyle and cultural background of the consumer and the family.
(2)A statement of goals, based on the needs, preferences, and life choices of the individual with developmental disabilities, and a statement of specific, time-limited objectives for implementing the persons goals and addressing his or her needs. These objectives shall be stated in terms that allow measurement of progress or monitoring of service delivery. These goals and objectives should maximize opportunities for the consumer to develop relationships, be part of community life in the areas of community participation, housing, work, school, and leisure, increase control over his or her life, acquire increasingly positive roles in community life, and develop competencies to help accomplish these goals.
(3)When developing individual program plans for children, regional centers shall be guided by the principles, process, and services and support parameters set forth in Section 4685.
(4)When developing an individual program plan for a transition age youth or working age adult, the planning team shall consider the Employment First Policy described in Chapter 14 (commencing with Section 4868).
(5)A schedule of the type and amount of services and supports to be purchased by the regional center or obtained from generic agencies or other resources in order to achieve the individual program plan goals and objectives, and identification of the provider or providers of service responsible for attaining each objective, including, but not limited to, vendors, contracted providers, generic service agencies, and natural supports. The individual program plan shall specify the approximate scheduled start date for services and supports and shall contain timelines for actions necessary to begin services and supports, including generic services. In addition to the requirements of subdivision (h) of Section 4646, each regional center shall offer, and upon request provide, a written copy of the individual program plan to the consumer, and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of their request in a threshold language, as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations.
(6)At the beginning of each individual program plan meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative a list of services provided by the regional center and information about the appeal and complaint process in his or her native language. threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate.
(7)At the end of the individual program plan meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative a written list of agreed-upon services and supports, including the amount and anticipated start date, and a list of any services and supports for which final agreement has not yet been reached and for which there will be a subsequent program plan meeting pursuant to subdivision (f) of Section 4646.
(8)
(7)When agreed to by the consumer, the parents, legally appointed guardian, or authorized representative of a minor consumer, or the legally appointed conservator of an adult consumer or the authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, and subdivision (e) of Section 4705, a review of the general health status of the adult or child, including medical, dental, and mental health needs, shall be conducted. This review shall include a discussion of current medications, any observed side effects, and the date of the last review of the medication. Service providers shall cooperate with the planning team to provide any information necessary to complete the health status review. If any concerns are noted during the review, referrals shall be made to regional center clinicians or to the consumers physician, as appropriate. Documentation of health status and referrals shall be made in the consumers record by the service coordinator.
(9)
(8)(A)The development of a transportation access plan for a consumer when all of the following conditions are met:
(i)The regional center is purchasing private, specialized transportation services or services from a residential, day, or other provider, excluding vouchered service providers, to transport the consumer to and from day or work services.
(ii)The planning team has determined that a consumers community integration and participation could be safe and enhanced through the use of public transportation services.
(iii)The planning team has determined that generic transportation services are available and accessible.
(B)To maximize independence and community integration and participation, the transportation access plan shall identify the services and supports necessary to assist the consumer in accessing public transportation and shall comply with Section 4648.35. These services and supports may include, but are not limited to, mobility training services and the use of transportation aides. Regional centers are encouraged to coordinate with local public transportation agencies.
(10)
(9)A schedule of regular periodic review and reevaluation to ascertain that planned services have been provided, that objectives have been fulfilled within the times specified, and that consumers and families are satisfied with the individual program plan and its implementation.
(b)For all active cases, individual program plans shall be reviewed and modified by the planning team, through the process described in Section 4646, as necessary, in response to the persons achievement or changing needs, and no less often than once every three years. If the consumer or, where appropriate, the consumers parents, legal guardian, authorized representative, or conservator requests an individual program plan review, the individual program shall be reviewed within 30 days after the request is submitted.
(c)(1)The department, with the participation of representatives of a statewide consumer organization, the Association of Regional Center Agencies, an organized labor organization representing service coordination staff, and the state council shall prepare training material and a standard format and instructions for the preparation of individual program plans, which embody an approach centered on the person and family.
(2)Each regional center shall use the training materials and format prepared by the department pursuant to paragraph (1).
(3)The department shall biennially review a random sample of individual program plans at each regional center to ensure that these plans are being developed and modified in compliance with Section 4646 and this section.
SEC. 2.SEC. 3.Section 4648 of the Welfare and Institutions Code is amended to read:4648.In order to achieve the stated objectives of a consumers 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 consumers 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 that the regional center and consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representatives, determines will best accomplish all or any part of that consumers 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; and the procedure for an individual or an agency to appeal any 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 facilitys 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 law or regulation, 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.
(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 consumers 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 consumers individual program plan. The system of payment shall include a 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 when appropriate, his or her parents, legal guardian, conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, 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 providers ability to deliver quality services or supports that can accomplish all or part of the consumers individual program plan.
(B)A providers success in achieving the objectives set forth in the individual program plan.
(C)Where 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 consumers 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 consumers choice of providers, or, when appropriate, the consumers parents, legal guardians, authorized representatives, or conservators choice of providers.
(7)No service or support provided by any agency or individual shall be continued unless the consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, 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 persons 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 childs parent or guardian shall be obtained before placement is made.
(B)Effective July 1, 2012, notwithstanding any other law or regulation, 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 departments 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 consumers 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, 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 consumers 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 plan meeting pursuant to this subparagraph and may participate in all individual program planning plan meetings unless the consumer objects on his or her own behalf. For purposes of this clause, notification to the clients rights advocate shall include a copy of the most recent comprehensive assessment or updated assessment and the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.
(v)If a consumer is placed in an institution for mental disease by another entity, the institution for mental disease shall inform the regional center of the placement within five days of the date the consumer is admitted. If an individuals records indicate that he or she is a regional center consumer, the institution for mental disease shall make every effort to contact the local regional center or department to determine which regional center to provide notice. As soon as possible within 30 days of admission to an institution for mental disease due to an emergency pursuant to clause (ii), or within 30 days of notification of admission to an institution for mental disease by an entity other than a regional center, an assessment shall be completed by the regional center.
(vi)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 consumers 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. For purposes of this clause, notification to the clients rights advocate shall include the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.
(D)A 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 persons 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 intellectual 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 audiotapes, 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 individuals 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 persons living arrangement. If crisis intervention services are unsuccessful, emergency housing shall be available in the persons 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 consumers 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 that 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 consumers in-person appearances at judicial proceedings or administrative due process hearings may be used only if the consumer or, when appropriate, the consumers 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 law or regulation, 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 advocacy assistance from the state council.
(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 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)When there are identified gaps in the system of services and supports or when 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, and at the time of development, scheduled review, or modification of a consumers individual program plan or individualized family service plan, 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. The regional center shall provide that statement in the native language of the make that statement available in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate, to the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both.
SEC. 3.Section 4648.35 of the Welfare and Institutions Code is amended to read:4648.35.At the time of development, review, or modification of a consumers individual program plan (IPP) or individualized family service plan (IFSP), all of the following shall apply to a regional center:
(a)A regional center shall not fund private specialized transportation services for an adult consumer who can safely access and utilize public transportation, when that transportation is available.
(b)A regional center shall fund the least expensive transportation modality that meets the consumers needs, as set forth in the consumers IPP or IFSP.
(c)A regional center shall fund transportation, when required, from the consumers residence to the lowest-cost vendor that provides the service that meets the consumers needs, as set forth in the consumers IPP or IFSP. For purposes of this subdivision, the cost of a vendor shall be determined by combining the vendors program costs and the costs to transport a consumer from the consumers residence to the vendor.
(d)A regional center shall fund transportation services for a minor child living in the family residence, only if the family of the child provides sufficient written documentation to the regional center to demonstrate that it is unable to provide transportation for the child. At the time of development, scheduled review, or modification of a consumers individual program plan or individualized family service plan, the regional center shall provide, in a non-technical, understandable form and in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a written statement of the requirement described in this subdivision and examples of sufficient written documentation that may be submitted. The regional center shall accept documentation submitted pursuant to this subdivision in any written form, including in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative.
SEC. 4.Section 4648.5 of the Welfare and Institutions Code is amended to read:4648.5.(a)Notwithstanding any other law or regulations to the contrary, effective July 1, 2009, a regional centers authority to purchase the following services shall be suspended pending implementation of the Individual Choice Budget and certification by the Director of Developmental Services that the Individual Choice Budget has been implemented and will result in state budget savings sufficient to offset the costs of providing the following services:
(1)Camping services and associated travel expenses.
(2)Social recreation activities, except for those activities vendored as community-based day programs.
(3)Educational services for children three to 17, inclusive, years of age.
(4)Nonmedical therapies, including, but not limited to, specialized recreation, art, dance, and music.
(b)For regional center consumers receiving services described in subdivision (a) as part of their individual program plan (IPP) or individualized family service plan (IFSP), the prohibition in subdivision (a) shall take effect on August 1, 2009.
(c)An exemption may be granted on an individual basis in extraordinary circumstances to permit purchase of a service identified in subdivision (a) when the regional center determines that the service is a primary or critical means for ameliorating the physical, cognitive, or psychosocial effects of the consumers developmental disability, or the service is necessary to enable the consumer to remain in his or her home and no alternative service is available to meet the consumers needs.
(d)At the time of development, scheduled review, or modification of a consumers individual program plan or individualized family service plan, the regional center shall provide, in a non-technical, understandable form and in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a written statement describing the exemption in subdivision (c) and examples of documentation that may be submitted to demonstrate qualification for the exemption.
SEC. 5.Section 4648.55 of the Welfare and Institutions Code is amended to read:4648.55.(a)A regional center shall not purchase day program, vocational education, work services, independent living program, or mobility training and related transportation services for a consumer who is 18 to 22 years of age, inclusive, if that consumer is eligible for special education and related education services and has not received a diploma or certificate of completion, unless the individual program plan (IPP) planning team determines that the consumers needs cannot be met in the educational system or grants an exemption pursuant to subdivision (d). If the planning team determines that generic services can meet the consumers day, vocational education, work services, independent living, or mobility training and related transportation needs, the regional center shall assist the consumer in accessing those services. To ensure that consumers receive appropriate educational services and an effective transition from services provided by educational agencies to services provided by regional centers, the regional center service coordinator, at the request of the consumer or, where appropriate, the consumers parent, legal guardian, or conservator, may attend the individualized education program (IEP) planning team meeting.
(b)For consumers who are 18 to 22 years of age, inclusive, who have left the public school system, and who are receiving regional center purchased services identified in subdivision (a) on or before the effective date of this section, a determination shall be made through the IPP as to whether the return to the educational system can be achieved while meeting the consumers needs. If the planning team determines that the consumers needs cannot be met in the educational system, the regional center may continue to purchase the services identified in subdivision (a). If the planning team determines that generic services can meet the consumers day, vocational education, work services, independent living, or mobility training and related transportation needs, the regional center shall assist the consumer in accessing those services.
(c)For consumers who are 18 to 22 years of age, inclusive, who have left school prior to enactment of this section, but who are not receiving any of the regional center purchased services identified in subdivision (a), the regional center shall use generic education services to meet the consumers day, vocational education, work services, independent living, or mobility training and related transportation needs if those needs are subsequently identified in the IPP unless the consumer is eligible for an exemption as set forth in subdivision (d). If the planning team determines that generic services can meet the consumers day, vocational education, work services, independent living, or mobility training and related transportation needs, the regional center shall assist the consumer in accessing those services.
(d)(1)An exemption to the provisions of this section may be granted on an individual basis in extraordinary circumstances to permit purchase of a service identified in subdivision (a). An exemption shall be granted through the IPP process and shall be based on a determination that the generic service is not appropriate to meet the consumers need.
(2)At the time of development, scheduled review, or modification of a consumers individual program plan, the regional center shall provide, in a non-technical, understandable form and in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a written statement describing the exemption in paragraph (1) and examples of documentation that may be submitted to demonstrate qualification for the exemption.
(3)The IPP planning team shall consider the standard set forth in Section 4688.05 when determining whether the consumer qualifies for an exemption under this subdivision for the purpose of meeting his or her independent living needs.
(e)A school district may contract with regional center vendors to meet the needs of consumers pursuant to this section.
SEC. 6.Section 4659 of the Welfare and Institutions Code is amended to read:4659.(a)Except as otherwise provided in subdivision (b) or (e), the regional center shall identify and pursue all possible sources of funding for consumers receiving regional center services. These sources shall include, but not be limited to, both of the following:
(1)Governmental or other entities or programs required to provide or pay the cost of providing services, including Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, school districts, and federal supplemental security income and the state supplementary program.
(2)Private entities, to the maximum extent they are liable for the cost of services, aid, insurance, or medical assistance to the consumer.
(b)Any revenues collected by a regional center pursuant to this section shall be applied against the cost of services prior to use of regional center funds for those services. This revenue shall not result in a reduction in the regional centers purchase of services budget, except as it relates to federal supplemental security income and the state supplementary program.
(c)Effective July 1, 2009, notwithstanding any other law or regulation, regional centers shall not purchase any service that would otherwise be available from Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, In-Home Support Services, California Childrens Services, private insurance, or a health care service plan when a consumer or a family meets the criteria of this coverage but chooses not to pursue that coverage. If, on July 1, 2009, a regional center is purchasing that service as part of a consumers individual program plan (IPP), the prohibition shall take effect on October 1, 2009.
(d)(1)Effective July 1, 2009, notwithstanding any other law or regulation, a regional center shall not purchase medical or dental services for a consumer three years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center determines that an appeal by the consumer or family of the denial does not have merit. If, on July 1, 2009, a regional center is purchasing the service as part of a consumers IPP, this provision shall take effect on August 1, 2009. At the time of development, scheduled review, or modification of a consumers individual program plan or individualized family service plan, the regional center shall provide, in a non-technical, understandable form and in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a written statement describing the documentation required pursuant to this paragraph. Regional centers shall pay for medical or dental services during the following periods:
(A)While coverage is being pursued, but before a denial is made.
(B)Pending a final administrative decision on the administrative appeal if the family has provided to the regional center a verification that an administrative appeal is being pursued.
(C)Until the commencement of services by Medi-Cal, private insurance, or a health care service plan.
(2)When necessary, the consumer or family may receive assistance from the regional center, the Clients Rights Advocate funded by the department, or the state council in pursuing these appeals.
(e)This section shall not impose any additional liability on the parents of children with developmental disabilities, or to restrict eligibility for, or deny services to, any individual who qualifies for regional center services but is unable to pay.
(f)In order to best utilize generic resources, federally funded programs, and private insurance programs for individuals with developmental disabilities, the department and regional centers shall engage in the following activities:
(1)Within existing resources, the department shall provide training to regional centers, no less than once every two years, in the availability and requirements of generic, federally funded and private programs available to persons with developmental disabilities, including, but not limited to, eligibility requirements, the application process and covered services, and the appeal process.
(2)Regional centers shall disseminate information and training to all service coordinators regarding the availability and requirements of generic, federally funded, and private insurance programs on the local level.
SEC. 7.SEC. 4.Section 4686.2 of the Welfare and Institutions Code is amended to read:4686.2.(a)Effective July 1, 2009, notwithstanding any other law or regulation to the contrary, any vendor who provides applied behavioral analysis (ABA) services, or intensive behavioral intervention services or both, as defined in subdivision (d), shall:
(1)Conduct a behavioral assessment of each consumer to whom the vendor provides these services.
(2)Design an intervention plan that shall include the service type, number of hours hours, and parent participation needed to achieve the consumers goals and objectives, as set forth in the consumers individual program plan (IPP) or individualized family service plan (IFSP). The intervention plan shall also set forth the frequency at which the consumers progress shall be evaluated and reported.
(3)Provide a copy of the intervention plan to the regional center for review and consideration by the planning team members.
(b)Effective July 1, 2009, notwithstanding any other law or regulation to the contrary, regional centers shall:
(1)Only purchase ABA services or intensive behavioral intervention services that reflect evidence-based practices, promote positive social behaviors, and ameliorate behaviors that interfere with learning and social interactions.
(2)(A)Only purchase ABA or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers, given the critical nature of parent participation to the success of the intervention plan.
(B)In determining the extent of parent participation required for the provision of ABA or intensive behavioral intervention services, the IPP or IFSP planning team shall consider any relevant hardships suffered by a parent or parents that may constitute a barrier to the consumer accessing those services, including, but not limited to, availability of group instruction courses, conflicts with employment, vocational training, or educational demands, financial hardship, or lack of transportation or child or other family member care, and language barriers. Any hardships shall be documented in the IPP or IFSP and reviewed annually to determine if there has been a change in circumstances. If the regional center determines that the extent of parent participation should be adjusted due to a change in circumstances, the regional center shall provide adequate notice pursuant to subdivision (a) of Section 4710.
(C)At the time of development, scheduled review, or modification of a consumers IPP or IFSP, the regional center shall provide, in a non-technical, understandable form and in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a written statement describing the process for determining the extent of parent participation pursuant to this paragraph and examples of documentation that may be submitted to demonstrate hardships.
(3)Not purchase either ABA or intensive behavioral intervention services for purposes of providing respite, day care, or school services.
(4)Discontinue purchasing ABA or intensive behavioral intervention services for a consumer when the consumers treatment goals and objectives, as described under subdivision (a), are achieved. ABA or intensive behavioral intervention services shall not be discontinued until the goals and objectives are reviewed and updated as required in paragraph (5) and shall be discontinued only if those updated treatment goals and objectives do not require ABA or intensive behavioral intervention services.
(5)For each consumer, evaluate the vendors intervention plan and number of service hours for ABA or intensive behavioral intervention no less than every six months, consistent with evidence-based practices. If necessary, the intervention plans treatment goals and objectives shall be updated and revised.
(6)Not reimburse a parent for participating in a behavioral services treatment program.
(c)For consumers receiving ABA or behavioral intervention services on July 1, 2009, as part of their IPP or IFSP, subdivision (b) shall apply on August 1, 2009.
(d)For purposes of this section the following definitions shall apply:
(1)Applied behavioral analysis means the design, implementation, and evaluation of systematic instructional and environmental modifications to promote positive social behaviors and reduce or ameliorate behaviors which interfere with learning and social interaction.
(2)Intensive behavioral intervention means any form of applied behavioral analysis that is comprehensive, designed to address all domains of functioning, and provided in multiple settings for no more than 40 hours per week, across all settings, depending on the individuals needs and progress. Interventions can be delivered in a one-to-one ratio or small group format, as appropriate.
(3)Evidence-based practice means a decisionmaking process that integrates the best available scientifically rigorous research, clinical expertise, and individuals characteristics. Evidence-based practice is an approach to treatment rather than a specific treatment. Evidence-based practice promotes the collection, interpretation, integration, and continuous evaluation of valid, important, and applicable individual- or family-reported, clinically-observed, and research-supported evidence. The best available evidence, matched to consumer circumstances and preferences, is applied to ensure the quality of clinical judgments and facilitates the most cost-effective care.
(4)Parent participation shall include, but shall not be limited to, the following meanings:
(A)Completion of group instruction on the basics of behavior intervention.
(B)Implementation of intervention strategies, according to the intervention plan.
(C)If needed, collection of data on behavioral strategies and submission of that data to the provider for incorporation into progress reports.
(D)Participation in any needed clinical meetings.
(E)Purchase of suggested behavior modification materials or community involvement if a reward system is used.
SEC. 8.Section 4686.5 of the Welfare and Institutions Code is amended to read:4686.5.(a)Effective July 1, 2009, notwithstanding any other provision of law or regulation to the contrary, all of the following shall apply:
(1)A regional center may only purchase respite services when the care and supervision needs of a consumer exceed that of an individual of the same age without developmental disabilities.
(2)A regional center shall not purchase more than 21 days of out-of-home respite services in a fiscal year nor more than 90 hours of in-home respite services in a quarter, for a consumer.
(3)(A)A regional center may grant an exemption to the requirements set forth in paragraphs (1) and (2) if it is demonstrated that the intensity of the consumers care and supervision needs are such that additional respite is necessary to maintain the consumer in the family home, or there is an extraordinary event that impacts the family members ability to meet the care and supervision needs of the consumer.
(B)At the time of development, scheduled review, or modification of a consumers individual program plan or individualized family service plan, the regional center shall provide, in a non-technical, understandable form and in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a written statement describing the exemption in subparagraph (A) and examples of documentation that may be submitted to demonstrate qualification for the exemption.
(C)For purposes of this section, family member means an individual who:
(i)Has a consumer residing with him or her.
(ii)Is responsible for the 24-hour care and supervision of the consumer.
(iii)Is not a licensed or certified residential care facility or foster family home receiving funds from any public agency or regional center for the care and supervision provided. Notwithstanding this provision, a relative who receives foster care funds shall not be precluded from receiving respite.
(4)A regional center shall not purchase day care services to replace or supplant respite services. For purposes of this section, day care is defined as regularly provided care, protection, and supervision of a consumer living in the home of his or her parents, for periods of less than 24 hours per day, while the parents are engaged in employment outside of the home or educational activities leading to employment, or both.
(5)A regional center shall only consider in-home supportive services a generic resource when the approved in-home supportive services meets the respite need as identified in the consumers individual program plan (IPP) or individualized family service plan (IFSP).
(b)For consumers receiving respite services on July 1, 2009, as part of their IPP or IFSP, subdivision (a) shall apply on August 1, 2009.
(c)This section shall remain in effect until implementation of the individual choice budget pursuant to Section 4648.6 and certification by the Director of the Department of Developmental Services that the individual choice budget has been implemented and will result in state budget savings sufficient to offset the costs associated with the repeal of this section. This section shall be repealed on the date of certification.
(a)The planning process for the individual program plan described in Section 4646 shall include all of the following:
(1)Gathering information and conducting assessments to determine the life goals, capabilities and strengths, preferences, barriers, and concerns or problems of the person with developmental disabilities. For children with developmental disabilities, this process should include a review of the strengths, preferences, and needs of the child and the family unit as a whole. Assessments shall be conducted by qualified individuals and performed in natural environments whenever possible. Information shall be taken from the consumer, his or her parents and other family members, his or her friends, advocates, authorized representative, if applicable, providers of services and supports, and other agencies. The assessment process shall reflect awareness of, and sensitivity to, the lifestyle and cultural background of the consumer and the family.
(2)A statement of goals, based on the needs, preferences, and life choices of the individual with developmental disabilities, and a statement of specific, time-limited objectives for implementing the persons goals and addressing his or her needs. These objectives shall be stated in terms that allow measurement of progress or monitoring of service delivery. These goals and objectives should maximize opportunities for the consumer to develop relationships, be part of community life in the areas of community participation, housing, work, school, and leisure, increase control over his or her life, acquire increasingly positive roles in community life, and develop competencies to help accomplish these goals.
(3)When developing individual program plans for children, regional centers shall be guided by the principles, process, and services and support parameters set forth in Section 4685.
(4)When developing an individual program plan for a transition age youth or working age adult, the planning team shall consider the Employment First Policy described in Chapter 14 (commencing with Section 4868).
(5)A schedule of the type and amount of services and supports to be purchased by the regional center or obtained from generic agencies or other resources in order to achieve the individual program plan goals and objectives, and identification of the provider or providers of service responsible for attaining each objective, including, but not limited to, vendors, contracted providers, generic service agencies, and natural supports. The individual program plan shall specify the approximate scheduled start date for services and supports and shall contain timelines for actions necessary to begin services and supports, including generic services. In addition to the requirements of subdivision (h) of Section 4646, each regional center shall offer, and upon request provide, a written copy of the individual program plan to the consumer, and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of their request in a threshold language, as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations.
(6)At the beginning of each individual program plan meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative a list of services provided by the regional center and information about the appeal and complaint process in his or her native language.
(7)At the end of the individual program plan meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative a written list of agreed-upon services and supports, including the amount and anticipated start date, and a list of any services and supports for which final agreement has not yet been reached and for which there will be a subsequent program plan meeting pursuant to subdivision (f) of Section 4646.
(6)
(8)When agreed to by the consumer, the parents, legally appointed guardian, or authorized representative of a minor consumer, or the legally appointed conservator of an adult consumer or the authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, and subdivision (e) of Section 4705, a review of the general health status of the adult or child, including medical, dental, and mental health needs, shall be conducted. This review shall include a discussion of current medications, any observed side effects, and the date of the last review of the medication. Service providers shall cooperate with the planning team to provide any information necessary to complete the health status review. If any concerns are noted during the review, referrals shall be made to regional center clinicians or to the consumers physician, as appropriate. Documentation of health status and referrals shall be made in the consumers record by the service coordinator.
(7)
(9)(A)The development of a transportation access plan for a consumer when all of the following conditions are met:
(i)The regional center is purchasing private, specialized transportation services or services from a residential, day, or other provider, excluding vouchered service providers, to transport the consumer to and from day or work services.
(ii)The planning team has determined that a consumers community integration and participation could be safe and enhanced through the use of public transportation services.
(iii)The planning team has determined that generic transportation services are available and accessible.
(B)To maximize independence and community integration and participation, the transportation access plan shall identify the services and supports necessary to assist the consumer in accessing public transportation and shall comply with Section 4648.35. These services and supports may include, but are not limited to, mobility training services and the use of transportation aides. Regional centers are encouraged to coordinate with local public transportation agencies.
(8)
(10)A schedule of regular periodic review and reevaluation to ascertain that planned services have been provided, that objectives have been fulfilled within the times specified, and that consumers and families are satisfied with the individual program plan and its implementation.
(b)For all active cases, individual program plans shall be reviewed and modified by the planning team, through the process described in Section 4646, as necessary, in response to the persons achievement or changing needs, and no less often than once every three years. If the consumer or, where appropriate, the consumers parents, legal guardian, authorized representative, or conservator requests an individual program plan review, the individual program shall be reviewed within 30 days after the request is submitted.
(c)(1)The department, with the participation of representatives of a statewide consumer organization, the Association of Regional Center Agencies, an organized labor organization representing service coordination staff, and the state council shall prepare training material and a standard format and instructions for the preparation of individual program plans, which embody an approach centered on the person and family.
(2)Each regional center shall use the training materials and format prepared by the department pursuant to paragraph (1).
(3)The department shall biennially review a random sample of individual program plans at each regional center to ensure that these plans are being developed and modified in compliance with Section 4646 and this section.
SEC. 2.Section 4648 of the Welfare and Institutions Code is amended to read:4648.In order to achieve the stated objectives of a consumers 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 consumers 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 that the regional center and consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representatives, determines will best accomplish all or any part of that consumers 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 any 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 facilitys 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 law or regulation, 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.
(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 consumers 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 a 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 when appropriate, his or her parents, legal guardian, conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, 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 providers ability to deliver quality services or supports that can accomplish all or part of the consumers individual program plan.
(B)A providers success in achieving the objectives set forth in the individual program plan.
(C)Where 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 consumers 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 consumers choice of providers, or, when appropriate, the consumers parents, legal guardians, authorized representatives, or conservators choice of providers.
(7)No service or support provided by any agency or individual shall be continued unless the consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, 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 persons 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 childs parent or guardian shall be obtained before placement is made.
(B)Effective July 1, 2012, notwithstanding any other law or regulation, 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 departments 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 consumers 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, 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 consumers 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. For purposes of this clause, notification to the clients rights advocate shall include a copy of the most recent comprehensive assessment or updated assessment and the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.
(v)If a consumer is placed in an institution for mental disease by another entity, the institution for mental disease shall inform the regional center of the placement within five days of the date the consumer is admitted. If an individuals records indicate that he or she is a regional center consumer, the institution for mental disease shall make every effort to contact the local regional center or department to determine which regional center to provide notice. As soon as possible within 30 days of admission to an institution for mental disease due to an emergency pursuant to clause (ii), or within 30 days of notification of admission to an institution for mental disease by an entity other than a regional center, an assessment shall be completed by the regional center.
(vi)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 consumers 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. For purposes of this clause, notification to the clients rights advocate shall include the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.
(D)A 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 persons 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 intellectual 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 audiotapes, 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 individuals 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 persons living arrangement. If crisis intervention services are unsuccessful, emergency housing shall be available in the persons 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 consumers 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 that 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 consumers in-person appearances at judicial proceedings or administrative due process hearings may be used only if the consumer or, when appropriate, the consumers 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 law or regulation, 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 advocacy assistance from the state council.
(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 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)When there are identified gaps in the system of services and supports or when 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, and at the time of development, scheduled review, or modification of a consumers individual program plan or individualized family service plan, 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. The regional center shall provide that statement in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both.
SEC. 3.Section 4648.35 of the Welfare and Institutions Code is amended to read:4648.35.At the time of development, review, or modification of a consumers individual program plan (IPP) or individualized family service plan (IFSP), all of the following shall apply to a regional center:
(a)A regional center shall not fund private specialized transportation services for an adult consumer who can safely access and utilize public transportation, when that transportation is available.
(b)A regional center shall fund the least expensive transportation modality that meets the consumers needs, as set forth in the consumers IPP or IFSP.
(c)A regional center shall fund transportation, when required, from the consumers residence to the lowest-cost vendor that provides the service that meets the consumers needs, as set forth in the consumers IPP or IFSP. For purposes of this subdivision, the cost of a vendor shall be determined by combining the vendors program costs and the costs to transport a consumer from the consumers residence to the vendor.
(d)A regional center shall fund transportation services for a minor child living in the family residence, only if the family of the child provides sufficient written documentation to the regional center to demonstrate that it is unable to provide transportation for the child. At the time of development, scheduled review, or modification of a consumers individual program plan or individualized family service plan, the regional center shall provide, in a non-technical, understandable form and in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a written statement of the requirement described in this subdivision and examples of sufficient written documentation that may be submitted. The regional center shall accept documentation submitted pursuant to this subdivision in any written form, including in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative.
SEC. 4.Section 4648.5 of the Welfare and Institutions Code is amended to read:4648.5.(a)Notwithstanding any other provision of law or regulations to the contrary, effective July 1, 2009, a regional centers authority to purchase the following services shall be suspended pending implementation of the Individual Choice Budget and certification by the Director of Developmental Services that the Individual Choice Budget has been implemented and will result in state budget savings sufficient to offset the costs of providing the following services:
(1)Camping services and associated travel expenses.
(2)Social recreation activities, except for those activities vendored as community-based day programs.
(3)Educational services for children three to 17, inclusive, years of age.
(4)Nonmedical therapies, including, but not limited to, specialized recreation, art, dance, and music.
(b)For regional center consumers receiving services described in subdivision (a) as part of their individual program plan (IPP) or individualized family service plan (IFSP), the prohibition in subdivision (a) shall take effect on August 1, 2009.
(c)An exemption may be granted on an individual basis in extraordinary circumstances to permit purchase of a service identified in subdivision (a) when the regional center determines that the service is a primary or critical means for ameliorating the physical, cognitive, or psychosocial effects of the consumers developmental disability, or the service is necessary to enable the consumer to remain in his or her home and no alternative service is available to meet the consumers needs.
(d)At the time of development, scheduled review, or modification of a consumers individual program plan or individualized family service plan, the regional center shall provide, in a non-technical, understandable form and in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a written statement describing the exemption in subdivision (c) and examples of documentation that may be submitted to demonstrate qualification for the exemption.
SEC. 5.Section 4648.55 of the Welfare and Institutions Code is amended to read:4648.55.(a)A regional center shall not purchase day program, vocational education, work services, independent living program, or mobility training and related transportation services for a consumer who is 18 to 22 years of age, inclusive, if that consumer is eligible for special education and related education services and has not received a diploma or certificate of completion, unless the individual program plan (IPP) planning team determines that the consumers needs cannot be met in the educational system or grants an exemption pursuant to subdivision (d). If the planning team determines that generic services can meet the consumers day, vocational education, work services, independent living, or mobility training and related transportation needs, the regional center shall assist the consumer in accessing those services. To ensure that consumers receive appropriate educational services and an effective transition from services provided by educational agencies to services provided by regional centers, the regional center service coordinator, at the request of the consumer or, where appropriate, the consumers parent, legal guardian, or conservator, may attend the individualized education program (IEP) planning team meeting.
(b)For consumers who are 18 to 22 years of age, inclusive, who have left the public school system, and who are receiving regional center purchased services identified in subdivision (a) on or before the effective date of this section, a determination shall be made through the IPP as to whether the return to the educational system can be achieved while meeting the consumers needs. If the planning team determines that the consumers needs cannot be met in the educational system, the regional center may continue to purchase the services identified in subdivision (a). If the planning team determines that generic services can meet the consumers day, vocational education, work services, independent living, or mobility training and related transportation needs, the regional center shall assist the consumer in accessing those services.
(c)For consumers who are 18 to 22 years of age, inclusive, who have left school prior to enactment of this section, but who are not receiving any of the regional center purchased services identified in subdivision (a), the regional center shall use generic education services to meet the consumers day, vocational education, work services, independent living, or mobility training and related transportation needs if those needs are subsequently identified in the IPP unless the consumer is eligible for an exemption as set forth in subdivision (d). If the planning team determines that generic services can meet the consumers day, vocational education, work services, independent living, or mobility training and related transportation needs, the regional center shall assist the consumer in accessing those services.
(d)(1)An exemption to the provisions of this section may be granted on an individual basis in extraordinary circumstances to permit purchase of a service identified in subdivision (a). An exemption shall be granted through the IPP process and shall be based on a determination that the generic service is not appropriate to meet the consumers need. The consumer shall be informed of the exemption and the process for obtaining an exemption.
(2)At the time of development, scheduled review, or modification of a consumers individual program plan, the regional center shall provide, in a non-technical, understandable form and in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a written statement describing the exemption in paragraph (1) and examples of documentation that may be submitted to demonstrate qualification for the exemption.
(3)The IPP planning team shall consider the standard set forth in Section 4688.05 when determining whether the consumer qualifies for an exemption under this subdivision for the purpose of meeting his or her independent living needs.
(e)A school district may contract with regional center vendors to meet the needs of consumers pursuant to this section.
SEC. 6.Section 4659 of the Welfare and Institutions Code is amended to read:4659.(a)Except as otherwise provided in subdivision (b) or (e), the regional center shall identify and pursue all possible sources of funding for consumers receiving regional center services. These sources shall include, but not be limited to, both of the following:
(1)Governmental or other entities or programs required to provide or pay the cost of providing services, including Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, school districts, and federal supplemental security income and the state supplementary program.
(2)Private entities, to the maximum extent they are liable for the cost of services, aid, insurance, or medical assistance to the consumer.
(b)Any revenues collected by a regional center pursuant to this section shall be applied against the cost of services prior to use of regional center funds for those services. This revenue shall not result in a reduction in the regional centers purchase of services budget, except as it relates to federal supplemental security income and the state supplementary program.
(c)Effective July 1, 2009, notwithstanding any other law or regulation, regional centers shall not purchase any service that would otherwise be available from Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, In-Home Support Services, California Childrens Services, private insurance, or a health care service plan when a consumer or a family meets the criteria of this coverage but chooses not to pursue that coverage. If, on July 1, 2009, a regional center is purchasing that service as part of a consumers individual program plan (IPP), the prohibition shall take effect on October 1, 2009.
(d)(1)Effective July 1, 2009, notwithstanding any other law or regulation, a regional center shall not purchase medical or dental services for a consumer three years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center determines that an appeal by the consumer or family of the denial does not have merit. If, on July 1, 2009, a regional center is purchasing the service as part of a consumers IPP, this provision shall take effect on August 1, 2009. At the time of development, scheduled review, or modification of a consumers individual program plan or individualized family service plan, the regional center shall provide, in a non-technical, understandable form and in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a written statement describing the documentation required pursuant to this paragraph. Regional centers may shall pay for medical or dental services during the following periods:
(A)While coverage is being pursued, but before a denial is made.
(B)Pending a final administrative decision on the administrative appeal if the family has provided to the regional center a verification that an administrative appeal is being pursued.
(C)Until the commencement of services by Medi-Cal, private insurance, or a health care service plan.
(2)When necessary, the consumer or family may receive assistance from the regional center, the Clients Rights Advocate funded by the department, or the state council in pursuing these appeals.
(e)This section shall not impose any additional liability on the parents of children with developmental disabilities, or to restrict eligibility for, or deny services to, any individual who qualifies for regional center services but is unable to pay.
(f)In order to best utilize generic resources, federally funded programs, and private insurance programs for individuals with developmental disabilities, the department and regional centers shall engage in the following activities:
(1)Within existing resources, the department shall provide training to regional centers, no less than once every two years, in the availability and requirements of generic, federally funded and private programs available to persons with developmental disabilities, including, but not limited to, eligibility requirements, the application process and covered services, and the appeal process.
(2)Regional centers shall disseminate information and training to all service coordinators regarding the availability and requirements of generic, federally funded, and private insurance programs on the local level.
SEC. 7.Section 4686.2 of the Welfare and Institutions Code is amended to read:4686.2.(a)Effective July 1, 2009, notwithstanding any other provision of law or regulation to the contrary, any vendor who provides applied behavioral analysis (ABA) services, or intensive behavioral intervention services or both, as defined in subdivision (d), shall:
(1)Conduct a behavioral assessment of each consumer to whom the vendor provides these services.
(2)Design an intervention plan that shall include the service type, number of hours and parent participation needed to achieve the consumers goals and objectives, as set forth in the consumers individual program plan (IPP) or individualized family service plan (IFSP). The intervention plan shall also set forth the frequency at which the consumers progress shall be evaluated and reported.
(3)Provide a copy of the intervention plan to the regional center for review and consideration by the planning team members.
(b)Effective July 1, 2009, notwithstanding any other provision of law or regulation to the contrary, regional centers shall:
(1)Only purchase ABA services or intensive behavioral intervention services that reflect evidence-based practices, promote positive social behaviors, and ameliorate behaviors that interfere with learning and social interactions.
(2)(A)Only purchase ABA or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers, given the critical nature of parent participation to the success of the intervention plan.
(B)In determining the extent of parent participation required for the provision of ABA or intensive behavioral intervention services, the IPP or IFSP planning team shall consider any relevant hardships suffered by a parent or parents that may constitute a barrier to the consumer accessing those services, including, but not limited to, availability of group instruction courses, conflicts with employment, vocational training, or educational demands, financial hardship, or lack of transportation or child or other family member care, and language barriers. Any hardships shall be documented in the IPP or IFSP and reviewed annually to determine if there has been a change in circumstances. If the regional center determines that the extent of parent participation should be adjusted due to a change in circumstances, the regional center shall provide adequate notice pursuant to subdivision (a) of Section 4710.
(C)At the time of development, scheduled review, or modification of a consumers IPP or IFSP, the regional center shall provide, in a non-technical, understandable form and in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a written statement describing the process for determining the extent of parent participation pursuant to this paragraph and examples of documentation that may be submitted to demonstrate hardships.
(3)Not purchase either ABA or intensive behavioral intervention services for purposes of providing respite, day care, or school services.
(4)Discontinue purchasing ABA or intensive behavioral intervention services for a consumer when the consumers treatment goals and objectives, as described under subdivision (a), are achieved. ABA or intensive behavioral intervention services shall not be discontinued until the goals and objectives are reviewed and updated as required in paragraph (5) and shall be discontinued only if those updated treatment goals and objectives do not require ABA or intensive behavioral intervention services.
(5)For each consumer, evaluate the vendors intervention plan and number of service hours for ABA or intensive behavioral intervention no less than every six months, consistent with evidence-based practices. If necessary, the intervention plans treatment goals and objectives shall be updated and revised.
(6)Not reimburse a parent for participating in a behavioral services treatment program.
(c)For consumers receiving ABA or behavioral intervention services on July 1, 2009, as part of their IPP or IFSP, subdivision (b) shall apply on August 1, 2009.
(d)For purposes of this section the following definitions shall apply:
(1)Applied behavioral analysis means the design, implementation, and evaluation of systematic instructional and environmental modifications to promote positive social behaviors and reduce or ameliorate behaviors which interfere with learning and social interaction.
(2)Intensive behavioral intervention means any form of applied behavioral analysis that is comprehensive, designed to address all domains of functioning, and provided in multiple settings for no more than 40 hours per week, across all settings, depending on the individuals needs and progress. Interventions can be delivered in a one-to-one ratio or small group format, as appropriate.
(3)Evidence-based practice means a decisionmaking process that integrates the best available scientifically rigorous research, clinical expertise, and individuals characteristics. Evidence-based practice is an approach to treatment rather than a specific treatment. Evidence-based practice promotes the collection, interpretation, integration, and continuous evaluation of valid, important, and applicable individual- or family-reported, clinically-observed, and research-supported evidence. The best available evidence, matched to consumer circumstances and preferences, is applied to ensure the quality of clinical judgments and facilitates the most cost-effective care.
(4)Parent participation shall include, but shall not be limited to, the following meanings:
(A)Completion of group instruction on the basics of behavior intervention.
(B)Implementation of intervention strategies, according to the intervention plan.
(C)If needed, collection of data on behavioral strategies and submission of that data to the provider for incorporation into progress reports.
(D)Participation in any needed clinical meetings.
(E)Purchase of suggested behavior modification materials or community involvement if a reward system is used.
SEC. 8.Section 4686.5 of the Welfare and Institutions Code is amended to read:4686.5.(a)Effective July 1, 2009, notwithstanding any other provision of law or regulation to the contrary, all of the following shall apply:
(1)A regional center may only purchase respite services when the care and supervision needs of a consumer exceed that of an individual of the same age without developmental disabilities.
(2)A regional center shall not purchase more than 21 days of out-of-home respite services in a fiscal year nor more than 90 hours of in-home respite services in a quarter, for a consumer.
(3)(A)A regional center may grant an exemption to the requirements set forth in paragraphs (1) and (2) if it is demonstrated that the intensity of the consumers care and supervision needs are such that additional respite is necessary to maintain the consumer in the family home, or there is an extraordinary event that impacts the family members ability to meet the care and supervision needs of the consumer.
(B)At the time of development, scheduled review, or modification of a consumers individual program plan or individualized family service plan, the regional center shall provide, in a non-technical, understandable form and in the native language of the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a written statement describing the exemption in subparagraph (A) and examples of documentation that may be submitted to demonstrate qualification for the exemption.
(B)
(C)For purposes of this section, family member means an individual who:
(i)Has a consumer residing with him or her.
(ii)Is responsible for the 24-hour care and supervision of the consumer.
(iii)Is not a licensed or certified residential care facility or foster family home receiving funds from any public agency or regional center for the care and supervision provided. Notwithstanding this provision, a relative who receives foster care funds shall not be precluded from receiving respite.
(4)A regional center shall not purchase day care services to replace or supplant respite services. For purposes of this section, day care is defined as regularly provided care, protection, and supervision of a consumer living in the home of his or her parents, for periods of less than 24 hours per day, while the parents are engaged in employment outside of the home or educational activities leading to employment, or both.
(5)A regional center shall only consider in-home supportive services a generic resource when the approved in-home supportive services meets the respite need as identified in the consumers individual program plan (IPP) or individualized family service plan (IFSP).
(b)For consumers receiving respite services on July 1, 2009, as part of their IPP or IFSP, subdivision (a) shall apply on August 1, 2009.
(c)This section shall remain in effect until implementation of the individual choice budget pursuant to Section 4648.6 and certification by the Director of the Department of Developmental Services that the individual choice budget has been implemented and will result in state budget savings sufficient to offset the costs associated with the repeal of this section. This section shall be repealed on the date of certification.
SECTION 1.It is the intent of the Legislature to enact legislation to require regional centers to provide nontechnical, understandable information in a consumers native language regarding the complex process of obtaining certain regional center services.
It is the intent of the Legislature to enact legislation to require regional centers to provide nontechnical, understandable information in a consumers native language regarding the complex process of obtaining certain regional center services.
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Date
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Status
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|---|---|
| May 27, 2016 | Read second time and amended. Ordered returned to second reading. |
| Aug 22, 2016 | Ordered to inactive file at the request of Senator Galgiani. |
| Aug 16, 2016 | Read second time and amended. Ordered to third reading. |
| Aug 15, 2016 | From committee: Amend, and do pass as amended. (Ayes 5. Noes 2.) (August 11). |
| Aug 1, 2016 | In committee: Referred to APPR. suspense file. |
| Jun 20, 2016 | Read second time and amended. Re-referred to Com. on APPR. |
| Jun 16, 2016 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 4. Noes 0.) (June 14). |
| Jun 9, 2016 | Referred to Coms. on HUMAN S. and APPR. |
| Jun 2, 2016 | In Senate. Read first time. To Com. on RLS. for assignment. |
| Jun 1, 2016 | Read third time. Passed. Ordered to the Senate. (Ayes 74. Noes 1.) |
| Jun 1, 2016 | Read third time. Passed. Ordered to the Senate. (Ayes 74. Noes 1. Page 5108.) |
| Jun 1, 2016 | Read third time. Passed. Ordered to the Senate. |
| May 31, 2016 | Read second time. Ordered to third reading. |
| Feb 19, 2016 | Introduced. To print. |
| May 27, 2016 | From committee: Amend, and do pass as amended. (Ayes 19. Noes 0.) (May 27). |
| May 18, 2016 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| May 5, 2016 | Re-referred to Com. on APPR. |
| May 4, 2016 | Read second time and amended. |
| May 3, 2016 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 6. Noes 0.) (April 26). |
| Apr 12, 2016 | In committee: Hearing postponed by committee. |
| Mar 28, 2016 | Re-referred to Com. on HUM. S. |
| Mar 18, 2016 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HUM. S. Read second time and amended. |
| Mar 17, 2016 | Referred to Com. on HUM. S. |
| Feb 22, 2016 | Read first time. |
| Feb 21, 2016 | From printer. May be heard in committee March 22. |
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Date
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Description
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Location
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Votes
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|---|---|---|---|---|
| Aug 11, 2016 | Do pass as amended | Senate Standing Committee on Appropriations |
Passed |
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| Aug 1, 2016 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
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| Jun 14, 2016 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Human Services |
Passed |
|
| Jun 1, 2016 | AB 2809 RODRIGUEZ Assembly Third Reading | Assembly Floor |
Passed |
|
| May 27, 2016 | Do pass as amended. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 26, 2016 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Human Services |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
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Organization
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Position
|
Date
|
|---|---|---|
| Association Of Regional Center Agencies | * Against | Apr 26, 2016 |
| California Disability Rights | * Support | Apr 26, 2016 |
| Center For Autism And Related Disorders (Card); The | * Support | Apr 26, 2016 |
| Crystal Stairs, Inc. | ** Support | Apr 26, 2016 |
| Disability Rights California | * Support | Apr 26, 2016 |
| Public Counsel - co-sponsor | ** Support | Apr 26, 2016 |
| Special Needs Network - co sponsor | ** Support | Apr 26, 2016 |
| Special Needs Network, Inc. | * Support | Apr 26, 2016 |
| State Council on Developmental Disabilities | ** Support | Apr 26, 2016 |
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 2809
:
SENATE HUMAN SERVICES COMMITTEE: 4-0, 6/14/16
AYES: McGuire, Hancock, Liu, Nguyen
NO VOTE RECORDED: Berryhill
SENATE APPROPRIATIONS COMMITTEE: 5-2, 8/11/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Bates, Nielsen
ASSEMBLY FLOOR: 74-1, 6/1/16 - See last page for vote
Special Needs Network
DIGEST: This bill requires regional centers to provide documents about the appeal and complaint process in threshold languages of a consumer and the consumer’s family, as specified. It also requires that a consumer’s annual summary of services be provided in the threshold language of the consumer, upon request.
Existing law:
- Establishes the Lanterman Developmental Disabilities Services Act, which declares California’s responsibility for providing an array of services and supports to meet the needs of each person with developmental disabilities in the least restrictive environment, regardless of age or degree of disability. (WIC 4500, et seq.)
- Establishes a system of nonprofit regional centers to provide fixed points of contact in the community for all persons with developmental disabilities and their families, to coordinate services and supports best suited to them through their lifetime. (WIC 4620)
- Establishes an Individual Program Plan (IPP) 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)
- Identifies required components of and timelines for the IPP, and identifies the participants who may help to create the IPP. Additionally, establishes the planning process for creating the IPP or Individualized Family Service Plan (IFSP) to include gathering information, conducting assessments, defining goals, identifying appropriate services, and other components. (WIC 4646, WIC 4646.5)
- Requires a regional center to communicate in the consumer’s native language, or, when appropriate, the native language of his or her family, legal guardian, conservator, or authorized representative, during the IPP planning process, including the program plan meeting, including providing alternative communication services. (WIC 4646 (h))
- Requires a regional center to document in a consumer’s IPP the native language of the consumer, or family, as specified, and to provide a copy of the IPP in the native language of the consumer or representative, as specified. (WIC 4646 (h))
- Requires a regional center to ensure, at the time of development, scheduled review, or modification of a consumer’s IPP or IFSP, the establishment of an internal process to adhere to federal and state law and regulation, as specified. Requires regional centers to provide the consumer and representatives, as specified, 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. (WIC 4646.4, WIC 4648 (h))
- Requires regional centers and the Department of Developmental Services (DDS) to annually compile and post data about purchase of service authorization, use, and expenditure by each regional center, including the languages spoken by consumers and the number of instances when a written copy of the IPP was provided in a language other than a threshold language. (WIC 4519.5)
- Defines in regulation a threshold language to mean one that has been identified as the primary language indicated on the Medi-Cal Eligibility Data system (MEDS). (CCR Title 9 1810.410 (a)(3))
- Requires that at the beginning of each IPP meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative information about the appeal and complaint process in threshold languages, as defined and appropriate.
- Requires that the annual statement of services and supports provided to the consumer be made available in threshold languages, as defined and as appropriate, to the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both.
- Specifies that these requirements are in addition to, and independent of, any other rights, remedies, or procedures under any other law and shall not be construed to alter, limit, or negate any other rights, remedies, or procedures provided for by law.
Background
Responsibility for approximately 295,000 consumers in California’s Developmental Services system is shared between DDS, which provides oversight and funding, and the state’s 21 regional centers, which assess clients’ needs and coordinate services locally. The Lanterman Developmental Disabilities Services Act established an entitlement to services and supports for Californians with developmental disabilities who are living in their communities. A developmental disability is one that originates before the age of 18, continues, or can be expected to continue, indefinitely, and constitutes a substantial disability.
Approximately 960 consumers live in three large Developmental Centers and one smaller state-run facility. The rest live in various community living arrangements. About 77 percent of all consumers and 97 percent of child consumers live in the home of a parent or guardian or in their own home. Services for consumers are determined through an IPP.
Access to services
The Senate Select Committee on Autism and Related Disorders held an informational hearing in 2012, to discuss questions surrounding equal access to regional center services for consumers with autism spectrum disorders (ASD). The hearing was prompted by a series of articles in the Los Angeles Times, which explored the differences that families of children with autism had in accessing services. The series concluded that people of color, low income families, and those living in socio-economically disadvantaged communities receive fewer services. Often, the articles found, parents whose children receive services are wealthier, more sophisticated in navigating bureaucratic systems, and fluent in English. In contrast, parents who work multiple jobs, single parents, immigrants, those who can’t speak English, and those with multiple children receive fewer services.
In response, a 20-member Taskforce on Equity and Diversity for Regional Center Autism Services was appointed by then-Senate President pro Tempore Darrell Steinberg. The group was charged with finding recommendations to ensure that consumers of regional center services receive appropriate and timely supports regardless of race, ethnicity, educational background and other socio-economic factors. A 119-page report, “A Preliminary Report by the Taskforce on Equity and Diversity for Regional Center Autism Services,” was published on March 18, 2013, and identified 19 recommendations, including the translation of key documents into a consumer’s or their family’s native language. Various pieces of legislation since then have attempted to implement key portions of the report, and regional centers are now posting annual information about caseload, including consumer languages spoken.
Language access
DDS states on its Web site that it strives to reduce and/or eliminate any language barriers for persons who are non-English speaking or who have limited English proficiency. The department’s policy is to provide verbal interpretation and translation of written materials related to the DDS service delivery system in the languages that meet a five percent threshold of the persons served, as well as many of other non-threshold languages as possible by utilizing certified bi-lingual DDS staff or contracted services.
According to a 2014 report which analyzed California’s Medi-Cal data, about 40 percent of Medi-Cal recipients, or more than 3.5 million people, reported having a language other than English as their primary language. The report additionally noted that there were 13 distinct languages that qualified statewide as threshold languages, and that Spanish was the most frequently occurring threshold language, with more than one-third of all Medi-Cal eligible Californians identifying Spanish as their primary language. Los Angeles had the greatest number of threshold languages of any single county, with 12. In addition to Spanish, threshold languages in California are Vietnamese, Cantonese, Armenian, Russian, Mandarin, Tagalog, Korean, Arabic, Hmong, Farsi, Cambodian, and other Chinese languages.
2nd Extraordinary Session of 2015-2016. The issue of access to regional center services has continued to be raised in the Legislature. The 2nd Extraordinary session package, passed this spring, included $11 million to address disparities. (ABX2-1, Thurmond, Chapter 3, Statutes of 2015-16 Second Extraordinary Session) Funding was targeted at creating pay differentials supporting bilingual service coordinators at regional centers when fluency in the second language helps to address the language needs of the regional center’s catchment area. The bill also funds implementation of recommendations and plans to help reduce disparities in the purchase-of-service expenditures and to encourage the development and expansion of culturally and linguistically appropriate services.
Related/Prior Legislation
SB 1034 (Mitchell, 2016), among other things, prohibits lack of parent or caregiver participation from being used to deny or reduce medically necessary behavioral health treatment, as specified.
ABX2-1 (Thurmond, Chapter 3, Statutes of 2015-16 Second Extraordinary Session) implemented targeted rate increases for the community-based developmental services system.
SB 82 (Committee on Budget and Fiscal Review, Chapter 23, Statutes of 2015) required each regional center to offer, and upon request provide, a written copy of the IPP to the consumer and family members, when appropriate, in a threshold language.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Senate Appropriations Committee, this bill will result in minor one-time costs for regional centers to translate information on the existing appeals and complaints process into the state’s threshold languages and ongoing costs of $25,000 per year for regional centers to provide information on the complaints and appeals process in threshold languages when a new IPP is adopted (General Fund and federal funds). Additionally, the analysis identified ongoing costs of about $775,000 for regional centers to provide the annual statement of services purchased on a consumer’s behalf in the threshold languages, upon request of a consumer or guardian (General Fund and federal funds). According to the DDS, about 25,000 consumers have one of the threshold languages as their primary language. The cost estimate above assumes that 25 percent of those consumers would request the statement to be provided in the threshold language.
Public Counsel (co-source)
Special Needs Network (co-source)
OPPOSITION: (Verified 8/15/16)
Association of Regional Center Agencies
California Department of Developmental Services
California Department of Finance
ARGUMENTS IN SUPPORT: Public Counsel, a co-sponsor of this bill, writes in support that AB 2809 encourages equal access of regional center services while supporting client self-advocacy, and “we must take bold steps to help underserved families access vital services. AB 2809 helps address these concerns.”
ARGUMENTS IN OPPOSITION: The Department of Finance (DOF) writes in opposition to this bill that it is opposed because it will result in General Fund costs that are not absorbable within the department’s existing resources. Furthermore, DOF states that the $11 million appropriated through the 2nd Extraordinary Session will address disparities in regional centers.
ASSEMBLY FLOOR: 74-1, 6/1/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, O'Donnell, Olsen, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon
NOES: Harper
NO VOTE RECORDED: Bigelow, Beth Gaines, Hadley, Obernolte, Patterson
8/16/16 17:52:53
SENATE COMMITTEE ON
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 2809 (Rodriguez) - Developmental services: regional centers
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on August 11, 2016
Bill Summary:
AB 2809 would require regional centers to provide certain information to consumers or their families in “threshold languages”. The bill would prohibit regional centers from denying behavioral services for a consumer if the consumer’s parent or caregiver does not complete a group instruction course.
Fiscal Impact:
- Minor one-time costs for regional centers to translate information on the existing appeals and complaints process into the state’s threshold languages (General Fund).
- Ongoing costs of $25,000 per year for regional centers to provide information on the complaints and appeals process in threshold languages when a new individualized program plan is adopted (usually annually) (General Fund and federal funds).
- Ongoing costs of about $775,000 for regional centers to provide the annual statement of services purchased on a consumer’s behalf in the threshold languages, upon request of a consumer or guardian (General Fund and federal funds). According to the Department, about 25,000 consumers have one of the threshold languages as their primary language. The cost estimate above assumes that 25% of those consumers would request the statement to be provided in the threshold language.
Committee Amendments:
Delete the changes to the existing parent participation requirement.
-- END --
SENATE COMMITTEE ON
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 2809 (Rodriguez) - Developmental services: regional centers
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
AB 2809 would require regional centers to provide certain information to consumers or their families in “threshold languages”. The bill would prohibit regional centers from denying behavioral services for a consumer if the consumer’s parent or caregiver does not complete a group instruction course.
Fiscal Impact:
- Minor one-time costs for regional centers to translate information on the existing appeals and complaints process into the state’s threshold languages (General Fund).
- Ongoing costs of $25,000 per year for regional centers to provide information on the complaints and appeals process in threshold languages when a new individualized program plan is adopted (usually annually) (General Fund and federal funds).
- Ongoing costs of about $775,000 for regional centers to provide the annual statement of services purchased on a consumer’s behalf in the threshold languages, upon request of a consumer or guardian (General Fund and federal funds). According to the Department, about 25,000 consumers have one of the threshold languages as their primary language. The cost estimate above assumes that 25% of those consumers would request the statement to be provided in the threshold language.
- Unknown increase in the utilization of behavioral services, potentially in the low millions per year (General Fund and federal funds). The bill would prohibit regional centers from denying behavioral services if a consumer’s parent or guardian did not complete a required group instruction course, if a hardship is demonstrated. To the extent that behavioral services are currently being denied due to noncompliance with this requirement (or families are not requesting behavioral services because they cannot comply with the requirement) there would be some amount of increased utilization of services. Because the regional centers do not track denials of service due to this requirement, it is impossible to determine the impact of this change. The state spends about $300 million per year in General Fund on behavioral health services, so even a minor increase in utilization would have costs in the low millions per year.
Background:
The Department of Developmental Services is responsible for coordinating care and services for about 250,000 people with developmental disabilities. The vast majority of these people are served by 21 regional centers, which are non-profit entities that contract with the state. The regional centers, in turn, contract with a variety of vendors to provide direct services to the developmentally disabled.
In the regional center system, infants or toddlers under three years of age are required to have an individualized family service plan which is used to direct services and supports for the child and its family. Regional center consumers over three years of age are required to have an individual program plan that directs the services and supports that will be provided to meet the consumer’s needs. Both individualized family service plans and individual program plans are developed by the regional center staff for individual consumers to meet the consumer’s specific needs for services.
Under current law, the state designates “threshold languages” based on the number of native speakers of those languages in a county. Public programs and private entities (such as health insurers) are required to provide certain documents to participants in the appropriate threshold language. There are 13 threshold languages in the state.
The 2012-13 developmental services trailer bill (AB 1472, Chapter 25 of 2012) requires the Department and the regional centers to collect and analyze data on the utilization of services by consumers with respect to age, race, language spoken, and disability.
Under current law (adopted as part of the 2009 Budget Act), regional centers shall only purchase behavioral services when the consumer’s parent or parents participate in the intervention plan, including a requirement that the parent or parents complete a group instruction on the basics of behavior intervention and meet other requirements for participation.
Proposed Law:
AB 2809 would require regional centers to provide certain information to consumers or their families in “threshold languages”. The bill prohibit regional centers from denying behavioral services for a consumer if the consumer’s parent or caregiver does not complete a group instruction course.
Specific provisions of the bill would:
- Require a regional center to provide consumers and/or their parent or legal guardian with information on the appeal and complaint process in the appropriate threshold language at each individual program plan meeting (typically every year);
- Upon request of a consumer or legal guardian, require a regional center to provide the annual statement of services purchased in the appropriate threshold language;
- Prohibit a parent or caregiver’s noncompletion of group instruction on behavior intervention from being used to deny coverage for a consumer’s behavioral services, if a hardship is demonstrated;
- Require the hardship to be reviewed every six months.
Related Legislation:
SB 1034 (Mitchell) would eliminate the existing sunset on the health benefit mandate to cover behavioral health treatment and would prohibit a lack of parental participation from being used by health plans or health insurers to deny coverage for behavioral treatment. That bill is pending in the Assembly.
-- END --
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: AB 2809
Author: | Rodriguez | ||
Version: | May 27, 2016 | Hearing Date: | June 14, 2016 |
Urgency: | No | Fiscal: | No |
Consultant: | Mareva Brown | ||
Subject: Developmental services: regional centers
SUMMARY
This bill would require regional centers to provide various documents in threshold languages of a consumer and the consumer’s family, as specified, including documents related to the Individual Program Plan or Individual Family Service Plan. It also requires a regional center to consider any barriers to a parent participating in intensive behavioral supports and to document those barriers every six months and adjust requirements, as specified.
ABSTRACT
Existing law:
- Establishes the Lanterman Developmental Disabilities Services Act, which declares California’s responsibility for providing an array of services and supports to meet the needs of each person with developmental disabilities in the least restrictive environment, regardless of age or degree of disability. (WIC 4500, et seq.)
- Establishes a system of nonprofit regional centers to provide fixed points of contact in the community for all persons with developmental disabilities and their families, to coordinate services and supports best suited to them through their lifetime. (WIC 4620)
- Establishes an Individual Program Plan (IPP) 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)
- Identifies required components of and timelines for, the IPP, and identifies the participants who may help to create the IPP. Additionally, establishes the planning process for creating the IPP or Individualized Family Service Plan (IFSP) to include gathering information, conducting assessments, defining goals, identifying appropriate services, and other components. (WIC 4646, WIC 4646.5)
- Requires a regional center to communicate in the consumer’s native language, or, when appropriate, the native language of his or her family, legal guardian, conservator, or authorized representative, during the IPP planning process, including the program plan meeting, including providing alternative communication services. (WIC 4646 (h))
- Requires a regional center to document in a consumer’s IPP the native language of the consumer, or family, as specified, and to provide a copy of the IPP in the native language of the consumer or representative, as specified. (WIC 4646 (h))
- Requires a regional center to ensure, at the time of development, scheduled review, or modification of a consumer’s IPP or IFSP, the establishment of an internal process to adhere to federal and state law and regulation, as specified. Requires regional centers to provide the consumer and representatives, as specified, 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. (WIC 4646.4, WIC 4648 (h))
- Requires regional centers and DDS to annually compile and post data about purchase of service authorization, use, and expenditure by each regional center, including the languages spoken by consumers and the number of instances when a written copy of the IPP was provided in a language other than a threshold language. (WIC 4519.5)
- Defines in regulation a threshold language to mean one that has been identified as the primary language indicated on the Medi-Cal Eligibility Data system (MEDS) (CCR Title 9 1810.410 (a)(3))
- Requires any vendor who provides applied behavioral analysis (ABA) services, or intensive behavioral intervention services, as specified, to conduct a behavioral assessment of each consumer to whom the vendor provides these services and to design an intervention plan that includes the number of hours, and parent participation needed to achieve the consumer’s goals and objectives, as defined. (WIC 4682.2)
- Mandates that a regional center may only purchase ABA or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers, given the critical nature of parent participation to the success of the intervention plan. (WIC 4686.2 (b))
This bill:
- Requires that at the time of development, scheduled review, or modification of a consumer’s IPP or IFSP, the regional center must make available notices to the consumer, or his or her parents, legal guardian, conservator, or authorized representative, or both. Requires the notices, about specific exemptions to prohibited services, be provided in a nontechnical, understandable form and in threshold languages in a document describing all of the following and the process for obtaining each exception or exemption:
- Transportation services for a minor child living in the family residence.
- Exemption to the prohibition on purchasing services that were suspended in 2009, such as camping, social recreation and nonmedical activities.
- Exemption to the prohibition on purchasing non-educationally based services for consumers aged 18 to 22, including day program, vocational education, work services, independent living program, as specified.
- Exemptions to the limitations to purchase respite services.
- Requires that at the beginning of each IPP meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative information about the appeal and complaint process in threshold languages, as defined and appropriate.
- Requires that the annual statement of services and supports provided to the consumer be made available in threshold languages, as defined and as appropriate, to the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both.
- Requires that, in determining the extent of parent participation required for the provision of ABA or intensive behavioral intervention services, the IPP or IFSP planning team shall consider any relevant hardships suffered by a parent or parents that may constitute a barrier to the consumer accessing those services, including, but not limited to, availability of group instruction courses, conflicts with employment, vocational training, or educational demands, financial hardship, or lack of transportation or child or other family member care, and language barriers.
- Requires that any hardships shall be documented in the IPP or IFSP and reviewed every six months to determine if there has been a change in circumstances. If the regional center determines that the extent of parent participation should be adjusted due to a change in circumstances, the regional center shall provide adequate notice, as specified.
FISCAL IMPACT
This bill has been keyed non-fiscal by Legislative Counsel. However, an analysis by the Assembly Committee on Appropriations identified one-time costs to Regional Centers to translate the statement of services for FY 2016-17 (6 mos) of approximately $1.5 million ($1 million GF). In 2017-18 and ongoing, the cost would be $3 million ($2 million GF) plus an average growth rate of individuals with a primary language other than English of 4.63%. Additionally, the committee identified one-time costs to DDS of approximately $14,000 (GF) to translate information about the appeal and complaint process, and exceptions and exemptions, into California's 13 non-English threshold languages. Translation cost for Spanish is approximately $68 per hour and other languages are approximately $90 per hour. Each translation is estimated to take approximately 12 hours.
The Assembly Appropriations Committee analysis additionally noted ongoing costs of approximately $50,000 (GF) annually to provide the above information in threshold languages at IPP and IFSP development, modification, and review meetings. Approximately 500,000 meetings occur annually. This assumes the information can be provided in two pages at $0.05 per page. The analysis also projected unknown costs, but likely in the low millions (GF), associated with the parental participation hardship adjustment. Costs would be expected from the likely decreased effectiveness of behavior intervention with reduced or no parent participation leading to a potential need to continue those services for a longer period of time.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, health disparities for people with developmental disabilities can result in significant health, social, and economic consequences. California's diverse language and ethnic communities account for about 60 percent of its population. In recent years, access to developmental services has been significantly limited due to severe budget cuts, with minority populations particularly adversely affected, the author states.
Consumers and family members who have limited proficiency in English have the right to culturally and linguistically competent information about accessing developmental services available through regional centers, including information on the process for obtaining certain services through statutory exemptions and meeting other affirmative requirements. Additionally, the author states, the level of parent participation required to access intensive behavioral intervention services is often too burdensome to meet for some families who are low-income and/or who have limited proficiency in English and the law should provide for some flexibility in authorizing for these services by accounting for hardship factors.
Background
Responsibility for approximately 295,000 consumers in California’s Developmental Services system is shared between the DDS, which provides oversight and funding, and the state’s 21 regional centers, which assess clients’ needs and coordinate services locally. The Lanterman Developmental Disabilities Services Act established an entitlement to services and supports for Californians with developmental disabilities who are living in their communities. A developmental disability is one that originates before the age of 18, continues, or can be expected to continue, indefinitely, and constitutes a substantial disability.
As of this month, 976 consumers lived in three Developmental Centers, large institutions that once cared for the majority of the state’s consumers, and one smaller state-run facility. The rest live in various community living arrangements. About 77 percent of all consumers and 97 percent of child consumers live in the home of a parent or guardian or in their own home. Services for consumers are determined through an IPP.
In July of 2009, several regional center categories of services were suspended or restricted in response to budget shortfalls related to the economic crisis. These included the suspension of camping and social recreation activities such as equestrian therapy, and limits on access to regional center-funded services while a consumer is between ages 18 and 22, during which time a consumer’s school district is supposed to be finding and providing services. Additionally, there were limits placed on the number of hours that consumers could qualify for respite services.
Access to services
The Senate Select Committee on Autism and Related Disorders held an informational hearing in 2012, to discuss questions surrounding equal access to regional center services for consumers with autism spectrum disorders (ASD). The hearing was prompted by a series of articles in the Los Angeles Times, which explored the differences that families of children with autism had in accessing services. The series concluded that people of color, low income, and those living in socio-economically disadvantaged communities receive comparatively fewer services. Often, the articles found, parents whose children receive services are wealthier, more sophisticated in navigating bureaucratic systems, and fluent in English. In contrast, parents who work multiple jobs, single parents, immigrants, those who can’t speak English, and those who have multiple children are less able to access services.
In response, a 20-member Taskforce on Equity and Diversity for Regional Center Autism Services was appointed by then-Senate President pro Tempore Darrell Steinberg. The group was charged with finding recommendations to ensure that consumers of regional center services receive appropriate and timely supports regardless of race, ethnicity, educational background and other socio-economic factors. A 119-page report, “A Preliminary Report by the Taskforce on Equity and Diversity for Regional Center Autism Services,” was published on March 18, 2013, and identified 19 recommendations, including the translation of key documents into a consumer’s or their family’s native language. Various pieces of legislation since then have attempted to implement key portions of the report, and regional centers are now posting annually information about caseload, including consumer languages spoken. This information is posted by regional center and not aggregated statewide.
Language access
DDS states on its website that it strives to reduce and/or eliminate any language barriers for persons who are non-English speaking or who have limited English proficiency. The department’s policy is to provide verbal interpretation and translation of written materials related to the DDS service delivery system in the languages that meet a 5 percent threshold of the persons served, as well as many of other non-threshold languages as possible by utilizing certified bi-lingual DDS staff or contracted services.
According to a 2014 report which analyzed California’s Medi-Cal data, about 40 percent of Medi-Cal recipients, or more than 3.5 million people, reported having a language other than English as their primary language.[1] The report additionally noted that there were 13 distinct languages that qualified statewide as threshold languages, and that Spanish was the most frequently occurring threshold language, with more than one-third of all Medi-Cal eligible Californians identifying Spanish as their primary language. Los Angeles had the greatest number of threshold languages of any single county, with 12. In addition to Spanish, threshold languages in California include Vietnamese, Cantonese, Armenian, Russian, Mandarin, Tagalog, Korean, Arabic, Hmong, Farsi, Cambodian, and other Chinese languages.
2nd Extraordinary Session of 2015-2016
The issue of access to the regional center system has continued to be raised in the Legislature. The 2nd Extraordinary session package, passed this spring, included $11 million to address disparities. (AB 2X1, Thurmond, Chapter 3, Statutes of 2016) Funding was targeted at creating pay differentials supporting bilingual service coordinators at regional centers when fluency in the second language helps to address the language needs of the regional center’s catchment area. The bill also funds implementation of recommendations and plans to help reduce disparities in the purchase-of-service expenditures and to encourage the development and expansion of culturally and linguistically appropriate services.
Applied Behavioral Analysis
Applied Behavioral Analysis (ABA) is a scientifically validated approach to understanding behavior and how it is affected by the environment. It has been used effectively in addressing Autism Spectrum Disorder. ABA is often used with younger children, particularly with those younger than age 4, and provides up to 40-hours per week of intensive teaching of life skills, social interactions and communication, along with positive reinforcements for appropriate behaviors. In particular, ABA techniques can help individuals with Autism or other disorders master basic skills such as looking, listening and imitating, as well as complex skills such as reading, conversing and understanding another person’s perspective.
Researchers have reported that many children with autism experience significant improvements in learning, reasoning, communication and adaptability when they participate in high-quality ABA programs.[2]&[3] Some preschoolers who participate in early intensive ABA for two or more years acquire sufficient skills to participate in regular classrooms with little or no additional support. One of the hallmarks of an ABA program is the need to maintain the active teaching and reinforcements 24 hours a day, which requires parents to participate in the ABA to ensure consistency.
Amid the fiscal crisis of 2009, statute was added that allowed regional centers to only purchase ABA or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers, given the critical nature of parent participation to the success of the intervention plan. A part of that requirement has been interpreted to be a mandate that parents must take a group orientation class on ABA prior to services being approved, according to the bill’s sponsor. The sponsor said this requirement can be difficult for families, especially single, working parents, who must take a series of orientation classes prior to ABA being authorized for their child.
Related legislation:
SB 1034 (Mitchell, 2016) among other things, would prohibit lack of parent or caregiver participation from being used to deny or reduce medically necessary behavioral health treatment, as specified. This bill is in the Assembly.
ABX2 1 (Thurmond, Chapter 3, Statutes of 2016) implemented targeted rate increases for the community-based developmental services system.
SB 82 (Committee on Budget and Fiscal Review, Chapter 23, Statutes of 2015) required each regional center to offer, and upon request provide, a written copy of the IPP to the consumer and family members, when appropriate, in a threshold language.
SB 555 (Correa, Chapter 685, Statutes of 2013) placed various requirements on regional centers to communicate and provide certain written materials in a consumer’s and/or family’s or other designated individual’s native language, as specified.
AB 9 X4 (Evans, Chapter 9, Statutes of 2009) enacted modifications to the 2009 Budget Act, including, but not limited to, suspending and limiting certain services for regional center consumers.
COMMENTS
This bill is opposed by both the Department of Developmental Services and the Association of Regional Center Agencies (ARCA). DDS writes “Current law and ABX2 1 provide flexibility for regional centers to work with local communities in developing strategies to address disparities. In contrast to current law and the newly enacted legislation, AB 2809 would take a prescriptive approach and would not allow local communities to determine the best use of limited resources to respond to local and regional needs.” The opposition letter additionally notes that while some of the information that this bill requires could be useful to some consumers, is “is not established” that information is not otherwise being effectively communicated. ARCA writes in opposition that “Ultimately, the goal of behavioral services is to help individuals to become more functional in natural settings. Relaxing parental participation requirements without developing an alternative plan to help children transfer their new skills to other settings is counterproductive.”
In order to address these and other concerns, the author offers and staff recommends the following amendments:
- Strike Section 1 of the bill.
- Amend Section 2 as follows to clarify that individuals who speak non-threshold languages retain the right to translation services:
WIC 4646.5. (a)(6) At the beginning of each individual program plan meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative information about the appeal and complaint process in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate. The provision of this section is in addition to and independent of any other rights, remedies or procedures under any other law. Nothing in this section shall be construed to alter, limit or negate any other rights, remedies or procedures provided by law.
- Amend Section 3 as follows:
WIC 4648 (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. Upon request of the consumer, or his or her parent or legal guardian, the regional center shall make that statement available in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate, to the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both. The provision of this section is in addition to and independent of any other rights, remedies or procedures under any other law. Nothing in this section shall be construed to alter, limit or negate any other rights, remedies or procedures provided by law.
- Amend Section 4 to address concerns that parent participation requirements be lessened for ABA therapy by reverting (b)(2) to the original statutory language, as follows, and amending (d)(4)(A) to clarify which requirements are being relaxed.
WIC 4686.2. (b) (2) (A) Only purchase ABA or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers, given the critical nature of parent participation to the success of the intervention plan.
(B) In determining the extent of parent participation required for the provision of ABA or intensive behavioral intervention services, the IPP or IFSP planning team shall consider any relevant hardships suffered by a parent or parents that may constitute a barrier to the consumer accessing those services, including, but not limited to, availability of group instruction courses, conflicts with employment, vocational training, or educational demands, financial hardship, or lack of transportation or child or other family member care, and language barriers. Any hardships shall be documented in the IPP or IFSP and reviewed every six months to determine if there has been a change in circumstances. If the regional center determines that the extent of parent participation should be adjusted due to a change in circumstances, the regional center shall provide adequate notice pursuant to subdivision (a) of Section 4710.
(d)(4) “Parent participation” shall include, but shall not be limited to, the following meanings:
(A) Completion of group instruction on the basics of behavior
intervention. Non-completion of group instruction by the parent or parents, or caregiver(s), shall not be used to deny, delay or reduce ABA or intensive behavioral intervention services, if the parent or caregiver can demonstrate hardship in accessing or attending group instruction classes. The parents’ or caregivers’ demonstration of hardship shall be reviewed by the IPP or IFSP team every 6 months.
PRIOR VOTES
Assembly Floor: | 74 - 1 |
Assembly Appropriations Committee: | 19 - 0 |
Assembly Human Services Committee: | 6 - 0 |
POSITIONS
Support:
None
Oppose:
ARCA
Department of Developmental Services
-- END --
http://www.dhcs.ca.gov/dataandstats/statistics/Documents/RASB_Issue_Brief_Annual_Threshold_Language_Report.pdf ↑
Roane, Henry, et al. “Applied Behavioral Analysis as Treatment for Autism Spectrum Disorder,” Journal of Pediatrics, May 2016. ↑
Vismara, Laurie and Sally Rogers, “Behavioral Treatments in Autism Spectrum Disorder: What Do We Know?” Clinical Psychology, April 2010. ↑
ASSEMBLY THIRD READING
ATR Bill Id:AB 2809
Author:(Rodriguez)
As Ver:
Majority vote
Committee | Votes | Ayes | Noes |
Human Services | 6-0 | Bonilla, Grove, Lopez, Maienschein, Mark Stone, Thurmond | |
Appropriations | 19-0 | Gonzalez, Bigelow, Bloom, Bonilla, Bonta, Calderon, Chang, Daly, Eggman, Eduardo Garcia, Roger Hernández, Holden, Jones, Obernolte, Quirk, Santiago, Wagner, Weber, Wood |
|
SUMMARY: Requires regional centers to provide certain information in threshold languages and requires that parental hardships be considered when determining the extent of parent participation for certain services. Specifically, this bill:
- Requires a regional center, at the time of development, scheduled review, or modification of a consumer's individual program plan (IPP) or individualized family service plan (IFSP), to provide the consumer and/or certain other individuals, in an understandable form and in the appropriate threshold language(s), as specified, with a document describing all of the following and the process for how to obtain each:
- Acquisition of transportation services for a minor child, as specified;
- Exemptions to the limitations on purchase of camping services, social recreation activities, educational services, and nonmedical therapies, as specified;
- Exemptions to the limitations on purchase of certain services for consumers ages 18 to 22 years old, as specified; and
- Exemptions to the limitations on purchase of respite services, as specified.
- Requires a regional center, at the beginning of each individual program plan (IPP) meeting, to provide a consumer and other specified individuals information about the appeal and complaint process in threshold languages, as specified and appropriate.
- Requires a regional center to provide the statement of services and supports purchased for a consumer in the threshold language(s), as specified, of the consumer and/or his or her parents, legal guardian, conservator, or authorized representative.
- Requires the IPP or IFSP planning team, when determining the extent of parent participation, to consider any relevant hardships suffered by a parent or parents that may constitute a barrier to the consumer accessing applied behavioral analysis (ABA) or intensive behavioral intervention services and that such hardships be documented in the IPP or IFSP and be reviewed every six months, as specified. Further, requires the regional center, if it determines that the extent of parent participation should be adjusted due to a change in circumstances, to provide adequate notice, as specified.
EXISTING LAW:
- Establishes an entitlement to services for individuals with developmental disabilities under the Lanterman Developmental Disabilities Services Act (Lanterman Act). (Welfare and Institutions Code Section (WIC) 4500 et seq.)
- 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 services and arrange for or purchase services that meet the needs of individuals with developmental disabilities, as defined. (WIC 4620 et seq.)
- 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)
- Places various requirements on regional centers to communicate and provide certain written materials in a consumer's and/or family's or other designated individual's native language, as specified. (Government Code Section (GOV) 95020(g); WIC 4642(b), 4643(d), 4646(h))
- Defines "threshold language" to mean a language that has been identified as the primary language, as specified, of 3,000 beneficiaries or 5% of the beneficiary population, whichever is lower, in an identified geographic area. (9 California Code of Regulations Section (CCR) 1810.410(a)(3))
- Provides for exemptions to certain service limitations, as specified, related to: transportation for minors; camping services, social recreation activities, educational services, and nonmedical therapies; certain services for consumers ages 18 to 22 years old; and respite services. (WIC 4648.35, 4648.5, 4648.55, 4686.5)
- Defines "parent participation" for purposes of ABA or intensive behavioral intervention services to include, but not be limited to: completion of group instruction on the basics of behavior intervention; implementation of intervention strategies, according to the intervention plan; collection of data on behavioral strategies and submission of that data, as specified; and participation in any needed clinical meetings. (WIC 4686.2(d)(4))
- Requires regional centers to only purchase ABA or intensive behavioral intervention services when the parent(s) of minor consumers receiving services participate in the intervention plan for the consumers. (WIC 4686.2(b)(2))
FISCAL EFFECT: According to the Assembly Appropriations Committee, this bill may result in the following costs:
- One-time costs to regional centers to translate the statement of services for Fiscal Year (FY) 2016-17 (6 months) of approximately $1.5 million ($1 million General Fund). In 2017-18 and ongoing, the cost would be $3 million ($2 million General Fund) plus an average growth rate of individuals with a primary language other than English of 4.63%
- One-time costs to DDS of approximately $14,000 (General Fund) to translate information about the appeal and complaint process, and exceptions and exemptions, into California's 13 non-English threshold languages. Translation cost for Spanish is approximately $68 per hour and other languages are approximately $90 per hour. Each translation is estimated to take approximately 12 hours on average.
- On-going costs of approximately $50,000 (General Fund) annually to provide the above information in threshold languages at IPP and IFSP development, modification, and review meetings. Approximately 500,000 meetings occur annually. This assumes the information can be provided in two pages at $0.05 per page.
- Unknown costs, but likely in the low millions (General Fund), associated with the parental participation hardship adjustment. Costs would be expected from the likely decreased effectiveness of behavior intervention with reduced or no parent participation leading to a potential need to continue those services for a longer period of time.
COMMENTS:
Developmental services: 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 21 regional centers serve approximately 290,000 consumers, providing services such as residential placements, supported living services, respite care, transportation, day treatment programs, work support programs, and various social and therapeutic activities. Approximately 1,005 consumers reside at one of California's three 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 outlined in an IPP, which is developed by the IPP team—including, among others, the consumer, his or her legally authorized representative, and one or more regional center representatives—and is based on the consumer's needs and choices.
In July of 2009, a number of state budget cuts were adopted in response to the budget shortfall resulting in large part from the national economic crisis. DDS had to make a number of cuts at this time; the department worked with stakeholders to identify over $300 million in General Fund savings. Examples of some of the many actions taken include: limiting transportation for minor children to when the family provides documentation that they cannot provide transportation themselves; suspending the purchase of camping services, certain social recreation activities, educational services, and non-medical therapies, except in cases where exemptions are granted; restricting the amount of respite services that may be purchased, except in cases where exemptions are granted; and providing for a standard that parent participation is critical to the success of the intervention plan and requiring regional centers to purchase ABA or intensive behavioral intervention services only when the parent agrees to participate in the intervention plan.
Threshold languages: Including English, 207 languages are spoken in the state. The California Code of Regulations (9 CCR 1810.410 (a)(3)) defines "threshold language" to mean a language that has been identified as the primary language, as specified, of 3,000 beneficiaries or 5% of the beneficiary population, whichever is lower, in an identified geographic area. A 2015 Budget Trailer bill (SB 82 (Senate Committee on Budget and Fiscal Review), Chapter 23, Statutes of 2015), among other things, required each regional center to offer, and upon request provide, a written copy of the IPP to the consumer and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of the request in a threshold language. For each regional center catchment area, the threshold languages are defined by the county or counties served by that regional center.
Recent special session actions: The Governor convened a special legislative session in June 2015 to address, among other things, funding rate increases for community service providers of services for individuals with developmental disabilities. One result of that special session was the passage of AB 1 X2 (Thurmond), Chapter 3, Statutes of 2016, signed by the Governor on March 1 of this year, which appropriated $287 million General Fund to regional centers and community services providers in 2016-17 in additional to leveraging an estimated $186 million in federal funding. Approximately 60% of the General Fund spending is marked for rate increases to go towards salaries and benefits for staff that provide direct care to consumers. Among other spending augmentations, AB 1 X2 also included a fixed appropriation of $11 million to promote equity and reduce disparities in the purchase of services, to be used for activities such as cultural competency training, parent education, and supporting bilingual regional center staff.
Need for this bill: According to the author, "For people with developmental disabilities, health disparities can result in significant health, social, and economic consequences. California's diverse language and ethnic communities account for about 60% of its population. In recent years, access to developmental services has been significantly limited due to severe budget cuts, with minority populations particularly adversely affected. In 2011, a Los Angeles Times series reported significant disparities in the funding of developmental services based on race, ethnicity, and language. Consumers and family members who are limited English proficient have the right to culturally and linguistically competent information about accessing developmental services available through regional centers, including information on the process for obtaining certain services through statutory exemptions and meeting other affirmative requirements. Additionally, the level of parent participation required to access intensive behavioral intervention services is often too burdensome to meet for some families who are low-income and/or who are limited English proficient, and the law should provide for some flexibility in authorizing for these services by accounting for hardship factors."
RELATED AND PRIOR LEGISLATION
SB 1034 (Mitchell) of the current legislative session, among other things, would prohibit lack of parent or caregiver participation from being used to deny or reduce medically necessary behavioral health treatment, as specified. This bill was heard in the Senate Appropriations Committee on May 27th.
AB 1 X2 (Thurmond), Chapter 3, Statutes of 2016, among other things, implemented targeted rate increases for the community-based developmental services system.
SB 82 (Senate Committee on Budget and Fiscal Review), Chapter 23, Statutes of 2015, among other things, required each regional center to offer, and upon request provide, a written copy of the IPP to the consumer and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of his, her, or their request in a threshold language, as defined, and further required the department and regional centers to annually collaborate to compile data on the number of instances in which an IPP was provided in this manner.
SB 555 (Correa), Chapter 685, Statutes of 2013, placed various requirements on regional centers to communicate and provide certain written materials in a consumer's and/or family's or other designated individual's native language, as specified.
AB 9 X4 (Evans), Chapter 9, Statutes of 2009, contained necessary changes to enact modifications to the 2009 Budget Act, including, but not limited to, suspending and limiting certain services for regional center consumers.
Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089 FN: 0003339
Date of Hearing: May 18, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
ABPCA Bill Id:AB 2809
Author:(Rodriguez) – As Amended Ver:May 4, 2016
Policy Committee: | Human Services | Vote: | 6 - 0 |
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| ||
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Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY: This bill requires regional centers to provide certain information and materials to consumers and other designated individuals at the time of the development, review, or modification of each Individual Program Plan (IPP) of Individualized Family Service Plan (ISFP), and that the information and materials be made available in threshold languages. The bill further requires that parental hardships be considered and documented when determining the extent of parent participation for certain services.
FISCAL EFFECT:
- One-time costs to Regional Centers to translate the statement of services for FY 2016-17 (6 mos) of approximately $1.5 million ($1 million GF). In 2017-18 and ongoing, the cost would be $3 million ($2 million GF) plus an average growth rate of individuals with a primary language other than English of 4.63%
- One-time costs to the Department of Developmental Services of approximately $14,000 (GF) to translate information about the appeal and complaint process, and exceptions and exemptions, into California's 13 non-English threshold languages. Translation cost for Spanish is approximately $68 per hour and other languages are approximately $90 per hour. Each translation is estimated to take approximately 12 hours on average.
- On-going costs of approximately $50,000 (GF) annually to provide the above information in threshold languages at IPP and IFSP development, modification, and review meetings. Approximately 500,000 meetings occur annually. This assumes the information can be provided in two pages at $0.05 per page.
- Unknown costs, but likely in the low millions (GF), associated with the parental participation hardship adjustment. Costs would be expected from the likely decreased effectiveness of behavior intervention with reduced or no parent participation leading to a potential need to continue those services for a longer period of time.
COMMENTS:
- Purpose. According to the author, “In 2011, a Los Angeles Times series reported significant disparities in the funding of developmental services based on race, ethnicity, and language. Consumers and family members who are limited English proficient have the right to culturally and linguistically competent information about accessing developmental services available through regional centers, including information on the process for obtaining certain services through statutory exemptions and meeting other affirmative requirements. Additionally, the level of parent participation required to access intensive behavioral intervention services is often too burdensome to meet for some families who are low-income and/or who are limited English proficient and the law should provide for some flexibility in authorizing for these services by accounting for hardship factors.”
- Threshold languages. Including English, 207 languages are spoken in the state. The California Code of Regulations defines “threshold language” to mean a language that has been identified as the primary language of 3,000 beneficiaries or 5% of the beneficiary population, whichever is lower, in an identified geographic area. California has 13 non-English threshold languages. Existing law requires each regional center to offer, and upon request provide, a written copy of the IPP to the consumer and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of the request in a threshold language.
For each regional center catchment area, the threshold languages are defined by the county or counties served by that regional center. There are an estimated 24,800 regional center consumers with a primary language that is a threshold language other than English. The threshold languages (and the percentage of the population speaking that language as their primary language) for a sampling of California's counties, as of May 2014, are as follows:
- Alameda County: Spanish (24.5%), Cantonese (5.8%), Vietnamese (2.7%), Mandarin (1.5%)
- Contra Costa County: Spanish (29.1%)
- Kern County: Spanish (34%)
- Los Angeles County: Spanish (42%), Armenian (2.3%), Cantonese (1.1%), Korean (1%),
Vietnamese (0.9%), Mandarin (0.9%), Farsi (0.5%), Tagalog (0.4%), Russian (0.4%), Cambodian (0.3%), Other Chinese (0.3%), Arabic (0.2%)
- Monterey County: Spanish (58.5%)
- San Diego County: Spanish (32.3%), Arabic (2.8%), Vietnamese (1.9%), Tagalog (1.2%)
- Santa Cruz County: Spanish (48.8%)
- Solano County: Spanish (22.7%)
- Related Legislation. SB 1034 (Mitchell), pending on the Senate Appropriations Committee's Suspense File, among other things, prohibits lack of parent or caregiver participation from being used to deny or reduce medically necessary behavioral health treatment, as specified.
- Prior Legislation.
- ABX2 1 (Thurmond), Chapter 3, Statutes of 2016, among other things, implemented targeted rate increases for the community-based developmental services system.
- SB 82 (Senate Committee on Budget and Fiscal Review), Chapter 23, Statutes of 2015, among other things, required each regional center to offer, and upon request provide, a written copy of the IPP to the consumer and, when appropriate, his or her parents, legal guardian, etc. within 45 days of his, her, or their request in a threshold language, as defined, and further required the department and regional centers to annually collaborate to compile data on the number of instances in which an IPP was provided in this manner.
- SB 555 (Correa), Chapter 685, Statutes of 2013, placed various requirements on regional centers to communicate and provide certain written materials in a consumer’s and/or family’s or other designated individual’s native language, as specified.
Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081
Date of Hearing: April 26, 2016
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Susan Bonilla, Chair
ABPCA Bill Id:AB 2809 (
Author:Rodriguez) – As Amended Ver:March 18, 2016
SUBJECT: Developmental services: regional centers
SUMMARY: Requires regional centers to pay for medical and dental services during specified periods and to provide certain information in the native language of consumers and other designated individuals and further, requires that parental hardships be considered when determining the extent of parent participation for certain services.
Specifically, this bill:
- Requires a regional center, at the beginning of each individual program plan (IPP) meeting, to provide a consumer and, when appropriate, other specified individuals, a list of services provided by the regional center and information about the appeal and complaint process in his or her native language.
- Requires a regional center, at the end of an IPP meeting, to provide a consumer and, when appropriate, other specified individuals, a written list of agreed-upon services and supports, including the amount and anticipated start date, and a list of any services and supports for which final agreement has not been reached and for which there will be a subsequent program plan meeting, as specified.
- Requires a regional center to provide the statement of services and supports purchased for a consumer, as specified, in the native language of the consumer and/or his or her parents, legal guardian, conservator, or authorized representative, and further requires this statement to be provided, in addition to the currently-required annual notice, at the time of development, scheduled review, or modification of a consumer’s IPP or individualized family service plan (IFSP).
- Requires a regional center, at the time of development, scheduled review, or modification of a consumer’s IPP or IFSP, to provide the consumer and/or other individuals with a written statement and examples of pertinent documentation in an understandable form and in the appropriate native language(s), as specified, regarding each of the following:
- Acquisition of transportation services for a minor child, as specified;
- Exemptions to the limitations on purchase of camping services, social recreation activities, educational services, and nonmedical therapies, as specified;
- Exemptions to the limitations on purchase of certain services for consumers ages 18 to 22 years old, as specified; and
- Exemptions to the limitations on purchase of respite services, as specified.
- Requires the regional center to accept documentation demonstrating that the family of a child is unable to provide transportation for that child in any written form, including in the native language of the consumer or other individuals, as specified.
- Requires an IPP planning team to, when making a determination regarding exemptions for the purchase of certain services for consumers ages 18 to 22, consider the standard requiring regional centers to provide independent living skills services to an adult consumer, consistent with his or her IPP, that provide the consumer with functional skills training that enables him or her to acquire or maintain skills to live independently or achieve greater independence, as specified.
- Requires regional centers to pay for medical or dental services during the following periods:
- While insurance coverage is being pursued, but before a denial is made;
- Pending final decision on an administrative appeal, as specified; and
- Until the commencement of Medi-Cal, private insurance, or a health care service plan.
- Requires a regional center, at the time of development, scheduled review, or modification of a consumer’s IPP or IFSP, to provide the consumer and/or other individuals with a written statement and examples of pertinent documentation in an understandable form and in the appropriate native language(s), as specified, regarding acquisition of coverage of medical and dental services during certain periods, as specified.
- Requires the IPP or IFSP planning team, when determining the extent of parent participation, to consider any relevant hardships suffered by a parent or parents that may constitute a barrier to the consumer accessing applied behavioral analysis (ABA) or intensive behavioral intervention services and that such hardships be documented in the IPP or IFSP and be reviewed annually, as specified. Further, requires the regional center, if it determines that the extent of parent participation should be adjusted due to a change in circumstances, to provide adequate notice, as specified.
- Requires a regional center, at the time of development, scheduled review, or modification of a consumer’s IPP or IFSP, to provide the consumer and/or other individuals with a written statement and examples of pertinent documentation in an understandable form and in the appropriate native language(s), as specified, regarding the process for determining the extent of parent participation and demonstration of hardships.
EXISTING LAW:
- Establishes an entitlement to services for individuals with developmental disabilities under the Lanterman Developmental Disabilities Services Act (Lanterman Act). (WIC 4500 et seq.)
- 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)
- 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 services and arrange for or purchase services that meet the needs of individuals with developmental disabilities, as defined. (WIC 4620 et seq.)
- 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)
- Requires the IPP planning processes to include:
- 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;
- Review and modification, as necessary, by the regional center’s planning team no less frequently than every three years; and
- Statewide training and review of the IPP plan creation, as specified. (WIC 4646.5)
- Prohibits discrimination against individuals in protected classes, including national origin and ethnic group identification, for purposes of providing full and equal access to benefits or programs that are operated or funded by the state. (GOV 11135 et seq.)
- Places various requirements on regional centers to communicate and provide certain written materials in a consumer’s and/or family’s or other designated individual’s native language, as specified. (GOV 95020 (g); WIC 4642 (b), 4643 (d), 4646 (h))
- Defines “threshold language” to mean a language that has been identified as the primary language, as specified, of 3,000 beneficiaries or 5% of the beneficiary population, whichever is lower, in an identified geographic area. (9 CCR § 1810.410 (a)(3))
- Requires each regional center to offer, and upon request provide, a written copy of the IPP to the consumer and, when appropriate, to his or her parents, legal guardian or conservator, or authorized representative within 45 days of his, her, or their request in a threshold language, as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations. (WIC 4646.5 (a)(5))
- Provides for exemptions to certain service limitations, as specified, related to: transportation for minors; camping services, social recreation activities, educational services, and nonmedical therapies; certain services for consumers ages 18 to 22 years old; and respite services. (WIC 4648.35, 4648.5, 4648.55, 4686.5)
- Authorizes regional centers to pay for medical or dental services pending pursuit or appeal with Medi-Cal, private insurance, or other health care plan. (WIC 4659 (d))
- Defines “parent participation” for purposes of ABA or intensive behavioral intervention services to include, but not be limited to: completion of group instruction on the basics of behavior intervention; implementation of intervention strategies, according to the intervention plan; collection of data on behavioral strategies and submission of that data, as specified; and participation in any needed clinical meetings. (WIC 4686.2 (d)(4))
- Requires any vendor who provides ABA or intensive behavioral intervention services to design an intervention plan that includes, among other things, the parent participation needed to achieve the consumer’s goals and objectives as set forth in the IPP. (WIC 4686.2 (a)(2))
- Requires regional centers to only purchase ABA or intensive behavioral intervention services when the parent(s) of minor consumers receiving services participate in the intervention plan for the consumers. (WIC 4686.2 (b)(2))
FISCAL EFFECT: Unknown.
COMMENTS:
Developmental services: The Lanterman Act (WIC § 4500 et seq.) 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.
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 21 regional centers serve approximately 290,000 consumers, providing services such as residential placements, supported living services, respite care, transportation, day treatment programs, work support programs, and various social and therapeutic activities. Approximately 1,005 consumers reside at one of California’s three 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 outlined in an IPP, which is developed by the IPP team—including, among others, the consumer, his or her legally authorized representative, and one or more regional center representatives—and is 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.
In July of 2009, a number of state budget cuts were adopted in response to the budget shortfall resulting in large part from the national economic crisis. DDS had to make a number of cuts at this time; the department worked with stakeholders to identify over $300 million in General Fund savings. Examples of some of the many actions taken include: limiting transportation for minor children to when the family provides documentation that they cannot provide transportation themselves; suspending the purchase of camping services, certain social recreation activities, educational services, and non-medical therapies, except in cases where exemptions are granted; restricting the amount of respite services that may be purchased, except in cases where exemptions are granted; and providing for a standard that parent participation is critical to the success of the intervention plan and requiring regional centers to purchase ABA or intensive behavioral intervention services only when the parent agrees to participate in the intervention plan.
Threshold languages: Including English, 207 languages are spoken in the state. The California Code of Regulations (9 CCR § 1810.410 (a)(3)) defines “threshold language” to mean a language that has been identified as the primary language, as specified, of 3,000 beneficiaries or 5% of the beneficiary population, whichever is lower, in an identified geographic area. A 2015 Budget Trailer bill (SB 82 (Senate Committee on Budget and Fiscal Review), Chapter 23, Statutes of 2015), among other things, required each regional center to offer, and upon request provide, a written copy of the IPP to the consumer and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of the request in a threshold language.
For each regional center catchment area, the threshold languages are defined by the county or counties served by that regional center. Below are the threshold languages (and the percentage of the population speaking that language as their primary language) for a sample of California counties, as of May 2014:
Alameda County: Spanish (24.5%), Cantonese (5.8%), Vietnamese (2.7%), Mandarin (1.5%)
Contra Costa County: Spanish (29.1%)
Kern County: Spanish (34%)
Los Angeles County: Spanish (42%), Armenian (2.3%), Cantonese (1.1%), Korean (1%),
Vietnamese (0.9%), Mandarin (0.9%), Farsi (0.5%), Tagalog (0.4%), Russian (0.4%), Cambodian (0.3%), Other Chinese (0.3%), Arabic (0.2%)
Monterey County: Spanish (58.5%)
San Diego County: Spanish (32.3%), Arabic (2.8%), Vietnamese (1.9%), Tagalog (1.2%)
Santa Cruz County: Spanish (48.8%)
Solano County: Spanish (22.7%)
Recent special session actions: The Governor convened a special legislative session in June 2015 to address, among other things, funding rate increases for community service providers of services for individuals with developmental disabilities. One result of that special session was the passage of ABX2 1 (Thurmond), Chapter 3, Statutes of 2016, signed by the Governor on March 1 of this year, which appropriated $287 million General Fund to regional centers and community services providers in 2016-17 in additional to leveraging an estimated $186 million in federal funding. Approximately 60% of the General Fund spending is marked for rate increases to go towards salaries and benefits for staff that provide direct care to consumers. Among other spending augmentations, ABX2 1 also included a fixed appropriation of $11 million to promote equity and reduce disparities in the purchase of services, to be used for activities such as cultural competency training, parent education, and supporting bilingual regional center staff.
Need for this bill: According to the author, “For people with developmental disabilities, health disparities can result in significant health, social, and economic consequences. California's diverse language and ethnic communities account for about 60% of its population. In recent years, access to developmental services has been significantly limited due to severe budget cuts, with minority populations particularly adversely affected. In 2011, a Los Angeles Times series reported significant disparities in the funding of developmental services based on race, ethnicity, and language. Consumers and family members who are limited English proficient have the right to culturally and linguistically competent information about accessing developmental services available through regional centers, including information on the process for obtaining certain services through statutory exemptions and meeting other affirmative requirements. Additionally, the level of parent participation required to access intensive behavioral intervention services is often too burdensome to meet for some families who are low-income and/or who are limited English proficient, and the law should provide for some flexibility in authorizing for these services by accounting for hardship factors.”
Staff comments: Ensuring that consumers of services for individuals with developmental disabilities receive communications in the appropriate languages is an important goal. Steps in recent years – including the passage SB 555 (Correa), Chapter 685, Statutes of 2013 and SB 82 (Senate Committee on Budget and Fiscal Review), Chapter 23, Statutes of 2015 – have made headway toward this goal. This bill seeks to provide additional materials in consumers’, and their families’ and other designated individuals’, native languages. With 206 languages currently spoken in California in addition to English, this could place significant strain on resources and substantially heighten related administrative duties for regional centers – all at a time when, in the wake the passage of the special session bill (ABX2 1 (Thurmond), Chapter 3, Statutes of 2016), attention is being directed towards how to best use augmented funds to the greatest benefit for consumers. Additionally, requiring regional centers to pay for medical and dental services pending pursuit or appeal with Medi-Cal, private insurance, or other health care plan, would only place further strain on regional centers. From both a policy and fiscal standpoint, it is important to judiciously weigh any new requirements and obligations placed on the regional center system as the state prepares for rate increases and other changes.
Recommended amendments: In order to address the issues raised above, committee staff recommends: 1) striking provisions of this bill that require regional centers to pay for medical or dental services pending pursuit or appeal with Medi-Cal, private insurance, or other health care plan, and 2) narrowing the requirements this bill places on regional centers to provide certain documents in native languages to instead require the provision of the following in threshold languages, as appropriate: information on appeals and complaints, the consumer’s annual statement of services and supports, and a document providing information on exceptions/exemptions to certain service limitations and how to pursue those exceptions/exemptions. Therefore, committee staff recommends the following amendments:
- Strike the following: lines 23 through 30 on page 4; lines 4 through 12 on page 18; lines 27 through 38 on page 19; lines 3 through 10 on page 23; and lines 8 through 16 on page 25.
- Make the following amendments starting on line 17 of page 4 of the bill:
17
(6) At the beginning of each individual program plan meeting,
18
the regional center shall provide a consumer and, when
19
appropriate, his or her parents, legal guardian, conservator, or
20
authorized representative a list of services provided by the regional
21
center and information about the appeal and complaint process
22
in threshold languages, as appropriate, and as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations. his or her native language.
- Make the following amendments starting on line 8 of page 16 of the bill:
8
(h) At least annually, and at the time of development, scheduled
9
review, or modification of a consumer’s individual program plan
10
or individualized family service plan, regional centers shall provide
11
the consumer, his or her parents, legal guardian, conservator, or
12
authorized representative a statement of services and supports the
13
regional center purchased for the purpose of ensuring that they are
14
delivered. The statement shall include the type, unit, month, and
15
cost of services and supports purchased. The regional center shall
16
provide that statement in the native language of the make that statement available in threshold languages, as appropriate, and as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, to the consumer or
17
his or her parents, legal guardian, conservator, or authorized
18
representative, or both.
- Make the following amendments starting on line 3 of page 17 of the bill:
3
the child. At the time of development, scheduled review, or
4
modification of a consumer’s individual program plan or
5
individualized family service plan, the regional center shall
6
provide, in a non-technical, understandable form and in the native
7
language of the consumer or his or her parents, legal guardian,
8
conservator, or authorized representative, or both, a written
9
statement of the requirement described in this subdivision and
10
examples of sufficient written documentation that may be submitted.
11
The regional center shall accept documentation submitted pursuant
12
to this subdivision in any written form, including in the native
13
language of the consumer or his or her parents, legal guardian,
14
conservator, or authorized representative.
- Make the following amendments starting on line 25 of page 19 of the bill:
25
to meet the consumer’s need. The consumer shall be informed of
26
the exemption and the process for obtaining an exemption. The consumer shall be informed of the exemption and the process for obtaining an exemption.
- Make the following amendments starting on line 39 of page 20 of the bill:
31
(d) (1) Effective July 1, 2009, notwithstanding any other law
32
or regulation, a regional center shall not purchase medical or dental
33
services for a consumer three years of age or older unless the
34
regional center is provided with documentation of a Medi-Cal,
35
private insurance, or a health care service plan denial and the
36
regional center determines that an appeal by the consumer or family
37
of the denial does not have merit. If, on July 1, 2009, a regional
38
center is purchasing the service as part of a consumer’s IPP, this
39
provision shall take effect on August 1, 2009. At the time of
40
development, scheduled review, or modification of a consumer’s
P21 1
individual program plan or individualized family service plan, the
2
regional center shall provide, in a non-technical, understandable
3
form and in the native language of the consumer or his or her
4
parents, legal guardian, conservator, or authorized representative,
5
or both, a written statement describing the documentation required
6
pursuant to this paragraph. Regional centers may may shall pay for
7
medical or dental services during the following periods:
8
(A) While coverage is being pursued, but before a denial is
9
made.
10
(B) Pending a final administrative decision on the administrative
11
appeal if the family has provided to the regional center a
12
verification that an administrative appeal is being pursued.
13
(C) Until the commencement of services by Medi-Cal, private
14
insurance, or a health care service plan.
- Insert the following language into the bill:
At the time of development, scheduled review, or modification of a consumer’s individual program plan or individualized family service plan, the regional center shall make available, in a non-technical, understandable form and in threshold languages, as appropriate, and as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, for the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, a document describing all of the following exceptions and exemptions to service limitations and the process for obtaining each exception and exemption:
- The exception described in subdivision (d) of Section 4648.35
- The exemption described in subdivision (c) of Section 4648.5
- The exemption described in subdivision (d) of Section 4648.55
- The exemption described in subparagraph (A) of paragraph (3) of subdivision (a) of Section 4686.5.
RELATED AND PRIOR LEGISLATION
SB 1034 (Mitchell), among other things, would prohibit lack of parent or caregiver participation from being used to deny or reduce medically necessary behavioral health treatment, as specified. This bill was heard in the Senate Health Committee on April 20th.
ABX2 1 (Thurmond), Chapter 3, Statutes of 2016, among other things, implemented targeted rate increases for the community-based developmental services system.
SB 82 (Senate Committee on Budget and Fiscal Review), Chapter 23, Statutes of 2015, among other things, required each regional center to offer, and upon request provide, a written copy of the IPP to the consumer and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of his, her, or their request in a threshold language, as defined, and further required the department and regional centers to annually collaborate to compile data on the number of instances in which an IPP was provided in this manner.
SB 555 (Correa), Chapter 685, Statutes of 2013, placed various requirements on regional centers to communicate and provide certain written materials in a consumer’s and/or family’s or other designated individual’s native language, as specified.
AB 9 X4 (Evans), Chapter 9, Statutes of 2009, contained necessary changes to enact modifications to the 2009 Budget Act, including, but not limited to, suspending and limiting certain services for regional center consumers.
REGISTERED SUPPORT / OPPOSITION:
Support
Crystal Stairs, Inc.
Disability Rights California
Public Counsel – co-sponsor
Special Needs Network – co sponsor
State Council on Developmental Disabilities
Opposition
Association of Regional Center Agencies (ARCA)
Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089
Discussed in Hearing
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Bill Author
Bill Co-Author(s):