Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services to contract with regional centers to provide services and supports to individuals with developmental disabilities and their families. Existing law establishes the Employment First Policy, which is the policy that opportunities for integrated, competitive employment be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities.

Existing law authorizes a consumer to choose a tailored day service or vouchered community-based training service, in lieu of any other regional center vendored day program, look-alike day program, supported employment program, or work activity program. Existing law requires a tailored day service to (1) include an individualized service design, as determined through the individual program plan (IPP) and approved by the regional center, that maximizes the consumers individualized choices and needs and (2) encourage opportunities to further the development or maintenance of employment, volunteer activities, or pursuit of postsecondary education; maximize consumer direction of the service; and increase the consumers ability to lead an integrated and inclusive life.

This bill would authorize a consumer in a supported employment program or work activity program who has the stated goal of integrated competitive employment in his or her IPP to request to use tailored day services in conjunction with his or her existing program to achieve that goal, if specified criteria are met, including that the type, amount, and provider of tailored day service allowed under these provisions is determined through the IPP process. The bill would specify the maximum hours of tailored day services that may be authorized in conjunction with existing services under these provisions.

Existing law, until January 1, 2025, provides that the Legislature intends that in order to increase effectiveness and opportunity to gain meaningful integrated competitive employment opportunities, habilitation services shall also provide community-based vocational development services. Existing law requires the department to conduct a 4-year demonstration project in up to 5 volunteer regional centers to determine whether the provision of community-based vocational development services increases integrated competitive employment outcomes and reduces purchase of service costs for working age adults. As part of the pilot program, existing law requires a plan to be developed if community-based vocational development services are determined to be a necessary step to achieve a supported employment outcome, and provides for the hourly rate for the services and hours of participation that may be provided. Existing law requires the department to secure federal Medicaid funding for these services prior to implementation of the project and requires these provisions to be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.

This bill would delete the provisions stating legislative intent and requiring the department to conduct a demonstration project, thereby implementing the provisions that require habilitation services to also provide community-based vocational development services effective statewide without a demonstration project. The bill would also delete the January 1, 2025, repeal date, and would thereby extend the operation of these provisions indefinitely.

Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services to contract with regional centers to provide services and supports to individuals with developmental disabilities and their families. Existing law establishes the Employment First Policy, which is the policy that opportunities for integrated, competitive employment be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities.

Existing law authorizes a consumer to choose a tailored day service or vouchered community-based training service, in lieu of any other regional center vendored day program, look-alike day program, supported employment program, or work activity program. Existing law requires a tailored day service to (1) include an individualized service design, as determined through the individual program plan (IPP) and approved by the regional center, that maximizes the consumers individualized choices and needs and (2) encourage opportunities to further the development or maintenance of employment, volunteer activities, or pursuit of postsecondary education; maximize consumer direction of the service; and increase the consumers ability to lead an integrated and inclusive life.

This bill would authorize a consumer in a supported employment program or work activity program who has the stated goal of integrated competitive employment in his or her IPP to request to use tailored day services in conjunction with his or her existing program to achieve that goal, if specified criteria are met, including that the type, amount, and provider of tailored day service allowed under these provisions is determined through the IPP process. The bill would specify the maximum hours of tailored day services that may be authorized in conjunction with existing services under these provisions.

Existing law, until January 1, 2025, provides that the Legislature intends that in order to increase effectiveness and opportunity to gain meaningful integrated competitive employment opportunities, habilitation services shall also provide community-based vocational development services. Existing law requires the department to conduct a 4-year demonstration project in up to 5 volunteer regional centers to determine whether the provision of community-based vocational development services increases integrated competitive employment outcomes and reduces purchase of service costs for working age adults. As part of the pilot program, existing law requires a plan to be developed if community-based vocational development services are determined to be a necessary step to achieve a supported employment outcome, and provides for the hourly rate for the services and hours of participation that may be provided. Existing law requires the department to secure federal Medicaid funding for these services prior to implementation of the project and requires these provisions to be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.

This bill would delete the provisions stating legislative intent and requiring the department to conduct a demonstration project, thereby implementing the provisions that require habilitation services to also provide community-based vocational development services effective statewide without a demonstration project. The bill would also delete the January 1, 2025, repeal date, and would thereby extend the operation of these provisions indefinitely.

Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services to contract with regional centers to provide services and supports to individuals with developmental disabilities and their families. Existing law establishes the Employment First Policy, which is the policy that opportunities for integrated, competitive employment be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities.

Existing law authorizes a consumer to choose a tailored day service or vouchered community-based training service, in lieu of any other regional center vendored day program, look-alike day program, supported employment program, or work activity program. Existing law requires a tailored day service to (1) include an individualized service design, as determined through the individual program plan (IPP) and approved by the regional center, that maximizes the consumers individualized choices and needs and (2) encourage opportunities to further the development or maintenance of employment, volunteer activities, or pursuit of postsecondary education; maximize consumer direction of the service; and increase the consumers ability to lead an integrated and inclusive life.

This bill would authorize a consumer in a supported employment program or work activity program who has the stated goal of integrated competitive employment in his or her IPP to request to use tailored day services in conjunction with his or her existing program to achieve that goal, if specified criteria are met, including that the type, amount, and provider of tailored day service allowed under these provisions is determined through the IPP process. The bill would specify the maximum hours of tailored day services that may be authorized in conjunction with existing services under these provisions.

Existing law, until January 1, 2025, provides that the Legislature intends that in order to increase effectiveness and opportunity to gain meaningful integrated competitive employment opportunities, habilitation services shall also provide community-based vocational development services. Existing law requires the department to conduct a 4-year demonstration project in up to 5 volunteer regional centers to determine whether the provision of community-based vocational development services increases integrated competitive employment outcomes and reduces purchase of service costs for working age adults. As part of the pilot program, existing law requires a plan to be developed if community-based vocational development services are determined to be a necessary step to achieve a supported employment outcome, and provides for the hourly rate for the services and hours of participation that may be provided. Existing law requires the department to secure federal Medicaid funding for these services prior to implementation of the project and requires these provisions to be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.

This bill would delete the provisions stating legislative intent and requiring the department to conduct a demonstration project, thereby implementing the provisions that require habilitation services to also provide community-based vocational development services effective statewide without a demonstration project. The bill would also delete the January 1, 2025, repeal date, and would thereby extend the operation of these provisions indefinitely.

Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services to contract with regional centers to provide services and supports to individuals with developmental disabilities and their families. Existing law establishes the Employment First Policy, which is the policy that opportunities for integrated, competitive employment be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities.

Existing law authorizes a consumer to choose a tailored day service or vouchered community-based training service, in lieu of any other regional center vendored day program, look-alike day program, supported employment program, or work activity program. Existing law requires a tailored day service to (1) include an individualized service design, as determined through the individual program plan (IPP) and approved by the regional center, that maximizes the consumers individualized choices and needs and (2) encourage opportunities to further the development or maintenance of employment, volunteer activities, or pursuit of postsecondary education; maximize consumer direction of the service; and increase the consumers ability to lead an integrated and inclusive life.

This bill would authorize a consumer being supported in a supported employment program or work activity program who has the stated goal of integrated competitive employment in his or her IPP to request to use tailored day services in conjunction with his or her existing program to achieve that goal, if specified criteria are met, including that the type and amount type, amount, and provider of tailored day service allowed under these provisions is determined through the IPP process. The bill would specify the maximum hours of tailored day services that may be authorized in conjunction with existing services under these provisions.

Existing law, until January 1, 2025, provides that the Legislature intends that in order to increase effectiveness and opportunity to gain meaningful integrated competitive employment opportunities, habilitation services shall also provide community-based vocational development services. Existing law requires the department to conduct a 4-year demonstration project in up to 5 volunteer regional centers to determine whether the provision of community-based vocational development services increases integrated competitive employment outcomes and reduces purchase of service costs for working age adults. As part of the pilot program, existing law requires a plan to be developed if community-based vocational development services are determined to be a necessary step to achieve a supported employment outcome, and provides for the hourly rate for the services and hours of participation that may be provided. Existing law requires the department to secure federal Medicaid funding for these services prior to implementation of the project and requires these provisions to be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.

This bill would delete the provisions stating legislative intent and requiring the department to conduct a demonstration project, thereby implementing the provisions that require habilitation services to also provide community-based vocational development services effective statewide without a demonstration project.

Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services to contract with regional centers to provide services and supports to individuals with developmental disabilities and their families. Existing law establishes the Employment First Policy, which is the policy that opportunities for integrated, competitive employment be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities.

Existing law authorizes a consumer to choose a tailored day service or vouchered community-based training service, in lieu of any other regional center vendored day program, look-alike day program, supported employment program, or work activity program. Existing law requires a tailored day service to (1) include an individualized service design, as determined through the individual program plan (IPP) and approved by the regional center, that maximizes the consumers individualized choices and needs and (2) encourage opportunities to further the development or maintenance of employment, volunteer activities, or pursuit of postsecondary education; maximize consumer direction of the service; and increase the consumers ability to lead an integrated and inclusive life.

This bill would authorize a consumer being supported in a supported employment program or work activity program who has the stated goal of integrated competitive employment in his or her IPP to request to use tailored day services in conjunction with his or her existing program to achieve that goal, if specified criteria are met, including that the type and amount of tailored day service allowed under these provisions is determined through the IPP process. The bill would specify the maximum hours of tailored day services that may be authorized in conjunction with existing services under these provisions.

Existing law, until January 1, 2025, provides that the Legislature intends that in order to increase effectiveness and opportunity to gain meaningful integrated competitive employment opportunities, habilitation services shall also provide community-based vocational development services. Existing law requires the department to conduct a 4-year demonstration project in up to 5 volunteer regional centers to determine whether the provision of community-based vocational development services increases integrated competitive employment outcomes and reduces purchase of service costs for working age adults. As part of the pilot program, existing law requires a plan to be developed if community-based vocational development services are determined to be a necessary step to achieve a supported employment outcome, and provides for the hourly rate for the services and hours of participation that may be provided. Existing law requires the department to secure federal Medicaid funding for these services prior to implementation of the project and requires these provisions to be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.

This bill would delete the provisions stating legislative intent and requiring the department to conduct a demonstration project, thereby implementing the provisions that require habilitation services to also provide community-based vocational development services effective statewide without a demonstration project.

GOVERNOR'S VETO

GV Bill Id:AB 1607

Author:(Frazier)

As Enrolled Ver:September 19, 2017

2/3 vote

Original Committee Reference: HUM. S.

SUMMARY: Allows a regional center consumer to request tailored day services in addition to his or her existing day program, and requires habilitation services to provide community-based vocational development services in order to increase integrated competitive employment outcomes and reduce purchase of service costs for working age adults.

Specifically, this bill:

1. Allows a consumer who is in a supported employment program or work activity program, and who has the stated goal of integrated employment in his or her individual program plan (IPP), to request tailored day services in addition to his or her existing program in order to achieve that goal if certain criteria are met, including:
   1. Determination of the type and amount of tailored day service allowed be made through the IPP process;
   2. Inclusion in the IPP of a description of how a consumer's individualized choices and needs will be met to achieve integrated competitive employment, and the type and amount of services and staffing needed to meet the consumer's specific choices and needs, as specified.
2. Allows an IPP to authorize a certain maximum number of hours of tailored day services to be authorized in conjunction with existing services, as follows:
   1. Up to 75 hours of service per calendar quarter for individuals currently receiving work activity program services, to be reduced from the individual's work activity program, as specified;
   2. Up to five hours a month of tailored day services in addition to job coaching supports received on the job for individuals who are receiving group supported employment services.
3. Changes from Legislative intent to a requirement the inclusion of community-based vocational development services among habilitation services in order to increase effectiveness and opportunity to gain meaningful integrated competitive employment opportunities.
4. Deletes requirements for the Department of Developmental Disabilities (DDS) to conduct a four-year demonstration project to determine whether community based vocational development services increase integrated competitive employment outcomes and reduce purchase of service costs for working age adults, and instead makes the following components of that pilot applicable statewide:
   1. Requires habilitation services to provide community-based vocational development services to enhance community employment readiness and develop the necessary social skills for successful community employment;
   2. Defines "community-based vocational developmental services" as services provided to enhance community employment readiness, social skill development services necessary to obtain and maintain community employment, services to access and participate in postsecondary education or career technical education, and building a network of community and employment opportunities, as specified;
   3. Requires a plan be developed through the IPP process that may include: an inventory of potential employment interests; preferences for types of work environments or situations; identification of any training or education needed for the consumer's desired job; opportunities to explore jobs or self-employment as a means to desired employment outcomes; and identification of personal or family networks that may help a consumer achieve his or her desired employment outcomes;
   4. Requires habilitation service providers and regional centers to semiannually review the plan to document progress, additional barriers, and other changes that impact the consumer's desired employment outcome;
   5. Requires the hourly rate for community-based vocational development services be $40 per hour for a maximum of 75 hours per calendar quarter for all services identified and provided, and requires DDS to secure federal Medicaid funding for services;
   6. Allows hours of participation in community-based vocational development services be provided in lieu of hours of participation in other community-based day program services for up to two years, as specified, and prohibits consumer participation in community-based vocational development services from exceeding more than four years; and
   7. Makes implementation of these provisions contingent on federal financial participation and once any necessary federal approvals have been obtained.
5. Makes amendments to avoid chaptering conflicts with AB 107, Chapter 18, Statutes of 2017.
6. Makes technical changes.

The Senate amendments make amendments to avoid chaptering conflicts with AB 107, Chapter 18, Statutes of 2017.

EXISTING LAW:

1. 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, and to support their integration into the mainstream life of the community. (Welfare and Institutions Code Section (WIC) 4500, et seq.)
2. 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 throughout their lifetime. (WIC 4620)
3. Creates a process by which regional centers may "vendorize" service providers, thereby providing a path to contract for services with that provider and ensuring maximum flexibility and availability of appropriate services and support for persons with developmental disabilities. (WIC 4648)
4. Requires the development of an IPP for each regional center consumer, which specifies services to be provided to the consumer, based on his or her individualized needs determination and preferences, and defines that planning process as the vehicle to ensure that services and supports are customized to meet the needs of consumers who are served by regional centers. (WIC 4512)
5. Allows a consumer to choose a tailored day service or vouchered community-based training service in lieu of any other regional center vendored day program, look-alike day program, supported employment program, or work activity program. (WIC 4688.21)
6. Establishes an Employment First Policy in California to prioritize opportunities for integrated, competitive employment for individuals with developmental disabilities, regardless of the severity of their disabilities, as specified. (WIC 4869)
7. Defines habilitation services as activities purchased for regional center consumers, including services provided under the Work Activity and Supported Employment programs to prepare and maintain consumers at their highest level of vocation functioning or to prepare them for referral to vocational rehabilitation services. (WIC 4851)
8. Establishes regulations regarding the Medicaid Home and Community-Based Services state plans. (42 Code of Federal Regulations (CFR) 441.710)

FISCAL EFFECT: According to the Assembly Appropriations Committee on May 3, 2017, this bill may result in the following costs:

1. Total costs of $21.3 million ($12.4 million General Fund) in Fiscal Year (FY) 2017-18, and $42.6 million ($24.8 million General Fund) in 2018-19 and ongoing for community-based vocational day services, assuming this service option would be used by 4,200 individuals (average of 200 per regional center); and
2. Total costs of $1.1 million ($0.6 million General Fund) in FY 2017-18, and $2.2 million ($1.3 million General Fund) in 2018-19 and ongoing for tailored day services, assuming 1,000 individuals would choose this option. DDS anticipates relatively low utilization of this option because individuals will likely be encouraged to choose community-based vocational day services because of the higher provider rate.

Staff notes that federal funding is contingent upon adding community-based vocational development services as a service under the existing federal Home and Community-Based Services Waiver, referred to as the DD Waiver. Because the demonstration project in existing law was not statewide, it required securing a new waiver, a time consuming and complex process resulting in substantial time delays. By deleting the demonstration project and applying the requirements statewide, DDS can instead request to amend the existing waiver, resulting in the receipt of federal funds more quickly.

COMMENTS:

Developmental Services: In 1969, the Lanterman Developmental Disabilities Act established that individuals with developmental disabilities and their families have a right to receive the services and supports necessary in order to live independently in the community. The Lanterman Act outlines the rights of individuals with developmental disabilities, the rights of their families, how regional centers and service providers may help these individuals, and what services and supports individuals may obtain. "Developmental disability" is defined as a disability that originates before an individual reaches 18 years of age, is expected to continue indefinitely, and constitutes a significant disability for that individual. Such disabilities include: cerebral palsy, epilepsy, and autism spectrum disorder.

In California, the developmental services system is administered by the Department of Developmental Services, which operates the state's 21 regional centers. The regional center system is a statewide network that serves communities throughout the state and is responsible for providing information to and helping coordinate services and supports for individuals with developmental disabilities as well as their families.

Individuals with developmental disabilities receive services that are outlined in an IPP which is based on the individual's needs and choices and is developed by an IPP team in order to maximize opportunities for each consumer to develop relationships, be a part of community life through integration, increase control over his or her life, and obtain positive roles in the community.

Employment First Policy: In 2013 California adopted the state's Employment First Policy, which is "the policy of the state that opportunities for competitive, integrated employment shall be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities," according to Welfare and Institutions Code Section 4869(a)(1). With the authorization of AB 1041 (Chesbro), Chapter 677, Statutes of 2013, California became the 12th state to adopt an Employment First Policy.

Work services: In order to address the employment needs of regional center consumers, the Work Services Program within the developmental services system provides work and community integration opportunities through Supported Employment programs. Administered by the Department of Rehabilitation (DOR) and regional centers, Supported Employment services can be provided either through the vocational rehabilitation program or the Habilitation Services Program, and aim to assist consumers in finding competitive work in a community integrated work setting for persons with severe disabilities who need ongoing support services to learn and perform the work. Supported Employment can involve individual or group placements where a consumer might work in the community with support services and on-the-job training provided by job coaches and is paid directly by the employer. "Work Activity Program" services include paid work, work adjustment and supportive habilitation services, and are typically offered in a sheltered work shop setting, and also allow consumers to be paid at a daily per capita rate based on productivity.

Tailored Day Services: Designed to maximize a regional center consumer's specific needs and choices, tailored day services allow consumers the ability to customize day services through individualized services. Tailored day services aim to increase a consumer's integration and inclusion in the community, develop and/or maintain employment opportunities, allow for volunteer activities, and enable attendance of post-secondary education programs; in certain circumstances tailored day services support goals of self-employment and small business creation. Current law allows a consumer to choose tailored day services in lieu of any other regional center-vendored day program, look-alike day program, supported employment program, or work activity program.

Home and Community Based-Services waiver: In 1983, Congress added section 1915(c) to the Social Security Act and gave States the option to receive Home and Community-Based Services (HCBS) waivers permitting states to use Medicaid dollars to provide long-term care services in home- and community-based settings as an alternative to the use of institutional settings. A variety of services can be offered under an HCBS waiver, including personal care, case management, adult day health, habilitation, home health aide, and other services. Federal law requires state HCBS waiver programs to: demonstrate that providing waiver services won't cost more than providing services in an institution; ensure the protection of an individual's health and welfare; provide adequate and reasonable provider standards to meet the needs of the target population; and ensure that services follow an individualized and person-centered plan of care. California's HCBS waiver provides a significant source of federal funds to California; for the 2017-18 fiscal year, DDS expects approximately $1.7 billion in federal funds for the HCBS waiver, to be used to pay for services for regional center consumers and for regional center operations.

Need for this bill: According to the author's office, "[This bill] will increase opportunities for individuals with developmental disabilities to engage in job discovery and job readiness training to assist their transition to competitive, integrated employment and to support employment success, and will start to build the self-sufficiency of adults with developmental disabilities, including increased earning capacity and reduced dependence on government benefit support, by providing the necessary services to transition into more competitive, integrated employment."

PRIOR LEGISLATION:

AB 107 (Budget Committee), Chapter 18, Statutes of 2017, was the Developmental Services Trailer Bill.

SB 1427 (Pavley) of 2016, would have required DDS to establish a Work Transition Project to facilitate the delivery or integrated services and assist in state compliance with federal Home and Community-Based Services Waiver regulations. It was held in the Assembly Appropriations Committee.

SB 577 (Pavley), Chapter 431, Statutes of 2014, required, contingent upon the receipt of federal funding, DDS to conduct a four-year demonstration project regarding the impacts of community-based vocational development services on employment outcomes for regional center consumers and on purchase-of-service costs for working-age adults.

AB 1041 (Chesbro), Chapter 677, Statutes of 2013, created a statewide Employment First Policy and set forth requirements related to the inclusion of employment opportunities and services in a regional center consumer's IPP.

GOVERNOR'S VETO MESSAGE:

This bill authorizes developmentally disabled consumers to participate in more than one adult day services program to receive services focused on employment. It also establishes community-based vocational development services as a new statewide program for these consumers.

These additional services have merit; however, they should be evaluated in the annual budget process.

Analysis Prepared by: Kelsy Castillo / HUM. S. / (916) 319-2089 FN: 0002475

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1607

Author:(Frazier)

As Amended Ver:September 8, 2017

Majority vote

Original Committee Reference: HUM. S.

SUMMARY: Allows a regional center consumer to request tailored day services in addition to his or her existing day program, and requires habilitation services to provide community-based vocational development services in order to increase integrated competitive employment outcomes and reduce purchase of service costs for working age adults.

Specifically, this bill:

1. Allows a consumer who is in a supported employment program or work activity program, and who has the stated goal of integrated employment in his or her individual program plan (IPP), to request tailored day services in addition to his or her existing program in order to achieve that goal if certain criteria are met, including:
   1. Determination of the type and amount of tailored day service allowed be made through the IPP process;
   2. Inclusion in the IPP of a description of how a consumer's individualized choices and needs will be met to achieve integrated competitive employment, and the type and amount of services and staffing needed to meet the consumer's specific choices and needs, as specified.
2. Allows an IPP to authorize a certain maximum number of hours of tailored day services to be authorized in conjunction with existing services, as follows:
   1. Up to 75 hours of service per calendar quarter for individuals currently receiving work activity program services, to be reduced from the individual's work activity program, as specified;
   2. Up to five hours a month of tailored day services in addition to job coaching supports received on the job for individuals who are receiving group supported employment services.
3. Changes from Legislative intent to a requirement the inclusion of community-based vocational development services among habilitation services in order to increase effectiveness and opportunity to gain meaningful integrated competitive employment opportunities.
4. Deletes requirements for the Department of Developmental Disabilities (DDS) to conduct a four-year demonstration project to determine whether community based vocational development services increase integrated competitive employment outcomes and reduce purchase of service costs for working age adults, and instead makes the following components of that pilot applicable statewide:
   1. Requires habilitation services to provide community-based vocational development services to enhance community employment readiness and develop the necessary social skills for successful community employment;
   2. Defines "community-based vocational developmental services" as services provided to enhance community employment readiness, social skill development services necessary to obtain and maintain community employment, services to access and participate in postsecondary education or career technical education, and building a network of community and employment opportunities, as specified;
   3. Requires a plan be developed through the IPP process that may include: an inventory of potential employment interests; preferences for types of work environments or situations; identification of any training or education needed for the consumer's desired job; opportunities to explore jobs or self-employment as a means to desired employment outcomes; and identification of personal or family networks that may help a consumer achieve his or her desired employment outcomes;
   4. Requires habilitation service providers and regional centers to semiannually review the plan to document progress, additional barriers, and other changes that impact the consumer's desired employment outcome;
   5. Requires the hourly rate for community-based vocational development services be $40 per hour for a maximum of 75 hours per calendar quarter for all services identified and provided, and requires DDS to secure federal Medicaid funding for services;
   6. Allows hours of participation in community-based vocational development services be provided in lieu of hours of participation in other community-based day program services for up to two years, as specified, and prohibits consumer participation in community-based vocational development services from exceeding more than four years; and
   7. Makes implementation of these provisions contingent on federal financial participation and once any necessary federal approvals have been obtained.
5. Makes amendments to avoid chaptering conflicts with AB 107, Chapter 18, Statutes of 2017.
6. Makes technical changes.

The Senate amendments make amendments to avoid chaptering conflicts with AB 107, Chapter 18, Statutes of 2017.

EXISTING LAW:

1. 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, and to support their integration into the mainstream life of the community. (Welfare and Institutions Code Section (WIC) 4500, et seq.)
2. 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 throughout their lifetime. (WIC 4620)
3. Creates a process by which regional centers may "vendorize" service providers, thereby providing a path to contract for services with that provider and ensuring maximum flexibility and availability of appropriate services and support for persons with developmental disabilities. (WIC 4648)
4. Requires the development of an IPP for each regional center consumer, which specifies services to be provided to the consumer, based on his or her individualized needs determination and preferences, and defines that planning process as the vehicle to ensure that services and supports are customized to meet the needs of consumers who are served by regional centers. (WIC 4512)
5. Allows a consumer to choose a tailored day service or vouchered community-based training service in lieu of any other regional center vendored day program, look-alike day program, supported employment program, or work activity program. (WIC 4688.21)
6. Establishes an Employment First Policy in California to prioritize opportunities for integrated, competitive employment for individuals with developmental disabilities, regardless of the severity of their disabilities, as specified. (WIC 4869)
7. Defines habilitation services as activities purchased for regional center consumers, including services provided under the Work Activity and Supported Employment programs to prepare and maintain consumers at their highest level of vocation functioning or to prepare them for referral to vocational rehabilitation services. (WIC 4851)
8. Establishes regulations regarding the Medicaid Home and Community-Based Services state plans. (42 Code of Federal Regulations (CFR) 441.710)

FISCAL EFFECT: According to the Assembly Appropriations Committee on May 3, 2017, this bill may result in the following costs:

1. Total costs of $21.3 million ($12.4 million General Fund) in Fiscal Year (FY) 2017-18, and $42.6 million ($24.8 million General Fund) in 2018-19 and ongoing for community-based vocational day services, assuming this service option would be used by 4,200 individuals (average of 200 per regional center); and
2. Total costs of $1.1 million ($0.6 million General Fund) in FY 2017-18, and $2.2 million ($1.3 million General Fund) in 2018-19 and ongoing for tailored day services, assuming 1,000 individuals would choose this option. DDS anticipates relatively low utilization of this option because individuals will likely be encouraged to choose community-based vocational day services because of the higher provider rate.

Staff notes that federal funding is contingent upon adding community-based vocational development services as a service under the existing federal Home and Community-Based Services Waiver, referred to as the DD Waiver. Because the demonstration project in existing law was not statewide, it required securing a new waiver, a time consuming and complex process resulting in substantial time delays. By deleting the demonstration project and applying the requirements statewide, DDS can instead request to amend the existing waiver, resulting in the receipt of federal funds more quickly.

COMMENTS:

Developmental Services: In 1969, the Lanterman Developmental Disabilities Act established that individuals with developmental disabilities and their families have a right to receive the services and supports necessary in order to live independently in the community. The Lanterman Act outlines the rights of individuals with developmental disabilities, the rights of their families, how regional centers and service providers may help these individuals, and what services and supports individuals may obtain. "Developmental disability" is defined as a disability that originates before an individual reaches 18 years of age, is expected to continue indefinitely, and constitutes a significant disability for that individual. Such disabilities include: cerebral palsy, epilepsy, and autism spectrum disorder.

In California, the developmental services system is administered by the Department of Developmental Services, which operates the state's 21 regional centers. The regional center system is a statewide network that serves communities throughout the state and is responsible for providing information to and helping coordinate services and supports for individuals with developmental disabilities as well as their families.

Individuals with developmental disabilities receive services that are outlined in an IPP which is based on the individual's needs and choices and is developed by an IPP team in order to maximize opportunities for each consumer to develop relationships, be a part of community life through integration, increase control over his or her life, and obtain positive roles in the community.

Employment First Policy: In 2013 California adopted the state's Employment First Policy, which is "the policy of the state that opportunities for competitive, integrated employment shall be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities," according to Welfare and Institutions Code Section 4869(a)(1). With the authorization of AB 1041 (Chesbro), Chapter 677, Statutes of 2013, California became the 12th state to adopt an Employment First Policy.

Work services: In order to address the employment needs of regional center consumers, the Work Services Program within the developmental services system provides work and community integration opportunities through Supported Employment programs. Administered by the Department of Rehabilitation (DOR) and regional centers, Supported Employment services can be provided either through the vocational rehabilitation program or the Habilitation Services Program, and aim to assist consumers in finding competitive work in a community integrated work setting for persons with severe disabilities who need ongoing support services to learn and perform the work. Supported Employment can involve individual or group placements where a consumer might work in the community with support services and on-the-job training provided by job coaches and is paid directly by the employer. "Work Activity Program" services include paid work, work adjustment and supportive habilitation services, and are typically offered in a sheltered work shop setting, and also allow consumers to be paid at a daily per capita rate based on productivity.

Tailored Day Services: Designed to maximize a regional center consumer's specific needs and choices, tailored day services allow consumers the ability to customize day services through individualized services. Tailored day services aim to increase a consumer's integration and inclusion in the community, develop and/or maintain employment opportunities, allow for volunteer activities, and enable attendance of post-secondary education programs; in certain circumstances tailored day services support goals of self-employment and small business creation. Current law allows a consumer to choose tailored day services in lieu of any other regional center-vendored day program, look-alike day program, supported employment program, or work activity program.

Home and Community Based-Services waiver: In 1983, Congress added section 1915(c) to the Social Security Act and gave States the option to receive Home and Community-Based Services (HCBS) waivers permitting states to use Medicaid dollars to provide long-term care services in home- and community-based settings as an alternative to the use of institutional settings. A variety of services can be offered under an HCBS waiver, including personal care, case management, adult day health, habilitation, home health aide, and other services. Federal law requires state HCBS waiver programs to: demonstrate that providing waiver services won't cost more than providing services in an institution; ensure the protection of an individual's health and welfare; provide adequate and reasonable provider standards to meet the needs of the target population; and ensure that services follow an individualized and person-centered plan of care. California's HCBS waiver provides a significant source of federal funds to California; for the 2017-18 fiscal year, DDS expects approximately $1.7 billion in federal funds for the HCBS waiver, to be used to pay for services for regional center consumers and for regional center operations.

Need for this bill: According to the author's office, "[This bill] will increase opportunities for individuals with developmental disabilities to engage in job discovery and job readiness training to assist their transition to competitive, integrated employment and to support employment success, and will start to build the self-sufficiency of adults with developmental disabilities, including increased earning capacity and reduced dependence on government benefit support, by providing the necessary services to transition into more competitive, integrated employment."

PRIOR LEGISLATION:

AB 107 (Budget Committee), Chapter 18, Statutes of 2017, was the Developmental Services Trailer Bill.

SB 1427 (Pavley) of 2016, would have required DDS to establish a Work Transition Project to facilitate the delivery or integrated services and assist in state compliance with federal Home and Community-Based Services Waiver regulations. It was held in the Assembly Appropriations Committee.

SB 577 (Pavley), Chapter 431, Statutes of 2014, required, contingent upon the receipt of federal funding, DDS to conduct a four-year demonstration project regarding the impacts of community-based vocational development services on employment outcomes for regional center consumers and on purchase-of-service costs for working-age adults.

AB 1041 (Chesbro), Chapter 677, Statutes of 2013, created a statewide Employment First Policy and set forth requirements related to the inclusion of employment opportunities and services in a regional center consumer's IPP.

Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089 FN: 0002350

 THIRD READING  

Bill No: AB 1607

Author:

:

Vote:

SENATE HUMAN SERVICES COMMITTEE: 7-0, 7/11/17

AYES: Wiener, Berryhill, Glazer, Leyva, McGuire, Nguyen, Portantino

SENATE APPROPRIATIONS COMMITTEE: 7-0, 9/1/17

AYES: Lara, Bates, Beall, Bradford, Hill, Nielsen, Wiener

ASSEMBLY FLOOR: 75-0, 5/31/17 - See last page for vote

SUBJECT:

SOURCE: California Disability Services Association

DIGEST:

This bill permits a consumer with a stated goal of competitive integrated employment to use tailored day services in conjunction with a supported employment program or work activity program, if specified criteria are met. This bill additionally deletes existing statute requiring the Department of Developmental Services (DDS) to conduct a demonstration project to establish community-based vocational development services, making the statutory authorization effective statewide without a demonstration project.

Senate Floor Amendments of 9/8/17 resolve chaptering conflicts between this bill language and AB 107 (Committee on Budget, Chapter 18, Statutes of 2017), the Developmental Services trailer bill.

ANALYSIS:

Existing law:

1. Establishes the Lanterman Developmental Disabilities Services Act, which states that California is responsible for providing an array of services and supports sufficiently complete to meet the needs and choices of each person with developmental disabilities, regardless of age or degree of disability, and at each stage of life and to support their integration into the community.
2. Establishes an Employment First Policy in California to prioritize opportunities for integrated, competitive employment for individuals with developmental disabilities, regardless of the severity of their disabilities, as specified.
3. Establishes a system of nonprofit regional centers, overseen by DDS, 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 throughout their lifetime.
4. 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.
5. Defines habilitation services as activities purchased for regional center consumers, including services under the Work Activity and Supported Employment programs to prepare and maintain consumers at their highest level of vocation functioning or to prepare them for referral to vocational rehabilitation services.
6. Establishes a tailored day program with an individualized service design, as determined through the IPP and approved by the regional center, to maximize a consumer’s individual choices and needs, including flexibility in duration and intensity of services, length of daily program and other designs.
7. Requires that the tailored day program be used to encourage opportunities to develop or maintain employment, volunteer activities, or in pursuit of postsecondary education; maximize consumer direction of the service; and increase the consumer’s ability to lead an integrated and inclusive life.
8. Limits use of the tailored day program to no more than the equivalent of four days per week of service design and a rate no more than four-fifths the median rate for comparable programs, as specified.
9. Authorizes a new service, community based vocational development, through a demonstration project to enhance community employment readiness, develop social skills necessary for successful community employment, and build a network of community and employment opportunities for individuals with developmental disabilities.
10. Makes the community based vocational development project contingent upon federal financial participation.

This bill:

1. Permits an individual who is participating in a supported employment program or work activity program who has the stated goal of integrated competitive employment in his or her IPP may request to use tailored day services in conjunction with his or her existing program to achieve that goal, if both of the following criteria are met:
   1. The type, amount, and provider of tailored day service allowed under this subdivision shall be determined through the IPP process, and
   2. The IPP must contain, at minimum, both a detailed description of the consumer’s individualized choices and needs detailing how these choices and needs will be met to achieve integrated competitive employment, and the type and amount of services and staffing needed to meet the consumer’s individualized choices and needs, and unique health and safety and other needs to gain integrated competitive employment.
2. Permits authorization of up to 75 hours of service per calendar quarter in tailored day programs for individuals currently receiving work activity program services. Requires the authorized hours to be reduced from the individual’s work activity program hours, and use specified billing procedures.
3. Permits authorization of up to five hours per month of tailored day services for individuals receiving group supported employment services. This authorization is in addition to the job coaching supports they receive on the job.
4. Deletes from statute the requirement that community-based vocational development services be implemented as a four-year demonstration project for the purpose of determining whether the service will increase competitive employment outcomes and other measures and related language requiring DDS review of the project outcomes and subsequent reports to the Legislature.
5. Deletes existing statute that requires community-based vocational development services be necessary for a goal of a supported employment outcome, and replaces that goal with one of integrated competitive employment, centered in the IPP process.

Background

Approximately 310,000 children and adults with developmental disabilities are served in community-based programs and supported by state- and federally funded services that are coordinated by local, nonprofit regional centers. The state’s 21 regional centers vary considerably in size and organization. A developmental disability is defined in statute as one that originates before the age of 18, continues, or can be expected to continue, indefinitely, and constitutes a substantial disability. Approximately 20,000 regional center consumers earned wages in 2015.

Employment. Employment of individuals with developmental disabilities has been a persistent focus of the state and legislature for nearly a decade. In 2009, the State Council on Developmental Disabilities established an Employment First Council to report on the state’s progress and make recommendations for policy change. In 2011, the Council released a report that indicated 26.5 percent of working-age adults with developmental disabilities live below the federal poverty line compared with 13 percent of adults in the general population. Other findings included a need for additional supports for individuals to prepare for and maintain employment.

In 2013, California established its Employment First Policy, which states that California’s policy is that opportunities for integrated competitive employment shall be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities. (WIC 4869)

Still, California’s rate of employment for individuals with developmental disabilities is low. According to data compiled by the State Council on Developmental Disabilities, just 13.1 percent of California’s working-aged adults with developmental disabilities were employed, as compared with 23.5 percent of adults with developmental disabilities nationwide. In California, the 20,196 regional center consumers who worked earned an average of $604 per month in 2015, an increase of about $100 from average earnings in 2008. The average hourly wage for people in integrated jobs made an average of $9.89 per hour, while people working in small groups under sub-minimum wage job regulations made about $6.24 per hour.

Individual and Group Employment. There are a variety of ways for consumers to be supported in a work environment. Typically, regional centers contract with employment services programs and providers to address the employment needs of individuals with developmental disabilities. Consumers are placed in jobs according to their individual skills, needs and choices, and provided support services on an individual basis or in a group.

Work Activity Programs. Employment services programs in a sheltered work environment for consumers who have acquired basic vocational and independent living skills are considered work activity programs. Consumers are paid at a daily per capita rate based on productivity. DDS data shows that as of March 2017, there were 99 Work Activity Program vendors and 9,141 consumers in the program.

Supported Employment Programs. Supported employment includes community-based rehabilitation programs that help consumers get or maintain employment in integrated settings either individually or in groups. Often supported employment includes a job coach that provides on-the-job services and training, and wages paid directly to the consumer by the employer. Supported employment can either be tailored to an individual, or performed with a group. According to data from DDS, as of March 2017, there were 159 group employment vendors and approximately 6,000 consumers. Individual supported employment, which is not the focus of this bill, included 186 vendors and more than 4,400 individual participants.

Tailored day program. The tailored day program was created to offer individuals who do not want to participate in a work-based or day program to customize volunteer work or other activities to fit their interests. Tailored day is limited to fewer hours and lower rates than work-activity, supported employment or day programs and allows for flexibility in the intensity and duration of services. The program was intended to allow a less-intense option for people who don’t want to do full day activities, such as individuals nearing retirement, those pursuing higher education, or those who want to customize supports to meet the needs not offered in traditional programs. Tailored day programs could be used to work on an individual’s social skills.

Currently, tailored day services are not permitted to be used in conjunction with another service. This bill will allow an individual to blend work activities with tailored day. The author states this allows providers to work individually with people who need to obtain softer skills to get and keep jobs, such as resume development and help with interpersonal skills.

Home and Community-Based Services (HCBS) waiver changes. In March 2014, the federal Centers for Medicaid and Medicare Services (CMS) released new regulations for federal reimbursement of home and community based services. Among the changes are requirements for consumers to live in and receive services in the most integrated setting possible. The new regulations affect federal HCBS waivers used by DDS to pay for consumer services. CMS requires California and other states to submit state transition plans no later than March 17, 2019, and DDS has begun a stakeholder process to identify service types that may be out of compliance. Generally a person living at home is considered to be in an integrated setting, as is a consumer who is employed in integrated settings and with a full salary. In May 2017, CMS issued a letter notifying states that it had extended the implementation period for the new HCBS rules to 2022, although it kept the 2019 state plan approval deadline. DDS has said it intends to maintain the existing timeline to transition existing services that are out of compliance.

Community Based Vocational Development. A year after enactment of California’s Employment First policy, SB 577 (Pavley, Chapter 431, Statutes of 2014) established a four-year pilot project to create community-based vocational development services to teach “softer” interpersonal skills to consumers, and to evaluate whether those skills are important to succeed in supported employment. The pilot was not enacted because it was contingent upon receiving federal funding under the state’s existing Home and Community-Based Services Waiver. In order to add Community Based Vocational Development services to the waiver, the demonstration project had to be approved by the federal Centers on Medicare and Medicaid Services (CMS). The waiver request appears to be stalled at the federal approval level, in part because the demonstration nature of the project requires securing a new waiver.

This bill deletes the demonstration project from the existing statute, instead making the program statewide. DDS can then request to amend the existing state waiver, which is expected to be a more efficient process. Under this bill, enactment of the services remains contingent upon federal funding.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

According to the Senate Appropriations Committee:

• Projected annual costs of about $2 million per year to provide tailored day services to consumers currently receiving work activity program services (General Fund and federal funds). These cost estimates include offsetting reductions in hours of work activity program services. DDS anticipates that about 1,000 consumers statewide would make use of these services. It is important to note that the cost estimates above are annual costs, at full implementation. In practice, if this bill is enacted it may take several years for all regional centers to be able to provide these services.
• Projected annual costs of about $40 million per year to provide community-based vocational services to regional center consumers (GF, federal funds). This cost estimate includes offsetting reductions in hours of work activity programs. DDS anticipates that about 4,200 consumers (about 200 per regional center) would make use of community-based vocational services. It is important to note that the cost estimates above are annual costs, at full implementation. In practice, if this bill is enacted it may take several years for all regional centers to be able to provide these services.
• Likely annual savings in the millions per year (GF, federal funds). To the extent that the new services authorized in the bill improve the employment prospects of regional center consumers, it is likely that consumers will shift from more expensive work activity programs and group supported employment programs to less expensive individual supported employment programs (wherein consumers are employed in the community, with ongoing assistance from regional center vendors). For example, if 50% of projected program participants are able to shift to individual supported employment, annual savings would be about $10 million per year.

The analysis also said it is important to note that the increased costs for a regional center consumer using the new services would likely only occur for the first year or two, whereas savings would continue as long as the consumer stays in individual supported employment. Thus the savings would increase over time while program costs are likely to remain relatively flat.

SUPPORT: (Verified 9/1/17)

California Disability Services Association (source)

Autism Society of California

East Bay Developmental Disabilities Legislative Coalition

Futures Explored, Inc.

OPPOSITION: (Verified 9/1/17)

Department of Finance

ARGUMENTS IN SUPPORT: The California Disability Services Association writes that this bill enables employment exploration and discovery which is “the missing link in services provided to people with autism and other developmental disabilities,” and that these services “will provide a pathway to transition consumers into different employment services in response to California’s Employment First Policy and changes to the federal (HCBS) settings rule.”

ARGUMENTS IN OPPOSITION: The California Department of Finance writes that it is opposed to this bill “because it expands community-based vocational and tailored day services and results in General Fund costs not included in the Administration’s current fiscal plan.”

ASSEMBLY FLOOR: 75-0, 5/31/17

AYES: Acosta, Aguiar-Curry, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Cunningham, Dababneh, Dahle, Daly, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NO VOTE RECORDED: Travis Allen, Chen, Choi, Eggman, Melendez

Prepared by:

9/9/17 16:03:27

**** END ****

 THIRD READING  

Bill No: AB 1607

Author:

:

Vote:

SENATE HUMAN SERVICES COMMITTEE: 7-0, 7/11/17

AYES: Wiener, Berryhill, Glazer, Leyva, McGuire, Nguyen, Portantino

SENATE APPROPRIATIONS COMMITTEE: 7-0, 9/1/17

AYES: Lara, Bates, Beall, Bradford, Hill, Nielsen, Wiener

ASSEMBLY FLOOR: 75-0, 5/31/17 - See last page for vote

SUBJECT:

SOURCE: California Disability Services Association

DIGEST:

This bill permits a consumer with a stated goal of competitive integrated employment to use tailored day services in conjunction with a supported employment program or work activity program, if specified criteria are met. This bill additionally deletes language in existing law requiring the Department of Developmental Services (DDS) to conduct a demonstration project to establish community-based vocational development services, making the statutory authorization effective statewide without a demonstration project.

ANALYSIS:

Existing law:

1. Establishes the Lanterman Developmental Disabilities Services Act, which states that California is responsible for providing an array of services and supports sufficiently complete to meet the needs and choices of each person with developmental disabilities, regardless of age or degree of disability, and at each stage of life and to support their integration into the mainstream life of the community.
2. Establishes an Employment First Policy in California to prioritize opportunities for integrated, competitive employment for individuals with developmental disabilities, regardless of the severity of their disabilities, as specified.
3. Establishes a system of nonprofit regional centers, overseen by DDS, 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 throughout their lifetime.
4. 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.
5. Defines habilitation services as activities purchased for regional center consumers, including services under the Work Activity and Supported Employment programs to prepare and maintain consumers at their highest level of vocation functioning or to prepare them for referral to vocational rehabilitation services.
6. Establishes a tailored day program with an individualized service design, as determined through the IPP and approved by the regional center, to maximize a consumer’s individual choices and needs, including flexibility in duration and intensity of services, length of daily program and other designs.
7. Requires that the tailored day program be used to encourage opportunities to further the development or maintenance of employment, volunteer activities, or pursuit of postsecondary education; maximize consumer direction of the service; and increase the consumer’s ability to lead an integrated and inclusive life.
8. Limits use of the tailored day program to no more than the equivalent of four days per week of service design and a rate no more than four-fifths the median rate for comparable programs, as specified.
9. Authorizes a new service, community based vocational development, through a demonstration project to enhance community employment readiness, develop social skills necessary for successful community employment, and build a network of community and employment opportunities for individuals with developmental disabilities.
10. Makes the community based vocational development project contingent upon federal financial participation.

This bill:

1. Permits an individual who is participating in a supported employment program or work activity program who has the stated goal of integrated competitive employment in his or her IPP may request to use tailored day services in conjunction with his or her existing program to achieve that goal, if both of the following criteria are met:
   1. The type, amount, and provider of tailored day service allowed under this subdivision shall be determined through the IPP process, and
   2. The IPP must contain, at minimum, both a detailed description of the consumer’s individualized choices and needs detailing how these choices and needs will be met to achieve integrated competitive employment, and the type and amount of services and staffing needed to meet the consumer’s individualized choices and needs, and unique health and safety and other needs to gain integrated competitive employment.
2. Permits authorization of up to 75 hours of service per calendar quarter in tailored day programs for individuals currently receiving work activity program services. Requires the authorized hours to be reduced from the individual’s work activity program hours, and use specified billing procedures.
3. Permits authorization of up to five hours per month of tailored day services for individuals receiving group supported employment services. States this authorization is in addition to the job coaching supports they receive on the job.
4. Deletes from statute the requirement that community-based vocational development services be implemented as a four-year demonstration project for the purpose of determining whether the service will increase competitive employment outcomes and other measures and related language requiring DDS review of the project outcomes and subsequent reports to the Legislature.
5. Deletes existing statute that requires community-based vocational development services be necessary for a goal of a supported employment outcome, and replaces that goal with one of integrated competitive employment, centered in the IPP process.

Background

Approximately 310,000 children and adults with developmental disabilities are served in community-based programs and supported by state- and federally funded services that are coordinated by local, nonprofit regional centers. The state’s 21 regional centers vary considerably in size and organization. A developmental disability is defined in statute as one that originates before the age of 18, continues, or can be expected to continue, indefinitely, and constitutes a substantial disability. Approximately 20,000 regional center consumers earned wages in 2015.

Employment. Employment of individuals with developmental disabilities has been a persistent focus of the state and legislature for nearly a decade. In 2009, the State Council on Developmental Disabilities established an Employment First Council to report on the state’s progress and make recommendations for policy change. In 2011, the Council released a report that indicated 26.5 percent of working-age adults with developmental disabilities live below the federal poverty line compared with 13 percent of adults in the general population. Other findings included a need for additional supports for individuals to prepare for and maintain employment.

In 2013, California established its Employment First Policy, which states that California’s policy is that opportunities for integrated competitive employment shall be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities. (WIC 4869)

Still, California’s rate of employment for individuals with developmental disabilities is low. According to data compiled by the State Council on Developmental Disabilities, just 13.1 percent of California’s working-aged adults with developmental disabilities were employed, as compared with 23.5 percent of adults with developmental disabilities nationwide. In California, the 20,196 regional center consumers who worked earned an average of $604 per month in 2015, an increase of about $100 from average earnings in 2008. The average hourly wage for people in integrated jobs made an average of $9.89 per hour, while people working in small groups under sub-minimum wage job regulations made about $6.24 per hour.

Individual and Group Employment. There are a variety of ways for consumers to be supported in a work environment. Typically, regional centers contract with employment services programs and providers to address the employment needs of individuals with developmental disabilities. Consumers are placed in jobs according to their individual skills, needs and choices, and provided support services on an individual basis or in a group.

Work Activity Programs. Employment services programs in a sheltered work environment for consumers who have acquired basic vocational and independent living skills are considered work activity programs. Consumers are paid at a daily per capita rate based on productivity. DDS data shows that as of March 2017, there were 99 Work Activity Program vendors and 9,141 consumers in the program.

Supported Employment Programs. Supported employment includes community-based rehabilitation programs that help consumers get or maintain employment in integrated settings either individually or in groups. Often supported employment includes a job coach that provides on-the-job services and training, and wages paid directly to the consumer by the employer. Supported employment can either be tailored to an individual, or performed with a group. According to data from DDS, as of March 2017, there were 159 group employment vendors and approximately 6,000 consumers. Individual supported employment, which is not the focus of this bill, included 186 vendors and more than 4,400 individual participants.

Tailored day program. The tailored day program was created to offer individuals who do not want to participate in a work-based or day program to customize volunteer work or other activities to fit their interests. Tailored day is limited to fewer hours and lower rates than work-activity, supported employment or day programs and allows for flexibility in the intensity and duration of services. The program was intended to allow a less-intense option for people who don’t want to do full day activities, such as individuals nearing retirement, those pursuing higher education, or those who want to customize supports to meet the needs not offered in traditional programs. Tailored day programs could be used to work on an individual’s social skills.

Currently, tailored day services are not permitted to be used in conjunction with another service. This bill will allow an individual to blend work activities with tailored day. The author states this allows providers to work individually with people who need to obtain softer skills to get and keep jobs, such as resume development and help with interpersonal skills.

Home and Community-Based Services (HCBS) waiver changes. In March 2014, the federal Centers for Medicaid and Medicare Services (CMS) released new regulations for federal reimbursement of home and community based services. Among the changes are requirements for consumers to live in and receive services in the most integrated setting possible. The new regulations affect federal HCBS waivers used by DDS to pay for consumer services. CMS requires California and other states to submit state transition plans no later than March 17, 2019, and DDS has begun a stakeholder process to identify service types that may be out of compliance. Generally a person living at home is considered to be in an integrated setting, as is a consumer who is employed in integrated settings and with a full salary. In May 2017, CMS issued a letter notifying states that it had extended the implementation period for the new HCBS rules to 2022, although it kept the 2019 state plan approval deadline. DDS has said it intends to maintain the existing timeline to transition existing services that are out of compliance.

Community Based Vocational Development. A year after enactment of California’s Employment First policy, SB 577 (Pavley, Chapter 431, Statutes of 2014) established a four-year pilot project to create community-based vocational development services to teach “softer” interpersonal skills to consumers, and to evaluate whether those skills are important to succeed in supported employment. The pilot was not enacted because it was contingent upon receiving federal funding under the state’s existing Home and Community-Based Services Waiver. In order to add Community Based Vocational Development services to the waiver, the demonstration project had to be approved by the federal Centers on Medicare and Medicaid Services (CMS). The waiver request appears to be stalled at the federal approval level, in part because the demonstration nature of the project requires securing a new waiver.

This bill deletes the demonstration project from the existing statute, instead making the program statewide. DDS can then request to amend the existing state waiver, which is expected to be a more efficient process. Under this bill, enactment of the services remains contingent upon federal funding.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

According to the Senate Appropriations Committee:

• Projected annual costs of about $2 million per year to provide tailored day services to consumers currently receiving work activity program services (General Fund and federal funds). These cost estimates include offsetting reductions in hours of work activity program services. DDS anticipates that about 1,000 consumers statewide would make use of these services. It is important to note that the cost estimates above are annual costs, at full implementation. In practice, if this bill is enacted it may take several years for all regional centers to be able to provide these services.
• Projected annual costs of about $40 million per year to provide community-based vocational services to regional center consumers (GF, federal funds). This cost estimate includes offsetting reductions in hours of work activity programs. DDS anticipates that about 4,200 consumers (about 200 per regional center) would make use of community-based vocational services. It is important to note that the cost estimates above are annual costs, at full implementation. In practice, if this bill is enacted it may take several years for all regional centers to be able to provide these services.
• Likely annual savings in the millions per year (GF, federal funds). To the extent that the new services authorized in the bill improve the employment prospects of regional center consumers, it is likely that consumers will shift from more expensive work activity programs and group supported employment programs to less expensive individual supported employment programs (wherein consumers are employed in the community, with ongoing assistance from regional center vendors). For example, if 50% of projected program participants are able to shift to individual supported employment, annual savings would be about $10 million per year.

The analysis also said it is important to note that the increased costs for a regional center consumer using the new services would likely only occur for the first year or two, whereas savings would continue as long as the consumer stays in individual supported employment. Thus the savings would increase over time while program costs are likely to remain relatively flat.

SUPPORT: (Verified 9/1/17)

California Disability Services Association (source)

Autism Society of California

East Bay Developmental Disabilities Legislative Coalition

Futures Explored, Inc.

OPPOSITION: (Verified 9/1/17)

Department of Finance

ARGUMENTS IN SUPPORT: The California Disability Services Association writes that this bill enables employment exploration and discovery which is “the missing link in services provided to people with autism and other developmental disabilities,” and that these services “will provide a pathway to transition consumers into different employment services in response to California’s Employment First Policy and changes to the federal (HCBS) settings rule.”

ARGUMENTS IN OPPOSITION: The California Department of Finance writes that it is opposed to this bill “because it expands community-based vocational and tailored day services and results in General Fund costs not included in the Administration’s current fiscal plan.”

ASSEMBLY FLOOR: 75-0, 5/31/17

AYES: Acosta, Aguiar-Curry, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Cunningham, Dababneh, Dahle, Daly, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NO VOTE RECORDED: Travis Allen, Chen, Choi, Eggman, Melendez

Prepared by:

9/2/17 15:31:59

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2017 - 2018 Regular Session

AB 1607 (Frazier) - Developmental services: integrated competitive employment

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

AB 1607 would permit a regional center consumer to use both tailored day services and supported employment services or a work activity program concurrently. The bill would make an existing (but unimplemented) pilot project to provide community-based vocational development services a statewide program.

Fiscal Impact:

• Projected annual costs of about $2 million per year to provide tailored day services to consumers currently receiving work activity program services (General Fund and federal funds). These cost estimates include offsetting reductions in hours of work activity program services. The Department of Developmental Services anticipates that about 1,000 consumers statewide would make use of these services. It is important to note that the cost estimates above are annual costs, at full implementation. In practice, if this bill is enacted it may take several years for all regional centers to be able to provide these services.
• Projected annual costs of about $40 million per year to provide community-based vocational services to regional center consumers (General Fund and federal funds). This cost estimate includes offsetting reductions in hours of work activity programs. The Department anticipates that about 4,200 consumers (about 200 per regional center) would make use of community-based vocational services. It is important to note that the cost estimates above are annual costs, at full implementation. In practice, if this bill is enacted it may take several years for all regional centers to be able to provide these services.
• Likely annual savings in the millions per year (General Fund and federal funds). To the extent that the new services authorized in the bill improve the employment prospects of regional center consumers, it is likely that consumers will shift from more expensive work activity programs and group supported employment programs to less expensive individual supported employment programs (wherein consumers are employed in the community, with ongoing assistance from regional center vendors). For example, if 50% of projected program participants are able to shift to individual supported employment, annual savings would be about $10 million per year.

It is important to note that the increased costs for a regional center consumer using the new services would likely only occur for the first year or two, whereas savings would continue as long as the consumer stays in individual supported employment. Thus the savings would increase over time while program costs are likely to remain relatively flat.

Background:

The Department of Developmental Services is responsible for coordinating services and supports 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 vendors to provide direct services to the developmentally disabled.

Regional centers provide a variety of services to consumers whose disabilities do not preclude them from some level of employment. Work activity programs (often referred to as sheltered workshops) allow consumers to work alongside other individuals with disabilities in a managed location, under the supervision of regional center vendor employees. Group supported employment programs allow consumers to work outside of a sheltered location, but still with the support of regional center vendors – for example alongside other consumers on landscaping or janitorial crews. Individual supported employment services are designed to support consumers working in a competitive employment situation. Individual supported employment services assist consumers in seeking out employment opportunities, getting hired, and adjusting to working in a competitive employment situation.

The federal Centers for Medicare and Medicaid Services has adopted revised program regulations that apply to regional center consumers participating in the state’s Home and Community Based Services Waiver. Under the changes, the state will be obligated to ensure that consumers are integrated into the community, including having access to work in competitive employment. The Department of Developmental Services is in the process of developing a plan to bring its waiver programs into compliance with the new federal requirements. It is likely that the state will have to phase out work activity programs as a placement for most consumers under the federal regulations.

AB X2 1 (Thurmond, Statutes of 2016) raised a number of rates for services provided through the regional center system, including implementing an 11.1% rate increase for supported employment services and a 7.5% increase for enhancing wages and benefits for staff who spend most of their time providing direct services to consumers. That bill also requires the Department to submit a rate study to the Legislature by March 1, 2019.

Proposed Law:

AB 1607 would permit a regional center consumer to use both tailored day services and supported employment services or a work activity program concurrently. The bill would make an existing (but unimplemented) pilot project to provide community-based vocational development services a statewide program.

Specific provisions of the bill would:

• Authorize a consumer in a supported employment program or work activity program to request the use of tailored day services in conjunction with his or her existing program to achieve integrated competitive employment;
• Limit hours of tailored day services authorized under the bill to 75 hours per quarter for individuals in work activity programs (to be reduced from the individual’s work activity program hours) or 5 hours per month for individuals in group supported employment programs;
• Delete the provision of existing law that limits the availability of community-based vocational developmental services to a four-year demonstration project (making the availability of services statewide and permanent).

Related Legislation:

• SB 1427 (Pavley, 2016) would have required the Department to establish a Work Transition Project for regional centers to allow blended or braided forms of integrated services that bill was held on the Assembly Appropriations Committee’s Suspense File.
• SB 577 (Pavley, Chapter 431, Statutes of 2014) established a four-year pilot project to create and evaluate whether community-based vocational development services are determined to be a necessary step to achieve a supported employment outcome. The pilot has not been enacted.

Staff Comments:

As noted above, it is unlikely that the bill would be fully implemented across all 21 regional centers within the first year or two of enactment. The cost and potential savings estimates above reflect a steady-state projection upon full implementation across the regional center system.

The intent of the bill is to provide services needed to move regional center consumers from less-integrated employment settings (work activity programs and group supported employment programs) to employment opportunities more fully integrated in the community and the competitive job market. This concept is aligned with the general requirements of the new federal guidelines for regional center consumers who participate in the Home and Community Based Services Waiver.

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SENATE COMMITTEE ON HUMAN SERVICES

Senator Wiener, Chair

2017 - 2018 Regular

Bill No: AB 1607

Subject: Developmental services: integrated competitive employment

SUMMARY

This bill permits a consumer with a stated goal of competitive integrated employment to use tailored day services in conjunction with a supported employment program or work activity program, if specified criteria are met. This bill additionally deletes language in existing law requiring the Department of Developmental Services (DDS) to conduct a demonstration project to establish community-based vocational development services, making the statutory authorization effective statewide without a demonstration project.

ABSTRACT

Existing law:

1. Establishes the Lanterman Developmental Disabilities Services Act, which states that California is responsible for providing an array of services and supports sufficiently complete to meet the needs and choices of each person with developmental disabilities, regardless of age or degree of disability, and at each stage of life and to support their integration into the mainstream life of the community. (WIC 4500, et al)
2. Establishes an Employment First Policy in California to prioritize opportunities for integrated, competitive employment for individuals with developmental disabilities, regardless of the severity of their disabilities, as specified. (WIC 4869)
3. Establishes a system of nonprofit regional centers, overseen by DDS, 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 throughout their lifetime. (WIC 4620)
4. 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)
5. Defines habilitation services as activities purchased for regional center consumers, including services under the Work Activity and Supported Employment programs to prepare and maintain consumers at their highest level of vocation functioning or to prepare them for referral to vocational rehabilitation services. (WIC 4851)
6. Establishes a tailored day program with an individualized service design, as determined through the individual program plan (IPP) and approved by the regional center, to maximize a consumer’s individual choices and needs, including flexibility in duration and intensity of services, length of daily program and other designs. (WIC 4688.21)
7. Requires that the tailored day program be used to encourage opportunities to further the development or maintenance of employment, volunteer activities, or pursuit of postsecondary education; maximize consumer direction of the service; and increase the consumer’s ability to lead an integrated and inclusive life.
8. Limits use of the tailored day program to no more than the equivalent of four days per week of service design and a rate no more than four-fifths the median rate for comparable programs, as specified.
9. Authorizes a new service, community based vocational development, through a demonstration project to enhance community employment readiness, develop social skills necessary for successful community employment, and build a network of community and employment opportunities for individuals with developmental disabilities. (WIC 4850.3)
10. Makes the community based vocational development project contingent upon federal financial participation. (WIC 4850.3 (b))

This bill:

1. Permits an individual who is participating in a supported employment program or work activity program who has the stated goal of integrated competitive employment in his or her IPP may request to use tailored day services in conjunction with his or her existing program to achieve that goal, if both of the following criteria are met:
   1. The type, amount, and provider of tailored day service allowed under this subdivision shall be determined through the IPP process, and
   2. The IPP must contain, at minimum, both a detailed description of the consumer’s individualized choices and needs detailing how these choices and needs will be met to achieve integrated competitive employment, and the type and amount of services and staffing needed to meet the consumer’s individualized choices and needs, and unique health and safety and other needs to gain integrated competitive employment.
2. Permits authorization of up to 75 hours of service per calendar quarter in tailored day programs for individuals currently receiving work activity program services. Requires the authorized hours to be reduced from the individual’s work activity program hours, and use specified billing procedures.
3. Permits authorization of up to five hours per month of tailored day services for individuals receiving group supported employment services. States this authorization is in addition to the job coaching supports they receive on the job.
4. Deletes from statute the requirement that community-based vocational development services be implemented as a four-year demonstration project for the purpose of determining whether the service will increase competitive employment outcomes and other measures and related language requiring DDS review of the project outcomes and subsequent reports to the Legislature.
5. Deletes existing statute that requires community-based vocational development services be necessary for a goal of a supported employment outcome, and replaces that goal with one of integrated competitive employment, centered in the IPP process.

FISCAL IMPACT

An analysis by the Assembly Committee on Appropriations identified total costs of $21.3 million ($12.4 million GF) in FY 2017-18, and $42.6 million ($24.8 million GF) in 2018-19 and ongoing for community-based vocational day services, assuming this service option would be used by 4,200 individuals (average of 200 per regional center).

Additionally, the analysis identified total costs of $1.1 million ($0.6 million GF) in FY 2017-18, and $2.2 million ($1.3 million GF) in 2018-19 and ongoing for tailored day services, assuming 1,000 individuals would choose this option. DDS anticipates relatively low utilization of this option because individuals will likely be encouraged to choose community-based vocational day services because of the higher provider rate.

BACKGROUND AND DISCUSSION

Purpose of the bill:

According to the author, this bill will allow individuals with developmental disabilities an opportunity for pre-employment services, such as job exploration, career interests and potential, and other activities that create a pathway for individuals into the workplace. “The current funding structure often results in limiting the career starting point of the individual as well as their long-term vocational success.” The author also notes that potentially thousands of individuals who currently are in employment activities that may not be considered sufficiently integrated could be ineligible for federal funding under proposed changes to the Home and Community Based Services waiver.

Background

Approximately 310,000 children and adults with developmental disabilities are served in community-based programs and supported by state- and federally funded services that are coordinated by local, nonprofit regional centers. The state’s 21 regional centers vary considerably in size and organization. A developmental disability is defined in statute as one that originates before the age of 18, continues, or can be expected to continue, indefinitely, and constitutes a substantial disability. Approximately 20,000 regional center consumers earned wages in 2015.

Regional centers provide the diagnosis and assess the eligibility of consumers, and help plan, access, coordinate and monitor the services and supports that are needed. Services for consumers are determined through an individual program plan (IPP).

Employment

Employment of individuals with developmental disabilities has been a persistent focus of the state and legislature for nearly a decade. In 2009, the State Council on Developmental Disabilities established an Employment First Council to report on the state’s progress and make recommendations for policy change. In 2011, the Council released a report that indicated 26.5 percent of working-age adults with developmental disabilities live below the federal poverty line compared with 13 percent of adults in the general population. Other findings included a need for additional supports for individuals to prepare for and maintain employment.

In 2013, California established its Employment First Policy, which states that California’s policy is that opportunities for integrated competitive employment shall be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities. (WIC 4869)

Still, California’s rate of employment for individuals with developmental disabilities is low. According to data compiled by the State Council on Developmental Disabilities, just 13.1 percent of California’s working-aged adults with developmental disabilities were employed, as compared with 23.5 percent of adults with developmental disabilities nationwide. In California, the 20,196 regional center consumers who worked earned an average of $604 per month in 2015, an increase of about $100 from average earnings in 2008. The average hourly wage for people in integrated jobs made an average of $9.89 per hour, while people working in small groups under sub-minimum wage job regulations made about $6.24 per hour.

Individual and Group Employment

There are a variety of ways for consumers to be supported in a work environment. Typically, regional centers contract with employment services programs and providers to address the employment needs of individuals with developmental disabilities. Consumers are placed in jobs according to their individual skills, needs and choices, and provided support services on an individual basis or in a group.

Work Activity Programs are employment services programs in a sheltered work environment for consumers who have acquired basic vocational and independent living skills. Consumers are paid at a daily per capita rate based on productivity. As of March 2017, there were 99 Work Activity Program vendors and 9,141 consumers in the program, according to DDS data.

Supported Employment Programs are community-based rehabilitation programs that focus on helping consumers obtain, retain or maintain employment in integrated settings either individually or in groups. Often supported employment includes a job coach that provides on-the-job services and training, and wages paid directly to the consumer by the employer. Supported employment can either be tailored to an individual, or performed with a group. According to data from DDS, as of March 2017, there were 159 group employment vendors and approximately 6,000 consumers. Individual supported employment, which is not the focus of this bill, included 186 vendors and more than 4,400 individual participants.

Tailored day program

The tailored day program was created to offer individuals who do not want to participate in a work-based or day program to customize volunteer work or other activities to fit their interests. Tailored day is limited to fewer hours and lower rates than work-activity, supported employment or day programs and allows for flexibility in the intensity and duration of services. The program was intended to allow a less-intense option for people who don’t want to do full day activities, such as individuals nearing retirement, those pursuing higher education, or those who want to customize supports to meet the needs not offered in traditional programs. Tailored day programs could be used to work on an individual’s social skills.

Currently, tailored day services are not permitted to be used in conjunction with another service. This bill will allow an individual to blend work activities with tailored day. The author states this allows providers to work individually with people who need to obtain softer skills to get and keep jobs, such as resume development and help with interpersonal skills.

Home and Community-Based Services (HCBS) waiver changes

In March 2014, the federal Centers for Medicaid and Medicare Services (CMS) released new regulations for federal reimbursement of home and community based services. Among the changes are requirements for consumers to live in and receive services in the most integrated setting possible. The new regulations affect federal HCBS waivers used by DDS to pay for consumer services. CMS requires California and other states to submit state transition plans no later than March 17, 2019, and DDS has begun a stakeholder process to identify service types that may be out of compliance. Generally a person living at home is considered to be in an integrated setting, as is a consumer who is employed in integrated settings and with a full salary.

In May 2017, CMS issued a letter notifying states that it had extended the implementation period for the new HCBS rules to 2022, although it kept the 2019 state plan approval deadline. It is unclear what effect this may have on the state’s efforts to move individuals into integrated competitive employment.

Community Based Vocational Development

A year after enactment of California’s Employment First policy, SB 577 (Pavley, Chapter 431, Statutes of 2014) established a four-year pilot project to create community-based vocational development services to teach “softer” interpersonal skills to consumers, and to evaluate whether those skills are important to succeed in supported employment. The pilot was not enacted because it was contingent upon receiving federal funding under the state’s existing Home and Community-Based Services Waiver.

In order to add Community Based Vocational Development services to the waiver, the demonstration project had to be approved by the federal Centers on Medicare and Medicaid Services (CMS). The waiver request appears to be stalled at the federal approval level, in part because the demonstration nature of the project requires securing a new waiver. This bill deletes the demonstration project from the existing statute, instead making the program statewide. DDS can then request to amend the existing state waiver, which is expected to be a more efficient process. Under this bill, enactment of the services remains contingent upon federal funding.

Related legislation:

SB 1427 (Pavley, 2016) would have required DDS to establish a Work Transition Project for regional centers to allow blended or braided forms of integrated services, as specified, and to assist in the state’s efforts to reach compliance with the federal Home and Community-Based Services Waiver regulations. It was held in the Assembly Appropriations Committee.

SB 577 (Pavley, Chapter 431, Statutes of 2014) established a four-year pilot project to create and evaluate whether community-based vocational development services are determined to be a necessary step to achieve a supported employment outcome. The pilot has not been enacted.

AB 1041 (Chesbro, Chapter 677, Statutes of 2013) enacted the state’s Employment First Policy and expanded the definition of competitive integrated employment. It also required regional centers to ensure that consumers, beginning at 16 years of age, are provided with information about options for integrated competitive employment and postsecondary education.

PRIOR VOTES

POSITIONS

Support:

None received.

Oppose:

None received.

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ASSEMBLY THIRD READING

ATR Bill Id:AB 1607

Author:(Frazier)

As Amended Ver:April 17, 2017

Majority vote

SUMMARY: Allows a regional center consumer to request tailored day services in addition to his or her existing day program, and requires habilitation services to provide community-based vocational development services in order to increase integrated competitive employment outcomes and reduce purchase of service costs for working age adults. Specifically, this bill:

1. Allows a consumer who is in a supported employment program or work activity program, and who has the stated goal of integrated employment in his or her individual program plan (IPP), to request tailored day services in addition to his or her existing program in order to achieve that goal if certain criteria are met, including:
   1. Determination of the type and amount of tailored day service allowed be made through the IPP process;
   2. Inclusion in the IPP of a description of how a consumer's individualized choices and needs will be met to achieve integrated competitive employment, and the type and amount of services and staffing needed to meet the consumer's specific choices and needs, as specified.
2. Allows an IPP to authorize a certain maximum number of hours of tailored day services to be authorized in conjunction with existing services, as follows:
   1. Up to 75 hours of service per calendar quarter for individuals currently receiving work activity program services, to be reduced from the individual's work activity program, as specified;
   2. Up to five hours a month of tailored day services in addition to job coaching supports received on the job for individuals who are receiving group supported employment services.
3. Changes from Legislative intent to a requirement the inclusion of community-based vocational development services among habilitation services in order to increase effectiveness and opportunity to gain meaningful integrated competitive employment opportunities.
4. Deletes requirements for the Department of Developmental Disabilities (DDS) to conduct a four-year demonstration project to determine whether community based vocational development services increase integrated competitive employment outcomes and reduce purchase of service costs for working age adults, and instead makes the following components of that pilot applicable statewide:
   1. Requires habitation services provide community-based vocational development services to enhance community employment readiness and develop the necessary social skills for successful community employment;
   2. Defines "community-based vocational developmental services" as services provided to enhance community employment readiness, social skill development services necessary to obtain and maintain community employment, services to access and participate in postsecondary education or career technical education, and building a network of community and employment opportunities, as specified;
   3. Requires a plan be developed through the IPP process that may include: an inventory of potential employment interests; preferences for types of work environments or situations; identification of any training or education needed for the consumer's desired job; opportunities to explore jobs or self-employment as a means to desired employment outcomes; and identification of personal or family networks that may help a consumer achieve his or her desired employment outcomes;
   4. Requires habilitation service providers and regional centers to semiannually review the plan to document progress, additional barriers, and other changes that impact the consumer's desired employment outcome;
   5. Requires the hourly rate for community-based vocational development services be $40 per hour for a maximum of 75 hours per calendar quarter for all services identified and provided, and requires DDS to secure federal Medicaid funding for services;
   6. Allows hours of participation in community-based vocational development services be provided in lieu of hours of participation in other community-based day program services for up to two years, as specified, and prohibits consumer participation in community-based vocational development services from exceeding more than four years; and
   7. Makes implementation of these provisions contingent on federal financial participation and once any necessary federal approvals have been obtained.
5. Makes technical changes.

EXISTING LAW:

1. 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, and to support their integration into the mainstream life of the community. (Welfare and Institutions Code Section (WIC) 4500, et seq.)
2. 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 throughout their lifetime. (WIC 4620)
3. Creates a process by which regional centers may "vendorize" service providers, thereby providing a path to contract for services with that provider and ensuring maximum flexibility and availability of appropriate services and support for persons with developmental disabilities. (WIC 4648)
4. Requires the development of an IPP for each regional center consumer, which specifies services to be provided to the consumer, based on his or her individualized needs determination and preferences, and defines that planning process as the vehicle to ensure that services and supports are customized to meet the needs of consumers who are served by regional centers. (WIC 4512)
5. Allows a consumer to choose a tailored day service or vouchered community-based training service in lieu of any other regional center vendored day program, look-alike day program, supported employment program, or work activity program. (WIC 4688.21)
6. Establishes an Employment First Policy in California to prioritize opportunities for integrated, competitive employment for individuals with developmental disabilities, regardless of the severity of their disabilities, as specified. (WIC 4869)
7. Defines habilitation services as activities purchased for regional center consumers, including services provided under the Work Activity and Supported Employment programs to prepare and maintain consumers at their highest level of vocation functioning or to prepare them for referral to vocational rehabilitation services. (WIC 4851)
8. Establishes regulations regarding the Medicaid Home and Community-Based Services state plans. (42 Code of Federal Regulations (CFR) 441.710)

FISCAL EFFECT: According to the Assembly Appropriations Committee on May 3, 2017, this bill may result in the following costs:

1. Total costs of $21.3 million ($12.4 million General Fund) in Fiscal Year (FY) 2017-18, and $42.6 million ($24.8 million General Fund) in 2018-19 and ongoing for community-based vocational day services, assuming this service option would be used by 4,200 individuals (average of 200 per regional center); and
2. Total costs of $1.1 million ($0.6 million General Fund) in FY 2017-18, and $2.2 million ($1.3 million General Fund) in 2018-19 and ongoing for tailored day services, assuming 1,000 individuals would choose this option. DDS anticipates relatively low utilization of this option because individuals will likely be encouraged to choose community-based vocational day services because of the higher provider rate.

Staff notes that federal funding is contingent upon adding community-based vocational development services as a service under the existing federal Home and Community-Based Services Waiver, referred to as the DD Waiver. Because the demonstration project in existing law was not statewide, it required securing a new waiver, a time consuming and complex process resulting in substantial time delays. By deleting the demonstration project and applying the requirements statewide, DDS can instead request to amend the existing waiver, resulting in the receipt of federal funds more quickly.

COMMENTS:

Developmental Services: In 1969, the Lanterman Developmental Disabilities Act established that individuals with developmental disabilities and their families have a right to receive the services and supports necessary in order to live independently in the community. The Lanterman Act outlines the rights of individuals with developmental disabilities, the rights of their families, how regional centers and service providers may help these individuals, and what services and supports individuals may obtain. "Developmental disability" is defined as a disability that originates before an individual reaches 18 years of age, is expected to continue indefinitely, and constitutes a significant disability for that individual. Such disabilities include: cerebral palsy, epilepsy, and autism spectrum disorder.

In California, the developmental services system is administered by the Department of Developmental Services, which operates the state's 21 regional centers. The regional center system is a statewide network that serves communities throughout the state and is responsible for providing information to and helping coordinate services and supports for individuals with developmental disabilities as well as their families.

Individuals with developmental disabilities receive services that are outlined in an IPP which is based on the individual's needs and choices and is developed by an IPP team in order to maximize opportunities for each consumer to develop relationships, be a part of community life through integration, increase control over his or her life, and obtain positive roles in the community.

Employment First Policy: In 2013 California adopted the state's Employment First Policy, which is "the policy of the state that opportunities for competitive, integrated employment shall be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities," according to Welfare and Institutions Code Section 4869(a)(1). With the authorization of AB 1041 (Chesbro), Chapter 677, Statutes of 2013, California became the 12th state to adopt an Employment First Policy.

Work services: In order to address the employment needs of regional center consumers, the Work Services Program within the developmental services system provides work and community integration opportunities through Supported Employment programs. Administered by the Department of Rehabilitation (DOR) and regional centers, Supported Employment services can be provided either through the vocational rehabilitation program or the Habilitation Services Program, and aim to assist consumers in finding competitive work in a community integrated work setting for persons with severe disabilities who need ongoing support services to learn and perform the work. Supported Employment can involve individual or group placements where a consumer might work in the community with support services and on-the-job training provided by job coaches and is paid directly by the employer. "Work Activity Program" services include paid work, work adjustment and supportive habilitation services, and are typically offered in a sheltered work shop setting, and also allow consumers to be paid at a daily per capita rate based on productivity.

Tailored Day Services: Designed to maximize a regional center consumer's specific needs and choices, tailored day services allow consumers the ability to customize day services through individualized services. Tailored day services aim to increase a consumer's integration and inclusion in the community, develop and/or maintain employment opportunities, allow for volunteer activities, and enable attendance of post-secondary education programs; in certain circumstances tailored day services support goals of self-employment and small business creation. Current law allows a consumer to choose tailored day services in lieu of any other regional center-vendored day program, look-alike day program, supported employment program, or work activity program.

Home and Community Based-Services waiver: In 1983, Congress added section 1915(c) to the Social Security Act and gave States the option to receive Home and Community-Based Services (HCBS) waivers permitting states to use Medicaid dollars to provide long-term care services in home- and community-based settings as an alternative to the use of institutional settings. A variety of services can be offered under an HCBS waiver, including personal care, case management, adult day health, habilitation, home health aide, and other services. Federal law requires state HCBS waiver programs to: demonstrate that providing waiver services won't cost more than providing services in an institution; ensure the protection of an individual's health and welfare; provide adequate and reasonable provider standards to meet the needs of the target population; and ensure that services follow an individualized and person-centered plan of care. California's HCBS waiver provides a significant source of federal funds to California; for the 2017-18 fiscal year, DDS expects approximately $1.7 billion in federal funds for the HCBS waiver, to be used to pay for services for regional center consumers and for regional center operations.

Need for this bill: According to the author's office, "[This bill] will increase opportunities for individuals with developmental disabilities to engage in job discovery and job readiness training to assist their transition to competitive, integrated employment and to support employment success, and will start to build the self-sufficiency of adults with developmental disabilities, including increased earning capacity and reduced dependence on government benefit support, by providing the necessary services to transition into more competitive, integrated employment."

PRIOR LEGISLATION:

SB 1427 (Pavley) of 2016, would have required DDS to establish a Work Transition Project to facilitate the delivery or integrated services and assist in state compliance with federal Home and Community-Based Services Waiver regulations. It was held in the Assembly Appropriations Committee.

SB 577 (Pavley), Chapter 431, Statutes of 2014, required, contingent upon the receipt of federal funding, DDS to conduct a four-year demonstration project regarding the impacts of community-based vocational development services on employment outcomes for regional center consumers and on purchase-of-service costs for working-age adults.

AB 1041 (Chesbro), Chapter 677, Statutes of 2013, created a statewide Employment First Policy and set forth requirements related to the inclusion of employment opportunities and services in a regional center consumer's IPP.

Analysis Prepared by: Kelsy Castillo / HUM. S. / (916) 319-2089 FN: 0000798

Date of Hearing: May 3, 2017

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 1607

Author:(Frazier) – As Amended Ver:April 17, 2017

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY: This bill allows a regional center consumer to request tailored day services in addition to his or her existing day program, and requires habilitation services to provide community-based vocational development services in order to increase integrated competitive employment outcomes and reduce purchase of service costs for working age adults. Specifically, this bill:

1. Allows a consumer who is in a supported employment program or work activity program, and who has the stated goal of integrated employment in his or her individual program plan (IPP), to request tailored day services in addition to his or her existing program in order to achieve that goal if certain criteria are met, including that the type, amount, and provider of tailored day services is determined through the individual program plan (IPP) process.
2. Allows an IPP to specify maximum number of hours of tailored day services to be authorized in conjunction with existing services.
3. Deletes requirements for the Department of Developmental Disabilities (DDS) to conduct a four-year demonstration project, and deletes from Legislative intent, and instead requires, the inclusion of community-based vocational development services among habilitation services statewide, without a demonstration project.

FISCAL EFFECT:

1. Total costs of $21.3 million ($12.4 million GF) in FY 2017-18, and $42.6 million ($24.8 million GF) in 2018-19 and ongoing for community-based vocational day services, assuming this service option would be used by 4,200 individuals (average of 200 per regional center).
2. Total costs of $1.1 million ($0.6 million GF) in FY 2017-18, and $2.2 million ($1.3 million GF) in 2018-19 and ongoing for tailored day services, assuming 1,000 individuals would choose this option. DDS anticipates relatively low utilization of this option because individuals will likely be encouraged to choose community-based vocational day services because of the higher provider rate.

Staff notes that federal funding is contingent upon adding community-based vocational development services as a service under the existing federal Home and Community-Based Services Waiver, referred to as the DD Waiver. Because the demonstration project in existing law was not statewide, it required securing a new waiver, a time consuming and complex process resulting in substantial time delays. By deleting the demonstration project and applying the requirements statewide, DDS can instead request to amend the existing waiver, resulting in the receipt of federal funds more quickly.

COMMENTS:

1. Purpose. According to the author’s office, “[This bill] will increase opportunities for individuals with developmental disabilities to engage in job discovery and job readiness training to assist their transition to competitive, integrated employment and to support employment success, and will start to build the self-sufficiency of adults with developmental disabilities, including increased earning capacity and reduced dependence on government benefit support, by providing the necessary services to transition into more competitive, integrated employment.”
2. Background. With the authorization of AB 1041 (Chesbro), Chapter 677, Statutes of 2013, California became the 12^th state to adopt an Employment First Policy, which states, “opportunities for competitive, integrated employment shall be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities."

When a transition-age youth or working age adult undergoes the IPP planning process, the Employment First Policy must be considered, such that integrated competitive employment, (employment in a workplace where an individual with a disability works with people without disabilities, earns at least the minimum wage, and receives the same pay, benefits, and opportunities for promotion as workers without disabilities), is intended to be the first option considered by planning teams for working individuals.

The Work Services Program within the developmental services system provides work and community integration opportunities through Supported Employment programs. Administered by the Department of Rehabilitation (DOR) and regional centers, Supported Employment services can be provided either through the vocational rehabilitation program or the Habilitation Services Program, and aim to assist consumers in finding competitive work in a community integrated work setting for persons with severe disabilities who need ongoing support services to learn and perform the work.

Tailored day services allow consumers the ability to customize day services through individualized services. Tailored day services aim to increase a consumer’s integration and inclusion in the community, develop and/or maintain employment opportunities, allow for volunteer activities, and enable attendance of post-secondary education programs. Current law allows a consumer to choose tailored day services in lieu of any other regional center-vendored day program, look-alike day program, supported employment program, or work activity program.

1. Prior Legislation. SB 1427 (Pavley), of the 2015-16 Legislative Session, would have required DDS to establish a Work Transition Project to facilitate the delivery or integrated services and assist in state compliance with federal Home and Community-Based Services Waiver regulations. That bill was held on this Committee's Suspense.

SB 577 (Pavley), Chapter 431, Statutes of 2014, required, contingent upon the receipt of federal funding, DDS to conduct a four-year demonstration project regarding the impacts of community-based vocational development services on employment outcomes for regional center consumers and on purchase-of-service costs for working-age adults.

Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081

Date of Hearing: April 4, 2017

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Blanca Rubio, Chair

ABPCA Bill Id:AB 1607 (

Author:Frazier) – As Amended Ver:March 28, 2017

SUBJECT: Developmental services: integrated competitive employment

SUMMARY: Allows a regional center consumer to request tailored day services in addition to his or her existing day program, and requires habilitation services to provide community-based vocational development services in order to increase integrated competitive employment outcomes and reduce purchase of service costs for working age adults.

Specifically, this bill:

1. Allows a consumer who is in a supported employment program or work activity program, and who has the stated goal of integrated employment in his or her individual program plan (IPP), to request tailored day services in addition to his or her existing program in order to achieve that goal if certain criteria are met, including:
   
   1. Determination of the type and amount of tailored day service allowed be made through the IPP process;
   2. Inclusion in the IPP of a description of how a consumer’s individualized choices and needs will be met to achieve integrated competitive employment, and the type and amount of services and staffing needed to meet the consumer’s specific choices and needs, as specified.
2. Allows an IPP to authorize a certain maximum number of hours of tailored day services to be authorized in conjunction with existing services, as follows:
   1. Up to 75 hours of service per calendar quarter for individuals currently receiving work activity program services, to be reduced from the individual’s work activity program hours, as specified;
   2. Up to five hours a month of tailored day services in addition to job coaching supports received on the job for individuals who are receiving group supported employment services.
3. Changes from Legislative intent to a requirement the inclusion of community-based vocational development services among habilitation services in order to increase effectiveness and opportunity to gain meaningful integrated competitive employment opportunities.
4. Deletes requirements for the Department of Developmental Disabilities (DDS) to conduct a four-year demonstration project to determine whether community based vocational development services increase integrated competitive employment outcomes and reduce purchase of service costs for working age adults, and instead makes the following components of that pilot applicable statewide:
   1. Requires habitation services provide community-based vocational development services to enhance community employment readiness and develop the necessary social skills for successful community employment;
   2. Defines “community-based vocational developmental services” as services provided to enhance community employment readiness, social skill development services necessary to obtain and maintain community employment, services to access and participate in postsecondary education or career technical education, and building a network of community and employment opportunities, as specified;
   3. Requires a plan be developed that may include: an inventory of potential employment interests; preferences for types of work environments or situations; identification of any training or education needed for the consumer’s desired job; opportunities to explore jobs or self-employment as a means to desired employment outcomes; and identification of personal or family networks that may help a consumer achieve his or her desired employment outcomes;
   4. Requires habilitation service providers and regional centers to semiannually review the plan to document progress, additional barriers, and other changes that impact the consumer’s desired employment outcome;
   5. Requires the hourly rate for community-based vocational development services be forty dollars ($40) per hour for a maximum of 75 hours per calendar quarter for all services identified and provided, and requires DDS to secure federal Medicaid funding for services;
   6. Allows hours of participation in community-based vocational development services be provided in lieu of hours of participation in other community-based day program services for up to two years, as specified, and prohibits consumer participation in community-based vocational development services from exceeding more than four years;
   7. Makes implementation of these provisions contingent on federal financial participation and once any necessary federal approvals have been obtained; and
   8. Repeals the provisions of this section on January 1, 2025, as specified.
5. Makes technical changes.

EXISTING LAW:

1. 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, and to support their integration into the mainstream life of the community. (WIC 4500, et seq.)
2. 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 throughout their lifetime. (WIC 4620)
3. Creates a process by which regional centers may “vendorize” service providers, thereby providing a path to contract for services with that provider and ensuring maximum flexibility and availability of appropriate services and support for persons with developmental disabilities. (WIC 4648)
4. Requires regional centers to provide the consumer, his or her parent, legal guardian, or other appropriate authorized representative, as specified, at least annually, a statement of services and supports the regional center purchased, for the purpose of ensuring that the services are delivered. (WIC 4648(h))
5. 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)
6. Allows a consumer to choose a tailored day service or vouchered community-based training service in lieu of any other regional center vendored day program, look-alike day program, supported employment program, or work activity program. (WIC 4688.21)
7. Establishes an Employment First Policy in California to prioritize opportunities for integrated, competitive employment for individuals with developmental disabilities, regardless of the severity of their disabilities, as specified. (WIC 4869)
8. Defines “competitive employment” to mean work in the competitive labor market that is performed on a full- or part-time basis in an integrated setting and for which the employee is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid for the same or similar work performed by individuals who are not disabled. (WIC 4868 (d)(1))
9. Defines “integrated employment” to mean the engagement of an employee with a disability in work in a setting usually found in the community, where interaction takes place between the employee and individuals without disabilities other than those who are providing services, to the same extent that individuals without disabilities in comparable positions interact with other persons. (WIC 4868 (d)(2))
10. Defines habilitation services as activities purchased for regional center consumers, including services provided under the Work Activity and Supported Employment programs to prepare and maintain consumers at their highest level of vocation functioning or to prepare them for referral to vocational rehabilitation services. (WIC 4851)
11. Establishes regulations regarding the Medicaid Home and Community-Based Services state plans. (42 CFR 441.710)

FISCAL EFFECT: Unknown.

COMMENTS:

Developmental Services: In 1969, the Lanterman Developmental Disabilities Act established that individuals with developmental disabilities and their families have a right to receive the services and supports necessary in order to live independently in the community. The Lanterman Act outlines the rights of individuals with developmental disabilities, the rights of their families, how regional centers and service providers may help these individuals, and what services and supports individuals may obtain. “Developmental disability” is defined as a disability that originates before an individual reaches 18 years of age, is expected to continue indefinitely, and constitutes a significant disability for that individual. Such disabilities include: cerebral palsy, epilepsy, and autism spectrum disorder.

In California, the developmental services system is administered by the Department of Developmental Services, which operates the state’s 21 regional centers. The regional center system is a statewide network that serves communities throughout the state and is responsible for providing information to and helping coordinate services and supports for individuals with developmental disabilities as well as their families. Regional centers however do not directly provide services to individuals. According to DDS, regional centers served just over 300,000 individuals with developmental disabilities during the 2016-17 fiscal year.

Individuals with developmental disabilities receive services that are outlined in an IPP which is based on the individual’s needs and choices and is developed by an IPP team, which includes: the consumer, his or her legally authorized representative, and one or more regional center representatives. The primary purpose of the IPP is to maximize opportunities for each consumer to develop relationships, be a part of community life through integration, increase control over his or her life, and obtain positive roles in the community. The IPP must also prioritize those services and supports that allow minors to live with their families and adults to live in the community as independently as possible.

Vendorization of community-based services: Because regional centers do not directly provide services, they instead contract with and provide funding for service providers within a particular catchment area to provide services in the community to individuals with developmental disabilities. Prior to the provision of these community-based services, providers undergo a “vendorization” process in which providers apply for contracts that enable them to serve individuals with disabilities; the vendorization process allows regional centers to verify, prior to the provision of services to consumers, that an applicant meets specific requirements and standards required to best serve the needs of individuals. The vendorization process makes a provider eligible to provide services paid for by the regional centers, but does not guarantee the regional center will refer customers. There is also nothing that precludes a vendor from being vendorized by more than one regional center, especially in instances where a provider is located close to multiple regional center catchment areas, as in the case in the Bay Area and the greater Los Angeles area.

Employment First Policy: In 2013 California adopted the state’s Employment First Policy, which is “the policy of the state that opportunities for competitive, integrated employment shall be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities,” according to Welfare and Institutions Code Section 4869(a)(1). With the authorization of AB 1041 (Chesbro), Chapter 677, Statutes of 2013, California became the 12^th state to adopt an Employment First Policy.

When a transition-age youth or working age adult undergoes the IPP planning process, the Employment First Policy must be considered, such that integrated competitive employment, meaning employment in a workplace where an individual with a disability works with people without disabilities, earns at least the minimum wage, and receives the same pay, benefits, and opportunities for promotion as workers without disabilities, is intended to be the first option considered by planning teams for working individuals. Still, individuals may choose to prioritize goals other than integrated competitive employment in their IPP plan.

Work services: In order to address the employment needs of regional center consumers, the Work Services Program within the developmental services system provides work and community integration opportunities through Supported Employment programs. Administered by the Department of Rehabilitation (DOR) and regional centers, Supported Employment services can be provided either through the vocational rehabilitation program or the Habilitation Services Program, and aim to assist consumers in finding competitive work in a community integrated work setting for persons with severe disabilities who need ongoing support services to learn and perform the work. Supported Employment can involve individual or group placements where a consumer might work in the community with support services and on-the-job training provided by job coaches and is paid directly by the employer. “Work Activity Program” services include paid work, work adjustment and supportive habilitation services, and are typically offered in a sheltered work shop setting, and also allow consumers to be paid at a daily per capita rate based on productivity.

Tailored Day Services: Designed to maximize a regional center consumer’s specific needs and choices, tailored day services allow consumers the ability to customize day services through individualized services. Tailored day services aim to increase a consumer’s integration and inclusion in the community, develop and/or maintain employment opportunities, allow for volunteer activities, and enable attendance of post-secondary education programs; in certain circumstances tailored day services support goals of self-employment and small business creation. Current law allows a consumer to choose tailored day services in lieu of any other regional center-vendored day program, look-alike day program, supported employment program, or work activity program.

Home and Community Based-Services waiver: In 1983, Congress added section 1915(c) to the Social Security Act and gave States the option to receive Home and Community-Based Services (HCBS) waivers permitting states to use Medicaid dollars to provide long-term care services in home- and community-based settings as an alternative to the use of institutional settings. A variety of services can be offered under an HCBS waiver, including personal care, case management, adult day health, habilitation, home health aide, and other services. Federal law requires state HCBS waiver programs to: demonstrate that providing waiver services won’t cost more than providing services in an institution; ensure the protection of an individual’s health and welfare; provide adequate and reasonable provider standards to meet the needs of the target population; and ensure that services follow an individualized and person-centered plan of care. California’s HCBS waiver provides a significant source of federal funds to California; for the 2017-18 fiscal year, DDS expects approximately $1.7 billion in federal funds for the HCBS waiver, to be used to pay for services for regional center consumers and for regional center operations.

In 2014, the federal Centers for Medicare and Medicaid Services (CMS) issued a new rule regarding HCBS waivers, specifically, that individuals receiving services through HCBS programs ought to be able to fully access the benefits of community living and receive services in the most integrated setting. Included in the many changes in the new regulations is the requirement that individuals with developmental disabilities be offered increased opportunities to participate in competitive, integrated employment.

In 2014, the Governor signed SB 577 (Pavley), Chapter 431, Statutes of 2014, which instructed DDS to conduct a four-year demonstration project to determine whether community-based vocational development services increase integrated competitive employment outcomes and reduce purchase of service costs for working age adults. Specifically, the pilot project would have selected up to five volunteer regional centers that reflect the geographic diversity of California to participate in the project. SB 577 defined “community-based vocational development services” as: services provided to enhance community employment readiness, social skill development services, services to use internship, apprenticeship, and volunteer opportunities, services to access and participate in postsecondary education or career technical education, and building a network of community and employment opportunities. The project was given a sunset date of January 1, 2025 and implementation was contingent upon federal financial participation; to date, the pilot project has not yet been implemented.

Need for this bill: According to the author’s office, “[This bill] will increase opportunities for individuals with developmental disabilities to engage in job discovery and job readiness training to assist their transition to competitive, integrated employment and to support employment success, and will start to build the self-sufficiency of adults with developmental disabilities, including increased earning capacity and reduced dependence on government benefit support, by providing the necessary services to transition into more competitive, integrated employment.”

Suggested amendments: In order to ensure ongoing provision of services provided for in this bill and to make a technical amendment, committee staff recommends the following amendments:

1. On page 8 of the bill, on line 1, include the following:
   

    1

competitive employment outcome, a plan shall be developed through the IPP process and

2

may include, but is not limited to, all of the following:

1. On page 9 of the bill, strike lines 23-25, inclusive.

23

(c) This section shall remain in effect only until January 1, 2025,

24

and as of that date is repealed, unless a later enacted statute, that

25

is enacted before January 1, 2025, deletes or extends that date.

PRIOR LEGISLATION:

SB 1427 (Pavley), 2016, would have required DDS to establish a Work Transition Project to facilitate the delivery or integrated services and assist in state compliance with federal Home and Community-Based Services Waiver regulations. It was held in the Assembly Appropriations Committee.

SB 577 (Pavley), Chapter 431, Statutes of 2014, required, contingent upon the receipt of federal funding, DDS to conduct a four-year demonstration project regarding the impacts of community-based vocational development services on employment outcomes for regional center consumers and on purchase-of-service costs for working-age adults.

AB 1041 (Chesbro), Chapter 677, Statutes of 2013, created a statewide Employment First Policy and set forth requirements related to the inclusion of employment opportunities and services in a regional center consumer's IPP.

REGISTERED SUPPORT / OPPOSITION:

Support

None on file.

Opposition

None on file.

Analysis Prepared by: Kelsy Castillo / HUM. S. / (916) 319-2089