AB 1610: Developmental services: regional centers.
- Session Year: 2017-2018
- House: Assembly
- Latest Version Date: 2017-04-18
(1)Existing law, the California Early Intervention Services Act, provides a statewide system of coordinated, comprehensive, family-centered, multidisciplinary, and interagency programs that are responsible for providing appropriate early intervention services and supports to all eligible infants and toddlers, as defined, and their families and requires an eligible infant or toddler receiving services under the act to have an individualized family service plan. The act requires these services to be provided pursuant to the existing regional center system under the Lanterman Developmental Disabilities Services Act.
Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services is responsible for providing various services and supports to individuals with developmental disabilities, and for ensuring the appropriateness and quality of those services and supports. Under existing law, the department contracts with regional centers to provide services and supports to persons with developmental disabilities. The services and supports to be provided to a regional center consumer are contained in an individual program plan, developed in accordance with prescribed requirements.
This bill would require regional centers to provide certain information to a consumer during the individual program plan process and to an infants or toddlers parents, legal guardian, conservator, or authorized representative at the initial individualized family service plan meeting and annually thereafter.
(2)Existing law requires each service identified on the individualized family service plan to be designated as an early intervention service, another service that the eligible infant or toddler or his or her family may receive from other state programs, or a referral to a nonrequired service that may be provided to an eligible infant or toddler or his or her family. With the exception of durable medical equipment, existing law prohibits a regional center from purchasing nonrequired services but authorizes a regional center to refer a family to a nonrequired service, as specified. Under existing law, the granting or denial of nonrequired services by a public or private agency is not subject to appeal.
This bill would additionally make an exception for respite services and other family support services to the prohibition on the purchase of nonrequired services. The bill would also make the granting or denial of durable medical equipment, respite services, and other family support services subject to appeal.
(3)Existing law states the right of individuals with developmental disabilities to make choices in their own lives requires that public or private agencies receiving state funds for the purpose of serving those persons respect the choices made by consumers or, if appropriate, their parents, legal guardian, or conservator.
This bill would make the requirement that public or private agencies receiving state funds respect the choices made by consumers, as described above, specifically applicable to choices made by an authorized representative of a consumer, if appropriate. The bill would also require a regional center to provide information in a manner that is culturally and linguistically appropriate for the consumer or, when appropriate, the consumers parents, legal guardian, conservator, or authorized representative, as specified.
(4)Existing law requires the department, in consultation with stakeholders, to develop an alternative service delivery model that provides an Individual Choice Budget for obtaining quality services and supports that provides choice and flexibility within a finite budget that, in the aggregate, reduces regional center purchase of service expenditures, reduces reliance on the General Fund, and maximizes federal financial participation. Existing law prohibits a regional center from purchasing specified services, including, among others, nonmedical therapies or social recreation activities, except as specified, and places certain restrictions on the purchase of respite services by a regional center, pending implementation of the Individual Choice Budget.
This bill would repeal the provisions relating to the Individual Choice Budget and the prohibitions and restrictions on the purchase of the above-described services. The bill would require the department, by March 31, 2018, to convene a task force to develop a purchase of services budget and allocation methodology based on consumer needs. The bill would require the task force to include the department and specified representatives, including, among others, representatives of consumers and families, as specified, regional centers, and providers. The bill would require the task force to submit a report of its recommendations on implementing the methodology to the Legislature by August 31, 2018.
(5)Existing law generally prohibits, beginning July 1, 2009, a regional center from purchasing medical or dental services for a consumer 3 years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center determines that an appeal of the denial by the consumer or family does not have merit. Existing law authorizes a regional center to pay for medical or dental services during certain periods, including, among others, while coverage is being pursued, but before a denial is made.
This bill would instead require a regional center to pay for medical or dental services identified as necessary to implement the consumers individual program plan during those periods.
(6)Existing law also requires a regional center to only purchase applied behavioral analysis (ABA) services or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers.
This bill would instead require a regional center, to the extent feasible, to facilitate a parents or caregivers participation in ABA or intensive behavioral intervention services for a minor consumer receiving those services through the provision of additional services and supports, accommodations, or both. The bill would prohibit a parents or caregivers failure to participate in ABA or intensive behavioral intervention services from being used to deny, delay, or reduce the provision of those services.
(1)Existing law, the California Early Intervention Services Act, provides a statewide system of coordinated, comprehensive, family-centered, multidisciplinary, and interagency programs that are responsible for providing appropriate early intervention services and supports to all eligible infants and toddlers, as defined, and their families and requires an eligible infant or toddler receiving services under the act to have an individualized family service plan. The act requires these services to be provided pursuant to the existing regional center system under the Lanterman Developmental Disabilities Services Act.
Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services is responsible for providing various services and supports to individuals with developmental disabilities, and for ensuring the appropriateness and quality of those services and supports. Under existing law, the department contracts with regional centers to provide services and supports to persons with developmental disabilities. The services and supports to be provided to a regional center consumer are contained in an individual program plan, developed in accordance with prescribed requirements.
This bill would require regional centers to provide certain information to a consumer during the individual program plan process and to an infants or toddlers parents, legal guardian, conservator, or authorized representative at the initial individualized family service plan meeting and annually thereafter.
(2)Existing law requires each service identified on the individualized family service plan to be designated as an early intervention service, another service that the eligible infant or toddler or his or her family may receive from other state programs, or a referral to a nonrequired service that may be provided to an eligible infant or toddler or his or her family. With the exception of durable medical equipment, existing law prohibits a regional center from purchasing nonrequired services but authorizes a regional center to refer a family to a nonrequired service, as specified. Under existing law, the granting or denial of nonrequired services by a public or private agency is not subject to appeal.
This bill would additionally make an exception for respite services and other family support services to the prohibition on the purchase of nonrequired services. The bill would also make the granting or denial of durable medical equipment, respite services, and other family support services subject to appeal.
(2)(3)Existing law states the right of individuals with developmental disabilities to make choices in their own lives requires that public or private agencies receiving state funds for the purpose of serving those persons respect the choices made by consumers or, if appropriate, their parents, legal guardian, or conservator.
This bill would make the requirement that public or private agencies receiving state funds respect the choices made by consumers, as described above, specifically applicable to choices made by an authorized representative of a consumer, if appropriate. The bill would also require a regional center to provide information in a manner that is culturally and linguistically appropriate for the consumer or, when appropriate, the consumers parents, legal guardian, conservator, or authorized representative, as specified.
(3)(4)Existing law requires the department, in consultation with stakeholders, to develop an alternative service delivery model that provides an Individual Choice Budget for obtaining quality services and supports that provides choice and flexibility within a finite budget that, in the aggregate, reduces regional center purchase of service expenditures, reduces reliance on the General Fund, and maximizes federal financial participation. Existing law prohibits a regional center from purchasing specified services services, including, among others, nonmedical therapies or social recreation activities, except as specified, and places certain restrictions on the purchase of respite services by a regional center, pending implementation of the Individual Choice Budget, except as specified. Budget.
This bill would require the department, by March 31, 2018, to provide a written report to the Legislature regarding the status of the Individual Choice Budget, and a projected timeframe for fully reinstating the suspended and restricted services. repeal the provisions relating to the Individual Choice Budget and the prohibitions and restrictions on the purchase of the above-described services. The bill would require the department, by March 31, 2018, to convene a task force to develop a purchase of services budget and allocation methodology based on consumer needs. The bill would require the task force to include the department and specified representatives, including, among others, representatives of consumers and families, as specified, regional centers, and providers. The bill would require the task force to submit a report of its recommendations on implementing the methodology to the Legislature by August 31, 2018.
(4)(5)Existing law generally provides, prohibits, beginning July 1, 2009, that a regional center shall not purchase from purchasing medical or dental services for a consumer 3 years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center determines that an appeal of the denial by the consumer or family does not have merit. Existing law authorizes a regional centers center to pay for medical or dental services during certain periods, including, among others, while coverage is being pursued, but before a denial is made.
This bill would instead require a regional centers center to pay for medical or dental services identified as necessary to implement the consumers individual program plan during those periods.
(5)(6)Existing law also requires a regional center to only purchase applied behavioral analysis (ABA) services or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers.
This bill would instead require a regional centers, center, to the extent feasible, to facilitate a parents or caregivers participation in ABA or intensive behavioral intervention services for a minor consumer receiving those services through the provision of additional services and supports, accommodations, or both. The bill would prohibit a parents or caregivers failure to participate in ABA or intensive behavioral intervention services from being used to deny, delay, or reduce the provision of those services.
(1)Existing law, the California Early Intervention Services Act, provides a statewide system of coordinated, comprehensive, family-centered, multidisciplinary, and interagency programs that are responsible for providing appropriate early intervention services and supports to all eligible infants and toddlers, as defined, and their families and requires an eligible infant or toddler receiving services under the act to have an individualized family service plan. The act requires these services to be provided pursuant to the existing regional center system under the Lanterman Developmental Disabilities Services Act.
Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services is responsible for providing various services and supports to individuals with developmental disabilities, and for ensuring the appropriateness and quality of those services and supports. Under existing law, the department contracts with regional centers to provide services and supports to persons with developmental disabilities. The services and supports to be provided to a regional center consumer are contained in an individual program plan (IPP), plan, developed in accordance with prescribed requirements.
This bill would require regional centers to provide certain information, including a statement of services and supports purchased and information about the appeal and complaint process, to a consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, in threshold languages, as defined. information to a consumer during the individual program plan process and to an infants or toddlers parents, legal guardian, conservator, or authorized representative at the initial individualized family service plan meeting and annually thereafter.
(2)Existing law states the right of individuals with developmental disabilities to make choices in their own lives requires that public or private agencies receiving state funds for the purpose of serving those persons respect the choices made by consumers or, if appropriate, their parents, legal guardian, or conservator.
This bill would make the requirement that public or private agencies receiving state funds respect the choices made by consumers, as described above, specifically applicable to choices made by an authorized representative of a consumer, if appropriate. The bill would also require a regional center to provide information in a manner that is culturally and linguistically appropriate for the consumer or, when appropriate, the consumers parents, legal guardian, conservator, or authorized representative, as specified.
(3)Existing law requires the department, in consultation with stakeholders, to develop an alternative service delivery model that provides an Individual Choice Budget for obtaining quality services and supports that provides choice and flexibility within a finite budget that, in the aggregate, reduces regional center purchase of service expenditures, reduces reliance on the General Fund, and maximizes federal financial participation. Existing law prohibits a regional center from purchasing specified services pending implementation of the Individual Choice Budget, except as specified.
This bill would require the department, by March 31, 2018, to provide a written report to the Legislature regarding the status of the Individual Choice Budget, and a projected timeframe for fully reinstating the suspended and restricted services.
(4)Existing law generally provides, beginning July 1, 2009, that a regional center shall not purchase medical or dental services for a consumer 3 years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center determines that an appeal of the denial by the consumer or family does not have merit. Existing law authorizes regional centers to pay for medical or dental services during certain periods, including, among others, while coverage is being pursued, but before a denial is made.
This bill would instead require regional centers to pay for medical or dental services identified as necessary to implement the consumers individual program plan during those periods.
(5)Existing law also requires a regional center to only purchase applied behavioral analysis (ABA) services or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers.
This bill would instead require regional centers, to the extent feasible, to facilitate a parents or caregivers participation in ABA or intensive behavioral intervention services for a minor consumer receiving those services through the provision of additional services and supports, accommodations, or both. The bill would prohibit a parents or caregivers failure to participate in ABA or intensive behavioral intervention services from being used to deny, delay, or reduce the provision of those services.
Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services is responsible for providing various services and supports to individuals with developmental disabilities, and for ensuring the appropriateness and quality of those services and supports. Under existing law, the department contracts with regional centers to provide services and supports to persons with developmental disabilities. The services and supports to be provided to a regional center consumer are contained in an individual program plan (IPP), developed in accordance with prescribed requirements.
This bill would require regional centers to provide certain information, including a statement of services and supports purchased and information about the appeal and complaint process, to a consumer or his or her parents, legal guardian, conservator, or authorized representative, or both, in threshold languages, as defined.
(a)An eligible infant or toddler shall have an individualized family service plan. The individualized family service plan shall be used in place of an individualized education program required pursuant to Sections 4646 and 4646.5 of the Welfare and Institutions Code, the individualized program plan required pursuant to Section 56340 of the Education Code, or any other applicable service plan.
(b)For an infant or toddler who has been evaluated for the first time, a meeting to share the results of the evaluation, to determine eligibility and, for children who are eligible, to develop the initial individualized family service plan shall be conducted within 45 calendar days of receipt of the written referral. Evaluation results and determination of eligibility may be shared in a meeting with the family prior to the individualized family service plan. Written parent consent to evaluate and assess shall be obtained within the 45-day timeline. A regional center, local educational agency, or the designee of one of those entities shall initiate and conduct this meeting. Families shall be afforded the opportunity to participate in all decisions regarding eligibility and services. During intake and assessment, but no later than the individualized family service plan meeting, the parents, legal guardian, or conservator shall provide copies of any health benefit cards under which the consumer is eligible to receive health benefits, including, but not limited to, private health insurance, a health care service plan, Medi-Cal, Medicare, and TRICARE. If the individual, or, when appropriate, the parents, legal guardians, or conservators, have no such benefits, the regional center shall not use that fact to negatively impact the services that the individual may or may not receive from the regional center.
(c)(1)Parents shall be fully informed of their rights, including the right to invite another person, including a family member or an advocate or peer parent, or any or all of them, to accompany them to any or all individualized family service plan meetings. With parental consent, a referral shall be made to the local family resource center or network.
(2)At the beginning of During the initial individualized family service plan meeting and at least annually thereafter at the beginning of during an individualized family service plan meeting or at a biannual review of the individualized family service plan, the regional center shall provide the infants or toddlers parents, legal guardian, conservator, or authorized representative written information about the appeal procedure established under Chapter 7 (commencing with Section 4700) of Division 4.5 of the Welfare and Institutions Code and the complaint process described in Section 52170 of Title 17 of the California Code of Regulations.
(d)The individualized family service plan shall be in writing and shall address all of the following:
(1)A statement of the infants or toddlers present levels of physical development including vision, hearing, and health status, cognitive development, communication development, social and emotional development, and adaptive developments.
(2)With the concurrence of the family, a statement of the familys concerns, priorities, and resources related to meeting the special developmental needs of the eligible infant or toddler.
(3)A statement of the major outcomes expected to be achieved for the infant or toddler and family where services for the family are related to meeting the special developmental needs of the eligible infant or toddler.
(4)The criteria, procedures, and timelines used to determine the degree to which progress toward achieving the outcomes is being made and whether modifications or revisions are necessary.
(5)(A)A statement of the specific early intervention services necessary to meet the unique needs of the infant or toddler as identified in paragraph (3), including, but not limited to, the frequency, intensity, location, duration, and method of delivering the services, and ways of providing services in natural generic environments, including group training for parents on behavioral intervention techniques in lieu of some or all of the in-home parent training component of the behavior intervention services, and purchase of neighborhood preschool services and needed qualified personnel in lieu of infant development programs.
(B)Effective July 1, 2009, at the time of development, review, or modification of an infants or toddlers individualized family service plan, the regional center shall consider both of the following:
(i)The use of group training for parents on behavior intervention techniques, in lieu of some or all of the in-home parent training component of the behavior intervention services.
(ii)The purchase of neighborhood preschool services and needed qualified personnel, in lieu of infant development programs.
(6)A statement of the agency responsible for providing the identified services.
(7)The name of the service coordinator who shall be responsible for facilitating implementation of the plan and coordinating with other agencies and persons.
(8)The steps to be taken to ensure transition of the infant or toddler upon reaching three years of age to other appropriate services. These may include, as appropriate, special education or other services offered in natural environments.
(9)The projected dates for the initiation of services in paragraph (5) and the anticipated duration of those services.
(e)Each service identified on the individualized family service plan shall be designated as one of three types:
(1)An early intervention service, as defined in subsection (4) of Section 1432 of Title 20 of the United States Code, and applicable regulations, that is provided or purchased through the regional center, local educational agency, or other participating agency. The State Department of Health Care Services and the State Department of Social Services shall provide services in accordance with state and federal law and applicable regulations, and up to the level of funding as appropriated by the Legislature. Early intervention services identified on an individualized family service plan that exceed the funding, statutory, and regulatory requirements of these departments shall be provided or purchased by regional centers or local educational agencies under subdivisions (b) and (c) of Section 95014. The State Department of Health Care Services and the State Department of Social Services shall not be required to provide early intervention services over their existing funding, statutory, and regulatory requirements.
(2)Another service, other than those specified in paragraph (1), that the eligible infant or toddler or his or her family may receive from other state programs, subject to the eligibility standards of those programs.
(3)A referral to a nonrequired service that may be provided to an eligible infant or toddler or his or her family. Nonrequired services are those services that are not defined as early intervention services or do not relate to meeting the special developmental needs of an eligible infant or toddler related to the disability, but that may be helpful to the family. With the exception of durable medical equipment, respite services, or other family support services, regional centers shall not purchase nonrequired services, but may refer a family to a nonrequired service that may be available to an eligible infant or toddler or his or her family. The granting or denial of nonrequired services, with the exception of durable medical equipment, respite services, or other family support services, by a public or private agency is not subject to appeal under this title.
(f)An annual review, and other periodic reviews, of the individualized family service plan for an infant or toddler and the infants or toddlers family shall be conducted to determine the degree of progress that is being made in achieving the outcomes specified in the plan and whether modification or revision of the outcomes or services is necessary. The frequency, participants, purpose, and required processes for annual and periodic reviews shall be consistent with the statutes and regulations under Part C of the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.) and this title, and shall be specified in regulations adopted pursuant to Section 95028. At the time of the review, the parents, legal guardian, or conservator shall provide copies of any health benefit cards under which the consumer is eligible to receive health benefits, including, but not limited to, private health insurance, a health care service plan, Medi-Cal, Medicare, and TRICARE. If the parents, legal guardian, or conservator have no such benefit cards, the regional center shall not use that fact to negatively impact the services that the individual may or may not receive from the regional center.
(g)(1)A regional center shall communicate and provide written materials in the familys native language during the assessment, evaluation, and planning process for the individualized family service plan, as required by Part C of the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.) and implementing regulations, and as required by Sections 11135 to 11139.7, inclusive, and implementing regulations, including providing alternative communication services pursuant to Sections 98210 to 98211, inclusive, of Title 22 of the California Code of Regulations.
(2)The familys native language shall be documented in the individualized family service plan.
SEC. 2.Section 95021 of the Government Code is amended to read:95021.(a)Notwithstanding any law or regulation to the contrary, any vendor who provides applied behavioral analysis (ABA) services or intensive behavioral intervention services, or both, as defined in subdivision (d), shall:
(1)Conduct a behavioral assessment of each infant or toddler to whom the vendor provides these services.
(2)Design an intervention plan that shall include the service type, number of hours, and parent participation recommended to achieve the goals and objectives of the infant or toddler, as set forth in his or her individualized family service plan (IFSP). The intervention plan shall also set forth the frequency at which the progress of the infant or toddler shall be evaluated and reported.
(3)Provide a copy of the intervention plan to the regional center for review and consideration by the planning team members.
(b)Notwithstanding any law or regulation to the contrary, regional centers shall:
(1)Only purchase ABA services or intensive behavioral intervention services that reflect evidence-based practices, promote positive social behaviors, and ameliorate behaviors that interfere with learning and social interactions.
(2)(A)To the extent feasible, facilitate a parents or caregivers participation in ABA or intensive behavioral intervention services for an infant or toddler consumer receiving those services through the provision of additional services and supports, accommodations, or both.
(B)A parents or caregivers failure to participate in ABA or intensive behavioral intervention services shall not be used to deny, delay, or reduce the provision of those services.
(3)Not purchase either ABA or intensive behavioral intervention services for purposes of providing respite, day care, or school services.
(4)Discontinue purchasing ABA or intensive behavioral intervention services for an infant or toddler when his or her treatment goals and objectives, as described under subdivision (a), are achieved. ABA or intensive behavioral intervention services shall not be discontinued until the goals and objectives are reviewed and updated as required in paragraph (5) and shall be discontinued only if those updated treatment goals and objectives do not require ABA or intensive behavioral intervention services.
(5)For each infant or toddler, evaluate the vendors intervention plan and number of service hours for ABA or intensive behavioral intervention no less than every six months, consistent with evidence-based practices. If necessary, the intervention plans treatment goals and objectives shall be updated and revised.
(6)Not reimburse a parent for participating in a behavioral services treatment program.
(c)For infants and toddlers receiving ABA or behavioral intervention services on July 1, 2009, as part of their IFSP, subdivision (b) shall apply on August 1, 2009.
(d)For purposes of this section the following definitions shall apply:
(1)Applied behavioral analysis means the design, implementation, and evaluation of systematic instructional and environmental modifications to promote positive social behaviors and reduce or ameliorate behaviors that interfere with learning and social interaction.
(2)Intensive behavioral intervention means any form of applied behavioral analysis that is comprehensive, designed to address all domains of functioning, and provided in multiple settings for no more than 40 hours per week, across all settings, depending on the individuals needs and progress. Interventions can be delivered in a one-to-one ratio or small group format, as appropriate.
(3)Evidence-based practice means a decisionmaking process that integrates the best available scientifically rigorous research, clinical expertise, and individuals characteristics. Evidence-based practice is an approach to treatment rather than a specific treatment. Evidence-based practice promotes the collection, interpretation, integration, and continuous evaluation of valid, important, and applicable individual- or family-reported, clinically-observed, and research-supported evidence. The best available evidence, matched to infant or toddler circumstances and preferences, is applied to ensure the quality of clinical judgments and facilitates the most cost-effective care.
(4)Parent has the same meaning as defined in paragraph (15) of subdivision (b) of Section 52000 of Title 17 of the California Code of Regulations.
(5)Parent participation shall include, but shall not be limited to, the following meanings:
(A)Completion of group instruction on the basics of behavior intervention.
(B)Implementation of intervention strategies according to the intervention plan.
(C)If needed, collection of data on behavioral strategies and submission of those data to the provider for incorporation into progress reports.
(D)Participation in any needed clinical meetings.
(E)Purchase of suggested behavior modification materials or community involvement if a reward system is used.
SEC. 3.Section 4502.1 of the Welfare and Institutions Code is amended to read:4502.1.(a)The right of individuals with developmental disabilities to make choices in their own lives requires that all public or private agencies receiving state funds for the purpose of serving persons with developmental disabilities, including, but not limited to, regional centers, shall respect the choices made by consumers or, if appropriate, their parents, legal guardian, conservator, or authorized representative. Those public or private agencies shall provide consumers with opportunities to exercise decisionmaking skills in any aspect of day-to-day living and shall provide consumers with relevant information in an understandable form to aid the consumer in making his or her choice.
(b)A regional center shall provide information in a manner that is culturally and linguistically appropriate for the consumer, or, when appropriate, the consumers parents, legal guardian, conservator, or authorized representative, including providing alternative communication services, as required by Article 9.5 (commencing with Section 11135) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code and the regulations implementing that article.
SEC. 4.Section 4646.45 is added to the Welfare and Institutions Code, immediately following Section 4646.4, to read:4646.45.At the time of development of the initial individual program plan, as described in subdivision (c) of Section 4646, and at least annually thereafter at the beginning of during an individual program plan meeting or at an annual review of the individual program plan, the regional center shall provide to the consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative, written information describing the process for obtaining both of the following:
(a)The exception described in subdivision (d) of Section 4648.35.
(b)The exemption described in subdivision (d) of Section 4648.55.
SEC. 5.Section 4646.5 of the Welfare and Institutions Code is amended to read:4646.5.(a)The planning process for the individual program plan described in Section 4646 shall include all of the following:
(1)Gathering information and conducting assessments to determine the life goals, capabilities and strengths, preferences, barriers, and concerns or problems of the person with developmental disabilities. For children with developmental disabilities, this process should include a review of the strengths, preferences, and needs of the child and the family unit as a whole. Assessments shall be conducted by qualified individuals and performed in natural environments whenever possible. Information shall be taken from the consumer, his or her parents and other family members, his or her friends, advocates, authorized representative, if applicable, providers of services and supports, and other agencies. The assessment process shall reflect awareness of, and sensitivity to, the lifestyle and cultural background of the consumer and the family.
(2)A statement of goals, based on the needs, preferences, and life choices of the individual with developmental disabilities, and a statement of specific, time-limited objectives for implementing the persons goals and addressing his or her needs. These objectives shall be stated in terms that allow measurement of progress or monitoring of service delivery. These goals and objectives should maximize opportunities for the consumer to develop relationships, be part of community life in the areas of community participation, housing, work, school, and leisure, increase control over his or her life, acquire increasingly positive roles in community life, and develop competencies to help accomplish these goals.
(3)When developing individual program plans for children, regional centers shall be guided by the principles, process, and services and support parameters set forth in Section 4685.
(4)When developing an individual program plan for a transition age youth or working age adult, the planning team shall consider the Employment First Policy described in Chapter 14 (commencing with Section 4868).
(5)A schedule of the type and amount of services and supports to be purchased by the regional center or obtained from generic agencies or other resources in order to achieve the individual program plan goals and objectives, and identification of the provider or providers of service responsible for attaining each objective, including, but not limited to, vendors, contracted providers, generic service agencies, and natural supports. The individual program plan shall specify the approximate scheduled start date for services and supports and shall contain timelines for actions necessary to begin services and supports, including generic services. In addition to the requirements of subdivision (h) of Section 4646, each regional center shall offer, and upon request provide, a written copy of the individual program plan to the consumer, and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of their request in a threshold language, as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations.
(6)At the time of development of the initial individual program plan, as described in subdivision (c) of Section 4646, and at least annually thereafter at the beginning of an individual program plan meeting or at an annual review of the individual program plan, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative a list of services provided purchased by the regional center and written information about the appeal procedure established under Chapter 7 (commencing with Section 4700) and the complaint process described in Section 4731.
(7)At the end of the individual program plan meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative a written list of agreed-upon services and supports, including the amount and anticipated start date, and a list of any requested services and supports for which final agreement has not yet been reached and for which there will be a subsequent program plan meeting pursuant to subdivision (f) of Section 4646.
(8)When agreed to by the consumer, the parents, legally appointed guardian, or authorized representative of a minor consumer, or the legally appointed conservator of an adult consumer or the authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, and subdivision (e) of Section 4705, a review of the general health status of the adult or child, including medical, dental, and mental health needs, shall be conducted. This review shall include a discussion of current medications, any observed side effects, and the date of the last review of the medication. Service providers shall cooperate with the planning team to provide any information necessary to complete the health status review. If any concerns are noted during the review, referrals shall be made to regional center clinicians or to the consumers physician, as appropriate. Documentation of health status and referrals shall be made in the consumers record by the service coordinator.
(9)(A)The development of a transportation access plan for a consumer when all of the following conditions are met:
(i)The regional center is purchasing private, specialized transportation services or services from a residential, day, or other provider, excluding vouchered service providers, to transport the consumer to and from day or work services.
(ii)The planning team has determined that a consumers community integration and participation could be safe and enhanced through the use of public transportation services.
(iii)The planning team has determined that generic transportation services are available and accessible.
(B)To maximize independence and community integration and participation, the transportation access plan shall identify the services and supports necessary to assist the consumer in accessing public transportation and shall comply with Section 4648.35. These services and supports may include, but are not limited to, mobility training services and the use of transportation aides. Regional centers are encouraged to coordinate with local public transportation agencies.
(10)A schedule of regular periodic review and reevaluation to ascertain that planned services have been provided, that objectives have been fulfilled within the times specified, and that consumers and families are satisfied with the individual program plan and its implementation.
(b)For all active cases, individual program plans shall be reviewed and modified by the planning team, through the process described in Section 4646, as necessary, in response to the persons achievement or changing needs, and no less often than once every three years. If the consumer or, where appropriate, the consumers parents, legal guardian, authorized representative, or conservator requests an individual program plan review, the individual program shall be reviewed within 30 days after the request is submitted.
(c)(1)The department, with the participation of representatives of a statewide consumer organization, the Association of Regional Center Agencies, an organized labor organization representing service coordination staff, and the state council shall prepare training material and a standard format and instructions for the preparation of individual program plans, which embody an approach centered on the person and family.
(2)Each regional center shall use the training materials and format prepared by the department pursuant to paragraph (1).
(3)The department shall biennially review a random sample of individual program plans at each regional center to ensure that these plans are being developed and modified in compliance with Section 4646 and this section.
SEC. 6.Section 4648.5 of the Welfare and Institutions Code is repealed.SEC. 7.Section 4648.6 of the Welfare and Institutions Code is repealed.SEC. 8.Section 4648.7 is added to the Welfare and Institutions Code, to read:4648.7.(a)By March 31, 2018, the department shall convene a task force to develop a purchase of services budget and allocation methodology based on consumer needs.
(b)The task force shall include the department and stakeholders, including representatives of all of the following:
(1)Consumers and families that reflect the ethnic and language diversity of regional center consumers.
(2)Regional centers.
(3)Advocates.
(4)Providers.
(5)The protection and advocacy agency, as defined in Section 4900.
(6)The State Council on Developmental Disabilities, as described in Section 4520.
(c)(1)(A)The task force shall submit a report of its recommendations on implementing the methodology described in subdivision (a) to the Legislature by August 31, 2018.
(B)A report submitted pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code.
(2)The requirement for submitting a report imposed under paragraph (1) is inoperative on January 1, 2022, pursuant to Section 10231.5 of the Government Code.
SEC. 9.Section 4659 of the Welfare and Institutions Code is amended to read:4659.(a)Except as otherwise provided in subdivision (b) or (e), the regional center shall identify and pursue all possible sources of funding for consumers receiving regional center services. These sources shall include, but not be limited to, both of the following:
(1)Governmental or other entities or programs required to provide or pay the cost of providing services, including Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, school districts, and federal supplemental security income and the state supplementary program.
(2)Private entities, to the maximum extent they are liable for the cost of services, aid, insurance, or medical assistance to the consumer.
(b)Any revenues collected by a regional center pursuant to this section shall be applied against the cost of services prior to use of regional center funds for those services. This revenue shall not result in a reduction in the regional centers purchase of services budget, except as it relates to federal supplemental security income and the state supplementary program.
(c)Effective July 1, 2009, notwithstanding any other law or regulation, regional centers shall not purchase any service that would otherwise be available from Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, In-Home Support Services, California Childrens Services, private insurance, or a health care service plan when a consumer or a family meets the criteria of this coverage but chooses not to pursue that coverage. If, on July 1, 2009, a regional center is purchasing that service as part of a consumers individual program plan (IPP), the prohibition shall take effect on October 1, 2009.
(d)(1)Effective July 1, 2009, notwithstanding any other law or regulation, a regional center shall not purchase medical or dental services for a consumer three years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center determines that an appeal by the consumer or family of the denial does not have merit. If, on July 1, 2009, a regional center is purchasing the service as part of a consumers IPP, this provision shall take effect on August 1, 2009. At the time of development of the initial individual program plan, as described in subdivision (c) of Section 4646, and at least annually thereafter at the beginning of during an individual program plan meeting or at an annual review of the individual program plan, the regional center shall provide a written description of the denial documentation consumers and families are required to provide pursuant to this paragraph. In order to ensure that there are no gaps in the provision of services and supports, regional centers shall pay for medical or dental services identified, pursuant to subdivision (d) of Section 4646 and paragraph (5) of subdivision (a) of Section 4646.5, as necessary to implement the consumers individual program plan during the following periods:
(A)While coverage is being pursued, but before a denial is made.
(B)Pending a final administrative decision on the administrative appeal if the family has provided to the regional center a verification that an administrative appeal is being pursued.
(C)Until the commencement of services by Medi-Cal, private insurance, or a health care service plan.
(2)When necessary, the consumer or family may receive assistance from the regional center, the Clients Rights Advocate funded by the department, or the state council in pursuing these appeals.
(e)This section shall not impose any additional liability on the parents of children with developmental disabilities, or to restrict eligibility for, or deny services to, any individual who qualifies for regional center services but is unable to pay.
(f)In order to best utilize generic resources, federally funded programs, and private insurance programs for individuals with developmental disabilities, the department and regional centers shall engage in the following activities:
(1)Within existing resources, the department shall provide training to regional centers, no less than once every two years, in the availability and requirements of generic, federally funded and private programs available to persons with developmental disabilities, including, but not limited to, eligibility requirements, the application process and covered services, and the appeal process.
(2)Regional centers shall disseminate information and training to all service coordinators regarding the availability and requirements of generic, federally funded, and private insurance programs on the local level.
SEC. 10.Section 4686.2 of the Welfare and Institutions Code is amended to read:4686.2.(a)Notwithstanding any law or regulation to the contrary, any vendor who provides applied behavioral analysis (ABA) services, or intensive behavioral intervention services or both, as defined in subdivision (d), shall:
(1)Conduct a behavioral assessment of each consumer to whom the vendor provides these services.
(2)Design an intervention plan that shall include the service type, number of hours, and parent participation recommended to achieve the consumers goals and objectives, as set forth in the consumers individual program plan (IPP) or individualized family service plan (IFSP). The intervention plan shall also set forth the frequency at which the consumers progress shall be evaluated and reported.
(3)Provide a copy of the intervention plan to the regional center for review and consideration by the planning team members.
(b)Notwithstanding any law or regulation to the contrary, regional centers shall:
(1)Only purchase ABA services or intensive behavioral intervention services that reflect evidence-based practices, promote positive social behaviors, and ameliorate behaviors that interfere with learning and social interactions.
(2)(A)To the extent feasible, facilitate a parents or caregivers participation in ABA or intensive behavioral intervention services for a minor consumer receiving those services through the provision of additional services and supports, accommodations, or both.
(B)A parents or caregivers failure to participate in ABA or intensive behavioral intervention services shall not be used to deny, delay, or reduce the provision of those services.
(3)Not purchase either ABA or intensive behavioral intervention services for purposes of providing respite, day care, or school services.
(4)Discontinue purchasing ABA or intensive behavioral intervention services for a consumer when the consumers treatment goals and objectives, as described under subdivision (a), are achieved. ABA or intensive behavioral intervention services shall not be discontinued until the goals and objectives are reviewed and updated as required in paragraph (5) and shall be discontinued only if those updated treatment goals and objectives do not require ABA or intensive behavioral intervention services.
(5)For each consumer, evaluate the vendors intervention plan and number of service hours for ABA or intensive behavioral intervention no less than every six months, consistent with evidence-based practices. If necessary, the intervention plans treatment goals and objectives shall be updated and revised.
(6)Not reimburse a parent for participating in a behavioral services treatment program.
(c)For consumers receiving ABA or behavioral intervention services on July 1, 2009, as part of their IPP or IFSP, subdivision (b) shall apply on August 1, 2009.
(d)For purposes of this section the following definitions shall apply:
(1)Applied behavioral analysis means the design, implementation, and evaluation of systematic instructional and environmental modifications to promote positive social behaviors and reduce or ameliorate behaviors that interfere with learning and social interaction.
(2)Intensive behavioral intervention means any form of applied behavioral analysis that is comprehensive, designed to address all domains of functioning, and provided in multiple settings for no more than 40 hours per week, across all settings, depending on the individuals needs and progress. Interventions can be delivered in a one-to-one ratio or small group format, as appropriate.
(3)Evidence-based practice means a decisionmaking process that integrates the best available scientifically rigorous research, clinical expertise, and individuals characteristics. Evidence-based practice is an approach to treatment rather than a specific treatment. Evidence-based practice promotes the collection, interpretation, integration, and continuous evaluation of valid, important, and applicable individual- or family-reported, clinically-observed, and research-supported evidence. The best available evidence, matched to consumer circumstances and preferences, is applied to ensure the quality of clinical judgments and facilitates the most cost-effective care.
(4)Parent participation shall include, but shall not be limited to, the following meanings:
(A)Completion of group instruction on the basics of behavior intervention.
(B)Implementation of intervention strategies, according to the intervention plan.
(C)If needed, collection of data on behavioral strategies and submission of those data to the provider for incorporation into progress reports.
(D)Participation in any needed clinical meetings.
(E)Purchase of suggested behavior modification materials or community involvement if a reward system is used.
SEC. 11.Section 4686.5 of the Welfare and Institutions Code is repealed.(a)An eligible infant or toddler shall have an individualized family service plan. The individualized family service plan shall be used in place of an individualized education program required pursuant to Sections 4646 and 4646.5 of the Welfare and Institutions Code, the individualized program plan required pursuant to Section 56340 of the Education Code, or any other applicable service plan.
(b)For an infant or toddler who has been evaluated for the first time, a meeting to share the results of the evaluation, to determine eligibility and, for children who are eligible, to develop the initial individualized family service plan shall be conducted within 45 calendar days of receipt of the written referral. Evaluation results and determination of eligibility may be shared in a meeting with the family prior to the individualized family service plan. Written parent consent to evaluate and assess shall be obtained within the 45-day timeline. A regional center, local educational agency, or the designee of one of those entities shall initiate and conduct this meeting. Families shall be afforded the opportunity to participate in all decisions regarding eligibility and services. During intake and assessment, but no later than the individualized family service plan meeting, the parents, legal guardian, or conservator shall provide copies of any health benefit cards under which the consumer is eligible to receive health benefits, including, but not limited to, private health insurance, a health care service plan, Medi-Cal, Medicare, and TRICARE. If the individual, or, when appropriate, the parents, legal guardians, or conservators, have no such benefits, the regional center shall not use that fact to negatively impact the services that the individual may or may not receive from the regional center.
(c)(1)Parents shall be fully informed of their rights, including the right to invite another person, including a family member or an advocate or peer parent, or any or all of them, to accompany them to any or all individualized family service plan meetings. With parental consent, a referral shall be made to the local family resource center or network.
(2)At the beginning of the initial individualized family service plan meeting and at least annually thereafter at the beginning of an individualized family service plan meeting or at a biannual review of the individualized family services service plan, the regional center shall provide the infants or toddlers parents, legal guardian, conservator, or authorized representative written information about the appeal procedure established under Chapter 7 (commencing with Section 4700) of Division 4.5 of the Welfare and Institutions Code and the complaint process described in Section 52170 of Title 17 of the California Code of Regulations.
(d)The individualized family service plan shall be in writing and shall address all of the following:
(1)A statement of the infants or toddlers present levels of physical development including vision, hearing, and health status, cognitive development, communication development, social and emotional development, and adaptive developments.
(2)With the concurrence of the family, a statement of the familys concerns, priorities, and resources related to meeting the special developmental needs of the eligible infant or toddler.
(3)A statement of the major outcomes expected to be achieved for the infant or toddler and family where services for the family are related to meeting the special developmental needs of the eligible infant or toddler.
(4)The criteria, procedures, and timelines used to determine the degree to which progress toward achieving the outcomes is being made and whether modifications or revisions are necessary.
(5)(A)A statement of the specific early intervention services necessary to meet the unique needs of the infant or toddler as identified in paragraph (3), including, but not limited to, the frequency, intensity, location, duration, and method of delivering the services, and ways of providing services in natural generic environments, including group training for parents on behavioral intervention techniques in lieu of some or all of the in-home parent training component of the behavior intervention services, and purchase of neighborhood preschool services and needed qualified personnel in lieu of infant development programs.
(B)Effective July 1, 2009, at the time of development, review, or modification of an infants or toddlers individualized family service plan, the regional center shall consider both of the following:
(i)The use of group training for parents on behavior intervention techniques, in lieu of some or all of the in-home parent training component of the behavior intervention services.
(ii)The purchase of neighborhood preschool services and needed qualified personnel, in lieu of infant development programs.
(6)A statement of the agency responsible for providing the identified services.
(7)The name of the service coordinator who shall be responsible for facilitating implementation of the plan and coordinating with other agencies and persons.
(8)The steps to be taken to ensure transition of the infant or toddler upon reaching three years of age to other appropriate services. These may include, as appropriate, special education or other services offered in natural environments.
(9)The projected dates for the initiation of services in paragraph (5) and the anticipated duration of those services.
(e)Each service identified on the individualized family service plan shall be designated as one of three types:
(1)An early intervention service, as defined in subsection (4) of Section 1432 of Title 20 of the United States Code, and applicable regulations, that is provided or purchased through the regional center, local educational agency, or other participating agency. The State Department of Health Care Services and the State Department of Social Services shall provide services in accordance with state and federal law and applicable regulations, and up to the level of funding as appropriated by the Legislature. Early intervention services identified on an individualized family service plan that exceed the funding, statutory, and regulatory requirements of these departments shall be provided or purchased by regional centers or local educational agencies under subdivisions (b) and (c) of Section 95014. The State Department of Health Care Services and the State Department of Social Services shall not be required to provide early intervention services over their existing funding, statutory, and regulatory requirements.
(2)Another service, other than those specified in paragraph (1), which that the eligible infant or toddler or his or her family may receive from other state programs, subject to the eligibility standards of those programs.
(3)A referral to a nonrequired service that may be provided to an eligible infant or toddler or his or her family. Nonrequired services are those services that are not defined as early intervention services or do not relate to meeting the special developmental needs of an eligible infant or toddler related to the disability, but that may be helpful to the family. The granting or denial of nonrequired services by a public or private agency is not subject to appeal under this title. Notwithstanding any other provision of law or regulation to the contrary, effective July 1, 2009, with With the exception of durable medical equipment, respite services, or other family support services, regional centers shall not purchase nonrequired services, but may refer a family to a nonrequired service that may be available to an eligible infant or toddler or his or her family. The granting or denial of nonrequired services, with the exception of durable medical equipment, respite services, or other family support services, by a public or private agency is not subject to appeal under this title.
(f)An annual review, and other periodic reviews, of the individualized family service plan for an infant or toddler and the infants or toddlers family shall be conducted to determine the degree of progress that is being made in achieving the outcomes specified in the plan and whether modification or revision of the outcomes or services is necessary. The frequency, participants, purpose, and required processes for annual and periodic reviews shall be consistent with the statutes and regulations under Part C of the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.) and this title, and shall be specified in regulations adopted pursuant to Section 95028. At the time of the review, the parents, legal guardian, or conservator shall provide copies of any health benefit cards under which the consumer is eligible to receive health benefits, including, but not limited to, private health insurance, a health care service plan, Medi-Cal, Medicare, and TRICARE. If the parents, legal guardian, or conservator have no such benefit cards, the regional center shall not use that fact to negatively impact the services that the individual may or may not receive from the regional center.
(g)(1)A regional center shall communicate and provide written materials in the familys native language during the assessment, evaluation, and planning process for the individualized family service plan, as required by Part C of the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.) and implementing regulations, and as required by Sections 11135 to 11139.7, inclusive, and implementing regulations, including providing alternative communication services pursuant to Sections 98210 to 98211, inclusive, of Title 22 of the California Code of Regulations.
(2)The familys native language shall be documented in the individualized family service plan.
SEC. 2.Section 95021 of the Government Code is amended to read:95021.(a)Notwithstanding any law or regulation to the contrary, any vendor who provides applied behavioral analysis (ABA) services or intensive behavioral intervention services, or both, as defined in subdivision (d), shall:
(1)Conduct a behavioral assessment of each infant or toddler to whom the vendor provides these services.
(2)Design an intervention plan that shall include the service type, number of hours, and parent participation recommended to achieve the goals and objectives of the infant or toddler, as set forth in his or her individualized family service plan (IFSP). The intervention plan shall also set forth the frequency at which the progress of the infant or toddler shall be evaluated and reported.
(3)Provide a copy of the intervention plan to the regional center for review and consideration by the planning team members.
(b)Notwithstanding any law or regulation to the contrary, regional centers shall:
(1)Only purchase ABA services or intensive behavioral intervention services that reflect evidence-based practices, promote positive social behaviors, and ameliorate behaviors that interfere with learning and social interactions.
(2)(A)To the extent feasible, facilitate a parents or caregivers participation in ABA or intensive behavioral intervention services for an infant or toddler consumer receiving those services through the provision of additional services and supports, accommodations, or both.
(B)A parents or caregivers failure to participate in ABA or intensive behavioral intervention services shall not be used to deny, delay, or reduce the provision of those services.
(3)Not purchase either ABA or intensive behavioral intervention services for purposes of providing respite, day care, or school services.
(4)Discontinue purchasing ABA or intensive behavioral intervention services for an infant or toddler when his or her treatment goals and objectives, as described under subdivision (a), are achieved. ABA or intensive behavioral intervention services shall not be discontinued until the goals and objectives are reviewed and updated as required in paragraph (5) and shall be discontinued only if those updated treatment goals and objectives do not require ABA or intensive behavioral intervention services.
(5)For each infant or toddler, evaluate the vendors intervention plan and number of service hours for ABA or intensive behavioral intervention no less than every six months, consistent with evidence-based practices. If necessary, the intervention plans treatment goals and objectives shall be updated and revised.
(6)Not reimburse a parent for participating in a behavioral services treatment program.
(c)For infants and toddlers receiving ABA or behavioral intervention services on July 1, 2009, as part of their IFSP, subdivision (b) shall apply on August 1, 2009.
(d)For purposes of this section the following definitions shall apply:
(1)Applied behavioral analysis means the design, implementation, and evaluation of systematic instructional and environmental modifications to promote positive social behaviors and reduce or ameliorate behaviors which that interfere with learning and social interaction.
(2)Intensive behavioral intervention means any form of applied behavioral analysis that is comprehensive, designed to address all domains of functioning, and provided in multiple settings for no more than 40 hours per week, across all settings, depending on the individuals needs and progress. Interventions can be delivered in a one-to-one ratio or small group format, as appropriate.
(3)Evidence-based practice means a decisionmaking process which that integrates the best available scientifically rigorous research, clinical expertise, and individuals characteristics. Evidence-based practice is an approach to treatment rather than a specific treatment. Evidence-based practice promotes the collection, interpretation, integration, and continuous evaluation of valid, important, and applicable individual- or family-reported, clinically-observed, and research-supported evidence. The best available evidence, matched to infant or toddler circumstances and preferences, is applied to ensure the quality of clinical judgments and facilitates the most cost-effective care.
(4)Parent has the same meaning as defined in paragraph (15) of subdivision (b) of Section 52000 of Title 17 of the California Code of Regulations.
(5)Parent participation shall include, but shall not be limited to, the following meanings:
(A)Completion of group instruction on the basics of behavior intervention.
(B)Implementation of intervention strategies according to the intervention plan.
(C)If needed, collection of data on behavioral strategies and submission of that those data to the provider for incorporation into progress reports.
(D)Participation in any needed clinical meetings.
(E)Purchase of suggested behavior modification materials or community involvement if a reward system is used.
SEC. 3.Section 4502.1 of the Welfare and Institutions Code is amended to read:4502.1.(a)The right of individuals with developmental disabilities to make choices in their own lives requires that all public or private agencies receiving state funds for the purpose of serving persons with developmental disabilities, including, but not limited to, regional centers, shall respect the choices made by consumers or, if appropriate, their parents, legal guardian, conservator, or authorized representative. Those public or private agencies shall provide consumers with opportunities to exercise decisionmaking skills in any aspect of day-to-day living and shall provide consumers with relevant information in an understandable form to aid the consumer in making his or her choice.
(b)A regional center shall provide information in a manner that is culturally and linguistically appropriate for the consumer, or, when appropriate, the consumers parents, legal guardian, conservator, or authorized representative, including providing alternative communication services, as required by Article 9.5 (commencing with Section 11135) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code and the regulations implementing that article.
SEC. 4.Section 4646.45 is added to the Welfare and Institutions Code, immediately following Section 4646.4, to read:4646.45.At the time of development of the initial individual program plan, as described in subdivision (c) of Section 4646, and at least annually thereafter at the beginning of an individual program plan meeting or at an annual review of the individual program plan, the regional center shall provide to the consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative, written information describing all of the following and the process for obtaining each exception or exemption: both of the following:
(a)The exception described in subdivision (d) of Section 4648.35.
(b)The exemption described in subdivision (c) of Section 4648.5.(c)(b)The exemption described in subdivision (d) of Section 4648.55.
(d)The exemption described in subparagraph (A) of paragraph (3) of subdivision (a) of Section 4686.5.SEC. 5.Section 4646.5 of the Welfare and Institutions Code is amended to read:4646.5.(a)The planning process for the individual program plan described in Section 4646 shall include all of the following:
(1)Gathering information and conducting assessments to determine the life goals, capabilities and strengths, preferences, barriers, and concerns or problems of the person with developmental disabilities. For children with developmental disabilities, this process should include a review of the strengths, preferences, and needs of the child and the family unit as a whole. Assessments shall be conducted by qualified individuals and performed in natural environments whenever possible. Information shall be taken from the consumer, his or her parents and other family members, his or her friends, advocates, authorized representative, if applicable, providers of services and supports, and other agencies. The assessment process shall reflect awareness of, and sensitivity to, the lifestyle and cultural background of the consumer and the family.
(2)A statement of goals, based on the needs, preferences, and life choices of the individual with developmental disabilities, and a statement of specific, time-limited objectives for implementing the persons goals and addressing his or her needs. These objectives shall be stated in terms that allow measurement of progress or monitoring of service delivery. These goals and objectives should maximize opportunities for the consumer to develop relationships, be part of community life in the areas of community participation, housing, work, school, and leisure, increase control over his or her life, acquire increasingly positive roles in community life, and develop competencies to help accomplish these goals.
(3)When developing individual program plans for children, regional centers shall be guided by the principles, process, and services and support parameters set forth in Section 4685.
(4)When developing an individual program plan for a transition age youth or working age adult, the planning team shall consider the Employment First Policy described in Chapter 14 (commencing with Section 4868).
(5)A schedule of the type and amount of services and supports to be purchased by the regional center or obtained from generic agencies or other resources in order to achieve the individual program plan goals and objectives, and identification of the provider or providers of service responsible for attaining each objective, including, but not limited to, vendors, contracted providers, generic service agencies, and natural supports. The individual program plan shall specify the approximate scheduled start date for services and supports and shall contain timelines for actions necessary to begin services and supports, including generic services. In addition to the requirements of subdivision (h) of Section 4646, each regional center shall offer, and upon request provide, a written copy of the individual program plan to the consumer, and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of their request in a threshold language, as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations.
(6)At the time of development of the initial individual program plan, as described in subdivision (c) of Section 4646, and at least annually thereafter at the beginning of an individual program plan meeting or at an annual review of the individual program plan, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative a list of services provided by the regional center and written information about the appeal procedure established under Chapter 7 (commencing with Section 4700) and the complaint process described in Section 4731.
(7)At the end of the individual program plan meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative a written list of agreed-upon services and supports, including the amount and anticipated start date, and a list of any requested services and supports for which final agreement has not yet been reached and for which there will be a subsequent program plan meeting pursuant to subdivision (f) of Section 4646.
(8)When agreed to by the consumer, the parents, legally appointed guardian, or authorized representative of a minor consumer, or the legally appointed conservator of an adult consumer or the authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, and subdivision (e) of Section 4705, a review of the general health status of the adult or child, including medical, dental, and mental health needs, shall be conducted. This review shall include a discussion of current medications, any observed side effects, and the date of the last review of the medication. Service providers shall cooperate with the planning team to provide any information necessary to complete the health status review. If any concerns are noted during the review, referrals shall be made to regional center clinicians or to the consumers physician, as appropriate. Documentation of health status and referrals shall be made in the consumers record by the service coordinator.
(9)(A)The development of a transportation access plan for a consumer when all of the following conditions are met:
(i)The regional center is purchasing private, specialized transportation services or services from a residential, day, or other provider, excluding vouchered service providers, to transport the consumer to and from day or work services.
(ii)The planning team has determined that a consumers community integration and participation could be safe and enhanced through the use of public transportation services.
(iii)The planning team has determined that generic transportation services are available and accessible.
(B)To maximize independence and community integration and participation, the transportation access plan shall identify the services and supports necessary to assist the consumer in accessing public transportation and shall comply with Section 4648.35. These services and supports may include, but are not limited to, mobility training services and the use of transportation aides. Regional centers are encouraged to coordinate with local public transportation agencies.
(10)A schedule of regular periodic review and reevaluation to ascertain that planned services have been provided, that objectives have been fulfilled within the times specified, and that consumers and families are satisfied with the individual program plan and its implementation.
(b)For all active cases, individual program plans shall be reviewed and modified by the planning team, through the process described in Section 4646, as necessary, in response to the persons achievement or changing needs, and no less often than once every three years. If the consumer or, where appropriate, the consumers parents, legal guardian, authorized representative, or conservator requests an individual program plan review, the individual program shall be reviewed within 30 days after the request is submitted.
(c)(1)The department, with the participation of representatives of a statewide consumer organization, the Association of Regional Center Agencies, an organized labor organization representing service coordination staff, and the state council shall prepare training material and a standard format and instructions for the preparation of individual program plans, which embody an approach centered on the person and family.
(2)Each regional center shall use the training materials and format prepared by the department pursuant to paragraph (1).
(3)The department shall biennially review a random sample of individual program plans at each regional center to ensure that these plans are being developed and modified in compliance with Section 4646 and this section.
SEC. 6.Section 4648.6 of the Welfare and Institutions Code is amended to read:4648.6.(a)The department, in consultation with stakeholders, shall develop an alternative service delivery model that provides an Individual Choice Budget for obtaining quality services and supports which provides choice and flexibility within a finite budget that in the aggregate reduces regional center purchase of service expenditures, reduces reliance on the state general fund, and maximizes federal financial participation in the delivery of services. The individual budget will be determined using a fair, equitable, transparent standardized process.(b)(1)(A)By March 31, 2018, the department shall provide a written report to the Legislature regarding the status of the Individual Choice Budget, and a projected timeframe for fully reinstating the services suspended pursuant to Section 4648.5 and for making the restrictions on services described in Section 4686.5 ineffective.(B)A report submitted pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code.(2)The requirement for submitting a report imposed under paragraph (1) is inoperative on January 1, 2022, pursuant to Section 10231.5 of the Government Code.SEC. 6.Section 4648.5 of the Welfare and Institutions Code is repealed.4648.5.(a)Notwithstanding any other provision of law or regulations to the contrary, effective July 1, 2009, a regional centers authority to purchase the following services shall be suspended pending implementation of the Individual Choice Budget and certification by the Director of Developmental Services that the Individual Choice Budget has been implemented and will result in state budget savings sufficient to offset the costs of providing the following services:(1)Camping services and associated travel expenses.(2)Social recreation activities, except for those activities vendored as community-based day programs.(3)Educational services for children three to 17, inclusive, years of age.(4)Nonmedical therapies, including, but not limited to, specialized recreation, art, dance, and music.(b)For regional center consumers receiving services described in subdivision (a) as part of their individual program plan (IPP) or individualized family service plan (IFSP), the prohibition in subdivision (a) shall take effect on August 1, 2009.(c)An exemption may be granted on an individual basis in extraordinary circumstances to permit purchase of a service identified in subdivision (a) when the regional center determines that the service is a primary or critical means for ameliorating the physical, cognitive, or psychosocial effects of the consumers developmental disability, or the service is necessary to enable the consumer to remain in his or her home and no alternative service is available to meet the consumers needs.SEC. 7.Section 4648.6 of the Welfare and Institutions Code is repealed.4648.6.The department, in consultation with stakeholders, shall develop an alternative service delivery model that provides an Individual Choice Budget for obtaining quality services and supports which provides choice and flexibility within a finite budget that in the aggregate reduces regional center purchase of service expenditures, reduces reliance on the state general fund, and maximizes federal financial participation in the delivery of services. The individual budget will be determined using a fair, equitable, transparent standardized process.SEC. 8.Section 4648.7 is added to the Welfare and Institutions Code, to read:4648.7.(a)By March 31, 2018, the department shall convene a task force to develop a purchase of services budget and allocation methodology based on consumer needs.
(b)The task force shall include the department and stakeholders, including representatives of all of the following:
(1)Consumers and families that reflect the ethnic and language diversity of regional center consumers.
(2)Regional centers.
(3)Advocates.
(4)Providers.
(5)The protection and advocacy agency, as defined in Section 4900.
(6)The State Council on Developmental Disabilities, as described in Section 4520.
(c)(1)(A)The task force shall submit a report of its recommendations on implementing the methodology described in subdivision (a) to the Legislature by August 31, 2018.
(B)A report submitted pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code.
(2)The requirement for submitting a report imposed under paragraph (1) is inoperative on January 1, 2022, pursuant to Section 10231.5 of the Government Code.
SEC. 7.SEC. 9.Section 4659 of the Welfare and Institutions Code is amended to read:4659.(a)Except as otherwise provided in subdivision (b) or (e), the regional center shall identify and pursue all possible sources of funding for consumers receiving regional center services. These sources shall include, but not be limited to, both of the following:
(1)Governmental or other entities or programs required to provide or pay the cost of providing services, including Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, school districts, and federal supplemental security income and the state supplementary program.
(2)Private entities, to the maximum extent they are liable for the cost of services, aid, insurance, or medical assistance to the consumer.
(b)Any revenues collected by a regional center pursuant to this section shall be applied against the cost of services prior to use of regional center funds for those services. This revenue shall not result in a reduction in the regional centers purchase of services budget, except as it relates to federal supplemental security income and the state supplementary program.
(c)Effective July 1, 2009, notwithstanding any other law or regulation, regional centers shall not purchase any service that would otherwise be available from Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, In-Home Support Services, California Childrens Services, private insurance, or a health care service plan when a consumer or a family meets the criteria of this coverage but chooses not to pursue that coverage. If, on July 1, 2009, a regional center is purchasing that service as part of a consumers individual program plan (IPP), the prohibition shall take effect on October 1, 2009.
(d)(1)Effective July 1, 2009, notwithstanding any other law or regulation, a regional center shall not purchase medical or dental services for a consumer three years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center determines that an appeal by the consumer or family of the denial does not have merit. If, on July 1, 2009, a regional center is purchasing the service as part of a consumers IPP, this provision shall take effect on August 1, 2009. At the time of development of the initial individual program plan, as described in subdivision (c) of Section 4646, and at least annually thereafter at the beginning of an individual program plan meeting or at an annual review of the individual program plan, the regional center shall provide a written description of the denial documentation consumers and families are required to provide pursuant to this paragraph. In order to ensure that there are no gaps in the provision of services and supports, regional centers shall pay for medical or dental services identified, pursuant to subdivision (d) of Section 4646 and paragraph (5) of subdivision (a) of Section 4646.5, as necessary to implement the consumers individual program plan during the following periods:
(A)While coverage is being pursued, but before a denial is made.
(B)Pending a final administrative decision on the administrative appeal if the family has provided to the regional center a verification that an administrative appeal is being pursued.
(C)Until the commencement of services by Medi-Cal, private insurance, or a health care service plan.
(2)When necessary, the consumer or family may receive assistance from the regional center, the Clients Rights Advocate funded by the department, or the state council in pursuing these appeals.
(e)This section shall not impose any additional liability on the parents of children with developmental disabilities, or to restrict eligibility for, or deny services to, any individual who qualifies for regional center services but is unable to pay.
(f)In order to best utilize generic resources, federally funded programs, and private insurance programs for individuals with developmental disabilities, the department and regional centers shall engage in the following activities:
(1)Within existing resources, the department shall provide training to regional centers, no less than once every two years, in the availability and requirements of generic, federally funded and private programs available to persons with developmental disabilities, including, but not limited to, eligibility requirements, the application process and covered services, and the appeal process.
(2)Regional centers shall disseminate information and training to all service coordinators regarding the availability and requirements of generic, federally funded, and private insurance programs on the local level.
SEC. 8.SEC. 10.Section 4686.2 of the Welfare and Institutions Code is amended to read:4686.2.(a)Notwithstanding any law or regulation to the contrary, any vendor who provides applied behavioral analysis (ABA) services, or intensive behavioral intervention services or both, as defined in subdivision (d), shall:
(1)Conduct a behavioral assessment of each consumer to whom the vendor provides these services.
(2)Design an intervention plan that shall include the service type, number of hours, and parent participation recommended to achieve the consumers goals and objectives, as set forth in the consumers individual program plan (IPP) or individualized family service plan (IFSP). The intervention plan shall also set forth the frequency at which the consumers progress shall be evaluated and reported.
(3)Provide a copy of the intervention plan to the regional center for review and consideration by the planning team members.
(b)Notwithstanding any law or regulation to the contrary, regional centers shall:
(1)Only purchase ABA services or intensive behavioral intervention services that reflect evidence-based practices, promote positive social behaviors, and ameliorate behaviors that interfere with learning and social interactions.
(2)(A)To the extent feasible, facilitate a parents or caregivers participation in ABA or intensive behavioral intervention services for a minor consumer receiving those services through the provision of additional services and supports, accommodations, or both.
(B)A parents or caregivers failure to participate in ABA or intensive behavioral intervention services shall not be used to deny, delay, or reduce the provision of those services.
(3)Not purchase either ABA or intensive behavioral intervention services for purposes of providing respite, day care, or school services.
(4)Discontinue purchasing ABA or intensive behavioral intervention services for a consumer when the consumers treatment goals and objectives, as described under subdivision (a), are achieved. ABA or intensive behavioral intervention services shall not be discontinued until the goals and objectives are reviewed and updated as required in paragraph (5) and shall be discontinued only if those updated treatment goals and objectives do not require ABA or intensive behavioral intervention services.
(5)For each consumer, evaluate the vendors intervention plan and number of service hours for ABA or intensive behavioral intervention no less than every six months, consistent with evidence-based practices. If necessary, the intervention plans treatment goals and objectives shall be updated and revised.
(6)Not reimburse a parent for participating in a behavioral services treatment program.
(c)For consumers receiving ABA or behavioral intervention services on July 1, 2009, as part of their IPP or IFSP, subdivision (b) shall apply on August 1, 2009.
(d)For purposes of this section the following definitions shall apply:
(1)Applied behavioral analysis means the design, implementation, and evaluation of systematic instructional and environmental modifications to promote positive social behaviors and reduce or ameliorate behaviors which that interfere with learning and social interaction.
(2)Intensive behavioral intervention means any form of applied behavioral analysis that is comprehensive, designed to address all domains of functioning, and provided in multiple settings for no more than 40 hours per week, across all settings, depending on the individuals needs and progress. Interventions can be delivered in a one-to-one ratio or small group format, as appropriate.
(3)Evidence-based practice means a decisionmaking process that integrates the best available scientifically rigorous research, clinical expertise, and individuals characteristics. Evidence-based practice is an approach to treatment rather than a specific treatment. Evidence-based practice promotes the collection, interpretation, integration, and continuous evaluation of valid, important, and applicable individual- or family-reported, clinically-observed, and research-supported evidence. The best available evidence, matched to consumer circumstances and preferences, is applied to ensure the quality of clinical judgments and facilitates the most cost-effective care.
(4)Parent participation shall include, but shall not be limited to, the following meanings:
(A)Completion of group instruction on the basics of behavior intervention.
(B)Implementation of intervention strategies, according to the intervention plan.
(C)If needed, collection of data on behavioral strategies and submission of that those data to the provider for incorporation into progress reports.
(D)Participation in any needed clinical meetings.
(E)Purchase of suggested behavior modification materials or community involvement if a reward system is used.
SEC. 11.Section 4686.5 of the Welfare and Institutions Code is repealed.4686.5.(a)Effective July 1, 2009, notwithstanding any other provision of law or regulation to the contrary, all of the following shall apply:(1)A regional center may only purchase respite services when the care and supervision needs of a consumer exceed that of an individual of the same age without developmental disabilities.(2)A regional center shall not purchase more than 21 days of out-of-home respite services in a fiscal year nor more than 90 hours of in-home respite services in a quarter, for a consumer.(3)(A)A regional center may grant an exemption to the requirements set forth in paragraphs (1) and (2) if it is demonstrated that the intensity of the consumers care and supervision needs are such that additional respite is necessary to maintain the consumer in the family home, or there is an extraordinary event that impacts the family members ability to meet the care and supervision needs of the consumer.(B)For purposes of this section, family member means an individual who:(i)Has a consumer residing with him or her.(ii)Is responsible for the 24-hour care and supervision of the consumer.(iii)Is not a licensed or certified residential care facility or foster family home receiving funds from any public agency or regional center for the care and supervision provided. Notwithstanding this provision, a relative who receives foster care funds shall not be precluded from receiving respite.(4)A regional center shall not purchase day care services to replace or supplant respite services. For purposes of this section, day care is defined as regularly provided care, protection, and supervision of a consumer living in the home of his or her parents, for periods of less than 24 hours per day, while the parents are engaged in employment outside of the home or educational activities leading to employment, or both.(5)A regional center shall only consider in-home supportive services a generic resource when the approved in-home supportive services meets the respite need as identified in the consumers individual program plan (IPP) or individualized family service plan (IFSP).(b)For consumers receiving respite services on July 1, 2009, as part of their IPP or IFSP, subdivision (a) shall apply on August 1, 2009.(c)This section shall remain in effect until implementation of the individual choice budget pursuant to Section 4648.6 and certification by the Director of the Department of Developmental Services that the individual choice budget has been implemented and will result in state budget savings sufficient to offset the costs associated with the repeal of this section. This section shall be repealed on the date of certification.(a)An eligible infant or toddler shall have an individualized family service plan. The individualized family service plan shall be used in place of an individualized education program required pursuant to Sections 4646 and 4646.5 of the Welfare and Institutions Code, the individualized program plan required pursuant to Section 56340 of the Education Code, or any other applicable service plan.
(b)For an infant or toddler who has been evaluated for the first time, a meeting to share the results of the evaluation, to determine eligibility and, for children who are eligible, to develop the initial individualized family service plan shall be conducted within 45 calendar days of receipt of the written referral. Evaluation results and determination of eligibility may be shared in a meeting with the family prior to the individualized family service plan. Written parent consent to evaluate and assess shall be obtained within the 45-day timeline. A regional center, local educational agency, or the designee of one of those entities shall initiate and conduct this meeting. Families shall be afforded the opportunity to participate in all decisions regarding eligibility and services. During intake and assessment, but no later than the individualized family service plan meeting, the parents, legal guardian, or conservator shall provide copies of any health benefit cards under which the consumer is eligible to receive health benefits, including, but not limited to, private health insurance, a health care service plan, Medi-Cal, Medicare, and TRICARE. If the individual, or, where when appropriate, the parents, legal guardians, or conservators, have no such benefits, the regional center shall not use that fact to negatively impact the services that the individual may or may not receive from the regional center.
(c)(1)Parents shall be fully informed of their rights, including the right to invite another person, including a family member or an advocate or peer parent, or any or all of them, to accompany them to any or all individualized family service plan meetings. With parental consent, a referral shall be made to the local family resource center or network.
(2)At the beginning of the initial individualized family service plan meeting and at least annually thereafter at the beginning of an individualized family service plan meeting or at a biannual review of the individualized family services plan, the regional center shall provide the infants or toddlers parents, legal guardian, conservator, or authorized representative written information about the appeal procedure established under Chapter 7 (commencing with Section 4700) of Division 4.5 of the Welfare and Institutions Code and the complaint process described in Section 52170 of Title 17 of the California Code of Regulations.
(d)The individualized family service plan shall be in writing and shall address all of the following:
(1)A statement of the infants or toddlers present levels of physical development including vision, hearing, and health status, cognitive development, communication development, social and emotional development, and adaptive developments.
(2)With the concurrence of the family, a statement of the familys concerns, priorities, and resources related to meeting the special developmental needs of the eligible infant or toddler.
(3)A statement of the major outcomes expected to be achieved for the infant or toddler and family where services for the family are related to meeting the special developmental needs of the eligible infant or toddler.
(4)The criteria, procedures, and timelines used to determine the degree to which progress toward achieving the outcomes is being made and whether modifications or revisions are necessary.
(5)(A)A statement of the specific early intervention services necessary to meet the unique needs of the infant or toddler as identified in paragraph (3), including, but not limited to, the frequency, intensity, location, duration, and method of delivering the services, and ways of providing services in natural generic environments, including group training for parents on behavioral intervention techniques in lieu of some or all of the in-home parent training component of the behavior intervention services, and purchase of neighborhood preschool services and needed qualified personnel in lieu of infant development programs.
(B)Effective July 1, 2009, at the time of development, review, or modification of an infants or toddlers individualized family service plan, the regional center shall consider both of the following:
(i)The use of group training for parents on behavior intervention techniques, in lieu of some or all of the in-home parent training component of the behavior intervention services.
(ii)The purchase of neighborhood preschool services and needed qualified personnel, in lieu of infant development programs.
(6)A statement of the agency responsible for providing the identified services.
(7)The name of the service coordinator who shall be responsible for facilitating implementation of the plan and coordinating with other agencies and persons.
(8)The steps to be taken to ensure transition of the infant or toddler upon reaching three years of age to other appropriate services. These may include, as appropriate, special education or other services offered in natural environments.
(9)The projected dates for the initiation of services in paragraph (5) and the anticipated duration of those services.
(e)Each service identified on the individualized family service plan shall be designated as one of three types:
(1)An early intervention service, as defined in subsection (4) of Section 1432 of Title 20 of the United States Code, and applicable regulations, that is provided or purchased through the regional center, local educational agency, or other participating agency. The State Department of Health Care Services and the State Department of Social Services shall provide services in accordance with state and federal law and applicable regulations, and up to the level of funding as appropriated by the Legislature. Early intervention services identified on an individualized family service plan that exceed the funding, statutory, and regulatory requirements of these departments shall be provided or purchased by regional centers or local educational agencies under subdivisions (b) and (c) of Section 95014. The State Department of Health Care Services and the State Department of Social Services shall not be required to provide early intervention services over their existing funding, statutory, and regulatory requirements.
(2)Another service, other than those specified in paragraph (1), which the eligible infant or toddler or his or her family may receive from other state programs, subject to the eligibility standards of those programs.
(3)A referral to a nonrequired service that may be provided to an eligible infant or toddler or his or her family. Nonrequired services are those services that are not defined as early intervention services or do not relate to meeting the special developmental needs of an eligible infant or toddler related to the disability, but that may be helpful to the family. The granting or denial of nonrequired services by a public or private agency is not subject to appeal under this title. Notwithstanding any other provision of law or regulation to the contrary, effective July 1, 2009, with the exception of durable medical equipment, regional centers shall not purchase nonrequired services, but may refer a family to a nonrequired service that may be available to an eligible infant or toddler or his or her family.
(f)An annual review, and other periodic reviews, of the individualized family service plan for an infant or toddler and the infants or toddlers family shall be conducted to determine the degree of progress that is being made in achieving the outcomes specified in the plan and whether modification or revision of the outcomes or services is necessary. The frequency, participants, purpose, and required processes for annual and periodic reviews shall be consistent with the statutes and regulations under Part C of the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.) and this title, and shall be specified in regulations adopted pursuant to Section 95028. At the time of the review, the parents, legal guardian, or conservator shall provide copies of any health benefit cards under which the consumer is eligible to receive health benefits, including, but not limited to, private health insurance, a health care service plan, Medi-Cal, Medicare, and TRICARE. If the parents, legal guardian, or conservator have no such benefit cards, the regional center shall not use that fact to negatively impact the services that the individual may or may not receive from the regional center.
(g)(1)A regional center shall communicate and provide written materials in the familys native language during the assessment, evaluation, and planning process for the individualized family service plan, as required by Part C of the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.) and implementing regulations, and as required by Sections 11135 to 11139.7, inclusive, and implementing regulations, including providing alternative communication services pursuant to Sections 98210 to 98211, inclusive, of Title 22 of the California Code of Regulations.
(2)The familys native language shall be documented in the individualized family service plan.
SEC. 2.Section 95021 of the Government Code is amended to read:95021.(a)Effective July 1, 2009, notwithstanding any other provision of Notwithstanding any law or regulation to the contrary, any vendor who provides applied behavioral analysis (ABA) services or intensive behavioral intervention services, or both, as defined in subdivision (d), shall:
(1)Conduct a behavioral assessment of each infant or toddler to whom the vendor provides these services.
(2)Design an intervention plan that shall include the service type, number of hours, and parent participation needed recommended to achieve the goals and objectives of the infant or toddler, as set forth in his or her individualized family service plan (IFSP). The intervention plan shall also set forth the frequency at which the progress of the infant or toddler shall be evaluated and reported.
(3)Provide a copy of the intervention plan to the regional center for review and consideration by the planning team members.
(b)Effective July 1, 2009, notwithstanding any other provision of Notwithstanding any law or regulation to the contrary, regional centers shall:
(1)Only purchase ABA services or intensive behavioral intervention services that reflect evidence-based practices, promote positive social behaviors, and ameliorate behaviors that interfere with learning and social interactions.
(2)Only purchase ABA or intensive behavioral intervention services when the parent or parents of an infant or toddler receiving services participate in the intervention plan for the infant or toddler, given the critical nature of parent participation to the success of the intervention plan.(2)(A)To the extent feasible, facilitate a parents or caregivers participation in ABA or intensive behavioral intervention services for an infant or toddler consumer receiving those services through the provision of additional services and supports, accommodations, or both.
(B)A parents or caregivers failure to participate in ABA or intensive behavioral intervention services shall not be used to deny, delay, or reduce the provision of those services.
(3)Not purchase either ABA or intensive behavioral intervention services for purposes of providing respite, day care, or school services.
(4)Discontinue purchasing ABA or intensive behavioral intervention services for an infant or toddler when his or her treatment goals and objectives, as described under subdivision (a), are achieved. ABA or intensive behavioral intervention services shall not be discontinued until the goals and objectives are reviewed and updated as required in paragraph (5) and shall be discontinued only if those updated treatment goals and objectives do not require ABA or intensive behavioral intervention services.
(5)For each infant or toddler, evaluate the vendors intervention plan and number of service hours for ABA or intensive behavioral intervention no less than every six months, consistent with evidence-based practices. If necessary, the intervention plans treatment goals and objectives shall be updated and revised.
(6)Not reimburse a parent for participating in a behavioral services treatment program.
(c)For infants and toddlers receiving ABA or behavioral intervention services on July 1, 2009, as part of their IFSP, subdivision (b) shall apply on August 1, 2009.
(d)For purposes of this section the following definitions shall apply:
(1)Applied behavioral analysis means the design, implementation, and evaluation of systematic instructional and environmental modifications to promote positive social behaviors and reduce or ameliorate behaviors which interfere with learning and social interaction.
(2)Intensive behavioral intervention means any form of applied behavioral analysis that is comprehensive, designed to address all domains of functioning, and provided in multiple settings for no more than 40 hours per week, across all settings, depending on the individuals needs and progress. Interventions can be delivered in a one-to-one ratio or small group format, as appropriate.
(3)Evidence-based practice means a decisionmaking process which integrates the best available scientifically rigorous research, clinical expertise, and individuals characteristics. Evidence-based practice is an approach to treatment rather than a specific treatment. Evidence-based practice promotes the collection, interpretation, integration, and continuous evaluation of valid, important, and applicable individual- or family-reported, clinically-observed, and research-supported evidence. The best available evidence, matched to infant or toddler circumstances and preferences, is applied to ensure the quality of clinical judgments and facilitates the most cost-effective care.
(4)Parent has the same meaning as defined in paragraph (15) of subdivision (b) of Section 52000 of Title 17 of the California Code of Regulations.
(5)Parent participation shall include, but shall not be limited to, the following meanings:
(A)Completion of group instruction on the basics of behavior intervention.
(B)Implementation of intervention strategies according to the intervention plan.
(C)If needed, collection of data on behavioral strategies and submission of that data to the provider for incorporation into progress reports.
(D)Participation in any needed clinical meetings.
(E)Purchase of suggested behavior modification materials or community involvement if a reward system is used.
SEC. 3.Section 4502.1 of the Welfare and Institutions Code is amended to read:4502.1.(a)The right of individuals with developmental disabilities to make choices in their own lives requires that all public or private agencies receiving state funds for the purpose of serving persons with developmental disabilities, including, but not limited to, regional centers, shall respect the choices made by consumers or, where if appropriate, their parents, legal guardian, or conservator. conservator, or authorized representative. Those public or private agencies shall provide consumers with opportunities to exercise decisionmaking skills in any aspect of day-to-day living and shall provide consumers with relevant information in an understandable form to aid the consumer in making his or her choice.
(b)A regional center shall provide information in a manner that is culturally and linguistically appropriate for the consumer, or, when appropriate, the consumers parents, legal guardian, conservator, or authorized representative, including providing alternative communication services, as required by Article 9.5 (commencing with Section 11135) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code and the regulations implementing that article.
SEC. 4.Section 4646.45 is added to the Welfare and Institutions Code, immediately following Section 4646.4, to read:4646.45.At the time of development of the initial individual program plan, as described in subdivision (c) of Section 4646, and at least annually thereafter at the beginning of an individual program plan meeting or at an annual review of the individual program plan, the regional center shall provide to the consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative, written information describing all of the following and the process for obtaining each exception or exemption:
(a)The exception described in subdivision (d) of Section 4648.35.
(b)The exemption described in subdivision (c) of Section 4648.5.
(c)The exemption described in subdivision (d) of Section 4648.55.
(d)The exemption described in subparagraph (A) of paragraph (3) of subdivision (a) of Section 4686.5.
SECTION 1.SEC. 5.Section 4646.5 of the Welfare and Institutions Code is amended to read:4646.5.(a)The planning process for the individual program plan described in Section 4646 shall include all of the following:
(1)Gathering information and conducting assessments to determine the life goals, capabilities and strengths, preferences, barriers, and concerns or problems of the person with developmental disabilities. For children with developmental disabilities, this process should include a review of the strengths, preferences, and needs of the child and the family unit as a whole. Assessments shall be conducted by qualified individuals and performed in natural environments whenever possible. Information shall be taken from the consumer, his or her parents and other family members, his or her friends, advocates, authorized representative, if applicable, providers of services and supports, and other agencies. The assessment process shall reflect awareness of, and sensitivity to, the lifestyle and cultural background of the consumer and the family.
(2)A statement of goals, based on the needs, preferences, and life choices of the individual with developmental disabilities, and a statement of specific, time-limited objectives for implementing the persons goals and addressing his or her needs. These objectives shall be stated in terms that allow measurement of progress or monitoring of service delivery. These goals and objectives should maximize opportunities for the consumer to develop relationships, be part of community life in the areas of community participation, housing, work, school, and leisure, increase control over his or her life, acquire increasingly positive roles in community life, and develop competencies to help accomplish these goals.
(3)When developing individual program plans for children, regional centers shall be guided by the principles, process, and services and support parameters set forth in Section 4685.
(4)When developing an individual program plan for a transition age youth or working age adult, the planning team shall consider the Employment First Policy described in Chapter 14 (commencing with Section 4868).
(5)A schedule of the type and amount of services and supports to be purchased by the regional center or obtained from generic agencies or other resources in order to achieve the individual program plan goals and objectives, and identification of the provider or providers of service responsible for attaining each objective, including, but not limited to, vendors, contracted providers, generic service agencies, and natural supports. The individual program plan shall specify the approximate scheduled start date for services and supports and shall contain timelines for actions necessary to begin services and supports, including generic services. In addition to the requirements of subdivision (h) of Section 4646, each regional center shall offer, and upon request provide, a written copy of the individual program plan to the consumer, and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of their request in a threshold language, as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations.
(6)At the beginning of each individual program plan meeting, time of development of the initial individual program plan, as described in subdivision (c) of Section 4646, and at least annually thereafter at the beginning of an individual program plan meeting or at an annual review of the individual program plan, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative a list of services provided by the regional center and written information about the appeal and complaint process in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate. This paragraph is in addition to, and independent of, any other rights, remedies, or procedures under any other law and shall not be construed to alter, limit, or negate any other rights, remedies, or procedures provided for by law. procedure established under Chapter 7 (commencing with Section 4700) and the complaint process described in Section 4731.
(7)At the end of the individual program plan meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative a written list of agreed-upon services and supports, including the amount and anticipated start date, and a list of any requested services and supports for which final agreement has not yet been reached and for which there will be a subsequent program plan meeting pursuant to subdivision (f) of Section 4646.
(7)(8)When agreed to by the consumer, the parents, legally appointed guardian, or authorized representative of a minor consumer, or the legally appointed conservator of an adult consumer or the authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, and subdivision (e) of Section 4705, a review of the general health status of the adult or child, including medical, dental, and mental health needs, shall be conducted. This review shall include a discussion of current medications, any observed side effects, and the date of the last review of the medication. Service providers shall cooperate with the planning team to provide any information necessary to complete the health status review. If any concerns are noted during the review, referrals shall be made to regional center clinicians or to the consumers physician, as appropriate. Documentation of health status and referrals shall be made in the consumers record by the service coordinator.
(8)(9)(A)The development of a transportation access plan for a consumer when all of the following conditions are met:
(i)The regional center is purchasing private, specialized transportation services or services from a residential, day, or other provider, excluding vouchered service providers, to transport the consumer to and from day or work services.
(ii)The planning team has determined that a consumers community integration and participation could be safe and enhanced through the use of public transportation services.
(iii)The planning team has determined that generic transportation services are available and accessible.
(B)To maximize independence and community integration and participation, the transportation access plan shall identify the services and supports necessary to assist the consumer in accessing public transportation and shall comply with Section 4648.35. These services and supports may include, but are not limited to, mobility training services and the use of transportation aides. Regional centers are encouraged to coordinate with local public transportation agencies.
(9)(10)A schedule of regular periodic review and reevaluation to ascertain that planned services have been provided, that objectives have been fulfilled within the times specified, and that consumers and families are satisfied with the individual program plan and its implementation.
(b)For all active cases, individual program plans shall be reviewed and modified by the planning team, through the process described in Section 4646, as necessary, in response to the persons achievement or changing needs, and no less often than once every three years. If the consumer or, where appropriate, the consumers parents, legal guardian, authorized representative, or conservator requests an individual program plan review, the individual program shall be reviewed within 30 days after the request is submitted.
(c)(1)The department, with the participation of representatives of a statewide consumer organization, the Association of Regional Center Agencies, an organized labor organization representing service coordination staff, and the state council shall prepare training material and a standard format and instructions for the preparation of individual program plans, which embody an approach centered on the person and family.
(2)Each regional center shall use the training materials and format prepared by the department pursuant to paragraph (1).
(3)The department shall biennially review a random sample of individual program plans at each regional center to ensure that these plans are being developed and modified in compliance with Section 4646 and this section.
SEC. 2.Section 4648 of the Welfare and Institutions Code is amended to read:4648.In order to achieve the stated objectives of a consumers individual program plan, the regional center shall conduct activities, including, but not limited to, all of the following:(a)Securing needed services and supports.(1)It is the intent of the Legislature that services and supports assist individuals with developmental disabilities in achieving the greatest self-sufficiency possible and in exercising personal choices. The regional center shall secure services and supports that meet the needs of the consumer, as determined in the consumers individual program plan, and within the context of the individual program plan, the planning team shall give highest preference to those services and supports which would allow minors with developmental disabilities to live with their families, adult persons with developmental disabilities to live as independently as possible in the community, and that allow all consumers to interact with persons without disabilities in positive, meaningful ways.(2)In implementing individual program plans, regional centers, through the planning team, shall first consider services and supports in natural community, home, work, and recreational settings. Services and supports shall be flexible and individually tailored to the consumer and, where appropriate, his or her family.(3)A regional center may, pursuant to vendorization or a contract, purchase services or supports for a consumer from any individual or agency that the regional center and consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representatives, determines will best accomplish all or any part of that consumers program plan.(A)Vendorization or contracting is the process for identification, selection, and utilization of service vendors or contractors, based on the qualifications and other requirements necessary in order to provide the service.(B)A regional center may reimburse an individual or agency for services or supports provided to a regional center consumer if the individual or agency has a rate of payment for vendored or contracted services established by the department, pursuant to this division, and is providing services pursuant to an emergency vendorization or has completed the vendorization procedures or has entered into a contract with the regional center and continues to comply with the vendorization or contracting requirements. The director shall adopt regulations governing the vendorization process to be utilized by the department, regional centers, vendors, and the individual or agency requesting vendorization.(C)Regulations shall include, but not be limited to: the vendor application process, and the basis for accepting or denying an application; the qualification and requirements for each category of services that may be provided to a regional center consumer through a vendor; requirements for emergency vendorization; procedures for termination of vendorization; and the procedure for an individual or an agency to appeal any vendorization decision made by the department or regional center.(D)A regional center may vendorize a licensed facility for exclusive services to persons with developmental disabilities at a capacity equal to or less than the facilitys licensed capacity. A facility already licensed on January 1, 1999, shall continue to be vendorized at their full licensed capacity until the facility agrees to vendorization at a reduced capacity.(E)Effective July 1, 2009, notwithstanding any other law or regulation, a regional center shall not newly vendor a State Department of Social Services licensed 24-hour residential care facility with a licensed capacity of 16 or more beds, unless the facility qualifies for receipt of federal funds under the Medicaid Program.(4)Notwithstanding subparagraph (B) of paragraph (3), a regional center may contract or issue a voucher for services and supports provided to a consumer or family at a cost not to exceed the maximum rate of payment for that service or support established by the department. If a rate has not been established by the department, the regional center may, for an interim period, contract for a specified service or support with, and establish a rate of payment for, any provider of the service or support necessary to implement a consumers individual program plan. Contracts may be negotiated for a period of up to three years, with annual review and subject to the availability of funds.(5)In order to ensure the maximum flexibility and availability of appropriate services and supports for persons with developmental disabilities, the department shall establish and maintain an equitable system of payment to providers of services and supports identified as necessary to the implementation of a consumers individual program plan. The system of payment shall include a provision for a rate to ensure that the provider can meet the special needs of consumers and provide quality services and supports in the least restrictive setting as required by law.(6)The regional center and the consumer, or when appropriate, his or her parents, legal guardian, conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, or subdivision (e) of Section 4705, shall, pursuant to the individual program plan, consider all of the following when selecting a provider of consumer services and supports:(A)A providers ability to deliver quality services or supports that can accomplish all or part of the consumers individual program plan.(B)A providers success in achieving the objectives set forth in the individual program plan.(C)Where appropriate, the existence of licensing, accreditation, or professional certification.(D)The cost of providing services or supports of comparable quality by different providers, if available, shall be reviewed, and the least costly available provider of comparable service, including the cost of transportation, who is able to accomplish all or part of the consumers individual program plan, consistent with the particular needs of the consumer and family as identified in the individual program plan, shall be selected. In determining the least costly provider, the availability of federal financial participation shall be considered. The consumer shall not be required to use the least costly provider if it will result in the consumer moving from an existing provider of services or supports to more restrictive or less integrated services or supports.(E)The consumers choice of providers, or, when appropriate, the consumers parents, legal guardians, authorized representatives, or conservators choice of providers.(7)No service or support provided by any agency or individual shall be continued unless the consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, or subdivision (e) of Section 4705, is satisfied and the regional center and the consumer or, when appropriate, the persons parents or legal guardian or conservator agree that planned services and supports have been provided, and reasonable progress toward objectives have been made.(8)Regional center funds shall not be used to supplant the budget of any agency that has a legal responsibility to serve all members of the general public and is receiving public funds for providing those services.(9)(A)A regional center may, directly or through an agency acting on behalf of the center, provide placement in, purchase of, or follow-along services to persons with developmental disabilities in, appropriate community living arrangements, including, but not limited to, support service for consumers in homes they own or lease, foster family placements, health care facilities, and licensed community care facilities. In considering appropriate placement alternatives for children with developmental disabilities, approval by the childs parent or guardian shall be obtained before placement is made.(B)Effective July 1, 2012, notwithstanding any other law or regulation, a regional center shall not purchase residential services from a State Department of Social Services licensed 24-hour residential care facility with a licensed capacity of 16 or more beds. This prohibition on regional center purchase of residential services shall not apply to any of the following:(i)A residential facility with a licensed capacity of 16 or more beds that has been approved to participate in the departments Home and Community Based Services Waiver or another existing waiver program or certified to participate in the Medi-Cal program.(ii)A residential facility service provider that has a written agreement and specific plan prior to July 1, 2012, with the vendoring regional center to downsize the existing facility by transitioning its residential services to living arrangements of 15 beds or less or restructure the large facility to meet federal Medicaid eligibility requirements on or before June 30, 2013.(iii)A residential facility licensed as a mental health rehabilitation center by the State Department of Health Care Services or successor agency under any of the following circumstances:(I)The facility is eligible for Medicaid reimbursement.(II)The facility has a department-approved plan in place by June 30, 2013, to transition to a program structure eligible for federal Medicaid funding, and this transition will be completed by June 30, 2014. The department may grant an extension for the date by which the transition will be completed if the facility demonstrates that it has made significant progress toward transition, and states with specificity the timeframe by which the transition will be completed and the specified steps that will be taken to accomplish the transition. A regional center may pay for the costs of care and treatment of a consumer residing in the facility on June 30, 2012, until June 30, 2013, inclusive, and, if the facility has a department-approved plan in place by June 30, 2013, may continue to pay the costs under this subparagraph until June 30, 2014, or until the end of any period during which the department has granted an extension.(III)There is an emergency circumstance in which the regional center determines that it cannot locate alternate federally eligible services to meet the consumers needs. Under such an emergency circumstance, an assessment shall be completed by the regional center as soon as possible and within 30 days of admission. An individual program plan meeting shall be convened immediately following the assessment to determine the services and supports needed for stabilization and to develop a plan to transition the consumer from the facility into the community. If transition is not expected within 90 days of admission, an individual program plan meeting shall be held to discuss the status of transition and to determine if the consumer is still in need of placement in the facility. Commencing October 1, 2012, this determination shall be made after also considering resource options identified by the statewide specialized resource service. If it is determined that emergency services continue to be necessary, the regional center shall submit an updated transition plan that can cover a period of up to 90 days. In no event shall placements under these emergency circumstances exceed 180 days.(C)(i)Effective July 1, 2012, notwithstanding any other law or regulation, a regional center shall not purchase new residential services from, or place a consumer in, institutions for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5, for which federal Medicaid funding is not available. Effective July 1, 2013, this prohibition applies regardless of the availability of federal funding.(ii)The prohibition described in clause (i) shall not apply to emergencies, as determined by the regional center, when a regional center cannot locate alternate services to meet the consumers needs. As soon as possible within 30 days of admission due to an emergency, an assessment shall be completed by the regional center. An individual program plan meeting shall be convened immediately following the assessment, to determine the services and supports needed for stabilization and to develop a plan to transition the consumer from the facility to the community. If transition is not expected within 90 days of admission, an emergency program plan meeting shall be held to discuss the status of the transition and to determine if the consumer is still in need of placement in the facility. If emergency services continue to be necessary, the regional center shall submit an updated transition plan to the department for an extension of up to 90 days. Placement shall not exceed 180 days.(iii)To the extent feasible, prior to any admission, the regional center shall consider resource options identified by the statewide specialized resource service established pursuant to subdivision (b) of Section 4418.25.(iv)The clients rights advocate shall be notified of each admission and individual program plan meeting pursuant to this subparagraph and may participate in all individual program plan meetings unless the consumer objects on his or her own behalf. For purposes of this clause, notification to the clients rights advocate shall include a copy of the most recent comprehensive assessment or updated assessment and the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.(v)If a consumer is placed in an institution for mental disease by another entity, the institution for mental disease shall inform the regional center of the placement within five days of the date the consumer is admitted. If an individuals records indicate that he or she is a regional center consumer, the institution for mental disease shall make every effort to contact the local regional center or department to determine which regional center to provide notice. As soon as possible within 30 days of admission to an institution for mental disease due to an emergency pursuant to clause (ii), or within 30 days of notification of admission to an institution for mental disease by an entity other than a regional center, an assessment shall be completed by the regional center.(vi)Regional centers shall complete a comprehensive assessment of any consumer residing in an institution for mental disease as of July 1, 2012, for which federal Medicaid funding is not available, and for any consumer residing in an institution for mental disease as of July 1, 2013, without regard to federal funding. The comprehensive assessment shall be completed prior to the consumers next scheduled individual program plan meeting and shall include identification of the services and supports needed and the timeline for identifying or developing those services needed to transition the consumer back to the community. Effective October 1, 2012, the regional center shall also consider resource options identified by the statewide specialized resource service. For each individual program plan meeting convened pursuant to this subparagraph, the clients rights advocate for the regional center shall be notified of the meeting and may participate in the meeting unless the consumer objects on his or her own behalf. For purposes of this clause, notification to the clients rights advocate shall include the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.(D)A person with developmental disabilities placed by the regional center in a community living arrangement shall have the rights specified in this division. These rights shall be brought to the persons attention by any means necessary to reasonably communicate these rights to each resident, provided that, at a minimum, the Director of Developmental Services prepare, provide, and require to be clearly posted in all residential facilities and day programs a poster using simplified language and pictures that is designed to be more understandable by persons with intellectual disabilities and that the rights information shall also be available through the regional center to each residential facility and day program in alternative formats, including, but not limited to, other languages, braille, and audiotapes, when necessary to meet the communication needs of consumers.(E)Consumers are eligible to receive supplemental services including, but not limited to, additional staffing, pursuant to the process described in subdivision (d) of Section 4646. Necessary additional staffing that is not specifically included in the rates paid to the service provider may be purchased by the regional center if the additional staff are in excess of the amount required by regulation and the individuals planning team determines the additional services are consistent with the provisions of the individual program plan. Additional staff should be periodically reviewed by the planning team for consistency with the individual program plan objectives in order to determine if continued use of the additional staff is necessary and appropriate and if the service is producing outcomes consistent with the individual program plan. Regional centers shall monitor programs to ensure that the additional staff is being provided and utilized appropriately.(10)Emergency and crisis intervention services including, but not limited to, mental health services and behavior modification services, may be provided, as needed, to maintain persons with developmental disabilities in the living arrangement of their own choice. Crisis services shall first be provided without disrupting a persons living arrangement. If crisis intervention services are unsuccessful, emergency housing shall be available in the persons home community. If dislocation cannot be avoided, every effort shall be made to return the person to his or her living arrangement of choice, with all necessary supports, as soon as possible.(11)Among other service and support options, planning teams shall consider the use of paid roommates or neighbors, personal assistance, technical and financial assistance, and all other service and support options which would result in greater self-sufficiency for the consumer and cost-effectiveness to the state.(12)When facilitation as specified in an individual program plan requires the services of an individual, the facilitator shall be of the consumers choosing.(13)The community support may be provided to assist individuals with developmental disabilities to fully participate in community and civic life, including, but not limited to, programs, services, work opportunities, business, and activities available to persons without disabilities. This facilitation shall include, but not be limited to, any of the following:(A)Outreach and education to programs and services within the community.(B)Direct support to individuals that would enable them to more fully participate in their community.(C)Developing unpaid natural supports when possible.(14)When feasible and recommended by the individual program planning team, for purposes of facilitating better and cost-effective services for consumers or family members, technology, including telecommunication technology, may be used in conjunction with other services and supports. Technology in lieu of a consumers in-person appearances at judicial proceedings or administrative due process hearings may be used only if the consumer or, when appropriate, the consumers parent, legal guardian, conservator, or authorized representative, gives informed consent. Technology may be used in lieu of, or in conjunction with, in-person training for providers, as appropriate.(15)Other services and supports may be provided as set forth in Sections 4685, 4686, 4687, 4688, and 4689, when necessary.(16)Notwithstanding any other law or regulation, effective July 1, 2009, regional centers shall not purchase experimental treatments, therapeutic services, or devices that have not been clinically determined or scientifically proven to be effective or safe or for which risks and complications are unknown. Experimental treatments or therapeutic services include experimental medical or nutritional therapy when the use of the product for that purpose is not a general physician practice. For regional center consumers receiving these services as part of their individual program plan (IPP) or individualized family service plan (IFSP) on July 1, 2009, this prohibition shall apply on August 1, 2009.(b)(1)Advocacy for, and protection of, the civil, legal, and service rights of persons with developmental disabilities as established in this division.(2)Whenever the advocacy efforts of a regional center to secure or protect the civil, legal, or service rights of any of its consumers prove ineffective, the regional center or the person with developmental disabilities or his or her parents, legal guardian, or other representative may request advocacy assistance from the state council.(c)The regional center may assist consumers and families directly, or through a provider, in identifying and building circles of support within the community.(d)In order to increase the quality of community services and protect consumers, the regional center shall, when appropriate, take either of the following actions:(1)Identify services and supports that are ineffective or of poor quality and provide or secure consultation, training, or technical assistance services for any agency or individual provider to assist that agency or individual provider in upgrading the quality of services or supports.(2)Identify providers of services or supports that may not be in compliance with local, state, and federal statutes and regulations and notify the appropriate licensing or regulatory authority to investigate the possible noncompliance.(e)When necessary to expand the availability of needed services of good quality, a regional center may take actions that include, but are not limited to, the following:(1)Soliciting an individual or agency by requests for proposals or other means, to provide needed services or supports not presently available.(2)Requesting funds from the Program Development Fund, pursuant to Section 4677, or community placement plan funds designated from that fund, to reimburse the startup costs needed to initiate a new program of services and supports.(3)Using creative and innovative service delivery models, including, but not limited to, natural supports.(f)Except in emergency situations, a regional center shall not provide direct treatment and therapeutic services, but shall utilize appropriate public and private community agencies and service providers to obtain those services for its consumers.(g)When there are identified gaps in the system of services and supports or when there are identified consumers for whom no provider will provide services and supports contained in his or her individual program plan, the department may provide the services and supports directly.(h)(1)At least annually, regional centers shall provide the consumer, his or her parents, legal guardian, conservator, or authorized representative a statement of services and supports the regional center purchased for the purpose of ensuring that they are delivered. The statement shall include the type, unit, month, and cost of services and supports purchased.(2)Upon request of the consumer, or his or her legal guardian, the regional center shall make the statement described in paragraph (1) available in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate, to the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both. This paragraph is in addition to, and independent of, any other rights, remedies, or procedures under any other law and shall not be construed to alter, limit, or negate any other rights, remedies, or procedures provided for by law.SEC. 6.Section 4648.6 of the Welfare and Institutions Code is amended to read:4648.6.(a)The department, in consultation with stakeholders, shall develop an alternative service delivery model that provides an Individual Choice Budget for obtaining quality services and supports which provides choice and flexibility within a finite budget that in the aggregate reduces regional center purchase of service expenditures, reduces reliance on the state general fund, and maximizes federal financial participation in the delivery of services. The individual budget will be determined using a fair, equitable, transparent standardized process.
(b)(1)(A)By March 31, 2018, the department shall provide a written report to the Legislature regarding the status of the Individual Choice Budget, and a projected timeframe for fully reinstating the services suspended pursuant to Section 4648.5 and for making the restrictions on services described in Section 4686.5 ineffective.
(B)A report submitted pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code.
(2)The requirement for submitting a report imposed under paragraph (1) is inoperative on January 1, 2022, pursuant to Section 10231.5 of the Government Code.
SEC. 7.Section 4659 of the Welfare and Institutions Code is amended to read:4659.(a)Except as otherwise provided in subdivision (b) or (e), the regional center shall identify and pursue all possible sources of funding for consumers receiving regional center services. These sources shall include, but not be limited to, both of the following:
(1)Governmental or other entities or programs required to provide or pay the cost of providing services, including Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, school districts, and federal supplemental security income and the state supplementary program.
(2)Private entities, to the maximum extent they are liable for the cost of services, aid, insurance, or medical assistance to the consumer.
(b)Any revenues collected by a regional center pursuant to this section shall be applied against the cost of services prior to use of regional center funds for those services. This revenue shall not result in a reduction in the regional centers purchase of services budget, except as it relates to federal supplemental security income and the state supplementary program.
(c)Effective July 1, 2009, notwithstanding any other law or regulation, regional centers shall not purchase any service that would otherwise be available from Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, In-Home Support Services, California Childrens Services, private insurance, or a health care service plan when a consumer or a family meets the criteria of this coverage but chooses not to pursue that coverage. If, on July 1, 2009, a regional center is purchasing that service as part of a consumers individual program plan (IPP), the prohibition shall take effect on October 1, 2009.
(d)(1)Effective July 1, 2009, notwithstanding any other law or regulation, a regional center shall not purchase medical or dental services for a consumer three years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center determines that an appeal by the consumer or family of the denial does not have merit. If, on July 1, 2009, a regional center is purchasing the service as part of a consumers IPP, this provision shall take effect on August 1, 2009. Regional At the time of development of the initial individual program plan, as described in subdivision (c) of Section 4646, and at least annually thereafter at the beginning of an individual program plan meeting or at an annual review of the individual program plan, the regional center shall provide a written description of the denial documentation consumers and families are required to provide pursuant to this paragraph. In order to ensure that there are no gaps in the provision of services and supports, regional centers may shall pay for medical or dental services identified, pursuant to subdivision (d) of Section 4646 and paragraph (5) of subdivision (a) of Section 4646.5, as necessary to implement the consumers individual program plan during the following periods:
(A)While coverage is being pursued, but before a denial is made.
(B)Pending a final administrative decision on the administrative appeal if the family has provided to the regional center a verification that an administrative appeal is being pursued.
(C)Until the commencement of services by Medi-Cal, private insurance, or a health care service plan.
(2)When necessary, the consumer or family may receive assistance from the regional center, the Clients Rights Advocate funded by the department, or the state council in pursuing these appeals.
(e)This section shall not impose any additional liability on the parents of children with developmental disabilities, or to restrict eligibility for, or deny services to, any individual who qualifies for regional center services but is unable to pay.
(f)In order to best utilize generic resources, federally funded programs, and private insurance programs for individuals with developmental disabilities, the department and regional centers shall engage in the following activities:
(1)Within existing resources, the department shall provide training to regional centers, no less than once every two years, in the availability and requirements of generic, federally funded and private programs available to persons with developmental disabilities, including, but not limited to, eligibility requirements, the application process and covered services, and the appeal process.
(2)Regional centers shall disseminate information and training to all service coordinators regarding the availability and requirements of generic, federally funded, and private insurance programs on the local level.
SEC. 8.Section 4686.2 of the Welfare and Institutions Code is amended to read:4686.2.(a)Effective July 1, 2009, notwithstanding any other provision of Notwithstanding any law or regulation to the contrary, any vendor who provides applied behavioral analysis (ABA) services, or intensive behavioral intervention services or both, as defined in subdivision (d), shall:
(1)Conduct a behavioral assessment of each consumer to whom the vendor provides these services.
(2)Design an intervention plan that shall include the service type, number of hours hours, and parent participation needed recommended to achieve the consumers goals and objectives, as set forth in the consumers individual program plan (IPP) or individualized family service plan (IFSP). The intervention plan shall also set forth the frequency at which the consumers progress shall be evaluated and reported.
(3)Provide a copy of the intervention plan to the regional center for review and consideration by the planning team members.
(b)Effective July 1, 2009, notwithstanding any other provision of Notwithstanding any law or regulation to the contrary, regional centers shall:
(1)Only purchase ABA services or intensive behavioral intervention services that reflect evidence-based practices, promote positive social behaviors, and ameliorate behaviors that interfere with learning and social interactions.
(2)Only purchase ABA or intensive behavioral intervention services when the parent or parents of minor consumers receiving services participate in the intervention plan for the consumers, given the critical nature of parent participation to the success of the intervention plan.(2)(A)To the extent feasible, facilitate a parents or caregivers participation in ABA or intensive behavioral intervention services for a minor consumer receiving those services through the provision of additional services and supports, accommodations, or both.
(B)A parents or caregivers failure to participate in ABA or intensive behavioral intervention services shall not be used to deny, delay, or reduce the provision of those services.
(3)Not purchase either ABA or intensive behavioral intervention services for purposes of providing respite, day care, or school services.
(4)Discontinue purchasing ABA or intensive behavioral intervention services for a consumer when the consumers treatment goals and objectives, as described under subdivision (a), are achieved. ABA or intensive behavioral intervention services shall not be discontinued until the goals and objectives are reviewed and updated as required in paragraph (5) and shall be discontinued only if those updated treatment goals and objectives do not require ABA or intensive behavioral intervention services.
(5)For each consumer, evaluate the vendors intervention plan and number of service hours for ABA or intensive behavioral intervention no less than every six months, consistent with evidence-based practices. If necessary, the intervention plans treatment goals and objectives shall be updated and revised.
(6)Not reimburse a parent for participating in a behavioral services treatment program.
(c)For consumers receiving ABA or behavioral intervention services on July 1, 2009, as part of their IPP or IFSP, subdivision (b) shall apply on August 1, 2009.
(d)For purposes of this section the following definitions shall apply:
(1)Applied behavioral analysis means the design, implementation, and evaluation of systematic instructional and environmental modifications to promote positive social behaviors and reduce or ameliorate behaviors which interfere with learning and social interaction.
(2)Intensive behavioral intervention means any form of applied behavioral analysis that is comprehensive, designed to address all domains of functioning, and provided in multiple settings for no more than 40 hours per week, across all settings, depending on the individuals needs and progress. Interventions can be delivered in a one-to-one ratio or small group format, as appropriate.
(3)Evidence-based practice means a decisionmaking process that integrates the best available scientifically rigorous research, clinical expertise, and individuals characteristics. Evidence-based practice is an approach to treatment rather than a specific treatment. Evidence-based practice promotes the collection, interpretation, integration, and continuous evaluation of valid, important, and applicable individual- or family-reported, clinically-observed, and research-supported evidence. The best available evidence, matched to consumer circumstances and preferences, is applied to ensure the quality of clinical judgments and facilitates the most cost-effective care.
(4)Parent participation shall include, but shall not be limited to, the following meanings:
(A)Completion of group instruction on the basics of behavior intervention.
(B)Implementation of intervention strategies, according to the intervention plan.
(C)If needed, collection of data on behavioral strategies and submission of that data to the provider for incorporation into progress reports.
(D)Participation in any needed clinical meetings.
(E)Purchase of suggested behavior modification materials or community involvement if a reward system is used.
(a)The planning process for the individual program plan described in Section 4646 shall include all of the following:
(1)Gathering information and conducting assessments to determine the life goals, capabilities and strengths, preferences, barriers, and concerns or problems of the person with developmental disabilities. For children with developmental disabilities, this process should include a review of the strengths, preferences, and needs of the child and the family unit as a whole. Assessments shall be conducted by qualified individuals and performed in natural environments whenever possible. Information shall be taken from the consumer, his or her parents and other family members, his or her friends, advocates, authorized representative, if applicable, providers of services and supports, and other agencies. The assessment process shall reflect awareness of, and sensitivity to, the lifestyle and cultural background of the consumer and the family.
(2)A statement of goals, based on the needs, preferences, and life choices of the individual with developmental disabilities, and a statement of specific, time-limited objectives for implementing the persons goals and addressing his or her needs. These objectives shall be stated in terms that allow measurement of progress or monitoring of service delivery. These goals and objectives should maximize opportunities for the consumer to develop relationships, be part of community life in the areas of community participation, housing, work, school, and leisure, increase control over his or her life, acquire increasingly positive roles in community life, and develop competencies to help accomplish these goals.
(3)When developing individual program plans for children, regional centers shall be guided by the principles, process, and services and support parameters set forth in Section 4685.
(4)When developing an individual program plan for a transition age youth or working age adult, the planning team shall consider the Employment First Policy described in Chapter 14 (commencing with Section 4868).
(5)A schedule of the type and amount of services and supports to be purchased by the regional center or obtained from generic agencies or other resources in order to achieve the individual program plan goals and objectives, and identification of the provider or providers of service responsible for attaining each objective, including, but not limited to, vendors, contracted providers, generic service agencies, and natural supports. The individual program plan shall specify the approximate scheduled start date for services and supports and shall contain timelines for actions necessary to begin services and supports, including generic services. In addition to the requirements of subdivision (h) of Section 4646, each regional center shall offer, and upon request provide, a written copy of the individual program plan to the consumer, and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of their request in a threshold language, as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations.
(6)At the beginning of each individual program plan meeting, the regional center shall provide a consumer and, when appropriate, his or her parents, legal guardian, conservator, or authorized representative information about the appeal and complaint process in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate. This paragraph is in addition to, and independent of, any other rights, remedies, or procedures under any other law and shall not be construed to alter, limit, or negate any other rights, remedies, or procedures provided for by law.
(6)(7)When agreed to by the consumer, the parents, legally appointed guardian, or authorized representative of a minor consumer, or the legally appointed conservator of an adult consumer or the authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, and subdivision (e) of Section 4705, a review of the general health status of the adult or child, including medical, dental, and mental health needs, shall be conducted. This review shall include a discussion of current medications, any observed side effects, and the date of the last review of the medication. Service providers shall cooperate with the planning team to provide any information necessary to complete the health status review. If any concerns are noted during the review, referrals shall be made to regional center clinicians or to the consumers physician, as appropriate. Documentation of health status and referrals shall be made in the consumers record by the service coordinator.
(7)(8)(A)The development of a transportation access plan for a consumer when all of the following conditions are met:
(i)The regional center is purchasing private, specialized transportation services or services from a residential, day, or other provider, excluding vouchered service providers, to transport the consumer to and from day or work services.
(ii)The planning team has determined that a consumers community integration and participation could be safe and enhanced through the use of public transportation services.
(iii)The planning team has determined that generic transportation services are available and accessible.
(B)To maximize independence and community integration and participation, the transportation access plan shall identify the services and supports necessary to assist the consumer in accessing public transportation and shall comply with Section 4648.35. These services and supports may include, but are not limited to, mobility training services and the use of transportation aides. Regional centers are encouraged to coordinate with local public transportation agencies.
(8)(9)A schedule of regular periodic review and reevaluation to ascertain that planned services have been provided, that objectives have been fulfilled within the times specified, and that consumers and families are satisfied with the individual program plan and its implementation.
(b)For all active cases, individual program plans shall be reviewed and modified by the planning team, through the process described in Section 4646, as necessary, in response to the persons achievement or changing needs, and no less often than once every three years. If the consumer or, where appropriate, the consumers parents, legal guardian, authorized representative, or conservator requests an individual program plan review, the individual program shall be reviewed within 30 days after the request is submitted.
(c)(1)The department, with the participation of representatives of a statewide consumer organization, the Association of Regional Center Agencies, an organized labor organization representing service coordination staff, and the state council shall prepare training material and a standard format and instructions for the preparation of individual program plans, which embody an approach centered on the person and family.
(2)Each regional center shall use the training materials and format prepared by the department pursuant to paragraph (1).
(3)The department shall biennially review a random sample of individual program plans at each regional center to ensure that these plans are being developed and modified in compliance with Section 4646 and this section.
SEC. 2.Section 4648 of the Welfare and Institutions Code is amended to read:4648.In order to achieve the stated objectives of a consumers individual program plan, the regional center shall conduct activities, including, but not limited to, all of the following:
(a)Securing needed services and supports.
(1)It is the intent of the Legislature that services and supports assist individuals with developmental disabilities in achieving the greatest self-sufficiency possible and in exercising personal choices. The regional center shall secure services and supports that meet the needs of the consumer, as determined in the consumers individual program plan, and within the context of the individual program plan, the planning team shall give highest preference to those services and supports which would allow minors with developmental disabilities to live with their families, adult persons with developmental disabilities to live as independently as possible in the community, and that allow all consumers to interact with persons without disabilities in positive, meaningful ways.
(2)In implementing individual program plans, regional centers, through the planning team, shall first consider services and supports in natural community, home, work, and recreational settings. Services and supports shall be flexible and individually tailored to the consumer and, where appropriate, his or her family.
(3)A regional center may, pursuant to vendorization or a contract, purchase services or supports for a consumer from any individual or agency that the regional center and consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representatives, determines will best accomplish all or any part of that consumers program plan.
(A)Vendorization or contracting is the process for identification, selection, and utilization of service vendors or contractors, based on the qualifications and other requirements necessary in order to provide the service.
(B)A regional center may reimburse an individual or agency for services or supports provided to a regional center consumer if the individual or agency has a rate of payment for vendored or contracted services established by the department, pursuant to this division, and is providing services pursuant to an emergency vendorization or has completed the vendorization procedures or has entered into a contract with the regional center and continues to comply with the vendorization or contracting requirements. The director shall adopt regulations governing the vendorization process to be utilized by the department, regional centers, vendors, and the individual or agency requesting vendorization.
(C)Regulations shall include, but not be limited to: the vendor application process, and the basis for accepting or denying an application; the qualification and requirements for each category of services that may be provided to a regional center consumer through a vendor; requirements for emergency vendorization; procedures for termination of vendorization; and the procedure for an individual or an agency to appeal any vendorization decision made by the department or regional center.
(D)A regional center may vendorize a licensed facility for exclusive services to persons with developmental disabilities at a capacity equal to or less than the facilitys licensed capacity. A facility already licensed on January 1, 1999, shall continue to be vendorized at their full licensed capacity until the facility agrees to vendorization at a reduced capacity.
(E)Effective July 1, 2009, notwithstanding any other law or regulation, a regional center shall not newly vendor a State Department of Social Services licensed 24-hour residential care facility with a licensed capacity of 16 or more beds, unless the facility qualifies for receipt of federal funds under the Medicaid Program.
(4)Notwithstanding subparagraph (B) of paragraph (3), a regional center may contract or issue a voucher for services and supports provided to a consumer or family at a cost not to exceed the maximum rate of payment for that service or support established by the department. If a rate has not been established by the department, the regional center may, for an interim period, contract for a specified service or support with, and establish a rate of payment for, any provider of the service or support necessary to implement a consumers individual program plan. Contracts may be negotiated for a period of up to three years, with annual review and subject to the availability of funds.
(5)In order to ensure the maximum flexibility and availability of appropriate services and supports for persons with developmental disabilities, the department shall establish and maintain an equitable system of payment to providers of services and supports identified as necessary to the implementation of a consumers consumers individual program plan. The system of payment shall include a provision for a rate to ensure that the provider can meet the special needs of consumers and provide quality services and supports in the least restrictive setting as required by law.
(6)The regional center and the consumer, or when appropriate, his or her parents, legal guardian, conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, or subdivision (e) of Section 4705, shall, pursuant to the individual program plan, consider all of the following when selecting a provider of consumer services and supports:
(A)A providers ability to deliver quality services or supports that can accomplish all or part of the consumers individual program plan.
(B)A providers success in achieving the objectives set forth in the individual program plan.
(C)Where appropriate, the existence of licensing, accreditation, or professional certification.
(D)The cost of providing services or supports of comparable quality by different providers, if available, shall be reviewed, and the least costly available provider of comparable service, including the cost of transportation, who is able to accomplish all or part of the consumers individual program plan, consistent with the particular needs of the consumer and family as identified in the individual program plan, shall be selected. In determining the least costly provider, the availability of federal financial participation shall be considered. The consumer shall not be required to use the least costly provider if it will result in the consumer moving from an existing provider of services or supports to more restrictive or less integrated services or supports.
(E)The consumers choice of providers, or, when appropriate, the consumers parents, legal guardians, authorized representatives, or conservators choice of providers.
(7)No service or support provided by any agency or individual shall be continued unless the consumer or, when appropriate, his or her parents, legal guardian, or conservator, or authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, or subdivision (e) of Section 4705, is satisfied and the regional center and the consumer or, when appropriate, the persons parents or legal guardian or conservator agree that planned services and supports have been provided, and reasonable progress toward objectives have been made.
(8)Regional center funds shall not be used to supplant the budget of any agency that has a legal responsibility to serve all members of the general public and is receiving public funds for providing those services.
(9)(A)A regional center may, directly or through an agency acting on behalf of the center, provide placement in, purchase of, or follow-along services to persons with developmental disabilities in, appropriate community living arrangements, including, but not limited to, support service for consumers in homes they own or lease, foster family placements, health care facilities, and licensed community care facilities. In considering appropriate placement alternatives for children with developmental disabilities, approval by the childs parent or guardian shall be obtained before placement is made.
(B)Effective July 1, 2012, notwithstanding any other law or regulation, a regional center shall not purchase residential services from a State Department of Social Services licensed 24-hour residential care facility with a licensed capacity of 16 or more beds. This prohibition on regional center purchase of residential services shall not apply to any of the following:
(i)A residential facility with a licensed capacity of 16 or more beds that has been approved to participate in the departments Home and Community Based Services Waiver or another existing waiver program or certified to participate in the Medi-Cal program.
(ii)A residential facility service provider that has a written agreement and specific plan prior to July 1, 2012, with the vendoring regional center to downsize the existing facility by transitioning its residential services to living arrangements of 15 beds or less or restructure the large facility to meet federal Medicaid eligibility requirements on or before June 30, 2013.
(iii)A residential facility licensed as a mental health rehabilitation center by the State Department of Mental Health Care Services or successor agency under any of the following circumstances:
(I)The facility is eligible for Medicaid reimbursement.
(II)The facility has a department-approved plan in place by June 30, 2013, to transition to a program structure eligible for federal Medicaid funding, and this transition will be completed by June 30, 2014. The department may grant an extension for the date by which the transition will be completed if the facility demonstrates that it has made significant progress toward transition, and states with specificity the timeframe by which the transition will be completed and the specified steps that will be taken to accomplish the transition. A regional center may pay for the costs of care and treatment of a consumer residing in the facility on June 30, 2012, until June 30, 2013, inclusive, and, if the facility has a department-approved plan in place by June 30, 2013, may continue to pay the costs under this subparagraph until June 30, 2014, or until the end of any period during which the department has granted an extension.
(III)There is an emergency circumstance in which the regional center determines that it cannot locate alternate federally eligible services to meet the consumers needs. Under such an emergency circumstance, an assessment shall be completed by the regional center as soon as possible and within 30 days of admission. An individual program plan meeting shall be convened immediately following the assessment to determine the services and supports needed for stabilization and to develop a plan to transition the consumer from the facility into the community. If transition is not expected within 90 days of admission, an individual program plan meeting shall be held to discuss the status of transition and to determine if the consumer is still in need of placement in the facility. Commencing October 1, 2012, this determination shall be made after also considering resource options identified by the statewide specialized resource service. If it is determined that emergency services continue to be necessary, the regional center shall submit an updated transition plan that can cover a period of up to 90 days. In no event shall placements under these emergency circumstances exceed 180 days.
(C)(i)Effective July 1, 2012, notwithstanding any other law or regulation, a regional center shall not purchase new residential services from, or place a consumer in, institutions for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5, for which federal Medicaid funding is not available. Effective July 1, 2013, this prohibition applies regardless of the availability of federal funding.
(ii)The prohibition described in clause (i) shall not apply to emergencies, as determined by the regional center, when a regional center cannot locate alternate services to meet the consumers needs. As soon as possible within 30 days of admission due to an emergency, an assessment shall be completed by the regional center. An individual program plan meeting shall be convened immediately following the assessment, to determine the services and supports needed for stabilization and to develop a plan to transition the consumer from the facility to the community. If transition is not expected within 90 days of admission, an emergency program plan meeting shall be held to discuss the status of the transition and to determine if the consumer is still in need of placement in the facility. If emergency services continue to be necessary, the regional center shall submit an updated transition plan to the department for an extension of up to 90 days. Placement shall not exceed 180 days.
(iii)To the extent feasible, prior to any admission, the regional center shall consider resource options identified by the statewide specialized resource service established pursuant to subdivision (b) of Section 4418.25.
(iv)The clients rights advocate shall be notified of each admission and individual program planning plan meeting pursuant to this subparagraph and may participate in all individual program planning plan meetings unless the consumer objects on his or her own behalf. For purposes of this clause, notification to the clients rights advocate shall include a copy of the most recent comprehensive assessment or updated assessment and the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.
(v)If a consumer is placed in an institution for mental disease by another entity, the institution for mental disease shall inform the regional center of the placement within five days of the date the consumer is admitted. If an individuals records indicate that he or she is a regional center consumer, the institution for mental disease shall make every effort to contact the local regional center or department to determine which regional center to provide notice. As soon as possible within 30 days of admission to an institution for mental disease due to an emergency pursuant to clause (ii), or within 30 days of notification of admission to an institution for mental disease by an entity other than a regional center, an assessment shall be completed by the regional center.
(vi)Regional centers shall complete a comprehensive assessment of any consumer residing in an institution for mental disease as of July 1, 2012, for which federal Medicaid funding is not available, and for any consumer residing in an institution for mental disease as of July 1, 2013, without regard to federal funding. The comprehensive assessment shall be completed prior to the consumers next scheduled individual program plan meeting and shall include identification of the services and supports needed and the timeline for identifying or developing those services needed to transition the consumer back to the community. Effective October 1, 2012, the regional center shall also consider resource options identified by the statewide specialized resource service. For each individual program plan meeting convened pursuant to this subparagraph, the clients rights advocate for the regional center shall be notified of the meeting and may participate in the meeting unless the consumer objects on his or her own behalf. For purposes of this clause, notification to the clients rights advocate shall include the time, date, and location of the meeting, and shall be provided as soon as practicable, but not less than seven calendar days prior to the meeting.
(D)A person with developmental disabilities placed by the regional center in a community living arrangement shall have the rights specified in this division. These rights shall be brought to the persons attention by any means necessary to reasonably communicate these rights to each resident, provided that, at a minimum, the Director of Developmental Services prepare, provide, and require to be clearly posted in all residential facilities and day programs a poster using simplified language and pictures that is designed to be more understandable by persons with intellectual disabilities and that the rights information shall also be available through the regional center to each residential facility and day program in alternative formats, including, but not limited to, other languages, braille, and audiotapes, when necessary to meet the communication needs of consumers.
(E)Consumers are eligible to receive supplemental services including, but not limited to, additional staffing, pursuant to the process described in subdivision (d) of Section 4646. Necessary additional staffing that is not specifically included in the rates paid to the service provider may be purchased by the regional center if the additional staff are in excess of the amount required by regulation and the individuals planning team determines the additional services are consistent with the provisions of the individual program plan. Additional staff should be periodically reviewed by the planning team for consistency with the individual program plan objectives in order to determine if continued use of the additional staff is necessary and appropriate and if the service is producing outcomes consistent with the individual program plan. Regional centers shall monitor programs to ensure that the additional staff is being provided and utilized appropriately.
(10)Emergency and crisis intervention services including, but not limited to, mental health services and behavior modification services, may be provided, as needed, to maintain persons with developmental disabilities in the living arrangement of their own choice. Crisis services shall first be provided without disrupting a persons living arrangement. If crisis intervention services are unsuccessful, emergency housing shall be available in the persons home community. If dislocation cannot be avoided, every effort shall be made to return the person to his or her living arrangement of choice, with all necessary supports, as soon as possible.
(11)Among other service and support options, planning teams shall consider the use of paid roommates or neighbors, personal assistance, technical and financial assistance, and all other service and support options which would result in greater self-sufficiency for the consumer and cost-effectiveness to the state.
(12)When facilitation as specified in an individual program plan requires the services of an individual, the facilitator shall be of the consumers choosing.
(13)The community support may be provided to assist individuals with developmental disabilities to fully participate in community and civic life, including, but not limited to, programs, services, work opportunities, business, and activities available to persons without disabilities. This facilitation shall include, but not be limited to, any of the following:
(A)Outreach and education to programs and services within the community.
(B)Direct support to individuals that would enable them to more fully participate in their community.
(C)Developing unpaid natural supports when possible.
(14)When feasible and recommended by the individual program planning team, for purposes of facilitating better and cost-effective services for consumers or family members, technology, including telecommunication technology, may be used in conjunction with other services and supports. Technology in lieu of a consumers in-person appearances at judicial proceedings or administrative due process hearings may be used only if the consumer or, when appropriate, the consumers parent, legal guardian, conservator, or authorized representative, gives informed consent. Technology may be used in lieu of, or in conjunction with, in-person training for providers, as appropriate.
(15)Other services and supports may be provided as set forth in Sections 4685, 4686, 4687, 4688, and 4689, when necessary.
(16)Notwithstanding any other law or regulation, effective July 1, 2009, regional centers shall not purchase experimental treatments, therapeutic services, or devices that have not been clinically determined or scientifically proven to be effective or safe or for which risks and complications are unknown. Experimental treatments or therapeutic services include experimental medical or nutritional therapy when the use of the product for that purpose is not a general physician practice. For regional center consumers receiving these services as part of their individual program plan (IPP) or individualized family service plan (IFSP) on July 1, 2009, this prohibition shall apply on August 1, 2009.
(b)(1)Advocacy for, and protection of, the civil, legal, and service rights of persons with developmental disabilities as established in this division.
(2)Whenever the advocacy efforts of a regional center to secure or protect the civil, legal, or service rights of any of its consumers prove ineffective, the regional center or the person with developmental disabilities or his or her parents, legal guardian, or other representative may request advocacy assistance from the state council.
(c)The regional center may assist consumers and families directly, or through a provider, in identifying and building circles of support within the community.
(d)In order to increase the quality of community services and protect consumers, the regional center shall, when appropriate, take either of the following actions:
(1)Identify services and supports that are ineffective or of poor quality and provide or secure consultation, training, or technical assistance services for any agency or individual provider to assist that agency or individual provider in upgrading the quality of services or supports.
(2)Identify providers of services or supports that may not be in compliance with local, state, and federal statutes and regulations and notify the appropriate licensing or regulatory authority to investigate the possible noncompliance.
(e)When necessary to expand the availability of needed services of good quality, a regional center may take actions that include, but are not limited to, the following:
(1)Soliciting an individual or agency by requests for proposals or other means, to provide needed services or supports not presently available.
(2)Requesting funds from the Program Development Fund, pursuant to Section 4677, or community placement plan funds designated from that fund, to reimburse the startup costs needed to initiate a new program of services and supports.
(3)Using creative and innovative service delivery models, including, but not limited to, natural supports.
(f)Except in emergency situations, a regional center shall not provide direct treatment and therapeutic services, but shall utilize appropriate public and private community agencies and service providers to obtain those services for its consumers.
(g)When there are identified gaps in the system of services and supports or when there are identified consumers for whom no provider will provide services and supports contained in his or her individual program plan, the department may provide the services and supports directly.
(h)(1)At least annually, regional centers shall provide the consumer, his or her parents, legal guardian, conservator, or authorized representative a statement of services and supports the regional center purchased for the purpose of ensuring that they are delivered. The statement shall include the type, unit, month, and cost of services and supports purchased.
(2)Upon request of the consumer, or his or her legal guardian, the regional center shall make the statement described in paragraph (1) available in threshold languages, as defined in paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations, as appropriate, to the consumer or his or her parents, legal guardian, conservator, or authorized representative, or both. This paragraph is in addition to, and independent of, any other rights, remedies, or procedures under any other law and shall not be construed to alter, limit, or negate any other rights, remedies, or procedures provided for by law.
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Date
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Status
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| Feb 1, 2018 | From committee: Filed with the Chief Clerk pursuant to Joint Rule 56. |
| Jan 31, 2018 | Died pursuant to Art. IV, Sec. 10(c) of the Constitution. |
| May 26, 2017 | In committee: Held under submission. |
| May 3, 2017 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| Apr 19, 2017 | Re-referred to Com. on APPR. |
| Apr 18, 2017 | Read second time and amended. |
| Apr 17, 2017 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 6. Noes 0.) (April 4). |
| Mar 28, 2017 | Re-referred to Com. on HUM. S. |
| Mar 27, 2017 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HUM. S. Read second time and amended. |
| Mar 21, 2017 | Re-referred to Com. on HUM. S. |
| Mar 20, 2017 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HUM. S. Read second time and amended. |
| Mar 16, 2017 | Referred to Com. on HUM. S. |
| Feb 19, 2017 | From printer. May be heard in committee March 21. |
| Feb 17, 2017 | Read first time. To print. |
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Date
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Description
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Location
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Votes
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| Apr 4, 2017 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Human Services |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
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Organization
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Position
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Date
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| Assembly District 54 | * Support | Apr 10, 2017 |
| Public Counsel | ** Support | Mar 31, 2017 |
| Special Needs Network | * Support | Apr 10, 2017 |
Date of Hearing: May 3, 2017
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
ABPCA Bill Id:AB 1610
Author:(Ridley-Thomas) â As Amended Ver:April 18, 2017
Policy Committee: | Human Services | Vote: | 6 - 0 |
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Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY: This bill makes changes to regional center requirements in order to increase access for consumers and their families to services and information. Specifically, this bill:
- Requires a regional center, during the initial individualized family service plan (IFSP) or individual program plan (IPP) meeting, and at least annually thereafter during an IFSP or IPP meeting or at a biannual review, to provide the infantâs or toddlerâs parents, legal guardian, conservator, or authorized representative with written information about the appeal procedure and complaint process, as specified.
- Authorizes regional centers to purchase respite and other family support services as nonrequired services, and stipulates that the granting or denial of durable medical equipment, respite services, or other family support services as nonrequired services, as specified, can be subject to appeal.
- Removes the requirement that a parent or parents participate in an infantâs, toddlerâs, or minor consumerâs intervention plan in order for a regional center to purchase applied behavioral analysis (ABA) or intensive behavioral intervention services, and instead requires a regional center to, to the extent feasible, facilitate a parentâs or caregiverâs participation in an infant, toddler, or minor consumerâs ABA or intensive behavioral intervention services through the provision of additional services and support, accommodations, or both.
- Prohibits a parentâs or caregiverâs failure to participate in ABA or intensive behavioral intervention services from being used to deny, delay, or reduce those services.
- Requires regional centers to provide information in a manner that is culturally and linguistically appropriate for a consumer and certain other parties, as specified.
- Deletes language permitting regional centers to pay for medical and dental services during certain periods, and instead requires regional centers to pay for these services during those periods as necessary to implement the consumerâs IPP.
- Requires the Department of Developmental Services (DDS) to convene a task force to develop a purchase of services budget and allocation methodology, and to submit a report to the Legislature by August 31, 2018.
FISCAL EFFECT:
- Annual costs of approximately $1.3 million ($0.87 million GF) to provide written information regarding the appeal and complaints processes at IFSP and IPP meetings, exemption and exception processes and documentation regarding medical and dental services, and to provide a list of services purchased by a regional center.
- Annual costs of approximately $9.5 million ($6.2 million GF) in FY 2017-18, and $37.8 million ($24.7 million GF) in 2018-19 and ongoing to restore camping, social recreation, and nonmedical therapies.
- Annual costs of approximately $9.9 million ($5.3 million GF) in FY 2017-18, and $20.7 million ($11.2 million GF) in 2018-19 and ongoing to remove respite services limits.
- Unknown costs regarding the payment of medical or dental services. These services are currently permissible and DDS does not track the number of consumers not receiving these services due to lack of regional center payment.
- Potential future costs to the extent a lack of parental participation in intensive behavioral intervention reduces the effectiveness of those services and requires the services be required over a longer period of time.
- Unknown, but likely minor costs to provide culturally and linguistically appropriate communication.
COMMENTS:
- Purpose. According to the author, "Access to developmental services has been significantly limited due to severe budget cuts that occurred in 2009, with minority populations especially affected adversely by the suspension and restrictions placed on certain services. The onus has been placed on the consumers and families to demonstrate that they qualify for certain services through a complex statutory scheme. These barriers are insurmountable to many consumers and families, especially those with limited English language proficiency. The suspended services and restricted respite service standards were only supposed to be temporary, pending the development and implementation of an Individual Choice Budget model that DDS appears to have abandoned.â
- Background. In recent years, heightened attention has been given to disparities in regional center spending and service provision. For example, data from DDS indicate that, statewide, per capita spending for services for a Latino consumer was $8,356 in 2015 compared to $18,171 for a white consumer. Moreover, statewide data show that Latino consumers utilize services for which they are authorized at a lower rate (76.6%) than white consumers (82.7%).
Stakeholders argue that consumers from minority communities may be less likely to use out-of-home services and more likely to rely on respite services, and thus, are disproportionately impacted by the reductions in services. Additionally, transportation needs, nontraditional work schedules, and other factors may make it more difficulty for minority and low-income families to meet parent participation requirements for ABA treatment.
In July of 2009, in response to the state budget shortfall, DDS made a number of cuts to achieve over $300 million in General Fund savings. Among the actions taken, the following were included: a) suspending the purchase of camping services, certain social recreation activities, educational services, and non-medical therapies; b) restricting the amount of respite services that may be purchased; c) providing for a standard that parent participation is critical to the success of the intervention plan and; and d) requiring regional centers to purchase ABA or intensive behavioral intervention services only when the parent agrees to participate in the intervention plan.
Additionally, budget trailer bill language required DDS, in consultation with stakeholders, to develop an alternative service delivery model that provided an âIndividual Choice Budgetâ for consumers to obtain quality services and supports that provided choice and flexibility within a finite budget. In the aggregate, this was intended to reduce regional center purchase of service expenditures, and maximize federal financial participation. The suspension of the purchase of camping services, social recreation activities, educational services for children aged 3 to 17 years, and non-medical therapies was adopted pending the implementation of this Individual Choice Budget. The Individual Choice Budget was never fully developed or implemented.
- Prior Legislation.
AB 2809 (Rodriguez), of the 2015-16 Legislative Session, would have required regional centers to provide documents about the appeal and complaint process in threshold languages of a consumer and the consumerâs family, as specified, and would have also required that a consumerâs annual summary of services be provided in the threshold language of the consumer, upon request. It died on the Senate inactive file.
SB 1034 (Mitchell), of the 2015-16 Legislative Session, among other things, would have prohibited lack of parent or caregiver participation from being used to deny or reduce medically necessary behavioral health treatment, as specified. It was held on this Committee's Suspense.
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 1610 (
Author:Ridley-Thomas) â As Amended Ver:March 27, 2017
SUBJECT: Developmental services: regional centers
SUMMARY: Places additional requirements on regional centers and repeals certain provisions of law in order to increase access for consumers and their families to certain services and information and requires the Department of Developmental Services (DDS) to convene a task force to develop a purchase of services budget and allocation methodology.
Specifically, this bill:
- Requires a regional center to, at the beginning of an initial individualized family service plan (IFSP) meeting and at least once a year thereafter at the beginning of an IFSP meeting or at a biannual review of the IFSP, to provide the infantâs or toddlerâs parents, legal guardian, conservator, or authorized representative with written information about the appeal procedure and complaint process, as specified.
- Authorizes regional centers to purchase respite and other family support services as nonrequired services.
- Stipulates that the granting or denial of durable medical equipment, respite services, or other family support services as nonrequired services, as specified, can be subject to appeal.
- Removes the requirement that a parent or parents participate in an infantâs, toddlerâs, or minor consumerâs intervention plan in order for a regional center to purchase applied behavioral analysis (ABA) or intensive behavioral intervention services and instead requires a regional center to, to the extent feasible, facilitate a parentâs or caregiverâs participation in an infantâs, toddlerâs, or minor consumerâs ABA or intensive behavioral intervention services through the provision of additional services and support, accommodations, or both.
- Prohibits a parentâs or caregiverâs failure to participate in ABA or intensive behavioral intervention services from being used to deny, delay, or reduce the provision of those services.
- Adds authorized representatives to the list of individuals whose choices, made on behalf of a consumer, are required to be respected by regional centers and other public and private agencies receiving state funds to serve individuals with developmental disabilities.
- Requires regional centers to provide information in a manner that is culturally and linguistically appropriate for a consumer and, when appropriate, certain other parties, as specified.
- Requires regional centers to provide a consumer and certain other parties, when appropriate, with written information describing the process for obtaining transportation services for a minor child and certain services for consumers between the ages of 18 and 22 when the initial individual program plan (IPP) is developed, and at least once per year thereafter at the beginning of an IPP meeting or at an annual review of the IPP, as specified.
- Requires a regional center to provide a consumer and certain other parties, when appropriate, a list of services provided by the regional center and information about the appeal process at the time an IPP is developed, and each year thereafter at the beginning on an IPP meeting or at an annual review of the IPP, as specified.
- Requires a regional center to, at that end of an IPP meeting, provide a consumer and certain other parties, when appropriate, a written list of agreed-upon services and supports and a list of any requested services and supports for which final agreement has not yet been reached and for which there will be a subsequent program plan meeting, as specified.
- Repeals provisions in current law that:
- Require DDS, in consultation with stakeholders, to develop an alternative service delivery model that provides an Individual Choice Budget enabling consumers to acquire, within a finite budget, services and supports, as specified;
- Suspend, except where individual exemptions apply, a regional centerâs authority to purchase camping services and associated travel expense social recreation therapies, educational services for children ages 3 to 17, and nonmedical therapies pending implementation of the Individual Choice Budget and certification by the Director of DDS that this implementation has occurred and will result in state budget savings, as specified;
- Stipulate, with specified exemptions, that a regional center may only purchase respite services when the care and supervision needs of a consumer exceed that of an individual of the same age without developmental disabilities;
- Prohibit, with specified exemptions, a regional center from purchasing for a consumer more than 21 days of out-of-home respite services per fiscal year or more than 90 hours of in-home respite services per quarter;
- Prohibit a regional center from purchasing day care services, as defined, to replace or supplant respite services; and
- Require a regional center to only consider in-home supportive services (IHSS) a generic resource when the approved IHSS meet the respite needs identified in the consumerâs IPP or IFSP.
- Requires DDS to, by March 31, 2018, convene a task force including specified representatives to develop a purchase of services budget and allocation methodology based on consumer needs and further, requires that task force to submit a report to the Legislature of its recommendations for implementing the methodology, as specified, by August 31, 2018.
- Requires a regional center, at the initial development of the IPP and at least once per year thereafter at the beginning of an IPP meeting or at an annual review of the IPP, to provide a written description of the denial documentation regarding medical and dental coverage that consumers and families are required to supply, as specified.
- Deletes language permitting regional centers to pay for medical and dental services during certain periods, and instead requires regional centers to pay for these services during those periods as necessary to implement the consumerâs IPP.
- Makes technical changes.
EXISTING LAW:
- Establishes an entitlement to services for individuals with developmental disabilities under the Lanterman Developmental Disabilities Services Act (Lanterman Act). (WIC 4500 et seq.)
- Grants all individuals with developmental disabilities, among all other rights and responsibilities established for any individual by the United States Constitution and laws and the California Constitution and laws, the right to treatment and habilitation services and supports in the least restrictive environment. (WIC 4502)
- Establishes a system of 21 nonprofit regional centers throughout the state to identify needs and coordinate services for eligible individuals with developmental disabilities and requires DDS to contract with regional centers to provide case management services and arrange for or purchase services that meet the needs of individuals with developmental disabilities, as defined. (WIC 4620 et seq.)
- Requires the development of an IPP for each regional center consumer, which specifies services to be provided to the consumer, based on his or her individualized needs determination and preferences, and defines that planning process as the vehicle to ensure that services and supports are customized to meet the needs of consumers who are served by regional centers. (WIC 4512)
- Requires the IPP planning processes to include:
- A statement of the individualâs goals and objectives, a schedule of the type and nature of services to be provided and other information and considerations, as specified;
- Review and modification, as necessary, by the regional centerâs planning team no less frequently than every three years; and
- Statewide training and review of the IPP plan creation, as specified. (WIC 4646.5)
- Prohibits discrimination against individuals in protected classes, including national origin and ethnic group identification, for purposes of providing full and equal access to benefits or programs that are operated or funded by the state. (GOV 11135 et seq.)
- Establishes the California Early Intervention Services Act giving the state authority to develop an early intervention service system to serve infants and toddlers who have a disability or are at risk of having a disability. (GOV 95000 et seq.)
- Requires, under the California Early Intervention Services Act, that eligible infants and toddlers have an IFSP in writing that addresses a number of factors, including, among others, the infantâs or toddlerâs present levels of physical development, cognitive development, communication development, social and emotional development, and adaptive developments, and a statement of major outcomes expected to be achieved, as specified. (GOV 95020)
- Entitles parents to be fully informed of their rights under the California Early Intervention Services Act, including the right to invite another person to accompany them to any or all IFSP meetings. (GOV 95020 (c))
- Prohibits, with the exception of durable medical equipment, a regional center from purchasing nonrequired services and further, stipulates that the granting or denial of nonrequired services by a public or private agency is not subject to appeal, as specified. (GOV 95020 (e)(3))
- Provides for an appeals process for consumers of developmental services, as specified. (WIC 4700 et seq.)
- Provides for exemptions to certain service limitations, as specified, related to: transportation for minors; camping services, social recreation activities, educational services, and nonmedical therapies; certain services for consumers ages 18 to 22 years old; and respite services. (WIC 4648.35, 4648.5, 4648.55, 4686.5)
- Authorizes regional centers to pay for medical or dental services pending pursuit or appeal with Medi-Cal, private insurance, or other health care plan. (WIC 4659 (d))
- Defines âparent participationâ for purposes of ABA or intensive behavioral intervention services to include, but not be limited to: completion of group instruction on the basics of behavior intervention; implementation of intervention strategies, according to the intervention plan; collection of data on behavioral strategies and submission of that data, as specified; and participation in any needed clinical meetings. (WIC 4686.2 (d)(4), GOV 95021 (d)(5))
- Requires any vendor who provides ABA or intensive behavioral intervention services to design an intervention plan that includes, among other things, the parent participation needed to achieve the consumerâs goals and objectives as set forth in the IPP. (WIC 4686.2 (a)(2))
- Requires regional centers to only purchase ABA or intensive behavioral intervention services when the parent(s) of infant, toddler, or minor consumers receiving services participate in the intervention plan for the consumers. (GOV 95021 (b)(2), WIC 4686.2 (b)(2))
- States that the right of individuals with developmental disabilities to make choices in their own lives requires that all public or private agencies receiving state funds for the purpose of serving those individuals respect the choice made by consumers or, where appropriate, other specified persons. (WIC 4502.1)
FISCAL EFFECT: Unknown.
COMMENTS:
Developmental services: Provision of services and supports to Californians with developmental disabilities is guided by the Lanterman Act (WIC § 4500 et seq.). Consumers (i.e., individuals under the Act) are legally entitled to treatment and habilitation services and supports in the least restrictive environment. Lanterman Act services are designed to enable all consumers to live more independent and productive lives in the community.
âDevelopmental disabilityâ means a disability that originates before an individual attains 18 years of age, is expected to continue indefinitely, and constitutes a substantial disability for that individual. It includes intellectual disabilities, cerebral palsy, epilepsy, and autism spectrum disorders (ASD). Other developmental disabilities are those disabling conditions similar to an intellectual disability that require treatment (i.e., care and management) similar to that required by individuals with an intellectual disability.
Direct responsibility for implementation of the Lanterman Act service system is shared by DDS and 21 regional centers, which are private nonprofit entities, established pursuant to the Lanterman Act, that contract with DDS to carry out many of the stateâs responsibilities under the Act. The 21 regional centers serve approximately 308,000 consumers, providing services such as residential placements, supported living services, respite care, transportation, day treatment programs, work support programs, and various social and therapeutic activities. Approximately 875 consumers reside at one of Californiaâs three Developmental Centersâand one state-operated, specialized community facilityâwhich provide 24-hour habilitation and medical and social treatment services.
Services provided to people with developmental disabilities are outlined in an IPP, which is developed by the IPP teamâincluding, among other individuals, the consumer, his or her legally authorized representative, and one or more regional center representativesâand is based on the consumerâs needs and choices. The Lanterman Act requires that the IPP promote community integration and maximize opportunities for each consumer to develop relationships, be part of community life, increase control over his or her life, and acquire increasingly positive roles in the community. The IPP must give the highest preference to those services and supports that allow minors to live with their families and adults to live as independently as possible in the community.
Individual Choice Budget: In July of 2009, a number of state budget cuts were adopted in response to the budget shortfall resulting in large part from the national economic crisis (the Developmental Services Trailer Bill was AB 9 X4 (Evans), Chapter 9, Statutes of 2009). DDS had to make a number of cuts at this time; the department worked with stakeholders to identify over $300 million in General Fund savings. Examples of some of the many actions taken include: limiting transportation for minor children to families that provide documentation that they cannot provide transportation themselves; suspending the purchase of camping services, certain social recreation activities, educational services, and non-medical therapies, except in cases where exemptions are granted; restricting the amount of respite services that may be purchased, except in cases where exemptions are granted; and providing for a standard that parent participation is critical to the success of the intervention plan and requiring regional centers to purchase ABA or intensive behavioral intervention services only when the parent agrees to participate in the intervention plan.
Additionally, this trailer bill language required DDS, in consultation with stakeholders, to develop an alternative service delivery model that provided an âIndividual Choice Budgetâ for consumers to obtain quality services and supports that provided choice and flexibility within a finite budget. In the aggregate, this was intended to reduce regional center purchase of service expenditures, and maximizes federal financial participation. The suspension of the purchase of camping services, social recreation activities, educational services for children aged 3 to 17 years, and non-medical therapies was adopted pending the implementation of this Individual Choice Budget; a process whereby exceptions could be granted was to be developed for extraordinary circumstances where the service was the primary or critical means of ameliorating the clientâs developmental disability. The Individual Choice Budget was never fully developed or implemented.
Disparities in regional center provision of services: In recent years, heightened attention has been given to disparities in regional center spending and service provision; data from DDS indicate that, statewide, per capita spending for services for a Latino consumer was $8,356 in 2015 compared to $18,171 for a white consumer. Moreover, statewide data show that Latino consumers utilize services for which they are authorized at a lower rate (76.6%) than white consumers (82.7%). Some argue that this lower utilization rate may indicate challenges to accessing approved services, such as lack of transportation and language barriers.
The budget cuts and service restrictions adopted in 2009 (described in the section above) have been seen by some stakeholders as exacerbating disparities; these stakeholders argue that consumers from minority communities may be less likely to use out-of-home services and more likely to rely on respite services, and thus, disproportionately impacted by the reductions in services. Additionally, transportation needs, nontraditional work schedules, and other factors may make it more difficulty for minority and low-income families to meet parent participation requirements for ABA treatment.
A state Taskforce on Equity and Diversity for Regional Center Autism Services was established as a result of a Senate oversight hearing held in April of 2012. This taskforce produced a report in March of 2013 that made a number of recommendations, and members of the Legislature introduced a package of bills â the majority of which reflected the task forceâs recommendations â aimed at addressing disparities in the developmental services system.
Despite these efforts, spending gaps persisted. ABX2 1 (Thurmond), Chapter 3, Statutes of 2016 â special session legislation â among other things, included $11 million to reduce disparities in purchase-of-service expenditures and facilitate the development and expansion of culturally and linguistically appropriate services. In January of 2017, DDS announced that it had approved projects to be awarded this $11 million worth of grants to address disparities, including efforts to: hire bilingual service coordinators, provide cultural competency training for regional center staff, establish services for monolingual consumers, and provide person-centered training to regional center staff, providers and/or families.
On March 14th of this year, the Senate Human Services Committee held an oversight hearing entitled âMoving Toward Equity: Addressing Disparities in Services Provided by the Regional Center System.â This hearing pointed to the ongoing need to evaluate current efforts to address disparities and to identify further steps that can be taken.
Need for this bill: According to the author:
âIn December 2011, a Los Angeles Times series reported significant disparities in the funding of developmental services based on race and language. The Senate Select Committee on Autism and Related Disorders held an informational meeting on April 30, 2012, on this issue and several recommendations came from that hearing, including the enactment of law requiring DDS and the regional centers to publish data on purchase of services funding. On March 14, 2017, the Senate Human Services Committee held another informational hearing on disparities and found that the purchase of services gap between Latinos and Whites served by the regional centers has only been reduced by 1/10th of a percent point since 2012, with Latinos now receiving 45.9% of what Whites receive, compared to 45.8% in 2012.
Access to developmental services has been significantly limited due to severe budget cuts that occurred in 2009, with minority populations especially affected adversely by the suspension and restrictions placed on certain services. The onus has been placed on the consumers and families to demonstrate that they qualify for certain services through a complex statutory scheme. These barriers are insurmountable to many consumers and families, especially those with limited English language proficiency. The suspended services and restricted respite service standards were only supposed to be temporary, pending the development and implementation of an Individual Choice Budget model that DDS appears to have abandoned.â
Specific to respite, camp and social recreation activities, the Association of Regional Center Agencies (ARCA) comments that âRestoring camp and social recreation, in addition to lifting the cap on respite, will improve regional centersâ ability to help individuals and their families to continue living together. In addition, as participants of regional center stakeholder meetings have suggested, the reinstatement of these services will also assist regional centers in meeting the goal of equitable spending across racial and ethnic lines.â
Staff comments: This bill contains a number of elements that must be considered in the context of the developmental services system as a whole, and with respect to current initiatives it has undertaken. With last yearâs special session bill (ABX2 1 (Thurmond), Chapter 3, Statutes of 2016), attention was directed towards how to best use augmented funds to the greatest benefit for consumers. Requiring regional centers to pay for medical and dental services pending pursuit or appeal with Medi-Cal, private insurance, or other health care plan, could place further strain on regional centers. Additionally, this bill calls for the establishment of a new task force to develop a purchase of services budget and allocation methodology based on consumer needs. It is unclear how the efforts of this new task force would intersect with, and potentially duplicate or interfere with, the current Developmental Services Task Force and its numerous activities.
From both a policy and fiscal standpoint, it is important to judiciously weigh any new requirements and obligations placed on the regional center system in order to ensure that efforts and resources are being marshalled as efficiently as possible so as to best achieve the developmental services systemâs primary objective: to equitably serve and promote the independence of Californians with developmental disabilities. Should this bill move forward, the author may wish to further refine this billâs proposals to better align with current system efforts and to ensure that the systemâs finite resources are used in a way that maximizes consumer benefit.
Additionally, concerns have been raised about this billâs requirements that certain information be provided at the outset of various meetings with consumers and their families. ARCA notes that âProviding information is a critical part of the collaborative, person-centered planning team work. This process begins by establishing a rapport with the individual/family. This fundamental premise, that âweâ (the individual, family, and service coordination team) are working together to meet âyourâ (the individual and, where applicable, the family) needs is absolutely critical to this process. The beginning of a meeting should remain a place for this understanding and rapport building to develop.â
Recommended amendments: In order to remove the level of prescription currently contained in the bill about the timing of provision of certain pieces of information, and to address the concerns raised above, alongside make a technical change, committee staff recommends the following amendments:
Beginning on line 19 of page 5 of the bill:
19
(2)âAt the beginning of During the initial individualized family service
20
plan meeting and at least annually thereafter at the beginning of during
21
an individualized family service plan meeting or at a biannual
22
review of the individualized family services service plan, the
23
regional center shall provide the infantâs or toddlerâs parents, legal
24
guardian, conservator, or authorized representative written
25
information about the appeal procedure established under Chapter
26
7 (commencing with Section 4700) of Division 4.5 of the Welfare
27
and Institutions Code and the complaint process described in
28
Section 52170 of Title 17 of the California Code of Regulations.
Beginning on line 24 of page 11 of the bill:
22
4646.45.   At the time of development of the initial individual
23
program plan, as described in subdivision (c) of Section 4646, and
24
at least annually thereafter at the beginning of during an individual
25
program plan meeting or at an annual review of the individual
26
program plan, the regional center shall provide to the consumer
27
and, when appropriate, his or her parents, legal guardian,
28
conservator, or authorized representative, written information
29
describing all of the following and the process for obtaining each
30
exception or exemption: both of the following:
Beginning on line 21 of page 13 of the bill:
15
(6)âAt the time of development of the initial individual program
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plan, as described in subdivision (c) of Section 4646, and at least
17
annually thereafter at the beginning of an individual program plan
18
meeting or at an annual review of the individual program plan, the
19
regional center shall provide a consumer and, when appropriate,
20
his or her parents, legal guardian, conservator, or authorized
21
representative a list of services provided purchased by the regional center
22
and written information about the appeal procedure established
23
under Chapter 7 (commencing with Section 4700) and the
24
complaint process described in Section 4731.
Beginning on line 26 of page 18 of the bill:
15
(d)â(1)âEffective July 1, 2009, notwithstanding any other law
16
or regulation, a regional center shall not purchase medical or dental
17
services for a consumer three years of age or older unless the
18
regional center is provided with documentation of a Medi-Cal,
19
private insurance, or a health care service plan denial and the
20
regional center determines that an appeal by the consumer or family
21
of the denial does not have merit. If, on July 1, 2009, a regional
22
center is purchasing the service as part of a consumerâs IPP, this
23
provision shall take effect on August 1, 2009. At the time of
24
development of the initial individual program plan, as described
25
in subdivision (c) of Section 4646, and at least annually thereafter
26
at the beginning of during an individual program plan meeting or at an
27
annual review of the individual program plan, the regional center
28
shall provide a written description of the denial documentation
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consumers and families are required to provide pursuant to this
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paragraph. In order to ensure that there are no gaps in the provision
31
of services and supports, regional centers shall pay for medical or
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dental services identified, pursuant to subdivision (d) of Section
33
4646 and paragraph (5) of subdivision (a) of Section 4646.5, as
34
necessary to implement the consumerâs individual program plan
35
during the following periods:
PRIOR LEGISLATION:
AB 959 (Holden), 2017, requires a regional center to make additional information available on its Internet Web site and increases regional center consumer access to vendors who are vendorized by a regional center outside of a consumerâs regional center catchment area. This bill is awaiting hearing in the Assembly Human Services Committee.
AB 2809 (Rodriguez), 2016, would have required regional centers to provide documents about the appeal and complaint process in threshold languages of a consumer and the consumerâs family, as specified, and would have also required that a consumerâs annual summary of services be provided in the threshold language of the consumer, upon request. It died on the Senate inactive file.
SB 1034 (Mitchell), 2016, among other things, would have prohibited lack of parent or caregiver participation from being used to deny or reduce medically necessary behavioral health treatment, as specified. It died in the Assembly Appropriations Committee.
ABX2 1 (Thurmond), Chapter 3, Statutes of 2016, among other things, implemented targeted rate increases for the community-based developmental services system.
SB 82 (Senate Committee on Budget and Fiscal Review), Chapter 23, Statutes of 2015, among other things, required each regional center to offer, and upon request provide, a written copy of the IPP to the consumer and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of his, her, or their request in a threshold language, as defined, and further required the department and regional centers to annually collaborate to compile data on the number of instances in which an IPP was provided in this manner.
SB 555 (Correa), Chapter 685, Statutes of 2013, placed various requirements on regional centers to communicate and provide certain written materials in a consumerâs and/or familyâs or other designated individualâs native language, as specified.
AB 9 X4 (Evans), Chapter 9, Statutes of 2009, contained necessary changes to enact modifications to the 2009 Budget Act, including, but not limited to, suspending and limiting certain services for regional center consumers.
REGISTERED SUPPORT / OPPOSITION:
Support
Public Counsel (Co-Sponsor)
Special Needs Network Inc.
Opposition
None on file.
Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089
Discussed in Hearing
1H
Assembly Standing Committee on Appropriations
54MIN
Assembly Standing Committee on Human Services
Bill Author
Bill Co-Author(s):