The Lanterman Developmental Disabilities Services Act makes the State Department of Developmental Services responsible for providing various services and supports to individuals with developmental disabilities, and for ensuring the appropriateness and quality of those services and supports. Pursuant to that law, the department contracts with regional centers to provide services and supports to persons with developmental disabilities.

Existing law prohibits regional centers from purchasing any service that would otherwise be available from Medi-Cal, Medicare, and private insurance, among other sources, when a consumer or a consumers family meets the criteria of this coverage, but chooses not to pursue that coverage. Existing law also prohibits regional centers 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, a private insurance, or a health care service plan denial, and the regional center determines that an appeal of the denial by the consumer or the consumers family of the denial does not have merit.

The Lanterman Developmental Disabilities Services Act makes the State Department of Developmental Services responsible for providing various services and supports to individuals with developmental disabilities, and for ensuring the appropriateness and quality of those services and supports. Pursuant to that law, the department contracts with regional centers to provide services and supports to persons with developmental disabilities.

Existing law prohibits regional centers from purchasing any service that would otherwise be available from Medi-Cal, Medicare, and private insurance, among other sources, when a consumer or a consumers family meets the criteria of this coverage, but chooses not to pursue that coverage. Existing law also prohibits regional centers 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, a private insurance, or a health care service plan denial, and the regional center determines that an appeal by the consumer or the consumers family of the denial does not have merit.

This bill would delete both of those prohibitions on regional center purchases.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 649 (Wilson) - Developmental services

Bill Summary:

AB 649 would specify that a consumer or family is not required to appeal the denial of services from another agency, as specified, in order for a regional center to purchase those services as part of a consumer’s individual program plan.

Fiscal Impact:

Unknown, ongoing General Fund costs to the extent there would be an increase in the purchase of services by regional centers.

Background:

The Lanterman Act establishes that individuals with developmental disabilities and their families have a right to receive the necessary supports and services required to live independently in the community. In addition to establishing the rights of individuals, the Lanterman Act also created California’s regional center system, comprised of 21 nonprofit regional centers throughout the state whose primary purpose is to connect individuals with services in the community. Services for individuals with intellectual and developmental disabilities are outlined in an individual program plan, which is developed according to the needs and personal choices of the individual. Services may include, but are not limited to, diagnosis, evaluation, treatment, and care coordination of services such as personal care, day care, special living arrangements, and physical, occupational, and speech therapy.

Current law prohibits a regional center from purchasing medical or dental services for a consumer three years of age or older unless provided with documentation of a denial of services from a Medi-Cal, private insurance, or health care services plan, and the regional center determines an appeal of the denial by the consumer or family does not have merit.

Proposed Law:

Specific provisions of the bill would:

• Remove the existing requirement for the regional center to determine that the appeal of the health coverage denial by the consumer or the consumer’s family does not have merit.
• Specify that a consumer or family is not required to appeal the denial of services from another agency that has a legal responsibility to serve all members of the general public and is receiving public funds for providing those services in order for a regional center to purchase those services as part of a consumer’s individual program plan.

-- END --

SENATE COMMITTEE ON HUMAN SERVICES

Senator Alvarado-Gil, Chair

2023 - 2024 Regular

Subject: Developmental services

SUMMARY

This bill removes the requirement for a consumer or family to appeal the denial of services from a developmental services agency before receiving assistance from a Regional Center, and permits a Regional Center to purchase services those as part of the consumer’s Individual Program Plan (IPP).

ABSTRACT

Existing Law:

1. Establishes the Lanterman Developmental Disabilities Services Act (Lanterman Act), which states that California is responsible for providing a range of services and supports sufficiently complete to meet the needs and choices of each person with developmental disabilities, regardless of age or degree of disability, and at each stage of life, and to support their integration into the mainstream life of the community. (WIC 4500, et seq.)
   
2. Establishes a system of nonprofit Regional Centers, overseen by the Department of Developmental Services (DDS), to provide fixed points of contract in the community for all persons with developmental disabilities and their families, to coordinate services and supports best suited to them throughout their lifetime. (WIC 4620)
   
3. Establishes an IPP as the process to ensure that services and supports are customized to meet the needs of consumers who are served by regional centers for the purpose of alleviating a developmental disability or toward the social, personal, physical, or economic habilitation or rehabilitation of an individual with a developmental disability, or toward the achievement and maintenance of independent, productive, and normal lives. (WIC 4512(b))
   
4. Prohibits regional centers from purchasing any service that a consumer or family meets eligibility criteria for through Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, In-Home Support Services, California Children’s Services, private insurance, or a health care service plan but chooses not to pursue. (WIC 4659(c))
5. Prohibits a Regional Center from purchasing medical or dental services for a consumer three years of age or older unless provided with documentation of a denial of services from a Medi-Cal, private insurance, or health care services plan, and the regional center determines an appeal of the denial by the consumer or family does not have merit. (WIC 4659(d)(1))
   
6. Authorizes a Regional Center to pay for medical or dental services during the following periods:
   
   1. While the consumer or family is pursuing coverage before a denial is made.
      
   2. While the consumer or family is awaiting a final decision on an appeal if verification of the appeal pursuit has been provided to the regional center.
      
   3. Until the commencement of services by Medi-Cal, private insurance, or a health care service plan. (WIC 4659(d)(1)(A-C)
7. Authorizes a consumer or family to receive assistance from the Regional Center, Clients’ Rights Advocate funded by DDS, or the state council in pursuing an appeal for coverage of services. (WIC 4659(d)(2))

This Bill:

1. Removes the requirement that a Regional Center receive a verification that the consumer or family is pursuing an appeal to a denial of services.
   
2. Specifies a consumer or family shall not be required to appeal the denial of services from another agency in order for a Regional Center to purchase services as part of a consumer’s IPP.

FISCAL IMPACT

According to the Assembly Appropriations Committee, the provisions of law this bill is deleting were added by AB 9 X4 (Evans), Chapter 9, Statutes of 2009, the developmental services budget trailer bill. AB 9 X4 made various changes that resulted in over $200 million in General Fund (GF) savings as part of a series of cost savings measures designed to close the state budget deficit. In 2009, the provisions being deleted by this bill were estimated to save the state approximately $16 million (GF) annually. Under this bill, the GF would resume responsibility for these costs

BACKGROUND AND DISCUSSION

Purpose of the Bill:

According to the author, “When the Great Recession struck, California took major steps to address the sudden and massive short- and long-term revenue effects it caused. The regional center system, a community-based model of care for people with developmental disabilities, saw roughly a billion dollars in funding cuts. A number of the cuts were made at the expense of access to services, disproportionately falling on diverse and low-income communities with limited recourse to other options. To restore our service system’s ability to most effectively meet changing needs in a changing state, requirements that families try to navigate bureaucratic obstacles in order to access critical services must be reversed. This bill provides a simple opportunity to do so by reversing an access-limiting change from 2009.”

Lanterman Act

In 1969, the Lanterman Developmental Disabilities Act established that individuals with developmental disabilities and their families have a right to receive the necessary supports and services required to live independently in the community. The Lanterman Act enumerates the rights of individuals with developmental disabilities, as well as the rights of their families, what services and supports are available to these individuals, and how regional centers and service providers work together to provide these supports and services. The term “developmental disability” is defined as a disability that originates before a person reaches 18 years of age, is expected to continue indefinitely, and is a significant disability for the individual; such disabilities include, among others: epilepsy, autism spectrum disorder, intellectual disability, and cerebral palsy.

In addition to establishing the rights of individuals, the Lanterman Act also created California’s regional center system, comprised of 21 nonprofit regional centers throughout the state whose primary purpose is to connect individuals with services in the community. Regional centers coordinate a robust array of services and supports for more than 329,000 individuals with developmental disabilities in California.

Services may include diagnosis, evaluation, treatment, and care coordination of services such as personal care, day care, special living arrangements, and physical, occupational, and speech therapy. Additional services include, but are not limited to mental health services, recreation, counseling for the individual served and their family, assistance locating a home, behavior training and modification programs, emergency and crisis intervention, and many others. The regional center system can also provide respite for family caregivers, short-term out-of-home care, social skills training, specialized medical and dental care, telehealth services and supports, training for parents of children with developmental disabilities, and transportation services necessary to ensure the delivery of services to persons with developmental disabilities.

Individual Program Plan (IPP)

Services for individuals with intellectual and developmental disabilities are outlined in an IPP, which is developed according to the needs and personal choices of the individual. The IPP is developed by an IPP team, which often includes the consumer, their legally authorized representative, and one or more Regional Center representatives. The IPP serves as a tool to maximize the opportunities for each consumer to develop relationships, integrate into community life, increase control over their life, and obtain positive roles in the community. The IPP is required to prioritize the services and supports that allow minors to live with their families and adults to live in the community as independently as possible.

Cost-Effectiveness and Consumer Preferences

In 2009, California was facing a major budget deficit. Policymakers spent the 2009–10 budget year reviewing cost efficiency while trying to balance consumer protection and preferences. As a result, AB 9 X4 (Evans, Chapter 9, Statutes of 2009) was signed into law and made various statutory changes to maximize cost efficiency. AB 9 X4 was a trailer bill that made changes to developmental services that resulted in General Fund savings. Among other changes, AB 9 X4 prohibited Regional Centers from purchasing medical or dental services for a client three years of age or older who is enrolled in Medi-Cal, has private insurance or is covered by a health care service plan, unless an appeal for requested services is being pursued by the client. The intent of AB 9 X4 was to utilize generic services prior to having the regional center purchase a service. The Assembly Floor Analysis stated that AB 9 X4 would result in $15.6 million General Fund savings in 2009–10.

The Legislative Analyst Office (LAO) released a report, 2009-10 Budget Analysis Series on Health, which recommended: “The Legislature should also clarify how a consumer’s choices and preferences in their services are to be balanced against the requirement that cost-effective services be provided to them. State law should specify that when two equally cost-effective and appropriate services are available, consumer preference should generally be the deciding factor, but that the more cost-effective services must be the ones provided if the services preferred by a consumer are a less cost-effective alternative.”

Related legislation:

SB 82 (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, their parents, legal guardian or conservator, or authorized representative within 45 days of their request in a threshold language, as defined, and further required the department and Regional Centers to annually collaborate to compile data on the number of instances in which an IPP was provided in this manner.

SB 555 (Correa, Chapter 685, Statutes of 2013) placed various requirements on regional centers to communicate and provide certain written materials in a consumer’s and/or family’s or other designated individual’s native language, as specified.

AB 9 X4 (Evans, Chapter 9, Statutes of 2009) contained changes to enact modifications to the Budget Act of 2009, including, but not limited to, suspending and limiting certain services for Regional Center consumers.

COMMENTS

This bill seeks to reduce barriers faced by individuals with developmental disabilities or their families to receiving assistance from a Regional Center.

According to stakeholders, the requirement to first exhaust other resources, such as MediCal and school districts, before seeking assistance from a Regional Center to purchase necessary services is burdensome on individuals with developmental disabilities and their families. The process involves a series of “jumping through hoops” including requesting purchase of services, requesting a formal denial notice, appealing the denial and losing the appeal, then returning to the Regional Center with proper documentation. According to stakeholders, this process can take several months, and many families give up on seeking funding assistance, especially due to the fact that caretaking for a relative with a developmental disability can be a big responsibility.

PRIOR VOTES

POSITIONS

Support:

Association of Regional Center Agencies (Sponsor)

California Association for Behavior Analysis

California Dental Association

California Disability Services Association

Oppose:

None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 649

Author:(Wilson)

As Amended Ver:May 18, 2023

Majority vote

SUMMARY

Removes the requirement for consumers at regional centers to provide appeals from health care service plan denials, and removes the requirement for regional centers to determine the merit of the denial from a health care service plan in order for the consumer to receive services from the regional center.

Major Provisions

1. Removes the requirement that a regional center cannot purchase medical or dental services for a consumer if a regional center determines an appeal of a health care service plan denial does not have merit.
2. Specifies that a consumer or family shall not be required to appeal the denial of services from another agency that has a legal responsibility to serve all members of the general public and is receiving public funds for providing those services in order for a regional center to purchase those services as part of a consumer's Individual Program Plan (IPP).

COMMENTS

Lanterman Act. California's Lanterman Act originally was passed in 1969. The Lanterman Act provides entitlement to services and supports for individuals ages three and older who have a qualifying developmental disability. Qualifying disabilities include autism, epilepsy, cerebral palsy, intellectual disabilities, and other conditions closely related to intellectual disabilities that require similar treatment. To qualify, an individual must have a disability that is substantial that began before the age of 18 and is expected to be life-long. There are no income‑related eligibility criteria. As of December 2022, the Department of Developmental Services (DDS) serves about 330,000 Lanterman‑eligible individuals and another 2,900 children ages three and four who are provisionally eligible.

Direct responsibility for implementation of the Lanterman Act service system is shared by DDS and a statewide network of 21 regional centers, which are private, community-based nonprofit entities, established pursuant to the Lanterman Act, that contract with DDS to carry out many of the state's responsibilities under the Act. The 21 regional centers serve approximately 370,000 consumers, providing services such as:

1. Information and referral;
2. Assessment and diagnosis;
3. Counseling;
4. Lifelong individualized planning and service coordination;
5. Purchase of necessary services included in the individual program plan;
6. Resource development;
7. Outreach;
8. Assistance in finding and using community and other resources;
9. Advocacy for the protection of legal, civil and service rights;
10. Early intervention services for at risk infants and their families;
11. Genetic counseling;
12. Family support;
13. Planning, placement, and monitoring for 24-hour out-of-home care;
14. Training and educational opportunities for individuals and families; and,
15. Community education about developmental disabilities.

Services provided to people with developmental disabilities are outlined in a person-centered IPP, which is developed by series of planning discussions and interactions with the IPP team – including, among other individuals, the consumer, their legally authorized representative, and one or more regional center representatives – and is based on the consumer's needs and choices. The team helps determines a "preferred future" by identifying a preferred place to live, favorite people with whom to socialize, and preferred types of daily activities, including preferred jobs.

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

Cost-Effectiveness and Consumer Preferences. In 2009, California was facing a major budget deficit and as such California spent the 2009-10 budget year reviewing cost efficiency while trying to balance consumer protection and preferences. As a result, AB 9 X4 (Evans), Chapter 9, Statutes of 2009-10 Fourth Extraordinary Session, was signed into law and made various statutory changes to maximize cost-efficiency. AB 9 X4 was a trailer bill that made various changes to developmental services that resulted in over $200 million in General Fund saving. In addition to other provisions, AB 9 X4 required DDS, 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, and maximizes federal financial participation. Further, AB 9 X4 prohibited Regional Centers from purchasing medical or dental services for a client three years of age or older who is enrolled in Medi-Cal, has private insurance or is covered by a health care service plan, unless an appeal for requested services is being pursued by the client. The intent of AB 9 X4 was to utilize generic services prior to having the regional center purchase a service. The Assembly Floor Analysis stated that AB 9 X4 would result in $15.6 million General Fund savings in 2009-10.

The Legislative Analyst Office (LAO) released a report, "2009-10 Budget Analysis Series on Health", which recommended, "The Legislature should also clarify how a consumer's choices and preferences in their services are to be balanced against the requirement that cost–effective services be provided to them. State law should specify that when two equally cost–effective and appropriate services are available, consumer preference should generally be the deciding factor, but that the more cost–effective services must be the ones provided if the services preferred by a consumer are a less cost–effective alternative."

Equity Implications: There continues to be disparities in regional center services. For almost a decade, 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 $12,152 in 2021 compared to $28,143 for a white consumer. In 2015, statewide data showed that Latino consumers utilize services for which they are authorized at a lower rate (76.6%) than white consumers (82.7%).

The budget cuts from and service restrictions adopted in 2009 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.

According to the Author

"When the Great Recession struck, California took major steps to address the sudden and massive short- and long-term revenue effects it caused. The regional center system, a community-based model of care for people with developmental disabilities, saw roughly a billion dollars in funding cuts. A number of the cuts were made at the expense of access to services, disproportionately falling on diverse and low-income communities with limited recourse to other options.

"To restore our service system's ability to most effectively meet changing needs in a changing state, requirements that families try to navigate bureaucratic obstacles in order to access critical services must be reversed. This bill provides a simple opportunity to do so by reversing an access-limiting change from 2009."

Arguments in Support

According to supporters, "This bureaucratic hurdle disempowers people from marginalized communities, worsens access disparities, and harms families who need the most assistance seeking regional center services."

Arguments in Opposition

None on file

FISCAL COMMENTS

According to the Assembly Appropriations Committee on May 18, 2023, the section of law affected by this bill was added by AB 9 X4 (Evans), Chapter 9, Statutes of 2009, the developmental services budget trailer bill. AB 9 X4 made various changes that resulted in over $200 million in General Fund (GF) savings as part of a series of cost savings measures designed to close the state budget deficit. In 2009, the section was estimated to save the state approximately $16 million (GF) annually. Under this bill, by eliminating the appeals requirement, the GF would resume responsibility for an unknown portion of these costs. :

VOTES

ASM HUMAN SERVICES: 7-0-1

YES: Jackson, Sanchez, Alanis, Arambula, Bryan, Calderon, Garcia

ABS, ABST OR NV: Bonta

ASM APPROPRIATIONS: 11-0-5

YES: Holden, Bryan, Calderon, Wendy Carrillo, Mike Fong, Hart, Lowenthal, Papan, Pellerin, Weber, Ortega

ABS, ABST OR NV: Megan Dahle, Dixon, Mathis, Robert Rivas, Sanchez

UPDATED

VERSION: May 18, 2023

CONSULTANT: Alexandria Smith / HUM. S. / (916) 319-2089 FN: 0000960

Date of Hearing: May 17, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

ABPCA Bill Id:AB 649

Author:(Wilson) – As Introduced Ver:February 9, 2023

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

SUMMARY:

This bill permits regional centers to purchase services that would otherwise be available from Medi-Cal and other sources when a consumer or a consumer’s representative chooses not to pursue coverage despite eligibility. The bill accomplishes this by deleting provisions of law prohibiting this practice.

Specifically, this bill:

1. Removes the requirements that a consumer must provide documentation of a Medi-Cal, private insurance, or a health care service plan denial and the regional center must determine that an appeal by the consumer or family of the denial does not have merit before the regional center can purchase medical or dental services for a consumer three years of age or older.
2. Removes the requirement that regional centers must 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 Children’s 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.

FISCAL EFFECT:

The provisions of law this bill is deleting were added by AB 9 X4 (Evans), Chapter 9, Statutes of 2009, the developmental services budget trailer bill. AB 9 X4 made various changes that resulted in over $200 million in General Fund (GF) savings as part of a series of cost savings measures designed to close the state budget deficit. In 2009, the provisions being deleted by this bill were estimated to save the state approximately $16 million (GF) annually. Under this bill, the GF would resume responsibility for these costs.

COMMENTS:

1. Purpose. The author seeks to restore regional center services that were eliminated in 2009 as a result of state budget cuts during an economic recession. According to the author:

When the Great Recession struck, California took major steps to address the sudden and massive short- and long-term revenue effects it caused. The regional center system, a community-based model of care for people with developmental disabilities, saw roughly a billion dollars in funding cuts. A number of the cuts were made at the expense of access to services disproportionately falling on diverse and low-income communities with limited recourse to other options. To restore our service system’s ability to most effectively meet changing needs in a changing state, requirements that families try to navigate bureaucratic obstacles in order to access critical services must be reversed. This bill provides a simple opportunity to do so by reversing an access-limiting change from 2009.

1. Background. The Lanterman Act, enacted in 1969, provides entitlement to services and supports for individuals ages three and older who have a qualifying developmental disability, including autism, epilepsy, cerebral palsy, intellectual disabilities, and other conditions closely related to intellectual disabilities that require similar treatment. To qualify, an individual must have a substantial disability that began before the age of 18 and is expected to be life-long. There are no income‑related eligibility criteria. As of December 2022, the Department of Developmental Services (DDS), the entity responsible for carrying out the Lanterman Act, serves about 330,000 Lanterman‑eligible individuals and another 2,900 children ages three and four who are provisionally eligible.

DDS oversees the coordination and delivery of services for individuals with developmental disabilities through a statewide network of 21 community-based, non-profit agencies known as regional centers. Regional centers provide assessments, determine eligibility for services, and offer case management services. Regional centers also develop, purchase, and coordinate the services in each person’s Individual Program Plan.

In 2009, while facing a major budget deficit, the state enacted AB 9 X4, the developmental services budget trailer bill that 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. Among its changes, AB 9 X4 required DDS to develop an alternative service delivery that, in the aggregate, reduced regional center “purchase of service” expenditures and maximized federal financial participation. As a result, individual choices were reduced for more cost-effectiveness including the ability to choose services outside of existing coverage.

Further, AB 9 X4 prohibited regional centers from purchasing medical or dental services for a client three years of age or older who is enrolled in Medi-Cal, has private insurance or is covered by a health care service plan, unless an appeal for requested services is being pursued by the client. The intent of AB 9 X4 was to utilize generic services prior to having the regional center purchase a service.

This bill reverses these actions.

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

Date of Hearing: April 18, 2023

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Corey A. Jackson, Chair

ABPCA Bill Id:AB 649 (

Author:Wilson) – As Introduced Ver:February 9, 2023

SUBJECT: Developmental services

SUMMARY: Permits regional centers to purchase services that would otherwise be available from other specified means when a consumer or a consumer’s representative chooses not to pursue coverage despite eligibility. Specifically, this bill:

1. Removes the requirement that a consumer must provide 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 before the regional center can purchase medical or dental services for a consumer three years of age or older.
2. Removes the requirement that regional centers must 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 Children’s 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.

EXISTING LAW:

1. Establishes an entitlement to services for individuals with developmental disabilities under the Lanterman Developmental Disabilities Services Act (Lanterman Act). (Welfare and Institutions Code Section [WIC] 4500 et seq.)
2. Grants all individuals with developmental disabilities, among all other rights and responsibilities established for any individual by the United States Constitution and laws and the California Constitution and laws, the right to treatment and habilitation services and supports in the least restrictive environment. (WIC 4502)
3. Establishes a system of nonprofit regional centers throughout the state to identify needs and coordinate services for eligible individuals with developmental disabilities and requires the Department of Developmental Services 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.)
4. Requires the development of an Individual Program Plan (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 4646)
5. Requires the IPP planning processes to include:
6. A statement of the individual’s goals and objectives, a schedule of the type and nature of services to be provided and other information and considerations, as specified;
7. Review and modification, as necessary, by the regional center’s planning team no less frequently than every three years; and,
8. Statewide training and review of the IPP plan creation, as specified. (WIC 4646.5)

FISCAL EFFECT: Unknown, this bill has not been analyzed by a fiscal committee.

COMMENTS:

Background: Lanterman Act. California’s Lanterman Act originally was passed in 1969. The Lanterman Act provides entitlement to services and supports for individuals ages three and older who have a qualifying developmental disability. Qualifying disabilities include autism, epilepsy, cerebral palsy, intellectual disabilities, and other conditions closely related to intellectual disabilities that require similar treatment. To qualify, an individual must have a disability that is substantial that began before the age of 18 and is expected to be life-long. There are no income‑related eligibility criteria. As of December 2022, DDS serves about 330,000 Lanterman‑eligible individuals and another 2,900 children ages three and four who are provisionally eligible.

Direct responsibility for implementation of the Lanterman Act service system is shared by DDS and a statewide network of 21 regional centers, which are private, community-based nonprofit entities, established pursuant to the Lanterman Act, that contract with DDS to carry out many of the state’s responsibilities under the Act. The 21 regional centers serve approximately 370,000 consumers, providing services such as:

• Information and referral;
• Assessment and diagnosis;
• Counseling;
• Lifelong individualized planning and service coordination;
• Purchase of necessary services included in the individual program plan;
• Resource development;
• Outreach;
• Assistance in finding and using community and other resources;
• Advocacy for the protection of legal, civil and service rights;
• Early intervention services for at risk infants and their families;
• Genetic counseling;
• Family support;
• Planning, placement, and monitoring for 24-hour out-of-home care;
• Training and educational opportunities for individuals and families; and,
• Community education about developmental disabilities.

Services provided to people with developmental disabilities are outlined in a person-centered IPP, which is developed by series of planning discussions and interactions with the IPP team—including, among other individuals, the consumer, their legally authorized representative, and one or more regional center representatives—and is based on the consumer’s needs and choices. The team helps determines a “preferred future” by identifying a preferred place to live, favorite people with whom to socialize, and preferred types of daily activities, including preferred jobs.

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

Cost-Effectiveness and Consumer Preferences. In 2009, California was facing a major budget deficit and as such California spent the 2009-10 budget year reviewing cost efficiency while trying to balance consumer protection and preferences. As a result, AB 9 X4 (Evans), Chapter 9, Statutes of 2009, was signed into law and made various statutory changes to maximize cost-efficiency. AB 9 X4 was a trailer bill that made various changes to developmental services that resulted in over $200 million in General Fund saving. In addition to other provisions, AB 9 X4 required DDS, 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, and maximizes federal financial participation. Further, AB 9 X4 prohibited Regional Centers from purchasing medical or dental services for a client three years of age or older who is enrolled in Medi-Cal, has private insurance or is covered by a health care service plan, unless an appeal for requested services is being pursued by the client. The intent of AB 9 X4 was to utilize generic services prior to having the regional center purchase a service. The Assembly Floor Analysis stated that AB 9 X4 would result in $15.6 million General Fund savings in 2009-10.

The Legislative Analyst Office (LAO) released a report, “2009-10 Budget Analysis Series on Health”, which recommended, “The Legislature should also clarify how a consumer’s choices and preferences in their services are to be balanced against the requirement that cost–effective services be provided to them. State law should specify that when two equally cost–effective and appropriate services are available, consumer preference should generally be the deciding factor, but that the more cost–effective services must be the ones provided if the services preferred by a consumer are a less cost–effective alternative.”

Author’s Statement: According to the Author, “When the Great Recession struck, California took major steps to address the sudden and massive short- and long-term revenue effects it caused. The regional center system, a community-based model of care for people with developmental disabilities, saw roughly a billion dollars in funding cuts. A number of the cuts were made at the expense of access to services, disproportionately falling on diverse and low-income communities with limited recourse to other options.

“To restore our service system’s ability to most effectively meet changing needs in a changing state, requirements that families try to navigate bureaucratic obstacles in order to access critical services must be reversed. This bill provides a simple opportunity to do so by reversing an access-limiting change from 2009.”

Need for this bill: As a result of budget cuts in 2009, individual choices were reduced for more cost-effectiveness including the ability to choose services outside of existing coverage. This bill will reverse this action from 12 years ago.

Equity Implications: There continues to be disparities in regional center services. For almost a decade, 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 $12,152 in 2021 compared to $28,143 for a white consumer. In 2015, statewide data showed that Latino consumers utilize services for which they are authorized at a lower rate (76.6%) than white consumers (82.7%).

The budget cuts from and service restrictions adopted in 2009 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.

RELATED AND PRIOR LEGISLATION:

SB 82 (Committee on Budget and Fiscal Review), Chapter 23, Statutes of 2015, among other things, required each regional center to offer, and upon request provide, a written copy of the IPP to the consumer and, when appropriate, his or her parents, legal guardian or conservator, or authorized representative within 45 days of his, her, or their request in a threshold language, as defined, and further required the department and regional centers to annually collaborate to compile data on the number of instances in which an IPP was provided in this manner.

SB 555 (Correa), Chapter 685, Statutes of 2013, placed various requirements on regional centers to communicate and provide certain written materials in a consumer’s and/or family’s or other designated individual’s native language, as specified.

AB 9 X4 (Evans), Chapter 9, Statutes of 2009, contained necessary changes to enact modifications to the 2009 Budget Act, including, but not limited to, suspending and limiting certain services for regional center consumers.

REGISTERED SUPPORT / OPPOSITION:

Support

Association of Regional Center Agencies (Sponsor)

California Dental Association

California Disability Services Association

Easterseals Northern California

Educate. Advocate.

Inland Regional Center

Los Angeles Coalition of Service Providers

North Bay Regional Center

Regional Center of the East Bay

The Arc and United Cerebral Palsy California Collaboration

Opposition

None on file

Analysis Prepared by: Alexandria Smith / HUM. S. / (916) 319-2089