Bill Text: CA SB468 | 2013-2014 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Developmental services: statewide Self-Determination

Spectrum: Slight Partisan Bill (Democrat 3-1)

Status: (Passed) 2013-10-09 - Chaptered by Secretary of State. Chapter 683, Statutes of 2013. [SB468 Detail]

Download: California-2013-SB468-Amended.html

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BILL NUMBER: SB 468	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 28, 2013
	AMENDED IN SENATE  APRIL 25, 2013
	AMENDED IN SENATE  APRIL 15, 2013

INTRODUCED BY   Senators Emmerson and Beall
   (Coauthor: Assembly Member Blumenfield)

                        FEBRUARY 21, 2013

   An act to add Section 4685.8 to the Welfare and Institutions Code,
relating to developmental services.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 468, as amended, Emmerson. Developmental services: statewide
Self-Determination Program.
   Under existing law, the Lanterman Developmental Disabilities
Services Act, the State Department of Developmental Services
contracts with regional centers to provide  support and
 services  and supports  to individuals with
developmental disabilities. Under existing law, the regional centers
purchase needed services and supports for individuals with
developmental disabilities through approved service providers, or
arrange for their provision through other publicly funded agencies.
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. Existing law
establishes, contingent upon approval of a federal waiver, the
Self-Directed Services Program, and requires the program to be
available in every regional center catchment area to provide
participants, within an individual budget, greater control over
needed services and supports.
   This bill would require the department, contingent upon approval
of federal funding, to establish and implement a state
Self-Determination Program, as defined, that would be available in
every regional center catchment area to provide participants and
their families, within an individual budget, increased flexibility
and choice, and greater control over decisions, resources, and needed
and desired services and supports to implement their IPP, in
accordance with prescribed requirements. The statewide program would
be phased in over 3 years, initially serving up to 2,500 regional
center consumers, and thereafter would be available on a voluntary
basis to all regional center consumers. The bill would require the
department to, among other things, apply for federal funding for the
program by  March 1,   December 31,  2014.

   Under the bill, 
    This bill would provide that  program participants
 would  receive an individual budget, as prescribed,
to be used for the purchase of services and supports necessary to
implement the participant's IPP. The bill would require program
participants to agree to, among other things, manage
self-determination services within the individual budget amount.
 Under the bill, the   The  individual
budget amount would be available to the participant each year for the
purchase of services and supports under the program until a new
individual budget has been determined. The bill would, among other
things, require each regional center to be responsible for
implementing the program as a term of its contract, and to establish
a local advisory committee to provide oversight of the project. The
bill would require the State Council on Developmental Disabilities to
issue to the Legislature a report regarding the status of the
program and recommendations to the program, as specified, and would
require the department, beginning January 10, 2016, to provide to the
appropriate policy and fiscal committees of the Legislature
prescribed information relating to the program.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) In 1998, the Legislature expanded the Lanterman Developmental
Disabilities Services Act to include a self-determination pilot
program. That pilot program was continued by the Legislature in 2002
and 2003. However, the pilot program was only available at five
regional centers and the number of individuals served by the
self-determination pilot program remains small, about 200 regional
center consumers.
   (b) As reflected in the State Department of Developmental Services
2002 Report to the Legislature, the pilot program remains an
innovative,  cost effective   cost-effective,
 and successful way of providing services to regional center
consumers and their families. The findings in the report show that
self-determination pilot program participants were happy and
experienced more freedom and responsibility in controlling the
direction of their services and life choices, and the program was
cost neutral in the aggregate. The report also found that good
self-determination requires intensive person-centered planning,
collaboration, and follow-along services and supports.
   (c) Most other states have self-directed or self-determination
services as a model for providing services. Many California consumers
and families have asked for a statewide expansion of the pilot
program believing it will do the following: increase innovative and
effective services, eliminate bureaucracy, and increase choices for
consumers and parents, thereby allowing them to increase their
control of services and supports by easily navigating increasingly
complex service systems.
   (d) The intent of this act is to allow for voluntary participation
in the Self-Determination Program while ensuring that the program is
available to all consumers regardless of geographic location,
economic or educational background, or race or ethnicity, and
ensuring a consistent statewide method of administration and
comparable services. To ensure these outcomes are achieved, it is the
intent of the Legislature that the State Department of Developmental
Services and local advisory boards be responsible for oversight and
monitoring of funds used for the Self-Determination Program and the
achievement of consumer outcomes.
   (e) In addition, the intent of this act is that the
Self-Determination Program be phased in over a three-year period and
that the program will continue to be available to all consumers as an
option after the initial phase-in period ends.
  SEC. 2.  Section 4685.8 is added to the Welfare and Institutions
Code, to read:
   4685.8.  (a) The department shall implement a statewide
Self-Determination Program. The Self-Determination Program shall be
available in every regional center catchment area to provide
participants and their families, within an individual budget,
increased flexibility and choice, and greater control over decisions,
resources, and needed and desired services and supports to implement
their IPP. The statewide Self-Determination Program shall be phased
in over three years, initially serving up to 2,500 regional center
consumers, and thereafter shall be available on a voluntary basis to
all regional center consumers.
   (b) The department in establishing the statewide program shall
ensure the following:
   (1) Participants in the program reflect the disability, ethnic,
and geographic diversity of the state.
   (2) The program is cost neutral in the aggregate.
   (3) A statewide method of administration and determining
comparable services.
   (4) Oversight of expenditure of self-determined funds and the
achievement of consumer outcomes over time.
   (5) Increased consumer and family control over which services best
meet their needs and the IPP objectives.
   (6) Comprehensive person-centered planning, including an
individual budget and services that are outcome based.
   (7) Consumer and family training to ensure understanding of the
planning process and management of budgets, services, and staff.
   (8) Choice of independent facilitators who can assist with the
person-centered planning process and financial management services
providers who can assist with payments and provide employee-related
services.
   (9) Innovation that will more effectively allow consumers to
achieve their goals.
   (c) For purposes of this section, the following definitions shall
apply:
   (1) "Financial management services" means services or functions
that assist the participant to manage and direct the distribution of
funds contained in the individual budget, and ensure that the
participant has the financial resources to implement his or her IPP
throughout the year. These may include, but are not limited to, bill
paying services and activities that facilitate the employment of
service and support workers by the participant, including, but not
limited to, fiscal accounting, tax withholding, and expenditure
reports. The department shall establish specific qualifications that
shall be required of a financial management services provider.
   (2) "Independent facilitator" means a person, selected and
directed by the participant, who may assist the participant in making
informed decisions about the individual budget, and in locating,
accessing, and coordinating services consistent with the participant'
s IPP. He or she is available to assist in identifying immediate and
long-term needs, developing options to meet those needs, leading or
participating in the person-centered planning process and development
of the IPP, and obtaining identified services and supports.
   (3) "Individual budget" means the amount of funding available to
the participant for the purchase of services and supports necessary
to implement the IPP. The individual budget shall be constructed
using a fair, equitable, and transparent methodology.
   (4) "IPP" means individual program plan.
   (5) "Participant" means an individual, and when appropriate, his
or her parents, legal guardian or conservator, or authorized
representative, who has been deemed eligible for, and has voluntarily
agreed to participate in, the Self-Determination Program.
   (6) "Self-determination" means a voluntary delivery system
consisting of a defined and comprehensive mix of services and
supports, selected and directed by a participant through
person-centered planning, in order to meet all or some of the
objectives in his or her IPP. Self-determination services and
supports are designed to assist the participant to achieve personally
defined outcomes in community settings that promote inclusion. The
Self-Determination Program shall only fund services and supports that
are approved by the federal  Center   Centers
 for Medicare and Medicaid Services.
   (d) Participation in the Self-Determination Program is fully
voluntary. A consumer may choose to participate in, and may choose to
leave, the Self-Determination Program at any time. A regional center
may not require or prohibit participation in the Self-Determination
Program as a condition of eligibility for, or the delivery of,
services and supports otherwise available under this division.
Participation in the Self-Determination Program shall be available to
any regional center consumer who meets the following eligibility
requirements:
   (1) The participant is three years of age or older.
   (2) The participant has a developmental disability, as defined in
Section 4512.
   (3) The participant does not live in a licensed long-term health
care facility, as defined in paragraph (44) of subdivision (a) of
Section 54302 of Title 17 of the California Code of Regulations. An
individual, and when appropriate his or her parent, legal guardian or
conservator, or authorized representative, who is not eligible to
participate in the Self-Determination Program pursuant to this
paragraph may request that the regional center provide
person-centered planning services in order to make arrangements for
transition to the Self-Determination Program. In that case, the
regional center shall initiate person-centered planning services
within 60 days of that request.
   (4) The participant agrees to all of the following terms and
conditions:
   (A) The participant shall receive an orientation to the
Self-Determination Program prior to enrollment.
   (B) The participant shall agree to utilize the services and
supports available within the Self-Determination Program only when
generic services and supports cannot be accessed.
   (C) The participant shall only use services and supports necessary
to implement his or her IPP and shall agree to comply with any and
all other terms and conditions for participation in the
Self-Determination Program described in this section.
   (D) The participant shall manage Self-Determination Program
services and supports within the individual budget amount.
   (E) The participant shall utilize the services of the
conflict-of-interest-free financial management services provider of
his or her own choosing.
   (F) The participant may utilize the services of a
conflict-of-interest-free independent facilitator of his or her own
choosing for the purpose of providing services and functions as
described in paragraph (2) of subdivision (c). The financial
management services provider shall determine that the independent
facilitator is adequately trained and otherwise qualified.
   (e) A participant who is not Medi-Cal eligible may participate in
the Self-Determination Program and receive self-determination
services and supports if all other program eligibility requirements
are met.
   (f) An individual receiving services and supports under the
self-determination projects authorized pursuant to Section 13 of
Chapter  80   1043  of the Statutes of
1998, as amended, may elect to continue to receive self-determination
services and supports pursuant to this section. An individual who
participates in the Self-Determination Program may elect to continue
to receive self-determination services and supports if he or she
transfers to another regional center catchment area.
   (g) If at any time during participation in the Self-Determination
Program a regional center determines that a participant is no longer
eligible to continue in, or a participant voluntarily chooses to
exit, the Self-Determination Program, the regional center shall
provide for the participant's transition from the Self-Determination
Program to other services and supports. This transition shall include
the development of a new IPP that reflects the services and supports
necessary to meet the individual's needs. The regional center shall
ensure that there is no gap in services and supports during the
transition period.
   (h) An individual determined to be ineligible for or who
voluntarily exits the Self-Determination Program shall be permitted
to return to the Self-Determination Program upon meeting all
applicable eligibility criteria and upon approval of the participant'
s IPP team, as described in subdivision (j) of Section 4512.
   (i) The IPP team shall utilize the person-centered planning
process to develop the IPP for a participant. The IPP shall detail
the goals and objectives of the participant that are to be met
through the purchase of participant-selected services and supports.
The IPP team shall determine the individual budget to ensure the
budget assists the participant to achieve the outcomes set forth in
his or her IPP and ensures his or her health and safety. The
completed individual budget shall be attached to the IPP.
   (j) The participant shall implement his or her IPP, including
choosing the services and supports allowable under this section
necessary to implement the plan. A participant is exempt from Section
4783, the Family Cost Participation Program, and cost control
restrictions, including, but not limited to, purchases of services
and supports pursuant to Sections 4648.35, 4648.5, and 4659,
subparagraph (B) of paragraph (3) of subdivision (c) of Section 4685,
Sections 4648.55, 4686.2, 4686.5, and 4689, and purchase of services
best practices enacted pursuant to Section 4620.3. A regional center
shall not prohibit the purchase of any service or support that is
otherwise allowable under this section.
   (k) A participant shall have all the rights established in Chapter
7 (commencing with Section 4700).
   (l) The department, in consultation with stakeholders, shall
develop a methodology for individual budgets that ensures the budgets
are computed in a fair, transparent, and equitable manner and are
based on consumer characteristics and needs, and a method for
adjusting individual budgets to address a participant's unanticipated
needs. In developing this methodology, the department shall ensure
that budgets of all participants are cost neutral in the aggregate
within each regional center.
   (m) The IPP team, using the methodology developed in subdivision
(l), shall determine the individual budget for the participant. That
individual budget amount shall be available to the participant each
year for the purchase of program services and supports until a new
individual budget has been determined. An individual budget shall be
calculated no more than once in a 12-month period, unless revised to
reflect the unanticipated needs of the participant. The individual
budget shall be distributed among uniform budget categories developed
by the department in consultation with stakeholders.
   (n) Annually, participants may transfer up to 20 percent of the
funds originally distributed to any budget category set forth in
subdivision (m), to another budget category or categories. Transfers
in excess of 20 percent of the original amount allocated to any
budget category may be made upon the approval of the regional center
or the participant's IPP team. Regional centers or the IPP team may
only deny a transfer if necessary to protect the health and safety of
the participant.
   (o) Consistent with the implementation date of the IPP, the IPP
team shall annually ascertain from the participant whether there are
any circumstances that require a change to the annual individual
budget. Based on that review, the IPP team shall calculate a new
individual budget consistent with the methodology identified in
subdivision (l).
   (p) On or before  March 1,   December 31,
 2014, the department shall apply for federal Medicaid funding
for the Self-Determination Program by applying for a state plan
amendment, an amendment to a current home- and community-based waiver
for individuals with developmental disabilities, for a new waiver,
or by seeking to maximize federal financial participation through
other means. Contingent upon approval of federal funding, the
Self-Determination Program shall be established. The department shall
adopt regulations to implement the procedures set forth in this
section.
   (q) The department, in consultation with stakeholders, shall
develop informational materials about the Self-Determination Program.
The department shall ensure that regional centers are trained in the
principles of self-determination, the mechanics of the
Self-Determination Program, and the rights of consumers and families
as candidates for, and participants in, the Self-Determination
Program.
   (r) Each regional center shall be responsible for implementing the
Self-Determination Program as a term of its contract under Section
4629. As part of implementing the program, the regional center shall
do all of the following:
   (1) Contract with local or family-run consumer organizations to
conduct outreach and training through local meetings or forums to
provide regional center consumers and their families with information
about the Self-Determination Program and to help ensure that the
program is available to a diverse group of participants, with special
outreach to underserved communities.
   (2) Advance funds to a financial management services provider to
facilitate participation in the Self-Determination Program, as
determined necessary by a participant's IPP team.
   (s) The financial management services provider shall provide the
participant, or his or her authorized representative, and the
regional center service coordinator with a monthly individual budget
statement that describes the amount of funds allocated by budget
category, the amount spent in the previous 30-day period, and the
amount of funding that remains available under the participant's
individual budget.
   (t) Only the financial management services provider is required to
apply for vendorization in accordance with Subchapter 2 (commencing
with Section 54300) of Chapter 3 of Title 17 of the California Code
of Regulations, for the Self-Determination Program. All other service
providers shall have applicable state licenses, certifications, or
other state required documentation, but are exempt from the
vendorization requirements set forth in Title 17 of the California
Code of Regulations. The financial management services provider shall
ensure and document that all service providers meet specified
requirements for any service that may be delivered to the
participant.
   (u) A participant may request, at no charge to the participant or
the regional center, criminal history background checks for persons
seeking employment as a provider of services and supports and
providing direct care services and supports to the participant.
   (1) Criminal history record checks pursuant to this subdivision
shall be performed and administered as described in subdivision (b)
and subdivisions (d) to (h), inclusive, of Section 4689.2, and
Sections 4689.4 to 4689.6, inclusive, and shall apply to
vendorization of providers and hiring of employees to provide
services and supports for family home agencies and family homes.
   (2) The department may enter into a written agreement with the
Department of Justice to implement this subdivision.
   (v) Each regional center shall establish a local advisory
committee to provide oversight of the Self-Determination Program. The
regional center, area board, and the Office of Clients' Rights
Advocacy of Disability Rights California shall each appoint one-third
of the membership of the committee, which shall consist of
consumers, family members, clients' rights advocates and other
advocates, and community leaders. A majority of the committee shall
be consumers and their family members. The committee shall reflect
the multicultural diversity and geographic profile of the catchment
area. The committee shall review the development and ongoing progress
of the Self-Determination Program, including whether the program is
operating consistent with the requirements of this section, and may
make ongoing recommendations for improvement to the regional center
and the department.
   (w) Commencing January 10, 2016, the department shall annually
provide the following information to the appropriate policy and
fiscal committees of the Legislature:
   (1) Number and characteristics of participants, by regional
center.
   (2) Types and ranking of services and supports purchased under the
Self-Determination Program, by regional center.
   (3) Range and average of individual budgets, by regional center,
including adjustments to the budget to address unanticipated need.
   (4) Information regarding participant satisfaction under the
Self-Determination Program and, when data is available, the
traditional service delivery system, by regional center.
   (5) The proportion of participants who report that their choices
and decisions are respected and supported.
   (6) The proportion of participants who report that they are able
to recruit and hire qualified service providers.
   (7) The number and outcome of individual budget appeals, by
regional center.
   (8) The number and outcome of fair hearing appeals, by regional
center.
   (9) The number of participants who voluntarily withdraw from the
Self-Determination Program and a summary of the reasons why, by
regional center.
   (10) The number of participants who are subsequently determined to
no longer be eligible for the Self-Determination Program and a
summary of the reasons why, by regional center.
   (11) Identification of barriers to participation and
recommendations for program improvements.
   (12) A comparison of average annual expenditures for individuals
with similar characteristics not participating in the
Self-Determination Program.
   (x) The State Council on Developmental Disabilities, in
collaboration with the protection and advocacy agency identified in
Section 4900 and the federally funded University Centers for
Excellence in Developmental Disabilities Education, Research, and
Service, shall issue a report to the Legislature no later than three
years following the approval of the federal funding on the status of
the Self-Determination Program authorized by this section, and
provide recommendations to enhance the effectiveness of the program.