BILL NUMBER: AB 1753 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Holden
FEBRUARY 14, 2014
An act to amend Sections 4629.5 and 4648 of the Welfare and
Institutions Code, relating to developmental services.
LEGISLATIVE COUNSEL'S DIGEST
AB 1753, as introduced, Holden. Developmental services: regional
centers: vendorization.
Under existing law, the Lanterman Developmental Disabilities
Services Act, the State Department of Developmental Services is
required to contract with regional centers to provide services and
supports to individuals with developmental disabilities and their
families. The services and supports to be provided by a regional
center to a consumer are contained in an individual program plan
(IPP) or individual family service plan (IFSP), developed in
accordance with prescribed requirements. Existing law authorizes a
regional center to purchase, pursuant to vendorization or a contract,
services or supports for a consumer from an individual or agency
that the regional center and consumer, or when appropriate, other
specified persons, determines will best accomplish all or any part of
that consumer's program plan.
This bill would, if a consumer, or his or her parents, legal
guardian, conservator, or authorized representative, requests that a
service specified in the consumer's individual program plan be
provided by a service vendor that has been vendored by another
regional center, authorize the service vendor to provide services to
the consumer under the same contractual terms as the vendoring
regional center if certain requirements are satisfied, including that
the service vendor is in good standing with the vendoring regional
center and that the service provider provides services at no
additional costs to the consumer or the consumer's regional center.
Existing law requires a regional center to include specified
information on its Internet Web site for the purpose of promoting
transparency and access to public information.
This bill would require that information to include a list of the
services that are provided directly to consumers by the regional
center or through service vendors or contractors. The bill would
require the list to be in a standardized form, as prescribed by the
department, and to be updated at least quarterly.
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. Section 4629.5 of the Welfare and Institutions Code is
amended to read:
4629.5. (a) In addition to the requirements set forth in Section
4629, the department's contract with a regional center shall require
the regional center to adopt, maintain, and post on its Internet Web
site a board-approved policy regarding transparency and access to
public information. The transparency and public information policy
shall provide for timely public access to information, including, but
not limited to, information regarding requests for proposals and
contract awards, service provider rates, documentation related to
establishment of negotiated rates, audits, and IRS Form 990. The
transparency and public information policy shall be in compliance
with applicable law relating to the confidentiality of consumer
service information and records, including, but not limited to,
Section 4514.
(b) To promote transparency, each regional center shall include on
its Internet Web site, as expeditiously as possible, at least all of
the following:
(1) Regional center annual independent audits.
(2) Biannual fiscal audits conducted by the department.
(3) Regional center annual reports pursuant to Section 4639.5.
(4) Contract awards, including the organization or entity awarded
the contract, and the amount and purpose of the award.
(5) Purchase of service policies.
(6) The names, types of service, and contact information of all
vendors, except consumers or family members of consumers.
(7) Board meeting agendas and approved minutes of open meetings of
the board and all committees of the board.
(8) Bylaws of the regional center governing board.
(9) The annual performance contract and year-end performance
contract entered into with the department pursuant to this division.
(10) The biannual Home and Community-based Services Waiver program
review conducted by the department and the State Department of
Health Care Services.
(11) The board-approved transparency and public information
policy.
(12) The board-approved conflict-of-interest policy.
(13) Reports required pursuant to Section 4639.5.
(13) A list of the services that are provided directly to
consumers by the regional center or through service vendors or
contractors. The list shall be in a standardized format prescribed by
the department and shall be updated at least quarterly.
(c) The department shall establish and maintain a transparency
portal on its Internet Web site that allows consumers, families,
advocates, and others to access provider and regional center
information. Posted information on the department's Internet Web site
transparency portal shall include, but need not be limited to, all
of the following:
(1) A link to each regional center's Internet Web site information
referenced in subdivision (b).
(2) Biannual fiscal audits conducted by the department.
(3) Vendor audits.
(4) Biannual Home and Community-based Services Waiver program
reviews conducted by the department and the State Department of
Health Care Services.
(5) Biannual targeted case management program and federal nursing
home reform program reviews conducted by the department.
(6) Early Start Program reviews conducted by the department.
(7) Annual performance contract and year-end performance contract
reports.
SEC. 2. Section 4648 of the Welfare and Institutions Code is
amended to read:
4648. In order to achieve the stated objectives of a consumer's
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 consumer's
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 which that the
regional center and consumer or, where when
appropriate, his or her parents, legal guardian, or
conservator, or authorized representatives, determines will best
accomplish all or any part of that consumer's program plan.
(A) Vendorization or contracting is the process for
identification, selection, and utilization of service vendors or
contractors, based on the qualifications and other requirements
necessary in order to provide the service.
(B) A regional center may reimburse an individual or agency for
services or supports provided to a regional center consumer if the
individual or agency has a rate of payment for vendored or contracted
services established by the department, pursuant to this division,
and is providing services pursuant to an emergency vendorization or
has completed the vendorization procedures or has entered into a
contract with the regional center and continues to comply with the
vendorization or contracting requirements. The director shall adopt
regulations governing the vendorization process to be utilized by the
department, regional centers, vendors and the individual or agency
requesting vendorization.
(C) Regulations shall include, but not be limited to: the vendor
application process, and the basis for accepting or denying an
application; the qualification and requirements for each category of
services that may be provided to a regional center consumer through a
vendor; requirements for emergency vendorization; procedures for
termination of vendorization; the procedure for an individual or an
agency to appeal any a 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 facility's 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
provision of law or regulation to the contrary, 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.
(F) (i) If a consumer, or his or her parents, legal guardian,
conservator, or authorized representative, requests that a service
specified in the consumer's individual program plan be provided by a
service vendor that has been vendored by another regional center, the
service vendor is authorized to provide services to the consumer in
accordance with paragraph (6) of this subdivision, and under the same
contractual terms as the vendoring regional center, if all of the
following requirements are satisfied:
(I) The service vendor is in good standing with the vendoring
regional center.
(II) The service vendor provides services at no additional cost to
the consumer or the consumer's regional center.
(III) The services provided by the service vendor are consistent
with, and provided at the same level of care and professionalism as,
the vendoring regional center's vendorization.
(ii) For purposes of this subparagraph, "vendoring regional center"
means the regional center that has vendored the service vendor.
(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 consumer'
s 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
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 where
when appropriate, his or her parents, legal
guardian, conservator, or authorized representative, including those
appointed pursuant to subdivision (d) of Section 4548, 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 provider's ability to deliver quality services or supports
which that can accomplish all or part
of the consumer's individual program plan.
(B) A provider's success in achieving the objectives set forth in
the individual program plan.
(C) Where When 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 consumer's 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 consumer's choice of providers, or, where
when appropriate, the consumer's parent's, legal
guardian's, authorized representative's, or conservator's choice of
providers.
(7) No service or support provided by any agency or individual
shall be continued unless the consumer or, where
when appropriate, his or her parents, legal guardian, or
conservator, or authorized representative, including those appointed
pursuant to subdivision (d) of Section 4548, 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 person'
s 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 child's parent or guardian shall be obtained before placement
is made.
(B) Effective July 1, 2012, notwithstanding any other law or
regulation to the contrary , 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 department's Home
and Community Based Services Waiver or another existing waiver
program or certified to participate in the Medi-Cal program.
(ii) A residential facility service provider that has a written
agreement and specific plan prior to July 1, 2012, with the vendoring
regional center to downsize the existing facility by transitioning
its residential services to living arrangements of 15 beds or less or
restructure the large facility to meet federal Medicaid eligibility
requirements on or before June 30, 2013.
(iii) A residential facility licensed as a mental health
rehabilitation center by the State Department of Mental Health or
successor agency under any of the following circumstances:
(I) The facility is eligible for Medicaid reimbursement.
(II) The facility has a department-approved plan in place by June
30, 2013, to transition to a program structure eligible for federal
Medicaid funding, and this transition will be completed by June 30,
2014. The department may grant an extension for the date by which the
transition will be completed if the facility demonstrates that it
has made significant progress toward transition, and states with
specificity the timeframe by which the transition will be completed
and the specified steps that will be taken to accomplish the
transition. A regional center may pay for the costs of care and
treatment of a consumer residing in the facility on June 30, 2012,
until June 30, 2013, inclusive, and, if the facility has a
department-approved plan in place by June 30, 2013, may continue to
pay the costs under this subparagraph until June 30, 2014, or until
the end of any period during which the department has granted an
extension.
(III) There is an emergency circumstance in which the regional
center determines that it cannot locate alternate federally eligible
services to meet the consumer's 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 to the contrary , 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 consumer's needs.
As soon as possible within 30 days of admission due to an emergency,
an assessment shall be completed by the regional center. An
individual program plan meeting shall be convened immediately
following the assessment, to determine the services and supports
needed for stabilization and to develop a plan to transition the
consumer from the facility to the community. If transition is not
expected within 90 days of admission, an emergency program plan
meeting shall be held to discuss the status of the transition and to
determine if the consumer is still in need of placement in the
facility. If emergency services continue to be necessary, the
regional center shall submit an updated transition plan to the
department for an extension of up to 90 days. Placement shall not
exceed 180 days.
(iii) To the extent feasible, prior to any admission, the regional
center shall consider resource options identified by the statewide
specialized resource service established pursuant to subdivision (b)
of Section 4418.25.
(iv) The clients' rights advocate shall be notified of each
admission and individual program planning meeting pursuant to this
subparagraph and may participate in all individual program planning
meetings unless the consumer objects on his or her own behalf.
(v) 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 consumer's 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.
(D) Each 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 person's 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
cognitive 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 audio tapes, 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 individual's 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
person's living arrangement. If crisis intervention services are
unsuccessful, emergency housing shall be available in the person's
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 consumer's 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 which
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 consumer's in-person
appearances at judicial proceedings or administrative due process
hearings may be used only if the consumer or, when appropriate, the
consumer's 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 provision of law
or regulation to the contrary , 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 the area board to initiate action
under the provisions defining area board advocacy functions
established in this division.
(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, or
request the area board 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) Where When there are identified
gaps in the system of services and supports or where
when there are identified consumers for whom no
provider will provide services and supports contained in his or her
individual program plan, the department may provide the services and
supports directly.
(h) At least annually, regional centers shall provide the
consumer, his or her parents, legal guardian, conservator, or
authorized representative a statement of services and supports the
regional center purchased for the purpose of ensuring that they are
delivered. The statement shall include the type, unit, month, and
cost of services and supports purchased.