California Senate Bill SB468 Amended / Bill

 BILL NUMBER: SB 468AMENDED BILL TEXT 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 project.   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 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, 2014.   Under the bill, 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 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.   This bill would require the department to implement a statewide self-determination project under which funds from regional center budgets are allocated for local self-determination projects that will enhance the ability of a consumer and his or her family to control the decisions and resources required to meet the objectives in his or her individual program plan. The statewide project would be phased in over 3 years, and serve up to 2500 regional center consumers. The bill would require the department to ensure, among other things, that self-determination is available as a choice and participants in the project reflect the disability, ethnic, and geographic diversity of the state. The bill would require self-determination projects to include, among other things, increased consumer and family control over which services best meet their needs and the IPP objectives and comprehensive person-centered planning. This bill would require a self-determination project to establish a local advisory committee, as prescribed, to provide oversight of the project and to submit, by September 1, 2016, specified recommendations to the department regarding the effectiveness of the project.   This bill would require the department to report to the Legislature, as provided, by January 1, 2017, regarding the status of each project established under the bill, and would render this reporting requirement inoperative on January 1, 2021.  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 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 projects   Self-Determination Program  while ensuring that the  project   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  self-determination projects   the Self-Determination Program  and the achievement of consumer outcomes. (e) In addition, the intent of this act is that the  self-determination project   Self-Determination Program  be phased in over a three-year period and that the  project   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)  Notwithstanding any other provision of law, the   The  department shall implement a statewide  self-determination project under which funds from regional center budgets shall be allocated for local self-determination projects that will enhance the ability of a consumer and his or her family to control the decisions and resources required to meet the objectives in his or her individual program plan.   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  project   Self-Determination Program  shall be phased in over three years,  and serve   initially serving  up to  2500   2,500  regional center  consumers.   consumers, and thereafter shall be available on a voluntary basis t   o all regional center consumers.  (b) The department in establishing the statewide  project   program  shall ensure the following: (1) That self-determination is available as a choice for up to 2500 regional center consumers.  (2) That participants   (1)     Participants  in the  project   program  reflect the disability, ethnic, and geographic diversity of the state.  (3) That the project   (2)     The program  is cost neutral in the aggregate.  (4)   (3)  A statewide method of administration and determining comparable services.  (5)   (4)  Oversight of expenditure of  self-directed   self-determined  funds and the achievement of consumer outcomes over time.  (c) Self-determination projects funded shall include, but not be limited to, all of the following:   (1)   (5)  Increased consumer and family control over which services best meet their needs and the  individual program plan   IPP  objectives.  (2)   (6)  Comprehensive person-centered planning, including an individual budget and services that are outcome based.  (3)   (7)  Consumer and family training to ensure understanding of the planning process and management of budgets, services, and staff.  (4)   (8)  Choice of independent facilitators who can assist with the person-centered planning process and  fiscal intermediaries   financial management service   s providers  who can assist with payments and provide employee-related services.  (5)   (9)  Innovation that will more effectively allow consumers to achieve their goals.  (6) Programs that provide for the utilization of parent vendors, direct pay options, individual budgets for the procurement of services and supports, alternative case management, and vouchers.   (c) For purposes of this section, the following definitions shall apply:   (1) "Financial management services" means services or functions that assists the participant to manage and direct the distribution of funds contained in the individual budget. 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 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 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.   (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, 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.   (d)   (v)  Each  self-determination project   regional center  shall establish a local advisory committee to provide oversight of the  self-determination project.   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 project   Self-Determination   Program  , including whether the  project   program  is operating consistent with the requirements of  subdivisions (a) and (b)   this section  , and may make ongoing recommendations for improvement to the regional center and the department.  By September 1, 2016, the local advisory committee shall submit to the department recommendations regarding the effectiveness of the project and the continuation and expansion of self-determined services.   (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.   (e)   (x)  The  department   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  January 1, 2017,   three years following the approval of the federal funding  on the status of  each self-determination project   the Self-Determination Program  authorized by this section, and provide recommendations  with respect to continuation and expansion.   to enhance the effectiveness of the program.   (f) (1) The requirement for submitting a report imposed under subdivision (e) is inoperative on January 1, 2021, pursuant to Section 10231.5 of the Government Code.   (2) A report to be submitted pursuant to subdivision (e) shall be submitted in compliance with Section 9797 of the Government Code.