AB 45

Bill Subjects

Abstract

Existing law, the California Early Intervention Services Act, provides a statewide system of coordinated, comprehensive, family-centered, multidisciplinary, and interagency programs that are responsible for providing appropriate early intervention services and support to all eligible infants and toddlers, as defined, and their families. The act requires these services to be provided pursuant to the existing regional center system under the Lanterman Developmental Disabilities Service Act, and further requires the regional centers to comply with that act and its implementing regulations, as specified. This bill additionally would require a family's private insurance for medical services or a health care service plan identified in the individualized family service plan to be used in compliance with applicable state law and regulation, except for specified purposes. The California Early Intervention Services Act requires an eligible infant or toddler receiving services under the act to have an individualized family service plan (IFSP) . The plan is required to be in writing and to address specified issues, including a statement of the specific early intervention services needed to meet the unique needs of the infant or toddler. This bill would revise the definition of an eligible infant or toddler for purposes of eligibility for services. The bill would also revise the contents of the individualized family service plan, including, retroactive to July 1, 2009, requiring the development, review, or modification of an individualized family service plan to consider certain group training and preschool activities and would make related changes. The bill would prohibit regional centers from purchasing nonrequired services, as defined, except durable medical equipment. This bill would, retroactive to July 1, 2009, require any vendor of applied behavioral analysis services or intensive behavioral intervention services, as defined, under either the California Early Intervention Services Act or the Lanterman Developmental Disabilities Services Act to conduct a behavioral assessment of each infant or toddler to whom the vendor provides these services and design an intervention plan for the child. The regional center would be required to purchase these services, subject to prescribed limitations. This bill would also require the State Department of Developmental Services to establish a prevention program for at-risk babies, as defined, under which intake, assessment, case management, and referral to generic agencies, as defined, would be provided. Each regional center would purchase or provide services under the program pursuant to its allocation from the department. Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services is responsible for providing various services and supports to individuals with developmental disabilities, and for ensuring the appropriateness and quality of those services and supports. Existing law requires that life quality assessments be conducted with consumers served by private nonprofit regional centers, pursuant to specified criteria. This bill, retroactive to January 1, 2010, would repeal existing quality assurance provisions relating to providing services and supports to individuals with developmental disabilities, including the life quality assessment requirements. The bill would, instead, require the State Department of Developmental Services to implement an improved, unified quality assessment system, on or before January 1, 2010. It would require the department to identify a valid and reliable quality assurance instrument that includes assessments of consumer and family satisfaction, provision of services, and personal outcomes. The bill would require the department to contract with an independent agency or organization for this purpose. Implementation of these provisions would be subject to an annual appropriation of funds in the Budget Act. Under existing law, the department contracts with the regional centers to provide services and supports to persons with developmental disabilities. The services and supports to be provided to a regional center consumer are contained in an individual program plan (IPP) , developed in accordance with prescribed requirements. These services and supports may include transportation services. This bill, retroactive to July 1, 2009, would impose various requirements relating to the funding of transportation services, at the time of the development, review, or modification of a consumer's IFSP or IPP, as specified. Existing law permits a regional center to purchase, pursuant to vendorization or contract, services and supports for the consumer from any individual or agency that the regional center and the consumer or, where appropriate, his or her parents, legal guardian, conservator, or authorized representative determine will best accomplish all or any part of the consumer's IPP. Under existing law, the regional center and the consumer or, where appropriate, his or her parents, legal guardian, conservator, or authorized representative are required, pursuant to the IPP, to consider specified factors when selecting a provider of services and supports, including the cost of providing services and supports of comparable quality by different providers, if available. This bill would, except as prescribed, require the least costly available provider of comparable services that is able to accomplish all or part of the consumer's IPP, consistent with the particular needs of the consumer and family, as identified in the IPP, to be selected. The bill would also prohibit, retroactive to July 1, 2009, a regional center from purchasing 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. It would delay application of this prohibition for persons receiving these services on July 1, 2009, until August 1, 2009. The bill would require a regional center to annually provide to the consumer and his or her parents, legal guardian, conservator, or legal representative a statement of services and supports that the regional center purchased, for the purpose of ensuring that they are delivered. Existing law contains various requirements pertaining to the responsibilities of the department and regional centers concerning the monitoring of consumers in health and residential care facilities. This bill would, retroactive to July 1, 2009, provide that a regional center shall not be required to perform triennial evaluations of specified community care facilities. This bill would, retroactive to July 1, 2009, with specified exceptions, prohibit a regional center from newly vendoring a 24-hour residential care facility licensed by the State Department of Social Services with a licensed capacity of 16 or more beds. Existing law requires a regional center to identify and pursue all possible sources of funding for consumers, including governmental or other entities or programs required to provide or pay the costs of providing services. This bill would require that the department, in consultation with stakeholders, develop an alternative service delivery model that provides an Individual Choice Budget for obtaining quality services and supports that provides choice and flexibility within a finite budget that, in the aggregate, reduces regional center purchase of service expenditures, reduces reliance on the General Fund, and maximizes federal financial participation. The bill would, effective July 1, 2009, prohibit a regional center from purchasing specified services pending implementation of the Individual Choice Budget, except that an exemption from this prohibition may be granted under prescribed circumstances. The bill would also, retroactive to July 1, 2009, impose restrictions on the amount of respite services that may be purchased for a consumer, except that a regional center may grant an exemption from these restrictions under prescribed circumstances. This respite service provision would be repealed upon the occurrence of prescribed conditions relating to the implementation of the Individual Choice Budget. This bill would, retroactive to July 1, 2009, and except as prescribed, provide that a regional center shall not purchase any service that would otherwise be available from prescribed publicly funded program, private insurance, or a health care service plan when the consumer or family meets the criteria of that coverage but chooses not to pursue that coverage. The bill would also, retroactive to July 1, 2009, and except as prescribed, prohibit a regional center from purchasing medical or dental services for a consumer 3 years of age or older from the Medi-Cal program private insurance, or health care service plan unless the regional center is provided documentation of a Medi-Cal, private insurance, or health care service plan denial appeal is being pursued, and the regional center makes a specified determination regarding the appeal. Existing law requires the Director of Developmental Services to establish, annually review, and adjust as needed, a schedule of parental fees for services received through the regional centers. Under existing law, adjustment of the parental fees by the department is subject to the approval of the State Council on Developmental Disabilities. This bill would revise the provisions relating to parental fees, by, among other things, exempting the July 1, 2009, parental fee adjustment from approval by the State Council on Developmental Disabilities and providing for additional factors to be used in determining the fee adjustment. Existing law authorizes an in-home respite worker, as defined, to perform gastrostomy care and feeding of regional center clients, after completing designated training. This bill would expand these provisions to include colostomy, ileostomy, and urinary catheter care, and would refer to these services collectively as incidental medical services. The bill would revise applicable training requirements, and would provide for specified wage increases for in-home respite agencies and staff providing incidental medical services. Existing law requires the department and regional centers to ensure that supported living arrangements for adults with developmental disabilities are made available, as specified. This bill would revise the provisions relating to supported living arrangements by, among other things, setting forth the circumstances under which a regional center would make rent, mortgage, or lease payments or household expenses, as defined, for a consumer. Existing law provides for the In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons receive services enabling them to remain in their own homes. This bill would prohibit a regional center from purchasing supportive services under the IHSS program for a consumer who meets the criteria for the program, but declines to apply for those services, unless the regional center director waives this provision, as specified, and documents this waiver in an addendum to the consumer's IPP. This bill would require the department and the State Department of Health Care Services, jointly, to seek a Medi-Cal program state plan amendment from the federal government to expand federal financial participation for services to persons with developmental disabilities provided by regional centers. Existing law requires the Director of Developmental Services to establish, maintain, and revise, as necessary, an equitable process for setting rates of state payment for nonresidential services purchased by regional centers, and authorizes the director to promulgate implementing regulations. This bill, retroactive to August 1, 2009, would prohibit regional centers from compensating designated nonresidential service programs for providing any service to a consumer on any of a list of holidays specified in the bill, with the department authorized to adjust these holidays through a program directive. Existing law prohibits the total number of developmental center residents in the secure treatment facility at Porterville Developmental Center from exceeding 297. This bill would include residents receiving services in the center's transition treatment program for purposes of this limit. This bill would require the department to provide information to the Assembly Committee on Budget and Senate Committee on Budget and Fiscal Review during budget hearings for the 2010–11 fiscal year about the effect on the developmental service system of the specific cost containment measures implemented to achieve designated General Fund reductions for the 2009–10 fiscal year pursuant to a specified item of the Budget Act of 2009. The bill also would require the department to continue to convene, as appropriate, a stakeholder review process to obtain information and comments about implementation of these cost containment measures and their effect on the developmental service system. The California Constitution authorizes the Governor to declare a fiscal emergency and to call the Legislature into special session for that purpose. The Governor issued a proclamation declaring a fiscal emergency, and calling a special session for this purpose, on December 19, 2008. This bill would state that it addresses the fiscal emergency declared by the Governor by proclamation issued on December 19, 2008, pursuant to the California Constitution.