AB 121

Bill Subjects

Abstract

(1) Existing law establishes the State Department of Developmental Services, and vests in the department jurisdiction over various state developmental centers for the provision of care to persons with developmental disabilities. Existing law establishes the State Department of State Hospitals within the California Health and Human Services Agency, and provides the department with jurisdiction over specified facilities for the care and treatment of persons with mental health disorders. Existing law requires that every individual with exceptional needs, as defined, who is eligible be provided with educational instruction, services, or both, at no cost to their parent or guardian or, as appropriate, to them. A free appropriate public education is required to be made available to individuals with exceptional needs in accordance with specified federal regulations adopted pursuant to the federal Individuals with Disabilities Education Act. Existing law recognizes that individuals with exceptional needs of mandated schoolage residing in California's state hospitals and developmental centers are entitled, under specified federal law, to have the same access to educational programs as is provided for individuals with exceptional needs residing in the community, and establishes contracting and funding provisions for that purpose. Existing law requires the Superintendent of Public Instruction, the Director of Developmental Services, and the Director of State Hospitals to develop written interagency agreements to carry out the provisions relating to educational programs for individuals with exceptional needs residing in those facilities. Existing law requires the transfer of pupils in state hospital school programs whose individualized education programs indicate that a community school program is appropriate to be transferred to schools located in the community. Existing law authorizes waivers to that requirement only when approved by both the Superintendent of Public Instruction and the Director of Developmental Services. Existing law requires the State Department of Developmental Services, on the first day of each month, upon submission of an invoice by the county superintendent of schools, to pay to the county superintendent of schools 8% of the amount projected to cover the cost of hospital pupils educated in community school programs, as specified. Existing law requires the county superintendent of schools to calculate the actual cost of educating those pupils and, if the actual cost is more or less than the projected amount, requires the following year's distribution to be adjusted accordingly. This bill would authorize waivers described above to be approved by the State Superintendent of Public Instruction and either the State Department of Developmental Services, for individuals receiving developmental disability services, or the State Department of State Hospitals, for individuals receiving mental health services, as specified. The bill would require the State Department of State Hospitals, rather than the State Department of Developmental Services, to make payments to county superintendents of schools with respect to pupils under the State Department of State Hospital's jurisdiction who are being educated in community school programs. The bill additionally would revise those payment provisions to require the relevant department to pay the entire amount invoiced by the county superintendent of schools, and would require an adjustment to the county's distribution to be adjusted in the following year only if the actual cost is greater than the amount invoiced by the county superintendent of schools. The bill would update existing references to state hospitals to also refer to developmental centers, and would make various other technical changes, and delete obsolete provisions. (2) Existing law, the Lanterman Developmental Disabilities Services Act (act) , requires the State Department of Developmental Services (department) to contract with regional centers to provide services and supports to persons with developmental disabilities and their families. Existing regulations require vendors and long-term health care facilities to report special incidents to regional centers, including, among others, reasonably suspected abuse or exploitation, reasonably suspected neglect, serious injuries, and unplanned or unscheduled hospitalizations, as specified. Existing regulations require regional centers to submit an initial report to the department following receipt of a report of a special incident. Existing law requires the department to provide information on topics at quarterly briefings with legislative staff of the appropriate policy and fiscal committees of the Legislature addressing, among other things, regional center accountability, transparency, and oversight efforts. This bill would require the department, as part of those quarterly briefings, to provide an annual update on the status of the department's efforts to improve oversight of special incidents and respond to special incident trends. The bill would require the status update to include a summary of the most recent annual report regarding special incidents involving individuals with developmental disabilities served by regional centers. The act defines "developmental disability" as a disability that originates before an individual attains 18 years of age, continues, or can be expected to continue, indefinitely, and constitutes a substantial disability for the individual. Under existing law, "developmental disability" includes intellectual disability, cerebral palsy, epilepsy, and autism, among other conditions, as specified. Under existing law, if a child who is 3 or 4 years of age is not otherwise eligible for regional center services under the above-described definition, the child is provisionally eligible for regional center services if the child has a disability that is not solely physical in nature and has significant functional limitations in at least 2 of specified areas of major life activity, such as learning or self-direction, as determined by a regional center and as appropriate to the age of the child. This bill would expand the above-described provisional eligibility for regional center services to children under 5 years of age, including those who are 2 years of age or younger. The act requires that an infant or toddler eligible for early intervention services, as specified, from a regional center be assessed by the regional center at least 90 days before they turn 3 years of age for purposes of determining their ongoing eligibility, including provisional eligibility, for regional center services. This bill would additionally require the regional center, after an infant or toddler has been determined eligible for early intervention services, to determine if the child is also provisionally eligible for regional center services. Existing law requires the department and regional centers to annually collaborate to compile specified data relating to purchase of service authorization, utilization, and expenditure by each regional center, including the age, race, or ethnicity of, and preferred language spoken by, the regional center consumer. Existing law requires the department and regional centers to post that information on its internet website. This bill would require the department and regional centers to compile and report that data consistent with applicable privacy laws. The bill would place additional requirements on the department and regional centers regarding the reporting of that data, including, among others, requiring that information to be posted in machine-readable format. The bill would further require that data to be deidentified in accordance with specified requirements. Existing law, on or before March 1, 2019, required the department to submit a rate study to specified committees of the Legislature regarding community-based services for individuals with developmental disabilities. Existing law requires the department to implement rate increases between April 1, 2022, and July 1, 2025, to raise service providers' rates to the fully funded rate reflected in the rate models that were included in the rate study. Existing law requires the fully funded rate models to be implemented using 2 payment components, a base rate equaling 90% of the rate model, and a quality incentive payment, equaling up to 10% of the rate model. Existing law requires the department to implement a quality incentive program, to develop quality measures or benchmarks, or both, with input from stakeholders, for consumer outcomes and regional center and service provider performance, as specified, and to develop a quality incentive payment structure for providers meeting the quality measures or benchmarks, or both. This bill would authorize the department to establish quality measures or benchmarks, or both, in the initial years of the quality incentive program that focus on building capacity, developing reporting systems, gathering baseline data, and similar activities while working towards meaningful outcome measures at the individual consumer level for all services. The bill would require the department to determine each provider's quality incentive payment percentage prior to the start of the fiscal year by measuring the provider's performance against the quality measures or benchmarks for the most recently available reporting period. The bill would require the department to provide a written communication, no later than 60 days after the quality incentive payment percentages are determined and the providers are informed of their payments, to specified committees of the Legislature that reports on the total amount of quality incentive payments estimated to be paid to providers. The bill, commencing July 1, 2024, would require the rate models to be updated to account for the current and any subsequent changes to the statewide minimum wage, as specified. Existing law authorizes a regional center to contract or issue a voucher for services and supports provided to a consumer or family. Existing law authorizes a consumer to choose a vouchered community-based training service to assist the consumer in the development of skills required for community integrated employment, among other things. Existing regulations authorize a regional center to offer participant-directed services to allow adult consumers or family members of consumers who are receiving vouchered services to procure their own community-based training service, daycare, nursing, respite, or transportation services, as specified. This bill would authorize the department to implement the provision of social recreation services, camping services, and nonmedical therapies, including, but not limited to, specialized recreation, art, dance, and music, by means of written directives or similar instructions, including the provision of those services as participant-directed services. The bill, effective July 1, 2023, would prohibit a regional center from requiring a consumer or family member to exhaust services under the In-Home Supportive Services program or to exchange respite hours or other services and supports or to pay a copayment, or a similar shared pay arrangement aimed at offsetting costs, in order to receive those services. The bill would make related findings and declarations. Existing law establishes requirements for family homes that provide services and supports for adults with developmental disabilities who do not require continuous skilled nursing care. Existing federal regulations require home and community-based settings and person-centered service plan requirements to meet specified standards. Existing law authorizes the department to adopt regulations and interim administrative program directives to implement and comply with federal home and community-based settings requirements. This bill would authorize the department to also adopt regulations and interim program directives to implement and comply with federal person-centered service plan requirements. Existing law authorizes the department to reimburse family home agencies that are vendored to recruit, approve, train, and monitor family home providers, provide social services and in-home support to family home providers, and assist adults with developmental disabilities in moving into approved family homes. Existing law requires the department to promulgate regulations related to these duties, including, among others, appropriate rates of payment for family home agencies and approved home providers. This bill would require that regional center reimbursements to family home agencies for services in a family home not exceed specified residential service provider rates for individuals who reside in a community care facility, as defined, that is vendored for 4 beds or fewer. (3) Under existing law, the California Early Intervention Services Act (act) , direct services for eligible infants and toddlers and their families are provided by regional centers and local educational agencies. The act requires an eligible infant or toddler receiving services to have an individualized family service plan (IFSP) . The act requires that parents be fully informed of their rights, including the right to invite another person, including a family member or an advocate or peer parent, to accompany them to any or all IFSP meetings. Existing law, until June 30, 2023, requires, at the request of the parent or legal guardian, an IFSP meeting to be held by remote electronic communications. This bill would extend that requirement until June 30, 2024. By extending an existing requirement for local educational agencies, this bill would impose a state-mandated local program. Existing law requires any vendor who provides applied behavioral analysis (ABA) or intensive behavioral intervention services to design an intervention plan that includes, among other things, the parent participation needed to achieve the goals and objectives of the infant, toddler, or minor consumer, as set forth in their IFSP or IPP, as provided. Existing law requires a regional center to only purchase ABA or intensive behavioral intervention services when the parent or parents of an infant, toddler, or minor consumer participates in the intervention plan. This bill would remove the requirement that regional centers only purchase those services when a parent or parents participate in the intervention plan. The bill would prohibit a regional center from denying or delaying the provision of ABA or intensive behavioral intervention services for an infant, toddler, or minor consumer due to a lack of parent participation, as specified. The bill would require vendors to design intervention plans that include, among other things, the recommended parent participation to achieve the goals and objectives set forth in an IFSP or IPP. (4) Existing law generally requires a regional center to identify and pursue all possible sources of funding for consumers receiving regional center services. Existing law prohibits a regional center from purchasing any service that would otherwise be available from the Medi-Cal program, the Medicare Program, private insurance, or a health care service plan, as specified. Existing law also prohibits a regional center from purchasing medical or dental services for a consumer 3 years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or health care service plan denial and the regional center determines that an appeal by the consumer or family of the denial does not have merit. Existing law requires a regional center to ensure, at the time of development, scheduled review, or modification of a consumer's individual program plan or of an individualized family service plan, the establishment of an internal process. Existing law requires the internal process to ensure, among other things, utilization of generic services and supports if appropriate, and utilization of other services and sources of funding as described above. Existing law authorizes the individualized family service planning team for infants and toddlers eligible for early intervention services to determine that a medical service identified in the plan is not available through the family's private health insurance policy or health care service plan and therefore will be funded by the regional center, as specified. This bill, for purposes of the above-described determination, would specify that the medical service is not available within 60 calendar days, would include the Medi-Cal program as one of the sources, and would instead specify that the medical services would be authorized for purchase-of-service funding by the regional center. The bill would authorize the individual program plan team to make a similar determination. The bill would require a regional center to authorize the provision of services through the purchase of services during any plan delays, including the appeals process. (5) Existing law establishes the Family Cost Participation Program, which requires the department to develop and establish a Family Cost Participation Schedule, consisting of a sliding scale for families with an annual gross income of not less than 400% of the federal poverty guideline, as specified, to be used by regional centers to assess the parents' cost participation for providing respite, daycare, and camping services to their children under 18 years of age who have developmental disabilities and who are not eligible for Medi-Cal, among other eligibility criteria. Existing law also requires a regional center to assess an annual family program fee, as specified, from parents whose adjusted gross family income is at or above 400% of the federal poverty level and who have a child meeting prescribed requirements, including receiving specified services from a regional center. Existing law, commencing July 1, 2022, to June 30, 2023, inclusive, requires regional centers to suspend existing and new assessments and reassessments of the cost participation and existing and new assessments, reassessments, and collections of the annual family program fee described above. This bill would require regional centers to suspend, until June 30, 2024, existing and new assessments and reassessments of the cost participation and existing and new assessments, reassessments, and collections of the annual family program fee described above. Existing law requires the department to submit to the Legislature, on or before January 10, 2023, as part of the annual budget process, a plan to revise the Family Cost Participation Program and the annual family program fee, including consideration of changes that include, but are not limited to, those that promote administrative efficiency and program compliance. This bill would authorize the department to implement, interpret, or make specific the recommendations provided in the plan submitted to the Legislature, through program directives or other processes, to streamline program administration and standardize procedures. (6) Existing law establishes the Employment First Policy, which is the policy of the state that opportunities for integrated, competitive employment be given the highest priority for working age individuals with developmental disabilities, regardless of the severity of their disabilities. Existing law requires the State Council on Developmental Disabilities to form a standing Employment First Committee to, among other responsibilities, identify strategies and recommend legislative, regulatory, and policy changes to increase integrated employment, self-employment, and microenterprises for persons with developmental disabilities, as specified. This bill would, commencing July 1, 2024, instead create the Office of Employment First under the California Health and Human Services Agency, and would require the office to form the Employment First Committee, which shall consist of the same members. This bill would state the office's mission and responsibilities, and would require the office to be under the control of an executive officer known as the Chief Employment First Officer, as specified. The bill would, on or before June 30, 2025, and annually thereafter, require the office to provide a report to the appropriate policy committees of the Legislature and to the Governor describing its work and recommendations made pursuant to these provisions. (7) Existing law recognizes the right of adults with disabilities to reside in the family home and requires the department to establish a Coordinated Family Support Services Pilot Program for adults who live with their families. Existing law requires that the services provided by the pilot program be flexible and tailored to assist the consumer to remain in the home of their family for as long as that remains the preferred living option for the consumer and their family. This bill would appropriate to the department $10,800,000 from the General Fund to support the pilot program's implementation. (8) Existing law grants the Department of Human Resources (department) the powers, duties, and authority necessary to operate the state civil service system, as specified. Existing law creates the Limited Examination and Appointment Program (LEAP) , which the department administers, to provide an alternative to the traditional civil service examination and appointment process to facilitate the hiring of persons with disabilities. Existing law repeals, on January 1, 2024, certain LEAP provisions regarding the department's obligation to permit a person with a developmental disability to choose to complete a written examination, readiness evaluation, or internship, as specified. This bill would delete the repeal date above, thereby indefinitely extending the operation of those provisions. (9) Existing law requires the department, no later than April 1, as specified, to submit a detailed plan to the Legislature whenever the department proposes the closure of a state developmental center. Existing law requires the department, in conjunction with the Governor's proposed 2023–24 budget, to submit to the Legislature an updated version of a specified safety net plan regarding how the department will provide access to crisis services after the closure of a developmental center and how the state will maintain its role in providing residential services to those whom private sector vendors cannot or will not serve. Existing law requires the plan update, among other provisions, to evaluate the progress made to create a safety net, including services or residences intended to facilitate transitions or diversions from institutions for mental disease, the Canyon Springs Community Facility, the secure treatment program at Porterville Developmental Center, prisons or jails, or other restrictive settings. Existing law prohibits the department from admitting anyone to a developmental center unless the person has been determined to be eligible for services, as specified, and the person meets certain conditions, including, among others, that the person is committed by a court on or before June 30, 2023, to Canyon Springs Community Facility and the person otherwise meets the criteria for admission due to an acute crisis, as defined, or is currently admitted to either an acute psychiatric hospital or an acute crisis facility due to an acute crisis, but requires continued treatment to achieve stabilization and successful community transition. This bill would delete the June 30, 2023, date, and instead apply the above-described criteria for admission to individuals committed to Canyon Springs Community Facility on or before June 30, 2024, or the opening of completed and licensed complex needs homes identified in the safety net plan, as specified, whichever is earlier. (10) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above. (11) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.