Assembly Bill No. 121 Developmental Services (Approved on July 10, 2023)

This assembly bill was introduced by Assembly Member Ting on January 9, 2023. Current law establishes the State Department of Developmental Services, granting the department authority over various state developmental centers for the care of individuals with developmental disabilities. Additionally, existing law forms the State Department of State Hospitals within the California Health and Human Services Agency, endowing the department with jurisdiction over specific facilities for the care and treatment of individuals with mental health disorders. The law mandates that eligible individuals with exceptional needs receive educational instruction or services, or both, at no cost to their parent, guardian, or themselves if appropriate. Individuals with exceptional needs must be provided a free appropriate public education in adherence to federal regulations under the Individuals with Disabilities Education Act. Moreover, existing law acknowledges the entitlement of individuals with exceptional needs residing in California's state hospitals and developmental centers to the same access to educational programs as those in the community, in accordance with federal law. To facilitate this, contracting and funding provisions are established. The Superintendent of Public Instruction, the Director of Developmental Services, and the Director of State Hospitals are required to develop written interagency agreements to implement the provisions related to educational programs for individuals with exceptional needs in these facilities.

Existing law necessitates the transfer of pupils in state hospital school programs to community schools if their individualized education programs suggest it is appropriate. Waivers to this requirement are permitted only with approval from both the Superintendent of Public Instruction and the Director of Developmental Services. The State Department of Developmental Services is further obligated to pay the county superintendent of schools 8% of the projected amount to cover the cost of educating hospital pupils in community school programs on the first day of each month, as specified. The actual cost is calculated by the county superintendent of schools, and adjustments to the next year's distribution are made if the actual cost differs from the projected amount.

This bill proposes to authorize waivers, as mentioned above, to be sanctioned 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. It would shift the responsibility for payments to county superintendents of schools, concerning pupils under the State Department of State Hospital's jurisdiction being educated in community school programs, from the State Department of Developmental Services to the State Department of State Hospitals. Furthermore, the bill would modify payment provisions, mandating the relevant department to remit the entire invoiced amount by the county superintendent of schools. An adjustment to the county's distribution would only be necessary in the subsequent year if the actual cost exceeds the invoiced amount. The bill aims to update references to state hospitals to also include developmental centers, introduce various technical adjustments, and remove outdated provisions. Current legislation, known as the Lanterman Developmental Disabilities Services Act (the act), mandates the State Department of Developmental Services (the department) to engage regional centers through contracts to furnish services and assistance to individuals with developmental disabilities and their families.

In adherence to existing regulations, vendors and long-term health care facilities are obligated to notify regional centers of special incidents, encompassing reasonably suspected abuse or exploitation, reasonably suspected neglect, severe injuries, and unplanned or unscheduled hospitalizations, as outlined. Additionally, regional centers are required by regulations to submit an initial report to the department following the reception of a special incident report. The law further necessitates the department to present information on various topics during quarterly briefings with legislative staff from pertinent policy and fiscal committees of the Legislature, including aspects related to regional center accountability, transparency, and oversight initiatives. This proposed legislation would mandate the department, as part of its quarterly briefings, to furnish an annual progress report on the department's initiatives aimed at enhancing oversight of special incidents and addressing trends related to such incidents. The bill specifies that this status update should encompass a recapitulation of the most recent annual report on special incidents involving individuals with developmental disabilities who are under the care of regional centers.

As defined in the act, a "developmental disability" is a condition that emerges before an individual reaches 18 years of age, persists or is anticipated to persist indefinitely, and constitutes a significant impairment for the individual. Existing law enumerates conditions such as intellectual disability, cerebral palsy, epilepsy, and autism within the definition of "developmental disability," among other specified conditions. Currently, if a child aged 3 or 4 is not eligible for regional center services based on the previously mentioned criteria, the child is conditionally eligible for such services under existing law. This provisional eligibility applies when the child has a non-exclusively physical disability and demonstrates substantial limitations in at least two designated areas of major life activity, including but not limited to learning or self-direction. The determination of these limitations is made by a regional center, taking into consideration the child's age.

This bill seeks to broaden the existing provisional eligibility for regional center services, extending it to encompass children under the age of 5, which includes those aged 2 years or younger. According to the current provisions, infants or toddlers eligible for early intervention services from a regional center must undergo assessment by the center at least 90 days before reaching 3 years of age to determine their ongoing eligibility, including provisional eligibility, for regional center services. This proposed legislation would further mandate the regional center to assess whether a child, deemed eligible for early intervention services, is also provisionally eligible for regional center services. The current legislation mandates an annual collaboration between the department and regional centers to collect designated data concerning the purchase of service authorization, utilization, and expenditure by each regional center. This information includes demographic details such as age, race, ethnicity, and preferred language spoken by regional center consumers. Furthermore, existing law dictates that both the department and regional centers must publish this data on their respective internet websites.

This proposed bill would necessitate the department and regional centers to aggregate and disclose the specified data while adhering to relevant privacy laws. The bill imposes additional obligations on both the department and regional centers with respect to reporting this data, encompassing the stipulation that the information must be presented in a machine-readable format. Additionally, the bill mandates the deidentification of data in accordance with specific requirements. By March 1, 2019, prevailing legislation mandated the department to submit a rate study to specified legislative committees concerning community-based services for individuals with developmental disabilities. Subsequently, the law directs the department to effectuate rate increases from April 1, 2022, to July 1, 2025, elevating service providers' rates to the fully funded rate indicated in the rate models featured in the study. These fully funded rate models incorporate a dual payment structure, encompassing a base rate equivalent to 90% of the rate model and a quality incentive payment, constituting up to 10% of the rate model. Furthermore, existing law mandates the implementation of a quality incentive program, the formulation of quality measures or benchmarks, or both, in consultation with stakeholders, pertaining to consumer outcomes and the performance of regional centers and service providers. Additionally, it directs the department to devise a payment structure for quality incentives granted to providers meeting the established quality measures or benchmarks, or both.

This bill proposes empowering the department to institute quality measures or benchmarks, or both, during the initial years of the quality incentive program, with a specific focus on activities like capacity building, developing reporting systems, and establishing baseline data. Simultaneously, efforts will be directed toward achieving meaningful outcome measures at the individual consumer level for all services. The legislation mandates the department to ascertain each provider's quality incentive payment percentage before the commencement of the fiscal year by assessing the provider's performance against the quality measures or benchmarks for the most recently available reporting period. Additionally, the bill obligates the department to furnish a written communication, no later than 60 days after the determination of quality incentive payment percentages and the subsequent notification of providers, to designated legislative committees. This communication should present an overview of the total amount of quality incentive payments estimated to be disbursed to providers.

Starting from July 1, 2024, the bill mandates the update of rate models to accommodate the current statewide minimum wage and any subsequent changes as specified. Current legislation allows a regional center to engage in contracts or provide vouchers for services and supports offered to a consumer or family. Moreover, consumers have the autonomy to select a vouchered community-based training service that aids in skill development for activities such as community integrated employment. In addition, existing regulations permit a regional center to extend participant-directed services, granting adult consumers or family members of consumers receiving vouchered services the ability to independently secure their community-based training service, daycare, nursing, respite, or transportation services, as outlined in specific guidelines. This legislation would empower the department to implement the delivery of social recreation services, camping services, and nonmedical therapies—such as specialized recreation, art, dance, and music—through written directives or similar instructions, including the provision of these services as participant-directed services.

Effective July 1, 2023, the bill would prohibit a regional center from mandating that a consumer or family member deplete services under the In-Home Supportive Services program or engage in exchanges of respite hours or other services and supports, or impose a copayment or analogous shared pay arrangement designed to offset costs, as a prerequisite for accessing these specified services. The bill includes related findings and declarations. The current legal framework outlines criteria for family homes offering services to adults with developmental disabilities who do not necessitate constant skilled nursing care. Federal regulations in place stipulate standards for home and community-based settings and mandate adherence to person-centered service plan requirements.

The existing law grants the department authority to adopt regulations and interim administrative program directives, ensuring compliance with federal standards for home and community-based settings. This legislation would grant the department the additional authority to adopt regulations and interim program directives, facilitating the implementation and adherence to federal requirements for person-centered service plans. Current law empowers the department to reimburse family home agencies, authorized to recruit, train, and oversee family home providers while delivering social services and in-home support to adults with developmental disabilities transitioning to approved family homes. The department is mandated to establish regulations covering these responsibilities, encompassing fair payment rates for family home agencies and approved home providers.

This proposed bill seeks to cap regional center reimbursements to family home agencies for services in a family home at specific rates, aligning with residential service provider rates for individuals in community care facilities with 4 beds or fewer. In accordance with the current law, the California Early Intervention Services Act (the Act) mandates the provision of direct services to eligible infants and toddlers, as well as their families, through regional centers and local educational agencies. For eligible infants or toddlers availing services, the Act stipulates the development of an individualized family service plan (IFSP). The Act further ensures that parents are fully apprised of their rights, including the option to invite another individual, such as a family member, advocate, or peer parent, to accompany them to any or all IFSP meetings.

Until June 30, 2023, the existing law accommodates the holding of remote electronic communication-based IFSP meetings upon the request of the parent or legal guardian. The proposed legislation aims to prolong the aforementioned obligation until June 30, 2024, thereby placing an extension on an existing mandate for local educational agencies, resulting in a state-mandated local program. Current regulations mandate that vendors delivering applied behavioral analysis (ABA) or intensive behavioral intervention services must formulate an intervention plan. This plan is required to incorporate various elements, including the extent of parent participation necessary to fulfill the established goals and objectives outlined in the Infant Family Service Plan (IFSP) or Individual Program Plan (IPP) for the respective infant, toddler, or minor consumer.

Moreover, regional centers are authorized to procure ABA or intensive behavioral intervention services solely under the condition that the parent or parents of the infant, toddler, or minor consumer actively engage in the intervention plan. This bill seeks to eliminate the stipulation that regional centers procure such services exclusively when parents partake in the intervention plan. It prohibits regional centers from refusing or postponing the delivery of Applied Behavioral Analysis (ABA) or intensive behavioral intervention services to an infant, toddler, or minor consumer solely based on insufficient parent participation. Instead, the legislation mandates vendors to structure intervention plans encompassing recommended levels of parent involvement essential for realizing the goals and objectives outlined in an Infant Family Service Plan (IFSP) or Individual Program Plan (IPP).

Existing law generally mandates regional centers to explore all potential funding sources for consumers under their care. These centers are prohibited from procuring services accessible through Medi-Cal, Medicare, private insurance, or health care service plans. Additionally, a regional center cannot obtain medical or dental services for consumers aged 3 or older without documentation of denial from Medi-Cal, private insurance, or a health care service plan. This denial must be accompanied by the regional center's determination that an appeal lacks merit. Ensuring the utilization of generic services and supports, as well as exploring alternative funding sources, is part of the internal process mandated during the development, review, or modification of a consumer’s individual program plan. For infants and toddlers in early intervention, the individualized family service planning team may decide that certain medical services, identified in the plan, are not covered by the family's private health insurance and should be funded by the regional center.

This bill would clarify the timeframe for determining the unavailability of a medical service within 60 calendar days and explicitly include the Medi-Cal program as one of the potential sources. Moreover, the bill would replace the term "funded by the regional center" with "authorized for purchase-of-service funding." It empowers the individual program plan team to make analogous determinations and mandates regional centers to approve service provision through the purchase of services during any plan delays, including the appeals process. Existing law establishes the Family Cost Participation Program, directing the department to formulate and institute a Family Cost Participation Schedule. This schedule entails a sliding scale tailored for families with an annual gross income exceeding 400% of the federal poverty guideline. Regional centers utilize this schedule to determine parents' cost participation for services like respite, daycare, and camping offered to their children under 18 years of age with developmental disabilities, particularly those ineligible for Medi-Cal. Furthermore, existing law mandates regional centers to appraise an annual family program fee, based on specified criteria, from parents whose adjusted gross family income reaches or surpasses 400% of the federal poverty level.

Effective from July 1, 2022, to June 30, 2023, regional centers are obligated to temporarily halt both existing and new assessments, reassessments, and collections related to cost participation and the annual family program fee. This bill would mandate regional centers to postpone, until June 30, 2024, any ongoing or upcoming assessments and reassessments related to cost participation, as well as the assessment, reassessment, and collection processes for the annual family program fee outlined earlier. Current legislation mandates that the department present a plan to the Legislature, as an integral component of the annual budget procedure, by January 10, 2023. This plan is expected to outline revisions to the Family Cost Participation Program and the annual family program fee, taking into account modifications that enhance administrative efficiency and program compliance, among other considerations. The proposed bill would grant the department the authority to enact, clarify, or specify the recommendations outlined in the plan submitted to the Legislature. This empowerment would be facilitated through various means, such as program directives or other established processes, with the overarching goal of simplifying program administration and establishing standardized procedures.

Current legislation defines the Employment First Policy as prioritizing integrated, competitive employment opportunities for working-age individuals with developmental disabilities, irrespective of the severity of their conditions. The State Council on Developmental Disabilities is mandated by existing law to establish a permanent Employment First Committee. This committee's primary responsibilities include identifying strategies and proposing legislative, regulatory, and policy adjustments aimed at enhancing integrated employment, self-employment, and microenterprises for individuals with developmental disabilities, as outlined in the legislation. Starting from July 1, 2024, this proposed legislation would establish the Office of Employment First within the California Health and Human Services Agency. The bill mandates the office to establish the Employment First Committee, consisting of the same members as the existing Employment First Committee. It outlines the office's mission and responsibilities and specifies that the office will be overseen by an executive officer known as the Chief Employment First Officer. Additionally, the bill requires the office to submit a report to the relevant policy committees of the Legislature and the Governor, detailing its activities and recommendations made under these provisions, by June 30, 2025, and annually thereafter.

The current legislation acknowledges the entitlement of adults with disabilities to dwell in their family homes and mandates the department to institute a Coordinated Family Support Services Pilot Program for such individuals. The pilot program's services are required to be adaptable and customized to aid the consumer in residing with their family for as long as it is their preferred living arrangement. This proposed bill would allocate $10,800,000 from the General Fund to facilitate the implementation of the pilot program. The current legal framework confers upon the Department of Human Resources (department) the necessary powers, duties, and authority for the operation of the state civil service system, as outlined. Additionally, the existing legislation establishes the Limited Examination and Appointment Program (LEAP), administered by the department, as an alternative to the conventional civil service examination and appointment procedures, specifically designed to facilitate the recruitment of individuals with disabilities. However, certain LEAP provisions pertaining to the department's requirement to allow individuals with developmental disabilities the option to undergo a written examination, readiness evaluation, or internship are set to be repealed on January 1, 2024.

This bill seeks to eliminate the specified repeal date mentioned above, thereby extending the duration of those provisions indefinitely. Current law mandates that the department must submit a comprehensive plan to the Legislature by April 1 whenever it proposes the closure of a state developmental center. Additionally, the department, in conjunction with the Governor's proposed 2023–24 budget, is required to present an updated safety net plan to the Legislature. This plan outlines how the department will ensure access to crisis services post-closure and how the state will maintain its responsibility for providing residential services to individuals not served by private sector vendors. The plan update must assess progress in creating a safety net, including services or residences aimed at transitioning or diverting individuals 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. The department is prohibited from admitting anyone to a developmental center unless the person is determined eligible for services, meets specified conditions, and is committed by a court on or before June 30, 2023, to the Canyon Springs Community Facility, among other criteria.

This bill proposes to eliminate the June 30, 2023, date and instead enforce the outlined admission criteria for individuals committed to the 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 occurs earlier. Regarding mandated costs, if the Commission on State Mandates determines that the bill imposes state-mandated costs, reimbursement for such costs will be in accordance with the established statutory provisions. The bill specifies that it is intended to take effect immediately as a measure providing appropriations related to the Budget Bill.