Developmental services: regional centers: provider rates.

Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services to contract with regional centers to provide services and supports to individuals with developmental disabilities. Existing law sets forth the department's and a regional center's authority to establish provider rates. Existing law prohibits a regional center from paying a greater rate to a provider of certain services or supports, as specified, or from approving a service level for a residential service provider that would result in an increase in state costs, unless the regional center demonstrates that the approval is necessary to protect the consumer's health or safety and the department has granted prior written authorization or, in certain circumstances, unless the increase is required by a contract between the regional center and the vendor, as specified. This bill would deem a request from a regional center for prior written authorization approved by the department if the department does not act on the request within 30 calendar days of receipt of the request, unless the director, in his or her discretion, determines that additional time is reasonably necessary to fully and fairly evaluate the request, as specified. If the director determines that additional time is necessary, the bill would grant the department an additional 30 calendar days to act on the request. The bill would authorize additional extensions of time only upon agreement of all parties, as specified. The bill would, for a request from a regional center for prior written authorization involving cases in which there is an imminent and serious threat to the health and safety of the individual consumer, as defined, require the department to notify the regional center of its decision to grant or deny the request within 3 working days from receipt of the request. The bill would authorize the department to request additional information from a regional center under those circumstances, and would prescribe the procedure for making that request. If requested, once that information is provided to the department, the bill would require the department to make a decision to grant or deny the request within 3 working days. The bill would also, for a request from a regional center for prior written authorization, require the department to provide receipt of those requests and the contact information of the department representative handling the request to the regional center. The bill would authorize the consumer or the regional center to request a meeting with the department representative handling the request, as prescribed. The bill would require the department to provide an accounting annually to the Legislature with regard to regional center requests for prior written authorization, as specified. Existing law prohibits a regional center from negotiating a rate with new residential service providers, new supported living service providers, or other certain service providers, as specified, that is higher than the statewide or regional center's median rate for the same service code and unit of service, whichever is lower. This bill would make an exception to the above prohibition if the regional center demonstrates that the approval is necessary to protect an individual consumer's health or safety and the department has granted prior written authorization. The bill would also make the 30-day and 3-day time frames described above applicable to these provisions. Existing law requires the department to promulgate regulations for payment for community-based programs, including a procedure for appealing rates. Existing law prohibits certain rate increases for residential service providers, but, commencing July 1, 2017, authorizes increases to those rates as necessary to adjust employee wages to meet the state minimum wage law. This bill would, on or before July 1, 2019, require the department to adopt regulations to create a process to review requests from regional centers in order to resolve systemic issues with service provider rates that have the potential to create economic distress for service providers or disrupt services to consumers, including, but not limited to, local minimum wage ordinances. The bill would require the department to include in the review process regulations a requirement that the department render a decision on the requested review no later than 60 calendar days after receipt of the review request unless the director, in his or her discretion, determines that additional time is reasonably necessary to fully and fairly evaluate the request, as specified.