Developmental services.

(1) 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 and their families. This bill would require the department to consult, commencing in the summer of 2019, with specified stakeholders, including representatives of the Developmental Services Task Force and the Department of Rehabilitation, to discuss system reforms to better serve consumers with developmental disabilities, to perform various duties, such as evaluating compliance with federal rules relating to specified services, to report on the progress of these efforts, and to post specified material on its internet website, including a summary of public comments. Under existing law, the services and supports to be provided to a regional center consumer are contained in an individual program plan (IPP) , developed in agreement between the regional center representative and the consumer or, when appropriate, the consumer's parent, legal guardian, conservator, or authorized representative at the IPP meeting, in accordance with prescribed requirements. Existing law requires both parties to sign the IPP prior to its implementation. This bill would additionally require an authorized representative of the regional center to provide to the consumer a list of the agreed-upon services and supports, and, if known, the projected start date, the frequency and duration, and the provider of services. The bill would require the authorized representative and the consumer or, when appropriate, the consumer's parent, legal guardian, conservator, or authorized representative to sign the list of agreed-upon services and supports prior to its implementation. Existing law provides for the department and regional centers to establish provider rates, including increases to these rates for specified services. This bill would require the department to provide a rate increase for specified services for which rates are set by the department or through negotiations between the regional centers and service providers, rates paid for supported employment services, and vouchered community-based services. The bill would exclude from the rate increase those services for which rates are determined by other entities, including the State Department of Health Care Services, or that are usual and customary. This bill would suspend the implementation of these rate increases on December 31, 2021, unless the Department of Finance makes a specified determination. (2) 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 supports to all eligible infants and toddlers and their families, and requires an eligible infant or toddler receiving services under the act to have an individualized family service plan (IFSP) . The act requires these services to be provided pursuant to the existing regional center system and the existing local education agency system. Existing law authorizes a regional center to pay any applicable copayment, coinsurance, or deductible for a service or support required by a consumer's IPP or IFSP when necessary to ensure that the consumer receives the service or support, if the service is paid for by the health care service plan or health insurance policy of the consumer's parent, guardian, or caregiver and, among other conditions, the family has an annual gross income that does not exceed 400% of the federal poverty level. This bill would instead require the regional center to pay any applicable copayment, coinsurance, or deductible for a service or support required by a consumer's IFSP if the service is paid for by the health care service plan or health insurance policy of the consumer's parent, guardian, or caregiver, regardless of the family's income level. (3) Existing law requires each regional center to post specified information on its internet website to promote transparency, including purchase of service policies. Existing law requires the State Department of Developmental Services to collect and review printed materials issued by the regional centers, including, among other things, purchase of service policies and other policies and guidelines utilized by regional centers when determining the service needs of a consumer. This bill would additionally require each regional center to post on its internet website any other policies, guidelines, or regional center-developed assessment tools used to determine the transportation, personal assistant, or independent or supported living service needs of a consumer, and would require the department to confirm that the purchase of service policies and other policies, guidelines, or assessment tools are available to the public on the regional center's internet website. (4) Existing law establishes governing boards of regional centers, and sets out requirements for the boards, including that the board include persons with legal, management, public relations, and developmental disability skills. Existing law requires the governing board of each regional center to submit to the department by August 15 of each year detailed documentation demonstrating that the composition of the board is in compliance with those provisions. This bill would, among other things, require the governing board of a regional center to, by August 15, 2020, include members with financial expertise and members with management or board governance expertise. The bill would, if the composition of the board is not in compliance with specified requirements, require the board to submit a plan to the department with its board composition documentation setting forth how and when the board will come into compliance with those requirements. The bill would require the governing board of each regional center, beginning May 1, 2020, and annually thereafter, to hold one or more public meetings regarding the prior year's contract performance objectives and outcomes. The bill would prohibit an attorney retained or hired by the governing board from being an employee of the regional center. Existing law requires the State Department of Developmental Services, in consultation with stakeholders, to identify a valid and reliable quality assurance instrument that assesses consumer and family satisfaction, provision of services, and personal outcomes, and, among other things, includes outcome-based measures such as health, safety, and well-being. This bill would require each regional center to annually present data collected from, and the findings of, the quality assurance instrument at a public meeting of its governing board, and to provide notice of this meeting to regional center consumers and families and individual stakeholders, as specified. The bill would require each regional center to submit a report to the department regarding its implementation of the requirements relating to the quality assurance instrument, including copies of the annual presentation. Existing law requires the department to develop and implement a plan to monitor, evaluate, and improve the quality of community-based services through the use of a performance dashboard, and requires the dashboard to be published annually. This bill would require the dashboard to be published in a machine-readable format, and would require each regional center to publish its own dashboard and to post a link to the department's dashboard on the regional center's internet website. This bill would also require a regional center, beginning July 1, 2020, to provide the department with a copy of a corrective action plan or sanction issued to a provider, as specified. Under existing law, a person believed to have a developmental disability or to have a high risk of parenting a developmentally disabled infant is eligible for initial intake and assessment in the regional centers. Existing law requires that specified information be provided as part of initial intake. This bill would require the department to develop information packets that include, among other things, an overview of the regional center system, to be provided to a person seeking regional center services. The bill would require a regional center to begin distributing the information packets within 60 days following the department providing the information packets and issuing directives regarding the distribution of the information packets, and to additionally post the full content of the most updated information packet on the regional center's internet website. (5) Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income persons receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing federal law provides for various home- and community-based services waivers that promote coverage and services that enable an individual who would otherwise be institutionalized to live at home or in the community. Existing law requires the department to seek all necessary waivers from the United States Department of Health and Human Services in order to provide in-home and community-based care. This bill would require the State Department of Developmental Services, through its Developmental Services Task Force, to identify key indicators to track the regional center system's delivery of services. The bill would require these indicators to include, among other things, both local and statewide measures and a recommendation for analysis and followup of any concerning trends. The bill would require the department, with stakeholder input, to identify recommendations for measuring outcomes and improving outcomes for consumers, as specified. The bill would require the department to report this analysis to the Legislature by a specified date. With respect to compliance with the federal Home and Community-Based Services (HCBS) Final Rule, the bill would require each regional center to post on its internet website information related to the provision of services, including, but not limited to, the number of providers identified as needing assessment for HCBS compliance and the number of providers within each provider type that have been inspected or reviewed for HCBS compliance. The bill would also require the department to provide this information to the Legislature by a specified date and on its internet website, as specified. In addition, the bill would require the department to annually update the Legislature with the number of complaints filed at each regional center, as prescribed, and the number of requests for fair hearings filed with each regional center or statewide and each hearing's resolution, as specified. The bill would require the department and each regional center to also include on their internet websites a link to the protection and advocacy agency and clients' rights advocate by a specified date. On and after October 1, 2019, the bill would require the department to post all new directives issued to regional centers on its internet website. (6) Existing law vests in the State Department of Developmental Services jurisdiction over state hospitals, referred to as developmental centers, for the provision of residential care to individuals with developmental disabilities, and requires the department to submit to the Legislature, on or before October 1, 2015, a plan or plans to close one or more developmental centers. Existing law requires the department, when closing a developmental center, to comply with procedural requirements that include the submission of a detailed plan to the Legislature, also known as a safety net plan. Existing law required the department to include an update to the Legislature in the 2017–18 May Revision to the Governor's Budget 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. This bill would require the department to submit an update of that plan to the Legislature on or before January 10, 2020. The bill would require the updated plan to be developed in consultation with stakeholders and to evaluate specified information, including the progress made to create a safety net. Existing law, commencing July 1, 2017, and until December 31, 2020, requires the department to provide quarterly updates to the appropriate policy and fiscal committees of the Legislature on the steps foreseen, planned, and completed in the development of services under that update by the department to the Legislature, as specified, and authorizes these updates to be made in conjunction with planned quarterly updates on closure activities for developmental centers. This bill, commencing with the first planned quarterly briefing described above after January 1, 2020, would require the department to provide specified information at quarterly briefings with legislative staff of the appropriate policy and fiscal committees of the Legislature that addresses consumer health and safety, quality outcomes for consumers, and regional center accountability, transparency, and oversight efforts, among other things. The bill would make related findings and declarations. (7) Under existing law, regional center contracts require certain specified staffing levels and expertise, including service coordinator-to-consumer ratios. This bill would require a regional center to maintain an average service coordinator-to-consumer ratio of 1 to 25 for consumers with complex needs. The bill would prohibit this ratio from being authorized for a consumer for more than 12 months unless an extension is granted. The bill would authorize an extension to be granted one time for no longer than 6 months. (8) Existing law prohibits a regional center from purchasing new residential services from, or placing a consumer in, institutions for mental disease, as specified, except in an emergency when a regional center cannot locate alternate services to meet the consumer's needs. Existing law authorizes a person with a developmental disability to be committed to the State Department of Developmental Services for residential placement if the person is found to be a danger to self or others. This bill would, effective January 1, 2020, no longer apply the above exception and would instead except from the above prohibition acute crises when specified conditions are met prior to a regional center purchasing new residential services from, or placing a consumer in, an institution for mental disease, including the regional center preparing an assessment detailing all considered community-based services and supports and an explanation of why those options could not meet the consumer's needs. This bill would require the regional center, when admission to an institution for mental disease occurs due to an acute crisis and the consumer does not transition back to a community setting within 72 hours, to complete any documentation necessary to support a filing of a petition for commitment, request the person authorized to present allegations for the commitment to file a petition for commitment, and complete a comprehensive assessment that includes identification of the services and supports for the crisis stabilization, among other things. The bill would prohibit the commitment to an institution for mental disease from being longer than 6 months, except as specified. The bill would require the department to monitor placements in an institution for mental disease pursuant to these provisions and subsequent transitions back to community-based settings. (9) Existing law requires the State Department of Developmental Services to contract for clients' rights advocacy services to ensure and uphold the rights of persons with developmental disabilities and to ensure that laws, regulations, and policies on the rights of persons with developmental disabilities are observed and protected. Existing law, the Lanterman-Petris-Short Act, provides for the involuntary commitment and treatment of a person who is a danger to self or others or who is gravely disabled. The act provides for a conservator of the person or estate to be appointed for a person who is gravely disabled, as specified. Existing law authorizes the commitment of a person with a developmental disability to the State Department of Developmental Services for residential placement other than in a state developmental center or state-operated community facility if the person is found to be a danger to self or others and meets other specified criteria. Existing law requires, in any proceedings conducted under this authority, the person alleged to have a developmental disability to be informed of their right to counsel by the court. This bill would require a regional center to notify the clients' rights advocate of all consumers placed on an involuntary psychiatric hold or in a conservatorship under the Lanterman-Petris-Short Act, as specified. The bill would additionally require the regional center to inform the clients' rights advocate when a commitment petition is filed and when a petition expires. The bill would require an order of commitment made pursuant to the provisions on or after January 1, 2020, with respect to the admission to an institution for mental disease, to expire automatically 6 months after the earlier of the order of commitment, the order of a placement in an institution for mental disease pursuant to a specified provision, or the date the regional center placed the individual in the institution for mental disease, unless extended, as specified. The bill would also authorize the court to issue any orders it deems appropriate in order for necessary steps to be taken to ensure that the individual can be safely and appropriately transitioned to the community in a timely manner. (10) Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, including, among others, community crisis homes, by the State Department of Social Services. Existing law defines "community crisis home" as a facility certified and licensed by the department as an adult residential facility that provides 24-hour nonmedical care to individuals with developmental disabilities receiving regional center services and in need of crisis intervention services who would otherwise be at risk of admission at specified mental health facilities, including, among others, an acute psychiatric hospital. A violation of the act is a misdemeanor. This bill would authorize group homes to be licensed as community crisis homes for children and would revise the definition of community crisis home to include certified and licensed group homes. The bill would also define a dual agency client for purposes of these provisions as a foster child in temporary custody of the child welfare agency or the juvenile court, as specified, who is either a consumer of regional center services or is receiving services pursuant to the California Early Intervention Services Act, but is under 3 years of age and has not yet been determined to have a developmental disability. The bill would subject dual agency clients, as defined, to the placement duration limitations imposed on specified temporary custody placements for dependent children. By expanding the definition of a community crisis home, this bill would change the scope of an existing crime, creating a state-mandated local program. (11) Existing law requires the State Department of Developmental Services, using community placement plan funds, to establish a community-based residential option consisting of community crisis homes for adults with developmental disabilities receiving regional center services who require crisis intervention services and who would otherwise be at risk of admission to the acute crisis center, a department-operated facility, an out-of-state placement, a general acute hospital, an acute psychiatric hospital, or an institution for mental disease, as specified. This bill would additionally require the department to include community-based residential options that consist of community crisis homes for children who meet the criteria described above. (12) Existing law requires a community crisis home to have a facility program plan approved by the State Department of Developmental Services and requires the plan to be submitted to the State Department of Social Services for inclusion in the facility plan of operation. This bill would require the department, no later than March 1, 2020, to develop guidelines regarding the use of restraint or containment in community crisis homes, which are required to be maintained in the facility program plan and plan of operation. The bill would prohibit a community crisis home from using physical restraint or containment for more than 15 minutes unless the department grants an exception and the use of physical restraint or containment conforms to the facility program plan approved by the department. (13) Existing law requires the State Department of Developmental Services to certify, and the State Department of Social Services to license, until January 1, 2020, enhanced behavioral supports homes, which are adult residential facilities or group homes that provide 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting, and that are eligible for federal Medicaid funding. This bill would extend the operation of these provisions until January 1, 2021, and would make conforming changes. (14) Existing law, until June 30, 2021, authorizes a court to commit an individual who meets specified criteria for admission due to an acute crisis to a separate and distinct unit of Canyon Springs Community Facility. This bill would authorize up to 5 persons to be admitted to the Canyon Springs Community Facility on or before June 30, 2021, if the person is currently committed to either an acute psychiatric facility, as defined, or an acute crisis facility due to an acute crisis and requires continued treatment to achieve stabilization and successful community transition. The bill would prohibit an admission pursuant to these provisions from extending beyond June 30, 2022. Existing law authorizes a person with a developmental disability to be released from a developmental center for provisional placement, not to exceed 12 months, and gives the person an automatic right of return to the developmental center during the period of provisional placement. This bill would limit admissions pursuant to that automatic right of return to 5 persons exercising the right on or before June 30, 2021. The bill would prohibit an admission pursuant to these provisions from extending beyond June 30, 2022. This bill would also authorize the department to admit to the Porterville Developmental Center up to 10 consumers committed by the court due to an acute crisis. The bill would prohibit admission pursuant to these provisions from extending beyond December 31, 2020, or upon the opening of the state-operated community acute crisis homes approved for development in the Budget Act of 2019. The bill would make conforming changes to related provisions. (15) Existing law generally prohibits regional centers from compensating certain vendors for providing any service to a consumer on specified holidays. Existing law also generally prohibits regional centers from compensating certain entities for transporting a consumer to receive those services for any of the listed holidays. This bill would suspend that provision until December 31, 2021, and would continue the suspension beyond that date if the estimates of General Fund revenues and expenditures for the 2021–22 and 2022–23 fiscal years contain estimated revenues that exceed estimated expenditures by a specified amount. (16) 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 no reimbursement is required by this act for a specified reason. (17) This bill would appropriate $4,710,000 from the General Fund, including reimbursements, to the State Department of Developmental Services to operate 2 acute crisis homes at the Porterville Developmental Center General Treatment Area. (18) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.