CDCAN Advocacy Without Borders :: One Community

Summary

Revises the maximum purchase by a regional center of respite services for consumers, from a maximum number of days per year and hours per quarter, to a percentage of the annualized volume of respite services utilized by a consumer who received those services in the 2008-09 fiscal year. Revises the requirement for specified vendors to offer an alternative senior program component to be permissive, and revises the requirement for regional centers to provide information and offer an alternative senior program to be permissive.

Existing Law

1. Provides that certain persons with developmental disabilities have the right to receive treatment and services to meet their needs regardless of age or degree of handicap, at each stage of life: the disability must begin before the consumer's 18th birthday, be expected to continue indefinitely, present a significant disability, and be attributable to certain medical conditions, such as mental retardation, autism, epilepsy, and cerebral palsy.
2. Requires that the state pay for these services through contracts with regional centers, and requires regional centers to arrange and contract for services in the community.
3. Requires regional centers to develop an individual program plan (IPP) for each consumer that sets forth the treatment and services to be provided to each consumer, which include, among other things, respite services, alternative senior programs, and alternative customized programs.
4. Requires regional centers to develop, where appropriate for children three years of age and younger, to develop individual family service plans (IFSP).

Respite Services

5. Restricts the amount of respite services that may be purchased for a client and their family. Specifically:
   1. a regional center may only purchase respite services when the care and supervision needs of a client exceed that of an individual of the same age without developmental disabilities;
   2. a regional center shall not purchase more than 21 days of out-of-home respite services in a fiscal year nor more than 90 hours of in-home respite services in a quarter.
   3. Effects these restrictions on August 1, 2009, for consumers receiving respite services on July 1, 2009, as part of their IPP or individual family service plan (IFSP).
6. Allows a regional center to grant an exemption from these restrictions under prescribed circumstances.
7. Repeals these restrictions upon implementation of the individual choice budget.

Alternative Senior Programs

8. Requires vendors of behavior management, activity center, and adult development center day programs, social recreation programs, socialization training programs, community integration training programs, community activities support programs, creative art programs, and work activity programs to offer an alternative senior program component focused on the needs of individuals with developmental disabilities who are over 50 years of age.
9. Requires the alternative senior program component to be provided at a ratio of no more than eight consumers to one staff member, at a rate not to exceed the lesser of thirty-five dollars ($35) per day or the vendor's existing daily rate.
10. Requires that the alternative senior program component be offered within the provider's existing vendored capacity as reflected in its program design or licensed capacity, consistent with the intent of the Lanterman Developmental Disabilities Services Act.
11. Effective July 1, 2009, requires, regional centers to provide, as appropriate, information about and offer an alternative senior program at the time of development, review, or modification of an eligible consumer's individual program plan, to eligible consumers who want to transition to a program component focused on the needs and interests of seniors.

This Bill

1. Eliminates the maximum purchase by a regional center of 21-days of out-of-home respite services in a fiscal year, and 90 hours of in-home respite services in a quarter, for a consumer; and, instead, prohibits regional centers from purchasing more than 98 percent of the annualized volume of in-home and out-of-home respite services utilized by a consumer who received those services in the 2008-09 fiscal year.
2. Revises the requirement for specified vendors to offer an alternative senior program component to be permissive, and revises the requirement for regional centers to provide information and offer an alternative senior program to be permissive.
3. Allows vendors to formulate agreements to meet the objectives of the requirements above, in order to meet consumer demand for these alternative senior programs.
4. Requires regional centers to take appropriate steps to make sure that sufficient program capacity exists to meet the individual needs of consumers wishing to enroll in alternative senior programs that are consistent with the individual's IPP.
5. Contains an urgency clause.

Fiscal Impact

Unknown. There is some debate about the fiscal impact. Based upon information from the Senate Budget Committee, this legislation will result in General Fund costs of at least $5.8 million. The savings associated with the seniors program would be eroded ($1 million General Fund), as would the savings from the respite cap ($4.8 million General Fund). The proponents believe that AB 1260 would provide at least the amount of savings that the Legislature intended be generated by provisions in ABx4 9 (Evans), Chapter 9, Statutes of 2009; however, with the provisions of AB 1260, the savings would not exceed the budget target.

Background and Discussion

As part of the July 2009 package of bills signed into law to address the budget shortfall, ABx4 9 (Evans), Chapter 9, Statutes of 2009, became law. This developmental services trailer bill, which became effective on July 28, 2009, made specified changes to achieve budget savings of more than $200 million. All of the proposed changes occur, unless otherwise specified, at the time of the development, scheduled review, or modification of a client's individual program plan -- IPP or IFSP. Among the changes were new restrictions for respite services, expected to yield savings of $5.3 million annually, and a requirement for specified vendors to offer less costly alternative senior program options, for an expected savings of $1 million.

Specifically, the new restrictions on respite services include a maximum of 21 days of out-of-home respite services in a fiscal year, and 90 hours of in-home respite services in a quarter, in addition to other restrictions. For existing consumers, these new restrictions go into effect on August 1, 2009.

The trailer bill also required all vendors of behavior management, activity center, and adult development center day programs, social recreation programs, socialization training programs, community integration training programs, community activities support programs, creative art programs, and work activity programs to offer an alternative senior program component focused on the needs of individuals with developmental disabilities who are over 50 years of age, and do so within their existing licensed capacity. It is estimated that hundreds of vendors would be subject to this requirement.

The budget set a goal of enrolling approximately 5 percent of eligible seniors in these alternative programs. Additionally, the bill required vendors to meet a staff-to-consumer ratio of no more than 1 to 8, and receive the lesser of $35 a day or their current daily rate. According to advocates, the average day program reimbursement has been approximately $45 per person, per day.

Author's Case

According to the author, respite agencies around the state believe the current cap on respite services would result in an estimated 20 percent reduction in services, rather than the 2 percent savings that was projected when the bill passed. Instead of saving $5.3 million, the author believes that the budget trailer bill will result in reductions of approximately $60 million in respite services - 20 percent of $314 million in the current year.

Similarly, the author believes that the goal and expected savings of the trailer bill regarding the alternative senior program component can be achieved, without the requirement for all vendors of specified services to offer it. The author believes that current law will lead to excessive capacity and unnecessarily force organizations to offer a program that they may be unable to offer.

Stakeholder Process

The Department of Developmental Services is unique in the health and human services in that statute directs it to convene a "stakeholder group" to make recommendations to the department and the Legislature on how best to meet targets for budget reductions. Representatives of professional organizations, service organizations, the regional centers, and advocacy groups participated in the stakeholder meetings. Legislative staff were also involved. The results of those meetings were forwarded to the Legislature and adopted as part of budget trailer bills.

Arguments in Support

For the senior program, advocates point out that to meet the budget goal of enrolling 5 percent of 23,000 eligible individuals over the age of 50, only 1,150 consumers would need to participate in these programs statewide, or an average of 55 participants per regional center catchment area. If a ratio of 1 staff to 8 consumers was used, fewer than 150 programs statewide or an average of seven programs per regional center would need to be offered to meet the 5 percent target, far fewer than the hundreds of vendors which the law requires to offer such programs. Advocates emphasize it may be difficult for some vendors to meet the requirements of offering this program within their current limited capacity (example: if a vendor has only 4 open slots, it may have to operate the program at a loss), and allowing greater flexibility through joint agreements may enhance vendors' ability to meet consumer demand.

Advocates state that programs tailored to seniors are already offered informally and believe that a regional center, which already has the responsibility to find appropriate services for consumers to meet their Individual Program Plan, will be capable of finding programs willing to offer the senior option, without a requirement that all vendors offer it. Additionally, advocates believe that because of the difference in the average rate for a day program and the statutorily set maximum rate for the alternative senior option (estimated to be approximately $10), the goal of 5 percent participation would significantly exceed the estimated savings associated with this option. Advocates believe that program savings could be achieved with only 569 participants, rather than 1,150, enrolled in about 75 programs statewide.

Questions and Comments

Respite care: is there evidence the budget trailer bill requires program reductions greater than $5.3 million?

The rationale for this section of the bill (Section 1, pp. 9-10) is that the language of ABx4 9 (Evans) imposes program reductions in excess of the Legislature's intent to reduce respite services by $5.3 million. Can the Department of Developmental Services provide information on implementation of respite services budget changes?

Does the language of ABx4 9 generate savings greater than $5.3 million?

Is there a disagreement about the meaning of the language - such that the department is interpreting it in ways that generate more savings than the Legislature intended?

Are individual regional centers differing in their interpretation of the language such that the savings generated are projected to be greater than necessary?

Respite care: is there evidence that the substitute language of AB 1260 will generate the necessary savings of $5.3 million in the current year's respite services budget?

The committee should ask the department to comment on this language and its budget impact.

Senior programs: is there evidence that the substitute language of AB 1260 will generate the necessary savings of $1 million in the current year's senior services budget?

The committee should ask the department to comment on this language and its budget impact.

Is this evidence sufficient to act now to alter the recently-passed budget trailer language, or is it preferable to study the implementation of the budget-act provisions during the next four months for review in January?

Support

• Arc of California
• California Association for Health Servicesat Home
• California Disability Services Organization
• California Respite Association
• California Supported Living Network
• Californians for Disability Rights
• Easter Seals
• Family Resource Center Network of California
• People First of California
• United Association of California Care Providers

Oppose

None received