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Assembly Republican Analysis - OpposeFor those who are not familiar with Assembly Bill 896, which proposes to
close California's institutions for people with developmental disabilities,
more information is available from this Inclusion Daily Express web page:
Assembly Republican Bill Analysis
Human Services Committee
AB 896 (ARONER)
DEVELOPMENTAL SERVICES: UNIFIED SYSTEM
Version: 3/27/01 Last Amended
Vote: Majority
AB 896 (Aroner)
Oppose
Policy Question
Should developmentally disabled clients be transferred from Developmental Centers to local
communities, with support provided through Regional Centers?
Summary
Would transfer developmentally disabled clients, for which the Department of Developmental Services (DDS) is responsible, from Developmental Centers to local communities with support provided by Regional Centers. Would provide a mechanism to transfer funds from the DCs to the RCs to provide services for the clients who transfer from the DCs to the Rcs. Specifically:
1. Provides a mechanism to transfer developmentally disabled clients from DCs to communities whereby services would be , arranged for or provided by RCs. Individual program planning for each person would be required and each individual would be transferred to the most appropriate regional center;
2. Requires DDS to contract each year for alternative community-based services for at least additional 400 persons assigned to DCs who are current residents of the state facilities;
3. Provides for a mechanism for DC funds to be transferred to RCs and for RCs to contract with
other community-based providers;
4. Provides that unexpended funds derived from the DC transfer, year-end regional center surplus operations or purchase of service funds, and funds derived from donations and bequests be used to augment and improve services and supports for those persons living in the community whose needs are the greatest;
5. Requires RCs to resolve wage-related difficulties encountered in attracting and retaining competent workers to provide services to persons served by the transfer of DC funds;
6. Mandates that workers be paid at least two times the state minimum wage;
7. Authorizes the RCs to contract with one or more state employees to implement the in individual program plan or plans; and requires DDS to prepare and implement a transition plan, to be revised annually, for DS's to accommodate the requirements of the diminishing resident
population;
8.Creates a trust to be administered by a specified board of trustees; and
9. Establishes a system to promote cooperation by local and federal agencies.
Support
California Coalition of United Cerebral Palsy
Associations; Easter Deals of California; Systems
Reform, Inc.; Consumer Advisory Committee;
ARC California; California Rehabilitation
Association; Residential Care Society; Aldea
Children and Family Services; Autism Society of
Los Angeles; Protection and Advocacy, Inc.;
Regional Center of Orange County; Association of
Regional Center Agencies; The ARC San
Francisco; San Andreas Regional Center;
Community Advocacy Services Association, Inc.;
Frank D. Lanterman Regional Center; San
Gabriel/Pomona Regional Center; Congressman
Pete McCloskey; 10 Individual Letters.
Opposition
Green Line Parent Group, Inc.; California
Association for the Retarded; Union of American
Physicians & Dentists; California State Employees
Association; 9 Individual Letters.
Assembly Republican Bill Analysis
Arguments In Support of the Bill
1. There is a need to change the developmental disability hospital system. The system has been overly expensive, spending 25% of the state's total developmental disabilities budget on 2% of the population served in the community and state hospital system.
2. The existing facilities have failed to meet federal standards.
3. The separate, segregated system operated directly by DDS does not comply with the intent of state law and is less cost-effective than the community-based system operated indirectly by the state through contracts with regional centers and subcontracts with a variety of direct service providers in local communities.
Arguments In Opposition to the Bill
1. Concerns By Family Members
There is an on-going concern by family members, especially aging parents of clients in the facilities, that their medically fragile relatives, who require a high level of care, remain in the DCs. Many oppose transferring clients to Rcs.
2. Placement Problems
There are existing problems placing clients in the community. An example is the Silicon Valley, where housing costs are prohibitive. Currently, even if a placement can be secured, the location may be a great distance from family members, which is not in the best interests of either the client or the family. This problem may be worsening by transferring clients from DCs to the community.
3. Significant costs to the state.
DCs are funded through federal Title XIX Medicaid funds (approximately 50% federal, 50% state General Funds). RCs are 100% General Fund except for 35,000 individuals who are served through a capped Medicaid Home and Community Based Waiver (approximately 50% federal, 50% state General Funds). If the clients are transferred from the DCs and the capped Medicaid Home and Community Based Waiver cannot be expanded, the costs will be 100% General Fund.
In addition, DCs have both fixed and variable costs. Even if clients are transferred to the community, the fixed costs will remain; hence there will be overlapping costs. There will also be costs associated with increased staff for DDS.
4. State Mandated Wage Scale
Requires RCs to resolve wage-related difficulties encountered in attracting and retaining competent workers to provide services to persons served by the transfer of DC funds. Currently, DDS sets rates for providers based on a formula dictated by statute and regulation. This bill would transfer the wage development responsibilities from DDS to the RCs and require a base wage rate of at least two times the state minimum wage. It is unclear if this new wage scale would apply to all staff or only staff who serve the most frail who transfer from DCs.
5. Illegal Contracting
The bill authorizes the RCs to contract with one or more state employees to implement the in individual program plan or plans. It is illegal for state employees to contract to provide services to outside agencies.
6. Overly Bureaucratic
The bill requires DDS to take action whenever necessary to secure the cooperation of any state or federal agencies whose procedures could present obstacles to, or would diminish funding for, the system unification processes. This is reasonable. However, the bill further requires that if there is lack of cooperation by any state or federal agency, DDS must report the problem and recommend solutions to:
• the Governor;
• the Secretary of the Health and Human Services
Agency; and
• the Chairpersons of appropriate committees of
the Senate and Assembly.
The bill also requires that if a federal agency is involved, DDS shall submit a copy of its report to
every Senator and Representative from California in the United States Congress as well as Protection and Advocacy, Inc.
If there is lack of cooperation by a state agency, it is the responsibility of the Governor to facilitate the necessary cooperation. If there is lack of cooperation with a federal agency, it is the responsibility of the Governor to facilitate the necessary cooperation with the White House. These provisions are overly bureaucratic and should not be placed in statute.
Fiscal Effect
Significant
Comments
This is a laudable effort on behalf of the author. With old facilities that, in many cases do not comply with health, safety and accessibility standards and with two percent of developmental disability population housed in thesis facilities consuming 25 % of the budget, there is a need for a change.
The bill is a work in progress. It is reasonable to provide services to some of the more medically fragile individuals through a community setting rather than through an institution. However, it should be done only if the individual can receive appropriate treatment in the community, only if the change will not deteriorate the individual's health and safety, and only if the family or guardian consents to the move.
This will open discussions on how or can this be accomplished. As the bill is written, there would be significant costs, even if federal funds can be obtained through expansion of the Home and Community Based Waiver. Fixed costs of the DCs will have to be absorbed even if clients are transferred to the community. Even if the wage setting provision for the RCs were deleted, there would be significant costs to DDS.
Developmental Disability System
The term developmental disability refers to a severe and chronic disability that is attributable to a mental or physical impairment. The disability must begin before the 18th birthday, be expected to continue indefinitely and present a substantial disability. Also, the disability must be due to one of the following conditions:
Mental Retardation Cerebral Palsy Epilepsy AutismA disabling condition closely related to mental retardation or requiring similar treatment.DDS is responsible for designing and coordinating a wide array of services for California residents with developmental disabilities. These services are provided through a statewide system of 21 locally based regional centers. Regional centers are nonprofit private corporations that have offices throughout California to provide a local resource to help find and access the many services available to individuals with developmental disabilities and their families. Both geographic accessibility and population density was considered when selecting locations for the 21 regional centers. The catchment area boundaries for the regional centers conform to county boundaries or groups of counties, except in Los Angeles County, which is divided into seven areas, each served by a regional center.
Regional centers provide or coordinate the following services for individuals with developmental disabilities and their families:
Information and referralAssessment and diagnosisCounselingLifelong individualized planning and service coordinationpurchase of necessary services included in the individual program planResource developmentOutreachAssistance in finding and using community and other resourcesAdvocacy for the protection of legal, civil, and service rightsEarly intervention services for high risk infantsGenetic counselingFamily supportPlanning, placement, and monitoring for 24-hour out -of-home careTraining and educational opportunities for individuals and familiesCommunity Education about developmental disabilitiesThe more severely disabled are served through DCs. A DC is a facility that is state owned and operated under the jurisdiction of DDS.
DCs have 3 distinct treatment parts: acute, which is for persons with significant or emergent medical needs, nursing for persons with ongoing medical needs that aren't acute in nature, and intermediate care which is the lowest level. DCs also provide a broad array of ancillary services such as dentistry, podiatry, and various therapies i.e., occupational and rehab. They even have special shops such as Adaptive Equipment where very specialized wheelchairs and other equipment are made specifically for an individual consumer's needs.