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SCLARC Presents Testimony for the Assembly Select Committee on Critical Issues Regarding Autism - Click Here for more information.

Regional Center Position on Budget Spending Reduction Proposals

SCLARC Support the Position of the Association of Regional Center Agencies (ARCA) on Their Positions Regarding the Governor's Mid-Year Budget Spending Reduction Proposals

• Oppose implementation of statewide purchase of service standards as presented in the Governor's mid-year budget spending reduction proposal
• Oppose reduction to Medi-Cal rates including those proposed for the 2003-04 fiscal year
• Oppose elimination of optional Medi-Cal benefits, including adult dental care
• Oppose any rate reductions to intermediate care facilities serving persons with developmental disabilities
• Oppose elimination of SSI/SSP cost of living adjustments

• Support $185 million in purchase of service and $19.1 million in operations for updating caseload growth and service utilization
• Support $37.5 million purchase of service base adjustment based on expenditure data through March, 2002, and updated utilization projections
• Support budget change proposals that would increase federal financial participation by $137 million over a multi-year period. This revenue should be used to offset the $100 million general fund reduction to the purchase of service budget as contained in the Governor¹s mid-year budget spending reduction proposal.
• Support the proposed increase of $65 million in Title XX funds for regional center budget
• Oppose the administration's proposal to implement a family co-pay assessment program for families with children between the ages of three and 17 living at home and not receiving Medi-Cal
• Support the department's "Bay Area Plan" to close Agnews Developmental Center by June 30, 2005
• Support the department's budget change proposal to continue the current regional center self-determination pilot projects and provide two positions to DDS to develop an independence plus waiver

Key housing issues affecting SCLARC and Its Stakeholders!


1) State Budget
In the past decade, the service delivery system for people with developmental disabilities has become stressed due to a number of factors. California's growing population will always include a percentage of individuals with a diagnosis of a developmental disability. Today, we see emerging populations that require new or unique services to meet their changing needs. Traditional programs designed decades ago are no longer fulfilling the goals of today.

Regional Centers are also experiencing a sharp rise in the rate of children being diagnosed with full=syndrome autism and requiring services that are currently not available or being provided for in the community. As this population continues to age, they are placing a strain on not only our overburdened system, but also on the public education system. As these children become adults, we are becoming painfully aware that the services to assist them transition are dangerously absent.

As fiscal woes have grown to impact local government and other generic service agencies, such as public schools and community mental health services, we have seen sharp decreases and reductions in their ability to meet the specialized needs of people with developmental disabilities. Regional centers have been forced to fill the gaps without additional funds to purchase services such dental care and mental health services.

The Governor's proposed budget for FY 08-09 will leave our fragile service delivery system with insufficient funds for the projected population growth to provide necessary services and supports, not only to today's consumers but those entering the system.

Over the past few years, the Department of Developmental Services has instituted a series of both short and long-term cost containment measures to curb the rate of increase in expenditures within our system. These measures included the freeze on rates to regional center service providers, instituted a family cost participation program, changes to the eligibility criteria to decrease access to services, increased the ratio of consumers to regional center service coordinators and the freeze on the use of regional center purchase-of-service dollars for new program development. These measures have contributed to the acceleration of eroding the quality and availability of services to consumers and families.

Among the other various cost containment measures was the introduction of a family cost participation program (FCPP), administered by the regional centers. This year, the Administration proposes an expansion to the existing program. We oppose this proposal for a number of reasons. The Department of Developmental Services will be required to submit an amendment to the federal waiver, which must then be approved in order to collect additional funds in the Early Start program. There is no guarantee that this waiver amendment will be approved, yet the state is relying on capturing these savings. The program, as it is currently operated is no cost-efficient and creates an intensive workload at the regional center level for very little return.

Reductions that will also have a continued negative impact on the lives of consumers and their families is the continued use of the extended intake and assessment timeline of 60 days to 120 days for new consumers. Individuals applying for regional center services have urgent needs for services. Another cost savings measure that directly impacts consumers and their families is the high average of caseload ratios for regional center service coordinators. Ratios are currently at a one to sixty-six average for consumers not on the Federal Home and Community-Based Services (HCBS) waiver and one to sixty-two average for consumers who are waiver eligible. In many cases, due to mixed caseload, the actual ratios for individual service coordinators can be much higher. In reviewing its priorities, we hope the Legislature will allow for all consumers, regardless of their waiver status to have a service coordinator with a lower caseload. This allows for service coordinators to spend time with consumers to properly identify the best quality and most cost-effective service options available.

SCLARC is also very concerned about the service coordinator caseload ratios as it applies to our ability to adequately and successfully implement self-directed services )SDS). While we applaud this consumer choice-driven program, we believe the funds are inadequate to fully implement the plan the way it was designed to function. In the five pilot programs, ratios were much lower affording proper time and attention to consumers in helping them map out their needs and goals. While the long-term program result may be a cost savings, to make it work initially, the DDS and Legislature need to understand that an investment needs to be made to ensure this is done correctly.

Other items in the Governor's budget that impact the lives of people throughout our state, regardless of their age or disability include the overall proposed reduction to Medi-Cal providers and the additional proposed elimination of Medi-Cal optional benefits. With a large percentage of out population reliant on Medi-Cal services, this reduction will only further erode the capacity of fewer medical professionals to adequately serve not only people with disabilities, but a growing general population in need.

Similar to the impact of Medi-Cal reductions is the proposed reduction of In-Home Support Services (IHSS) hours. The IHSS program assists not only people with developmental disabilities, but countless others in the community who would otherwise be forced to live in institutional settings, which come at a much higher cost to the state. While the average percentage may appear to be minimal, the actual direct impact on the lives of people relying on these services will place them in extremely difficult situations. From the regional center perspective, we will absorb the proposed reductions through our anticipated increase of utilization in the supported living services (SLS) program. Our consumers will still need and require a certain level of support and when IHSS hours are decreased, SLS hours will need to increase to bridge that gap of care.

With the multiple reductions proposed in other agencies that provide services to our consumers, consumers and their families will look to the regional center to absorb these costs for necessary services and support. As payors of last resort, regional centers believe the proposed purchase-of-service budget will be insufficient to assume existing service needs costs due to the elimination of and decreased availability of generic services.

Therefore South Central L.A. Regional Center (SCLARC) stands with the Association of Regional Center Agencies (ARCA) on the following positions regarding:

Purchase of Service (POS)

1. Ensure sufficient funds to continue provision of services to current regional center consumers and for needed services for new consumers. The projected growth in consumers is 5%, which includes a 10% growth for Early Start consumers (consumers from birth to age 3).
   
   
2. Oppose the reduction of $192.7 million for the "Adjustment to Purchase of Services Increases". This reduction is proposed by the administration because historical trends project higher growth than can be justified by increased cost due solely to caseload growth.
   
   
3. Support the rollback of the Department's contract withy Devereux of California (estimated savings $1.2 million).
   
   
4. Oppose redesign and continuation of the Family Cost Participation Program (estimated savings $773,000). (NOTE: There is no provision for additional OPS funds to support the increased workload associated with the expansion of this program.)
   
   
5. Oppose continuation of past cost-containment measures and the attempted use of Budget-Balancing Reductions to make the temporary measures permanent (estimated savings $311.4 million). These include:
   
   a. Rate Freezes for residential services, community-based day programs, habilitation service programs, in-home respite service providers and the following 11 services:
   
   (1)  Supported living services
   (2)  Transportation, including travel reimbursement
   (3)  Socialization training programs
   (4)  Behavioral intervention training
   (5)  Community integration training
   (6)  Community activities support services
   (7)  Mobile day programs
   (8)  Creative art programs
   (9)  Supplemental day service program supports
   (10) Adaptive skills trainers
   (11) Independent living specialist
   
   b. Prohibition on use of POS funds for start-up of non-CPP programs
   
   c. Cost-of-living adjustments for SSI/SSP may not be passed through to CCF providers.
   
   
6. Oppose the freeze on negotiated rates for providers whose rates are set by negotiation between the provider and the regional center and are not already included in the services listed above (estimated savings $18.3 million). If this proposal is adopted, oppose the proposed methodology that negotiated rates for new providers be set at the lesser of the median rate for similar providers at the regional center of the median rate for similar providers statewide.
   
   
7. Oppose the 10% rate reduction for Supported Employment program (estimated savings $9.6 million)
   
   
8. Support POS budget augmentations to fund increase in services due to the Budget-Balancing Reductions suffered in other departments and programs.

Operations (OPS)

1. Support sufficient funds to provide case management services to projected 5% increase in consumers served ($21.4 million).
   
   
2. Oppose continuation of past cost containment measures and the attempted use of Budget-Balancing Reductions to make the temporary measures permanent (estimated savings $36.9 million). These include:
   
   a. Extending time to complete intake of new consumers from 60 days to 120 days ($4.5 million).
   
   b. Increasing the mandated caseload ratios for consumers not on the HCBS Waiver from 1:62 to 1:66 ($32.4 million).
   
   
3. Oppose the reduction of Community Placement Plan (CPP) operations funding by 10% (estimated savings $660,000 in FY 2007-2008 and $2.0 million in FY 2008-09).
   
   
4. Oppose the reduction of operations funding for Health Information Portability and Accountability Act (HIPAA) compliance by 10% (estimated savings $46,000 in FY 2007-08 and $141,000 in FY 2008-09).
   
   
5. Support the proposal to increase access to mental health services for regional center consumers. The estimated cost of $740,000 will be funded by the Mental Health Services Fund (Proposition 63 - Mental Health Services Act) and will have no General Fund impact (NOTE: These funds are for contractors to provide various training's throughout the state and will not be allocated out to regional centers.)

Developmental Centers (DC)

1. Oppose proposed cap on number of residents in Porterville's Secure Treatment Program ($11.7 million).
   
   
2. Support closure of the two Regional Resource Development Program (RRDP) offices no longer situated on the grounds of a DC ($1.1 million).

Other Concerns

The following are ARCA's position on certain aspects of the proposed budgets for other programs that would have a negative impact on regional center budgets:

1. Oppose the 10% rate reduction for Medi-Cal providers.
   
   
2. Oppose the elimination of optional services from the Medi-Cal program including dental care for adults, optometrists and optician services, speech therapy, and audiology.
   
   
3. Oppose 18% reduction in In-Home Support Services (IHSS) hours for domestic and related services.
   
   
4. Oppose elimination of SSP cost-of-living adjustment to SSI/SSP recipients.
   
   
5. Oppose the 10% reduction in rates for Adult Day Health Care Programs.
   
   
6. Oppose the $92.7 million reductions in the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program.
   
   
7. Oppose the proposed reduction of $400 million in special education funding.

2) Self Directed Services:

• Will be the new way of doing business within the California developmental disabilities system
  
  
• Will fundamentally change the way services are developed and delivered for all parties - i.e., consumers, families, Regional Centers, service providers, DDS, etc.
  
  
• Will not be the way all people want to receive services, but will be the way some do
  
  
• New business and enterprises will crop up throughout the state in response to the implementation of SDS
  
  
• Self-Directed Services are authorized in Statute: Welfare and Institutions Code 4685.7
  
  
• DDS will offer self-directed services *SDS) contingent on the approval of a federal waiver - 1915(c) home and community-based services waiver.
  
  
• Once approved, the SDS program will be available to all eligible consumers.
  

Under Self-Directed Services principles, participants:

• Plan their lives
• Control their Individual Budget
• Choose services and supports to implement their IPP
• Maintain accountability for spending of public funds
• Serve as leaders and self-advocates

SCLARC's Board of Directors' Self Directed Services Resolution

On January 22, 2008, Mr. Reuben Lee, South Central L.A. Regional Center's Director of Children & Adult Services, provided a brief report and presentation on Self-Directed Services to SCLARC's Board of Directors. Mr. Lee presented the values/principles of the Self-Directed Services (SSDS) program and explained that SDS is "a means by which individuals who are eligible for state developmental disabilities services are empowered to gain control over the selection of services and supports, that meet their own needs".

Mr. Lee also shared the sentiments of the Chief Counselors' group in regards to SDS. His colleagues urge Regional Centers to delay the full implementation of the SDS program. After reviewing the Chief Counselors' reasons for opposition, SCLARC's Board of Directors agrees that implementation of this program should be tabled until several factors that could severely hinder the success of this program and undermine its very values and principles can be corrected. Therefore, pursuant to the Association of Regional Center Agencies' (ARCA) request that South Central L.A. Regional Center's Board of Directors indicate its position regarding implementation of the SDS program in California, the Board finds the following:

Whereas, studies have shown the need for much lower caseload ratios that currently exist within the California Regional Center System which now average well over 1:62 when the national median case management ratio for people with developmental disabilities is 1:40 for states with self-directed services, and

Whereas, it is the opinion of SCLARC's Board of Directors that Service Coordination resources which are not currently budgeted into the program's design are included, and

Whereas, Regional Centers cannot effectively manage the additional responsibilities of the SDS program without additional case management staff and resources, and

Whereas, SCLARC's board members feel that many consumers/families in South Central would be vulnerable to persons who could take advantage fiscally if safeguards and oversight are not included in the program.

Therefore, be it resolved that while the members of South Central L.A. Regional Center's Board of Directors do support the concept of Self-Directed Services, we find that we are not, at this time, able to endorse or support the implementation of the program in its present form. And we further resolve that we do not believe that the SDS program should be implemented until those issues that we have identified can be adequately addressed.

3) Housing

Friends Housing Corporation recently mailed 900 (which is approximately 10% of SCLARC's consumers and families) Housing Surveys to SCLARC in order to assess the housing needs of those whom SCLARC serves. Within a 5 day period, Friends Housing was bombarded with many calls regarding dire housing issues. The following concerns were among the top.

• 80% of callers requested assistance in finding appropriate and affordable housing for either their family or for a consumer wishing to live independently.
  
  
• Of the Spanish-speaking callers requesting assistance with housing, more than half informed staff that they did not have any type of immigration papers.
  
  
• Of those families with severely disabled children, many expressed fear over what would happen to their child if they were to die or leave the child alone.
  
  
• Many of the callers requesting housing assistance described overcrowded housing situations, with families of 3-4 living in studio apartments or sharing one bedroom in a larger family house.
  
  
• Only one of the callers requesting assistance for housing had a voucher for Section 8.
  
  
• Of those callers who met residency and income requirements for affordable housing buildings, none were currently living in an affordable apartment building.
  
  
• Most seemed aware of any resources to be able to locate, or apply for affordable housing.

4) Supported Employment

A prime example of programs operating under depressed rates is supported employment programs, which assist consumers in realizing their goal of having a job. Like most people in our state, individuals with developmental disabilities want to work.

The proposed Governor's Budget will reduce the 24 percent rate increase received by providers of Supported Employment services in 2006-07 by 10%. The proposed reduction to employment services runs counter to the commitment the Legislature has made over the past few years. The investment made to help this program grow and see more people successfully and gainfully employed has not yet been fully tested.

Regional Centers believes that as the program begins to experience the impact of the return on our investment after years of depressed rates, a cost savings will recognized as people transition from more expensive day programs into work.

California Legislation Update (5/19/2008)

Bill: AB 1825
Author: Beall
Position: Support
Status: 05/01/2008-Referred to Com. on HUMAN S.

Summary: Under existing law, the regional centers purchase needed services for individuals with developmental disabilities through approved service providers or arrange for their provision through other publicly funded agencies. This bill establishes procedures for the dispute resolutions between regional centers and publicly funded agencies over payment for services contained in an individualized family service plan or individualized program plan for children under six.



Bill: AB 1872
Author: Coto
Position: Watch +
Status: 04/30/2008-In committee: Set, first hearing. Referred to APPR. suspense file.

Summary: This bill would create the California Autism Spectrum Disorder Clearinghouse within the State Department of Education to provide evidence-based and recommended practices for the education of students with ASD. The department would be required to administer the clearinghouse in coordination with the State Department of Developmental Services. The bill would require that access to the clearinghouse be provided at schools, specified regional centers, diagnostic centers, family empowerment centers, and public libraries for the purpose of making resources available to families. The department would be required to utilize federal special education funding for the development and maintenance of the clearinghouse.

Bill: AB 1983
Author: Evans
Position: Watch +
Status: 05/07/2008-In committee: Set, first hearing. Referred to APPR. suspense file.

Summary: Directs the Department of Developmental Services to establish a registry of care providers with abusive histories and make the information available to the groups hiring caregivers. Requires employers to consult the registry prior to hiring a caregiver, and prohibits the hiring of any caregiver listed on the registry. Also requires employers of caregivers report instances of abuse to the department for inclusion on the registry.

Bill: AB 2302
Author: Bass
Position: Support
Status: 05/08/2008-Referred to Com. on ED.

Summary: AB 2302 would provide a new option for local educational agencies and schools to assign teachers who hold a credential authorizing the instruction of students with mild and moderate disabilities to serve students with autism. The measure would allow this option, with the teacher's consent, if the teacher has provided full-time instruction for at least one year in a special education program that serves pupils with autism and received a favorable evaluation or recommendation; or has completed a minimum of three semester units of coursework in the subject of autism offered by a regionally accredited institution of higher education.

Bill: AB 2891
Author: Levine
Position: Support
Status: 05/07/2008-In committee: Set, first hearing. Referred to APPR. suspense file.

Summary: Existing law requires the Department of Developmental Services to allocate funds to private nonprofit regional centers for the provision of community services and support for persons with developmental disabilities and their families. This bill would establish the Lanterman Accessible and Affordable Housing Fund to provide resources for grants to purchase residential property for community housing for persons with developmental disabilities. The bill would, upon appropriation by the Legislature, authorize use of moneys in the fund by the department for these purposes.

Bill: SB 527
Author: Steinberg
Position: Watch +
Status: 04/07/2008-From committee with author's amendments. Read second time. Amended. Re-referred to Com. on HEALTH.

Summary: Establishes the Autism Early Identification Advisory Committee (AEIAC) that will identify best practices for identification, assessment and treatment of children with ASD.

Bill: SB 1175
Author: Steinberg
Position: Support
Status: 05/15/2008-To Com. on HUMAN S.

Summary: Expands the existing authority granted to the Bay Area Housing Consortium Regional Centers to all regional centers as well as allow regional centers to enter into contracts for housing for clients.

Bill: SB 1317
Author: Steinberg
Position: Watch +
Status: 05/15/2008-Set for hearing May 22.

Summary: This bill would permit a regional center to assign a person to a career opportunity program, at an hourly rate set by the department, as part of an individual program plan. This bill would define career opportunity program as an accredited nonprofit agency that competitively offers prescribed goods or services that provide employment opportunities to persons with disabilities.

Bill: SB 1364
Author: Cedillo
Position: Support
Status: 05/15/2008-Set for hearing May 22.

Summary: This bill would require the State Department of Public Health, by January 1, 2010, to establish the Autism Spectrum Disorders Advisory Council. This bill would require the council to provide recommendations to the department to enable it to deal more effectively with the public health crisis of autism spectrum disorders.

Bill: SB 1475
Author: Torlakson
Position: Watch +
Status: 05/15/2008-From committee with author's amendments. Read second time. Amended. Re-referred to Com. on APPR.

Summary: This bill would require the State Department of Developmental Services to establish a 2-year pilot project to, among other things, provide methods, instruments, and systems of care between regional centers and school districts for the early identification and assessment of children with ASD from birth to 5 years of age.

Bill: SB 1531
Author: Correa
Position: Support
Status: 05/15/2008-Set for hearing May 22.

Summary: Requires the Commission on Peace Officer Standards and Training to create and make available on DVD and electronically a course on how to recognize and interact with people with ASD for peace officers, firefighters, ambulance attendants and other emergency workers.

Bill: SB 1687
Author: Negrete McLeod
Position: Watch +
Status: 05/15/2008-Set for hearing May 22.

Summary: This bill would establish a statewide participation goal of not less than 2% for developmentally disabled business enterprises to participate in all contracts awarded by a state department for construction, services, materials, supplies, equipment, alterations, repairs, or improvements.