SECTIONS 4640-4659

4640.  (a) Contracts between the department and regional centersshall specify the service area and the categories of persons thatregional centers shall be expected to serve and the services andsupports to be provided. (b) In order to ensure uniformity in the application of thedefinition of developmental disability contained in this division,the Director of Developmental Services shall, by March 1, 1977, issueregulations that delineate, by diagnostic category and degree ofdisability, those persons who are eligible for services and supportsby regional centers. In issuing the regulations, the director shallinvite and consider the views of regional center contractingagencies, the state council, and persons with a demonstrated anddirect interest in developmental disabilities.4640.6.  (a) In approving regional center contracts, the departmentshall ensure that regional center staffing patterns demonstrate thatdirect service coordination are the highest priority. (b) Contracts between the department and regional centers shallrequire that regional centers implement an emergency response systemthat ensures that a regional center staff person will respond to aconsumer, or individual acting on behalf of a consumer, within twohours of the time an emergency call is placed. This emergencyresponse system shall be operational 24 hours per day, 365 days peryear. (c) Contracts between the department and regional centers shallrequire regional centers to have service coordinator-to-consumerratios, as follows: (1) An average service coordinator-to-consumer ratio of 1 to 62for all consumers who have not moved from the developmental centersto the community since April 14, 1993. In no case shall a servicecoordinator for these consumers have an assigned caseload in excessof 79 consumers for more than 60 days. (2) An average service coordinator-to-consumer ratio of 1 to 45for all consumers who have moved from a developmental center to thecommunity since April 14, 1993. In no case shall a servicecoordinator for these consumers have an assigned caseload in excessof 59 consumers for more than 60 days. (3) Commencing January 1, 2004, the followingcoordinator-to-consumer ratios shall apply: (A) All consumers three years of age and younger and for consumersenrolled in the Home and Community-based Services Waiver program forpersons with developmental disabilities, an average servicecoordinator-to-consumer ratio of 1 to 62. (B) All consumers who have moved from a developmental center tothe community since April 14, 1993, and have lived continuously inthe community for at least 12 months, an average servicecoordinator-to-consumer ratio of 1 to 62. (C) All consumers who have not moved from the developmentalcenters to the community since April 14, 1993, and who are notdescribed in subparagraph (A), an average servicecoordinator-to-consumer ratio of 1 to 66. (4) For purposes of paragraph (3), service coordinators may have amixed caseload of consumers three years of age and younger,consumers enrolled in the Home and Community-based Services Waiverprogram for persons with developmental disabilities, and otherconsumers if the overall average caseload is weighted proportionatelyto ensure that overall regional center average servicecoordinator-to-consumer ratios as specified in paragraph (3) are met.For purposes of paragraph (3), in no case shall a servicecoordinator have an assigned caseload in excess of 84 for more than60 days. (d) For purposes of this section, "service coordinator" means aregional center employee whose primary responsibility includespreparing, implementing, and monitoring consumers' individual programplans, securing and coordinating consumer services and supports, andproviding placement and monitoring activities. (e) In order to ensure that caseload ratios are maintainedpursuant to this section, each regional center shall provide servicecoordinator caseload data to the department, annually for each fiscalyear. The data shall be submitted in the format, including thecontent, prescribed by the department. Within 30 days of receipt ofdata submitted pursuant to this subdivision, the department shallmake a summary of the data available to the public upon request. Thedepartment shall verify the accuracy of the data when conductingregional center fiscal audits. Data submitted by regional centerspursuant to this subdivision shall: (1) Only include data on service coordinator positions as definedin subdivision (d). Regional centers shall identify the number ofpositions that perform service coordinator duties on less than afull-time basis. Staffing ratios reported pursuant to thissubdivision shall reflect the appropriate proportionality of thesestaff to consumers served. (2) Be reported separately for service coordinators whose caseloadincludes any of the following: (A) Consumers who are three years of age and older and who havenot moved from the developmental center to the community since April14, 1993. (B) Consumers who have moved from a developmental center to thecommunity since April 14, 1993. (C) Consumers who are younger than three years of age. (D) Consumers enrolled in the Home and Community-based ServicesWaiver program. (3) Not include positions that are vacant for more than 60 days ornew positions established within 60 days of the reporting month thatare still vacant. (4) For purposes of calculating caseload ratios for consumersenrolled in the Home- and Community-based Services Waiver program,vacancies shall not be included in the calculations. (f) The department shall provide technical assistance and requirea plan of correction for any regional center that, for twoconsecutive reporting periods, fails to maintain service coordinatorcaseload ratios required by this section or otherwise demonstrates aninability to maintain appropriate staffing patterns pursuant to thissection. Plans of correction shall be developed following input fromthe local area board, local organizations representing consumers,family members, regional center employees, including recognized labororganizations, and service providers, and other interested parties. (g) Contracts between the department and regional center shallrequire the regional center to have, or contract for, all of thefollowing areas: (1) Criminal justice expertise to assist the regional center inproviding services and support to consumers involved in the criminaljustice system as a victim, defendant, inmate, or parolee. (2) Special education expertise to assist the regional center inproviding advocacy and support to families seeking appropriateeducational services from a school district. (3) Family support expertise to assist the regional center inmaximizing the effectiveness of support and services provided tofamilies. (4) Housing expertise to assist the regional center in accessingaffordable housing for consumers in independent or supportive livingarrangements. (5) Community integration expertise to assist consumers andfamilies in accessing integrated services and supports and improvedopportunities to participate in community life. (6) Quality assurance expertise, to assist the regional center toprovide the necessary coordination and cooperation with the areaboard in conducting quality-of-life assessments and coordinating theregional center quality assurance efforts. (7) Each regional center shall employ at least one consumeradvocate who is a person with developmental disabilities. (8) Other staffing arrangements related to the delivery ofservices that the department determines are necessary to ensuremaximum cost-effectiveness and to ensure that the service needs ofconsumers and families are met. (h) Any regional center proposing a staffing arrangement thatsubstantially deviates from the requirements of this section shallrequest a waiver from the department. Prior to granting a waiver, thedepartment shall require a detailed staffing proposal, including,but not limited to, how the proposed staffing arrangement willbenefit consumers and families served, and shall demonstrate clearand convincing support for the proposed staffing arrangement fromconstituencies served and impacted, that include, but are not limitedto, consumers, families, providers, advocates, and recognized labororganizations. In addition, the regional center shall submit to thedepartment any written opposition to the proposal from organizationsor individuals, including, but not limited to, consumers, families,providers, and advocates, including recognized labor organizations.The department may grant waivers to regional centers thatsufficiently demonstrate that the proposed staffing arrangement is inthe best interest of consumers and families served, complies withthe requirements of this chapter, and does not violate anycontractual requirements. A waiver shall be approved by thedepartment for up to 12 months, at which time a regional center maysubmit a new request pursuant to this subdivision. (i) From February 1, 2009, to June 30, 2010, inclusive, thefollowing shall not apply: (1) The service coordinator-to-consumer ratio requirements ofparagraph (1), and subparagraph (C) of paragraph (3), of subdivision(c). (2) The requirements of subdivision (e). The regional centersshall, instead, maintain sufficient service coordinator caseload datato document compliance with the service coordinator-to-consumerratio requirements in effect pursuant to this section. (3) The requirements of paragraphs (1) to (6), inclusive, ofsubdivision (g). (j) From July 1, 2010, to June 30, 2011, inclusive, the followingshall not apply: (1) The service coordinator-to-consumer ratio requirements ofparagraph (1), and subparagraph (C) of paragraph (3), of subdivision(c). (2) The requirements of paragraphs (1) to (6), inclusive, ofsubdivision (g). (k) (1) Any contract between the department and a regional centerentered into on and after January 1, 2003, shall require that allemployment contracts entered into with regional center staff orcontractors be available to the public for review, upon request. Forpurposes of this subdivision, an employment contract or portionthereof may not be deemed confidential nor unavailable for publicreview. (2) Notwithstanding paragraph (1), the social security number ofthe contracting party may not be disclosed. (3) The term of the employment contract between the regionalcenter and an employee or contractor shall not exceed the term of thestate's contract with the regional center.4640.7.  (a) It is the intent of the Legislature that regionalcenters assist persons with developmental disabilities and theirfamilies in securing those services and supports which maximizeopportunities and choices for living, working, learning, andrecreating in the community. (b) Each regional center design shall reflect the maximumcost-effectiveness possible and shall be based on a servicecoordination model, in which each consumer shall have a designatedservice coordinator who is responsible for providing or ensuring thatneeded services and supports are available to the consumer. Regionalcenters shall examine the differing levels of coordination servicesneeded by consumers and families in order to establish varyingcaseload ratios within the regional center which will best meet thoseneeds of their consumers.4640.8.  When convening any task force or advisory group, a regionalcenter shall make its best effort to ensure representation byconsumers and family members representing the community'smulticultural diversity.4641.  All regional centers shall conduct casefinding activities,including notification of availability of service in English and suchother languages as may be appropriate to the service area, outreachservices in areas with a high incidence of developmentaldisabilities, and identification of persons who may need service.4642.  Any person believed to have a developmental disability, andany person believed to have a high risk of parenting adevelopmentally disabled infant shall be eligible for initial intakeand assessment services in the regional centers. In addition, anyinfant having a high risk of becoming developmentally disabled may beeligible for initial intake and assessment services in the regionalcenters. For purposes of this section, "high-risk infant" means achild less than 36 months of age whose genetic, medical, orenvironmental history is predictive of a substantially greater riskfor developmental disability than that for the general population.The department, in consultation with the State Department of HealthServices, shall develop specific risk and service criteria for thehigh-risk infant program on or before July 1, 1983. These criteriamay be modified in subsequent years based on analysis of actualclinical experience. Initial intake shall be performed within 15 working days followingrequest for assistance. Initial intake shall include, but need notbe limited to, information and advice about the nature andavailability of services provided by the regional center and by otheragencies in the community, including guardianship, conservatorship,income maintenance, mental health, housing, education, work activityand vocational training, medical, dental, recreational, and otherservices or programs that may be useful to persons with developmentaldisabilities or their families. Intake shall also include a decisionto provide assessment.4643.  (a) If assessment is needed, the assessment shall beperformed within 120 days following initial intake. Assessment shallbe performed as soon as possible and in no event more than 60 daysfollowing initial intake where any delay would expose the client tounnecessary risk to his or her health and safety or to significantfurther delay in mental or physical development, or the client wouldbe at imminent risk of placement in a more restrictive environment.Assessment may include collection and review of available historicaldiagnostic data, provision or procurement of necessary tests andevaluations, and summarization of developmental levels and serviceneeds and is conditional upon receipt of the release of informationspecified in subdivision (b). (b) In determining if an individual meets the definition ofdevelopmental disability contained in subdivision (a) of Section4512, the regional center may consider evaluations and tests,including, but not limited to, intelligence tests, adaptivefunctioning tests, neurological and neuropsychological tests,diagnostic tests performed by a physician, psychiatric tests, andother tests or evaluations that have been performed by, and areavailable from, other sources.4643.3.  (a) (1) On or before April 1, 2002, the department shalldevelop evaluation and diagnostic procedures for the diagnosis ofautism disorder and other autistic spectrum disorders. (2) The department shall publish or arrange for the publication ofthe evaluation and diagnostic procedures required by paragraph (1).The published evaluation and diagnostic procedures shall be availableto the public. (b) The department shall develop a training program for regionalcenter clinical staff in the utilization of diagnostic procedures forthe diagnosis of autism disorder. The training program shall beimplemented on or before July 1, 2002.4643.5.  (a) If a consumer is or has been determined to be eligiblefor services by a regional center, he or she shall also be consideredeligible by any other regional center if he or she has moved toanother location within the state. (b) An individual who is determined by any regional center to havea developmental disability shall remain eligible for services fromregional centers unless a regional center, following a comprehensivereassessment, concludes that the original determination that theindividual has a developmental disability is clearly erroneous. (c) Whenever a consumer transfers from one regional centercatchment area to another, the level and types of services andsupports specified in the consumer's individual program plan shall beauthorized and secured, if available, pending the development of anew individual program plan for the consumer. If these services andsupports do not exist, the regional center shall convene a meeting todevelop a new individual program plan within 30 days. Prior toapproval of the new individual program plan, the regional centershall provide alternative services and supports that best meet theindividual program plan objectives in the least restrictive setting.The department shall develop guidelines that describe theresponsibilities of regional centers in ensuring a smooth transitionof services and supports from one regional center to another,including, but not limited to, pretransferring planning and a disputeresolution process to resolve disagreements between regional centersregarding their responsibilities related to the transfer of casemanagement services.4644.  (a) In addition to any person eligible for initial intake orassessment services, regional centers may cause to be providedpreventive services to any potential parent requesting these servicesand who is determined to be at high risk of parenting adevelopmentally disabled infant, or, at the request of the parent orguardian, to any infant at high risk of becoming developmentallydisabled. It is the intent of the Legislature that preventiveservices shall be given equal priority with all other basic regionalcenter services. These services shall, inasmuch as feasible, beprovided by appropriate generic agencies, including, but not limitedto, county departments of health, perinatal centers, and geneticcenters. The department shall implement operating procedures toensure that prevention activities are funded from regional centerpurchase of service funds only when funding for these services isunavailable from local generic agencies. In no case, shall regionalcenter funds be used to supplant funds budgeted by any agency whichhas a responsibility to provide prevention services to the generalpublic. (b) For purposes of this section, "generic agency" means anyagency which has a legal responsibility to serve all members of thegeneral public and which is receiving public funds for providing suchservices.4646.  (a) It is the intent of the Legislature to ensure that theindividual program plan and provision of services and supports by theregional center system is centered on the individual and the familyof the individual with developmental disabilities and takes intoaccount the needs and preferences of the individual and the family,where appropriate, as well as promoting community integration,independent, productive, and normal lives, and stable and healthyenvironments. It is the further intent of the Legislature to ensurethat the provision of services to consumers and their families beeffective in meeting the goals stated in the individual program plan,reflect the preferences and choices of the consumer, and reflect thecost-effective use of public resources. (b) The individual program plan is developed through a process ofindividualized needs determination. The individual with developmentaldisabilities and, where appropriate, his or her parents, legalguardian or conservator, or authorized representative, shall have theopportunity to actively participate in the development of the plan. (c) An individual program plan shall be developed for any personwho, following intake and assessment, is found to be eligible forregional center services. These plans shall be completed within 60days of the completion of the assessment. At the time of intake, theregional center shall inform the consumer and, where appropriate, hisor her parents, legal guardian or conservator, or authorizedrepresentative, of the services available through the local areaboard and the protection and advocacy agency designated by theGovernor pursuant to federal law, and shall provide the address andtelephone numbers of those agencies. (d) Individual program plans shall be prepared jointly by theplanning team. Decisions concerning the consumer's goals, objectives,and services and supports that will be included in the consumer'sindividual program plan and purchased by the regional center orobtained from generic agencies shall be made by agreement between theregional center representative and the consumer or, whereappropriate, the parents, legal guardian, conservator, or authorizedrepresentative at the program plan meeting. (e) Regional centers shall comply with the request of a consumer,or where appropriate, the request of his or her parents, legalguardian, or conservator, that a designated representative receivewritten notice of all meetings to develop or revise his or herindividual program plan and of all notices sent to the consumerpursuant to Section 4710. The designated representative may be aparent or family member. (f) If a final agreement regarding the services and supports to beprovided to the consumer cannot be reached at a program planmeeting, then a subsequent program plan meeting shall be convenedwithin 15 days, or later at the request of the consumer or, whenappropriate, the parents, legal guardian, conservator, or authorizedrepresentative or when agreed to by the planning team. Additionalprogram plan meetings may be held with the agreement of the regionalcenter representative and the consumer or, where appropriate, theparents, legal guardian, conservator, or authorized representative. (g) An authorized representative of the regional center and theconsumer or, where appropriate, his or her parents, legal guardian,or conservator, shall sign the individual program plan prior to itsimplementation. If the consumer or, where appropriate, his or herparents, legal guardian, or conservator, does not agree with allcomponents of the plan, they may indicate that disagreement on theplan. Disagreement with specific plan components shall not prohibitthe implementation of services and supports agreed to by the consumeror, where appropriate, his or her parents, legal guardian, orconservator. If the consumer or, where appropriate, his or herparents, legal guardian, or conservator, does not agree with the planin whole or in part, he or she shall be sent written notice of thefair hearing rights, as required by Section 4701.4646.4.  (a) Effective September 1, 2008, regional centers shallensure, at the time of development, scheduled review, or modificationof a consumer's individual program plan developed pursuant toSections 4646 and 4646.5, or of an individualized family service planpursuant to Section 95020 of the Government Code, the establishmentof an internal process. This internal process shall ensure adherencewith federal and state law and regulation, and when purchasingservices and supports, shall ensure all of the following: (1) Conformance with the regional center's purchase of servicepolicies, as approved by the department pursuant to subdivision (d)of Section 4434. (2) Utilization of generic services and supports when appropriate. (3) Utilization of other services and sources of funding ascontained in Section 4659. (4) Consideration of the family's responsibility for providingsimilar services and supports for a minor child without disabilitiesin identifying the consumer's service and support needs as providedin the least restrictive and most appropriate setting. In thisdetermination, regional centers shall take into account the consumer's need for extraordinary care, services, supports and supervision,and the need for timely access to this care. (b) Final decisions regarding the consumer's individual programplan shall be made pursuant to Section 4646. (c) Final decisions regarding the individual family support planshall be made pursuant to Section 95020 of the Government Code. (d) By no later than April 1, 2009, the department shall providethe fiscal and policy committees of the Legislature with a writtenupdate regarding the implementation of this section.4646.5.  (a) The planning process for the individual program plandescribed in Section 4646 shall include all of the following: (1) Gathering information and conducting assessments to determinethe life goals, capabilities and strengths, preferences, barriers,and concerns or problems of the person with developmentaldisabilities. For children with developmental disabilities, thisprocess should include a review of the strengths, preferences, andneeds of the child and the family unit as a whole. Assessments shallbe conducted by qualified individuals and performed in naturalenvironments whenever possible. Information shall be taken from theconsumer, his or her parents and other family members, his or herfriends, advocates, providers of services and supports, and otheragencies. The assessment process shall reflect awareness of, andsensitivity to, the lifestyle and cultural background of the consumerand the family. (2) A statement of goals, based on the needs, preferences, andlife choices of the individual with developmental disabilities, and astatement of specific, time-limited objectives for implementing theperson's goals and addressing his or her needs. These objectivesshall be stated in terms that allow measurement of progress ormonitoring of service delivery. These goals and objectives shouldmaximize opportunities for the consumer to develop relationships, bepart of community life in the areas of community participation,housing, work, school, and leisure, increase control over his or herlife, acquire increasingly positive roles in community life, anddevelop competencies to help accomplish these goals. (3) When developing individual program plans for children,regional centers shall be guided by the principles, process, andservices and support parameters set forth in Section 4685. (4) A schedule of the type and amount of services and supports tobe purchased by the regional center or obtained from generic agenciesor other resources in order to achieve the individual program plangoals and objectives, and identification of the provider or providersof service responsible for attaining each objective, including, butnot limited to, vendors, contracted providers, generic serviceagencies, and natural supports. The plan shall specify theapproximate scheduled start date for services and supports and shallcontain timelines for actions necessary to begin services andsupports, including generic services. (5) When agreed to by the consumer, the parents or legallyappointed guardian of a minor consumer, or the legally appointedconservator of an adult consumer or the authorized representative,including those appointed pursuant to subdivision (d) of Section 4548and subdivision (e) of Section 4705, a review of the general healthstatus of the adult or child including a medical, dental, and mentalhealth needs shall be conducted. This review shall include adiscussion of current medications, any observed side effects, and thedate of last review of the medication. Service providers shallcooperate with the planning team to provide any information necessaryto complete the health status review. If any concerns are notedduring the review, referrals shall be made to regional centerclinicians or to the consumer's physician, as appropriate.Documentation of health status and referrals shall be made in theconsumer's record by the service coordinator. (6) A schedule of regular periodic review and reevaluation toascertain that planned services have been provided, that objectiveshave been fulfilled within the times specified, and that consumersand families are satisfied with the individual program plan and itsimplementation. (b) For all active cases, individual program plans shall bereviewed and modified by the planning team, through the processdescribed in Section 4646, as necessary, in response to the person'sachievement or changing needs, and no less often than once everythree years. If the consumer or, where appropriate, the consumer'sparents, legal guardian, or conservator requests an individualprogram plan review, the individual program shall be reviewed within30 days after the request is submitted. (c) (1) The department, with the participation of representativesof a statewide consumer organization, the Association of RegionalCenter Agencies, an organized labor organization representing servicecoordination staff, and the Organization of Area Boards shallprepare training material and a standard format and instructions forthe preparation of individual program plans, which embodies anapproach centered on the person and family. (2) Each regional center shall use the training materials andformat prepared by the department pursuant to paragraph (1). (3) The department shall biennially review a random sample ofindividual program plans at each regional center to assure that theseplans are being developed and modified in compliance with Section4646 and this section.4646.55.  (a) Notwithstanding any other provision of law orregulation to the contrary, and to the extent federal financialparticipation is available, effective July 1, 2007, the StateDepartment of Developmental Services is hereby authorized to makesupplemental payment to an enrolled Medi-Cal provider that is alicensed intermediate care facility/developmentallydisabled-habilitative, licensed intermediate carefacility/developmentally disabled-nursing, or licensed intermediatecare facility/developmentally disabled, for day treatment andtransportation services provided pursuant to Sections 4646 and4646.5, applicable regulations, and Section 14132.925, to Medi-Calbeneficiaries residing in a licensed intermediate carefacility/developmentally disabled-habilitative, licensed intermediatecare facility/developmentally disabled-nursing, or licensedintermediate care facility/developmentally disabled. These paymentsshall be considered supplemental payments to the enrolled Medi-Calprovider and shall be comprised of the full costs of reimbursingregional centers for making disbursements to day treatment andtransportation service providers, plus a coordination fee which willinclude an administrative fee and reimbursement for the increasedcosts associated with the quality assurance fee paid accordingly andwithout a separate State Department of Developmental Servicescontract. (b) Notwithstanding any other provision of law and to the extentfederal financial participation is available, and in furtherance ofthis section and Section 14132.925, the State Department ofDevelopmental Services shall amend the regional center contracts forthe 2007-08 fiscal year to extend the contract liquidation perioduntil June 30, 2011. The contract amendments and budget adjustmentsshall be exempt from the provisions of Article 1 (commencing withSection 4620).4646.6.  Notwithstanding Section 632 of the Penal Code, a consumer,or his or her parent, guardian, conservator, or authorizedrepresentative, shall have the right to record electronically theproceedings of the individual program plan meetings on an audiotaperecorder. The consumer, or his or her parent, guardian, conservator,or authorized representative, shall notify the regional center oftheir intent to record a meeting at least 24 hours prior to themeeting. If the regional center initiates the notice of intent toaudiotape record a meeting and the consumer, or his or her parent,guardian, conservator, or authorized representative, refuses toattend the meeting because it will be tape recorded, the meetingshall not be recorded on an audiotape recorder. However, the regionalcenter shall have the right to electronically record the meetingwhen notice of intent to record has been given by the consumer or onthe consumer's behalf.4647.  (a) Pursuant to Section 4640.7, service coordination shallinclude those activities necessary to implement an individual programplan, including, but not limited to, participation in the individualprogram plan process; assurance that the planning team considers allappropriate options for meeting each individual program planobjective; securing, through purchasing or by obtaining from genericagencies or other resources, services and supports specified in theperson's individual program plan; coordination of service and supportprograms; collection and dissemination of information; andmonitoring implementation of the plan to ascertain that objectiveshave been fulfilled and to assist in revising the plan as necessary. (b) The regional center shall assign a service coordinator whoshall be responsible for implementing, overseeing, and monitoringeach individual program plan. The service coordinator may be anemployee of the regional center or may be a qualified individual oremployee of an agency with whom the regional center has contracted toprovide service coordination services, or persons described inSection 4647.2. The regional center shall provide the consumer or,where appropriate, his or her parents, legal guardian, or conservatoror authorized representative, with written notification of anypermanent change in the assigned service coordinator within 10business days. No person shall continue to serve as a servicecoordinator for any individual program plan unless there is agreementby all parties that the person should continue to serve as servicecoordinator. (c) Where appropriate, a consumer or the consumer's parents orother family members, legal guardian, or conservator, may perform allor part of the duties of the service coordinator described in thissection if the regional center director agrees and it is feasible. (d) If any person described in subdivision (c) is designated asthe service coordinator, that person shall not deviate from theagreed-upon program plan and shall provide any reasonable informationand reports required by the regional center director. (e) If any person described in subdivision (c) is designated asthe service coordinator, the regional center shall provide ongoinginformation and support as necessary, to assist the person to performall or part of the duties of service coordinator.4648.  In order to achieve the stated objectives of a consumer'sindividual program plan, the regional center shall conductactivities, including, but not limited to, all of the following: (a) Securing needed services and supports. (1) It is the intent of the Legislature that services and supportsassist individuals with developmental disabilities in achieving thegreatest self-sufficiency possible and in exercising personalchoices. The regional center shall secure services and supports thatmeet the needs of the consumer, as determined in the consumer'sindividual program plan, and within the context of the individualprogram plan, the planning team shall give highest preference tothose services and supports which would allow minors withdevelopmental disabilities to live with their families, adult personswith developmental disabilities to live as independently as possiblein the community, and that allow all consumers to interact withpersons without disabilities in positive, meaningful ways. (2) In implementing individual program plans, regional centers,through the planning team, shall first consider services and supportsin natural community, home, work, and recreational settings.Services and supports shall be flexible and individually tailored tothe consumer and, where appropriate, his or her family. (3) A regional center may, pursuant to vendorization or acontract, purchase services or supports for a consumer from anyindividual or agency which the regional center and consumer or, whereappropriate, his or her parents, legal guardian, or conservator, orauthorized representatives, determines will best accomplish all orany part of that consumer's program plan. (A) Vendorization or contracting is the process foridentification, selection, and utilization of service vendors orcontractors, based on the qualifications and other requirementsnecessary in order to provide the service. (B) A regional center may reimburse an individual or agency forservices or supports provided to a regional center consumer if theindividual or agency has a rate of payment for vendored or contractedservices established by the department, pursuant to this division,and is providing services pursuant to an emergency vendorization orhas completed the vendorization procedures or has entered into acontract with the regional center and continues to comply with thevendorization or contracting requirements. The director shall adoptregulations governing the vendorization process to be utilized by thedepartment, regional centers, vendors and the individual or agencyrequesting vendorization. (C) Regulations shall include, but not be limited to: the vendorapplication process, and the basis for accepting or denying anapplication; the qualification and requirements for each category ofservices that may be provided to a regional center consumer through avendor; requirements for emergency vendorization; procedures fortermination of vendorization; the procedure for an individual or anagency to appeal any vendorization decision made by the department orregional center. (D) A regional center may vendorize a licensed facility forexclusive services to persons with developmental disabilities at acapacity equal to or less than the facility's licensed capacity. Afacility already licensed on January 1, 1999, shall continue to bevendorized at their full licensed capacity until the facility agreesto vendorization at a reduced capacity. (E) Effective July 1, 2009, notwithstanding any other provision oflaw or regulation to the contrary, a regional center shall not newlyvendor a State Department of Social Services licensed 24-hourresidential care facility with a licensed capacity of 16 or morebeds, unless the facility qualifies for receipt of federal fundsunder the Medicaid Program. (4) Notwithstanding subparagraph (B), a regional center maycontract or issue a voucher for services and supports provided to aconsumer or family at a cost not to exceed the maximum rate ofpayment for that service or support established by the department. Ifa rate has not been established by the department, the regionalcenter may, for an interim period, contract for a specified serviceor support with, and establish a rate of payment for, any provider ofthe service or support necessary to implement a consumer'sindividual program plan. Contracts may be negotiated for a period ofup to three years, with annual review and subject to the availabilityof funds. (5) In order to ensure the maximum flexibility and availability ofappropriate services and supports for persons with developmentaldisabilities, the department shall establish and maintain anequitable system of payment to providers of services and supportsidentified as necessary to the implementation of a consumers'individual program plan. The system of payment shall includeprovision for a rate to ensure that the provider can meet the specialneeds of consumers and provide quality services and supports in theleast restrictive setting as required by law. (6) The regional center and the consumer, or where appropriate,his or her parents, legal guardian, conservator, or authorizedrepresentative, including those appointed pursuant to subdivision (d)of Section 4548 or subdivision (e) of Section 4705, shall, pursuantto the individual program plan, consider all of the following whenselecting a provider of consumer services and supports: (A) A provider's ability to deliver quality services or supportswhich can accomplish all or part of the consumer's individual programplan. (B) A provider's success in achieving the objectives set forth inthe individual program plan. (C) Where appropriate, the existence of licensing, accreditation,or professional certification. (D) The cost of providing services or supports of comparablequality by different providers, if available, shall be reviewed, andthe least costly available provider of comparable service, includingthe cost of transportation, who is able to accomplish all or part ofthe consumer's individual program plan, consistent with theparticular needs of the consumer and family as identified in theindividual program plan, shall be selected. In determining the leastcostly provider, the availability of federal financial participationshall be considered. The consumer shall not be required to use theleast costly provider if it will result in the consumer moving froman existing provider of services or supports to more restrictive orless integrated services or supports. (E) The consumer's or, where appropriate, the parents, legalguardian, or conservator of a consumer's choice of providers. (7) No service or support provided by any agency or individualshall be continued unless the consumer or, where appropriate, his orher parents, legal guardian, or conservator, or authorizedrepresentative, including those appointed pursuant to subdivision (d)of Section 4548 or subdivision (e) of Section 4705, is satisfied andthe regional center and the consumer or, when appropriate, theperson's parents or legal guardian or conservator agree that plannedservices and supports have been provided, and reasonable progresstoward objectives have been made. (8) Regional center funds shall not be used to supplant the budgetof any agency which has a legal responsibility to serve all membersof the general public and is receiving public funds for providingthose services. (9) (A) A regional center may, directly or through an agencyacting on behalf of the center, provide placement in, purchase of, orfollow-along services to persons with developmental disabilities in,appropriate community living arrangements, including, but notlimited to, support service for consumers in homes they own or lease,foster family placements, health care facilities, and licensedcommunity care facilities. In considering appropriate placementalternatives for children with developmental disabilities, approvalby the child's parent or guardian shall be obtained before placementis made. (B) Effective July 1, 2012, notwithstanding any other provision oflaw or regulation to the contrary, a regional center shall notpurchase residential services from a State Department of SocialServices licensed 24-hour residential care facility with a licensedcapacity of 16 or more beds. This prohibition on regional centerpurchase of residential services shall not apply to either of thefollowing: (i) A residential facility with a licensed capacity of 16 or morebeds that has been approved to participate in the department's Homeand Community Based Services Waiver or another existing waiverprogram or certified to participate in the Medi-Cal program. (ii) A residential facility service provider that has a writtenagreement and specific plan prior to July 1, 2012, with the vendoringregional center to downsize the existing facility by transitioningits residential services to living arrangements of 15 beds or less orrestructure the large facility to meet federal Medicaid eligibilityrequirements on or before June 30, 2013. (C) Each person with developmental disabilities placed by theregional center in a community living arrangement shall have therights specified in this division. These rights shall be brought tothe person's attention by any means necessary to reasonablycommunicate these rights to each resident, provided that, at aminimum, the Director of Developmental Services prepare, provide, andrequire to be clearly posted in all residential facilities and dayprograms a poster using simplified language and pictures that isdesigned to be more understandable by persons with cognitivedisabilities and that the rights information shall also be availablethrough the regional center to each residential facility and dayprogram in alternative formats, including, but not limited to, otherlanguages, braille, and audio tapes, when necessary to meet thecommunication needs of consumers. (D) Consumers are eligible to receive supplemental servicesincluding, but not limited to, additional staffing, pursuant to theprocess described in subdivision (d) of Section 4646. Necessaryadditional staffing that is not specifically included in the ratespaid to the service provider may be purchased by the regional centerif the additional staff are in excess of the amount required byregulation and the individual's planning team determines theadditional services are consistent with the provisions of theindividual program plan. Additional staff should be periodicallyreviewed by the planning team for consistency with the individualprogram plan objectives in order to determine if continued use of theadditional staff is necessary and appropriate and if the service isproducing outcomes consistent with the individual program plan.Regional centers shall monitor programs to ensure that the additionalstaff is being provided and utilized appropriately. (10) Emergency and crisis intervention services including, but notlimited to, mental health services and behavior modificationservices, may be provided, as needed, to maintain persons withdevelopmental disabilities in the living arrangement of their ownchoice. Crisis services shall first be provided without disrupting aperson's living arrangement. If crisis intervention services areunsuccessful, emergency housing shall be available in the person'shome community. If dislocation cannot be avoided, every effort shallbe made to return the person to his or her living arrangement ofchoice, with all necessary supports, as soon as possible. (11) Among other service and support options, planning teams shallconsider the use of paid roommates or neighbors, personalassistance, technical and financial assistance, and all other serviceand support options which would result in greater self-sufficiencyfor the consumer and cost-effectiveness to the state. (12) When facilitation as specified in an individual program planrequires the services of an individual, the facilitator shall be ofthe consumer's choosing. (13) The community support may be provided to assist individualswith developmental disabilities to fully participate in community andcivic life, including, but not limited to, programs, services, workopportunities, business, and activities available to persons withoutdisabilities. This facilitation shall include, but not be limited to,any of the following: (A) Outreach and education to programs and services within thecommunity. (B) Direct support to individuals which would enable them to morefully participate in their community. (C) Developing unpaid natural supports when possible. (14) Other services and supports may be provided as set forth inSections 4685, 4686, 4687, 4688, and 4689, when necessary. (15) Notwithstanding any other provision of law or regulation tothe contrary, effective July 1, 2009, regional centers shall notpurchase experimental treatments, therapeutic services, or devicesthat have not been clinically determined or scientifically proven tobe effective or safe or for which risks and complications areunknown. Experimental treatments or therapeutic services includeexperimental medical or nutritional therapy when the use of theproduct for that purpose is not a general physician practice. Forregional center consumers receiving these services as part of theirindividual program plan (IPP) or individualized family service plan(IFSP) on July 1, 2009, this prohibition shall apply on August 1,2009. (b) (1) Advocacy for, and protection of, the civil, legal, andservice rights of persons with developmental disabilities asestablished in this division. (2) Whenever the advocacy efforts of a regional center to secureor protect the civil, legal, or service rights of any of itsconsumers prove ineffective, the regional center or the person withdevelopmental disabilities or his or her parents, legal guardian, orother representative may request the area board to initiate actionunder the provisions defining area board advocacy functionsestablished in this division. (c) The regional center may assist consumers and familiesdirectly, or through a provider, in identifying and building circlesof support within the community. (d) In order to increase the quality of community services andprotect consumers, the regional center shall, when appropriate, takeeither of the following actions: (1) Identify services and supports that are ineffective or of poorquality and provide or secure consultation, training, or technicalassistance services for any agency or individual provider to assistthat agency or individual provider in upgrading the quality ofservices or supports. (2) Identify providers of services or supports that may not be incompliance with local, state, and federal statutes and regulationsand notify the appropriate licensing or regulatory authority, orrequest the area board to investigate the possible noncompliance. (e) When necessary to expand the availability of needed servicesof good quality, a regional center may take actions that include, butare not limited to, the following: (1) Soliciting an individual or agency by requests for proposalsor other means, to provide needed services or supports not presentlyavailable. (2) Requesting funds from the Program Development Fund, pursuantto Section 4677, or community placement plan funds designated fromthat fund, to reimburse the startup costs needed to initiate a newprogram of services and supports. (3) Using creative and innovative service delivery models,including, but not limited to, natural supports. (f) Except in emergency situations, a regional center shall notprovide direct treatment and therapeutic services, but shall utilizeappropriate public and private community agencies and serviceproviders to obtain those services for its consumers. (g) Where there are identified gaps in the system of services andsupports or where there are identified consumers for whom no providerwill provide services and supports contained in his or herindividual program plan, the department may provide the services andsupports directly. (h) At least annually, regional centers shall provide theconsumer, his or her parents, legal guardian, conservator, orauthorized representative a statement of services and supports theregional center purchased for the purpose of ensuring that they aredelivered. The statement shall include the type, unit, month, andcost of services and supports purchased.4648.1.  (a) The State Department of Developmental Services andregional centers may monitor services and supports purchased forregional center consumers with or without prior notice. Not less thantwo monitoring visits to a licensed long-term health care orcommunity care facility or family home agency home each year shall beunannounced. The department may conduct fiscal reviews and audits ofthe service providers' records. (b) Department and regional center staff involved in monitoring orauditing services provided to the regional centers' consumers by aservice provider shall have access to the provider's grounds,buildings, and service program, and to all related records, includingbooks, papers, computerized data, accounting records, and relateddocumentation. All persons connected with the service provider'sprogram, including, but not limited to, program administrators,staff, consultants, and accountants, shall provide information andaccess to facilities as required by the department or regionalcenter. (c) The department, in cooperation with regional centers, shallensure that all providers of services and supports purchased byregional centers for their consumers are informed of all of thefollowing: (1) The provisions of this section. (2) The responsibility of providers to comply with laws andregulations governing both their service program and the provision ofservices and supports to people with developmental disabilities. (3) The responsibility of providers to comply with conditions ofany contract or agreement between the regional center and theprovider, and between the provider and the department. (4) The rights of providers established in regulations adoptedpursuant to Sections 4648.2, 4748, and 4780.5, to appeal actionstaken by regional centers or the department as a result of theirmonitoring and auditing findings. (d) A regional center may terminate payments for services, and mayterminate its contract or authorization for the purchase of consumerservices if it determines that the provider has not complied withprovisions of its contract or authorization with the regional centeror with applicable state laws and regulations. When terminatingpayments for services or its contract or authorization for thepurchase of consumer services, a regional center shall makereasonable efforts to avoid unnecessary disruptions of consumerservices. (e) A regional center or the department may recover from theprovider funds paid for services when the department or the regionalcenter determines that either of the following has occurred: (1) The services were not provided in accordance with the regionalcenter's contract or authorization with the provider, or withapplicable state laws or regulations. (2) The rate paid is based on inaccurate data submitted by theprovider on a provider cost statement. Any funds so recovered shall be remitted to the department. (f) Any evidence of suspected licensing violations found bydepartment or regional center personnel shall be reported immediatelyto the appropriate state licensing agency. (g) Regional centers may establish volunteer teams, made up ofconsumers, parents, other family members, and advocates to conductthe monitoring activities described in this section. (h) In meeting its responsibility to provide technical assistanceto providers of community living arrangements for persons withdevelopmental disabilities, including, but not limited to, licensedresidential facilities, family home agencies, and supported orindependent living arrangements, a regional center shall utilize the"Looking at Service Quality-Provider's Handbook" developed by thedepartment or subsequent revisions developed by the department. (i) Effective July 1, 2009, a regional center shall not berequired to perform triennial evaluations of community carefacilities, as described in Sections 56046, 56049, 56050, 56051, and56052 of Title 17 of the California Code of Regulations.4648.2.  By September 1, 1986, the State Department of DevelopmentalServices shall promulgate regulations which establish a process forservice providers to appeal actions the department takes as a resultof its auditing and monitoring activities. To the extent possible,this process shall include procedures contained in fiscal auditappeals regulations established pursuant to Section 4780.5.4648.3.  A provider of transportation services to regional centerclients for the regional center shall maintain protection againstliability for damages for bodily injuries or death and for damage toor destruction of property, which may be incurred by the provider inthe course of providing those services. The protection shall bemaintained at the level established by the regional center to whichthe transportation services are provided.4648.35.  Effective July 1, 2009, at the time of development,review, or modification of a consumer's individual program plan (IPP)or individualized family service plan (IFSP), all of the followingshall apply to a regional center: (a) A regional center shall not fund private specializedtransportation services for an adult consumer who can safely accessand utilize public transportation, when that transportation isavailable. (b) A regional center shall fund the least expensivetransportation modality that meets the consumer's needs, as set forthin the consumer's IPP or IFSP. (c) A regional center shall fund transportation, when required,from the consumer's residence to the lowest-cost vendor that providesthe service that meets the consumer's needs, as set forth in theconsumer's IPP or IFSP. For purposes of this subdivision, the cost ofa vendor shall be determined by combining the vendor's program costsand the costs to transport a consumer from the consumer's residenceto the vendor. (d) A regional center shall fund transportation services for aminor child living in the family residence, only if the family of thechild provides sufficient written documentation to the regionalcenter to demonstrate that it is unable to provide transportation forthe child.4648.4.  (a) Notwithstanding any other provision of law orregulation, commencing July 1, 2006, rates for services listed inparagraphs (1), (2), with the exception of travel reimbursement, (3)to (8), inclusive, (10), and (11) of subdivision (b), shall beincreased by 3 percent, subject to funds specifically appropriatedfor this increase in the Budget Act of 2006. The increase shall beapplied as a percentage, and the percentage shall be the same for allproviders. Any subsequent change shall be governed by subdivision(b). (b) Notwithstanding any other provision of law or regulation,except for subdivision (a), no regional center may pay any providerof the following services or supports a rate that is greater than therate that is in effect on or after June 30, 2008, unless theincrease is required by a contract between the regional center andthe vendor that is in effect on June 30, 2008, or the regional centerdemonstrates that the approval is necessary to protect the consumer's health or safety and the department has granted prior writtenauthorization: (1) Supported living services. (2) Transportation, including travel reimbursement. (3) Socialization training programs. (4) Behavior intervention training. (5) Community integration training programs. (6) Community activities support services. (7) Mobile day programs. (8) Creative art programs. (9) Supplemental day services program supports. (10) Adaptive skills trainers. (11) Independent living specialists.4648.5.  (a) Notwithstanding any other provision of law orregulations to the contrary, effective July 1, 2009, a regionalcenters' authority to purchase the following services shall besuspended pending implementation of the Individual Choice Budget andcertification by the Director of Developmental Services that theIndividual Choice Budget has been implemented and will result instate budget savings sufficient to offset the costs of providing thefollowing services: (1) Camping services and associated travel expenses. (2) Social recreation activities, except for those activitiesvendored as community-based day programs. (3) Educational services for children three to 17, inclusive,years of age. (4) Nonmedical therapies, including, but not limited to,specialized recreation, art, dance, and music. (b) For regional center consumers receiving services described insubdivision (a) as part of their individual program plan (IPP) orindividualized family service plan (IFSP), the prohibition insubdivision (a) shall take effect on August 1, 2009. (c) An exemption may be granted on an individual basis inextraordinary circumstances to permit purchase of a serviceidentified in subdivision (a) when the regional center determinesthat the service is a primary or critical means for ameliorating thephysical, cognitive, or psychosocial effects of the consumer'sdevelopmental disability, or the service is necessary to enable theconsumer to remain in his or her home and no alternative service isavailable to meet the consumer's needs.4648.6.  The department, in consultation with stakeholders, shalldevelop an alternative service delivery model that provides anIndividual Choice Budget for obtaining quality services and supportswhich provides choice and flexibility within a finite budget that inthe aggregate reduces regional center purchase of serviceexpenditures, reduces reliance on the state general fund, andmaximizes federal financial participation in the delivery ofservices. The individual budget will be determined using a fair,equitable, transparent standardized process.4649.  Regional centers shall cooperate with area boards in jointefforts to inform the public of services available to persons withdevelopmental disabilities and of their unmet needs, providematerials and education programs to community groups and agencieswith interest in, or responsibility for, persons with developmentaldisabilities, and develop resource materials, if necessary,containing information about local agencies, facilities, and serviceproviders offering services to persons with developmentaldisabilities.4650.  Regional centers shall be responsible for developing anannual plan and program budget to be submitted to the director nolater than September 1 of each fiscal year. An information copy shallbe submitted to the area board and state council by the same date.4651.  (a) It is the intent of the Legislature that regional centersshall find innovative and economical methods of achieving theobjectives contained in individual program plans of persons withdevelopmental disabilities. (b) The department shall encourage and assist regional centers touse innovative programs, techniques, and staffing arrangements tocarry out their responsibilities.4652.  A regional center shall investigate every appropriate andeconomically feasible alternative for care of a developmentallydisabled person available within the region. If suitable care cannotbe found within the region, services may be obtained outside of theregion.4653.  Except for those developmentally disabled persons judiciallycommitted to state hospitals, no developmentally disabled personshall be admitted to a state hospital except upon the referral of aregional center. Upon discharge from a state hospital, adevelopmentally disabled person shall be referred to an appropriateregional center.4654.  Before any person is examined by a regional center pursuantto Section 1370.1 of the Penal Code, the court ordering such medicalexamination shall transmit to the regional center a copy of theorders made pursuant to proceedings conducted under Sections 1368 and1369 of the Penal Code. The purpose of the mental examination shallbe to determine if developmental disability is the primary diagnosis.4655.  The director of a regional center or his designee may giveconsent to medical, dental, and surgical treatment of a regionalcenter client and provide for such treatment to be given to theperson under the following conditions: (a) If the developmentally disabled person's parent, guardian, orconservator legally authorized to consent to such treatment does notrespond within a reasonable time to the request of the director orhis designee for the granting or denying of consent for suchtreatment, the director of a regional center or his designee mayconsent on behalf of the developmentally disabled person to suchtreatment and provide for such treatment to be given to such person. (b) If the developmentally disabled person has no parent,guardian, or conservator legally authorized to consent to medical,dental, or surgical treatment on behalf of the person, the directorof the regional center or his designee may consent to such treatmenton behalf of the person and provide for such treatment to be given tothe person. The director of a regional center or his designee maythereupon also initiate, or cause to be initiated, proceedings forthe appointment of a guardian or conservator legally authorized toconsent to medical, dental, or surgical services. (c) If the developmentally disabled person is an adult and has noconservator, consent to treatment may be given by someone other thanthe person on the person's behalf only if the developmentallydisabled person is mentally incapable of giving his own consent.4656.  (a) A qualified physician and surgeon who diagnoses adevelopmental disability, as defined in subdivision (a) of Section4512, of a patient who is a minor shall attempt to determine from thepatie