4640. (a) Contracts between the department and regional centers
shall specify the service area and the categories of persons that
regional centers shall be expected to serve and the services and
supports to be provided.
(b) In order to ensure uniformity in the application of the
definition of developmental disability contained in this division,
the Director of Developmental Services shall, by March 1, 1977, issue
regulations that delineate, by diagnostic category and degree of
disability, those persons who are eligible for services and supports
by regional centers. In issuing the regulations, the director shall
invite and consider the views of regional center contracting
agencies, the state council, and persons with a demonstrated and
direct interest in developmental disabilities.
4640.6. (a) In approving regional center contracts, the department
shall ensure that regional center staffing patterns demonstrate that
direct service coordination are the highest priority.
(b) Contracts between the department and regional centers shall
require that regional centers implement an emergency response system
that ensures that a regional center staff person will respond to a
consumer, or individual acting on behalf of a consumer, within two
hours of the time an emergency call is placed. This emergency
response system shall be operational 24 hours per day, 365 days per
year.
(c) Contracts between the department and regional centers shall
require regional centers to have service coordinator-to-consumer
ratios, as follows:
(1) An average service coordinator-to-consumer ratio of 1 to 62
for all consumers who have not moved from the developmental centers
to the community since April 14, 1993. In no case shall a service
coordinator for these consumers have an assigned caseload in excess
of 79 consumers for more than 60 days.
(2) An average service coordinator-to-consumer ratio of 1 to 45
for all consumers who have moved from a developmental center to the
community since April 14, 1993. In no case shall a service
coordinator for these consumers have an assigned caseload in excess
of 59 consumers for more than 60 days.
(3) Commencing January 1, 2004, the following
coordinator-to-consumer ratios shall apply:
(A) All consumers three years of age and younger and for consumers
enrolled in the Home and Community-based Services Waiver program for
persons with developmental disabilities, an average service
coordinator-to-consumer ratio of 1 to 62.
(B) All consumers who have moved from a developmental center to
the community since April 14, 1993, and have lived continuously in
the community for at least 12 months, an average service
coordinator-to-consumer ratio of 1 to 62.
(C) All consumers who have not moved from the developmental
centers to the community since April 14, 1993, and who are not
described in subparagraph (A), an average service
coordinator-to-consumer ratio of 1 to 66.
(4) For purposes of paragraph (3), service coordinators may have a
mixed caseload of consumers three years of age and younger,
consumers enrolled in the Home and Community-based Services Waiver
program for persons with developmental disabilities, and other
consumers if the overall average caseload is weighted proportionately
to ensure that overall regional center average service
coordinator-to-consumer ratios as specified in paragraph (3) are met.
For purposes of paragraph (3), in no case shall a service
coordinator have an assigned caseload in excess of 84 for more than
60 days.
(d) For purposes of this section, "service coordinator" means a
regional center employee whose primary responsibility includes
preparing, implementing, and monitoring consumers' individual program
plans, securing and coordinating consumer services and supports, and
providing placement and monitoring activities.
(e) In order to ensure that caseload ratios are maintained
pursuant to this section, each regional center shall provide service
coordinator caseload data to the department, annually for each fiscal
year. The data shall be submitted in the format, including the
content, prescribed by the department. Within 30 days of receipt of
data submitted pursuant to this subdivision, the department shall
make a summary of the data available to the public upon request. The
department shall verify the accuracy of the data when conducting
regional center fiscal audits. Data submitted by regional centers
pursuant to this subdivision shall:
(1) Only include data on service coordinator positions as defined
in subdivision (d). Regional centers shall identify the number of
positions that perform service coordinator duties on less than a
full-time basis. Staffing ratios reported pursuant to this
subdivision shall reflect the appropriate proportionality of these
staff to consumers served.
(2) Be reported separately for service coordinators whose caseload
includes any of the following:
(A) Consumers who are three years of age and older and who have
not moved from the developmental center to the community since April
14, 1993.
(B) Consumers who have moved from a developmental center to the
community since April 14, 1993.
(C) Consumers who are younger than three years of age.
(D) Consumers enrolled in the Home and Community-based Services
Waiver program.
(3) Not include positions that are vacant for more than 60 days or
new positions established within 60 days of the reporting month that
are still vacant.
(4) For purposes of calculating caseload ratios for consumers
enrolled 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 require
a plan of correction for any regional center that, for two
consecutive reporting periods, fails to maintain service coordinator
caseload ratios required by this section or otherwise demonstrates an
inability to maintain appropriate staffing patterns pursuant to this
section. Plans of correction shall be developed following input from
the local area board, local organizations representing consumers,
family members, regional center employees, including recognized labor
organizations, and service providers, and other interested parties.
(g) Contracts between the department and regional center shall
require the regional center to have, or contract for, all of the
following areas:
(1) Criminal justice expertise to assist the regional center in
providing services and support to consumers involved in the criminal
justice system as a victim, defendant, inmate, or parolee.
(2) Special education expertise to assist the regional center in
providing advocacy and support to families seeking appropriate
educational services from a school district.
(3) Family support expertise to assist the regional center in
maximizing the effectiveness of support and services provided to
families.
(4) Housing expertise to assist the regional center in accessing
affordable housing for consumers in independent or supportive living
arrangements.
(5) Community integration expertise to assist consumers and
families in accessing integrated services and supports and improved
opportunities to participate in community life.
(6) Quality assurance expertise, to assist the regional center to
provide the necessary coordination and cooperation with the area
board in conducting quality-of-life assessments and coordinating the
regional center quality assurance efforts.
(7) Each regional center shall employ at least one consumer
advocate who is a person with developmental disabilities.
(8) Other staffing arrangements related to the delivery of
services that the department determines are necessary to ensure
maximum cost-effectiveness and to ensure that the service needs of
consumers and families are met.
(h) Any regional center proposing a staffing arrangement that
substantially deviates from the requirements of this section shall
request a waiver from the department. Prior to granting a waiver, the
department shall require a detailed staffing proposal, including,
but not limited to, how the proposed staffing arrangement will
benefit consumers and families served, and shall demonstrate clear
and convincing support for the proposed staffing arrangement from
constituencies served and impacted, that include, but are not limited
to, consumers, families, providers, advocates, and recognized labor
organizations. In addition, the regional center shall submit to the
department any written opposition to the proposal from organizations
or individuals, including, but not limited to, consumers, families,
providers, and advocates, including recognized labor organizations.
The department may grant waivers to regional centers that
sufficiently demonstrate that the proposed staffing arrangement is in
the best interest of consumers and families served, complies with
the requirements of this chapter, and does not violate any
contractual requirements. A waiver shall be approved by the
department for up to 12 months, at which time a regional center may
submit a new request pursuant to this subdivision.
(i) From February 1, 2009, to June 30, 2010, inclusive, the
following shall not apply:
(1) The service coordinator-to-consumer ratio requirements of
paragraph (1), and subparagraph (C) of paragraph (3), of subdivision
(c).
(2) The requirements of subdivision (e). The regional centers
shall, instead, maintain sufficient service coordinator caseload data
to document compliance with the service coordinator-to-consumer
ratio requirements in effect pursuant to this section.
(3) The requirements of paragraphs (1) to (6), inclusive, of
subdivision (g).
(j) From July 1, 2010, to June 30, 2011, inclusive, the following
shall not apply:
(1) The service coordinator-to-consumer ratio requirements of
paragraph (1), and subparagraph (C) of paragraph (3), of subdivision
(c).
(2) The requirements of paragraphs (1) to (6), inclusive, of
subdivision (g).
(k) (1) Any contract between the department and a regional center
entered into on and after January 1, 2003, shall require that all
employment contracts entered into with regional center staff or
contractors be available to the public for review, upon request. For
purposes of this subdivision, an employment contract or portion
thereof may not be deemed confidential nor unavailable for public
review.
(2) Notwithstanding paragraph (1), the social security number of
the contracting party may not be disclosed.
(3) The term of the employment contract between the regional
center and an employee or contractor shall not exceed the term of the
state's contract with the regional center.
4640.7. (a) It is the intent of the Legislature that regional
centers assist persons with developmental disabilities and their
families in securing those services and supports which maximize
opportunities and choices for living, working, learning, and
recreating in the community.
(b) Each regional center design shall reflect the maximum
cost-effectiveness possible and shall be based on a service
coordination model, in which each consumer shall have a designated
service coordinator who is responsible for providing or ensuring that
needed services and supports are available to the consumer. Regional
centers shall examine the differing levels of coordination services
needed by consumers and families in order to establish varying
caseload ratios within the regional center which will best meet those
needs of their consumers.
4640.8. When convening any task force or advisory group, a regional
center shall make its best effort to ensure representation by
consumers and family members representing the community's
multicultural diversity.
4641. All regional centers shall conduct casefinding activities,
including notification of availability of service in English and such
other languages as may be appropriate to the service area, outreach
services in areas with a high incidence of developmental
disabilities, and identification of persons who may need service.
4642. Any person believed to have a developmental disability, and
any person believed to have a high risk of parenting a
developmentally disabled infant shall be eligible for initial intake
and assessment services in the regional centers. In addition, any
infant having a high risk of becoming developmentally disabled may be
eligible for initial intake and assessment services in the regional
centers. For purposes of this section, "high-risk infant" means a
child less than 36 months of age whose genetic, medical, or
environmental history is predictive of a substantially greater risk
for developmental disability than that for the general population.
The department, in consultation with the State Department of Health
Services, shall develop specific risk and service criteria for the
high-risk infant program on or before July 1, 1983. These criteria
may be modified in subsequent years based on analysis of actual
clinical experience.
Initial intake shall be performed within 15 working days following
request for assistance. Initial intake shall include, but need not
be limited to, information and advice about the nature and
availability of services provided by the regional center and by other
agencies in the community, including guardianship, conservatorship,
income maintenance, mental health, housing, education, work activity
and vocational training, medical, dental, recreational, and other
services or programs that may be useful to persons with developmental
disabilities or their families. Intake shall also include a decision
to provide assessment.
4643. (a) If assessment is needed, the assessment shall be
performed within 120 days following initial intake. Assessment shall
be performed as soon as possible and in no event more than 60 days
following initial intake where any delay would expose the client to
unnecessary risk to his or her health and safety or to significant
further delay in mental or physical development, or the client would
be at imminent risk of placement in a more restrictive environment.
Assessment may include collection and review of available historical
diagnostic data, provision or procurement of necessary tests and
evaluations, and summarization of developmental levels and service
needs and is conditional upon receipt of the release of information
specified in subdivision (b).
(b) In determining if an individual meets the definition of
developmental disability contained in subdivision (a) of Section
4512, the regional center may consider evaluations and tests,
including, but not limited to, intelligence tests, adaptive
functioning tests, neurological and neuropsychological tests,
diagnostic tests performed by a physician, psychiatric tests, and
other tests or evaluations that have been performed by, and are
available from, other sources.
4643.3. (a) (1) On or before April 1, 2002, the department shall
develop evaluation and diagnostic procedures for the diagnosis of
autism disorder and other autistic spectrum disorders.
(2) The department shall publish or arrange for the publication of
the evaluation and diagnostic procedures required by paragraph (1).
The published evaluation and diagnostic procedures shall be available
to the public.
(b) The department shall develop a training program for regional
center clinical staff in the utilization of diagnostic procedures for
the diagnosis of autism disorder. The training program shall be
implemented on or before July 1, 2002.
4643.5. (a) If a consumer is or has been determined to be eligible
for services by a regional center, he or she shall also be considered
eligible by any other regional center if he or she has moved to
another location within the state.
(b) An individual who is determined by any regional center to have
a developmental disability shall remain eligible for services from
regional centers unless a regional center, following a comprehensive
reassessment, concludes that the original determination that the
individual has a developmental disability is clearly erroneous.
(c) Whenever a consumer transfers from one regional center
catchment area to another, the level and types of services and
supports specified in the consumer's individual program plan shall be
authorized and secured, if available, pending the development of a
new individual program plan for the consumer. If these services and
supports do not exist, the regional center shall convene a meeting to
develop a new individual program plan within 30 days. Prior to
approval of the new individual program plan, the regional center
shall provide alternative services and supports that best meet the
individual program plan objectives in the least restrictive setting.
The department shall develop guidelines that describe the
responsibilities of regional centers in ensuring a smooth transition
of services and supports from one regional center to another,
including, but not limited to, pretransferring planning and a dispute
resolution process to resolve disagreements between regional centers
regarding their responsibilities related to the transfer of case
management services.
4644. (a) In addition to any person eligible for initial intake or
assessment services, regional centers may cause to be provided
preventive services to any potential parent requesting these services
and who is determined to be at high risk of parenting a
developmentally disabled infant, or, at the request of the parent or
guardian, to any infant at high risk of becoming developmentally
disabled. It is the intent of the Legislature that preventive
services shall be given equal priority with all other basic regional
center services. These services shall, inasmuch as feasible, be
provided by appropriate generic agencies, including, but not limited
to, county departments of health, perinatal centers, and genetic
centers. The department shall implement operating procedures to
ensure that prevention activities are funded from regional center
purchase of service funds only when funding for these services is
unavailable from local generic agencies. In no case, shall regional
center funds be used to supplant funds budgeted by any agency which
has a responsibility to provide prevention services to the general
public.
(b) For purposes of this section, "generic agency" means any
agency which has a legal responsibility to serve all members of the
general public and which is receiving public funds for providing such
services.
4646. (a) It is the intent of the Legislature to ensure that the
individual program plan and provision of services and supports by the
regional center system is centered on the individual and the family
of the individual with developmental disabilities and takes into
account 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 healthy
environments. It is the further intent of the Legislature to ensure
that the provision of services to consumers and their families be
effective in meeting the goals stated in the individual program plan,
reflect the preferences and choices of the consumer, and reflect the
cost-effective use of public resources.
(b) The individual program plan is developed through a process of
individualized needs determination. The individual with developmental
disabilities and, where appropriate, his or her parents, legal
guardian or conservator, or authorized representative, shall have the
opportunity to actively participate in the development of the plan.
(c) An individual program plan shall be developed for any person
who, following intake and assessment, is found to be eligible for
regional center services. These plans shall be completed within 60
days of the completion of the assessment. At the time of intake, the
regional center shall inform the consumer and, where appropriate, his
or her parents, legal guardian or conservator, or authorized
representative, of the services available through the local area
board and the protection and advocacy agency designated by the
Governor pursuant to federal law, and shall provide the address and
telephone numbers of those agencies.
(d) Individual program plans shall be prepared jointly by the
planning team. Decisions concerning the consumer's goals, objectives,
and services and supports that will be included in the consumer's
individual program plan and purchased by the regional center or
obtained from generic agencies shall be made by agreement between the
regional center representative and the consumer or, where
appropriate, the parents, legal guardian, conservator, or authorized
representative 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, legal
guardian, or conservator, that a designated representative receive
written notice of all meetings to develop or revise his or her
individual program plan and of all notices sent to the consumer
pursuant to Section 4710. The designated representative may be a
parent or family member.
(f) If a final agreement regarding the services and supports to be
provided to the consumer cannot be reached at a program plan
meeting, then a subsequent program plan meeting shall be convened
within 15 days, or later at the request of the consumer or, when
appropriate, the parents, legal guardian, conservator, or authorized
representative or when agreed to by the planning team. Additional
program plan meetings may be held with the agreement of the regional
center representative and the consumer or, where appropriate, the
parents, legal guardian, conservator, or authorized representative.
(g) An authorized representative of the regional center and the
consumer or, where appropriate, his or her parents, legal guardian,
or conservator, shall sign the individual program plan prior to its
implementation. If the consumer or, where appropriate, his or her
parents, legal guardian, or conservator, does not agree with all
components of the plan, they may indicate that disagreement on the
plan. Disagreement with specific plan components shall not prohibit
the implementation of services and supports agreed to by the consumer
or, where appropriate, his or her parents, legal guardian, or
conservator. If the consumer or, where appropriate, his or her
parents, legal guardian, or conservator, does not agree with the plan
in whole or in part, he or she shall be sent written notice of the
fair hearing rights, as required by Section 4701.
4646.4. (a) Effective September 1, 2008, regional centers shall
ensure, at the time of development, scheduled review, or modification
of a consumer's individual program plan developed pursuant to
Sections 4646 and 4646.5, or of an individualized family service plan
pursuant to Section 95020 of the Government Code, the establishment
of an internal process. This internal process shall ensure adherence
with federal and state law and regulation, and when purchasing
services and supports, shall ensure all of the following:
(1) Conformance with the regional center's purchase of service
policies, 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 as
contained in Section 4659.
(4) Consideration of the family's responsibility for providing
similar services and supports for a minor child without disabilities
in identifying the consumer's service and support needs as provided
in the least restrictive and most appropriate setting. In this
determination, 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 program
plan shall be made pursuant to Section 4646.
(c) Final decisions regarding the individual family support plan
shall be made pursuant to Section 95020 of the Government Code.
(d) By no later than April 1, 2009, the department shall provide
the fiscal and policy committees of the Legislature with a written
update regarding the implementation of this section.
4646.5. (a) The planning process for the individual program plan
described in Section 4646 shall include all of the following:
(1) Gathering information and conducting assessments to determine
the life goals, capabilities and strengths, preferences, barriers,
and concerns or problems of the person with developmental
disabilities. For children with developmental disabilities, this
process should include a review of the strengths, preferences, and
needs of the child and the family unit as a whole. Assessments shall
be conducted by qualified individuals and performed in natural
environments whenever possible. Information shall be taken from the
consumer, his or her parents and other family members, his or her
friends, advocates, providers of services and supports, and other
agencies. The assessment process shall reflect awareness of, and
sensitivity to, the lifestyle and cultural background of the consumer
and the family.
(2) A statement of goals, based on the needs, preferences, and
life choices of the individual with developmental disabilities, and a
statement of specific, time-limited objectives for implementing the
person's goals and addressing his or her needs. These objectives
shall be stated in terms that allow measurement of progress or
monitoring of service delivery. These goals and objectives should
maximize opportunities for the consumer to develop relationships, be
part of community life in the areas of community participation,
housing, work, school, and leisure, increase control over his or her
life, acquire increasingly positive roles in community life, and
develop competencies to help accomplish these goals.
(3) When developing individual program plans for children,
regional centers shall be guided by the principles, process, and
services and support parameters set forth in Section 4685.
(4) A schedule of the type and amount of services and supports to
be purchased by the regional center or obtained from generic agencies
or other resources in order to achieve the individual program plan
goals and objectives, and identification of the provider or providers
of service responsible for attaining each objective, including, but
not limited to, vendors, contracted providers, generic service
agencies, and natural supports. The plan shall specify the
approximate scheduled start date for services and supports and shall
contain timelines for actions necessary to begin services and
supports, including generic services.
(5) When agreed to by the consumer, the parents or legally
appointed guardian of a minor consumer, or the legally appointed
conservator of an adult consumer or the authorized representative,
including those appointed pursuant to subdivision (d) of Section 4548
and subdivision (e) of Section 4705, a review of the general health
status of the adult or child including a medical, dental, and mental
health needs shall be conducted. This review shall include a
discussion of current medications, any observed side effects, and the
date of last review of the medication. Service providers shall
cooperate with the planning team to provide any information necessary
to complete the health status review. If any concerns are noted
during the review, referrals shall be made to regional center
clinicians or to the consumer's physician, as appropriate.
Documentation of health status and referrals shall be made in the
consumer's record by the service coordinator.
(6) A schedule of regular periodic review and reevaluation to
ascertain that planned services have been provided, that objectives
have been fulfilled within the times specified, and that consumers
and families are satisfied with the individual program plan and its
implementation.
(b) For all active cases, individual program plans shall be
reviewed and modified by the planning team, through the process
described in Section 4646, as necessary, in response to the person's
achievement or changing needs, and no less often than once every
three years. If the consumer or, where appropriate, the consumer's
parents, legal guardian, or conservator requests an individual
program plan review, the individual program shall be reviewed within
30 days after the request is submitted.
(c) (1) The department, with the participation of representatives
of a statewide consumer organization, the Association of Regional
Center Agencies, an organized labor organization representing service
coordination staff, and the Organization of Area Boards shall
prepare training material and a standard format and instructions for
the preparation of individual program plans, which embodies an
approach centered on the person and family.
(2) Each regional center shall use the training materials and
format prepared by the department pursuant to paragraph (1).
(3) The department shall biennially review a random sample of
individual program plans at each regional center to assure that these
plans are being developed and modified in compliance with Section
4646 and this section.
4646.55. (a) Notwithstanding any other provision of law or
regulation to the contrary, and to the extent federal financial
participation is available, effective July 1, 2007, the State
Department of Developmental Services is hereby authorized to make
supplemental payment to an enrolled Medi-Cal provider that is a
licensed intermediate care facility/developmentally
disabled-habilitative, licensed intermediate care
facility/developmentally disabled-nursing, or licensed intermediate
care facility/developmentally disabled, for day treatment and
transportation services provided pursuant to Sections 4646 and
4646.5, applicable regulations, and Section 14132.925, to Medi-Cal
beneficiaries residing in a licensed intermediate care
facility/developmentally disabled-habilitative, licensed intermediate
care facility/developmentally disabled-nursing, or licensed
intermediate care facility/developmentally disabled. These payments
shall be considered supplemental payments to the enrolled Medi-Cal
provider and shall be comprised of the full costs of reimbursing
regional centers for making disbursements to day treatment and
transportation service providers, plus a coordination fee which will
include an administrative fee and reimbursement for the increased
costs associated with the quality assurance fee paid accordingly and
without a separate State Department of Developmental Services
contract.
(b) Notwithstanding any other provision of law and to the extent
federal financial participation is available, and in furtherance of
this section and Section 14132.925, the State Department of
Developmental Services shall amend the regional center contracts for
the 2007-08 fiscal year to extend the contract liquidation period
until June 30, 2011. The contract amendments and budget adjustments
shall be exempt from the provisions of Article 1 (commencing with
Section 4620).
4646.6. Notwithstanding Section 632 of the Penal Code, a consumer,
or his or her parent, guardian, conservator, or authorized
representative, shall have the right to record electronically the
proceedings of the individual program plan meetings on an audiotape
recorder. The consumer, or his or her parent, guardian, conservator,
or authorized representative, shall notify the regional center of
their intent to record a meeting at least 24 hours prior to the
meeting. If the regional center initiates the notice of intent to
audiotape record a meeting and the consumer, or his or her parent,
guardian, conservator, or authorized representative, refuses to
attend the meeting because it will be tape recorded, the meeting
shall not be recorded on an audiotape recorder. However, the regional
center shall have the right to electronically record the meeting
when notice of intent to record has been given by the consumer or on
the consumer's behalf.
4647. (a) Pursuant to Section 4640.7, service coordination shall
include those activities necessary to implement an individual program
plan, including, but not limited to, participation in the individual
program plan process; assurance that the planning team considers all
appropriate options for meeting each individual program plan
objective; securing, through purchasing or by obtaining from generic
agencies or other resources, services and supports specified in the
person's individual program plan; coordination of service and support
programs; collection and dissemination of information; and
monitoring implementation of the plan to ascertain that objectives
have been fulfilled and to assist in revising the plan as necessary.
(b) The regional center shall assign a service coordinator who
shall be responsible for implementing, overseeing, and monitoring
each individual program plan. The service coordinator may be an
employee of the regional center or may be a qualified individual or
employee of an agency with whom the regional center has contracted to
provide service coordination services, or persons described in
Section 4647.2. The regional center shall provide the consumer or,
where appropriate, his or her parents, legal guardian, or conservator
or authorized representative, with written notification of any
permanent change in the assigned service coordinator within 10
business days. No person shall continue to serve as a service
coordinator for any individual program plan unless there is agreement
by all parties that the person should continue to serve as service
coordinator.
(c) Where appropriate, a consumer or the consumer's parents or
other family members, legal guardian, or conservator, may perform all
or part of the duties of the service coordinator described in this
section if the regional center director agrees and it is feasible.
(d) If any person described in subdivision (c) is designated as
the service coordinator, that person shall not deviate from the
agreed-upon program plan and shall provide any reasonable information
and reports required by the regional center director.
(e) If any person described in subdivision (c) is designated as
the service coordinator, the regional center shall provide ongoing
information and support as necessary, to assist the person to perform
all or part of the duties of service coordinator.
4648. In order to achieve the stated objectives of a consumer's
individual program plan, the regional center shall conduct
activities, 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 supports
assist individuals with developmental disabilities in achieving the
greatest self-sufficiency possible and in exercising personal
choices. The regional center shall secure services and supports that
meet the needs of the consumer, as determined in the consumer's
individual program plan, and within the context of the individual
program plan, the planning team shall give highest preference to
those services and supports which would allow minors with
developmental disabilities to live with their families, adult persons
with developmental disabilities to live as independently as possible
in the community, and that allow all consumers to interact with
persons without disabilities in positive, meaningful ways.
(2) In implementing individual program plans, regional centers,
through the planning team, shall first consider services and supports
in natural community, home, work, and recreational settings.
Services and supports shall be flexible and individually tailored to
the consumer and, where appropriate, his or her family.
(3) A regional center may, pursuant to vendorization or a
contract, purchase services or supports for a consumer from any
individual or agency which the regional center and consumer or, where
appropriate, his or her parents, legal guardian, or conservator, or
authorized representatives, determines will best accomplish all or
any part of that consumer's program plan.
(A) Vendorization or contracting is the process for
identification, selection, and utilization of service vendors or
contractors, based on the qualifications and other requirements
necessary in order to provide the service.
(B) A regional center may reimburse an individual or agency for
services or supports provided to a regional center consumer if the
individual or agency has a rate of payment for vendored or contracted
services established by the department, pursuant to this division,
and is providing services pursuant to an emergency vendorization or
has completed the vendorization procedures or has entered into a
contract with the regional center and continues to comply with the
vendorization or contracting requirements. The director shall adopt
regulations governing the vendorization process to be utilized by the
department, regional centers, vendors and the individual or agency
requesting vendorization.
(C) Regulations shall include, but not be limited to: the vendor
application process, and the basis for accepting or denying an
application; the qualification and requirements for each category of
services that may be provided to a regional center consumer through a
vendor; requirements for emergency vendorization; procedures for
termination of vendorization; the procedure for an individual or an
agency to appeal any vendorization decision made by the department or
regional center.
(D) A regional center may vendorize a licensed facility for
exclusive services to persons with developmental disabilities at a
capacity equal to or less than the facility's licensed capacity. A
facility already licensed on January 1, 1999, shall continue to be
vendorized at their full licensed capacity until the facility agrees
to vendorization at a reduced capacity.
(E) Effective July 1, 2009, notwithstanding any other provision of
law or regulation to the contrary, a regional center shall not newly
vendor a State Department of Social Services licensed 24-hour
residential care facility with a licensed capacity of 16 or more
beds, unless the facility qualifies for receipt of federal funds
under the Medicaid Program.
(4) Notwithstanding subparagraph (B), a regional center may
contract or issue a voucher for services and supports provided to a
consumer or family at a cost not to exceed the maximum rate of
payment for that service or support established by the department. If
a rate has not been established by the department, the regional
center may, for an interim period, contract for a specified service
or support with, and establish a rate of payment for, any provider of
the service or support necessary to implement a consumer's
individual program plan. Contracts may be negotiated for a period of
up to three years, with annual review and subject to the availability
of funds.
(5) In order to ensure the maximum flexibility and availability of
appropriate services and supports for persons with developmental
disabilities, the department shall establish and maintain an
equitable system of payment to providers of services and supports
identified as necessary to the implementation of a consumers'
individual program plan. The system of payment shall include
provision for a rate to ensure that the provider can meet the special
needs of consumers and provide quality services and supports in the
least restrictive setting as required by law.
(6) The regional center and the consumer, or where appropriate,
his or her parents, legal guardian, conservator, or authorized
representative, including those appointed pursuant to subdivision (d)
of Section 4548 or subdivision (e) of Section 4705, shall, pursuant
to the individual program plan, consider all of the following when
selecting a provider of consumer services and supports:
(A) A provider's ability to deliver quality services or supports
which can accomplish all or part of the consumer's individual program
plan.
(B) A provider's success in achieving the objectives set forth in
the individual program plan.
(C) Where appropriate, the existence of licensing, accreditation,
or professional certification.
(D) The cost of providing services or supports of comparable
quality by different providers, if available, shall be reviewed, and
the least costly available provider of comparable service, including
the cost of transportation, who is able to accomplish all or part of
the consumer's individual program plan, consistent with the
particular needs of the consumer and family as identified in the
individual program plan, shall be selected. In determining the least
costly provider, the availability of federal financial participation
shall be considered. The consumer shall not be required to use the
least costly provider if it will result in the consumer moving from
an existing provider of services or supports to more restrictive or
less integrated services or supports.
(E) The consumer's or, where appropriate, the parents, legal
guardian, or conservator of a consumer's choice of providers.
(7) No service or support provided by any agency or individual
shall be continued unless the consumer or, where appropriate, his or
her parents, legal guardian, or conservator, or authorized
representative, including those appointed pursuant to subdivision (d)
of Section 4548 or subdivision (e) of Section 4705, is satisfied and
the regional center and the consumer or, when appropriate, the
person's parents or legal guardian or conservator agree that planned
services and supports have been provided, and reasonable progress
toward objectives have been made.
(8) Regional center funds shall not be used to supplant the budget
of any agency which has a legal responsibility to serve all members
of the general public and is receiving public funds for providing
those services.
(9) (A) A regional center may, directly or through an agency
acting on behalf of the center, provide placement in, purchase of, or
follow-along services to persons with developmental disabilities in,
appropriate community living arrangements, including, but not
limited to, support service for consumers in homes they own or lease,
foster family placements, health care facilities, and licensed
community care facilities. In considering appropriate placement
alternatives for children with developmental disabilities, approval
by the child's parent or guardian shall be obtained before placement
is made.
(B) Effective July 1, 2012, notwithstanding any other provision of
law or regulation to the contrary, a regional center shall not
purchase residential services from a State Department of Social
Services licensed 24-hour residential care facility with a licensed
capacity of 16 or more beds. This prohibition on regional center
purchase of residential services shall not apply to either of the
following:
(i) A residential facility with a licensed capacity of 16 or more
beds that has been approved to participate in the department's Home
and Community Based Services Waiver or another existing waiver
program or certified to participate in the Medi-Cal program.
(ii) A residential facility service provider that has a written
agreement and specific plan prior to July 1, 2012, with the vendoring
regional center to downsize the existing facility by transitioning
its residential services to living arrangements of 15 beds or less or
restructure the large facility to meet federal Medicaid eligibility
requirements on or before June 30, 2013.
(C) Each person with developmental disabilities placed by the
regional center in a community living arrangement shall have the
rights specified in this division. These rights shall be brought to
the person's attention by any means necessary to reasonably
communicate these rights to each resident, provided that, at a
minimum, the Director of Developmental Services prepare, provide, and
require to be clearly posted in all residential facilities and day
programs a poster using simplified language and pictures that is
designed to be more understandable by persons with cognitive
disabilities and that the rights information shall also be available
through the regional center to each residential facility and day
program in alternative formats, including, but not limited to, other
languages, braille, and audio tapes, when necessary to meet the
communication needs of consumers.
(D) Consumers are eligible to receive supplemental services
including, but not limited to, additional staffing, pursuant to the
process described in subdivision (d) of Section 4646. Necessary
additional staffing that is not specifically included in the rates
paid to the service provider may be purchased by the regional center
if the additional staff are in excess of the amount required by
regulation and the individual's planning team determines the
additional services are consistent with the provisions of the
individual program plan. Additional staff should be periodically
reviewed by the planning team for consistency with the individual
program plan objectives in order to determine if continued use of the
additional staff is necessary and appropriate and if the service is
producing outcomes consistent with the individual program plan.
Regional centers shall monitor programs to ensure that the additional
staff is being provided and utilized appropriately.
(10) Emergency and crisis intervention services including, but not
limited to, mental health services and behavior modification
services, may be provided, as needed, to maintain persons with
developmental disabilities in the living arrangement of their own
choice. Crisis services shall first be provided without disrupting a
person's living arrangement. If crisis intervention services are
unsuccessful, emergency housing shall be available in the person's
home community. If dislocation cannot be avoided, every effort shall
be made to return the person to his or her living arrangement of
choice, with all necessary supports, as soon as possible.
(11) Among other service and support options, planning teams shall
consider the use of paid roommates or neighbors, personal
assistance, technical and financial assistance, and all other service
and support options which would result in greater self-sufficiency
for the consumer and cost-effectiveness to the state.
(12) When facilitation as specified in an individual program plan
requires the services of an individual, the facilitator shall be of
the consumer's choosing.
(13) The community support may be provided to assist individuals
with developmental disabilities to fully participate in community and
civic life, including, but not limited to, programs, services, work
opportunities, business, and activities available to persons without
disabilities. This facilitation shall include, but not be limited to,
any of the following:
(A) Outreach and education to programs and services within the
community.
(B) Direct support to individuals which would enable them to more
fully participate in their community.
(C) Developing unpaid natural supports when possible.
(14) Other services and supports may be provided as set forth in
Sections 4685, 4686, 4687, 4688, and 4689, when necessary.
(15) Notwithstanding any other provision of law or regulation to
the contrary, effective July 1, 2009, regional centers shall not
purchase experimental treatments, therapeutic services, or devices
that have not been clinically determined or scientifically proven to
be effective or safe or for which risks and complications are
unknown. Experimental treatments or therapeutic services include
experimental medical or nutritional therapy when the use of the
product for that purpose is not a general physician practice. For
regional center consumers receiving these services as part of their
individual 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, and
service rights of persons with developmental disabilities as
established in this division.
(2) Whenever the advocacy efforts of a regional center to secure
or protect the civil, legal, or service rights of any of its
consumers prove ineffective, the regional center or the person with
developmental disabilities or his or her parents, legal guardian, or
other representative may request the area board to initiate action
under the provisions defining area board advocacy functions
established in this division.
(c) The regional center may assist consumers and families
directly, or through a provider, in identifying and building circles
of support within the community.
(d) In order to increase the quality of community services and
protect consumers, the regional center shall, when appropriate, take
either of the following actions:
(1) Identify services and supports that are ineffective or of poor
quality and provide or secure consultation, training, or technical
assistance services for any agency or individual provider to assist
that agency or individual provider in upgrading the quality of
services or supports.
(2) Identify providers of services or supports that may not be in
compliance with local, state, and federal statutes and regulations
and notify the appropriate licensing or regulatory authority, or
request the area board to investigate the possible noncompliance.
(e) When necessary to expand the availability of needed services
of good quality, a regional center may take actions that include, but
are not limited to, the following:
(1) Soliciting an individual or agency by requests for proposals
or other means, to provide needed services or supports not presently
available.
(2) Requesting funds from the Program Development Fund, pursuant
to Section 4677, or community placement plan funds designated from
that fund, to reimburse the startup costs needed to initiate a new
program 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 not
provide direct treatment and therapeutic services, but shall utilize
appropriate public and private community agencies and service
providers to obtain those services for its consumers.
(g) Where there are identified gaps in the system of services and
supports or where there are identified consumers for whom no provider
will provide services and supports contained in his or her
individual program plan, the department may provide the services and
supports directly.
(h) At least annually, regional centers shall provide the
consumer, his or her parents, legal guardian, conservator, or
authorized representative a statement of services and supports the
regional center purchased for the purpose of ensuring that they are
delivered. The statement shall include the type, unit, month, and
cost of services and supports purchased.
4648.1. (a) The State Department of Developmental Services and
regional centers may monitor services and supports purchased for
regional center consumers with or without prior notice. Not less than
two monitoring visits to a licensed long-term health care or
community care facility or family home agency home each year shall be
unannounced. The department may conduct fiscal reviews and audits of
the service providers' records.
(b) Department and regional center staff involved in monitoring or
auditing services provided to the regional centers' consumers by a
service provider shall have access to the provider's grounds,
buildings, and service program, and to all related records, including
books, papers, computerized data, accounting records, and related
documentation. All persons connected with the service provider's
program, including, but not limited to, program administrators,
staff, consultants, and accountants, shall provide information and
access to facilities as required by the department or regional
center.
(c) The department, in cooperation with regional centers, shall
ensure that all providers of services and supports purchased by
regional centers for their consumers are informed of all of the
following:
(1) The provisions of this section.
(2) The responsibility of providers to comply with laws and
regulations governing both their service program and the provision of
services and supports to people with developmental disabilities.
(3) The responsibility of providers to comply with conditions of
any contract or agreement between the regional center and the
provider, and between the provider and the department.
(4) The rights of providers established in regulations adopted
pursuant to Sections 4648.2, 4748, and 4780.5, to appeal actions
taken by regional centers or the department as a result of their
monitoring and auditing findings.
(d) A regional center may terminate payments for services, and may
terminate its contract or authorization for the purchase of consumer
services if it determines that the provider has not complied with
provisions of its contract or authorization with the regional center
or with applicable state laws and regulations. When terminating
payments for services or its contract or authorization for the
purchase of consumer services, a regional center shall make
reasonable efforts to avoid unnecessary disruptions of consumer
services.
(e) A regional center or the department may recover from the
provider funds paid for services when the department or the regional
center determines that either of the following has occurred:
(1) The services were not provided in accordance with the regional
center's contract or authorization with the provider, or with
applicable state laws or regulations.
(2) The rate paid is based on inaccurate data submitted by the
provider on a provider cost statement.
Any funds so recovered shall be remitted to the department.
(f) Any evidence of suspected licensing violations found by
department or regional center personnel shall be reported immediately
to the appropriate state licensing agency.
(g) Regional centers may establish volunteer teams, made up of
consumers, parents, other family members, and advocates to conduct
the monitoring activities described in this section.
(h) In meeting its responsibility to provide technical assistance
to providers of community living arrangements for persons with
developmental disabilities, including, but not limited to, licensed
residential facilities, family home agencies, and supported or
independent living arrangements, a regional center shall utilize the
"Looking at Service Quality-Provider's Handbook" developed by the
department or subsequent revisions developed by the department.
(i) Effective July 1, 2009, a regional center shall not be
required to perform triennial evaluations of community care
facilities, as described in Sections 56046, 56049, 56050, 56051, and
56052 of Title 17 of the California Code of Regulations.
4648.2. By September 1, 1986, the State Department of Developmental
Services shall promulgate regulations which establish a process for
service providers to appeal actions the department takes as a result
of its auditing and monitoring activities. To the extent possible,
this process shall include procedures contained in fiscal audit
appeals regulations established pursuant to Section 4780.5.
4648.3. A provider of transportation services to regional center
clients for the regional center shall maintain protection against
liability for damages for bodily injuries or death and for damage to
or destruction of property, which may be incurred by the provider in
the course of providing those services. The protection shall be
maintained at the level established by the regional center to which
the 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 following
shall apply to a regional center:
(a) A regional center shall not fund private specialized
transportation services for an adult consumer who can safely access
and utilize public transportation, when that transportation is
available.
(b) A regional center shall fund the least expensive
transportation modality that meets the consumer's needs, as set forth
in 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 provides
the service that meets the consumer's needs, as set forth in the
consumer's IPP or IFSP. For purposes of this subdivision, the cost of
a vendor shall be determined by combining the vendor's program costs
and the costs to transport a consumer from the consumer's residence
to the vendor.
(d) A regional center shall fund transportation services for a
minor child living in the family residence, only if the family of the
child provides sufficient written documentation to the regional
center to demonstrate that it is unable to provide transportation for
the child.
4648.4. (a) Notwithstanding any other provision of law or
regulation, commencing July 1, 2006, rates for services listed in
paragraphs (1), (2), with the exception of travel reimbursement, (3)
to (8), inclusive, (10), and (11) of subdivision (b), shall be
increased by 3 percent, subject to funds specifically appropriated
for this increase in the Budget Act of 2006. The increase shall be
applied as a percentage, and the percentage shall be the same for all
providers. 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 provider
of the following services or supports a rate that is greater than the
rate that is in effect on or after June 30, 2008, unless the
increase is required by a contract between the regional center and
the vendor that is in effect on June 30, 2008, or the regional center
demonstrates that the approval is necessary to protect the consumer'
s health or safety and the department has granted prior written
authorization:
(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 or
regulations to the contrary, effective July 1, 2009, a regional
centers' authority to purchase the following services shall be
suspended pending implementation of the Individual Choice Budget and
certification by the Director of Developmental Services that the
Individual Choice Budget has been implemented and will result in
state budget savings sufficient to offset the costs of providing the
following services:
(1) Camping services and associated travel expenses.
(2) Social recreation activities, except for those activities
vendored 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 in
subdivision (a) as part of their individual program plan (IPP) or
individualized family service plan (IFSP), the prohibition in
subdivision (a) shall take effect on August 1, 2009.
(c) An exemption may be granted on an individual basis in
extraordinary circumstances to permit purchase of a service
identified in subdivision (a) when the regional center determines
that the service is a primary or critical means for ameliorating the
physical, cognitive, or psychosocial effects of the consumer's
developmental disability, or the service is necessary to enable the
consumer to remain in his or her home and no alternative service is
available to meet the consumer's needs.
4648.6. The department, in consultation with stakeholders, shall
develop an alternative service delivery model that provides an
Individual Choice Budget for obtaining quality services and supports
which provides choice and flexibility within a finite budget that in
the aggregate reduces regional center purchase of service
expenditures, reduces reliance on the state general fund, and
maximizes federal financial participation in the delivery of
services. The individual budget will be determined using a fair,
equitable, transparent standardized process.
4649. Regional centers shall cooperate with area boards in joint
efforts to inform the public of services available to persons with
developmental disabilities and of their unmet needs, provide
materials and education programs to community groups and agencies
with interest in, or responsibility for, persons with developmental
disabilities, and develop resource materials, if necessary,
containing information about local agencies, facilities, and service
providers offering services to persons with developmental
disabilities.
4650. Regional centers shall be responsible for developing an
annual plan and program budget to be submitted to the director no
later than September 1 of each fiscal year. An information copy shall
be submitted to the area board and state council by the same date.
4651. (a) It is the intent of the Legislature that regional centers
shall find innovative and economical methods of achieving the
objectives contained in individual program plans of persons with
developmental disabilities.
(b) The department shall encourage and assist regional centers to
use innovative programs, techniques, and staffing arrangements to
carry out their responsibilities.
4652. A regional center shall investigate every appropriate and
economically feasible alternative for care of a developmentally
disabled person available within the region. If suitable care cannot
be found within the region, services may be obtained outside of the
region.
4653. Except for those developmentally disabled persons judicially
committed to state hospitals, no developmentally disabled person
shall be admitted to a state hospital except upon the referral of a
regional center. Upon discharge from a state hospital, a
developmentally disabled person shall be referred to an appropriate
regional center.
4654. Before any person is examined by a regional center pursuant
to Section 1370.1 of the Penal Code, the court ordering such medical
examination shall transmit to the regional center a copy of the
orders made pursuant to proceedings conducted under Sections 1368 and
1369 of the Penal Code. The purpose of the mental examination shall
be to determine if developmental disability is the primary diagnosis.
4655. The director of a regional center or his designee may give
consent to medical, dental, and surgical treatment of a regional
center client and provide for such treatment to be given to the
person under the following conditions:
(a) If the developmentally disabled person's parent, guardian, or
conservator legally authorized to consent to such treatment does not
respond within a reasonable time to the request of the director or
his designee for the granting or denying of consent for such
treatment, the director of a regional center or his designee may
consent on behalf of the developmentally disabled person to such
treatment 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 director
of the regional center or his designee may consent to such treatment
on behalf of the person and provide for such treatment to be given to
the person. The director of a regional center or his designee may
thereupon also initiate, or cause to be initiated, proceedings for
the appointment of a guardian or conservator legally authorized to
consent to medical, dental, or surgical services.
(c) If the developmentally disabled person is an adult and has no
conservator, consent to treatment may be given by someone other than
the person on the person's behalf only if the developmentally
disabled person is mentally incapable of giving his own consent.
4656. (a) A qualified physician and surgeon who diagnoses a
developmental disability, as defined in subdivision (a) of Section
4512, of a patient who is a minor shall attempt to determine from the
patie
4640. (a) Contracts between the department and regional centers
shall specify the service area and the categories of persons that
regional centers shall be expected to serve and the services and
supports to be provided.
(b) In order to ensure uniformity in the application of the
definition of developmental disability contained in this division,
the Director of Developmental Services shall, by March 1, 1977, issue
regulations that delineate, by diagnostic category and degree of
disability, those persons who are eligible for services and supports
by regional centers. In issuing the regulations, the director shall
invite and consider the views of regional center contracting
agencies, the state council, and persons with a demonstrated and
direct interest in developmental disabilities.
4640.6. (a) In approving regional center contracts, the department
shall ensure that regional center staffing patterns demonstrate that
direct service coordination are the highest priority.
(b) Contracts between the department and regional centers shall
require that regional centers implement an emergency response system
that ensures that a regional center staff person will respond to a
consumer, or individual acting on behalf of a consumer, within two
hours of the time an emergency call is placed. This emergency
response system shall be operational 24 hours per day, 365 days per
year.
(c) Contracts between the department and regional centers shall
require regional centers to have service coordinator-to-consumer
ratios, as follows:
(1) An average service coordinator-to-consumer ratio of 1 to 62
for all consumers who have not moved from the developmental centers
to the community since April 14, 1993. In no case shall a service
coordinator for these consumers have an assigned caseload in excess
of 79 consumers for more than 60 days.
(2) An average service coordinator-to-consumer ratio of 1 to 45
for all consumers who have moved from a developmental center to the
community since April 14, 1993. In no case shall a service
coordinator for these consumers have an assigned caseload in excess
of 59 consumers for more than 60 days.
(3) Commencing January 1, 2004, the following
coordinator-to-consumer ratios shall apply:
(A) All consumers three years of age and younger and for consumers
enrolled in the Home and Community-based Services Waiver program for
persons with developmental disabilities, an average service
coordinator-to-consumer ratio of 1 to 62.
(B) All consumers who have moved from a developmental center to
the community since April 14, 1993, and have lived continuously in
the community for at least 12 months, an average service
coordinator-to-consumer ratio of 1 to 62.
(C) All consumers who have not moved from the developmental
centers to the community since April 14, 1993, and who are not
described in subparagraph (A), an average service
coordinator-to-consumer ratio of 1 to 66.
(4) For purposes of paragraph (3), service coordinators may have a
mixed caseload of consumers three years of age and younger,
consumers enrolled in the Home and Community-based Services Waiver
program for persons with developmental disabilities, and other
consumers if the overall average caseload is weighted proportionately
to ensure that overall regional center average service
coordinator-to-consumer ratios as specified in paragraph (3) are met.
For purposes of paragraph (3), in no case shall a service
coordinator have an assigned caseload in excess of 84 for more than
60 days.
(d) For purposes of this section, "service coordinator" means a
regional center employee whose primary responsibility includes
preparing, implementing, and monitoring consumers' individual program
plans, securing and coordinating consumer services and supports, and
providing placement and monitoring activities.
(e) In order to ensure that caseload ratios are maintained
pursuant to this section, each regional center shall provide service
coordinator caseload data to the department, annually for each fiscal
year. The data shall be submitted in the format, including the
content, prescribed by the department. Within 30 days of receipt of
data submitted pursuant to this subdivision, the department shall
make a summary of the data available to the public upon request. The
department shall verify the accuracy of the data when conducting
regional center fiscal audits. Data submitted by regional centers
pursuant to this subdivision shall:
(1) Only include data on service coordinator positions as defined
in subdivision (d). Regional centers shall identify the number of
positions that perform service coordinator duties on less than a
full-time basis. Staffing ratios reported pursuant to this
subdivision shall reflect the appropriate proportionality of these
staff to consumers served.
(2) Be reported separately for service coordinators whose caseload
includes any of the following:
(A) Consumers who are three years of age and older and who have
not moved from the developmental center to the community since April
14, 1993.
(B) Consumers who have moved from a developmental center to the
community since April 14, 1993.
(C) Consumers who are younger than three years of age.
(D) Consumers enrolled in the Home and Community-based Services
Waiver program.
(3) Not include positions that are vacant for more than 60 days or
new positions established within 60 days of the reporting month that
are still vacant.
(4) For purposes of calculating caseload ratios for consumers
enrolled 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 require
a plan of correction for any regional center that, for two
consecutive reporting periods, fails to maintain service coordinator
caseload ratios required by this section or otherwise demonstrates an
inability to maintain appropriate staffing patterns pursuant to this
section. Plans of correction shall be developed following input from
the local area board, local organizations representing consumers,
family members, regional center employees, including recognized labor
organizations, and service providers, and other interested parties.
(g) Contracts between the department and regional center shall
require the regional center to have, or contract for, all of the
following areas:
(1) Criminal justice expertise to assist the regional center in
providing services and support to consumers involved in the criminal
justice system as a victim, defendant, inmate, or parolee.
(2) Special education expertise to assist the regional center in
providing advocacy and support to families seeking appropriate
educational services from a school district.
(3) Family support expertise to assist the regional center in
maximizing the effectiveness of support and services provided to
families.
(4) Housing expertise to assist the regional center in accessing
affordable housing for consumers in independent or supportive living
arrangements.
(5) Community integration expertise to assist consumers and
families in accessing integrated services and supports and improved
opportunities to participate in community life.
(6) Quality assurance expertise, to assist the regional center to
provide the necessary coordination and cooperation with the area
board in conducting quality-of-life assessments and coordinating the
regional center quality assurance efforts.
(7) Each regional center shall employ at least one consumer
advocate who is a person with developmental disabilities.
(8) Other staffing arrangements related to the delivery of
services that the department determines are necessary to ensure
maximum cost-effectiveness and to ensure that the service needs of
consumers and families are met.
(h) Any regional center proposing a staffing arrangement that
substantially deviates from the requirements of this section shall
request a waiver from the department. Prior to granting a waiver, the
department shall require a detailed staffing proposal, including,
but not limited to, how the proposed staffing arrangement will
benefit consumers and families served, and shall demonstrate clear
and convincing support for the proposed staffing arrangement from
constituencies served and impacted, that include, but are not limited
to, consumers, families, providers, advocates, and recognized labor
organizations. In addition, the regional center shall submit to the
department any written opposition to the proposal from organizations
or individuals, including, but not limited to, consumers, families,
providers, and advocates, including recognized labor organizations.
The department may grant waivers to regional centers that
sufficiently demonstrate that the proposed staffing arrangement is in
the best interest of consumers and families served, complies with
the requirements of this chapter, and does not violate any
contractual requirements. A waiver shall be approved by the
department for up to 12 months, at which time a regional center may
submit a new request pursuant to this subdivision.
(i) From February 1, 2009, to June 30, 2010, inclusive, the
following shall not apply:
(1) The service coordinator-to-consumer ratio requirements of
paragraph (1), and subparagraph (C) of paragraph (3), of subdivision
(c).
(2) The requirements of subdivision (e). The regional centers
shall, instead, maintain sufficient service coordinator caseload data
to document compliance with the service coordinator-to-consumer
ratio requirements in effect pursuant to this section.
(3) The requirements of paragraphs (1) to (6), inclusive, of
subdivision (g).
(j) From July 1, 2010, to June 30, 2011, inclusive, the following
shall not apply:
(1) The service coordinator-to-consumer ratio requirements of
paragraph (1), and subparagraph (C) of paragraph (3), of subdivision
(c).
(2) The requirements of paragraphs (1) to (6), inclusive, of
subdivision (g).
(k) (1) Any contract between the department and a regional center
entered into on and after January 1, 2003, shall require that all
employment contracts entered into with regional center staff or
contractors be available to the public for review, upon request. For
purposes of this subdivision, an employment contract or portion
thereof may not be deemed confidential nor unavailable for public
review.
(2) Notwithstanding paragraph (1), the social security number of
the contracting party may not be disclosed.
(3) The term of the employment contract between the regional
center and an employee or contractor shall not exceed the term of the
state's contract with the regional center.
4640.7. (a) It is the intent of the Legislature that regional
centers assist persons with developmental disabilities and their
families in securing those services and supports which maximize
opportunities and choices for living, working, learning, and
recreating in the community.
(b) Each regional center design shall reflect the maximum
cost-effectiveness possible and shall be based on a service
coordination model, in which each consumer shall have a designated
service coordinator who is responsible for providing or ensuring that
needed services and supports are available to the consumer. Regional
centers shall examine the differing levels of coordination services
needed by consumers and families in order to establish varying
caseload ratios within the regional center which will best meet those
needs of their consumers.
4640.8. When convening any task force or advisory group, a regional
center shall make its best effort to ensure representation by
consumers and family members representing the community's
multicultural diversity.
4641. All regional centers shall conduct casefinding activities,
including notification of availability of service in English and such
other languages as may be appropriate to the service area, outreach
services in areas with a high incidence of developmental
disabilities, and identification of persons who may need service.
4642. Any person believed to have a developmental disability, and
any person believed to have a high risk of parenting a
developmentally disabled infant shall be eligible for initial intake
and assessment services in the regional centers. In addition, any
infant having a high risk of becoming developmentally disabled may be
eligible for initial intake and assessment services in the regional
centers. For purposes of this section, "high-risk infant" means a
child less than 36 months of age whose genetic, medical, or
environmental history is predictive of a substantially greater risk
for developmental disability than that for the general population.
The department, in consultation with the State Department of Health
Services, shall develop specific risk and service criteria for the
high-risk infant program on or before July 1, 1983. These criteria
may be modified in subsequent years based on analysis of actual
clinical experience.
Initial intake shall be performed within 15 working days following
request for assistance. Initial intake shall include, but need not
be limited to, information and advice about the nature and
availability of services provided by the regional center and by other
agencies in the community, including guardianship, conservatorship,
income maintenance, mental health, housing, education, work activity
and vocational training, medical, dental, recreational, and other
services or programs that may be useful to persons with developmental
disabilities or their families. Intake shall also include a decision
to provide assessment.
4643. (a) If assessment is needed, the assessment shall be
performed within 120 days following initial intake. Assessment shall
be performed as soon as possible and in no event more than 60 days
following initial intake where any delay would expose the client to
unnecessary risk to his or her health and safety or to significant
further delay in mental or physical development, or the client would
be at imminent risk of placement in a more restrictive environment.
Assessment may include collection and review of available historical
diagnostic data, provision or procurement of necessary tests and
evaluations, and summarization of developmental levels and service
needs and is conditional upon receipt of the release of information
specified in subdivision (b).
(b) In determining if an individual meets the definition of
developmental disability contained in subdivision (a) of Section
4512, the regional center may consider evaluations and tests,
including, but not limited to, intelligence tests, adaptive
functioning tests, neurological and neuropsychological tests,
diagnostic tests performed by a physician, psychiatric tests, and
other tests or evaluations that have been performed by, and are
available from, other sources.
4643.3. (a) (1) On or before April 1, 2002, the department shall
develop evaluation and diagnostic procedures for the diagnosis of
autism disorder and other autistic spectrum disorders.
(2) The department shall publish or arrange for the publication of
the evaluation and diagnostic procedures required by paragraph (1).
The published evaluation and diagnostic procedures shall be available
to the public.
(b) The department shall develop a training program for regional
center clinical staff in the utilization of diagnostic procedures for
the diagnosis of autism disorder. The training program shall be
implemented on or before July 1, 2002.
4643.5. (a) If a consumer is or has been determined to be eligible
for services by a regional center, he or she shall also be considered
eligible by any other regional center if he or she has moved to
another location within the state.
(b) An individual who is determined by any regional center to have
a developmental disability shall remain eligible for services from
regional centers unless a regional center, following a comprehensive
reassessment, concludes that the original determination that the
individual has a developmental disability is clearly erroneous.
(c) Whenever a consumer transfers from one regional center
catchment area to another, the level and types of services and
supports specified in the consumer's individual program plan shall be
authorized and secured, if available, pending the development of a
new individual program plan for the consumer. If these services and
supports do not exist, the regional center shall convene a meeting to
develop a new individual program plan within 30 days. Prior to
approval of the new individual program plan, the regional center
shall provide alternative services and supports that best meet the
individual program plan objectives in the least restrictive setting.
The department shall develop guidelines that describe the
responsibilities of regional centers in ensuring a smooth transition
of services and supports from one regional center to another,
including, but not limited to, pretransferring planning and a dispute
resolution process to resolve disagreements between regional centers
regarding their responsibilities related to the transfer of case
management services.
4644. (a) In addition to any person eligible for initial intake or
assessment services, regional centers may cause to be provided
preventive services to any potential parent requesting these services
and who is determined to be at high risk of parenting a
developmentally disabled infant, or, at the request of the parent or
guardian, to any infant at high risk of becoming developmentally
disabled. It is the intent of the Legislature that preventive
services shall be given equal priority with all other basic regional
center services. These services shall, inasmuch as feasible, be
provided by appropriate generic agencies, including, but not limited
to, county departments of health, perinatal centers, and genetic
centers. The department shall implement operating procedures to
ensure that prevention activities are funded from regional center
purchase of service funds only when funding for these services is
unavailable from local generic agencies. In no case, shall regional
center funds be used to supplant funds budgeted by any agency which
has a responsibility to provide prevention services to the general
public.
(b) For purposes of this section, "generic agency" means any
agency which has a legal responsibility to serve all members of the
general public and which is receiving public funds for providing such
services.
4646. (a) It is the intent of the Legislature to ensure that the
individual program plan and provision of services and supports by the
regional center system is centered on the individual and the family
of the individual with developmental disabilities and takes into
account 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 healthy
environments. It is the further intent of the Legislature to ensure
that the provision of services to consumers and their families be
effective in meeting the goals stated in the individual program plan,
reflect the preferences and choices of the consumer, and reflect the
cost-effective use of public resources.
(b) The individual program plan is developed through a process of
individualized needs determination. The individual with developmental
disabilities and, where appropriate, his or her parents, legal
guardian or conservator, or authorized representative, shall have the
opportunity to actively participate in the development of the plan.
(c) An individual program plan shall be developed for any person
who, following intake and assessment, is found to be eligible for
regional center services. These plans shall be completed within 60
days of the completion of the assessment. At the time of intake, the
regional center shall inform the consumer and, where appropriate, his
or her parents, legal guardian or conservator, or authorized
representative, of the services available through the local area
board and the protection and advocacy agency designated by the
Governor pursuant to federal law, and shall provide the address and
telephone numbers of those agencies.
(d) Individual program plans shall be prepared jointly by the
planning team. Decisions concerning the consumer's goals, objectives,
and services and supports that will be included in the consumer's
individual program plan and purchased by the regional center or
obtained from generic agencies shall be made by agreement between the
regional center representative and the consumer or, where
appropriate, the parents, legal guardian, conservator, or authorized
representative 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, legal
guardian, or conservator, that a designated representative receive
written notice of all meetings to develop or revise his or her
individual program plan and of all notices sent to the consumer
pursuant to Section 4710. The designated representative may be a
parent or family member.
(f) If a final agreement regarding the services and supports to be
provided to the consumer cannot be reached at a program plan
meeting, then a subsequent program plan meeting shall be convened
within 15 days, or later at the request of the consumer or, when
appropriate, the parents, legal guardian, conservator, or authorized
representative or when agreed to by the planning team. Additional
program plan meetings may be held with the agreement of the regional
center representative and the consumer or, where appropriate, the
parents, legal guardian, conservator, or authorized representative.
(g) An authorized representative of the regional center and the
consumer or, where appropriate, his or her parents, legal guardian,
or conservator, shall sign the individual program plan prior to its
implementation. If the consumer or, where appropriate, his or her
parents, legal guardian, or conservator, does not agree with all
components of the plan, they may indicate that disagreement on the
plan. Disagreement with specific plan components shall not prohibit
the implementation of services and supports agreed to by the consumer
or, where appropriate, his or her parents, legal guardian, or
conservator. If the consumer or, where appropriate, his or her
parents, legal guardian, or conservator, does not agree with the plan
in whole or in part, he or she shall be sent written notice of the
fair hearing rights, as required by Section 4701.
4646.4. (a) Effective September 1, 2008, regional centers shall
ensure, at the time of development, scheduled review, or modification
of a consumer's individual program plan developed pursuant to
Sections 4646 and 4646.5, or of an individualized family service plan
pursuant to Section 95020 of the Government Code, the establishment
of an internal process. This internal process shall ensure adherence
with federal and state law and regulation, and when purchasing
services and supports, shall ensure all of the following:
(1) Conformance with the regional center's purchase of service
policies, 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 as
contained in Section 4659.
(4) Consideration of the family's responsibility for providing
similar services and supports for a minor child without disabilities
in identifying the consumer's service and support needs as provided
in the least restrictive and most appropriate setting. In this
determination, 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 program
plan shall be made pursuant to Section 4646.
(c) Final decisions regarding the individual family support plan
shall be made pursuant to Section 95020 of the Government Code.
(d) By no later than April 1, 2009, the department shall provide
the fiscal and policy committees of the Legislature with a written
update regarding the implementation of this section.
4646.5. (a) The planning process for the individual program plan
described in Section 4646 shall include all of the following:
(1) Gathering information and conducting assessments to determine
the life goals, capabilities and strengths, preferences, barriers,
and concerns or problems of the person with developmental
disabilities. For children with developmental disabilities, this
process should include a review of the strengths, preferences, and
needs of the child and the family unit as a whole. Assessments shall
be conducted by qualified individuals and performed in natural
environments whenever possible. Information shall be taken from the
consumer, his or her parents and other family members, his or her
friends, advocates, providers of services and supports, and other
agencies. The assessment process shall reflect awareness of, and
sensitivity to, the lifestyle and cultural background of the consumer
and the family.
(2) A statement of goals, based on the needs, preferences, and
life choices of the individual with developmental disabilities, and a
statement of specific, time-limited objectives for implementing the
person's goals and addressing his or her needs. These objectives
shall be stated in terms that allow measurement of progress or
monitoring of service delivery. These goals and objectives should
maximize opportunities for the consumer to develop relationships, be
part of community life in the areas of community participation,
housing, work, school, and leisure, increase control over his or her
life, acquire increasingly positive roles in community life, and
develop competencies to help accomplish these goals.
(3) When developing individual program plans for children,
regional centers shall be guided by the principles, process, and
services and support parameters set forth in Section 4685.
(4) A schedule of the type and amount of services and supports to
be purchased by the regional center or obtained from generic agencies
or other resources in order to achieve the individual program plan
goals and objectives, and identification of the provider or providers
of service responsible for attaining each objective, including, but
not limited to, vendors, contracted providers, generic service
agencies, and natural supports. The plan shall specify the
approximate scheduled start date for services and supports and shall
contain timelines for actions necessary to begin services and
supports, including generic services.
(5) When agreed to by the consumer, the parents or legally
appointed guardian of a minor consumer, or the legally appointed
conservator of an adult consumer or the authorized representative,
including those appointed pursuant to subdivision (d) of Section 4548
and subdivision (e) of Section 4705, a review of the general health
status of the adult or child including a medical, dental, and mental
health needs shall be conducted. This review shall include a
discussion of current medications, any observed side effects, and the
date of last review of the medication. Service providers shall
cooperate with the planning team to provide any information necessary
to complete the health status review. If any concerns are noted
during the review, referrals shall be made to regional center
clinicians or to the consumer's physician, as appropriate.
Documentation of health status and referrals shall be made in the
consumer's record by the service coordinator.
(6) A schedule of regular periodic review and reevaluation to
ascertain that planned services have been provided, that objectives
have been fulfilled within the times specified, and that consumers
and families are satisfied with the individual program plan and its
implementation.
(b) For all active cases, individual program plans shall be
reviewed and modified by the planning team, through the process
described in Section 4646, as necessary, in response to the person's
achievement or changing needs, and no less often than once every
three years. If the consumer or, where appropriate, the consumer's
parents, legal guardian, or conservator requests an individual
program plan review, the individual program shall be reviewed within
30 days after the request is submitted.
(c) (1) The department, with the participation of representatives
of a statewide consumer organization, the Association of Regional
Center Agencies, an organized labor organization representing service
coordination staff, and the Organization of Area Boards shall
prepare training material and a standard format and instructions for
the preparation of individual program plans, which embodies an
approach centered on the person and family.
(2) Each regional center shall use the training materials and
format prepared by the department pursuant to paragraph (1).
(3) The department shall biennially review a random sample of
individual program plans at each regional center to assure that these
plans are being developed and modified in compliance with Section
4646 and this section.
4646.55. (a) Notwithstanding any other provision of law or
regulation to the contrary, and to the extent federal financial
participation is available, effective July 1, 2007, the State
Department of Developmental Services is hereby authorized to make
supplemental payment to an enrolled Medi-Cal provider that is a
licensed intermediate care facility/developmentally
disabled-habilitative, licensed intermediate care
facility/developmentally disabled-nursing, or licensed intermediate
care facility/developmentally disabled, for day treatment and
transportation services provided pursuant to Sections 4646 and
4646.5, applicable regulations, and Section 14132.925, to Medi-Cal
beneficiaries residing in a licensed intermediate care
facility/developmentally disabled-habilitative, licensed intermediate
care facility/developmentally disabled-nursing, or licensed
intermediate care facility/developmentally disabled. These payments
shall be considered supplemental payments to the enrolled Medi-Cal
provider and shall be comprised of the full costs of reimbursing
regional centers for making disbursements to day treatment and
transportation service providers, plus a coordination fee which will
include an administrative fee and reimbursement for the increased
costs associated with the quality assurance fee paid accordingly and
without a separate State Department of Developmental Services
contract.
(b) Notwithstanding any other provision of law and to the extent
federal financial participation is available, and in furtherance of
this section and Section 14132.925, the State Department of
Developmental Services shall amend the regional center contracts for
the 2007-08 fiscal year to extend the contract liquidation period
until June 30, 2011. The contract amendments and budget adjustments
shall be exempt from the provisions of Article 1 (commencing with
Section 4620).
4646.6. Notwithstanding Section 632 of the Penal Code, a consumer,
or his or her parent, guardian, conservator, or authorized
representative, shall have the right to record electronically the
proceedings of the individual program plan meetings on an audiotape
recorder. The consumer, or his or her parent, guardian, conservator,
or authorized representative, shall notify the regional center of
their intent to record a meeting at least 24 hours prior to the
meeting. If the regional center initiates the notice of intent to
audiotape record a meeting and the consumer, or his or her parent,
guardian, conservator, or authorized representative, refuses to
attend the meeting because it will be tape recorded, the meeting
shall not be recorded on an audiotape recorder. However, the regional
center shall have the right to electronically record the meeting
when notice of intent to record has been given by the consumer or on
the consumer's behalf.
4647. (a) Pursuant to Section 4640.7, service coordination shall
include those activities necessary to implement an individual program
plan, including, but not limited to, participation in the individual
program plan process; assurance that the planning team considers all
appropriate options for meeting each individual program plan
objective; securing, through purchasing or by obtaining from generic
agencies or other resources, services and supports specified in the
person's individual program plan; coordination of service and support
programs; collection and dissemination of information; and
monitoring implementation of the plan to ascertain that objectives
have been fulfilled and to assist in revising the plan as necessary.
(b) The regional center shall assign a service coordinator who
shall be responsible for implementing, overseeing, and monitoring
each individual program plan. The service coordinator may be an
employee of the regional center or may be a qualified individual or
employee of an agency with whom the regional center has contracted to
provide service coordination services, or persons described in
Section 4647.2. The regional center shall provide the consumer or,
where appropriate, his or her parents, legal guardian, or conservator
or authorized representative, with written notification of any
permanent change in the assigned service coordinator within 10
business days. No person shall continue to serve as a service
coordinator for any individual program plan unless there is agreement
by all parties that the person should continue to serve as service
coordinator.
(c) Where appropriate, a consumer or the consumer's parents or
other family members, legal guardian, or conservator, may perform all
or part of the duties of the service coordinator described in this
section if the regional center director agrees and it is feasible.
(d) If any person described in subdivision (c) is designated as
the service coordinator, that person shall not deviate from the
agreed-upon program plan and shall provide any reasonable information
and reports required by the regional center director.
(e) If any person described in subdivision (c) is designated as
the service coordinator, the regional center shall provide ongoing
information and support as necessary, to assist the person to perform
all or part of the duties of service coordinator.
4648. In order to achieve the stated objectives of a consumer's
individual program plan, the regional center shall conduct
activities, 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 supports
assist individuals with developmental disabilities in achieving the
greatest self-sufficiency possible and in exercising personal
choices. The regional center shall secure services and supports that
meet the needs of the consumer, as determined in the consumer's
individual program plan, and within the context of the individual
program plan, the planning team shall give highest preference to
those services and supports which would allow minors with
developmental disabilities to live with their families, adult persons
with developmental disabilities to live as independently as possible
in the community, and that allow all consumers to interact with
persons without disabilities in positive, meaningful ways.
(2) In implementing individual program plans, regional centers,
through the planning team, shall first consider services and supports
in natural community, home, work, and recreational settings.
Services and supports shall be flexible and individually tailored to
the consumer and, where appropriate, his or her family.
(3) A regional center may, pursuant to vendorization or a
contract, purchase services or supports for a consumer from any
individual or agency which the regional center and consumer or, where
appropriate, his or her parents, legal guardian, or conservator, or
authorized representatives, determines will best accomplish all or
any part of that consumer's program plan.
(A) Vendorization or contracting is the process for
identification, selection, and utilization of service vendors or
contractors, based on the qualifications and other requirements
necessary in order to provide the service.
(B) A regional center may reimburse an individual or agency for
services or supports provided to a regional center consumer if the
individual or agency has a rate of payment for vendored or contracted
services established by the department, pursuant to this division,
and is providing services pursuant to an emergency vendorization or
has completed the vendorization procedures or has entered into a
contract with the regional center and continues to comply with the
vendorization or contracting requirements. The director shall adopt
regulations governing the vendorization process to be utilized by the
department, regional centers, vendors and the individual or agency
requesting vendorization.
(C) Regulations shall include, but not be limited to: the vendor
application process, and the basis for accepting or denying an
application; the qualification and requirements for each category of
services that may be provided to a regional center consumer through a
vendor; requirements for emergency vendorization; procedures for
termination of vendorization; the procedure for an individual or an
agency to appeal any vendorization decision made by the department or
regional center.
(D) A regional center may vendorize a licensed facility for
exclusive services to persons with developmental disabilities at a
capacity equal to or less than the facility's licensed capacity. A
facility already licensed on January 1, 1999, shall continue to be
vendorized at their full licensed capacity until the facility agrees
to vendorization at a reduced capacity.
(E) Effective July 1, 2009, notwithstanding any other provision of
law or regulation to the contrary, a regional center shall not newly
vendor a State Department of Social Services licensed 24-hour
residential care facility with a licensed capacity of 16 or more
beds, unless the facility qualifies for receipt of federal funds
under the Medicaid Program.
(4) Notwithstanding subparagraph (B), a regional center may
contract or issue a voucher for services and supports provided to a
consumer or family at a cost not to exceed the maximum rate of
payment for that service or support established by the department. If
a rate has not been established by the department, the regional
center may, for an interim period, contract for a specified service
or support with, and establish a rate of payment for, any provider of
the service or support necessary to implement a consumer's
individual program plan. Contracts may be negotiated for a period of
up to three years, with annual review and subject to the availability
of funds.
(5) In order to ensure the maximum flexibility and availability of
appropriate services and supports for persons with developmental
disabilities, the department shall establish and maintain an
equitable system of payment to providers of services and supports
identified as necessary to the implementation of a consumers'
individual program plan. The system of payment shall include
provision for a rate to ensure that the provider can meet the special
needs of consumers and provide quality services and supports in the
least restrictive setting as required by law.
(6) The regional center and the consumer, or where appropriate,
his or her parents, legal guardian, conservator, or authorized
representative, including those appointed pursuant to subdivision (d)
of Section 4548 or subdivision (e) of Section 4705, shall, pursuant
to the individual program plan, consider all of the following when
selecting a provider of consumer services and supports:
(A) A provider's ability to deliver quality services or supports
which can accomplish all or part of the consumer's individual program
plan.
(B) A provider's success in achieving the objectives set forth in
the individual program plan.
(C) Where appropriate, the existence of licensing, accreditation,
or professional certification.
(D) The cost of providing services or supports of comparable
quality by different providers, if available, shall be reviewed, and
the least costly available provider of comparable service, including
the cost of transportation, who is able to accomplish all or part of
the consumer's individual program plan, consistent with the
particular needs of the consumer and family as identified in the
individual program plan, shall be selected. In determining the least
costly provider, the availability of federal financial participation
shall be considered. The consumer shall not be required to use the
least costly provider if it will result in the consumer moving from
an existing provider of services or supports to more restrictive or
less integrated services or supports.
(E) The consumer's or, where appropriate, the parents, legal
guardian, or conservator of a consumer's choice of providers.
(7) No service or support provided by any agency or individual
shall be continued unless the consumer or, where appropriate, his or
her parents, legal guardian, or conservator, or authorized
representative, including those appointed pursuant to subdivision (d)
of Section 4548 or subdivision (e) of Section 4705, is satisfied and
the regional center and the consumer or, when appropriate, the
person's parents or legal guardian or conservator agree that planned
services and supports have been provided, and reasonable progress
toward objectives have been made.
(8) Regional center funds shall not be used to supplant the budget
of any agency which has a legal responsibility to serve all members
of the general public and is receiving public funds for providing
those services.
(9) (A) A regional center may, directly or through an agency
acting on behalf of the center, provide placement in, purchase of, or
follow-along services to persons with developmental disabilities in,
appropriate community living arrangements, including, but not
limited to, support service for consumers in homes they own or lease,
foster family placements, health care facilities, and licensed
community care facilities. In considering appropriate placement
alternatives for children with developmental disabilities, approval
by the child's parent or guardian shall be obtained before placement
is made.
(B) Effective July 1, 2012, notwithstanding any other provision of
law or regulation to the contrary, a regional center shall not
purchase residential services from a State Department of Social
Services licensed 24-hour residential care facility with a licensed
capacity of 16 or more beds. This prohibition on regional center
purchase of residential services shall not apply to either of the
following:
(i) A residential facility with a licensed capacity of 16 or more
beds that has been approved to participate in the department's Home
and Community Based Services Waiver or another existing waiver
program or certified to participate in the Medi-Cal program.
(ii) A residential facility service provider that has a written
agreement and specific plan prior to July 1, 2012, with the vendoring
regional center to downsize the existing facility by transitioning
its residential services to living arrangements of 15 beds or less or
restructure the large facility to meet federal Medicaid eligibility
requirements on or before June 30, 2013.
(C) Each person with developmental disabilities placed by the
regional center in a community living arrangement shall have the
rights specified in this division. These rights shall be brought to
the person's attention by any means necessary to reasonably
communicate these rights to each resident, provided that, at a
minimum, the Director of Developmental Services prepare, provide, and
require to be clearly posted in all residential facilities and day
programs a poster using simplified language and pictures that is
designed to be more understandable by persons with cognitive
disabilities and that the rights information shall also be available
through the regional center to each residential facility and day
program in alternative formats, including, but not limited to, other
languages, braille, and audio tapes, when necessary to meet the
communication needs of consumers.
(D) Consumers are eligible to receive supplemental services
including, but not limited to, additional staffing, pursuant to the
process described in subdivision (d) of Section 4646. Necessary
additional staffing that is not specifically included in the rates
paid to the service provider may be purchased by the regional center
if the additional staff are in excess of the amount required by
regulation and the individual's planning team determines the
additional services are consistent with the provisions of the
individual program plan. Additional staff should be periodically
reviewed by the planning team for consistency with the individual
program plan objectives in order to determine if continued use of the
additional staff is necessary and appropriate and if the service is
producing outcomes consistent with the individual program plan.
Regional centers shall monitor programs to ensure that the additional
staff is being provided and utilized appropriately.
(10) Emergency and crisis intervention services including, but not
limited to, mental health services and behavior modification
services, may be provided, as needed, to maintain persons with
developmental disabilities in the living arrangement of their own
choice. Crisis services shall first be provided without disrupting a
person's living arrangement. If crisis intervention services are
unsuccessful, emergency housing shall be available in the person's
home community. If dislocation cannot be avoided, every effort shall
be made to return the person to his or her living arrangement of
choice, with all necessary supports, as soon as possible.
(11) Among other service and support options, planning teams shall
consider the use of paid roommates or neighbors, personal
assistance, technical and financial assistance, and all other service
and support options which would result in greater self-sufficiency
for the consumer and cost-effectiveness to the state.
(12) When facilitation as specified in an individual program plan
requires the services of an individual, the facilitator shall be of
the consumer's choosing.
(13) The community support may be provided to assist individuals
with developmental disabilities to fully participate in community and
civic life, including, but not limited to, programs, services, work
opportunities, business, and activities available to persons without
disabilities. This facilitation shall include, but not be limited to,
any of the following:
(A) Outreach and education to programs and services within the
community.
(B) Direct support to individuals which would enable them to more
fully participate in their community.
(C) Developing unpaid natural supports when possible.
(14) Other services and supports may be provided as set forth in
Sections 4685, 4686, 4687, 4688, and 4689, when necessary.
(15) Notwithstanding any other provision of law or regulation to
the contrary, effective July 1, 2009, regional centers shall not
purchase experimental treatments, therapeutic services, or devices
that have not been clinically determined or scientifically proven to
be effective or safe or for which risks and complications are
unknown. Experimental treatments or therapeutic services include
experimental medical or nutritional therapy when the use of the
product for that purpose is not a general physician practice. For
regional center consumers receiving these services as part of their
individual 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, and
service rights of persons with developmental disabilities as
established in this division.
(2) Whenever the advocacy efforts of a regional center to secure
or protect the civil, legal, or service rights of any of its
consumers prove ineffective, the regional center or the person with
developmental disabilities or his or her parents, legal guardian, or
other representative may request the area board to initiate action
under the provisions defining area board advocacy functions
established in this division.
(c) The regional center may assist consumers and families
directly, or through a provider, in identifying and building circles
of support within the community.
(d) In order to increase the quality of community services and
protect consumers, the regional center shall, when appropriate, take
either of the following actions:
(1) Identify services and supports that are ineffective or of poor
quality and provide or secure consultation, training, or technical
assistance services for any agency or individual provider to assist
that agency or individual provider in upgrading the quality of
services or supports.
(2) Identify providers of services or supports that may not be in
compliance with local, state, and federal statutes and regulations
and notify the appropriate licensing or regulatory authority, or
request the area board to investigate the possible noncompliance.
(e) When necessary to expand the availability of needed services
of good quality, a regional center may take actions that include, but
are not limited to, the following:
(1) Soliciting an individual or agency by requests for proposals
or other means, to provide needed services or supports not presently
available.
(2) Requesting funds from the Program Development Fund, pursuant
to Section 4677, or community placement plan funds designated from
that fund, to reimburse the startup costs needed to initiate a new
program 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 not
provide direct treatment and therapeutic services, but shall utilize
appropriate public and private community agencies and service
providers to obtain those services for its consumers.
(g) Where there are identified gaps in the system of services and
supports or where there are identified consumers for whom no provider
will provide services and supports contained in his or her
individual program plan, the department may provide the services and
supports directly.
(h) At least annually, regional centers shall provide the
consumer, his or her parents, legal guardian, conservator, or
authorized representative a statement of services and supports the
regional center purchased for the purpose of ensuring that they are
delivered. The statement shall include the type, unit, month, and
cost of services and supports purchased.
4648.1. (a) The State Department of Developmental Services and
regional centers may monitor services and supports purchased for
regional center consumers with or without prior notice. Not less than
two monitoring visits to a licensed long-term health care or
community care facility or family home agency home each year shall be
unannounced. The department may conduct fiscal reviews and audits of
the service providers' records.
(b) Department and regional center staff involved in monitoring or
auditing services provided to the regional centers' consumers by a
service provider shall have access to the provider's grounds,
buildings, and service program, and to all related records, including
books, papers, computerized data, accounting records, and related
documentation. All persons connected with the service provider's
program, including, but not limited to, program administrators,
staff, consultants, and accountants, shall provide information and
access to facilities as required by the department or regional
center.
(c) The department, in cooperation with regional centers, shall
ensure that all providers of services and supports purchased by
regional centers for their consumers are informed of all of the
following:
(1) The provisions of this section.
(2) The responsibility of providers to comply with laws and
regulations governing both their service program and the provision of
services and supports to people with developmental disabilities.
(3) The responsibility of providers to comply with conditions of
any contract or agreement between the regional center and the
provider, and between the provider and the department.
(4) The rights of providers established in regulations adopted
pursuant to Sections 4648.2, 4748, and 4780.5, to appeal actions
taken by regional centers or the department as a result of their
monitoring and auditing findings.
(d) A regional center may terminate payments for services, and may
terminate its contract or authorization for the purchase of consumer
services if it determines that the provider has not complied with
provisions of its contract or authorization with the regional center
or with applicable state laws and regulations. When terminating
payments for services or its contract or authorization for the
purchase of consumer services, a regional center shall make
reasonable efforts to avoid unnecessary disruptions of consumer
services.
(e) A regional center or the department may recover from the
provider funds paid for services when the department or the regional
center determines that either of the following has occurred:
(1) The services were not provided in accordance with the regional
center's contract or authorization with the provider, or with
applicable state laws or regulations.
(2) The rate paid is based on inaccurate data submitted by the
provider on a provider cost statement.
Any funds so recovered shall be remitted to the department.
(f) Any evidence of suspected licensing violations found by
department or regional center personnel shall be reported immediately
to the appropriate state licensing agency.
(g) Regional centers may establish volunteer teams, made up of
consumers, parents, other family members, and advocates to conduct
the monitoring activities described in this section.
(h) In meeting its responsibility to provide technical assistance
to providers of community living arrangements for persons with
developmental disabilities, including, but not limited to, licensed
residential facilities, family home agencies, and supported or
independent living arrangements, a regional center shall utilize the
"Looking at Service Quality-Provider's Handbook" developed by the
department or subsequent revisions developed by the department.
(i) Effective July 1, 2009, a regional center shall not be
required to perform triennial evaluations of community care
facilities, as described in Sections 56046, 56049, 56050, 56051, and
56052 of Title 17 of the California Code of Regulations.
4648.2. By September 1, 1986, the State Department of Developmental
Services shall promulgate regulations which establish a process for
service providers to appeal actions the department takes as a result
of its auditing and monitoring activities. To the extent possible,
this process shall include procedures contained in fiscal audit
appeals regulations established pursuant to Section 4780.5.
4648.3. A provider of transportation services to regional center
clients for the regional center shall maintain protection against
liability for damages for bodily injuries or death and for damage to
or destruction of property, which may be incurred by the provider in
the course of providing those services. The protection shall be
maintained at the level established by the regional center to which
the 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 following
shall apply to a regional center:
(a) A regional center shall not fund private specialized
transportation services for an adult consumer who can safely access
and utilize public transportation, when that transportation is
available.
(b) A regional center shall fund the least expensive
transportation modality that meets the consumer's needs, as set forth
in 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 provides
the service that meets the consumer's needs, as set forth in the
consumer's IPP or IFSP. For purposes of this subdivision, the cost of
a vendor shall be determined by combining the vendor's program costs
and the costs to transport a consumer from the consumer's residence
to the vendor.
(d) A regional center shall fund transportation services for a
minor child living in the family residence, only if the family of the
child provides sufficient written documentation to the regional
center to demonstrate that it is unable to provide transportation for
the child.
4648.4. (a) Notwithstanding any other provision of law or
regulation, commencing July 1, 2006, rates for services listed in
paragraphs (1), (2), with the exception of travel reimbursement, (3)
to (8), inclusive, (10), and (11) of subdivision (b), shall be
increased by 3 percent, subject to funds specifically appropriated
for this increase in the Budget Act of 2006. The increase shall be
applied as a percentage, and the percentage shall be the same for all
providers. 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 provider
of the following services or supports a rate that is greater than the
rate that is in effect on or after June 30, 2008, unless the
increase is required by a contract between the regional center and
the vendor that is in effect on June 30, 2008, or the regional center
demonstrates that the approval is necessary to protect the consumer'
s health or safety and the department has granted prior written
authorization:
(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 or
regulations to the contrary, effective July 1, 2009, a regional
centers' authority to purchase the following services shall be
suspended pending implementation of the Individual Choice Budget and
certification by the Director of Developmental Services that the
Individual Choice Budget has been implemented and will result in
state budget savings sufficient to offset the costs of providing the
following services:
(1) Camping services and associated travel expenses.
(2) Social recreation activities, except for those activities
vendored 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 in
subdivision (a) as part of their individual program plan (IPP) or
individualized family service plan (IFSP), the prohibition in
subdivision (a) shall take effect on August 1, 2009.
(c) An exemption may be granted on an individual basis in
extraordinary circumstances to permit purchase of a service
identified in subdivision (a) when the regional center determines
that the service is a primary or critical means for ameliorating the
physical, cognitive, or psychosocial effects of the consumer's
developmental disability, or the service is necessary to enable the
consumer to remain in his or her home and no alternative service is
available to meet the consumer's needs.
4648.6. The department, in consultation with stakeholders, shall
develop an alternative service delivery model that provides an
Individual Choice Budget for obtaining quality services and supports
which provides choice and flexibility within a finite budget that in
the aggregate reduces regional center purchase of service
expenditures, reduces reliance on the state general fund, and
maximizes federal financial participation in the delivery of
services. The individual budget will be determined using a fair,
equitable, transparent standardized process.
4649. Regional centers shall cooperate with area boards in joint
efforts to inform the public of services available to persons with
developmental disabilities and of their unmet needs, provide
materials and education programs to community groups and agencies
with interest in, or responsibility for, persons with developmental
disabilities, and develop resource materials, if necessary,
containing information about local agencies, facilities, and service
providers offering services to persons with developmental
disabilities.
4650. Regional centers shall be responsible for developing an
annual plan and program budget to be submitted to the director no
later than September 1 of each fiscal year. An information copy shall
be submitted to the area board and state council by the same date.
4651. (a) It is the intent of the Legislature that regional centers
shall find innovative and economical methods of achieving the
objectives contained in individual program plans of persons with
developmental disabilities.
(b) The department shall encourage and assist regional centers to
use innovative programs, techniques, and staffing arrangements to
carry out their responsibilities.
4652. A regional center shall investigate every appropriate and
economically feasible alternative for care of a developmentally
disabled person available within the region. If suitable care cannot
be found within the region, services may be obtained outside of the
region.
4653. Except for those developmentally disabled persons judicially
committed to state hospitals, no developmentally disabled person
shall be admitted to a state hospital except upon the referral of a
regional center. Upon discharge from a state hospital, a
developmentally disabled person shall be referred to an appropriate
regional center.
4654. Before any person is examined by a regional center pursuant
to Section 1370.1 of the Penal Code, the court ordering such medical
examination shall transmit to the regional center a copy of the
orders made pursuant to proceedings conducted under Sections 1368 and
1369 of the Penal Code. The purpose of the mental examination shall
be to determine if developmental disability is the primary diagnosis.
4655. The director of a regional center or his designee may give
consent to medical, dental, and surgical treatment of a regional
center client and provide for such treatment to be given to the
person under the following conditions:
(a) If the developmentally disabled person's parent, guardian, or
conservator legally authorized to consent to such treatment does not
respond within a reasonable time to the request of the director or
his designee for the granting or denying of consent for such
treatment, the director of a regional center or his designee may
consent on behalf of the developmentally disabled person to such
treatment 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 director
of the regional center or his designee may consent to such treatment
on behalf of the person and provide for such treatment to be given to
the person. The director of a regional center or his designee may
thereupon also initiate, or cause to be initiated, proceedings for
the appointment of a guardian or conservator legally authorized to
consent to medical, dental, or surgical services.
(c) If the developmentally disabled person is an adult and has no
conservator, consent to treatment may be given by someone other than
the person on the person's behalf only if the developmentally
disabled person is mentally incapable of giving his own consent.
4656. (a) A qualified physician and surgeon who diagnoses a
developmental disability, as defined in subdivision (a) of Section
4512, of a patient who is a minor shall attempt to determine from the
patie
4640. (a) Contracts between the department and regional centers
shall specify the service area and the categories of persons that
regional centers shall be expected to serve and the services and
supports to be provided.
(b) In order to ensure uniformity in the application of the
definition of developmental disability contained in this division,
the Director of Developmental Services shall, by March 1, 1977, issue
regulations that delineate, by diagnostic category and degree of
disability, those persons who are eligible for services and supports
by regional centers. In issuing the regulations, the director shall
invite and consider the views of regional center contracting
agencies, the state council, and persons with a demonstrated and
direct interest in developmental disabilities.
4640.6. (a) In approving regional center contracts, the department
shall ensure that regional center staffing patterns demonstrate that
direct service coordination are the highest priority.
(b) Contracts between the department and regional centers shall
require that regional centers implement an emergency response system
that ensures that a regional center staff person will respond to a
consumer, or individual acting on behalf of a consumer, within two
hours of the time an emergency call is placed. This emergency
response system shall be operational 24 hours per day, 365 days per
year.
(c) Contracts between the department and regional centers shall
require regional centers to have service coordinator-to-consumer
ratios, as follows:
(1) An average service coordinator-to-consumer ratio of 1 to 62
for all consumers who have not moved from the developmental centers
to the community since April 14, 1993. In no case shall a service
coordinator for these consumers have an assigned caseload in excess
of 79 consumers for more than 60 days.
(2) An average service coordinator-to-consumer ratio of 1 to 45
for all consumers who have moved from a developmental center to the
community since April 14, 1993. In no case shall a service
coordinator for these consumers have an assigned caseload in excess
of 59 consumers for more than 60 days.
(3) Commencing January 1, 2004, the following
coordinator-to-consumer ratios shall apply:
(A) All consumers three years of age and younger and for consumers
enrolled in the Home and Community-based Services Waiver program for
persons with developmental disabilities, an average service
coordinator-to-consumer ratio of 1 to 62.
(B) All consumers who have moved from a developmental center to
the community since April 14, 1993, and have lived continuously in
the community for at least 12 months, an average service
coordinator-to-consumer ratio of 1 to 62.
(C) All consumers who have not moved from the developmental
centers to the community since April 14, 1993, and who are not
described in subparagraph (A), an average service
coordinator-to-consumer ratio of 1 to 66.
(4) For purposes of paragraph (3), service coordinators may have a
mixed caseload of consumers three years of age and younger,
consumers enrolled in the Home and Community-based Services Waiver
program for persons with developmental disabilities, and other
consumers if the overall average caseload is weighted proportionately
to ensure that overall regional center average service
coordinator-to-consumer ratios as specified in paragraph (3) are met.
For purposes of paragraph (3), in no case shall a service
coordinator have an assigned caseload in excess of 84 for more than
60 days.
(d) For purposes of this section, "service coordinator" means a
regional center employee whose primary responsibility includes
preparing, implementing, and monitoring consumers' individual program
plans, securing and coordinating consumer services and supports, and
providing placement and monitoring activities.
(e) In order to ensure that caseload ratios are maintained
pursuant to this section, each regional center shall provide service
coordinator caseload data to the department, annually for each fiscal
year. The data shall be submitted in the format, including the
content, prescribed by the department. Within 30 days of receipt of
data submitted pursuant to this subdivision, the department shall
make a summary of the data available to the public upon request. The
department shall verify the accuracy of the data when conducting
regional center fiscal audits. Data submitted by regional centers
pursuant to this subdivision shall:
(1) Only include data on service coordinator positions as defined
in subdivision (d). Regional centers shall identify the number of
positions that perform service coordinator duties on less than a
full-time basis. Staffing ratios reported pursuant to this
subdivision shall reflect the appropriate proportionality of these
staff to consumers served.
(2) Be reported separately for service coordinators whose caseload
includes any of the following:
(A) Consumers who are three years of age and older and who have
not moved from the developmental center to the community since April
14, 1993.
(B) Consumers who have moved from a developmental center to the
community since April 14, 1993.
(C) Consumers who are younger than three years of age.
(D) Consumers enrolled in the Home and Community-based Services
Waiver program.
(3) Not include positions that are vacant for more than 60 days or
new positions established within 60 days of the reporting month that
are still vacant.
(4) For purposes of calculating caseload ratios for consumers
enrolled 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 require
a plan of correction for any regional center that, for two
consecutive reporting periods, fails to maintain service coordinator
caseload ratios required by this section or otherwise demonstrates an
inability to maintain appropriate staffing patterns pursuant to this
section. Plans of correction shall be developed following input from
the local area board, local organizations representing consumers,
family members, regional center employees, including recognized labor
organizations, and service providers, and other interested parties.
(g) Contracts between the department and regional center shall
require the regional center to have, or contract for, all of the
following areas:
(1) Criminal justice expertise to assist the regional center in
providing services and support to consumers involved in the criminal
justice system as a victim, defendant, inmate, or parolee.
(2) Special education expertise to assist the regional center in
providing advocacy and support to families seeking appropriate
educational services from a school district.
(3) Family support expertise to assist the regional center in
maximizing the effectiveness of support and services provided to
families.
(4) Housing expertise to assist the regional center in accessing
affordable housing for consumers in independent or supportive living
arrangements.
(5) Community integration expertise to assist consumers and
families in accessing integrated services and supports and improved
opportunities to participate in community life.
(6) Quality assurance expertise, to assist the regional center to
provide the necessary coordination and cooperation with the area
board in conducting quality-of-life assessments and coordinating the
regional center quality assurance efforts.
(7) Each regional center shall employ at least one consumer
advocate who is a person with developmental disabilities.
(8) Other staffing arrangements related to the delivery of
services that the department determines are necessary to ensure
maximum cost-effectiveness and to ensure that the service needs of
consumers and families are met.
(h) Any regional center proposing a staffing arrangement that
substantially deviates from the requirements of this section shall
request a waiver from the department. Prior to granting a waiver, the
department shall require a detailed staffing proposal, including,
but not limited to, how the proposed staffing arrangement will
benefit consumers and families served, and shall demonstrate clear
and convincing support for the proposed staffing arrangement from
constituencies served and impacted, that include, but are not limited
to, consumers, families, providers, advocates, and recognized labor
organizations. In addition, the regional center shall submit to the
department any written opposition to the proposal from organizations
or individuals, including, but not limited to, consumers, families,
providers, and advocates, including recognized labor organizations.
The department may grant waivers to regional centers that
sufficiently demonstrate that the proposed staffing arrangement is in
the best interest of consumers and families served, complies with
the requirements of this chapter, and does not violate any
contractual requirements. A waiver shall be approved by the
department for up to 12 months, at which time a regional center may
submit a new request pursuant to this subdivision.
(i) From February 1, 2009, to June 30, 2010, inclusive, the
following shall not apply:
(1) The service coordinator-to-consumer ratio requirements of
paragraph (1), and subparagraph (C) of paragraph (3), of subdivision
(c).
(2) The requirements of subdivision (e). The regional centers
shall, instead, maintain sufficient service coordinator caseload data
to document compliance with the service coordinator-to-consumer
ratio requirements in effect pursuant to this section.
(3) The requirements of paragraphs (1) to (6), inclusive, of
subdivision (g).
(j) From July 1, 2010, to June 30, 2011, inclusive, the following
shall not apply:
(1) The service coordinator-to-consumer ratio requirements of
paragraph (1), and subparagraph (C) of paragraph (3), of subdivision
(c).
(2) The requirements of paragraphs (1) to (6), inclusive, of
subdivision (g).
(k) (1) Any contract between the department and a regional center
entered into on and after January 1, 2003, shall require that all
employment contracts entered into with regional center staff or
contractors be available to the public for review, upon request. For
purposes of this subdivision, an employment contract or portion
thereof may not be deemed confidential nor unavailable for public
review.
(2) Notwithstanding paragraph (1), the social security number of
the contracting party may not be disclosed.
(3) The term of the employment contract between the regional
center and an employee or contractor shall not exceed the term of the
state's contract with the regional center.
4640.7. (a) It is the intent of the Legislature that regional
centers assist persons with developmental disabilities and their
families in securing those services and supports which maximize
opportunities and choices for living, working, learning, and
recreating in the community.
(b) Each regional center design shall reflect the maximum
cost-effectiveness possible and shall be based on a service
coordination model, in which each consumer shall have a designated
service coordinator who is responsible for providing or ensuring that
needed services and supports are available to the consumer. Regional
centers shall examine the differing levels of coordination services
needed by consumers and families in order to establish varying
caseload ratios within the regional center which will best meet those
needs of their consumers.
4640.8. When convening any task force or advisory group, a regional
center shall make its best effort to ensure representation by
consumers and family members representing the community's
multicultural diversity.
4641. All regional centers shall conduct casefinding activities,
including notification of availability of service in English and such
other languages as may be appropriate to the service area, outreach
services in areas with a high incidence of developmental
disabilities, and identification of persons who may need service.
4642. Any person believed to have a developmental disability, and
any person believed to have a high risk of parenting a
developmentally disabled infant shall be eligible for initial intake
and assessment services in the regional centers. In addition, any
infant having a high risk of becoming developmentally disabled may be
eligible for initial intake and assessment services in the regional
centers. For purposes of this section, "high-risk infant" means a
child less than 36 months of age whose genetic, medical, or
environmental history is predictive of a substantially greater risk
for developmental disability than that for the general population.
The department, in consultation with the State Department of Health
Services, shall develop specific risk and service criteria for the
high-risk infant program on or before July 1, 1983. These criteria
may be modified in subsequent years based on analysis of actual
clinical experience.
Initial intake shall be performed within 15 working days following
request for assistance. Initial intake shall include, but need not
be limited to, information and advice about the nature and
availability of services provided by the regional center and by other
agencies in the community, including guardianship, conservatorship,
income maintenance, mental health, housing, education, work activity
and vocational training, medical, dental, recreational, and other
services or programs that may be useful to persons with developmental
disabilities or their families. Intake shall also include a decision
to provide assessment.
4643. (a) If assessment is needed, the assessment shall be
performed within 120 days following initial intake. Assessment shall
be performed as soon as possible and in no event more than 60 days
following initial intake where any delay would expose the client to
unnecessary risk to his or her health and safety or to significant
further delay in mental or physical development, or the client would
be at imminent risk of placement in a more restrictive environment.
Assessment may include collection and review of available historical
diagnostic data, provision or procurement of necessary tests and
evaluations, and summarization of developmental levels and service
needs and is conditional upon receipt of the release of information
specified in subdivision (b).
(b) In determining if an individual meets the definition of
developmental disability contained in subdivision (a) of Section
4512, the regional center may consider evaluations and tests,
including, but not limited to, intelligence tests, adaptive
functioning tests, neurological and neuropsychological tests,
diagnostic tests performed by a physician, psychiatric tests, and
other tests or evaluations that have been performed by, and are
available from, other sources.
4643.3. (a) (1) On or before April 1, 2002, the department shall
develop evaluation and diagnostic procedures for the diagnosis of
autism disorder and other autistic spectrum disorders.
(2) The department shall publish or arrange for the publication of
the evaluation and diagnostic procedures required by paragraph (1).
The published evaluation and diagnostic procedures shall be available
to the public.
(b) The department shall develop a training program for regional
center clinical staff in the utilization of diagnostic procedures for
the diagnosis of autism disorder. The training program shall be
implemented on or before July 1, 2002.
4643.5. (a) If a consumer is or has been determined to be eligible
for services by a regional center, he or she shall also be considered
eligible by any other regional center if he or she has moved to
another location within the state.
(b) An individual who is determined by any regional center to have
a developmental disability shall remain eligible for services from
regional centers unless a regional center, following a comprehensive
reassessment, concludes that the original determination that the
individual has a developmental disability is clearly erroneous.
(c) Whenever a consumer transfers from one regional center
catchment area to another, the level and types of services and
supports specified in the consumer's individual program plan shall be
authorized and secured, if available, pending the development of a
new individual program plan for the consumer. If these services and
supports do not exist, the regional center shall convene a meeting to
develop a new individual program plan within 30 days. Prior to
approval of the new individual program plan, the regional center
shall provide alternative services and supports that best meet the
individual program plan objectives in the least restrictive setting.
The department shall develop guidelines that describe the
responsibilities of regional centers in ensuring a smooth transition
of services and supports from one regional center to another,
including, but not limited to, pretransferring planning and a dispute
resolution process to resolve disagreements between regional centers
regarding their responsibilities related to the transfer of case
management services.
4644. (a) In addition to any person eligible for initial intake or
assessment services, regional centers may cause to be provided
preventive services to any potential parent requesting these services
and who is determined to be at high risk of parenting a
developmentally disabled infant, or, at the request of the parent or
guardian, to any infant at high risk of becoming developmentally
disabled. It is the intent of the Legislature that preventive
services shall be given equal priority with all other basic regional
center services. These services shall, inasmuch as feasible, be
provided by appropriate generic agencies, including, but not limited
to, county departments of health, perinatal centers, and genetic
centers. The department shall implement operating procedures to
ensure that prevention activities are funded from regional center
purchase of service funds only when funding for these services is
unavailable from local generic agencies. In no case, shall regional
center funds be used to supplant funds budgeted by any agency which
has a responsibility to provide prevention services to the general
public.
(b) For purposes of this section, "generic agency" means any
agency which has a legal responsibility to serve all members of the
general public and which is receiving public funds for providing such
services.
4646. (a) It is the intent of the Legislature to ensure that the
individual program plan and provision of services and supports by the
regional center system is centered on the individual and the family
of the individual with developmental disabilities and takes into
account 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 healthy
environments. It is the further intent of the Legislature to ensure
that the provision of services to consumers and their families be
effective in meeting the goals stated in the individual program plan,
reflect the preferences and choices of the consumer, and reflect the
cost-effective use of public resources.
(b) The individual program plan is developed through a process of
individualized needs determination. The individual with developmental
disabilities and, where appropriate, his or her parents, legal
guardian or conservator, or authorized representative, shall have the
opportunity to actively participate in the development of the plan.
(c) An individual program plan shall be developed for any person
who, following intake and assessment, is found to be eligible for
regional center services. These plans shall be completed within 60
days of the completion of the assessment. At the time of intake, the
regional center shall inform the consumer and, where appropriate, his
or her parents, legal guardian or conservator, or authorized
representative, of the services available through the local area
board and the protection and advocacy agency designated by the
Governor pursuant to federal law, and shall provide the address and
telephone numbers of those agencies.
(d) Individual program plans shall be prepared jointly by the
planning team. Decisions concerning the consumer's goals, objectives,
and services and supports that will be included in the consumer's
individual program plan and purchased by the regional center or
obtained from generic agencies shall be made by agreement between the
regional center representative and the consumer or, where
appropriate, the parents, legal guardian, conservator, or authorized
representative 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, legal
guardian, or conservator, that a designated representative receive
written notice of all meetings to develop or revise his or her
individual program plan and of all notices sent to the consumer
pursuant to Section 4710. The designated representative may be a
parent or family member.
(f) If a final agreement regarding the services and supports to be
provided to the consumer cannot be reached at a program plan
meeting, then a subsequent program plan meeting shall be convened
within 15 days, or later at the request of the consumer or, when
appropriate, the parents, legal guardian, conservator, or authorized
representative or when agreed to by the planning team. Additional
program plan meetings may be held with the agreement of the regional
center representative and the consumer or, where appropriate, the
parents, legal guardian, conservator, or authorized representative.
(g) An authorized representative of the regional center and the
consumer or, where appropriate, his or her parents, legal guardian,
or conservator, shall sign the individual program plan prior to its
implementation. If the consumer or, where appropriate, his or her
parents, legal guardian, or conservator, does not agree with all
components of the plan, they may indicate that disagreement on the
plan. Disagreement with specific plan components shall not prohibit
the implementation of services and supports agreed to by the consumer
or, where appropriate, his or her parents, legal guardian, or
conservator. If the consumer or, where appropriate, his or her
parents, legal guardian, or conservator, does not agree with the plan
in whole or in part, he or she shall be sent written notice of the
fair hearing rights, as required by Section 4701.
4646.4. (a) Effective September 1, 2008, regional centers shall
ensure, at the time of development, scheduled review, or modification
of a consumer's individual program plan developed pursuant to
Sections 4646 and 4646.5, or of an individualized family service plan
pursuant to Section 95020 of the Government Code, the establishment
of an internal process. This internal process shall ensure adherence
with federal and state law and regulation, and when purchasing
services and supports, shall ensure all of the following:
(1) Conformance with the regional center's purchase of service
policies, 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 as
contained in Section 4659.
(4) Consideration of the family's responsibility for providing
similar services and supports for a minor child without disabilities
in identifying the consumer's service and support needs as provided
in the least restrictive and most appropriate setting. In this
determination, 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 program
plan shall be made pursuant to Section 4646.
(c) Final decisions regarding the individual family support plan
shall be made pursuant to Section 95020 of the Government Code.
(d) By no later than April 1, 2009, the department shall provide
the fiscal and policy committees of the Legislature with a written
update regarding the implementation of this section.
4646.5. (a) The planning process for the individual program plan
described in Section 4646 shall include all of the following:
(1) Gathering information and conducting assessments to determine
the life goals, capabilities and strengths, preferences, barriers,
and concerns or problems of the person with developmental
disabilities. For children with developmental disabilities, this
process should include a review of the strengths, preferences, and
needs of the child and the family unit as a whole. Assessments shall
be conducted by qualified individuals and performed in natural
environments whenever possible. Information shall be taken from the
consumer, his or her parents and other family members, his or her
friends, advocates, providers of services and supports, and other
agencies. The assessment process shall reflect awareness of, and
sensitivity to, the lifestyle and cultural background of the consumer
and the family.
(2) A statement of goals, based on the needs, preferences, and
life choices of the individual with developmental disabilities, and a
statement of specific, time-limited objectives for implementing the
person's goals and addressing his or her needs. These objectives
shall be stated in terms that allow measurement of progress or
monitoring of service delivery. These goals and objectives should
maximize opportunities for the consumer to develop relationships, be
part of community life in the areas of community participation,
housing, work, school, and leisure, increase control over his or her
life, acquire increasingly positive roles in community life, and
develop competencies to help accomplish these goals.
(3) When developing individual program plans for children,
regional centers shall be guided by the principles, process, and
services and support parameters set forth in Section 4685.
(4) A schedule of the type and amount of services and supports to
be purchased by the regional center or obtained from generic agencies
or other resources in order to achieve the individual program plan
goals and objectives, and identification of the provider or providers
of service responsible for attaining each objective, including, but
not limited to, vendors, contracted providers, generic service
agencies, and natural supports. The plan shall specify the
approximate scheduled start date for services and supports and shall
contain timelines for actions necessary to begin services and
supports, including generic services.
(5) When agreed to by the consumer, the parents or legally
appointed guardian of a minor consumer, or the legally appointed
conservator of an adult consumer or the authorized representative,
including those appointed pursuant to subdivision (d) of Section 4548
and subdivision (e) of Section 4705, a review of the general health
status of the adult or child including a medical, dental, and mental
health needs shall be conducted. This review shall include a
discussion of current medications, any observed side effects, and the
date of last review of the medication. Service providers shall
cooperate with the planning team to provide any information necessary
to complete the health status review. If any concerns are noted
during the review, referrals shall be made to regional center
clinicians or to the consumer's physician, as appropriate.
Documentation of health status and referrals shall be made in the
consumer's record by the service coordinator.
(6) A schedule of regular periodic review and reevaluation to
ascertain that planned services have been provided, that objectives
have been fulfilled within the times specified, and that consumers
and families are satisfied with the individual program plan and its
implementation.
(b) For all active cases, individual program plans shall be
reviewed and modified by the planning team, through the process
described in Section 4646, as necessary, in response to the person's
achievement or changing needs, and no less often than once every
three years. If the consumer or, where appropriate, the consumer's
parents, legal guardian, or conservator requests an individual
program plan review, the individual program shall be reviewed within
30 days after the request is submitted.
(c) (1) The department, with the participation of representatives
of a statewide consumer organization, the Association of Regional
Center Agencies, an organized labor organization representing service
coordination staff, and the Organization of Area Boards shall
prepare training material and a standard format and instructions for
the preparation of individual program plans, which embodies an
approach centered on the person and family.
(2) Each regional center shall use the training materials and
format prepared by the department pursuant to paragraph (1).
(3) The department shall biennially review a random sample of
individual program plans at each regional center to assure that these
plans are being developed and modified in compliance with Section
4646 and this section.
4646.55. (a) Notwithstanding any other provision of law or
regulation to the contrary, and to the extent federal financial
participation is available, effective July 1, 2007, the State
Department of Developmental Services is hereby authorized to make
supplemental payment to an enrolled Medi-Cal provider that is a
licensed intermediate care facility/developmentally
disabled-habilitative, licensed intermediate care
facility/developmentally disabled-nursing, or licensed intermediate
care facility/developmentally disabled, for day treatment and
transportation services provided pursuant to Sections 4646 and
4646.5, applicable regulations, and Section 14132.925, to Medi-Cal
beneficiaries residing in a licensed intermediate care
facility/developmentally disabled-habilitative, licensed intermediate
care facility/developmentally disabled-nursing, or licensed
intermediate care facility/developmentally disabled. These payments
shall be considered supplemental payments to the enrolled Medi-Cal
provider and shall be comprised of the full costs of reimbursing
regional centers for making disbursements to day treatment and
transportation service providers, plus a coordination fee which will
include an administrative fee and reimbursement for the increased
costs associated with the quality assurance fee paid accordingly and
without a separate State Department of Developmental Services
contract.
(b) Notwithstanding any other provision of law and to the extent
federal financial participation is available, and in furtherance of
this section and Section 14132.925, the State Department of
Developmental Services shall amend the regional center contracts for
the 2007-08 fiscal year to extend the contract liquidation period
until June 30, 2011. The contract amendments and budget adjustments
shall be exempt from the provisions of Article 1 (commencing with
Section 4620).
4646.6. Notwithstanding Section 632 of the Penal Code, a consumer,
or his or her parent, guardian, conservator, or authorized
representative, shall have the right to record electronically the
proceedings of the individual program plan meetings on an audiotape
recorder. The consumer, or his or her parent, guardian, conservator,
or authorized representative, shall notify the regional center of
their intent to record a meeting at least 24 hours prior to the
meeting. If the regional center initiates the notice of intent to
audiotape record a meeting and the consumer, or his or her parent,
guardian, conservator, or authorized representative, refuses to
attend the meeting because it will be tape recorded, the meeting
shall not be recorded on an audiotape recorder. However, the regional
center shall have the right to electronically record the meeting
when notice of intent to record has been given by the consumer or on
the consumer's behalf.
4647. (a) Pursuant to Section 4640.7, service coordination shall
include those activities necessary to implement an individual program
plan, including, but not limited to, participation in the individual
program plan process; assurance that the planning team considers all
appropriate options for meeting each individual program plan
objective; securing, through purchasing or by obtaining from generic
agencies or other resources, services and supports specified in the
person's individual program plan; coordination of service and support
programs; collection and dissemination of information; and
monitoring implementation of the plan to ascertain that objectives
have been fulfilled and to assist in revising the plan as necessary.
(b) The regional center shall assign a service coordinator who
shall be responsible for implementing, overseeing, and monitoring
each individual program plan. The service coordinator may be an
employee of the regional center or may be a qualified individual or
employee of an agency with whom the regional center has contracted to
provide service coordination services, or persons described in
Section 4647.2. The regional center shall provide the consumer or,
where appropriate, his or her parents, legal guardian, or conservator
or authorized representative, with written notification of any
permanent change in the assigned service coordinator within 10
business days. No person shall continue to serve as a service
coordinator for any individual program plan unless there is agreement
by all parties that the person should continue to serve as service
coordinator.
(c) Where appropriate, a consumer or the consumer's parents or
other family members, legal guardian, or conservator, may perform all
or part of the duties of the service coordinator described in this
section if the regional center director agrees and it is feasible.
(d) If any person described in subdivision (c) is designated as
the service coordinator, that person shall not deviate from the
agreed-upon program plan and shall provide any reasonable information
and reports required by the regional center director.
(e) If any person described in subdivision (c) is designated as
the service coordinator, the regional center shall provide ongoing
information and support as necessary, to assist the person to perform
all or part of the duties of service coordinator.
4648. In order to achieve the stated objectives of a consumer's
individual program plan, the regional center shall conduct
activities, 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 supports
assist individuals with developmental disabilities in achieving the
greatest self-sufficiency possible and in exercising personal
choices. The regional center shall secure services and supports that
meet the needs of the consumer, as determined in the consumer's
individual program plan, and within the context of the individual
program plan, the planning team shall give highest preference to
those services and supports which would allow minors with
developmental disabilities to live with their families, adult persons
with developmental disabilities to live as independently as possible
in the community, and that allow all consumers to interact with
persons without disabilities in positive, meaningful ways.
(2) In implementing individual program plans, regional centers,
through the planning team, shall first consider services and supports
in natural community, home, work, and recreational settings.
Services and supports shall be flexible and individually tailored to
the consumer and, where appropriate, his or her family.
(3) A regional center may, pursuant to vendorization or a
contract, purchase services or supports for a consumer from any
individual or agency which the regional center and consumer or, where
appropriate, his or her parents, legal guardian, or conservator, or
authorized representatives, determines will best accomplish all or
any part of that consumer's program plan.
(A) Vendorization or contracting is the process for
identification, selection, and utilization of service vendors or
contractors, based on the qualifications and other requirements
necessary in order to provide the service.
(B) A regional center may reimburse an individual or agency for
services or supports provided to a regional center consumer if the
individual or agency has a rate of payment for vendored or contracted
services established by the department, pursuant to this division,
and is providing services pursuant to an emergency vendorization or
has completed the vendorization procedures or has entered into a
contract with the regional center and continues to comply with the
vendorization or contracting requirements. The director shall adopt
regulations governing the vendorization process to be utilized by the
department, regional centers, vendors and the individual or agency
requesting vendorization.
(C) Regulations shall include, but not be limited to: the vendor
application process, and the basis for accepting or denying an
application; the qualification and requirements for each category of
services that may be provided to a regional center consumer through a
vendor; requirements for emergency vendorization; procedures for
termination of vendorization; the procedure for an individual or an
agency to appeal any vendorization decision made by the department or
regional center.
(D) A regional center may vendorize a licensed facility for
exclusive services to persons with developmental disabilities at a
capacity equal to or less than the facility's licensed capacity. A
facility already licensed on January 1, 1999, shall continue to be
vendorized at their full licensed capacity until the facility agrees
to vendorization at a reduced capacity.
(E) Effective July 1, 2009, notwithstanding any other provision of
law or regulation to the contrary, a regional center shall not newly
vendor a State Department of Social Services licensed 24-hour
residential care facility with a licensed capacity of 16 or more
beds, unless the facility qualifies for receipt of federal funds
under the Medicaid Program.
(4) Notwithstanding subparagraph (B), a regional center may
contract or issue a voucher for services and supports provided to a
consumer or family at a cost not to exceed the maximum rate of
payment for that service or support established by the department. If
a rate has not been established by the department, the regional
center may, for an interim period, contract for a specified service
or support with, and establish a rate of payment for, any provider of
the service or support necessary to implement a consumer's
individual program plan. Contracts may be negotiated for a period of
up to three years, with annual review and subject to the availability
of funds.
(5) In order to ensure the maximum flexibility and availability of
appropriate services and supports for persons with developmental
disabilities, the department shall establish and maintain an
equitable system of payment to providers of services and supports
identified as necessary to the implementation of a consumers'
individual program plan. The system of payment shall include
provision for a rate to ensure that the provider can meet the special
needs of consumers and provide quality services and supports in the
least restrictive setting as required by law.
(6) The regional center and the consumer, or where appropriate,
his or her parents, legal guardian, conservator, or authorized
representative, including those appointed pursuant to subdivision (d)
of Section 4548 or subdivision (e) of Section 4705, shall, pursuant
to the individual program plan, consider all of the following when
selecting a provider of consumer services and supports:
(A) A provider's ability to deliver quality services or supports
which can accomplish all or part of the consumer's individual program
plan.
(B) A provider's success in achieving the objectives set forth in
the individual program plan.
(C) Where appropriate, the existence of licensing, accreditation,
or professional certification.
(D) The cost of providing services or supports of comparable
quality by different providers, if available, shall be reviewed, and
the least costly available provider of comparable service, including
the cost of transportation, who is able to accomplish all or part of
the consumer's individual program plan, consistent with the
particular needs of the consumer and family as identified in the
individual program plan, shall be selected. In determining the least
costly provider, the availability of federal financial participation
shall be considered. The consumer shall not be required to use the
least costly provider if it will result in the consumer moving from
an existing provider of services or supports to more restrictive or
less integrated services or supports.
(E) The consumer's or, where appropriate, the parents, legal
guardian, or conservator of a consumer's choice of providers.
(7) No service or support provided by any agency or individual
shall be continued unless the consumer or, where appropriate, his or
her parents, legal guardian, or conservator, or authorized
representative, including those appointed pursuant to subdivision (d)
of Section 4548 or subdivision (e) of Section 4705, is satisfied and
the regional center and the consumer or, when appropriate, the
person's parents or legal guardian or conservator agree that planned
services and supports have been provided, and reasonable progress
toward objectives have been made.
(8) Regional center funds shall not be used to supplant the budget
of any agency which has a legal responsibility to serve all members
of the general public and is receiving public funds for providing
those services.
(9) (A) A regional center may, directly or through an agency
acting on behalf of the center, provide placement in, purchase of, or
follow-along services to persons with developmental disabilities in,
appropriate community living arrangements, including, but not
limited to, support service for consumers in homes they own or lease,
foster family placements, health care facilities, and licensed
community care facilities. In considering appropriate placement
alternatives for children with developmental disabilities, approval
by the child's parent or guardian shall be obtained before placement
is made.
(B) Effective July 1, 2012, notwithstanding any other provision of
law or regulation to the contrary, a regional center shall not
purchase residential services from a State Department of Social
Services licensed 24-hour residential care facility with a licensed
capacity of 16 or more beds. This prohibition on regional center
purchase of residential services shall not apply to either of the
following:
(i) A residential facility with a licensed capacity of 16 or more
beds that has been approved to participate in the department's Home
and Community Based Services Waiver or another existing waiver
program or certified to participate in the Medi-Cal program.
(ii) A residential facility service provider that has a written
agreement and specific plan prior to July 1, 2012, with the vendoring
regional center to downsize the existing facility by transitioning
its residential services to living arrangements of 15 beds or less or
restructure the large facility to meet federal Medicaid eligibility
requirements on or before June 30, 2013.
(C) Each person with developmental disabilities placed by the
regional center in a community living arrangement shall have the
rights specified in this division. These rights shall be brought to
the person's attention by any means necessary to reasonably
communicate these rights to each resident, provided that, at a
minimum, the Director of Developmental Services prepare, provide, and
require to be clearly posted in all residential facilities and day
programs a poster using simplified language and pictures that is
designed to be more understandable by persons with cognitive
disabilities and that the rights information shall also be available
through the regional center to each residential facility and day
program in alternative formats, including, but not limited to, other
languages, braille, and audio tapes, when necessary to meet the
communication needs of consumers.
(D) Consumers are eligible to receive supplemental services
including, but not limited to, additional staffing, pursuant to the
process described in subdivision (d) of Section 4646. Necessary
additional staffing that is not specifically included in the rates
paid to the service provider may be purchased by the regional center
if the additional staff are in excess of the amount required by
regulation and the individual's planning team determines the
additional services are consistent with the provisions of the
individual program plan. Additional staff should be periodically
reviewed by the planning team for consistency with the individual
program plan objectives in order to determine if continued use of the
additional staff is necessary and appropriate and if the service is
producing outcomes consistent with the individual program plan.
Regional centers shall monitor programs to ensure that the additional
staff is being provided and utilized appropriately.
(10) Emergency and crisis intervention services including, but not
limited to, mental health services and behavior modification
services, may be provided, as needed, to maintain persons with
developmental disabilities in the living arrangement of their own
choice. Crisis services shall first be provided without disrupting a
person's living arrangement. If crisis intervention services are
unsuccessful, emergency housing shall be available in the person's
home community. If dislocation cannot be avoided, every effort shall
be made to return the person to his or her living arrangement of
choice, with all necessary supports, as soon as possible.
(11) Among other service and support options, planning teams shall
consider the use of paid roommates or neighbors, personal
assistance, technical and financial assistance, and all other service
and support options which would result in greater self-sufficiency
for the consumer and cost-effectiveness to the state.
(12) When facilitation as specified in an individual program plan
requires the services of an individual, the facilitator shall be of
the consumer's choosing.
(13) The community support may be provided to assist individuals
with developmental disabilities to fully participate in community and
civic life, including, but not limited to, programs, services, work
opportunities, business, and activities available to persons without
disabilities. This facilitation shall include, but not be limited to,
any of the following:
(A) Outreach and education to programs and services within the
community.
(B) Direct support to individuals which would enable them to more
fully participate in their community.
(C) Developing unpaid natural supports when possible.
(14) Other services and supports may be provided as set forth in
Sections 4685, 4686, 4687, 4688, and 4689, when necessary.
(15) Notwithstanding any other provision of law or regulation to
the contrary, effective July 1, 2009, regional centers shall not
purchase experimental treatments, therapeutic services, or devices
that have not been clinically determined or scientifically proven to
be effective or safe or for which risks and complications are
unknown. Experimental treatments or therapeutic services include
experimental medical or nutritional therapy when the use of the
product for that purpose is not a general physician practice. For
regional center consumers receiving these services as part of their
individual 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, and
service rights of persons with developmental disabilities as
established in this division.
(2) Whenever the advocacy efforts of a regional center to secure
or protect the civil, legal, or service rights of any of its
consumers prove ineffective, the regional center or the person with
developmental disabilities or his or her parents, legal guardian, or
other representative may request the area board to initiate action
under the provisions defining area board advocacy functions
established in this division.
(c) The regional center may assist consumers and families
directly, or through a provider, in identifying and building circles
of support within the community.
(d) In order to increase the quality of community services and
protect consumers, the regional center shall, when appropriate, take
either of the following actions:
(1) Identify services and supports that are ineffective or of poor
quality and provide or secure consultation, training, or technical
assistance services for any agency or individual provider to assist
that agency or individual provider in upgrading the quality of
services or supports.
(2) Identify providers of services or supports that may not be in
compliance with local, state, and federal statutes and regulations
and notify the appropriate licensing or regulatory authority, or
request the area board to investigate the possible noncompliance.
(e) When necessary to expand the availability of needed services
of good quality, a regional center may take actions that include, but
are not limited to, the following:
(1) Soliciting an individual or agency by requests for proposals
or other means, to provide needed services or supports not presently
available.
(2) Requesting funds from the Program Development Fund, pursuant
to Section 4677, or community placement plan funds designated from
that fund, to reimburse the startup costs needed to initiate a new
program 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 not
provide direct treatment and therapeutic services, but shall utilize
appropriate public and private community agencies and service
providers to obtain those services for its consumers.
(g) Where there are identified gaps in the system of services and
supports or where there are identified consumers for whom no provider
will provide services and supports contained in his or her
individual program plan, the department may provide the services and
supports directly.
(h) At least annually, regional centers shall provide the
consumer, his or her parents, legal guardian, conservator, or
authorized representative a statement of services and supports the
regional center purchased for the purpose of ensuring that they are
delivered. The statement shall include the type, unit, month, and
cost of services and supports purchased.
4648.1. (a) The State Department of Developmental Services and
regional centers may monitor services and supports purchased for
regional center consumers with or without prior notice. Not less than
two monitoring visits to a licensed long-term health care or
community care facility or family home agency home each year shall be
unannounced. The department may conduct fiscal reviews and audits of
the service providers' records.
(b) Department and regional center staff involved in monitoring or
auditing services provided to the regional centers' consumers by a
service provider shall have access to the provider's grounds,
buildings, and service program, and to all related records, including
books, papers, computerized data, accounting records, and related
documentation. All persons connected with the service provider's
program, including, but not limited to, program administrators,
staff, consultants, and accountants, shall provide information and
access to facilities as required by the department or regional
center.
(c) The department, in cooperation with regional centers, shall
ensure that all providers of services and supports purchased by
regional centers for their consumers are informed of all of the
following:
(1) The provisions of this section.
(2) The responsibility of providers to comply with laws and
regulations governing both their service program and the provision of
services and supports to people with developmental disabilities.
(3) The responsibility of providers to comply with conditions of
any contract or agreement between the regional center and the
provider, and between the provider and the department.
(4) The rights of providers established in regulations adopted
pursuant to Sections 4648.2, 4748, and 4780.5, to appeal actions
taken by regional centers or the department as a result of their
monitoring and auditing findings.
(d) A regional center may terminate payments for services, and may
terminate its contract or authorization for the purchase of consumer
services if it determines that the provider has not complied with
provisions of its contract or authorization with the regional center
or with applicable state laws and regulations. When terminating
payments for services or its contract or authorization for the
purchase of consumer services, a regional center shall make
reasonable efforts to avoid unnecessary disruptions of consumer
services.
(e) A regional center or the department may recover from the
provider funds paid for services when the department or the regional
center determines that either of the following has occurred:
(1) The services were not provided in accordance with the regional
center's contract or authorization with the provider, or with
applicable state laws or regulations.
(2) The rate paid is based on inaccurate data submitted by the
provider on a provider cost statement.
Any funds so recovered shall be remitted to the department.
(f) Any evidence of suspected licensing violations found by
department or regional center personnel shall be reported immediately
to the appropriate state licensing agency.
(g) Regional centers may establish volunteer teams, made up of
consumers, parents, other family members, and advocates to conduct
the monitoring activities described in this section.
(h) In meeting its responsibility to provide technical assistance
to providers of community living arrangements for persons with
developmental disabilities, including, but not limited to, licensed
residential facilities, family home agencies, and supported or
independent living arrangements, a regional center shall utilize the
"Looking at Service Quality-Provider's Handbook" developed by the
department or subsequent revisions developed by the department.
(i) Effective July 1, 2009, a regional center shall not be
required to perform triennial evaluations of community care
facilities, as described in Sections 56046, 56049, 56050, 56051, and
56052 of Title 17 of the California Code of Regulations.
4648.2. By September 1, 1986, the State Department of Developmental
Services shall promulgate regulations which establish a process for
service providers to appeal actions the department takes as a result
of its auditing and monitoring activities. To the extent possible,
this process shall include procedures contained in fiscal audit
appeals regulations established pursuant to Section 4780.5.
4648.3. A provider of transportation services to regional center
clients for the regional center shall maintain protection against
liability for damages for bodily injuries or death and for damage to
or destruction of property, which may be incurred by the provider in
the course of providing those services. The protection shall be
maintained at the level established by the regional center to which
the 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 following
shall apply to a regional center:
(a) A regional center shall not fund private specialized
transportation services for an adult consumer who can safely access
and utilize public transportation, when that transportation is
available.
(b) A regional center shall fund the least expensive
transportation modality that meets the consumer's needs, as set forth
in 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 provides
the service that meets the consumer's needs, as set forth in the
consumer's IPP or IFSP. For purposes of this subdivision, the cost of
a vendor shall be determined by combining the vendor's program costs
and the costs to transport a consumer from the consumer's residence
to the vendor.
(d) A regional center shall fund transportation services for a
minor child living in the family residence, only if the family of the
child provides sufficient written documentation to the regional
center to demonstrate that it is unable to provide transportation for
the child.
4648.4. (a) Notwithstanding any other provision of law or
regulation, commencing July 1, 2006, rates for services listed in
paragraphs (1), (2), with the exception of travel reimbursement, (3)
to (8), inclusive, (10), and (11) of subdivision (b), shall be
increased by 3 percent, subject to funds specifically appropriated
for this increase in the Budget Act of 2006. The increase shall be
applied as a percentage, and the percentage shall be the same for all
providers. 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 provider
of the following services or supports a rate that is greater than the
rate that is in effect on or after June 30, 2008, unless the
increase is required by a contract between the regional center and
the vendor that is in effect on June 30, 2008, or the regional center
demonstrates that the approval is necessary to protect the consumer'
s health or safety and the department has granted prior written
authorization:
(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 or
regulations to the contrary, effective July 1, 2009, a regional
centers' authority to purchase the following services shall be
suspended pending implementation of the Individual Choice Budget and
certification by the Director of Developmental Services that the
Individual Choice Budget has been implemented and will result in
state budget savings sufficient to offset the costs of providing the
following services:
(1) Camping services and associated travel expenses.
(2) Social recreation activities, except for those activities
vendored 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 in
subdivision (a) as part of their individual program plan (IPP) or
individualized family service plan (IFSP), the prohibition in
subdivision (a) shall take effect on August 1, 2009.
(c) An exemption may be granted on an individual basis in
extraordinary circumstances to permit purchase of a service
identified in subdivision (a) when the regional center determines
that the service is a primary or critical means for ameliorating the
physical, cognitive, or psychosocial effects of the consumer's
developmental disability, or the service is necessary to enable the
consumer to remain in his or her home and no alternative service is
available to meet the consumer's needs.
4648.6. The department, in consultation with stakeholders, shall
develop an alternative service delivery model that provides an
Individual Choice Budget for obtaining quality services and supports
which provides choice and flexibility within a finite budget that in
the aggregate reduces regional center purchase of service
expenditures, reduces reliance on the state general fund, and
maximizes federal financial participation in the delivery of
services. The individual budget will be determined using a fair,
equitable, transparent standardized process.
4649. Regional centers shall cooperate with area boards in joint
efforts to inform the public of services available to persons with
developmental disabilities and of their unmet needs, provide
materials and education programs to community groups and agencies
with interest in, or responsibility for, persons with developmental
disabilities, and develop resource materials, if necessary,
containing information about local agencies, facilities, and service
providers offering services to persons with developmental
disabilities.
4650. Regional centers shall be responsible for developing an
annual plan and program budget to be submitted to the director no
later than September 1 of each fiscal year. An information copy shall
be submitted to the area board and state council by the same date.
4651. (a) It is the intent of the Legislature that regional centers
shall find innovative and economical methods of achieving the
objectives contained in individual program plans of persons with
developmental disabilities.
(b) The department shall encourage and assist regional centers to
use innovative programs, techniques, and staffing arrangements to
carry out their responsibilities.
4652. A regional center shall investigate every appropriate and
economically feasible alternative for care of a developmentally
disabled person available within the region. If suitable care cannot
be found within the region, services may be obtained outside of the
region.
4653. Except for those developmentally disabled persons judicially
committed to state hospitals, no developmentally disabled person
shall be admitted to a state hospital except upon the referral of a
regional center. Upon discharge from a state hospital, a
developmentally disabled person shall be referred to an appropriate
regional center.
4654. Before any person is examined by a regional center pursuant
to Section 1370.1 of the Penal Code, the court ordering such medical
examination shall transmit to the regional center a copy of the
orders made pursuant to proceedings conducted under Sections 1368 and
1369 of the Penal Code. The purpose of the mental examination shall
be to determine if developmental disability is the primary diagnosis.
4655. The director of a regional center or his designee may give
consent to medical, dental, and surgical treatment of a regional
center client and provide for such treatment to be given to the
person under the following conditions:
(a) If the developmentally disabled person's parent, guardian, or
conservator legally authorized to consent to such treatment does not
respond within a reasonable time to the request of the director or
his designee for the granting or denying of consent for such
treatment, the director of a regional center or his designee may
consent on behalf of the developmentally disabled person to such
treatment 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 director
of the regional center or his designee may consent to such treatment
on behalf of the person and provide for such treatment to be given to
the person. The director of a regional center or his designee may
thereupon also initiate, or cause to be initiated, proceedings for
the appointment of a guardian or conservator legally authorized to
consent to medical, dental, or surgical services.
(c) If the developmentally disabled person is an adult and has no
conservator, consent to treatment may be given by someone other than
the person on the person's behalf only if the developmentally
disabled person is mentally incapable of giving his own consent.
4656. (a) A qualified physician and surgeon who diagnoses a
developmental disability, as defined in subdivision (a) of Section
4512, of a patient who is a minor shall attempt to determine from the
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