4690. The Director of Developmental Services shall establish,
maintain, and revise, as necessary, an equitable process for setting
rates of state payment for nonresidential services purchased by
regional centers, and may promulgate regulations establishing program
standards, or the process to be used for setting these rates, or
both, in order to assure that regional centers may secure
high-quality services for developmentally disabled persons from
individuals or agencies vendored to provide these services. In
developing the rates pursuant to regulation, the director may require
vendors to submit program, cost, or other information, as necessary.
The director shall take into account the rates paid by other
agencies and jurisdictions for comparable services in order to assure
that regional center rates are at competitive levels. In no event
shall rates established pursuant to this article be any less than
those established for comparable services under the Medi-Cal program.
4690.1. (a) By March 1, 1986, the department, in consultation with
representatives of regional centers and providers of transportation
services to regional center clients, shall develop a cost statement
to be used in setting rates for providers of transportation services.
(b) Notwithstanding subdivision (a), the department may develop
alternative procedures for establishing rates for providers of
transportation services, including, but not limited to, a
noncompetitive process and a competitive process for use by regional
centers in which rates of reimbursement are established based on
contract bids or proposals.
4690.2. (a) The Director of Developmental Services shall develop
program standards and establish, maintain, and revise, as necessary,
an equitable process for setting rates of state payment, based upon
those standards, for in-home respite services purchased by regional
centers from agencies vendored to provide these services. The
Director of Developmental Services may promulgate regulations
establishing these standards and the process to be used for setting
rates. "In-home respite services" means intermittent or regularly
scheduled temporary nonmedical care and supervision provided in the
client's own home, for a regional center client who resides with a
family member. These services are designed to do all of the
following:
(1) Assist family members in maintaining the client at home.
(2) Provide appropriate care and supervision to ensure the client'
s safety in the absence of family members.
(3) Relieve family members from the constantly demanding
responsibility of caring for the client.
(4) Attend to the client's basic self-help needs and other
activities of daily living including interaction, socialization, and
continuation of usual daily routines which would ordinarily be
performed by the family members.
(b) The provisions of subdivisions (b) to (f), inclusive, of
Section 4691 and subdivisions (a) to (f), inclusive, and subdivision
(h) of Section 4691.5 applicable to community-based day programs,
shall also apply to in-home respite service vendors for the purpose
of establishing standards and an equitable process for setting rates,
except:
(1) The process specified in paragraph (4) of subdivision (a) of
Section 4691.5 for increasing rates for fiscal year 1990-91 shall
apply only to the administrative portion of the rate for eligible
in-home respite service vendors, and the amount of funds available
for this increase shall not exceed three hundred thousand dollars
($300,000) of the total amount appropriated for rate increases. The
administrative portion of the rate shall consist of the in-home
respite service vendor's allowable costs, other than those for
respite worker's salary, wage, benefits, and travel. Vendors eligible
for this rate increase shall include only those in-home respite
service vendors which received a deficiency adjustment in their
permanent or provisional rate for fiscal year 1989-90, as specified
in paragraph (4) of subdivision (a) of Section 4691.5.
(2) In addition, a rate increase shall also be provided for fiscal
year 1990-91, for the salary, wage, and benefit portion of the rate
for in-home respite service vendors eligible for the increase. The
amount of funds available for this rate increase is limited to the
remaining funds appropriated for this paragraph and paragraph (1) for
fiscal year 1990-91. The amount of increase which each eligible
in-home respite service vendor shall receive shall be limited to the
amount necessary to increase the salary, wage, and benefit portion of
the rate for respite workers to five dollars and six cents ($5.06)
per hour in salary and wages plus ninety-five cents ($0.95) in
benefits. Vendors eligible for this increase shall include only those
in-home respite service vendors whose salary, wage, and benefit
portion of their existing provisional or permanent rate, as
established by the department for respite workers is below the
amounts specified in this paragraph, and the vendor agrees to
reimburse its respite workers at no less than these amounts during
fiscal year 1990-91 and thereafter. In order to establish rates
pursuant to this paragraph, existing programs receiving a permanent
or provisional rate shall submit to the department, the program,
cost, and other information specified by the department for either
the 1988 calendar year, or for the 1988-89 fiscal year. The specified
information shall be submitted on forms developed by the department,
not later than 45 days following receipt of the required forms from
the department, after the effective date of this section. Programs
which fail to submit the required information within the time
specified shall have payment of their permanent or provisional rate
suspended until the required information has been submitted.
(3) Effective July 1, 1990, and pursuant to the rate methodology
developed by the department, the administrative portion and the
salary, wage, and benefit portion of the rates for in-home respite
service vendors currently receiving a provisional or permanent rate
shall be combined and paid as a single rate.
(4) Rate increases for fiscal year 1990-91 shall be limited to
those specified in paragraphs (1) and (2). For fiscal year 1991-92
and all succeeding fiscal years, the provisions of subdivision (c) of
Section 4691, which specify that any rate increases shall be subject
to the appropriation of sufficient funds in the Budget Act, shall
also apply to rates for in-home respite service vendors.
(5) For the 1998-99 fiscal year, an in-home respite service vendor
shall receive rate increases pursuant to subdivision (e) of Section
4691.5. Any rate increase shall be subject to the appropriation of
funds pursuant to the Budget Act.
(6) The rate methodology developed by the department may include a
supplemental amount of reimbursement for travel costs of respite
workers using their private vehicles to and from and between respite
sites. The supplemental amount shall be the minimum rate for travel
reimbursement for state employees.
4690.3. (a) For the 1998-99 fiscal year, rates for in-home respite
services agencies that are vendored pursuant to Section 4690.2 and
the department's regulations to provide in-home respite services
shall be increased based on the amount appropriated in the Budget Act
of 1998 for the purpose of increasing the salary, wage, and benefit
portion of the rate for in-home respite services workers. Agencies
shall reimburse their respite workers at no less than the increased
amount in their rate for the 1998-99 fiscal year and thereafter.
(b) For the 1998-99 fiscal years an individual who provides
in-home respite services, pursuant to vendorization pursuant to the
department's regulations, shall also receive a rate increase pursuant
to subdivision (a).
4690.4. (a) Sections 4690.2, 4691, and 4691.5, which relate to
in-home respite service agencies and community-based day programs,
shall apply in the 1998-99 fiscal year with the following exceptions:
(1) The 1997-98 fiscal year allowable costs and consumer
attendance data submitted to the department by September 30, 1998,
shall not be utilized by the department to determine a new mean rate
and allowable range of rates, pursuant to regulations, but may be
used only in developing a new rate system.
(2) The allowable range of rates and mean rate established for the
1997-98 fiscal year shall be continued.
(3) The rate for new programs shall be the mean rate determined
for the same type of program and staff-to-consumer ratio for the
1997-98 fiscal year.
(b) The department shall, in consultation with stakeholder
organizations, develop performance based consumer outcome rate
systems for community-based day programs and in-home respite
services. If rates for community-based day programs are increased in
the 1998-99 fiscal year pursuant to paragraphs (1) to (3), inclusive,
of subdivision (e) of Section 4691.5, and rates for in-home respite
services are increased in the 1998-99 fiscal year pursuant to
paragraph (5) of subdivision (b) of Section 4690.2, as added by the
act adding this section to the Welfare and Institutions Code, then
effective September 1, 1998, and until such time as the new rate
systems are implemented, or unless funds are otherwise appropriated
for rate adjustments, rates shall be frozen.
4690.5. Notwithstanding any other provision of law or regulation,
commencing July 1, 2006, the rate for family member-provided respite
services authorized by the department and in operation June 30, 2006,
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.
4691. (a) The Legislature reaffirms its intent that community-based
day programs be planned and provided as part of a continuum of
services to enable persons with developmental disabilities to
approximate the pattern of everyday living available to people of the
same age without disabilities. The Legislature further intends that
standards be developed to ensure high-quality services, and that
equitable ratesetting procedures based upon those standards be
established, maintained, and revised, as necessary. The Legislature
intends that ratesetting procedures be developed for all
community-based day programs, which include adult development
centers, activity centers, infant day programs, behavior management
programs, social recreational programs, and independent living
programs.
(b) For the purpose of ensuring that regional centers may secure
high-quality services for persons with developmental disabilities,
the State Department of Developmental Services shall promulgate
regulations establishing program standards and an equitable process
for setting rates of state payment for community-based day programs.
These regulations shall include, but are not limited to, all of the
following:
(1) The standards and requirements related to the operation of the
program including, but not limited to, staff qualifications,
staff-to-client ratios, client entrance and exit criteria, program
design, program evaluation, program and client records and
documentation, client placement, and personnel requirements and
functions.
(2) The allowable cost components of the program including salary
and wages, staff benefits, operating expenses, and management
organization costs where two or more programs are operated by a
separate and distinct corporation or entity.
(3) The rate determination processes for establishing rates, based
on the allowable costs of the allowable cost components. Different
rate determination processes may be developed for establishing rates
for new and existing programs, and for the initial and subsequent
years of implementation of the regulations. The processes shall
include, but are not limited to, all of the following:
(A) The procedure for identification and grouping of programs by
type of day program and approved staff-to-client ratio.
(B) The requirements for an identification of the program, cost,
and other information, if any, which the program is required to
submit to the department or the regional center, the consequences, if
any, for failure to do so, and the timeframes and format for
submission and review.
(C) The ratesetting methodology.
(D) A procedure for adjusting rates as a result of anticipated and
unanticipated program changes and fiscal audits of the program and a
procedure for appealing rates, including the timeframes for the
program to request an adjustment or appeal, and for the department to
respond.
(E) A procedure for increasing established rates and the allowable
range of rates due to cost-of-living adjustments.
(F) A procedure for increasing established rates as a result of
Budget Act appropriations made pursuant to the ratesetting
methodology established pursuant to Section 4691.5 and subdivision
(c) of this section.
The department shall develop these regulations in consultation
with representatives from organizations representing the
developmental services system as determined by the department. The
State Council on Developmental Disabilities, and other organizations
representing regional centers, providers, and clients shall have an
opportunity to review and comment upon the proposed regulations prior
to their promulgation. The department shall promulgate these
regulations for all community-based day programs by July 1, 1990.
(c) Upon the promulgation of regulations pursuant to subdivision
(b), and pursuant to Section 4691.5, and by September 1 of each year
thereafter, the department shall establish rates pursuant to the
regulations. Rate increases during the 1990-91 and 1991-92 fiscal
years shall be limited to those specified in subdivision (b). For the
1992-93 fiscal year and all succeeding fiscal years, any increases
proposed during those years in the rates of reimbursement established
pursuant to the regulations, except for rate increases due to rate
appeals and rate adjustments based on unanticipated program changes,
shall be subject to the appropriation of sufficient funds in the
Budget Act, for those purposes, to fully provide the proposed
increase to all eligible programs for the entire fiscal year. If the
funds appropriated in the Budget Act are not sufficient to fully
provide for the proposed increase in the rates of reimbursement for
all eligible programs for the entire fiscal year, the proposed
increase shall be limited to the level of funds appropriated. The
increases proposed in the rates of reimbursement shall be reduced
equitably among all eligible providers in accordance with funds
appropriated and the eligible programs shall be reimbursed at the
reduced amount for the entire fiscal year.
(d) Using the reported costs of day programs reimbursed at a
permanent rate and the standards and ratesetting processes
promulgated pursuant to subdivision (b) as a basis, the department
shall report to the Legislature as follows:
(1) By April 15, 1993, and every odd year thereafter, the
difference between permanent rates for existing programs and the
rates of those programs based upon their allowable costs and client
attendance, submitted pursuant to the regulations specified in
subdivision (b). In reporting the difference, the department shall
also identify the amount of the difference associated with programs
whose rates are above the allowable range of rates, which is
available for increasing the rates of programs whose rates are below
the allowable range, to within the allowable range, and any other
pertinent cost or rate information which the department deems
necessary.
(2) By April 15, 1994, and every even year thereafter, the level
of funding, if any, which was not appropriated to reimburse providers
at the proposed rates reported the prior fiscal year pursuant to
paragraph (1), and any other pertinent cost or rate information which
the department deems necessary.
(3) The April 15, 1996, report pursuant to paragraph (2) shall be
prepared jointly by the department and organizations representing
community-based day program providers, as determined by the
department. That report shall also include a review of the
ratesetting process and recommendations, if any, for its
modification.
(e) Rates established by the department pursuant to subdivision
(b) are exempt from the provisions of Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code.
(f) The department shall ensure that the regional centers monitor
compliance with program standards.
4691.5. The ratesetting methodology, to be established pursuant to
subparagraph (C) of paragraph (3) of subdivision (b) of Section 4691
shall include, but need not be limited to, all of the following:
(a) A process for establishing rates during fiscal year 1990-91
for new programs and existing programs receiving a provisional or
permanent rate.
(1) The rate for new programs shall be the mean rate determined
for the same type of day program and staff-to-client ratio. This rate
shall be a temporary rate. Determination of the mean rate for new
programs shall be based on the program, cost, and other information
of existing programs receiving a permanent rate, using allowable
costs and client attendance information of those existing programs.
In order to establish rates pursuant to this paragraph existing
programs receiving a permanent rate shall submit to the department,
the program, cost, and other information specified by the department
for either calendar year 1988 or fiscal year 1988-89. The specified
information shall be submitted on forms developed by the department,
not later than 45 days following receipt of the required forms from
the department, after the effective date of this section. Programs
which fail to submit the required information within the time
specified shall have payment of their permanent rate suspended until
the required information has been submitted.
(2) Except as provided in paragraph (4) the rate for existing
programs receiving a provisional rate, whose rate would otherwise
expire during fiscal year 1990-91, shall be extended at the
provisional rate until September 1, 1991.
(3) Except as provided in paragraph (4) below, the rate for
existing programs receiving a permanent rate shall be reestablished
at the permanent rate until June 30, 1991.
(4) The rate for existing programs receiving a provisional or
permanent rate as specified in paragraph (2) and paragraph (3) shall
be increased for all programs eligible for the increase. Eligible
programs shall include only those programs which received a
deficiency adjustment in their permanent or provisional rate for
fiscal year 1989-90, based on calendar year 1988 program and cost
information submitted to the department, pursuant to the stipulated
order in the case of California Association of Rehabilitation
Facilities et al. v. State of California, Sacramento County Superior
Court Case No. 355326, and the adjustment was insufficient to fund
the entire deficiency. The amount of funds available for the increase
is limited to the one million dollars ($1,000,000) appropriated for
that purpose for fiscal year 1990-91, and it shall be distributed
proportionately among all eligible programs. The amount of increase
which each eligible program shall receive toward its remaining
deficiency, based on calendar year 1988 program and cost information,
shall be equal to the percentage that one million dollars
($1,000,000) represents of the total deficiency, based on calendar
year 1988 program and cost information, for all eligible programs.
(b) A process for establishing rates during fiscal year 1991-92
for new programs and existing programs receiving a temporary,
provisional, or permanent rate.
(1) The rate for existing programs receiving a permanent rate,
shall be determined based on fiscal year 1989-90 program, cost, and
other information submitted to the department and regional center.
The ratesetting process shall include, but shall not be limited to,
all of the following:
(A) A process for determination of a mean rate and an allowable
range of rates for the same type of day program and staff-to-client
ratio. The mean rate shall be determined using those programs'
allowable costs and client attendance and the allowable range of
rates shall be defined as the rates of those programs included
between the 10th and 90th percentiles.
(B) The rates for existing programs receiving a permanent rate
shall be increased or decreased to their allowable costs for fiscal
year 1991-92, as follows:
(i) The rate shall be decreased if the program's allowable costs
and client attendance, for fiscal year 1989-90, determined pursuant
to the regulations, would result in a rate that is lower than its
existing permanent rate.
(ii) The rate shall be increased if the program's allowable costs
and client attendance for fiscal year 1989-90, determined pursuant to
the regulations, would result in a rate that is higher than its
existing permanent rate and its existing permanent rate is below or
within the allowable range of rates.
(iii) No rate increase shall be provided that would result in the
rate exceeding the allowable range of rates. No increase shall be
provided for programs whose existing permanent rate is above the
allowable range of rates. The amount of funds appropriated for that
purpose for fiscal year 1991-92 shall be distributed only to those
programs eligible for the increase.
(C) A process for the reduction or increase in the rate of any
program whose existing permanent rate is not within the allowable
range of rates. This process shall be based upon all of the
following:
(i) For programs whose existing permanent rates are above the
allowable range of rates, their existing permanent rate shall be
reduced by 5 percent or to the allowable range, whichever is less.
(ii) For programs whose existing permanent rates are below the
allowable range of rates, after the increase specified in clause (ii)
of subparagraph (B) their rate shall be increased, up to the
allowable range, in proportion to the amount of funds obtained from
reducing the rate of programs whose rates are above the range.
(2) The rate for new programs shall be the mean rate determined
pursuant to the process in paragraph (1) for the same type of day
program and staff-to-client ratio using the program, cost, and other
information submitted by providers receiving a permanent rate.
(3) The rate for existing programs receiving a provisional rate,
whose rate expired during fiscal year 1990-91 and was extended until
September 1, 1991, shall be determined pursuant to the process
specified in paragraph (1) for permanent rates, except that the
determination shall be based upon 12 consecutive months of
representative costs incurred by the program during the period it was
receiving its provisional rate. The program shall submit these costs
and other program information, designated by the department, to the
department within the time frames specified in the regulations. If
the program has not incurred or cannot provide 12 consecutive months
of representative costs, the department may determine the rate based
on less than 12 consecutive months of representative costs.
(4) The rate for existing programs receiving a provisional rate,
whose rate will expire in July or August of 1991, shall be extended
until September 1, 1991, and then determined pursuant to the process
specified in paragraph (3).
(c) A process for establishing rates during fiscal year 1992-93
for new programs and existing programs receiving a temporary or
permanent rate:
(1) The rate for new programs shall be the mean rate, determined
pursuant to the process in paragraph (2) of subdivision (b) for
fiscal year 1991-92, for the same type of day program and
staff-to-client ratio.
(2) The rate for existing programs receiving a temporary rate
shall be continued at the rate established for fiscal year 1991-92,
until the rate expires or a permanent rate is established pursuant to
the process in paragraph (4) of subdivision (b) for fiscal year
1991-92.
(3) The rate for existing programs receiving a permanent rate
shall be reestablished at the rate established for fiscal year
1991-92, except for programs whose rates are not within the allowable
range of rates. For those programs whose rates are not within the
allowable range, their rates shall be reduced or increased pursuant
to the process in subparagraph (C) of paragraph (1) of subdivision
(b) for fiscal year 1991-92.
(d) A process for establishing rates during fiscal year 1993-94
for new programs and existing programs receiving a temporary or
permanent rate:
(1) The rate for existing programs receiving a permanent rate
shall be determined based on fiscal year 1991-92 program, cost, and
other information submitted to the department and regional center.
The ratesetting process shall include the process specified in
paragraph (1) of subdivision (b) for fiscal year 1991-92, except that
the allowable range of rates shall be determined by computing 50
percent of the mean rate for fiscal year 1993-94 and converting that
amount into a range of rates, distributed equally above and below the
mean. This process shall compare the range of rates computed for
fiscal year 1993-94 with the range of rates calculated for fiscal
year 1991-92 based on 80 percent of the programs, and shall use the
lesser of the two ranges in the comparison as the allowable range of
rates. Once established, this range shall be permanent.
(2) The rate for new programs shall be the mean rate determined
pursuant to the process in paragraph (1) for the same type of day
program and staff-to-client ratio using the program, cost, and other
information submitted by providers receiving a permanent rate.
(3) The rate for existing programs receiving a temporary rate
shall be continued at the established rate until the program has
incurred 12 consecutive months of representative costs within the
timeframes specified in the regulations. Once the representative
costs have been incurred, the rate shall be determined pursuant to
the process specified in paragraph (1) for permanent rates.
(e) A process for establishing rates, during fiscal year 1994-95
and each alternative fiscal year thereafter, for new programs and
existing programs receiving a temporary or permanent rate. The
process shall be the same as that specified in subdivision (c) for
determining, continuing, and reestablishing rates, but shall be based
on the program, cost, and other information submitted to the
department and regional center for establishment of rates for fiscal
year 1993-94 and each alternative fiscal year thereafter, except for
the following:
(1) For the 1998-99 fiscal year, the rates for existing
community-based day programs receiving a permanent rate shall be
increased if the program's allowable costs and client attendance, for
the 1995-96 fiscal year, determined pursuant to the regulations,
would result in a rate that is higher than its existing permanent
rate and its existing permanent rate is below or within the allowable
range of rates. The rate shall not be decreased if the program's
allowable costs and client attendance for the 1995-96 fiscal year,
determined pursuant to the regulations, would result in a rate that
is lower than its existing permanent rate.
(2) For the 1998-99 fiscal year, existing community-based day
programs receiving a permanent rate, and whose permanent rate is
still below the lower limit of the allowable range of rates for like
programs after receiving an increase pursuant to paragraph (1), shall
receive an increase in their permanent rate up to the lower limit of
the allowable range of rates.
(3) The requirements of subdivision (c) of Section 4691, which
specify that any rate increases shall be subject to the appropriation
of sufficient funds in the Budget Act, shall also apply to rates
governed by paragraphs (1) and (2).
(f) A process for establishing rates, during fiscal year 1995-96
and each alternative fiscal year thereafter, for new programs and
existing programs receiving a temporary or permanent rate. The
process shall be the same as that specified in subdivision (d) except
for the following:
(1) The rate for programs receiving a permanent rate shall be
based on program, cost, and other information submitted to the
department and regional center for fiscal year 1993-94 and each
alternative fiscal year thereafter.
(2) The allowable range of rates, permanently established during
fiscal year 1993-94, shall be applied to the mean rate determined for
fiscal year 1995-96 and each alternative fiscal year thereafter.
(3) Existing programs receiving a permanent rate whose rates are
not within the allowable range of rates shall, by September 1, 1995,
have their rates reduced or increased as follows:
(A) For programs whose existing permanent rates are above the
allowable range of rates, their rate shall be reduced to the
allowable range.
(B) For programs whose existing rates are below the allowable
range of rates, their rate shall be increased up to the allowable
range in proportion to the amount of funds obtained from reducing the
rate of programs whose rates are above the range.
(g) A process for establishing a uniform supplemental rate of
reimbursement for programs serving nonambulatory clients, as
determined by the department.
(h) A process for notifying the program of the established rate.
4691.6. (a) Notwithstanding any other provision of law or
regulation, commencing July 1, 2006, the community-based day program,
work activity program, and in-home respite service agency rate
schedules authorized by the department and in operation June 30,
2006, 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 increase shall be
governed by subdivisions (b), (c), (d), and (e) and Section 4691.9.
(b) Notwithstanding any other provision of law or regulation, the
department may not establish any permanent payment rate for a
community-based day program or in-home respite service agency
provider that has a temporary payment rate in effect on June 30,
2008, if the permanent payment rate would be greater than the
temporary payment rate in effect on or after June 30, 2008, unless
the regional center demonstrates to the department that the permanent
payment rate is necessary to protect the consumers' health or
safety.
(c) Notwithstanding any other provision of law or regulation,
neither the department nor any regional center may approve any
program design modification or revendorization for a community-based
day program or in-home respite service agency provider that would
result in an increase in the rate to be paid to the vendor from the
rate that is in effect on or after June 30, 2008, unless the regional
center demonstrates that the program design modification or
revendorization is necessary to protect the consumers' health or
safety and the department has granted prior written authorization.
(d) Notwithstanding any other provision of law or regulation, the
department may not approve an anticipated rate adjustment for a
community-based day program or in-home respite service agency
provider that would result in an increase in the rate to be paid to
the vendor from the rate that is in effect on or after June 30, 2008,
unless the regional center demonstrates that the anticipated rate
adjustment is necessary to protect the consumers' health or safety.
(e) Notwithstanding any other provision of law or regulation, the
department may not approve any rate adjustment for a work activity
program that would result in an increase in the rate to be paid to
the vendor from the rate that is in effect on or after June 30, 2008,
unless the regional center demonstrates that the rate adjustment is
necessary to protect the consumers' health and safety and the
department has granted prior written authorization.
4691.8. (a) Notwithstanding any other provision of law or
regulation, and to the extent funds are appropriated in the annual
Budget Act for this purpose, the department may provide a rate
increase for the purpose of enhancing wages for direct care staff in
day programs and in work activity programs, as defined in subdivision
(e) of Section 4851, and in look-alike programs, that meet any of
the following criteria:
(1) Provide a majority of their services and supports in
integrated community settings.
(2) Are day programs that are converting to integrated community
settings.
(3) Are work activity programs that are converting to supported
work programs.
(b) The department may approve a temporary rate increase for a
program that is converting pursuant to paragraph (2) or (3) of
subdivision (a). A program shall not be eligible for a permanent rate
increase pursuant to this section unless it meets the criteria
established in paragraph (1) of subdivision (a).
(c) A rate increase provided pursuant to paragraph (1) of
subdivision (a) to existing programs shall be effective not more than
60 days following the adoption of the Budget Act that appropriates
the necessary funding.
(d) Prior to implementation of this section, the department shall
consult with stakeholders, including various provider organizations,
the regional centers, and all other interested parties.
(e) The department shall provide the Legislature, by April 1,
2007, with a description of how this section has been implemented,
along with the following information:
(1) The number of day programs and work activity centers receiving
an enhanced rate, by regional center.
(2) The number of program conversions, by regional center.
(3) The percentage of rate increase provided to programs.
(4) The effect of the rate increase on direct care staff wages.
4691.9. Notwithstanding any other provision of law or regulation,
commencing July 1, 2008:
(a) No regional center shall pay an existing service provider, for
services where rates are determined through a negotiation between
the regional center and the provider, a rate higher than the rate in
effect on 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.
(b) No regional center may negotiate a rate with a new service
provider, for services where rates are determined through a
negotiation between the regional center and the provider, that is
higher than the regional center's median rate for the same service
code and unit of service, or the statewide median rate for the same
service code and unit of service, whichever is lower. The unit of
service designation must conform with an existing regional center
designation or, if none exists, a designation used to calculate the
statewide median rate for the same service. The regional center shall
annually certify to the State Department of Developmental Services
its median rate for each negotiated rate service code, by designated
unit of service. This certification will be subject to verification
through the department's biennial fiscal audit of the regional
center.
(c) This section shall not apply to those services for which rates
are determined by the State Department of Health Care Services, or
the State Department of Developmental Services, or are usual and
customary.
4692. (a) Effective August 1, 2009, subject to subdivisions (c) and
(e), regional centers shall not compensate a work activity program,
activity center, adult development center, behavior management
program, social recreation program, adaptive skills trainer, infant
development program, program support group (day service),
socialization training program, client/parent support behavior
intervention training program, community integration training
program, community activities support service, or creative arts
program, as defined in Title 17 of the California Code of
Regulations, for providing any service to a consumer on any of the
following holidays:
(1) January 1.
(2) The third Monday in January.
(3) The third Monday in February.
(4) March 31.
(5) The last Monday in May.
(6) July 4.
(7) The first Monday in September.
(8) November 11.
(9) Thanksgiving Day.
(10) December 25.
(11) The four business days between December 25 and January 1.
(b) Effective August 1, 2009, subject to subdivisions (c) and (e),
regional centers shall not compensate a transportation vendor/family
member, transportation company, transportation/additional component
vendor, transportation broker, transportation assistant/vendor,
transportation vendor/auto driver, or transportation vendor/public or
rental car agency or taxi, in accordance with Title 17 of the
California Code of Regulations, for transporting any consumer to
receive services from any of the vendors specified in subdivision (a)
for any of the holidays set forth in paragraphs (1) to (11),
inclusive, of subdivision (a).
(c) If a holiday listed in this section falls on a Saturday or a
Sunday, the following Monday shall be deemed to be the holiday in
lieu of the day observed.
(d) Contracts between the vendors described in this section and
regional centers shall reflect the holiday closures set forth in this
section and shall be renegotiated accordingly, as necessary.
(e) The department may adjust the holidays set forth in
subdivision (a) through a program directive. This directive shall be
provided to the regional centers and posted on the department's
Internet Web site at least 60 days prior to the effective date of the
change in holiday.
4693. For the purposes of this article, "infant day program" means
a day training and activity program where infants and their families
are provided training individually and in groups for a day or less,
and are provided an organized program of activity. These programs are
designed to encourage the development and adjustment of the infants
in the community and their homes, and to prepare the infants for
entrance into classes of local schools or other appropriate
facilities.
4694. Commencing July 1, 2006, all regional center vendors who are
qualified providers under Title XIX of the federal Social Security
Act (42 U.S.C. Sec. 1396 et seq.) and are serving individuals
enrolled under the Home- and Community-based Services Waiver program
for persons with developmental disabilities, shall ensure that
billing information provided to regional centers identifies each
individual consumer and, for each consumer, the specific dates of
service, location of service, service unit, unit costs, and other
information necessary to support billing under the home- and
community-based services waiver. Regional centers shall also ensure
that their contractual and other billing and payment arrangements
with providers require the provision of any information necessary to
support billing under the Home- and Community-based Services Waiver
program. Resources provided to regional centers, pursuant to the
Budget Act of 2006 and following budgets, to implement this provision
shall be allocated to the regional centers only until implementation
of a statewide electronic data system that collects the billing
information necessary to support billing under the Home- and
Community-based Services Waiver program.
4690. The Director of Developmental Services shall establish,
maintain, and revise, as necessary, an equitable process for setting
rates of state payment for nonresidential services purchased by
regional centers, and may promulgate regulations establishing program
standards, or the process to be used for setting these rates, or
both, in order to assure that regional centers may secure
high-quality services for developmentally disabled persons from
individuals or agencies vendored to provide these services. In
developing the rates pursuant to regulation, the director may require
vendors to submit program, cost, or other information, as necessary.
The director shall take into account the rates paid by other
agencies and jurisdictions for comparable services in order to assure
that regional center rates are at competitive levels. In no event
shall rates established pursuant to this article be any less than
those established for comparable services under the Medi-Cal program.
4690.1. (a) By March 1, 1986, the department, in consultation with
representatives of regional centers and providers of transportation
services to regional center clients, shall develop a cost statement
to be used in setting rates for providers of transportation services.
(b) Notwithstanding subdivision (a), the department may develop
alternative procedures for establishing rates for providers of
transportation services, including, but not limited to, a
noncompetitive process and a competitive process for use by regional
centers in which rates of reimbursement are established based on
contract bids or proposals.
4690.2. (a) The Director of Developmental Services shall develop
program standards and establish, maintain, and revise, as necessary,
an equitable process for setting rates of state payment, based upon
those standards, for in-home respite services purchased by regional
centers from agencies vendored to provide these services. The
Director of Developmental Services may promulgate regulations
establishing these standards and the process to be used for setting
rates. "In-home respite services" means intermittent or regularly
scheduled temporary nonmedical care and supervision provided in the
client's own home, for a regional center client who resides with a
family member. These services are designed to do all of the
following:
(1) Assist family members in maintaining the client at home.
(2) Provide appropriate care and supervision to ensure the client'
s safety in the absence of family members.
(3) Relieve family members from the constantly demanding
responsibility of caring for the client.
(4) Attend to the client's basic self-help needs and other
activities of daily living including interaction, socialization, and
continuation of usual daily routines which would ordinarily be
performed by the family members.
(b) The provisions of subdivisions (b) to (f), inclusive, of
Section 4691 and subdivisions (a) to (f), inclusive, and subdivision
(h) of Section 4691.5 applicable to community-based day programs,
shall also apply to in-home respite service vendors for the purpose
of establishing standards and an equitable process for setting rates,
except:
(1) The process specified in paragraph (4) of subdivision (a) of
Section 4691.5 for increasing rates for fiscal year 1990-91 shall
apply only to the administrative portion of the rate for eligible
in-home respite service vendors, and the amount of funds available
for this increase shall not exceed three hundred thousand dollars
($300,000) of the total amount appropriated for rate increases. The
administrative portion of the rate shall consist of the in-home
respite service vendor's allowable costs, other than those for
respite worker's salary, wage, benefits, and travel. Vendors eligible
for this rate increase shall include only those in-home respite
service vendors which received a deficiency adjustment in their
permanent or provisional rate for fiscal year 1989-90, as specified
in paragraph (4) of subdivision (a) of Section 4691.5.
(2) In addition, a rate increase shall also be provided for fiscal
year 1990-91, for the salary, wage, and benefit portion of the rate
for in-home respite service vendors eligible for the increase. The
amount of funds available for this rate increase is limited to the
remaining funds appropriated for this paragraph and paragraph (1) for
fiscal year 1990-91. The amount of increase which each eligible
in-home respite service vendor shall receive shall be limited to the
amount necessary to increase the salary, wage, and benefit portion of
the rate for respite workers to five dollars and six cents ($5.06)
per hour in salary and wages plus ninety-five cents ($0.95) in
benefits. Vendors eligible for this increase shall include only those
in-home respite service vendors whose salary, wage, and benefit
portion of their existing provisional or permanent rate, as
established by the department for respite workers is below the
amounts specified in this paragraph, and the vendor agrees to
reimburse its respite workers at no less than these amounts during
fiscal year 1990-91 and thereafter. In order to establish rates
pursuant to this paragraph, existing programs receiving a permanent
or provisional rate shall submit to the department, the program,
cost, and other information specified by the department for either
the 1988 calendar year, or for the 1988-89 fiscal year. The specified
information shall be submitted on forms developed by the department,
not later than 45 days following receipt of the required forms from
the department, after the effective date of this section. Programs
which fail to submit the required information within the time
specified shall have payment of their permanent or provisional rate
suspended until the required information has been submitted.
(3) Effective July 1, 1990, and pursuant to the rate methodology
developed by the department, the administrative portion and the
salary, wage, and benefit portion of the rates for in-home respite
service vendors currently receiving a provisional or permanent rate
shall be combined and paid as a single rate.
(4) Rate increases for fiscal year 1990-91 shall be limited to
those specified in paragraphs (1) and (2). For fiscal year 1991-92
and all succeeding fiscal years, the provisions of subdivision (c) of
Section 4691, which specify that any rate increases shall be subject
to the appropriation of sufficient funds in the Budget Act, shall
also apply to rates for in-home respite service vendors.
(5) For the 1998-99 fiscal year, an in-home respite service vendor
shall receive rate increases pursuant to subdivision (e) of Section
4691.5. Any rate increase shall be subject to the appropriation of
funds pursuant to the Budget Act.
(6) The rate methodology developed by the department may include a
supplemental amount of reimbursement for travel costs of respite
workers using their private vehicles to and from and between respite
sites. The supplemental amount shall be the minimum rate for travel
reimbursement for state employees.
4690.3. (a) For the 1998-99 fiscal year, rates for in-home respite
services agencies that are vendored pursuant to Section 4690.2 and
the department's regulations to provide in-home respite services
shall be increased based on the amount appropriated in the Budget Act
of 1998 for the purpose of increasing the salary, wage, and benefit
portion of the rate for in-home respite services workers. Agencies
shall reimburse their respite workers at no less than the increased
amount in their rate for the 1998-99 fiscal year and thereafter.
(b) For the 1998-99 fiscal years an individual who provides
in-home respite services, pursuant to vendorization pursuant to the
department's regulations, shall also receive a rate increase pursuant
to subdivision (a).
4690.4. (a) Sections 4690.2, 4691, and 4691.5, which relate to
in-home respite service agencies and community-based day programs,
shall apply in the 1998-99 fiscal year with the following exceptions:
(1) The 1997-98 fiscal year allowable costs and consumer
attendance data submitted to the department by September 30, 1998,
shall not be utilized by the department to determine a new mean rate
and allowable range of rates, pursuant to regulations, but may be
used only in developing a new rate system.
(2) The allowable range of rates and mean rate established for the
1997-98 fiscal year shall be continued.
(3) The rate for new programs shall be the mean rate determined
for the same type of program and staff-to-consumer ratio for the
1997-98 fiscal year.
(b) The department shall, in consultation with stakeholder
organizations, develop performance based consumer outcome rate
systems for community-based day programs and in-home respite
services. If rates for community-based day programs are increased in
the 1998-99 fiscal year pursuant to paragraphs (1) to (3), inclusive,
of subdivision (e) of Section 4691.5, and rates for in-home respite
services are increased in the 1998-99 fiscal year pursuant to
paragraph (5) of subdivision (b) of Section 4690.2, as added by the
act adding this section to the Welfare and Institutions Code, then
effective September 1, 1998, and until such time as the new rate
systems are implemented, or unless funds are otherwise appropriated
for rate adjustments, rates shall be frozen.
4690.5. Notwithstanding any other provision of law or regulation,
commencing July 1, 2006, the rate for family member-provided respite
services authorized by the department and in operation June 30, 2006,
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.
4691. (a) The Legislature reaffirms its intent that community-based
day programs be planned and provided as part of a continuum of
services to enable persons with developmental disabilities to
approximate the pattern of everyday living available to people of the
same age without disabilities. The Legislature further intends that
standards be developed to ensure high-quality services, and that
equitable ratesetting procedures based upon those standards be
established, maintained, and revised, as necessary. The Legislature
intends that ratesetting procedures be developed for all
community-based day programs, which include adult development
centers, activity centers, infant day programs, behavior management
programs, social recreational programs, and independent living
programs.
(b) For the purpose of ensuring that regional centers may secure
high-quality services for persons with developmental disabilities,
the State Department of Developmental Services shall promulgate
regulations establishing program standards and an equitable process
for setting rates of state payment for community-based day programs.
These regulations shall include, but are not limited to, all of the
following:
(1) The standards and requirements related to the operation of the
program including, but not limited to, staff qualifications,
staff-to-client ratios, client entrance and exit criteria, program
design, program evaluation, program and client records and
documentation, client placement, and personnel requirements and
functions.
(2) The allowable cost components of the program including salary
and wages, staff benefits, operating expenses, and management
organization costs where two or more programs are operated by a
separate and distinct corporation or entity.
(3) The rate determination processes for establishing rates, based
on the allowable costs of the allowable cost components. Different
rate determination processes may be developed for establishing rates
for new and existing programs, and for the initial and subsequent
years of implementation of the regulations. The processes shall
include, but are not limited to, all of the following:
(A) The procedure for identification and grouping of programs by
type of day program and approved staff-to-client ratio.
(B) The requirements for an identification of the program, cost,
and other information, if any, which the program is required to
submit to the department or the regional center, the consequences, if
any, for failure to do so, and the timeframes and format for
submission and review.
(C) The ratesetting methodology.
(D) A procedure for adjusting rates as a result of anticipated and
unanticipated program changes and fiscal audits of the program and a
procedure for appealing rates, including the timeframes for the
program to request an adjustment or appeal, and for the department to
respond.
(E) A procedure for increasing established rates and the allowable
range of rates due to cost-of-living adjustments.
(F) A procedure for increasing established rates as a result of
Budget Act appropriations made pursuant to the ratesetting
methodology established pursuant to Section 4691.5 and subdivision
(c) of this section.
The department shall develop these regulations in consultation
with representatives from organizations representing the
developmental services system as determined by the department. The
State Council on Developmental Disabilities, and other organizations
representing regional centers, providers, and clients shall have an
opportunity to review and comment upon the proposed regulations prior
to their promulgation. The department shall promulgate these
regulations for all community-based day programs by July 1, 1990.
(c) Upon the promulgation of regulations pursuant to subdivision
(b), and pursuant to Section 4691.5, and by September 1 of each year
thereafter, the department shall establish rates pursuant to the
regulations. Rate increases during the 1990-91 and 1991-92 fiscal
years shall be limited to those specified in subdivision (b). For the
1992-93 fiscal year and all succeeding fiscal years, any increases
proposed during those years in the rates of reimbursement established
pursuant to the regulations, except for rate increases due to rate
appeals and rate adjustments based on unanticipated program changes,
shall be subject to the appropriation of sufficient funds in the
Budget Act, for those purposes, to fully provide the proposed
increase to all eligible programs for the entire fiscal year. If the
funds appropriated in the Budget Act are not sufficient to fully
provide for the proposed increase in the rates of reimbursement for
all eligible programs for the entire fiscal year, the proposed
increase shall be limited to the level of funds appropriated. The
increases proposed in the rates of reimbursement shall be reduced
equitably among all eligible providers in accordance with funds
appropriated and the eligible programs shall be reimbursed at the
reduced amount for the entire fiscal year.
(d) Using the reported costs of day programs reimbursed at a
permanent rate and the standards and ratesetting processes
promulgated pursuant to subdivision (b) as a basis, the department
shall report to the Legislature as follows:
(1) By April 15, 1993, and every odd year thereafter, the
difference between permanent rates for existing programs and the
rates of those programs based upon their allowable costs and client
attendance, submitted pursuant to the regulations specified in
subdivision (b). In reporting the difference, the department shall
also identify the amount of the difference associated with programs
whose rates are above the allowable range of rates, which is
available for increasing the rates of programs whose rates are below
the allowable range, to within the allowable range, and any other
pertinent cost or rate information which the department deems
necessary.
(2) By April 15, 1994, and every even year thereafter, the level
of funding, if any, which was not appropriated to reimburse providers
at the proposed rates reported the prior fiscal year pursuant to
paragraph (1), and any other pertinent cost or rate information which
the department deems necessary.
(3) The April 15, 1996, report pursuant to paragraph (2) shall be
prepared jointly by the department and organizations representing
community-based day program providers, as determined by the
department. That report shall also include a review of the
ratesetting process and recommendations, if any, for its
modification.
(e) Rates established by the department pursuant to subdivision
(b) are exempt from the provisions of Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code.
(f) The department shall ensure that the regional centers monitor
compliance with program standards.
4691.5. The ratesetting methodology, to be established pursuant to
subparagraph (C) of paragraph (3) of subdivision (b) of Section 4691
shall include, but need not be limited to, all of the following:
(a) A process for establishing rates during fiscal year 1990-91
for new programs and existing programs receiving a provisional or
permanent rate.
(1) The rate for new programs shall be the mean rate determined
for the same type of day program and staff-to-client ratio. This rate
shall be a temporary rate. Determination of the mean rate for new
programs shall be based on the program, cost, and other information
of existing programs receiving a permanent rate, using allowable
costs and client attendance information of those existing programs.
In order to establish rates pursuant to this paragraph existing
programs receiving a permanent rate shall submit to the department,
the program, cost, and other information specified by the department
for either calendar year 1988 or fiscal year 1988-89. The specified
information shall be submitted on forms developed by the department,
not later than 45 days following receipt of the required forms from
the department, after the effective date of this section. Programs
which fail to submit the required information within the time
specified shall have payment of their permanent rate suspended until
the required information has been submitted.
(2) Except as provided in paragraph (4) the rate for existing
programs receiving a provisional rate, whose rate would otherwise
expire during fiscal year 1990-91, shall be extended at the
provisional rate until September 1, 1991.
(3) Except as provided in paragraph (4) below, the rate for
existing programs receiving a permanent rate shall be reestablished
at the permanent rate until June 30, 1991.
(4) The rate for existing programs receiving a provisional or
permanent rate as specified in paragraph (2) and paragraph (3) shall
be increased for all programs eligible for the increase. Eligible
programs shall include only those programs which received a
deficiency adjustment in their permanent or provisional rate for
fiscal year 1989-90, based on calendar year 1988 program and cost
information submitted to the department, pursuant to the stipulated
order in the case of California Association of Rehabilitation
Facilities et al. v. State of California, Sacramento County Superior
Court Case No. 355326, and the adjustment was insufficient to fund
the entire deficiency. The amount of funds available for the increase
is limited to the one million dollars ($1,000,000) appropriated for
that purpose for fiscal year 1990-91, and it shall be distributed
proportionately among all eligible programs. The amount of increase
which each eligible program shall receive toward its remaining
deficiency, based on calendar year 1988 program and cost information,
shall be equal to the percentage that one million dollars
($1,000,000) represents of the total deficiency, based on calendar
year 1988 program and cost information, for all eligible programs.
(b) A process for establishing rates during fiscal year 1991-92
for new programs and existing programs receiving a temporary,
provisional, or permanent rate.
(1) The rate for existing programs receiving a permanent rate,
shall be determined based on fiscal year 1989-90 program, cost, and
other information submitted to the department and regional center.
The ratesetting process shall include, but shall not be limited to,
all of the following:
(A) A process for determination of a mean rate and an allowable
range of rates for the same type of day program and staff-to-client
ratio. The mean rate shall be determined using those programs'
allowable costs and client attendance and the allowable range of
rates shall be defined as the rates of those programs included
between the 10th and 90th percentiles.
(B) The rates for existing programs receiving a permanent rate
shall be increased or decreased to their allowable costs for fiscal
year 1991-92, as follows:
(i) The rate shall be decreased if the program's allowable costs
and client attendance, for fiscal year 1989-90, determined pursuant
to the regulations, would result in a rate that is lower than its
existing permanent rate.
(ii) The rate shall be increased if the program's allowable costs
and client attendance for fiscal year 1989-90, determined pursuant to
the regulations, would result in a rate that is higher than its
existing permanent rate and its existing permanent rate is below or
within the allowable range of rates.
(iii) No rate increase shall be provided that would result in the
rate exceeding the allowable range of rates. No increase shall be
provided for programs whose existing permanent rate is above the
allowable range of rates. The amount of funds appropriated for that
purpose for fiscal year 1991-92 shall be distributed only to those
programs eligible for the increase.
(C) A process for the reduction or increase in the rate of any
program whose existing permanent rate is not within the allowable
range of rates. This process shall be based upon all of the
following:
(i) For programs whose existing permanent rates are above the
allowable range of rates, their existing permanent rate shall be
reduced by 5 percent or to the allowable range, whichever is less.
(ii) For programs whose existing permanent rates are below the
allowable range of rates, after the increase specified in clause (ii)
of subparagraph (B) their rate shall be increased, up to the
allowable range, in proportion to the amount of funds obtained from
reducing the rate of programs whose rates are above the range.
(2) The rate for new programs shall be the mean rate determined
pursuant to the process in paragraph (1) for the same type of day
program and staff-to-client ratio using the program, cost, and other
information submitted by providers receiving a permanent rate.
(3) The rate for existing programs receiving a provisional rate,
whose rate expired during fiscal year 1990-91 and was extended until
September 1, 1991, shall be determined pursuant to the process
specified in paragraph (1) for permanent rates, except that the
determination shall be based upon 12 consecutive months of
representative costs incurred by the program during the period it was
receiving its provisional rate. The program shall submit these costs
and other program information, designated by the department, to the
department within the time frames specified in the regulations. If
the program has not incurred or cannot provide 12 consecutive months
of representative costs, the department may determine the rate based
on less than 12 consecutive months of representative costs.
(4) The rate for existing programs receiving a provisional rate,
whose rate will expire in July or August of 1991, shall be extended
until September 1, 1991, and then determined pursuant to the process
specified in paragraph (3).
(c) A process for establishing rates during fiscal year 1992-93
for new programs and existing programs receiving a temporary or
permanent rate:
(1) The rate for new programs shall be the mean rate, determined
pursuant to the process in paragraph (2) of subdivision (b) for
fiscal year 1991-92, for the same type of day program and
staff-to-client ratio.
(2) The rate for existing programs receiving a temporary rate
shall be continued at the rate established for fiscal year 1991-92,
until the rate expires or a permanent rate is established pursuant to
the process in paragraph (4) of subdivision (b) for fiscal year
1991-92.
(3) The rate for existing programs receiving a permanent rate
shall be reestablished at the rate established for fiscal year
1991-92, except for programs whose rates are not within the allowable
range of rates. For those programs whose rates are not within the
allowable range, their rates shall be reduced or increased pursuant
to the process in subparagraph (C) of paragraph (1) of subdivision
(b) for fiscal year 1991-92.
(d) A process for establishing rates during fiscal year 1993-94
for new programs and existing programs receiving a temporary or
permanent rate:
(1) The rate for existing programs receiving a permanent rate
shall be determined based on fiscal year 1991-92 program, cost, and
other information submitted to the department and regional center.
The ratesetting process shall include the process specified in
paragraph (1) of subdivision (b) for fiscal year 1991-92, except that
the allowable range of rates shall be determined by computing 50
percent of the mean rate for fiscal year 1993-94 and converting that
amount into a range of rates, distributed equally above and below the
mean. This process shall compare the range of rates computed for
fiscal year 1993-94 with the range of rates calculated for fiscal
year 1991-92 based on 80 percent of the programs, and shall use the
lesser of the two ranges in the comparison as the allowable range of
rates. Once established, this range shall be permanent.
(2) The rate for new programs shall be the mean rate determined
pursuant to the process in paragraph (1) for the same type of day
program and staff-to-client ratio using the program, cost, and other
information submitted by providers receiving a permanent rate.
(3) The rate for existing programs receiving a temporary rate
shall be continued at the established rate until the program has
incurred 12 consecutive months of representative costs within the
timeframes specified in the regulations. Once the representative
costs have been incurred, the rate shall be determined pursuant to
the process specified in paragraph (1) for permanent rates.
(e) A process for establishing rates, during fiscal year 1994-95
and each alternative fiscal year thereafter, for new programs and
existing programs receiving a temporary or permanent rate. The
process shall be the same as that specified in subdivision (c) for
determining, continuing, and reestablishing rates, but shall be based
on the program, cost, and other information submitted to the
department and regional center for establishment of rates for fiscal
year 1993-94 and each alternative fiscal year thereafter, except for
the following:
(1) For the 1998-99 fiscal year, the rates for existing
community-based day programs receiving a permanent rate shall be
increased if the program's allowable costs and client attendance, for
the 1995-96 fiscal year, determined pursuant to the regulations,
would result in a rate that is higher than its existing permanent
rate and its existing permanent rate is below or within the allowable
range of rates. The rate shall not be decreased if the program's
allowable costs and client attendance for the 1995-96 fiscal year,
determined pursuant to the regulations, would result in a rate that
is lower than its existing permanent rate.
(2) For the 1998-99 fiscal year, existing community-based day
programs receiving a permanent rate, and whose permanent rate is
still below the lower limit of the allowable range of rates for like
programs after receiving an increase pursuant to paragraph (1), shall
receive an increase in their permanent rate up to the lower limit of
the allowable range of rates.
(3) The requirements of subdivision (c) of Section 4691, which
specify that any rate increases shall be subject to the appropriation
of sufficient funds in the Budget Act, shall also apply to rates
governed by paragraphs (1) and (2).
(f) A process for establishing rates, during fiscal year 1995-96
and each alternative fiscal year thereafter, for new programs and
existing programs receiving a temporary or permanent rate. The
process shall be the same as that specified in subdivision (d) except
for the following:
(1) The rate for programs receiving a permanent rate shall be
based on program, cost, and other information submitted to the
department and regional center for fiscal year 1993-94 and each
alternative fiscal year thereafter.
(2) The allowable range of rates, permanently established during
fiscal year 1993-94, shall be applied to the mean rate determined for
fiscal year 1995-96 and each alternative fiscal year thereafter.
(3) Existing programs receiving a permanent rate whose rates are
not within the allowable range of rates shall, by September 1, 1995,
have their rates reduced or increased as follows:
(A) For programs whose existing permanent rates are above the
allowable range of rates, their rate shall be reduced to the
allowable range.
(B) For programs whose existing rates are below the allowable
range of rates, their rate shall be increased up to the allowable
range in proportion to the amount of funds obtained from reducing the
rate of programs whose rates are above the range.
(g) A process for establishing a uniform supplemental rate of
reimbursement for programs serving nonambulatory clients, as
determined by the department.
(h) A process for notifying the program of the established rate.
4691.6. (a) Notwithstanding any other provision of law or
regulation, commencing July 1, 2006, the community-based day program,
work activity program, and in-home respite service agency rate
schedules authorized by the department and in operation June 30,
2006, 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 increase shall be
governed by subdivisions (b), (c), (d), and (e) and Section 4691.9.
(b) Notwithstanding any other provision of law or regulation, the
department may not establish any permanent payment rate for a
community-based day program or in-home respite service agency
provider that has a temporary payment rate in effect on June 30,
2008, if the permanent payment rate would be greater than the
temporary payment rate in effect on or after June 30, 2008, unless
the regional center demonstrates to the department that the permanent
payment rate is necessary to protect the consumers' health or
safety.
(c) Notwithstanding any other provision of law or regulation,
neither the department nor any regional center may approve any
program design modification or revendorization for a community-based
day program or in-home respite service agency provider that would
result in an increase in the rate to be paid to the vendor from the
rate that is in effect on or after June 30, 2008, unless the regional
center demonstrates that the program design modification or
revendorization is necessary to protect the consumers' health or
safety and the department has granted prior written authorization.
(d) Notwithstanding any other provision of law or regulation, the
department may not approve an anticipated rate adjustment for a
community-based day program or in-home respite service agency
provider that would result in an increase in the rate to be paid to
the vendor from the rate that is in effect on or after June 30, 2008,
unless the regional center demonstrates that the anticipated rate
adjustment is necessary to protect the consumers' health or safety.
(e) Notwithstanding any other provision of law or regulation, the
department may not approve any rate adjustment for a work activity
program that would result in an increase in the rate to be paid to
the vendor from the rate that is in effect on or after June 30, 2008,
unless the regional center demonstrates that the rate adjustment is
necessary to protect the consumers' health and safety and the
department has granted prior written authorization.
4691.8. (a) Notwithstanding any other provision of law or
regulation, and to the extent funds are appropriated in the annual
Budget Act for this purpose, the department may provide a rate
increase for the purpose of enhancing wages for direct care staff in
day programs and in work activity programs, as defined in subdivision
(e) of Section 4851, and in look-alike programs, that meet any of
the following criteria:
(1) Provide a majority of their services and supports in
integrated community settings.
(2) Are day programs that are converting to integrated community
settings.
(3) Are work activity programs that are converting to supported
work programs.
(b) The department may approve a temporary rate increase for a
program that is converting pursuant to paragraph (2) or (3) of
subdivision (a). A program shall not be eligible for a permanent rate
increase pursuant to this section unless it meets the criteria
established in paragraph (1) of subdivision (a).
(c) A rate increase provided pursuant to paragraph (1) of
subdivision (a) to existing programs shall be effective not more than
60 days following the adoption of the Budget Act that appropriates
the necessary funding.
(d) Prior to implementation of this section, the department shall
consult with stakeholders, including various provider organizations,
the regional centers, and all other interested parties.
(e) The department shall provide the Legislature, by April 1,
2007, with a description of how this section has been implemented,
along with the following information:
(1) The number of day programs and work activity centers receiving
an enhanced rate, by regional center.
(2) The number of program conversions, by regional center.
(3) The percentage of rate increase provided to programs.
(4) The effect of the rate increase on direct care staff wages.
4691.9. Notwithstanding any other provision of law or regulation,
commencing July 1, 2008:
(a) No regional center shall pay an existing service provider, for
services where rates are determined through a negotiation between
the regional center and the provider, a rate higher than the rate in
effect on 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.
(b) No regional center may negotiate a rate with a new service
provider, for services where rates are determined through a
negotiation between the regional center and the provider, that is
higher than the regional center's median rate for the same service
code and unit of service, or the statewide median rate for the same
service code and unit of service, whichever is lower. The unit of
service designation must conform with an existing regional center
designation or, if none exists, a designation used to calculate the
statewide median rate for the same service. The regional center shall
annually certify to the State Department of Developmental Services
its median rate for each negotiated rate service code, by designated
unit of service. This certification will be subject to verification
through the department's biennial fiscal audit of the regional
center.
(c) This section shall not apply to those services for which rates
are determined by the State Department of Health Care Services, or
the State Department of Developmental Services, or are usual and
customary.
4692. (a) Effective August 1, 2009, subject to subdivisions (c) and
(e), regional centers shall not compensate a work activity program,
activity center, adult development center, behavior management
program, social recreation program, adaptive skills trainer, infant
development program, program support group (day service),
socialization training program, client/parent support behavior
intervention training program, community integration training
program, community activities support service, or creative arts
program, as defined in Title 17 of the California Code of
Regulations, for providing any service to a consumer on any of the
following holidays:
(1) January 1.
(2) The third Monday in January.
(3) The third Monday in February.
(4) March 31.
(5) The last Monday in May.
(6) July 4.
(7) The first Monday in September.
(8) November 11.
(9) Thanksgiving Day.
(10) December 25.
(11) The four business days between December 25 and January 1.
(b) Effective August 1, 2009, subject to subdivisions (c) and (e),
regional centers shall not compensate a transportation vendor/family
member, transportation company, transportation/additional component
vendor, transportation broker, transportation assistant/vendor,
transportation vendor/auto driver, or transportation vendor/public or
rental car agency or taxi, in accordance with Title 17 of the
California Code of Regulations, for transporting any consumer to
receive services from any of the vendors specified in subdivision (a)
for any of the holidays set forth in paragraphs (1) to (11),
inclusive, of subdivision (a).
(c) If a holiday listed in this section falls on a Saturday or a
Sunday, the following Monday shall be deemed to be the holiday in
lieu of the day observed.
(d) Contracts between the vendors described in this section and
regional centers shall reflect the holiday closures set forth in this
section and shall be renegotiated accordingly, as necessary.
(e) The department may adjust the holidays set forth in
subdivision (a) through a program directive. This directive shall be
provided to the regional centers and posted on the department's
Internet Web site at least 60 days prior to the effective date of the
change in holiday.
4693. For the purposes of this article, "infant day program" means
a day training and activity program where infants and their families
are provided training individually and in groups for a day or less,
and are provided an organized program of activity. These programs are
designed to encourage the development and adjustment of the infants
in the community and their homes, and to prepare the infants for
entrance into classes of local schools or other appropriate
facilities.
4694. Commencing July 1, 2006, all regional center vendors who are
qualified providers under Title XIX of the federal Social Security
Act (42 U.S.C. Sec. 1396 et seq.) and are serving individuals
enrolled under the Home- and Community-based Services Waiver program
for persons with developmental disabilities, shall ensure that
billing information provided to regional centers identifies each
individual consumer and, for each consumer, the specific dates of
service, location of service, service unit, unit costs, and other
information necessary to support billing under the home- and
community-based services waiver. Regional centers shall also ensure
that their contractual and other billing and payment arrangements
with providers require the provision of any information necessary to
support billing under the Home- and Community-based Services Waiver
program. Resources provided to regional centers, pursuant to the
Budget Act of 2006 and following budgets, to implement this provision
shall be allocated to the regional centers only until implementation
of a statewide electronic data system that collects the billing
information necessary to support billing under the Home- and
Community-based Services Waiver program.
4690. The Director of Developmental Services shall establish,
maintain, and revise, as necessary, an equitable process for setting
rates of state payment for nonresidential services purchased by
regional centers, and may promulgate regulations establishing program
standards, or the process to be used for setting these rates, or
both, in order to assure that regional centers may secure
high-quality services for developmentally disabled persons from
individuals or agencies vendored to provide these services. In
developing the rates pursuant to regulation, the director may require
vendors to submit program, cost, or other information, as necessary.
The director shall take into account the rates paid by other
agencies and jurisdictions for comparable services in order to assure
that regional center rates are at competitive levels. In no event
shall rates established pursuant to this article be any less than
those established for comparable services under the Medi-Cal program.
4690.1. (a) By March 1, 1986, the department, in consultation with
representatives of regional centers and providers of transportation
services to regional center clients, shall develop a cost statement
to be used in setting rates for providers of transportation services.
(b) Notwithstanding subdivision (a), the department may develop
alternative procedures for establishing rates for providers of
transportation services, including, but not limited to, a
noncompetitive process and a competitive process for use by regional
centers in which rates of reimbursement are established based on
contract bids or proposals.
4690.2. (a) The Director of Developmental Services shall develop
program standards and establish, maintain, and revise, as necessary,
an equitable process for setting rates of state payment, based upon
those standards, for in-home respite services purchased by regional
centers from agencies vendored to provide these services. The
Director of Developmental Services may promulgate regulations
establishing these standards and the process to be used for setting
rates. "In-home respite services" means intermittent or regularly
scheduled temporary nonmedical care and supervision provided in the
client's own home, for a regional center client who resides with a
family member. These services are designed to do all of the
following:
(1) Assist family members in maintaining the client at home.
(2) Provide appropriate care and supervision to ensure the client'
s safety in the absence of family members.
(3) Relieve family members from the constantly demanding
responsibility of caring for the client.
(4) Attend to the client's basic self-help needs and other
activities of daily living including interaction, socialization, and
continuation of usual daily routines which would ordinarily be
performed by the family members.
(b) The provisions of subdivisions (b) to (f), inclusive, of
Section 4691 and subdivisions (a) to (f), inclusive, and subdivision
(h) of Section 4691.5 applicable to community-based day programs,
shall also apply to in-home respite service vendors for the purpose
of establishing standards and an equitable process for setting rates,
except:
(1) The process specified in paragraph (4) of subdivision (a) of
Section 4691.5 for increasing rates for fiscal year 1990-91 shall
apply only to the administrative portion of the rate for eligible
in-home respite service vendors, and the amount of funds available
for this increase shall not exceed three hundred thousand dollars
($300,000) of the total amount appropriated for rate increases. The
administrative portion of the rate shall consist of the in-home
respite service vendor's allowable costs, other than those for
respite worker's salary, wage, benefits, and travel. Vendors eligible
for this rate increase shall include only those in-home respite
service vendors which received a deficiency adjustment in their
permanent or provisional rate for fiscal year 1989-90, as specified
in paragraph (4) of subdivision (a) of Section 4691.5.
(2) In addition, a rate increase shall also be provided for fiscal
year 1990-91, for the salary, wage, and benefit portion of the rate
for in-home respite service vendors eligible for the increase. The
amount of funds available for this rate increase is limited to the
remaining funds appropriated for this paragraph and paragraph (1) for
fiscal year 1990-91. The amount of increase which each eligible
in-home respite service vendor shall receive shall be limited to the
amount necessary to increase the salary, wage, and benefit portion of
the rate for respite workers to five dollars and six cents ($5.06)
per hour in salary and wages plus ninety-five cents ($0.95) in
benefits. Vendors eligible for this increase shall include only those
in-home respite service vendors whose salary, wage, and benefit
portion of their existing provisional or permanent rate, as
established by the department for respite workers is below the
amounts specified in this paragraph, and the vendor agrees to
reimburse its respite workers at no less than these amounts during
fiscal year 1990-91 and thereafter. In order to establish rates
pursuant to this paragraph, existing programs receiving a permanent
or provisional rate shall submit to the department, the program,
cost, and other information specified by the department for either
the 1988 calendar year, or for the 1988-89 fiscal year. The specified
information shall be submitted on forms developed by the department,
not later than 45 days following receipt of the required forms from
the department, after the effective date of this section. Programs
which fail to submit the required information within the time
specified shall have payment of their permanent or provisional rate
suspended until the required information has been submitted.
(3) Effective July 1, 1990, and pursuant to the rate methodology
developed by the department, the administrative portion and the
salary, wage, and benefit portion of the rates for in-home respite
service vendors currently receiving a provisional or permanent rate
shall be combined and paid as a single rate.
(4) Rate increases for fiscal year 1990-91 shall be limited to
those specified in paragraphs (1) and (2). For fiscal year 1991-92
and all succeeding fiscal years, the provisions of subdivision (c) of
Section 4691, which specify that any rate increases shall be subject
to the appropriation of sufficient funds in the Budget Act, shall
also apply to rates for in-home respite service vendors.
(5) For the 1998-99 fiscal year, an in-home respite service vendor
shall receive rate increases pursuant to subdivision (e) of Section
4691.5. Any rate increase shall be subject to the appropriation of
funds pursuant to the Budget Act.
(6) The rate methodology developed by the department may include a
supplemental amount of reimbursement for travel costs of respite
workers using their private vehicles to and from and between respite
sites. The supplemental amount shall be the minimum rate for travel
reimbursement for state employees.
4690.3. (a) For the 1998-99 fiscal year, rates for in-home respite
services agencies that are vendored pursuant to Section 4690.2 and
the department's regulations to provide in-home respite services
shall be increased based on the amount appropriated in the Budget Act
of 1998 for the purpose of increasing the salary, wage, and benefit
portion of the rate for in-home respite services workers. Agencies
shall reimburse their respite workers at no less than the increased
amount in their rate for the 1998-99 fiscal year and thereafter.
(b) For the 1998-99 fiscal years an individual who provides
in-home respite services, pursuant to vendorization pursuant to the
department's regulations, shall also receive a rate increase pursuant
to subdivision (a).
4690.4. (a) Sections 4690.2, 4691, and 4691.5, which relate to
in-home respite service agencies and community-based day programs,
shall apply in the 1998-99 fiscal year with the following exceptions:
(1) The 1997-98 fiscal year allowable costs and consumer
attendance data submitted to the department by September 30, 1998,
shall not be utilized by the department to determine a new mean rate
and allowable range of rates, pursuant to regulations, but may be
used only in developing a new rate system.
(2) The allowable range of rates and mean rate established for the
1997-98 fiscal year shall be continued.
(3) The rate for new programs shall be the mean rate determined
for the same type of program and staff-to-consumer ratio for the
1997-98 fiscal year.
(b) The department shall, in consultation with stakeholder
organizations, develop performance based consumer outcome rate
systems for community-based day programs and in-home respite
services. If rates for community-based day programs are increased in
the 1998-99 fiscal year pursuant to paragraphs (1) to (3), inclusive,
of subdivision (e) of Section 4691.5, and rates for in-home respite
services are increased in the 1998-99 fiscal year pursuant to
paragraph (5) of subdivision (b) of Section 4690.2, as added by the
act adding this section to the Welfare and Institutions Code, then
effective September 1, 1998, and until such time as the new rate
systems are implemented, or unless funds are otherwise appropriated
for rate adjustments, rates shall be frozen.
4690.5. Notwithstanding any other provision of law or regulation,
commencing July 1, 2006, the rate for family member-provided respite
services authorized by the department and in operation June 30, 2006,
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.
4691. (a) The Legislature reaffirms its intent that community-based
day programs be planned and provided as part of a continuum of
services to enable persons with developmental disabilities to
approximate the pattern of everyday living available to people of the
same age without disabilities. The Legislature further intends that
standards be developed to ensure high-quality services, and that
equitable ratesetting procedures based upon those standards be
established, maintained, and revised, as necessary. The Legislature
intends that ratesetting procedures be developed for all
community-based day programs, which include adult development
centers, activity centers, infant day programs, behavior management
programs, social recreational programs, and independent living
programs.
(b) For the purpose of ensuring that regional centers may secure
high-quality services for persons with developmental disabilities,
the State Department of Developmental Services shall promulgate
regulations establishing program standards and an equitable process
for setting rates of state payment for community-based day programs.
These regulations shall include, but are not limited to, all of the
following:
(1) The standards and requirements related to the operation of the
program including, but not limited to, staff qualifications,
staff-to-client ratios, client entrance and exit criteria, program
design, program evaluation, program and client records and
documentation, client placement, and personnel requirements and
functions.
(2) The allowable cost components of the program including salary
and wages, staff benefits, operating expenses, and management
organization costs where two or more programs are operated by a
separate and distinct corporation or entity.
(3) The rate determination processes for establishing rates, based
on the allowable costs of the allowable cost components. Different
rate determination processes may be developed for establishing rates
for new and existing programs, and for the initial and subsequent
years of implementation of the regulations. The processes shall
include, but are not limited to, all of the following:
(A) The procedure for identification and grouping of programs by
type of day program and approved staff-to-client ratio.
(B) The requirements for an identification of the program, cost,
and other information, if any, which the program is required to
submit to the department or the regional center, the consequences, if
any, for failure to do so, and the timeframes and format for
submission and review.
(C) The ratesetting methodology.
(D) A procedure for adjusting rates as a result of anticipated and
unanticipated program changes and fiscal audits of the program and a
procedure for appealing rates, including the timeframes for the
program to request an adjustment or appeal, and for the department to
respond.
(E) A procedure for increasing established rates and the allowable
range of rates due to cost-of-living adjustments.
(F) A procedure for increasing established rates as a result of
Budget Act appropriations made pursuant to the ratesetting
methodology established pursuant to Section 4691.5 and subdivision
(c) of this section.
The department shall develop these regulations in consultation
with representatives from organizations representing the
developmental services system as determined by the department. The
State Council on Developmental Disabilities, and other organizations
representing regional centers, providers, and clients shall have an
opportunity to review and comment upon the proposed regulations prior
to their promulgation. The department shall promulgate these
regulations for all community-based day programs by July 1, 1990.
(c) Upon the promulgation of regulations pursuant to subdivision
(b), and pursuant to Section 4691.5, and by September 1 of each year
thereafter, the department shall establish rates pursuant to the
regulations. Rate increases during the 1990-91 and 1991-92 fiscal
years shall be limited to those specified in subdivision (b). For the
1992-93 fiscal year and all succeeding fiscal years, any increases
proposed during those years in the rates of reimbursement established
pursuant to the regulations, except for rate increases due to rate
appeals and rate adjustments based on unanticipated program changes,
shall be subject to the appropriation of sufficient funds in the
Budget Act, for those purposes, to fully provide the proposed
increase to all eligible programs for the entire fiscal year. If the
funds appropriated in the Budget Act are not sufficient to fully
provide for the proposed increase in the rates of reimbursement for
all eligible programs for the entire fiscal year, the proposed
increase shall be limited to the level of funds appropriated. The
increases proposed in the rates of reimbursement shall be reduced
equitably among all eligible providers in accordance with funds
appropriated and the eligible programs shall be reimbursed at the
reduced amount for the entire fiscal year.
(d) Using the reported costs of day programs reimbursed at a
permanent rate and the standards and ratesetting processes
promulgated pursuant to subdivision (b) as a basis, the department
shall report to the Legislature as follows:
(1) By April 15, 1993, and every odd year thereafter, the
difference between permanent rates for existing programs and the
rates of those programs based upon their allowable costs and client
attendance, submitted pursuant to the regulations specified in
subdivision (b). In reporting the difference, the department shall
also identify the amount of the difference associated with programs
whose rates are above the allowable range of rates, which is
available for increasing the rates of programs whose rates are below
the allowable range, to within the allowable range, and any other
pertinent cost or rate information which the department deems
necessary.
(2) By April 15, 1994, and every even year thereafter, the level
of funding, if any, which was not appropriated to reimburse providers
at the proposed rates reported the prior fiscal year pursuant to
paragraph (1), and any other pertinent cost or rate information which
the department deems necessary.
(3) The April 15, 1996, report pursuant to paragraph (2) shall be
prepared jointly by the department and organizations representing
community-based day program providers, as determined by the
department. That report shall also include a review of the
ratesetting process and recommendations, if any, for its
modification.
(e) Rates established by the department pursuant to subdivision
(b) are exempt from the provisions of Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code.
(f) The department shall ensure that the regional centers monitor
compliance with program standards.
4691.5. The ratesetting methodology, to be established pursuant to
subparagraph (C) of paragraph (3) of subdivision (b) of Section 4691
shall include, but need not be limited to, all of the following:
(a) A process for establishing rates during fiscal year 1990-91
for new programs and existing programs receiving a provisional or
permanent rate.
(1) The rate for new programs shall be the mean rate determined
for the same type of day program and staff-to-client ratio. This rate
shall be a temporary rate. Determination of the mean rate for new
programs shall be based on the program, cost, and other information
of existing programs receiving a permanent rate, using allowable
costs and client attendance information of those existing programs.
In order to establish rates pursuant to this paragraph existing
programs receiving a permanent rate shall submit to the department,
the program, cost, and other information specified by the department
for either calendar year 1988 or fiscal year 1988-89. The specified
information shall be submitted on forms developed by the department,
not later than 45 days following receipt of the required forms from
the department, after the effective date of this section. Programs
which fail to submit the required information within the time
specified shall have payment of their permanent rate suspended until
the required information has been submitted.
(2) Except as provided in paragraph (4) the rate for existing
programs receiving a provisional rate, whose rate would otherwise
expire during fiscal year 1990-91, shall be extended at the
provisional rate until September 1, 1991.
(3) Except as provided in paragraph (4) below, the rate for
existing programs receiving a permanent rate shall be reestablished
at the permanent rate until June 30, 1991.
(4) The rate for existing programs receiving a provisional or
permanent rate as specified in paragraph (2) and paragraph (3) shall
be increased for all programs eligible for the increase. Eligible
programs shall include only those programs which received a
deficiency adjustment in their permanent or provisional rate for
fiscal year 1989-90, based on calendar year 1988 program and cost
information submitted to the department, pursuant to the stipulated
order in the case of California Association of Rehabilitation
Facilities et al. v. State of California, Sacramento County Superior
Court Case No. 355326, and the adjustment was insufficient to fund
the entire deficiency. The amount of funds available for the increase
is limited to the one million dollars ($1,000,000) appropriated for
that purpose for fiscal year 1990-91, and it shall be distributed
proportionately among all eligible programs. The amount of increase
which each eligible program shall receive toward its remaining
deficiency, based on calendar year 1988 program and cost information,
shall be equal to the percentage that one million dollars
($1,000,000) represents of the total deficiency, based on calendar
year 1988 program and cost information, for all eligible programs.
(b) A process for establishing rates during fiscal year 1991-92
for new programs and existing programs receiving a temporary,
provisional, or permanent rate.
(1) The rate for existing programs receiving a permanent rate,
shall be determined based on fiscal year 1989-90 program, cost, and
other information submitted to the department and regional center.
The ratesetting process shall include, but shall not be limited to,
all of the following:
(A) A process for determination of a mean rate and an allowable
range of rates for the same type of day program and staff-to-client
ratio. The mean rate shall be determined using those programs'
allowable costs and client attendance and the allowable range of
rates shall be defined as the rates of those programs included
between the 10th and 90th percentiles.
(B) The rates for existing programs receiving a permanent rate
shall be increased or decreased to their allowable costs for fiscal
year 1991-92, as follows:
(i) The rate shall be decreased if the program's allowable costs
and client attendance, for fiscal year 1989-90, determined pursuant
to the regulations, would result in a rate that is lower than its
existing permanent rate.
(ii) The rate shall be increased if the program's allowable costs
and client attendance for fiscal year 1989-90, determined pursuant to
the regulations, would result in a rate that is higher than its
existing permanent rate and its existing permanent rate is below or
within the allowable range of rates.
(iii) No rate increase shall be provided that would result in the
rate exceeding the allowable range of rates. No increase shall be
provided for programs whose existing permanent rate is above the
allowable range of rates. The amount of funds appropriated for that
purpose for fiscal year 1991-92 shall be distributed only to those
programs eligible for the increase.
(C) A process for the reduction or increase in the rate of any
program whose existing permanent rate is not within the allowable
range of rates. This process shall be based upon all of the
following:
(i) For programs whose existing permanent rates are above the
allowable range of rates, their existing permanent rate shall be
reduced by 5 percent or to the allowable range, whichever is less.
(ii) For programs whose existing permanent rates are below the
allowable range of rates, after the increase specified in clause (ii)
of subparagraph (B) their rate shall be increased, up to the
allowable range, in proportion to the amount of funds obtained from
reducing the rate of programs whose rates are above the range.
(2) The rate for new programs shall be the mean rate determined
pursuant to the process in paragraph (1) for the same type of day
program and staff-to-client ratio using the program, cost, and other
information submitted by providers receiving a permanent rate.
(3) The rate for existing programs receiving a provisional rate,
whose rate expired during fiscal year 1990-91 and was extended until
September 1, 1991, shall be determined pursuant to the process
specified in paragraph (1) for permanent rates, except that the
determination shall be based upon 12 consecutive months of
representative costs incurred by the program during the period it was
receiving its provisional rate. The program shall submit these costs
and other program information, designated by the department, to the
department within the time frames specified in the regulations. If
the program has not incurred or cannot provide 12 consecutive months
of representative costs, the department may determine the rate based
on less than 12 consecutive months of representative costs.
(4) The rate for existing programs receiving a provisional rate,
whose rate will expire in July or August of 1991, shall be extended
until September 1, 1991, and then determined pursuant to the process
specified in paragraph (3).
(c) A process for establishing rates during fiscal year 1992-93
for new programs and existing programs receiving a temporary or
permanent rate:
(1) The rate for new programs shall be the mean rate, determined
pursuant to the process in paragraph (2) of subdivision (b) for
fiscal year 1991-92, for the same type of day program and
staff-to-client ratio.
(2) The rate for existing programs receiving a temporary rate
shall be continued at the rate established for fiscal year 1991-92,
until the rate expires or a permanent rate is established pursuant to
the process in paragraph (4) of subdivision (b) for fiscal year
1991-92.
(3) The rate for existing programs receiving a permanent rate
shall be reestablished at the rate established for fiscal year
1991-92, except for programs whose rates are not within the allowable
range of rates. For those programs whose rates are not within the
allowable range, their rates shall be reduced or increased pursuant
to the process in subparagraph (C) of paragraph (1) of subdivision
(b) for fiscal year 1991-92.
(d) A process for establishing rates during fiscal year 1993-94
for new programs and existing programs receiving a temporary or
permanent rate:
(1) The rate for existing programs receiving a permanent rate
shall be determined based on fiscal year 1991-92 program, cost, and
other information submitted to the department and regional center.
The ratesetting process shall include the process specified in
paragraph (1) of subdivision (b) for fiscal year 1991-92, except that
the allowable range of rates shall be determined by computing 50
percent of the mean rate for fiscal year 1993-94 and converting that
amount into a range of rates, distributed equally above and below the
mean. This process shall compare the range of rates computed for
fiscal year 1993-94 with the range of rates calculated for fiscal
year 1991-92 based on 80 percent of the programs, and shall use the
lesser of the two ranges in the comparison as the allowable range of
rates. Once established, this range shall be permanent.
(2) The rate for new programs shall be the mean rate determined
pursuant to the process in paragraph (1) for the same type of day
program and staff-to-client ratio using the program, cost, and other
information submitted by providers receiving a permanent rate.
(3) The rate for existing programs receiving a temporary rate
shall be continued at the established rate until the program has
incurred 12 consecutive months of representative costs within the
timeframes specified in the regulations. Once the representative
costs have been incurred, the rate shall be determined pursuant to
the process specified in paragraph (1) for permanent rates.
(e) A process for establishing rates, during fiscal year 1994-95
and each alternative fiscal year thereafter, for new programs and
existing programs receiving a temporary or permanent rate. The
process shall be the same as that specified in subdivision (c) for
determining, continuing, and reestablishing rates, but shall be based
on the program, cost, and other information submitted to the
department and regional center for establishment of rates for fiscal
year 1993-94 and each alternative fiscal year thereafter, except for
the following:
(1) For the 1998-99 fiscal year, the rates for existing
community-based day programs receiving a permanent rate shall be
increased if the program's allowable costs and client attendance, for
the 1995-96 fiscal year, determined pursuant to the regulations,
would result in a rate that is higher than its existing permanent
rate and its existing permanent rate is below or within the allowable
range of rates. The rate shall not be decreased if the program's
allowable costs and client attendance for the 1995-96 fiscal year,
determined pursuant to the regulations, would result in a rate that
is lower than its existing permanent rate.
(2) For the 1998-99 fiscal year, existing community-based day
programs receiving a permanent rate, and whose permanent rate is
still below the lower limit of the allowable range of rates for like
programs after receiving an increase pursuant to paragraph (1), shall
receive an increase in their permanent rate up to the lower limit of
the allowable range of rates.
(3) The requirements of subdivision (c) of Section 4691, which
specify that any rate increases shall be subject to the appropriation
of sufficient funds in the Budget Act, shall also apply to rates
governed by paragraphs (1) and (2).
(f) A process for establishing rates, during fiscal year 1995-96
and each alternative fiscal year thereafter, for new programs and
existing programs receiving a temporary or permanent rate. The
process shall be the same as that specified in subdivision (d) except
for the following:
(1) The rate for programs receiving a permanent rate shall be
based on program, cost, and other information submitted to the
department and regional center for fiscal year 1993-94 and each
alternative fiscal year thereafter.
(2) The allowable range of rates, permanently established during
fiscal year 1993-94, shall be applied to the mean rate determined for
fiscal year 1995-96 and each alternative fiscal year thereafter.
(3) Existing programs receiving a permanent rate whose rates are
not within the allowable range of rates shall, by September 1, 1995,
have their rates reduced or increased as follows:
(A) For programs whose existing permanent rates are above the
allowable range of rates, their rate shall be reduced to the
allowable range.
(B) For programs whose existing rates are below the allowable
range of rates, their rate shall be increased up to the allowable
range in proportion to the amount of funds obtained from reducing the
rate of programs whose rates are above the range.
(g) A process for establishing a uniform supplemental rate of
reimbursement for programs serving nonambulatory clients, as
determined by the department.
(h) A process for notifying the program of the established rate.
4691.6. (a) Notwithstanding any other provision of law or
regulation, commencing July 1, 2006, the community-based day program,
work activity program, and in-home respite service agency rate
schedules authorized by the department and in operation June 30,
2006, 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 increase shall be
governed by subdivisions (b), (c), (d), and (e) and Section 4691.9.
(b) Notwithstanding any other provision of law or regulation, the
department may not establish any permanent payment rate for a
community-based day program or in-home respite service agency
provider that has a temporary payment rate in effect on June 30,
2008, if the permanent payment rate would be greater than the
temporary payment rate in effect on or after June 30, 2008, unless
the regional center demonstrates to the department that the permanent
payment rate is necessary to protect the consumers' health or
safety.
(c) Notwithstanding any other provision of law or regulation,
neither the department nor any regional center may approve any
program design modification or revendorization for a community-based
day program or in-home respite service agency provider that would
result in an increase in the rate to be paid to the vendor from the
rate that is in effect on or after June 30, 2008, unless the regional
center demonstrates that the program design modification or
revendorization is necessary to protect the consumers' health or
safety and the department has granted prior written authorization.
(d) Notwithstanding any other provision of law or regulation, the
department may not approve an anticipated rate adjustment for a
community-based day program or in-home respite service agency
provider that would result in an increase in the rate to be paid to
the vendor from the rate that is in effect on or after June 30, 2008,
unless the regional center demonstrates that the anticipated rate
adjustment is necessary to protect the consumers' health or safety.
(e) Notwithstanding any other provision of law or regulation, the
department may not approve any rate adjustment for a work activity
program that would result in an increase in the rate to be paid to
the vendor from the rate that is in effect on or after June 30, 2008,
unless the regional center demonstrates that the rate adjustment is
necessary to protect the consumers' health and safety and the
department has granted prior written authorization.
4691.8. (a) Notwithstanding any other provision of law or
regulation, and to the extent funds are appropriated in the annual
Budget Act for this purpose, the department may provide a rate
increase for the purpose of enhancing wages for direct care staff in
day programs and in work activity programs, as defined in subdivision
(e) of Section 4851, and in look-alike programs, that meet any of
the following criteria:
(1) Provide a majority of their services and supports in
integrated community settings.
(2) Are day programs that are converting to integrated community
settings.
(3) Are work activity programs that are converting to supported
work programs.
(b) The department may approve a temporary rate increase for a
program that is converting pursuant to paragraph (2) or (3) of
subdivision (a). A program shall not be eligible for a permanent rate
increase pursuant to this section unless it meets the criteria
established in paragraph (1) of subdivision (a).
(c) A rate increase provided pursuant to paragraph (1) of
subdivision (a) to existing programs shall be effective not more than
60 days following the adoption of the Budget Act that appropriates
the necessary funding.
(d) Prior to implementation of this section, the department shall
consult with stakeholders, including various provider organizations,
the regional centers, and all other interested parties.
(e) The department shall provide the Legislature, by April 1,
2007, with a description of how this section has been implemented,
along with the following information:
(1) The number of day programs and work activity centers receiving
an enhanced rate, by regional center.
(2) The number of program conversions, by regional center.
(3) The percentage of rate increase provided to programs.
(4) The effect of the rate increase on direct care staff wages.
4691.9. Notwithstanding any other provision of law or regulation,
commencing July 1, 2008:
(a) No regional center shall pay an existing service provider, for
services where rates are determined through a negotiation between
the regional center and the provider, a rate higher than the rate in
effect on 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.
(b) No regional center may negotiate a rate with a new service
provider, for services where rates are determined through a
negotiation between the regional center and the provider, that is
higher than the regional center's median rate for the same service
code and unit of service, or the statewide median rate for the same
service code and unit of service, whichever is lower. The unit of
service designation must conform with an existing regional center
designation or, if none exists, a designation used to calculate the
statewide median rate for the same service. The regional center shall
annually certify to the State Department of Developmental Services
its median rate for each negotiated rate service code, by designated
unit of service. This certification will be subject to verification
through the department's biennial fiscal audit of the regional
center.
(c) This section shall not apply to those services for which rates
are determined by the State Department of Health Care Services, or
the State Department of Developmental Services, or are usual and
customary.
4692. (a) Effective August 1, 2009, subject to subdivisions (c) and
(e), regional centers shall not compensate a work activity program,
activity center, adult development center, behavior management
program, social recreation program, adaptive skills trainer, infant
development program, program support group (day service),
socialization training program, client/parent support behavior
intervention training program, community integration training
program, community activities support service, or creative arts
program, as defined in Title 17 of the California Code of
Regulations, for providing any service to a consumer on any of the
following holidays:
(1) January 1.
(2) The third Monday in January.
(3) The third Monday in February.
(4) March 31.
(5) The last Monday in May.
(6) July 4.
(7) The first Monday in September.
(8) November 11.
(9) Thanksgiving Day.
(10) December 25.
(11) The four business days between December 25 and January 1.
(b) Effective August 1, 2009, subject to subdivisions (c) and (e),
regional centers shall not compensate a transportation vendor/family
member, transportation company, transportation/additional component
vendor, transportation broker, transportation assistant/vendor,
transportation vendor/auto driver, or transportation vendor/public or
rental car agency or taxi, in accordance with Title 17 of the
California Code of Regulations, for transporting any consumer to
receive services from any of the vendors specified in subdivision (a)
for any of the holidays set forth in paragraphs (1) to (11),
inclusive, of subdivision (a).
(c) If a holiday listed in this section falls on a Saturday or a
Sunday, the following Monday shall be deemed to be the holiday in
lieu of the day observed.
(d) Contracts between the vendors described in this section and
regional centers shall reflect the holiday closures set forth in this
section and shall be renegotiated accordingly, as necessary.
(e) The department may adjust the holidays set forth in
subdivision (a) through a program directive. This directive shall be
provided to the regional centers and posted on the department's
Internet Web site at least 60 days prior to the effective date of the
change in holiday.
4693. For the purposes of this article, "infant day program" means
a day training and activity program where infants and their families
are provided training individually and in groups for a day or less,
and are provided an organized program of activity. These programs are
designed to encourage the development and adjustment of the infants
in the community and their homes, and to prepare the infants for
entrance into classes of local schools or other appropriate
facilities.
4694. Commencing July 1, 2006, all regional center vendors who are
qualified providers under Title XIX of the federal Social Security
Act (42 U.S.C. Sec. 1396 et seq.) and are serving individuals
enrolled under the Home- and Community-based Services Waiver program
for persons with developmental disabilities, shall ensure that
billing information provided to regional centers identifies each
individual consumer and, for each consumer, the specific dates of
service, location of service, service unit, unit costs, and other
information necessary to support billing under the home- and
community-based services waiver. Regional centers shall also ensure
that their contractual and other billing and payment arrangements
with providers require the provision of any information necessary to
support billing under the Home- and Community-based Services Waiver
program. Resources provided to regional centers, pursuant to the
Budget Act of 2006 and following budgets, to implement this provision
shall be allocated to the regional centers only until implementation
of a statewide electronic data system that collects the billing
information necessary to support billing under the Home- and
Community-based Services Waiver program.
