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AB-3291 Developmental services.(2023-2024)

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Date Published: 09/23/2024 02:00 PM
AB3291:v95#DOCUMENT

Assembly Bill No. 3291
CHAPTER 441

An act to amend Sections 4646.5 and 4689 of the Welfare and Institutions Code, relating to developmental services.

[ Approved by Governor  September 22, 2024. Filed with Secretary of State  September 22, 2024. ]

LEGISLATIVE COUNSEL'S DIGEST


AB 3291, Committee on Human Services. Developmental services.
(1) Existing law, the Lanterman Developmental Disabilities Services Act (act), requires the State Department of Developmental Services to contract with regional centers to provide services and supports to individuals with developmental disabilities and their families. Under existing law, the regional centers purchase needed services and supports for individuals with developmental disabilities through approved service providers, or arrange for their provision through other publicly funded agencies. The services and supports to be provided to a regional center consumer are contained in an individual program plan (IPP), which is developed by the planning team according to specified procedures. Existing law requires the planning process for the IPP to include various components and guidelines, such as a statement of goals, based on the needs, preferences, and life choices of the individual with developmental disabilities, a review of the general health status of the individual, and a transportation access plan, as specified.
This bill additionally would require the IPP planning process to include, when a regional center consumer is being cared for in the family home, no later than the consumer’s 22nd birthday, and annually thereafter, a discussion regarding caregiver succession and, under specified circumstances, development of a caregiver succession plan, as specified. The bill would define “caregiver succession” as the transition between one caregiver and the caregiver that assumes responsibility to care for a regional center consumer.
(2) Existing law requires the department and regional centers to provide specified supported living services for individuals with developmental disabilities and their families. Existing law lists the range of supported living services and supports to include, among other things, recruiting, training, and hiring individuals to provide personal care and other assistance. Existing law also authorizes regional centers to make rent, mortgage, or lease payments under specified circumstances, including when the regional center executive director verifies in writing that making the rent, mortgage, or lease payments or paying for household expenses is required to meet the specific care needs unique to the individual consumer, as specified, and is required when a consumer’s demonstrated medical, behavioral, or psychiatric condition presents a health and safety risk to the consumer or another.
This bill would additionally authorize a regional center to make rent, mortgage, or lease payments or pay for household expenses when the executive director certifies in writing that the consumer’s demonstrated risk of homelessness presents a health and safety risk to the consumer or another.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 4646.5 of the Welfare and Institutions Code is amended to read:

4646.5.
 (a) The planning process for the individual program plan described in Section 4646 shall include all of the following:
(1) Gathering information and conducting assessments to determine the life goals, capabilities and strengths, preferences, barriers, and concerns or problems of the person with developmental disabilities. For children with developmental disabilities, this process should include a review of the strengths, preferences, and needs of the child and the family unit as a whole. Assessments shall be conducted by qualified individuals and performed in natural environments whenever possible. Information shall be taken from the consumer, the consumer’s parents and other family members, the consumer’s friends, advocates, authorized representative, if applicable, providers of services and supports, and other agencies. The assessment process shall reflect awareness of, and sensitivity to, the lifestyle and cultural background of the consumer and the family.
(2) A statement of goals, based on the needs, preferences, and life choices of the individual with developmental disabilities, and a statement of specific, time-limited objectives for implementing the person’s goals and addressing the person’s needs. These objectives shall be stated in terms that allow measurement of progress or monitoring of service delivery. These goals and objectives should maximize opportunities for the consumer to develop relationships, be part of community life in the areas of community participation, housing, work, school, and leisure, increase control over the consumer’s life, acquire increasingly positive roles in community life, and develop competencies to help accomplish these goals.
(3) In developing individual program plans for children, regional centers shall be guided by the principles, process, and services and support parameters set forth in Section 4685.
(4) In developing an individual program plan for a transition age youth or working age adult, the planning team shall consider the Employment First Policy described in Chapter 14 (commencing with Section 4868).
(5) A schedule of the type and amount of services and supports to be purchased by the regional center or obtained from generic agencies or other resources in order to achieve the individual program plan goals and objectives, and identification of the provider or providers of service responsible for attaining each objective, including, but not limited to, vendors, contracted providers, generic service agencies, and natural supports. The individual program plan shall specify the approximate scheduled start date for services and supports and shall contain timelines for actions necessary to begin services and supports, including generic services. In addition to the requirements of subdivision (h) of Section 4646, each regional center shall offer, and upon request provide, a written copy of the individual program plan to the consumer, and, if appropriate, the consumer’s parents, legal guardian or conservator, or authorized representative within 45 days of their request in a threshold language, as defined by paragraph (3) of subdivision (a) of Section 1810.410 of Title 9 of the California Code of Regulations.
(6) If agreed to by the consumer, the parents, legally appointed guardian, or authorized representative of a minor consumer, or the legally appointed conservator of an adult consumer or the authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, subdivision (b) of Section 4701.6, and subdivision (e) of Section 4705, a review of the general health status of the adult or child, including medical, dental, and mental health needs, shall be conducted. This review shall include a discussion of current medications, any observed side effects, and the date of the last review of the medication. Service providers shall cooperate with the planning team to provide any information necessary to complete the health status review. If any concerns are noted during the review, referrals shall be made to regional center clinicians or to the consumer’s physician, as appropriate. Documentation of health status and referrals shall be made in the consumer’s record by the service coordinator.
(7) (A) The development of a transportation access plan for a consumer when all of the following conditions are met:
(i) The regional center is purchasing private, specialized transportation services or services from a residential, day, or other provider, excluding vouchered service providers, to transport the consumer to and from day or work services.
(ii) The planning team has determined that a consumer’s community integration and participation could be safe and enhanced through the use of public transportation services.
(iii) The planning team has determined that generic transportation services are available and accessible.
(B) To maximize independence and community integration and participation, the transportation access plan shall identify the services and supports necessary to assist the consumer in accessing public transportation and shall comply with Section 4648.35. These services and supports may include, but are not limited to, mobility training services and the use of transportation aides. Regional centers are encouraged to coordinate with local public transportation agencies.
(8) A schedule of regular periodic review and reevaluation to ascertain that planned services have been provided, that objectives have been fulfilled within the times specified, and that consumers and families are satisfied with the individual program plan and its implementation.
(9) (A) When a regional center consumer is being cared for in the family home, no later than the consumer’s 22nd birthday, and annually thereafter, a discussion regarding caregiver succession and, if determined by the consumer or the consumer’s representative to be necessary, development of a caregiver succession plan, which may include, but is not limited to, both of the following:
(i) Identification of individuals who may provide care to the consumer when the current caregiver is no longer able to perform the necessary tasks.
(ii) Identification of possible housing options for the regional center consumer when the consumer can no longer live at home.
(B) For purposes of this paragraph, “caregiver succession” means the point at which the primary caregiver is no longer able to fully care for a regional center consumer.
(b) For all active cases, individual program plans shall be reviewed and modified by the planning team, through the process described in Section 4646, as necessary, in response to the person’s achievement or changing needs, and no less often than once every three years. If the consumer or, if appropriate, the consumer’s parents, legal guardian, authorized representative, or conservator requests an individual program plan review, the individual program plan shall be reviewed within 30 days after the request is submitted, or no later than 7 days after the request is submitted if necessary for the consumer’s health and safety or to maintain the consumer in their home.
(c) (1) The department, with the participation of representatives of a statewide consumer organization, the Association of Regional Center Agencies, an organized labor organization representing service coordination staff, and the state council shall prepare training material and a standard format and instructions for the preparation of individual program plans, which embody an approach centered on the person and family.
(2) Each regional center shall use the training materials and format prepared by the department pursuant to paragraph (1).
(3) The department shall biennially review a random sample of individual program plans at each regional center to ensure that these plans are being developed and modified in compliance with Section 4646 and this section.

SEC. 2.

 Section 4689 of the Welfare and Institutions Code is amended to read:

4689.
 Consistent with state and federal law, the Legislature places a high priority on providing opportunities for adults with developmental disabilities, regardless of the degree of disability, to live in homes that they own or lease with support available as often and for as long as it is needed, when that is the preferred objective in the individual program plan. In order to provide opportunities for adults to live in their own homes, the following procedures shall be adopted:
(a) The department and regional centers shall ensure that supported living arrangements adhere to the following principles:
(1) Consumers shall be supported in living arrangements that are typical of those in which persons without disabilities reside.
(2) The services or supports that a consumer receives shall change as their needs change without the consumer having to move elsewhere.
(3) The consumer’s preference shall guide decisions concerning where and with whom the consumer lives.
(4) Consumers shall have control over the environment within their own home.
(5) The purpose of furnishing services and supports to a consumer shall be to assist that individual to exercise choice in their life while building critical and durable relationships with other individuals.
(6) The services or supports shall be flexible and tailored to a consumer’s needs and preferences.
(7) Services and supports are most effective when furnished where a person lives and within the context of the person’s day-to-day activities.
(8) Consumers shall not be excluded from supported living arrangements based solely on the nature and severity of their disabilities.
(b) Regional centers may contract with agencies or individuals to assist consumers in securing their own homes and to provide consumers with the supports needed to live in their own homes.
(c) The range of supported living services and supports available include, but are not limited to, assessment of consumer needs; assistance in finding, modifying and maintaining a home; facilitating circles of support to encourage the development of unpaid and natural supports in the community; advocacy and self-advocacy facilitation; development of employment goals; social, behavioral, and daily living skills training and support; development and provision of 24-hour emergency response systems; securing and maintaining adaptive equipment and supplies; recruiting, training, and hiring individuals to provide personal care and other assistance, including in-home supportive services workers, paid neighbors, and paid roommates; providing respite and emergency relief for personal care attendants; and facilitating community participation. Assessment of consumer needs may begin before 18 years of age to enable the consumer to move to their own home when they reach 18 years of age.
(d) Regional centers shall provide information and education to consumers and their families about supported living principles and services.
(e) Regional centers shall monitor and ensure the quality of services and supports provided to individuals living in homes that they own or lease. Monitoring shall take into account all of the following:
(1) Adherence to the principles set forth in this section.
(2) Whether the services and supports outlined in the consumer’s individual program plan are congruent with the choices and needs of the individual.
(3) Whether services and supports described in the consumer’s individual program plan are being delivered.
(4) Whether services and supports are having the desired effects.
(5) Whether the consumer is satisfied with the services and supports.
(f) The planning team, established pursuant to subdivision (j) of Section 4512, for a consumer receiving supported living services shall confirm that all appropriate and available sources of natural and generic supports have been utilized to the fullest extent possible for that consumer.
(g) Regional centers shall utilize the same supported living provider for consumers who reside in the same domicile, provided that each individual consumer’s particular needs can still be met pursuant to their individual program plans.
(h) Rent, mortgage, and lease payments of a supported living home and household expenses shall be the responsibility of the consumer and any roommate who resides with the consumer.
(i) A regional center may make rent, mortgage, or lease payments on a supported living home, or pay for household expenses of consumers receiving supported living services only under the following circumstances:
(1) If all of the following conditions are met, a regional center may make rent, mortgage, or lease payments as follows:
(A) The regional center executive director verifies in writing that making the rent, mortgage, or lease payments or paying for household expenses is required to meet the specific care needs unique to the individual consumer as set forth in an addendum to the consumer’s individual program plan, and is required when a consumer’s demonstrated risk of homelessness, medical, behavioral, or psychiatric condition presents a health and safety risk to the consumer or another.
(B) During the time period that a regional center is making rent, mortgage, or lease payments, or paying for household expenses, the supported living services vendor shall assist the consumer in accessing all sources of generic and natural supports consistent with the needs of the consumer.
(C) The regional center shall not make rent, mortgage, or lease payments on a supported living home or pay for household expenses for more than six months, unless the regional center finds that it is necessary to meet the individual consumer’s particular needs pursuant to the consumer’s individual program plan. The regional center shall review a finding of necessity on a quarterly basis and the regional center executive director shall annually verify in an addendum to the consumer’s individual program plan that the requirements set forth in subparagraph (A) continue to be met.
(2) A regional center that has been contributing to rent, mortgage, or lease payments or paying for household expenses prior to July 1, 2009, shall at the time of development, review, or modification of a consumer’s individual program plan determine if the conditions in paragraph (1) are met. If the planning team determines that these contributions are no longer appropriate under this section, a reasonable time for transition, not to exceed six months, shall be permitted.
(j) All paid roommates and live-in support staff in supported living arrangements in which regional centers have made rent, mortgage, or lease payments, or have paid for household expenses pursuant to subdivision (i) shall pay their share of the rent, mortgage, or lease payments or household expenses for the supported living home, subject to the requirements of Industrial Welfare Commission Order No. 15-2001 and the Housing Choice Voucher Program, as set forth in Section 1437f of Title 42 of the United States Code.
(k) Regional centers shall ensure that the supported living services vendors’ administrative costs are necessary and reasonable, given the particular services that they are providing and the number of consumers to whom the vendor provides services. Administrative costs shall be limited to allowable costs for community-based day programs, as defined in Section 57434 of Title 17 of the California Code of Regulations, or its successor.
(l) Regional centers shall ensure that the most cost effective of the rate methodologies is utilized to determine the negotiated rate for vendors of supported living services, consistent with Section 4689.8 and Title 17 of the California Code of Regulations.
(m) For purposes of this section, “household expenses” means general living expenses and includes, but is not limited to, utilities paid and food consumed within the home.
(n) A supported living services provider shall provide assistance to a consumer who is a Medi-Cal beneficiary in applying for in-home supportive services, as set forth in Section 12300, within five days of the consumer moving into a supported living services arrangement.
(o) For consumers receiving supported living services who share a household with one or more adults receiving supported living services, efficiencies in the provision of service may be achieved if some tasks can be shared, meaning the tasks can be provided at the same time while still ensuring that each person’s individual needs are met. These tasks shall only be shared to the extent they are permitted under the Labor Code and related regulations, including, but not limited to, Industrial Welfare Commission Minimum Wage Order No. 15. The planning team, as defined in subdivision (j) of Section 4512, at the time of development, review, or modification of a consumer’s individual program plan (IPP), for housemates currently in a supported living arrangement or planning to move together into a supported living arrangement, or for consumers who live with a housemate not receiving supported living services who is responsible for the task, shall consider, with input from the service provider, whether any tasks, such as meal preparation and cleanup, menu planning, laundry, shopping, general household tasks, or errands can appropriately be shared. If tasks can be appropriately shared, the regional center shall purchase the prorated share of the activity. Upon a determination of a reduction in services pursuant to this section, the regional center shall inform the consumer of the reason for the determination, and shall provide a written notice of fair hearing rights pursuant to Section 4701.
(p) (1) To ensure that consumers in or entering into supported living arrangements receive the appropriate amount and type of supports to meet the person’s choice and needs as determined by the IPP team, and that generic resources are utilized to the fullest extent possible, the IPP team shall complete a standardized assessment questionnaire at the time of development, review, or modification of a consumer’s IPP. The questionnaire shall be used during the individual program plan meetings, in addition to the provider’s assessment, to assist in determining whether the services provided or recommended are necessary and sufficient and that the most cost-effective methods of supported living services are utilized. With input from stakeholders, including regional centers, the department shall develop and post the questionnaire on its internet website, and, by June 30, 2012, shall provide it to the regional centers.
(2) Supported living service providers shall conduct comprehensive assessments for the purpose of getting to know the consumer they will be supporting and developing a support plan congruent with the choices and needs of the individual and consistent with the principles of supported living set forth in this section and in Subchapter 19 (commencing with Section 58600) of Chapter 3 of Division 2 of Title 17 of the California Code of Regulations. The independent assessment required by this paragraph is not intended to take the place of or repeat the service provider’s comprehensive assessment.
(3) Upon a determination of a reduction in services pursuant to this section, the regional center shall inform the consumer of the reason for the determination, and shall provide a written notice of fair hearing rights pursuant to Section 4701.
(4) This section does not preclude the completion of an independent assessment.