PAI #5129.01

October 18, 2001 (Retyped)

TO: REGIONAL CENTER EXECUTIVE DIRECTORS

SUBJECT: PROGRAM ADVISORY CFSB 01-1: EARLY START SPECIALIZED THERAPEUTIC SERVICES CODE

The enclosed program advisory provides clarification on the use of the Early Start specialized therapeutic services code in cases where application of the Lanterman Developmental Disabilities Services Act and its implementing regulations would result in any delays in, or any cost to, the families for the provision of early intervention services for consumers under the age of three. Regional center use of the new service code requires authorization by the Department of Developmental Services. The program advisory also provides information on the process regional centers must use when submitting their "Request for Authorization" application form. Such requests must be submitted to:

Ken Freedlander, Chief
Early Start Local Support Section
Department of Developmental Services
1600 9^th Street, MS 3-8
Sacramento, CA 95814

Please contact Mr. Freedlander, at (916) 654-2766, if you have any questions related to the "Request for Authorization" process.

Sincerely,

JULIE A. JACKSON, Deputy Director
Community Services and Supports Division

Enclosure

CFSB 01-0 October 12, 2001

EARLY START SPECIAL SERVICE CODE

BACKGROUND

The omnibus health trailer bill to the Budget Act of 2001 (Assembly Bill 430 Chapter 171, Statutes of 2001), amended the California Early Intervention Services Act (CEISA), Government Code Section 95004(b). The new language clarifies the requirement for regional centers to comply with the Lanterman Developmental Disabilities Services Act and its implementing regulations (Title 17 of the California Code of Regulations (CCR)), including, but not limited to, those provisions relating to vendorization and ratesetting. The new language goes on to reemphasize that application of state law cannot conflict with federal early intervention statutes. Therefore, a provision was added which specifies that in cases where application of the Lanterman Act would result in any delays in or any cost to, the families for the provision of early intervention, the Department of Developmental Services (DDS) may authorize a regional center to use a special service code that allows immediate procurement of the service. The complete amended text of Section 95004 can be found in Attachment A.

It is important to note that the amendments were intended to clarify the relationship between the Lanterman Act and Early Start state and federal statutes and regulations.

Existing state regulations have always stated that regional centers are the payor of last resort, after all other public and private sources for payment have been reviewed. They further state, "This review shall not delay the provision of early intervention services specified on the individualized family services plan (IFSP). Early intervention services specified on the IFSP shall begin as soon as possible." (Title 17, CCR Section 52109(b)). Therefore, it is the policy of DDS that the timely provision of early intervention services to children, birth to three years of age, may not be delayed while a regional center seeks alternative resources, or pending a formal appeal of another agency’s funding denial (DDS Program Advisory, RCB 00-1, June 22, 2000).

Early Start regulations have also required the multidisciplinary team, including the parent, to conduct the IFSP process to identify appropriate services based on assessed need, and to establish the initiation date for those services (Title 17 CCR, Sections 52104 and 52106).

What is new, is the statutory authority for DDS to authorize a service code to be used under special conditions.

This advisory applies to services purchased for consumers, age birth to 36 months, and their families, eligible for Early Start. The purpose of this program advisory is to inform regional centers of the requirements and procedures for seeking authorization from DDS to use the newly established special service code. This will allow for the immediate procurement of an early intervention service when the existing vendorization and ratesetting provisions would result in service delivery delays or costs to families.

DDS established a new miscellaneous service code specifically for this purpose: 116 – Early Start Specialized Therapeutic Services. A description of this service code can be found in Attachment B. The newly established service code was developed specifically in response to the trailer bill language, and is not meant to circumvent existing ratesetting provisions. It will be authorized for use only under the unique circumstances in which there is a finding of a delay in the delivery of service or a cost to the family.

Regional centers must submit a "Request for Authorization" application (Attachment C) to DDS for approval, prior to the initial use of the 116 service code. Regional centers do not have to request use of the code for each consumer for which the service will be purchased. The application process provides authorization for all applicable purchases. Upon receipt of the request DDS will respond to the regional center within five working days. The authorization request application addresses special circumstances requiring the use of the 116 service code, the area(s) in which the service code will be used and the anticipated time period for which the authorization is requested.

Regional centers using the new 116 service code will be required to vendor individuals; however, emergency vendorization procedures may be applied (Title 17 CCR, Section 54324).

The Schedule of Maximum Allowances (SMA) does not apply to the 116 service code. The maximum rate of reimbursement for the 116 service code shall be established pursuant to Title 17 CCR, Section 57210(a)(19), or Section 57300(e) (see Attachment D).

Any fiscal impact of these amendments on the CEISA will be closely tracked by DDS and, if necessary, will be addressed in the May Revision survey to be sent to regional centers next quarter.

Contact Ken Freedlander, Chief, Early Start Local Support Section, at (916) 654-2760, if you have questions related to the "Request for Authorization" process.

You may also contact Glenda Davis, Chief, Community Rate Section, at (916) 654-2001, if you have questions concerning the vendorization or ratesetting processes to be used for the 116 service code.

ATTACHMENT A

FILED WITH SECRETARY OF STATE AUGUST 10, 2001

Section 95004 of the Government Code, as amended by Section 3 of Chapter 294 of the Statutes of 1997, is amended to read:

The amendment states (changes underlined):

95004. The early intervention services specified in this title shall be provided as follows:

(a) Direct services for eligible infants and toddlers and their families shall be provided pursuant to the existing regional center system under the Lanterman Developmental Disabilities Services Act (Division 4.5. (commencing with Section 56000) of the Education Code and regulations adopted pursuant thereto, and Part C of the Individuals with Disabilities Education Act (20 U.S.C. Sec. 1431 et seq.).

(2) When compliance with this subdivision would result in any delays in the provision of early intervention services or costs to families for the provision of any of these services, the department may authorize a regional center to use a special service code that allows immediate procurement of the service.

(c) …

ATTACHMENT B

MISCELLANEOUS SERVICES CODE

Service Description: A regional center shall classify an individual as an Early Start Therapeutic Services provider if the person provides services for consumers aged birth to 36 months who require specialized services, as deemed necessary based on informed clinical opinion. These services must be identified in the Individualized Family Service Plan. Early Start specialized therapeutic services include, but are not limited to: services necessary to increase or maintain health and/or developmental progress; and, when provided as ancillary to these services, family and/or individual education and training; family support and counseling; provider travel; interagency consultation; and consultation with and training for other involved professionals. Vendors shall be individuals offering these services, and shall ensure possession of licenses, certifications and/or credentials as required by the State of California to practice in the field being offered. In addition, the vendor shall have at a minimum, one year’s experience working with persons with developmental disabilities.

ATTACHMENT D

Section 57219(a)(19) Usual and Customary Rate means the rate which is regularly charged by a vendor for a service that is used by both regional center consumers and/or their families and where at least 30% of the recipients of the given service are not regional center consumers or their families. If more than one rate is charged for a given service, the rate determined to be the usual and customary rate for a regional center consumer and/or family shall not exceed whichever rate is regularly charged to members of the general public who are seeking the service for an individual with a developmental disability who is not a regional center consumer, and any difference between the two rates must be for extra services provided and not imposed as a surcharge to cover the cost of measures necessary for the vendor to achieve compliance with the Americans With Disabilities Act. New programs applying for vendorization shall provide a written declaration to the vendoring regional center that it is their intent to comply with this subsection and will be allowed up to 12 months to achieve compliance. The vendoring regional center may audit a vendor’s records to determine compliance with this subsection and, if the vendor is found not to be in compliance, shall revoke the vendor’s usual and customary rate and negotiate a rate pursuant to Section 57300;

Section 57300(e) If a vendor does not have a rate established by the Department, and if the SMA is not applicable to the service provided by the vendor, and if the vendor does not have an established usual and customary rate as defined in Section 57210(a)(19), the vendoring regional center shall negotiate with the vendor the level of payment for services provided to consumers for a specified period of time.