SB 468 (Emmerson/Beall/Mitchell/Chesbro) Statewide Self-Determination Program

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Self-determination means everyone should get what they need to have a good life. A good life includes family and independence. It also includes choice. This pub tells you about the program for regional center clients.

SB 4681 creates a state-wide Self-Determination Program which is a voluntary, alternative to the traditional way of providing regional center services. It provides consumers and their family with more control over the services and supports they need. Consumers and families for example, may purchase existing services from services providers or local businesses, hire support workers or negotiate unique arrangements with local community resources. Self-determination provides consumers, and their families, with an individual budget2, which they can use to purchase the services and supports they need to implement their Individual Program Plan (IPP).

1. When will the statewide Self-Determination Program be up and running?

It will take several years for self-determination to be in place. First, the Department of Developmental Services (DDS) has until December 31, 2014 to apply for federal Medicaid funding to establish and fund the program. Once federal approval is obtained, most likely in 2015, the program will be available statewide but for the first three years is capped at 2500 individuals.  After the three-year phase-in period, the program is available to all eligible consumers on a voluntary basis.

2. Who is eligible for the Self-Determination Program?

To be eligible for the program, you must:

  1. Have a developmental disability, as defined in the Lanterman Act3, and currently be receiving services under the Lanterman Act. This means that consumers between the ages of birth through two who receive services under the California Early Intervention Services4 program are not eligible to participate. However, consumers who are age 3 or older but new to the regional center system are eligible to participate in self-determination.
  2. Not live in a licensed long-term health care facility unless transitioning from that facility5.
  3. Agree to do the following:
    • Receive an orientation to the Self-Determination Program.
    • Utilize self-determination services and supports only when generic services and supports are not available6.
    • Manage the services and supports within your individual budget.
    • Utilize the services of a fiscal manager you choose who is vendored by a regional center.

3. How will the Self-Determination Program be implemented?

Each regional center is required to implement the Self-Determination Program and do the following:

  1. Contract with local consumer or family-run organizations to conduct outreach to consumers and families to provide information about the Self-Determination Program and help ensure that the program is available to a diverse group of participants and underserved communities; and
  2. Collaborate with the local consumer or family-run organizations to jointly conduct training on the Self-Determination Program for interested consumers and their families.

4. How will regional centers decide who participates in the program during the three year phase in period?

The Self-Determination Program must be available to individuals who reflect the disability, ethnic and geographic diversity of the state.  While SB 468 does not specify how participants will be chosen during the initial phase-in period, regional centers must ensure that the program is available to the diverse group of consumers served in their catchment area.

In the first three years, DDS will determine the number of Self-Determination Program participants in each regional center. This will be based on the relative percentage of total consumers served by the regional centers minus any remaining participants in the self-determination pilot projects.

The bill also recognizes that consumers in traditionally underserved linguistic, cultural, socioeconomic, and ethnic communities have unique challenges in accessing needed regional center services and that the Self-Determination Program offers increased service flexibility, which will help promote access to needed services for these consumers and their families.

5.  How is my IPP developed in the Self-Determination Program?

Your IPP team will use a person-centered planning process to develop your IPP.  The IPP will include the services and supports, selected and directed by you to achieve the objectives in your IPP.  Information about your IPP may be found in our publication “Rights Under the Lanterman Act”, Chapter 4: Individual Program Plans.

6. How is my individual budget determined in the Self-Determination Program?

The individual budget is the amount of regional center funding available to you to purchase the services and supports you need to implement your IPP and ensure your health or safety. The individual budget is calculated once during a 12-month period but may be revised to reflect a change in your circumstances, needs or resources.

For current regional center consumers, the budget will equal 100% of the amount of the total purchase of service expenditures made by the regional center during the past 12 months. This amount can be adjusted by the IPP team, if the team determine an adjustment is needed for one of the following reasons:

  • There is a change in your circumstances, needs, or resources that would result in and increase or decrease in your purchase of service expenditures; or
  • There are prior needs or resources that were unaddressed in the IPP, which would have resulted in an increase or decrease in your purchase of service expenditures.

For a participant who is new to the regional center system or does not have 12 months of purchase of service expenditures, the IPP team will determine the services and supports needed and available resources. The regional center will use this information to identify the cost of providing the services and supports based on the average cost paid by the regional center unless the regional center determines that you have unique needs that require a higher or lower cost. This amount will be your individual budget unless it is adjusted as described below.

The regional center must certify that regional center expenditures for the individual budget, including any adjustment for current consumers, would have occurred regardless of your participation in the Self-Determination Program.

The budget will not be adjusted to include additional funds for either the independent facilitator or the financial management services.

7. Who can assist me during the person-centered planning process?

You can use an independent facilitator that they select to assist in the person-centered planning and IPP processes. An independent facilitator must be a person who does not provide services to you and is not employed by a person who provides services to you. You may also use a regional center service coordinator to assist with these functions. An independent facilitator can advocate for you during a person centered planning meeting, assist you in making informed choices about your budget, and help you identify and secure services. The cost of the independent facilitator is paid from your individual budget.

8. Who assists me with managing my budget so that my funds will last throughout the year?

Participants are required to use a fiscal manager, vendored through the regional center, to help manage and direct the distribution of funds contained in your individual budget and ensure you have enough funds to implement your IPP throughout the year. These services can include bill paying, facilitating the employment of service and support workers, accounting, and compliance with applicable laws.  The cost of the fiscal manager is paid from your individual budget, except for the costs of any criminal background check. You and your regional center service coordinator will receive a monthly statement from the fiscal manager which shows the budget amount in each category, the amount you have spent and the amount remaining.

9. Can I move money around in my budget? 

The bill allows you to annually transfer up to 10% of the funds originally distributed to any budget category to another budget category or categories, and allows transfers of more than 10% provided the transfer is approved by your IPP team or the regional center. DDS will determine the budget categories with input from stakeholders.

10. What services and supports can I get with self-determination?

The Self-Determination Program will fund only those services and supports that are eligible for federal matching funds and only when generic services (for example, other governmental services such as special education, IHSS, Medi-Cal or insurance) are not available.  It will also allow the purchase of some services which were suspended services such as social recreation, camping, non-medical therapies, and respite7.  

11. What happens if I move from one regional center to another?  Can I still participate in the Self-Determination Program?

You will continue to receive self-determination services and supports if you transfer to another regional center catchment area, provided that you remain eligible for the program.  The bill requires the balance of your individual budget to be reallocated to the receiving regional center.

12. What happens if I no longer want to participate in self-determination or am no longer eligible for the program?

The bill requires regional centers to provide for your transition from the Self-Determination Program to traditional regional center services and supports if you are no longer eligible for or voluntarily choose to leave the program..

13. If I leave the Self-Determination Program, can I return?

If the regional center finds you ineligible for the Self-Determination Program you can return to the program upon meeting all applicable eligibility requirements, and upon approval of your planning team.   If you, leave the program voluntarily you cannot return to the program for at least twelve months. During the first three years of the program, your right to return is also conditioned on your regional center not having reached its limit on the number of participants.

14. Can my regional center require me to participate in self-determination if I don’t want to?

The Self-Determination Program is fully voluntary.  A regional center cannot require participation in the program.

15. What if I am in a licensed long-term care facility and I want to participate in the in Self-Determination?

If you currently live in a licensed long-term care facility you are not eligible for the Self-Determination Program.  However, you may request that the regional center provide person-centered planning services in order to make arrangements for transition to the Self-Determination Program, provided that you are reasonably expected to transition to the community within 90 days. In that case, the regional center shall initiate person-centered planning services within 60 days of the request. If you are not ready to transition to the community, you may ask that your interest in self-determination be reflected in your IPP and request the regional center help you participation in self-determination as part of the transition process. 

16. What if I do not receive Medi-Cal? Can I still participate in self-determination?

The bill authorizes participation in the Self-Determination Program for consumers who are not eligible for Medi-Cal, provided that they meet all other program eligibility requirements and the services and supports they receive are otherwise eligible for federal matching.

17.  How does the Self-Determination Program ensure the safety of consumers?

The bill establishes criminal background check requirements for providers of services and supports under the Self-Determination Program.  It requires DDS to issue a program directive identifying the non-vendored providers that must submit to a criminal background check,  which shall include but not be limited to, individuals who provide direct personal care services to a participant and other non-vendored providers for whom a criminal background check is requested by a participant or his/her financial management service.  The criminal background check includes a fingerprint requirement for all prospective providers.  The cost of the background check is paid by the provider of services.

18. What happens to the individuals who are participating in the self- determination pilot programs?

Individuals receiving services and supports under the self-determination pilot projects can either continue to receive services and supports under the Self-Determination Program, or transition to the traditional model of providing services and supports within the regional center system.

19.  What steps can I take if I disagree with a regional center’s decision?

The Lanterman Act due process rights apply to self-determination participants.  This means, for example, you will receive notice of the regional center finds you ineligible for self-determination or proposes to changes your budget.  It also means that you can request a hearing if you disagree with a regional center decision such as your right to participate in self-determination or the amount of your budget.

20. How does the Self-Determination Program ensure transparency and accountability?

Each regional center is required to have a volunteer advisory committee; the majority of whose members are consumers and family members appointed by the regional center and the local Area Board. The clients’ rights advocates are also part of the committee. The state Developmental Disability Council will also convene a statewide advisory committee to identify best practices, design effective training materials, and make recommendations for improvements in the Self-Determination Program. DDS is also required to collect and report outcome data to the Legislature as a means of ensuring transparency and accountability.

21. What can consumers and family members do now to learn more or help implement the statewide Self-Determination Program created by SB 468?

  • The Autism Society of Los Angeles plans to hold trainings and conferences as well as distribute materials so consumers and families can learn more.  Check the Autism Society’s website at http://www.autismla.org/1/   to learn more.
  • If you are part of a self-advocacy group or family member groups, you ask your Clients’ Rights Advocate or Area Board to do a training about self-determination for your group.
  • Share information about self-determination with other consumers and families.
  • At your next IPP meeting, ask your regional center to note on your IPP that you are interested in participating in self-determination.
  • Volunteer to be on your regional center’s advisory committee when it is formed, probably in 2015.
  • DDS will obtain input from stakeholders in several areas including, informational materials, possible other budget methodologies and uniform budget categories, and may adopt regulations.  You may want to look at DDS website, www.dds.ca.gov, to learn about opportunities to provide input. 
 

1http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0451-0500/sb_468_bill_20131009_chaptered.pdf. – (Return to main document)

2 See question 6 for an explanation of the individual budget. – (Return to main document)

3 See Welfare and Institutions Code Section 4512. – (Return to main document)

4 The early intervention law is found in Government Code Section 95000 et seq. – (Return to main document)

5 These facilities are defined in paragraph (44) of subdivision (a) of Section 54302 of Title 17 of the California Code of Regulations. – (Return to main document)

6 This requirement to use generic services is identical to the generic services requirement in the traditional regional center system. – (Return to main document)

7 Welfare and Institutions Code Section 4648.5(a) and 4686.5 – (Return to main document)

 

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