DDS shall consult with stakeholders groups by 11yflme

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									                                                          Disability
                                                          Rights
                                                          California
                        California’s protection and advocacy system
                                  www.disabilityrightsca.org
                                  Toll Free: (800) 776-5746
                                     TTY: (800) 719-5798



Redesign of Services for Individuals with Challenging Service Needs1

                            Effective July 1, 2012, Pub #F070.01

The State Legislature required the Department of Developmental Services
(DDS) to reduce its budget by $200 million for this fiscal year, 2012-2013.
This reduction is in addition to significant reductions in prior fiscal years.
As a result, there are changes to the services that regional centers can
purchase and how the regional centers operate. The state budget also
includes a provision for an additional $50 million dollar reduction if the tax
initiatives are not approved by voters in the November election plus a $100
million reduction in fiscal year 2013-2014. If the additional cuts occur, DDS
is required to have the reduction affect consumer services as little as
possible. DDS shall consult with stakeholders groups, including,
consumers, family members, advocacy groups, service providers and staff
of regional centers and developmental centers to determine how the
budget reduction will be achieved.

This fact sheet describes the 2012 changes intended to decrease the
State’s reliance on developmental centers (DCs), mental health facilities
that are not eligible for federal funds, and out-of-state placements. DDS
has called these changes a “redesign of services for individuals with
challenging service needs.”


1
    The changes are part of the Budget Trailer Bill (TBL) AB 1472. You may find the law at:
http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_1451-1500/ab_1472_bill_20120613_amended_sen_v98.html
Changes affecting the redesign of service for individuals with challenging service needs are located at
Welfare and Institutions Code, Sec.
Reasons for Change in the Law

The Lanterman Act requires that all services including residential services
be provided in the least restrictive environment to meet individual’s needs.
There are different types of residential services for Californians with
developmental disabilities. These include the most integrated (such as
independent or supported living) up to the most restrictive and least
integrated (such as a locked unit at a developmental center (DC)).

Some people still live in restrictive settings even though their needs can be
met in the community in homes of their own, group homes with specialized
supports, and other integrated, community-based settings.

When people are unnecessarily placed in restrictive settings, it violates
their right to live in the least restrictive environment. Restrictive settings
are usually the most expensive, and may not be eligible for federal
Medicaid funding. It no federal funds can be use the State must pay all of
the cost of services in these settings.

For these reasons, the State has reduced its use of some restrictive
settings. These settings include DCs, mental health facilities that are not
eligible for federal Medicaid funding, and out-of-state placements. 2

How the Law Changed

The new law achieves its goals in three ways:

    1) The new law expands the availability of community-based living so
       that people can choose less restrictive settings.

    A. DDS must establish a statewide specialized resource service that:



2
  DCs are public institutions operated by the State. A list of California DCs can be found here:
https://dds.ca.gov/DevCtrs/Home.cfm. MHRCs provide services, often in institutional settings, designed to assist
people with mental illnesses. A current list of MHRCs can be found here:
http://www.dmh.ca.gov/services_and_programs/Quality_Oversight/Licensing_and_Certification/MHRC.asp. IMDs are
institutions of more than 16 beds and primarily engaged in providing diagnosis, treatment, or care of persons with
mental illnesses. A current list of IMDs can be found here:
http://www.dmh.ca.gov/services_and_programs/adults/docs/IMD/IMDList_2011.pdf




                                                        2
          a. Tracks the availability of specialty residential beds and
             services, and specialty clinical services; coordinates the need
             for specialty services and supports in conjunction with regional
             centers; and identifies developmental center services and
             supports that can be made available to consumers residing in
             the community, when no other community resource has been
             identified.3

    B. Requires regional centers to share specialty resources developed
       with community placement plan funds that keep people out of
       institutions with DDS and make these resources available to other
       regional centers.4

    C. Gives funding priority to the development of specialty services
       designed to keep people out of institutions and supports, including
       regional community crisis homes.5

    D. Expands the availability of adult residential facilities for people with
       special health care needs to consumers from any DC, instead of just
       Agnews DC or Lanterman DC.6 The law also allows a person not
       residing in a DC to move to this type of home if:
             There is a vacancy; no DC resident meets the requirements for
             admission; and the placement is necessary to protect the
             person’s health or safety.7
    E. Authorizes certain facilities with less than 15 beds to use “delayed
       egress devices” and “secured perimeters.” "Delayed egress device"
       means a device that prevents someone from leaving for a set period
       of time (for example, 30 seconds). “Secured perimeters” means
       fences. 8
          a. There are specific eligibility requirements for this type of facility.
             For example, before someone can be admitted, their IPP (IPP)
             team must decide that without the placement, the person would
             be at risk of admission to, or would have no option but to


3
  Welfare and Institutions Code Sec. 4418.25(b)(1)
4
  Welfare and Institutions Code Sec. 4418.25(b)(2)
5
  Welfare and Institutions Code Secs. 4418.25(b)(3)-(5)
6
  Welfare and Institutions Code Sec. 4684.53(b)(3)
7
  Welfare and Institutions Code Sec. 4684.65(b)(3)
8
  Health and Safety Code Sec. 1531.15


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             remain in, a more restrictive placement.9
          b. Before these facilities can be developed, DDS must write
             emergency regulations that require input from others, and
             which establish standards regarding admission criteria and the
             responsibility of regional centers to create a timeline to
             transition residents to a less restrictive setting.10

     2) Limits new admissions to DCs, mental health facilities that are not
        eligible for federal funds, and out-of-state placements.

     A. The law limits new admissions to DCs to individuals with
        developmental disabilities who are:
          a. Committed by a court to Porterville DC because of involvement
             with the criminal justice system and there has been a
             determination that the person is incompetent to stand trial (or if
             competency cannot be restored and a court determines the
             person is a danger to him or herself or others).11
          b. Committed by a court to Fairview DC due to an acute crisis.12
                 i. Acute crisis means a situation where a person is found by
                    a court to be a danger to him or herself or others and:
                        1. There is imminent risk for substantial harm to self or
                           others.
                        2. The service and support needs of the person cannot
                           be met in the community, including with additional
                           staffing, emergency and crisis intervention services,
                           or any resource identified by the statewide
                           specialized resource service.
                        3. Due to serious and potentially life-threatening
                           conditions, the person requires a more restrictive
                           environment for crisis stabilization.13
                ii. Under the new law, transition planning for people who are
                    committed to Fairview DC due to an acute crisis starts


9
  Health and Safety Code Sec. 1531.15(c)(3)(B)(i)
10
   Health and Safety Code Sec. 1531.15(k)
11
   Welfare and Institutions Code Secs. 7505(a)(1),(3) & (5)
12
   Welfare and Institutions Code Sec. 7505(a)(2)
13
   Welfare and Institutions Code Sec.
4418.7(d)(2), 4418.7(b)


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                     immediately. As soon as possible following the
                     admission, the regional center must complete a
                     comprehensive assessment which includes the services
                     and supports needed for crisis stabilization and the
                     timeline for identifying or developing the services and
                     supports needed to transition the consumer back to the
                     community.14
                iii. The law also limits initial admissions to Fairview DC to six
                     months unless certain conditions are met and the
                     committing court extends the commitment for an
                     additional period.15 Under no circumstances can the
                     commitment legally exceed 395 days.16 In addition, the
                     law revises the statute governing court-ordered DC
                     placements and stays of individuals with developmental
                     disabilities, to fit with the admission criteria and time limits
                     for placements at Fairview DC.17
                iv. When a person is committed to Fairview DC, the regional
                    center clients’ rights advocate will be notified of every
                    significant step in the process and, unless the person
                    objects, may attend IPP meetings and related judicial
                    proceedings.18

     B. Regional centers may not purchase residential services for people to
        reside in mental health rehabilitation centers (MHRCs) unless:
          a. The facility is eligible for federal Medicaid funding; or
          b. Has an approved plan in place to transition to a Medicaid-
             eligible program structure within specified timeframes; or
          c. In the event of an emergency and for no longer than six months
             when alternative services cannot be located.19
     C. Regional centers may not purchase residential services from
        institutions for mental diseases (IMDs) for which federal Medicaid




14
   Welfare and Institutions Code Sec. 4418.7(e)(1)
15
   Welfare and Institutions Code Sec. 4418.7(e)(3)
16
   Welfare and Institutions Code Sec. 4418.7(e)(3)(C)
17
   Welfare and Institutions Code Sec. 6500(c)(2)
18
   Welfare and Institutions Code Sec. 4418.7(e)(3)(B)
19
   Welfare and Institutions Code Sec. 4648(a)(9)(B)(iii)


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        funding is not available, except in emergencies.20 In addition:
           a. Within 30 days of admission, the regional center must
              complete an assessment to determine the services and
              supports needed for stabilization and to develop a plan to
              transition the person from the facility to the community.
           b. New admissions to IMDs cannot last longer than 180 days.21

     D. Prior authorization is needed from DDS before a regional center can
        purchase out of state services.
           a. Before DDS can authorize a placement, the regional center
              must:
                 i. Conduct a comprehensive assessment and convene an
                    IPP meeting to determine the services and supports
                    needed for the consumer to receive services in California;
                 ii. Request assistance from the statewide specialized
                     resource service in identifying options to serve the person
                     in California.
                iii. The request shall include details regarding all options
                     considered and an explanation of why these options
                     cannot meet the consumer's needs.
           b. New out-of-state placements are also limited to one six-month
              authorization, with a possible one six-month extension based
              on a comprehensive assessment and determination that the
              person’s needs cannot be met in California.22

     3) Comprehensive assessments are required for people who currently
        live in DCs, mental health facilities that are not eligible for federal
        funds, and out-of-state placements.

     A. For most people who currently live in DCs, the law requires:
           a. Regional centers to complete by December 31, 2015,
              comprehensive assessments which identify the types of
              community-based services and supports available to the
              consumer.


20
   Welfare and Institutions Code Sec. 4648(a)(9)(C)
21
   Welfare and Institutions Code Sec. 4648(a)(9)(C)(ii)
22
   Welfare and Institutions Code Sec. 4519(a)


                                            6
             b. The assessments must be provided to the person’s IPP team to
                assist the team in determining the least restrictive environment.
             c. The assessment must be updated annually as part of the IPP
                process.23

      B. For people who live in IMDs which do not receive federal Medicaid
         funds, the law requires:
             a. Regional centers to complete a comprehensive assessment
                prior to the person’s next scheduled IPP meeting.
             b. The assessment is to include the identification of the services
                and supports needed and the timeline for identifying or
                developing those services needed to transition the consumer
                back to the community.
             c. Effective October 1, 2012, the regional center is to consider
                resource options identified by the statewide specialized
                resource service.
             d. Regional centers are to notify the clients’ rights advocate for the
                regional center, who may participate in the IPP meeting unless
                the consumer objects.24

      C. For people who currently live in out-of-state placements, the law
         requires regional centers to develop a transition plan, by December
         31, 2012, to return them to California.25

Change in Law Regarding Placements Ordered by the Court

Previous law allowed a petition to the court for a person with mental
retardation to be committed to the State Department of Developmental
Services if a regional center believed a person with mental retardation to be
“dangerous to self or others.”26 This was known as a 6500 Commitment
and placement was usually into a Developmental Center. The new law
allows a 6500 Commitment by a court for a person with a developmental
disability who is “dangerous to self or others.” Thus, the new law expands
this type of commitment to any person who is a regional center client and
“dangerous to self or others.”


23
     Welfare and Institutions Code Secs. 4418.25(c)(2)(A)-(D)
24
     Welfare and Institutions Code Sec. 4648(a)(9)(C)(iii)
25
     Welfare and Institutions Code Sec. 4519(a)(e)
26
     Welfare and Institutions Code Sec. 6500 et. seq.



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What Will Happen If the Regional Center Moves You to One of These
Facilities?

If your regional center wants to move you to a new facility, other than
through a court order, it must either hold an IPP meeting and reach
agreement with you about the change or give you a written notice.27 The
notice must be given 30 days before the change begins.28 The notice must
give you the following information:

        the action the regional center is taking;
        the basic facts about why the regional center is making its decision;
        the reason for the action;
        the effective date; and,
        the specific law, regulation or policy that supports the action.29

If you are already receiving the service and you disagree with the regional
center’s decision and want to continue to receive it, you must request a fair
hearing within 10 days of receiving the notice.30 Otherwise, the request
must be made within 30 days.31 If exemptions are available and you think
you meet an exemption, remember to additionally put “I meet an
exemption” into your fair hearing request.

For more important information on how to appeal decisions by the regional
center, read our fact sheet, Regional Center Due Process and Hearing
Rights at http://www.disabilityrightsca.org/pubs/F02601.pdf.




27
   Usually, decisions about the services you need must be decided by an IPP team.
Welfare and Institutions Code § 4646.4(a)-(c). However, the law says if a regional
center wants to reduce, end or change a service in your IPP without your consent, it has
to give you a 30 day notice first. Welfare and Institutions Code Sec. 4710
28
   Welfare and Institutions Code Sec. 4710
29
   Welfare and Institutions Code Sec. 4701. The information must also be in the language you
understand.
30
   Welfare and Institutions Code Sec. 4715
31
   Welfare and Institutions Code Sec. 4710.5(a)



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