Bill Text: CA SB579 | 2013-2014 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Developmental services: Commission on Oversight
Spectrum: Partisan Bill (Republican 1-0)
Status: (Engrossed - Dead) 2014-06-17 - Set, first hearing. Hearing canceled at the request of author. [SB579 Detail]
Download: California-2013-SB579-Amended.html
Bill Title: Developmental services: Commission on Oversight
Spectrum: Partisan Bill (Republican 1-0)
Status: (Engrossed - Dead) 2014-06-17 - Set, first hearing. Hearing canceled at the request of author. [SB579 Detail]
Download: California-2013-SB579-Amended.html
BILL NUMBER: SB 579 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 9, 2013
INTRODUCED BY Senator Berryhill
( Coauthor: Senator Emmerson
)
FEBRUARY 22, 2013
An act to amend Section 12306.1 of add
Section 4751 to the Welfare and Institutions Code, relating to
public social developmental services.
LEGISLATIVE COUNSEL'S DIGEST
SB 579, as amended, Berryhill. In-home supportive
services. Developmental services: Oversight Efficiency
and Quality Enhancement Model.
The Lanterman Developmental Disabilities Services Act authorizes
the State Department of Developmental Services to contract with
regional centers to provide services and supports to individuals with
developmental disabilities. The services and supports to be provided
to a regional center consumer are contained in an individual program
plan, developed in accordance with prescribed requirements.
This bill would, commencing January 1, 2014, and to the extent
that funds are made available, establish a 41/2 year Oversight
Efficiency and Quality Enhancement Model pilot project in specified
regional center catchment areas to implement a unified oversight and
quality enhancement process, as specified, shifting the oversight of
the service providers from the Community Care Licensing Division of
the State Department of Social Services and the Licensing and
Certification Division of the State Department of Public Health to
the department and the pilot regional centers.
This bill would require the Legislative Analyst's Office to
conduct a study identifying all of the financial and human resources
expended in relation to current quality assurance activities for the
licensed programs identified in the pilot project and to determine
the amount of current quality assurance costs that are covered by
federal dollars and what could be federally funded if the system and
waiver were changed. The bill, by October 1, 2016, would also require
the department to contract with an independent agency or
organization to evaluate the pilot project and prepare a written
report of its findings.
Existing law provides for the county-administered In-Home
Supportive Services (IHSS) program, under which qualified aged,
blind, and disabled persons are provided with services in order to
permit them to remain in their own homes and avoid
institutionalization. Existing law requires, except as provided, a
county to use county-only funds to fund both the county share and the
state share when any increase in IHSS provider wages or benefits is
negotiated or agreed to by a public authority or nonprofit
consortium, as specified.
This bill would make a technical, nonsubstantive change to that
provision.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 4751 is added to the
Welfare and Institutions Code , to read:
4751. (a) The Legislature finds and declares all of the
following:
(1) Evaluation of the services that people with developmental
disabilities receive from both service providers and regional centers
is a critical component of the service system.
(2) The current system of having three state entities, the State
Department of Developmental Services with the regional centers, the
Community Care Licensing Division of the State Department of Social
Services, and the Licensing and Certification Division of the State
Department of Public Health, all charged with monitoring and
maintaining quality services and supports for people with
developmental disabilities, is duplicative and wasteful of limited
state dollars and resources and fails to obtain optimal results.
(3) The efficiency and efficacy of the oversight and quality
review processes can be significantly enhanced by unifying the
current duplicative quality review system, thus conserving limited
state fiscal resources and reducing the wasteful use of state staff
and service providers' time while simultaneously improving the lives
of people with developmental disabilities in California.
(b) Notwithstanding any other law, commencing January 1, 2014, a
four-and one-half year Oversight Efficiency and Quality Enhancement
Model pilot project shall be established to shift the authority and
resources to the State Department of Developmental Services, in
conjunction with the pilot regional centers, to implement a unified
oversight and quality enhancement process. This process shall ensure
the welfare, community participation, health, and safety of all those
with developmental disabilities who are served in programs currently
licensed by the Community Care Licensing Division of the State
Department of Social Services and the Licensing and Certification
Division of the State Department of Public Health. The project shall
also enhance accountability and quality review processes for the
services directly provided by regional centers. At the conclusion of
the pilot project, it is the intent of the Legislature that if, based
upon the analysis and recommendations of an independent evaluation,
as well as experience in each of the pilot regional centers, the
pilot project has sufficiently met the goals and standards of the
Oversignt Efficiency and Quality Enhancement Model set forth in
subdivision (f), the creation of an Oversight Efficiency and Quality
Enhancement Model shall be extended statewide.
(c) The pilot project shall be conducted in the catchment areas of
the Golden Gate Regional Center, the Tri-Counties Regional Center,
and the San Diego Regional Center. On or before February 1, 2014, the
State Department of Developmental Services may select two additional
regional centers to participate in the pilot project on a voluntary
basis. Additional regional centers shall be selected according to
criteria developed by the department in consultation with the
Association of Regional Center Agencies. In selecting additional
pilot regional centers, the department shall promote diversity among
participating regional centers in terms of size and geographical
location. An agreement shall be negotiated between each pilot
regional center and the department regarding the scope of activities,
project milestones, and resources available to each pilot regional
center.
(d) By February 1, 2014, each pilot regional center shall
establish a local Quality Enhancement Advisory Committee, including
consumers, family members, service providers, and advocates, to
provide input and feedback in the design, implementation, and
evaluation of the Oversight Efficiency and Quality Enhancement Model.
The local advisory committee shall review pilot project data,
including, but not limited to, baselines and outcomes of quality
reviews of providers' services and the individuals served by these
providers and baselines and outcomes of the quality reviews of the
services the regional center directly provides.
(e) From January 1, 2014, to April 1, 2014, inclusive, the
department, working with representatives from the pilot regional
centers, shall, consistent with the parameters set forth in this
section, develop the structure for transfer of responsibilities from
the Community Care Licensing Division of the State Department of
Social Services and the Licensing and Certification Division of the
State Department of Public Health, including the systems and
procedures for certification and decertification, quality reviews,
oversight, and complaint investigation of all programs currently
licensed by those agencies that serve people with developmental
disabilities in the pilot regional center catchment areas. The
Community Care Licensing Division of the State Department of Social
Services and the Licensing and Certification Division of the State
Department of Public Health shall provide staff to consult with the
State Department of Developmental Services and regional centers
during this process.
(f) The Oversight Efficiency and Quality Enhancement Model shall
focus on the impact of services on consumers' lives, support the
continuous investigation and enhancement of the quality and impact of
services, and be informed by reliable data on service effectiveness
and consumer outcomes. The model shall do all of the following:
(1) Be lean, simple, efficient, and understood by the people it
serves.
(2) Avoid unnecessary redundancies of process, permissions,
oversight, and enforcement.
(3) Base reviews on quality standards that, in accordance with
Lanterman Developmental Disabilities Services Act principles, address
individual outcomes, including, but not limited to, health, safety,
independence, choice, empowerment, inclusion, and participation in
community life.
(4) Recognize that service outcomes and effectiveness, the impact
of services on consumers' lives, and satisfaction data will be key to
ensuring quality.
(5) Shift the focus of quality efforts to a service enhancement
model that encourages and recognizes service provider and regional
center improvements.
(6) Include multiple options for proactive consumer protections,
including screening for qualified providers, an emphasis on an
evolving improvement system of coaching and mentoring service
providers toward quality, and an immediate response capacity to
address people in imminent danger.
(7) Report aggregate service and individual outcomes to highlight
excellence, innovation, and satisfaction in the services provided and
in the lives of individuals with developmental disabilities.
(8) Enhance transparency, accountability, quality standards, and
measurement processes for the services directly provided by regional
centers.
(9) Provide consumers, families, service providers, and regional
center staff the opportunity to participate in system evaluation.
(10) Ensure that the results of oversight, quality enhancement,
and assurance review activities are available to people with
developmental disabilities and their families in plain language so
they can be informed consumers of the services that they receive.
(g) On or before July 1, 2014, the department and pilot regional
centers, in consultation with stakeholder organizations, shall do all
of the following:
(1) Establish model certification requirements that shall be
applied in certifying new service providers and service provider
performance standards that shall be used in conducting ongoing
quality reviews and enhancement activities. Certification
requirements and performance standards shall be consistent and shall
include standards for health, safety, and welfare, as well as quality
of life outcomes, including, but not limited to, community inclusion
and participation, choice, friendship, and empowerment. The
principles set forth in subdivision (f), current regulatory and
statutory requirements, as well as nationally accepted quality of
life standards shall be considered in developing the model
certification requirements and performance standards. The model
performance standards shall replace current standards from Titles 17
and 22 of the California Code of Regulations for the specific
services subject to the pilot project in the pilot regional center
areas. The model certification requirements and performance standards
shall support the development, maintenance, and continuous
improvement of innovative, cost-effective services.
(2) Establish pilot regional center performance standards for use
during the pilot project, including, but not limited to, quality
expectations for customer service, resource development, conducting
quality assurance of service providers, accounting, and intake,
outreach, and service coordination, including individual program plan
development and implementation. The regional center performance
standards shall work in concert with the service provider performance
standards and be aligned with the values of the Lanterman
Developmental Disabilities Services Act and the principles set forth
in subdivision (f). The standards shall address how the regional
center's services have resulted in consumer or family empowerment and
in more independent, productive, and normal lives for the persons
served.
(3) Develop a uniform data collection system that provides
reliable, valid, and actionable data from multiple stakeholder
perspectives and is consistently deployed at each pilot regional
center. The data system shall include information on service provider
and pilot regional center performance, as well as the
quality-of-life outcomes and individual program plan goals of the
individuals served in the project. The data system shall be flexible,
have the capacity to allow field-based data entry and analysis, and
to document, measure, and analyze the implementation of the model. To
the extent possible, data currently being collected by regional
centers or the department shall be utilized in the data system.
(4) Consider the experience and outcomes from the Agnews
Developmental Center, Bay Area Quality Management System and from
current quality reviews of unlicensed Lanterman Developmental
Disabilities Services Act support models, including family home
agencies and supported living, in developing the structure,
standards, and data collection methodologies for the model.
(h) From January 1, 2014, to June 30, 2014, inclusive, pilot
regional centers shall collect baseline data on existing service
quality and quality assurance processes in programs and services for
people with developmental disabilities that have been covered by
licensing requirements through the Community Care Licensing Division
of the State Department of Social Services or the Licensing and
Certification Division of the State Department of Public Health.
Baseline data shall meet all of the following requirements:
(1) Be collected by an independent third party surveying a
statistically significant sample of regional center employees,
service provider staff, and individuals and families providing or
receiving those services.
(2) Address all of the following:
(A) The satisfaction of regional center employees, service
provider staff, individuals, and families with the current quality
assurance system.
(B) The impact of services on consumers' lives, including, but not
limited to, the areas of health, safety, community participation,
friendship, empowerment, and choice.
(C) The effectiveness and efficiency of existing quality assurance
processes, including training and related service provider support,
as well as the quality and efficacy of regional center-service
provider relationships.
(3) Be made available to the pilot project's independent evaluator
for comparison with pilot project data as described in subdivision
(k).
(i) The Legislative Analyst's Office shall conduct a study
identifying all of the financial and human resources expended by the
Community Care Licensing Division of the State Department of Social
Services, the Licensing and Certification Division of the State
Department of Public Health, the State Department of Developmental
Services, regional centers, and service providers in relation to
current quality assurance activities for the licensed programs
identified in the pilot project. The study shall also determine the
amount of current quality assurance costs that are covered by federal
funds, primarily through the home-and community-based service waiver
program, and what could be federally funded if the system and waiver
were changed. Based on this study, the Legislative Analyst's Office
shall make recommendations on amounts of, and the best possible means
for, reallocation of funding to augment current quality review and
monitoring staff at the State Department of Developmental Services
and regional centers and provide the resources necessary to implement
the Oversight Efficiency and Quality Enhancement Model.
(j) Full implementation of the pilot project and transfer of
responsibilities will begin on July 1, 2014. Commencing on that date
and for the remainder of the pilot project period, quality review and
oversight functions in the pilot regional center areas shall be
accomplished as follows:
(1) The State Department of Developmental Services shall certify,
rather than license, new programs and services for people with
developmental disabilities that would previously have been subject to
licensing requirements through the Community Care Licensing Division
of the State Department of Social Services or the Licensing and
Certification Division of the State Department of Public Health. A
service provider seeking to start a new program or service shall
first be selected by the regional center through a request for
proposal process and then obtain certification. The certification
process shall include submission of a program design that reflects
the model standards and certification requirements developed pursuant
to paragraph (1) of subdivision (g). The potential service provider
shall complete an initial application for certification with the
local pilot regional center. The application shall then be submitted
to the department for issuance of a certificate.
(2) The State Department of Developmental Services shall deem
certified all programs in the pilot regional center areas that are
licensed prior to July 1, 2014, either by the Community Care
Licensing Division of the State Department of Social Services or the
Licensing and Certification Division of the State Department of
Public Health and these programs shall no longer be monitored by
those licensing agencies. All of these programs shall be deemed
certified by the State Department of Developmental Services without
the certification process requirements developed pursuant to
paragraph (1) of subdivision (g), and shall be subject to quality
monitoring and decertification processes as if they had been issued a
certificate.
(3) All certified programs shall have an annual quality review
conducted by pilot regional center staff. Additionally, a
comprehensive quality enhancement and performance evaluation shall be
scheduled, as needed, depending on the findings of the annual
quality reviews. Quality reviews and monitoring visits shall be
effective and efficient and be based upon the performance standards
developed pursuant to paragraph (1) of subdivision (g).
(4) Training is central to the Oversight Efficiency and Quality
Enhancement Model, and all certified service providers shall submit a
training plan to all pilot regional centers for which they provide
services. The training program shall be subject to the approval of
the pilot regional center. Training shall emphasize continuous
improvement and be proactive and responsive to the findings of
quality reviews. Service providers shall be utilized as training
resources for their own programs as well as to assist other providers
and self-assessment tools shall be developed.
(5) Complaints regarding service provider performance shall be
addressed by the State Department of Developmental Services and pilot
regional centers, as determined during the development of the
structure of the pilot project pursuant to subdivision (e). The pilot
regional center shall initiate investigations of serious complaints
within 24 hours of receipt, or sooner if imminent danger is alleged.
A "serious complaint" is one which, upon investigation, has
identified a condition of "immediate danger," as defined in paragraph
(18) of subdivision (a) of Section 56002 of Title 17 of the
California Code of Regulations. In cases of immediate danger to a
consumer, the pilot regional center shall plan for relocation of the
consumer. The complainant, if known, shall be advised of the outcome
of the investigation and of any corrective actions required of the
service provider.
(6) The department and pilot regional centers shall have the right
and responsibility to decertify a provider based upon a
substantiated serious complaint; a serious, life threatening,
preventable occurrence at the program; or a documented, established
pattern of substandard performance that continues after notice and
opportunity for corrective action.
(7) The department and pilot regional centers shall conduct a
transparent annual quality service review for the continuous
investigation and improvement of the quality of the services a pilot
regional center directly provides, based on the regional center
performance standards developed pursuant to paragraph (2) of
subdivision (g). The department shall monitor pilot regional center
service quality and outcomes, hold pilot regional centers accountable
for their performance, and use a service enhancement approach to
encourage and recognize regional center improvements. Regional center
annual quality service reviews shall include, but not be limited to,
all of the following:
(A) The existing performance contract with department pursuant to
Section 4629.
(B) An annual survey by an independent third party of a
statistically significant sample of consumers and families that
addresses both service provider and pilot regional center services
and includes, but is not limited to, improvements in consumer life
outcomes, the delivery and outcomes of services specified in the
individual program plan, and consumer satisfaction with service
coordination, including individual program plan development and
implementation and satisfaction with the consumer's service provider.
Each pilot regional center shall select an independent third-party
entity, with advice from others outside the regional center, to
complete the annual survey described in this subparagraph.
(C) An annual survey by an independent third party of a
statistically significant sample of service providers that addresses
their satisfaction with the pilot regional center's customer service
to the provider and support of the provider's service quality
performance. Data shall include, but not be limited to, provider
evaluation of regional center quality assurance, training, and
resource development processes, including the effectiveness,
efficiency, and timeliness of those functions. The independent
third-party entity selected to complete the annual survey described
in this subparagraph will be the same entity as the one selected to
complete the annual survey described in subparagraph (B).
(D) Additional components, as determined by the pilot regional
centers and the department.
(8) The Community Care Licensing Division of the State Department
of Social Services and the Licensing and Certification Division of
the State Department of Public Health shall continue to be
responsible for criminal background checks, as required by law, for
service provider staff.
(9) The State Department of Developmental Services and the pilot
regional centers shall implement, test, and verify the Oversight
Efficiency and Quality Enhancement Model data collection system
described in paragraph (3) of subdivision (g).
(10) The department and pilot regional centers shall share with
local advisory committees and statewide stakeholder organizations the
aggregate service provider quality review information and analysis
and regional center annual quality service reviews, including the
information described in paragraph (7). Pilot regional centers shall
make available for review by consumers, families, advocates, and
other interested persons the annual quality reviews and quality
enhancement and performance evaluation reviews of service providers
described in paragraph (3). These reviews shall not contain
personally identifiable consumer information.
(k) (1) On or before October 1, 2016, the State Department of
Developmental Services shall contract with an independent agency or
organization to evaluate the pilot project and prepare a written
report of its findings. The scope of services for the contractor
shall be prepared by the department, in consultation with the State
Department of Social Services, the State Department of Public Health,
the Association of Regional Center Agencies, and stakeholder
organizations, including representatives of service provider
organizations. The evaluation shall, at a minimum, address all of the
following:
(A) A description of the structure and process of implementation
of the Oversight Efficiency and Quality Enhancement Model.
(B) The number and characteristics of the service providers and
programs subject to the pilot project, and the number of consumers
served under the pilot project.
(C) The overall impact of the model on consumers, including, but
not limited to, the extent to which consumers' quality of life
outcomes improve, especially in the areas of health, safety,
community inclusion and participation, friendship, empowerment,
choice, and satisfaction.
(D) The overall impact of the model on service providers,
including, but not limited to, changes in the quality of services
provided, their ability to support people with developmental
disabilities, the cost of quality assurance-related activities,
including use of all resources, and the effectiveness and efficiency
of the model on their internal operations, business model, and
relationships with the regional centers.
(E) The overall impact of the model on pilot regional centers,
including, but not limited to, changes in the quality of services
directly provided by pilot regional centers, effectiveness and
efficiency of pilot regional centers' quality oversight, and
enhancement efforts with service providers, their ability to support
people with developmental disabilities, the cost of quality
assurance-related activities, and the effectiveness and efficiency of
the model on their internal operations, business model, and
relationships between the service providers, pilot regional centers,
and the department.
(F) The overall impact of the model on the State Department of
Developmental Services, including, but not limited to, the department'
s role in monitoring pilot regional center service quality and
outcomes, in holding pilot regional centers accountable for their
performance, in ensuring that pilot regional centers are aligned with
Lanterman Developmental Disabilities Services Act values, and in
supporting evaluation enhancement of the quality of services directly
provided by pilot regional centers. The department shall also
consider the cost of quality assurance-related activities, and the
effectiveness and efficiency of the
model on the department's internal operations and
relationships with pilot regional centers.
(G) The overall impressions, including, but not limited to, pilot
project strengths, weaknesses, and recommendations for improvement of
the model by employees of the department, pilot regional center
participants, service provider organizations and their staff, state
licensing and monitoring personnel, and consumers and families,
including, but not limited to, improvements and innovations
demonstrated, problems encountered, regulatory, statutory, and
programmatic barriers identified, and corrective responses employed.
(H) The satisfaction with the model by department employees, pilot
regional center participants, provider organizations and their
staff, state licensing and monitoring personnel, consumers, and
families.
(I) Identification of the model's strongest performance standard
areas, those most in need of improvement, and those with the greatest
quality improvement for both service providers and pilot regional
centers, as documented during the pilot project period.
(J) Aggregate and comparison data regarding service provider
certification attainment and losses of certification.
(K) The types, amounts, qualifications, and sufficiency of
staffing at the department and pilot regional centers to effectively
implement the model.
(L) The costs and cost-effectiveness of the model as compared with
the multiagency, statewide quality systems involved in services to
people with developmental disabilities, as measured and described by
the Legislative Analyst's Office study of the current system, as
described in subdivision (i).
(M) An analysis and summary findings of all pilot project
consumers' special incident reports and unusual occurrences reported
during the evaluation period, in comparison to special incident
reports under the current quality assurance systems.
(N) Recommendations for statewide application and expansion of the
Oversight Efficiency and Quality Enhancement Model.
(2) The evaluation by the independent agency or organization shall
include, at a minimum, the following approaches and methodologies in
the investigation of the evaluation parameters pursuant to paragraph
(1).
(A) Interviews, surveys, focus groups, and other assessments of
the pilot project participant groups, specifically, State Department
of Developmental Services employees, state licensing and monitoring
personnel, pilot regional center participants, service provider
organizations and their staff, and consumers and families, by the
independent evaluator or another independent third-party agency or
organization.
(B) Analysis of the Oversight Efficiency and Quality Enhancement
Model data system information.
(C) A comparison of consumers' quality of life outcomes under the
model to baseline consumer outcome data collected at the start of the
pilot pursuant to subdivision (h). This data shall be made available
both as an aggregate of all pilot regional centers, as well as by
individual pilot regional center.
(D) A comparison, both historically and between regional centers,
of data collected pursuant to Section 4571 regarding consumer and
family satisfaction, provision of services, and individual consumer
outcomes, between and among those served in the pilot project and
those served using traditional quality assurance systems.
(E) A review of selected service provider annual quality reviews
and a comprehensive quality enhancement and performance evaluation
review from each pilot regional center.
(F) A review of the pilot regional centers' annual quality service
reviews and a comparison of that data to the baseline data collected
pursuant to subdivision (h). This data shall be made available both
as an aggregate of all pilot regional centers, as well as by
individual pilot regional center.
(G) A comparison of the impact of the model on regional center
accountability and quality of services compared to the impact of the
current performance contract processes under Section 4629 at both
pilot and nonpilot regional centers.
(3) The written report by the independent agency or organization
shall be submitted to the State Department of Developmental Services.
The department shall circulate the report to the Community Care
Licensing Division of the State Department of Social Services, the
Licensing and Certification Division of the State Department of
Public Health, and the Association of Regional Center Agencies. The
department shall also submit the report to the appropriate fiscal and
policy committees of the Legislature by July 1, 2017, and make it
readily available to the public.
(l) The department may administer the pilot project through the
issuance of written directives that shall have the same force and
effect as regulations. Any directive affecting Article 1 (commencing
with Section 700) of Chapter 7 of Title 11 of the California Code of
Regulations shall be approved by the Department of Justice. The
directives shall be exempt from the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(m) The department may adopt emergency regulations to implement
this section. The adoption, amendment, repeal, or readoption of a
regulation authorized by this section is deemed to be necessary for
the immediate preservation of the public peace, health and safety, or
general welfare, for purposes of Sections 11346.1 and 11349.6 of the
Government Code, and the State Department of Developmental Services
is hereby exempted from the requirement that it describe specific
facts showing the need for immediate action. A certificate of
compliance for these implementing regulations shall be filed within
24 months following the adoption of the first emergency regulations
filed pursuant to this section.
(n) The department may waive regulations that pose a barrier to
implementation and operation of this pilot project. The waiver of
regulations by the department pursuant to this section shall apply to
only those counties participating in the pilot project and only for
the duration of the pilot project.
(o) All aggregate and system-level reports generated pursuant to
this section shall be made publicly available, but shall not contain
the personal identifying information of any consumer or other
individual.
(p) This section shall only be implemented to the extent that
funds are made available through an appropriation in the annual
Budget Act. All matter omitted in this version of the bill
appears in the bill as introduced in the Senate, February 22, 2013.
(JR11)
