BILL ANALYSIS Ó SENATE COMMITTEE ON HUMAN SERVICES Senator McGuire, Chair 2015 - 2016 Regular Bill No: SB 1427 ----------------------------------------------------------------- |Author: |Pavley | ----------------------------------------------------------------- |----------+-----------------------+-----------+-----------------| |Version: |March 28, 2016 |Hearing | | | | |Date: | | |----------+-----------------------+-----------+-----------------| |Urgency: |No |Fiscal: |Yes | ---------------------------------------------------------------- ----------------------------------------------------------------- |Consultant|Mareva Brown | |: | | ----------------------------------------------------------------- Subject: Workforce development: developmentally disabled individuals SUMMARY This bill requires the Department of Developmental Services (DDS) to establish a Work Transition Project, as specified, for regional centers to allow blended or braided forms of integrated services, as specified, and to assist in the state's efforts to reach compliance with the federal Home and Community-Based Services Waiver regulations. The bill authorizes the department to waive regulatory requirements that inhibit the provision of services in competitive integrated settings. It also requires DDS to assess the decrease in time that it takes a consumer under these provisions to become job ready and to transition into an integrated work setting, and to report that information to the Legislature, as specified. ABSTRACT Existing law: 1) Establishes the Lanterman Developmental Disabilities Services Act, which declares California's responsibility for providing an array of services and supports to meet the needs of each person with developmental disabilities in the least restrictive environment, regardless of age or degree of disability, and to support their integration into the SB 1427 (Pavley) PageB of? mainstream life of the community. (WIC 4500, et seq.) 2) Establishes a system of nonprofit regional centers to provide fixed points of contact in the community for all persons with developmental disabilities and their families, to coordinate services and supports best suited to them throughout their lifetime. (WIC 4620) 3) Establishes an Individual Program Plan (IPP) and defines that planning process as the vehicle to ensure that services and supports are customized to meet the needs of consumers who are served by regional centers. (WIC 4512) 4) Defines habilitation services as activities purchased for regional center consumers, including services provided under the Work Activity and Supported Employment programs to prepare and maintain consumers at their highest level of vocation functioning or to prepare them for referral to vocational rehabilitation services. (WIC 4851) 5) Establishes an individual habilitation services plan and specifies areas in which consumers must meet individual employment goals. (WIC 4853, WIC 4854) 6) Requires a regional center to authorize appropriate services for a consumer while he or she is on a waiting list for services from the Department of Rehabilitation (DOR), as specified. (WIC 4855) 7) Establishes fees and hourly rates for service providers who work with consumers in various job development and support activities. (WIC 4860) 8) Establishes in federal law state reimbursements for achieving work outcomes for individuals with disabilities, as specified. (CFR 411.582) SB 1427 (Pavley) PageC of? 9) Establishes an Employment First Policy in California to prioritize opportunities for integrated, competitive employment for individuals with developmental disabilities, regardless of the severity of their disabilities, as specified. (WIC 4869) This bill: 1) Makes various findings and declarations, including: a. It is the intent of the Legislature to ensure that individuals with developmental disabilities who are earning income do not lose their vocational opportunities and earning power as a result of changes related to the home- and community-based services settings (HCBS) rule due to the implementation of the Workforce Innovation and Opportunity Act. b. There are thousands of consumers today earning some income in existing employment programs, who are complying with current rules and deserve specific attention during this transition period to ensure they have the opportunity for, and access to, more integrated work settings of their choice. c. In order to increase the self-sufficiency of adults with developmental disabilities, as specified, it is important that the state implement a program to provide opportunities for individuals to engage in job discovery and job readiness training to assist their transition to more competitive integrated employment and to ensure employment success. 2) Requires that on or before July 1, 2017, DDS shall establish a Work Transition Project with guidelines and an approved process for regional centers to allow blended or braided forms of integrated services using allowable services under existing state and federal law. 3) Requires that the project assist in the state's efforts to reach compliance with the federal Home and Community-Based Services waiver regulations by March 31, 2019. 4) Permits a maximum of 75 hours per quarter, at no more SB 1427 (Pavley) PageD of? than an equivalent of $40 per hour to be authorized for vendors to provide needed job readiness and support services aimed at individualized transition services for consumers currently placed in segregated work settings who choose to move toward competitive integrated employment. 5) Defines "blended or braided forms of integrated services" to mean services for a single consumer that are funded by multiple agencies or entities and that work as a single program. 6) Requires DDS to permit regional centers to customize skill development and job readiness programs for consumers, as appropriate, by partnering with work activity programs and group supported employment vendors to transition those consumers who choose to move towards integrated competitive employment. 7) Permits DDS to waive, until March 31, 2019, regulatory requirements that inhibit the provision of services in competitive integrated settings. 8) Requires DDS to assess the decrease in time that it takes a consumer under these provisions to become job ready and to transition into an integrated work setting. 9) Requires DDS to report to the budget committee of each house of the Legislature during the annual budget process regarding the use of these provisions and the measurable outcomes, as specified. FISCAL IMPACT This bill has not been analyzed by a fiscal committee. BACKGROUND AND DISCUSSION Purpose of the bill: The author states that this bill will help individuals with SB 1427 (Pavley) PageE of? developmental disabilities who are working in group employment or work activity programs to move toward competitive integrated employment, which will be required by new federal regulations in 2019. "Currently, there are thousands of consumers who are earning income in settings that are compliant with current rules, whose employment will be threatened under the forthcoming requirements," the author states. "These consumers deserve specific attention during this transition period to ensure that they have a reasonable opportunity for, and access to, more integrated work settings of their choice." The author further states that many of these programs do not provide job discovery or soft skills training needed to transition the consumers into competitive, integrated employment and that existing models are inflexible. "If this population is left without purposefully designed pathways into more competitive, integrated employment, these adults will be at higher risk of losing income and increasing public dependency throughout the course of their lives." Regional centers California's 21 nonprofit regional centers are part of a system of care for individuals with developmental disabilities overseen by DDS. The department is responsible for coordinating care and providing services for nearly 290,000 people who live in their communities, and about 1,000 people who lived in developmental centers as of March 2016. Regional centers provide diagnosis and assessment of eligibility and, if consumers qualify for services, case management to help to plan, access, coordinate and monitor the services and supports that are needed. Services for consumers are determined through an individual program plan (IPP). Employment AB 287 (Beall, Chapter 231, Statutes of 2009) required that the State Council on Developmental Disabilities establish a standing Employment First Committee to identify strategies, best practices, and incentives, and to develop an Employment First Policy. The goal of the policy was to increase the number of people with developmental disabilities who are employed in SB 1427 (Pavley) PageF of? integrated work, self-employment, and microenterprises, and the number earning wages at or above minimum wage. A subsequent report, released in 2011, found that 26.5 percent of working-age adults with developmental disabilities live below the federal poverty line compared with 13 percent of adults in the general population. Other findings included a need for additional supports for individuals to prepare for and maintain employment. That report, and a subsequent report in 2012,<1> prompted a number of legislative efforts, including SB 577 (Pavley, Chapter 431, Statutes of 2014) which established a four-year pilot project to create community-based vocational development services to teach "softer" interpersonal skills to consumers, and to evaluate whether those skills are important to succeed in supported employment. The pilot was not enacted. Individual and Group Employment There are a variety of ways for consumers to be supported in a work environment. Typically, regional centers contract with employment services programs and providers to address the employment needs of individuals with developmental disabilities. Consumers are placed in jobs according to their individual skills, needs and choices, and provided support services on an individual basis or in a group. Work Activity Programs are employment services programs in a sheltered work environment for consumers who have acquired basic vocational and independent living skills. Consumers are paid at a daily per capita rate based on productivity. As of May 2015, there were 108 Work Activity Program vendors and about 9,600 consumers in the program, according to DDS data. Supported Employment Programs are community-based rehabilitation programs that focus on helping consumers obtain, retain or maintain employment in integrated settings either individually or in groups. Often supported employment includes a job coach --------------------------- <1>http://www.scdd.ca.gov/res/docs/pdf/Employment_First/2012%20EF C%20Annual%20Report%20Jan%2016%202013.pdf SB 1427 (Pavley) PageG of? that provides on-the-job services and training, and wages paid directly to the consumer by the employer. Supported employment can either be tailored to an individual, or performed with a group. According to data from DDS, as of May 2015, there were 167 group employment vendors and approximately 5,900 consumers. Individual supported employment, which is not the focus of this bill, employed about 188 vendors and nearly, 4,400 individual participants. Home and Community-Based Services waiver changes On January 10, 2014, the federal Centers for Medicare and Medicaid Services (CMS) released a new "final rule" summarizing key changes in its requirements for states' home and community-based services waivers. The rule affects three types of waivers, all of which are applied in California to serve populations including individuals with developmental disabilities. Elements of the new requirements include that an individual has a lease or other legally enforceable agreement providing similar protections, has privacy in their living unit including lockable doors and a choice of roommates, controls his or her own schedule and can access food at any time, among other practices. Experts believe that group work paid at sub-minimum wages will not be supported under the new HCBS rule but that consumers will need to be employed in integrated settings and with a full salary. According to CMS: "In this final rule, CMS is moving away from defining home and community-based settings by "what they are not," and toward defining them by the nature and quality of individuals' experiences. The home and community-based setting provisions in this final rule establish a more outcome-oriented definition of home and community-based settings, rather than one based solely on a setting's location, geography, or physical characteristics. The changes related to clarification of home and community-based settings will maximize the opportunities for participants in HCBS programs to have access to the benefits of community living and to receive services in the most integrated setting and will effectuate the law's intention for Medicaid HCBS to provide alternatives to SB 1427 (Pavley) PageH of? services provided in institutions."<2> CMS requires states to submit a plan for changes to its service delivery system to comply with the final rule. California's Department of Health Care Services (DHCS) is coordinating the state's response, with input from DDS and other affected departments. On August 14, 2015, DHCS, submitted the Statewide Transition Plan for home and community-based settings to CMS for approval. The state is currently negotiating elements of its plan with CMS. The state must be in full compliance with the new HCBS guidelines in order to receive federal funding by March 2019. Related legislation: SB 577 (Pavley, Chapter 431, Statutes of 2014) established a four-year pilot project to create and evaluate whether community-based vocational development services are determined to be a necessary step to achieve a supported employment outcome. The pilot has not been enacted. AB 1041 (Chesbro, Chapter 677, Statutes of 2013) expanded the definition of competitive integrated employment and required regional centers to ensure that consumers, beginning at 16 years of age, are provided with information about options for integrated competitive employment and other services, including postsecondary education. AB 287 (Beall, Chapter 231, Statutes of 2009) established an "Employment First" effort for the State to undertake, which has led to the State Council on Developmental Disabilities to put together an "Employment First" policy and several attempts to get that policy passed into law. COMMENTS --------------------------- <2> https://www.medicaid.gov/medicaid-chip-program-information/by-top ics/long-term-services-and-supports/home-and-community-based-serv ices/downloads/hcbs-setting-fact-sheet.pdf SB 1427 (Pavley) PageI of? This bill seeks to move a group of consumers who currently are in group employment activities into competitive integrated employment, as is preferred by the new HCBS ruling, by creating a transition program for individuals to learn social and other necessary job skills. The bill would create a time-limited opportunity to braid funding from various state departments and regional center vendors to support consumers in obtaining independent employment. Per the author, this is intended to move the state toward solutions that can be incorporated into the new HCBS state plan during the period when the state is formulating then plan. The bill is similar in concept to SB 577, a four-year pilot project which was contingent upon federal funding and established the same rate structure and similar job skills training. SB 577 was signed and chaptered, however it has been stalled by a lack of federal approval while the state's HCBS waiver is pending. All new services or waivers must be approved by the federal government to receive matching funding. The sponsors of this bill hope that by removing the federal funding requirement and permitting instead braided and blended funding for existing categories of services, that these programs will be established prior to the HCBS waiver process completion and the enactment of SB 577. Should this bill be passed from the Senate Human Services Committee, the author may want to provide additional definition of blended and braided funding and how these services would be structured to provide the required training. POSITIONS Support: California Disability Services Association Arc and United Cerebral Palsy California Collaboration Oppose: None received. -- END -- SB 1427 (Pavley) PageJ of?