BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON HUMAN SERVICES
                               Senator McGuire, Chair
                                2015 - 2016  Regular 

          Bill No:              SB 1427
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          |Author:   |Pavley                                                |
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          |Version:  |March 28, 2016         |Hearing    |                 |
          |          |                       |Date:      |                 |
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          |Urgency:  |No                     |Fiscal:    |Yes              |
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          |Consultant|Mareva Brown                                          |
          |:         |                                                      |
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             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  








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               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) 










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             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  









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               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  









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          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  









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          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










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          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  









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               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








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          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 --
          











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