SECTIONS 4685-4689.8 - California Statutes

WELFARE AND INSTITUTIONS CODE

SECTION 4685-4689.8

4685. (a) Consistent with state and federal law, the Legislature
finds and declares that children with developmental disabilities most
often have greater opportunities for educational and social growth
when they live with their families. The Legislature further finds and
declares that the cost of providing necessary services and supports
which enable a child with developmental disabilities to live at home
is typically equal to or lower than the cost of providing out-of-home
placement. The Legislature places a high priority on providing
opportunities for children with developmental disabilities to live
with their families, when living at home is the preferred objective
in the child's individual program plan.
(b) It is the intent of the Legislature that regional centers
provide or secure family support services that do all of the
following:
(1) Respect and support the decisionmaking authority of the
family.
(2) Be flexible and creative in meeting the unique and individual
needs of families as they evolve over time.
(3) Recognize and build on family strengths, natural supports, and
existing community resources.
(4) Be designed to meet the cultural preferences, values, and
lifestyles of families.
(5) Focus on the entire family and promote the inclusion of
children with disabilities in all aspects of school and community.
(c) In order to provide opportunities for children to live with
their families, the following procedures shall be adopted:
(1) The department and regional centers shall give a very high
priority to the development and expansion of services and supports
designed to assist families that are caring for their children at
home, when that is the preferred objective in the individual program
plan. This assistance may include, but is not limited to specialized
medical and dental care, special training for parents, infant
stimulation programs, respite for parents, homemaker services,
camping, day care, short-term out-of-home care, child care,
counseling, mental health services, behavior modification programs,
special adaptive equipment such as wheelchairs, hospital beds,
communication devices, and other necessary appliances and supplies,
and advocacy to assist persons in securing income maintenance,
educational services, and other benefits to which they are entitled.
(2) When children with developmental disabilities live with their
families, the individual program plan shall include a family plan
component which describes those services and supports necessary to
successfully maintain the child at home. Regional centers shall
consider every possible way to assist families in maintaining their
children at home, when living at home will be in the best interest of
the child, before considering out-of-home placement alternatives.
When the regional center first becomes aware that a family may
consider an out-of-home placement, or is in need of additional
specialized services to assist in caring for the child in the home,
the regional center shall meet with the family to discuss the
situation and the family's current needs, solicit from the family
what supports would be necessary to maintain the child in the home,
and utilize creative and innovative ways of meeting the family's
needs and providing adequate supports to keep the family together, if
possible.
(3) (A) To ensure that these services and supports are provided in
the most cost-effective and beneficial manner, regional centers may
utilize innovative service-delivery mechanisms, including, but not
limited to, vouchers; alternative respite options such as foster
families, vacant community facility beds, crisis child care
facilities; group training for parents on behavioral intervention
techniques in lieu of some or all of the in-home parent training
component of the behavioral intervention services; purchase of
neighborhood preschool services and needed qualified personnel in
lieu of infant development programs; and alternative child care
options such as supplemental support to generic child care facilities
and parent child care cooperatives.
(B) Effective July 1, 2009, at the time of development, review, or
modification of a child's individualized family service plan or
individual program plan, the regional center shall consider both of
the following:
(i) The use of group training for parents on behavioral
intervention techniques in lieu of some or all of the in-home parent
training component of the behavioral intervention services.
(ii) The purchase of neighborhood preschool services and needed
qualified personnel in lieu of infant development programs.
(4) If the parent of any child receiving services and supports
from a regional center believes that the regional center is not
offering adequate assistance to enable the family to keep the child
at home, the parent may initiate a request for fair hearing as
established in this division. A family shall not be required to start
a placement process or to commit to placing a child in order to
receive requested services.
(5) Nothing in this section shall be construed to encourage the
continued residency of adult children in the home of their parents
when that residency is not in the best interests of the person.
(6) When purchasing or providing a voucher for day care services
for parents who are caring for children at home, the regional center
may pay only the cost of the day care service that exceeds the cost
of providing day care services to a child without disabilities. The
regional center may pay in excess of this amount when a family can
demonstrate a financial need and when doing so will enable the child
to remain in the family home.
(7) A regional center may purchase or provide a voucher for
diapers for children three years of age or older. A regional center
may purchase or provide vouchers for diapers under three years of age
when a family can demonstrate a financial need and when doing so
will enable the child to remain in the family home.

4685.1. (a) When a minor child requires a living arrangement
outside of the family home, as determined in the individual program
plan developed pursuant to Section 4646 and Section 4648, the
regional center shall make every effort to secure a living
arrangement, consistent with the individual program plan, in
reasonably close proximity to the family home.
(b) When the parents or guardian of a minor child requests that an
out-of-home living arrangement for a minor child be in close
proximity to the family home, and when such a living arrangement
cannot be secured by the regional center, the regional center shall
include with the individual program plan a written statement of its
efforts to locate, develop, or adapt appropriate services and
supports in a living arrangement within close proximity to the family
home and what steps will be taken by the regional center to develop
the services and supports necessary to return the child to the family
home or within close proximity of the family home. This statement
shall be updated every six months, or as agreed to by the parents or
guardians, and a copy shall be forwarded to the parents or guardians
of the minor and to the director of the department.
(c) This section shall not be construed to impede the movement of
consumers to other geographic areas or the preference of the parent
or guardian for the placement of their minor child.

4685.7. (a) Contingent upon approval of a federal waiver, the
Self-Directed Services Program (SDS Program) is hereby established
and shall be available in every regional center catchment area to
provide participants, within an individual budget, greater control
over needed services and supports. The Self-Directed Services Program
shall be consistent with the requirements set forth in this section.
In order to provide opportunities to participate in the program, the
department shall adopt regulations, consistent with federal law, to
implement the procedures set forth in this section.
(b) For purposes of this section, the following definitions shall
apply:
(1) "Financial management services" means a service or function
that assists the participant to manage and direct the distribution of
funds contained in the individual budget. This may include, but is
not limited to, bill paying services and activities that facilitate
the employment of service workers by the participant, including, but
not limited to, federal, state, and local tax withholding payments,
unemployment compensation fees, setting of wages and benefits, wage
settlements, fiscal accounting, and expenditure reports. The
department shall establish specific qualifications which shall be
required of a financial management services provider.
(2) "Supports brokerage" means a service or function that assists
participants in making informed decisions about the individual
budget, and assists in locating, accessing and coordinating services
consistent with and reflecting a participant's needs and preferences.
The service is available to assist in identifying immediate and
long-term needs, developing options to meet those needs,
participating in the person-centered planning process and development
of the individual program plan, and obtaining identified supports
and services.
(3) "Supports broker" means a person, selected and directed by the
participant, who fulfills the supports brokerage service or function
and assists the participant in the SDS Program. Specific
qualifications shall be established by the department and required of
a supports broker provider.
(4) "Waiver" means a waiver of federal law pursuant to Section
1396n of Title 42 of the United States Code.
(5) "Independence Plus Self-Directed (IPSD) Waiver Program" or
"Self-Directed Waiver Program" means a federal waiver to the state's
Medicaid plan to allow a person with developmental disabilities who
needs or requires long-term supports and services, and when
appropriate, the person's family, greater opportunity to control his
or her own health and well-being by utilization of self-directed
services.
(6) "Self-directed services" or "SDS" means a voluntary delivery
system consisting of a defined and comprehensive mix of services and
supports, selected and directed by a participant, in order to meet
all or some of the objectives in his or her individual program plan.
Self-directed services are designed to assist the participant to
achieve personally defined outcomes in inclusive community settings.
Self-directed services shall include, but are not limited to, all
of the following:
(A) Home health aide services.
(B) Supported employment and prevocational services.
(C) Respite services.
(D) Supports broker functions and services.
(E) Financial management services and functions.
(F) Environmental accessibility adaptations.
(G) Skilled nursing.
(H) Transportation.
(I) Specialized medical equipment and supplies.
(J) Personal emergency response system.
(K) Integrative therapies.
(L) Vehicle adaptations.
(M) Communication support.
(N) Crises intervention.
(O) Nutritional consultation.
(P) Behavior intervention services.
(Q) Specialized therapeutic services.
(R) Family assistance and support.
(S) Housing access supports.
(T) Community living supports, including, but not limited to,
socialization, personal skill development, community participation,
recreation, leisure, home and personal care.
(U) Advocacy services.
(V) Individual training and education.
(W) Participant-designated goods and services.
(X) Training and education transition services.
The department shall include all of the services and supports
listed in this paragraph in the IPSD Waiver Program application.
Notwithstanding this paragraph, only services and supports included
in an approved IPSD Waiver shall be funded through the SDS Program.
(7) "Advocacy services" means services and supports that
facilitate the participant in exercising his or her legal, civil and
service rights to gain access to generic services and benefits that
the participant is entitled to receive. Advocacy services shall only
be provided when other sources of similar assistance are not
available to the participant, and when advocacy is directed towards
obtaining generic services.
(8) "Individual budget" means the amount of funding available to
the participant for the purchase of services and supports necessary
to implement an individual program plan. The individual budget shall
be constructed using a fair, equitable, and transparent methodology.
(9) "Risk pool" means an account that is available for use in
addressing the unanticipated needs of participants in the SDS
Program.
(10) "Participant" means an individual, and when appropriate, his
or her parents, legal guardian or conservator, or authorized
representative, who have been deemed eligible for, and have
voluntarily agreed to participate in, the SDS Program.
(c) Participation in the SDS Program is fully voluntary. A
participant may choose to participate in, and may choose to leave,
the SDS Program at any time. A regional center may not require
participation in the SDS Program as a condition of eligibility for,
or the delivery of, services and supports otherwise available under
this Division.
(d) The department shall develop informational materials about the
SDS Program. The department shall ensure that regional centers are
trained in the principles of SDS, the mechanics of the SDS Program
and the rights of consumers and families as candidates for, and
participants, in the SDS Program. Regional centers shall conduct
local meetings or forums to provide regional center consumers and
families with information about the SDS Program. All consumers and
families who express an interest in participating in the SDS program
shall receive an in-depth orientation, conducted by the regional
center, prior to enrollment in the program.
(e) Prior to enrollment in the SDS Program, and based on the
methodologies described below, an individual, and when appropriate,
his or her parents, legal guardian or conservator, or authorized
representative, shall be provided in writing two individual budget
amounts. If the individual, and when appropriate his parents, legal
guardian or conservator, or authorized representative, elects to
become a participant in the SDS Program, he or she shall choose which
of the two budget amounts provided will be used to implement their
individual program plan.
(1) The methodologies and formulae for determining the two
individual budget amounts shall be detailed in departmental
regulations, as follows:
(A) One individual budget amount shall equal 90 percent of the
annual purchase of services costs for the individual. The annual
costs shall reflect the average annual costs for the previous two
fiscal years for the individual.
(B) One individual budget amount shall equal 90 percent of the
annual per capita purchase of service costs for the previous two
fiscal years for consumers with similar characteristics, who do not
receive services through the SDS Program, based on factors including,
but not limited to, age, type of residence, type of disability and
ability, functional skills, and whether the individual is in
transition. This budget methodology shall be constructed using data
available on the State Department of Developmental Services
information system.
(2) Once a participant has selected an individual budget amount,
that individual budget amount shall be available to the participant
each year for the purchase of self-directed services until a new
individual budget amount has been determined. An individual budget
amount shall be calculated no more than once in a 12-month period.
(3) As determined by the participant, the individual budget shall
be distributed among the following budget categories in order to
implement the IPP:
(A) Community Living.
(B) Health and Clinical Services.
(C) Employment.
(D) Training and Education.
(E) Environment and Medical Supports.
(F) Transportation.
(4) Annually, participants may transfer up to 10 percent of the
funds originally distributed to any budget category set forth in
paragraph (3), to another budget category or categories. Transfers in
excess of 10 percent of the original amount allocated to any budget
category may be made upon the approval of the regional center.
Regional centers may only deny a transfer if necessary to protect the
health and safety of the participant.
(5) The regional center shall annually ascertain from the
participant whether there are any circumstances that require a change
to the annual individual budget amount. The department shall detail
in regulations the process by which this annual review shall be
achieved.
(6) A regional center's calculation of an individual budget amount
may be appealed to the executive director of the regional center, or
his or her designee, within 30 days after receipt of the budget
amount. The executive director shall issue a written decision within
10 working days. The decision of the executive director may be
appealed to the Director of Developmental Services, or his or her
designee, within 15 days of receipt of the written decision. The
decision of the department is final.
(f) The department shall establish a risk pool fund to meet the
unanticipated needs of participants in the SDS Program. The fund
shall be administered by the department. Notwithstanding Section
13340 of the Government Code, all moneys in the fund shall be
continuously appropriated to the department, without regard to fiscal
years, for the purpose of funding services and supports pursuant to
this subdivision.
(1) The risk pool shall be funded at the equivalent of 5 percent
of the historic annual purchase of service costs for consumers
participating in the SDS Program.
(2) The risk pool shall be allocated by the department to regional
centers through a process specified by the department.
(3) The risk pool may be used only in the event of substantial
change in a participant's service and support needs that were not
known at the time the individual budget was set, including an urgent
need to relocate a residence, and catastrophic injury or illness.
(4) The risk pool may be accessed by a participant more than once
in a lifetime.
(g) In the first year of the SDS Program, the department shall
provide for establishment of savings to the General Fund equivalent
to 5 percent of the historic annual purchase of service costs for SDS
program participants. In subsequent fiscal years, the department
shall annually provide for establishment of savings to the General
Fund equivalent to 5 percent of the annual purchase of services costs
for SDS Program participants, averaged over the prior two fiscal
years.
(h) A regional center may advance funds to a financial management
services entity pursuant to SDS Program regulations to facilitate
development of a participant's individual budget and transition into
the SDS Program.
(i) Participation in the SDS Program shall be available to any
regional center consumer who meets the following eligibility
requirements.
(1) The participant is three years of age or older.
(2) The participant has a developmental disability, as defined in
Section 4512.
(3) The participant does not live in a licensed long-term health
care facility, as defined in paragraph (44) of subdivision (a) of
Section 54302 of Title 17 of the California Code of Regulations, or a
residential facility, as defined in paragraph (55) of subdivision
(a) of Section 54302 of Title 17 of the California Code of
Regulations, or receive day program or habilitation services, as
defined in paragraph (16) or (34) of subdivision (a) of Section 54302
of Title 17 of the California Code of Regulations, respectively. An
individual, and when appropriate, his or her parent, legal guardian
or conservator, or authorized representative, who is not eligible to
participate in the SDS Program pursuant to this paragraph, may
request that the regional center provide person-centered planning
services in order to make arrangements for transition to the SDS
Program. In that case, the regional center shall initiate
person-centered planning services within 60 days of a request.
(4) The participant agrees to all of the following terms and
conditions:
(A) The participant shall undergo an in-depth orientation to the
SDS Program prior to enrollment.
(B) The participant shall agree to utilize the services and
supports available within the SDS Program only when generic services
cannot be accessed, and except for Medi-Cal state plan benefits when
applicable.
(C) The participant shall consent to use only services necessary
to implement his or her individual program plan as described in the
IPSD Waiver Program, and as defined in paragraph (6) of subdivision
(b), as an available service in the SDS Program, and shall agree to
comply with any and all other terms and conditions for participation
in the SDS Program described in this section.
(D) The participant shall manage self-directed services within the
individual budget amount, chosen pursuant to subdivision (e).
(E) The participant shall utilize the services of a financial
management services entity of his or her own choosing. A financial
management services provider may either be hired or designated by the
participant. A designated financial management services provider
shall perform services on a nonpaid basis. An individual or a parent
of an individual in the SDS Program shall provide financial
management services only as a designated provider and only if the
capacity to fulfill the roles and responsibilities as described in
the financial management services provider qualifications can be
demonstrated to the regional center.
(F) The participant shall utilize the services of a supports
broker of his or her own choosing for the purpose of providing
services and functions as described in paragraphs (2) and (3) of
subdivision (b). A supports broker may either be hired or designated
by the participant. A designated supports broker shall perform
support brokerage services on a nonpaid basis. An individual or a
parent of an individual in the SDS Program shall provide supports
brokerage services or his or her designated representative shall
provide the services only as a designated provider and only if the
capacity to fulfill the role and responsibilities as described in the
supports broker provider qualifications can be demonstrated to the
financial management services entity.
(j) A participant who is not Medi-Cal eligible may participate in
the SDS Program without IPSD Waiver Program enrollment and receive
self-directed services if all other IPSD Waiver Program eligibility
requirements are met.
(k) The planning team, established pursuant to subdivision (j) of
Section 4512, shall utilize the person-centered planning process to
develop the Individual Program Plan (IPP) for an SDS participant. The
IPP shall detail the goals and objectives of the participant that
are to be met through the purchase of participant selected services
and supports.
(l) The participant shall implement his or her IPP, including
choosing the services and supports allowable under this section
necessary to implement the plan. A regional center may not prohibit
the purchase of any service or support that is otherwise allowable
under this section.
(m) An adult may designate an authorized representative to effect
the implementation. The representative shall meet all of the
following requirements:
(1) He or she shall demonstrate knowledge and understanding of the
participant's needs and preferences.
(2) He or she shall be willing and able to comply with SDS Program
requirements.
(3) He or she shall be at least 18 years of age.
(4) He or she shall be approved by the participant to act in the
capacity of a representative.
(n) The participant, or his or her authorized representative and
the regional center case manager shall receive a monthly budget
statement that describes the amount of funds allocated by budget
category, the amount spent in the previous 30-day period, and the
amount of funding that remains available under the participant's
individual budget.
(o) If at any time during participation in the SDS Program a
regional center determines that an individual is no longer eligible
to continue based on the criteria described in subdivision (i), or a
participant voluntarily chooses to exit the SDS Program, the regional
center shall provide for the participant's transition from the SDS
Program to other services and supports. This shall include the
development of a new individual program plan that reflects the
services and supports necessary to meet the individual's needs. The
regional center shall ensure that there is no gap in services and
supports during the transition period.
(1) Upon determination of ineligibility pursuant to this
subdivision, the regional center shall inform the participant in
writing of his or her ineligibility, the reason for the determination
of ineligibility and shall provide a written notice of the fair
hearing rights, as required by Section 4701.
(2) An individual determined ineligible, or who voluntarily exits
the SDS Program, shall be permitted to return to the SDS Program upon
meeting all applicable eligibility criteria and after a minimum of
12 months time has elapsed.
(p) A participant in the SDS Program shall have all the rights
established in Chapter 7 (commencing with Section 4700), except as
provided under paragraph (6) of subdivision (e).
(q) Only a financial management services provider is required to
apply for vendorization in accordance with Subchapter 2 (commencing
with Section 54300) of Chapter 3 of Title 17 of the California Code
of Regulations, for the SDS Program. All other service providers
shall have applicable state licenses, certifications, or other state
required documentation, but are exempt from the vendorization
requirements set forth in Title 17 of the California Code of
Regulations. The financial management services entity shall ensure
and document that all service providers meet specified requirements
for any service that may be delivered to the participant.
(r) A participant in the SDS Program may request, at no charge to
the participant or the regional center, criminal history background
checks for persons seeking employment as a service provider and
providing direct care services to the participant.
(1) Criminal history records checks pursuant to this subdivision
shall be performed and administered as described in subdivision (b)
and subdivisions (d) to (h), inclusive, of Section 4689.2, and
Sections 4689.4 to 4689.6, inclusive, and shall apply to
vendorization of providers and hiring of employees to provide
services for family home agencies and family homes.
(2) The department may enter into a written agreement with the
Department of Justice to implement this subdivision.
(s) A participant enrolled in the SDS Program pursuant to this
section and utilizing an individual budget for services and supports
is exempt from Section 4783 and from the Family Cost Participation
Program.
(t) Notwithstanding any provision of law, an individual receiving
services and supports under the self-determination projects
established pursuant to Section 4685.5 may elect to continue to
receive self-determination services within his or her current scope
and existing procedures and parameters. Participation in a
self-determination project pursuant to Section 4685.5 may only be
terminated upon a participant's voluntary election and qualification
to receive services under another delivery system.
(u) Each regional center shall be responsible for implementing an
SDS Program as a term of its contract under Section 4629.
(v) Commencing January 10, 2008, the department shall annually
provide the following information to the policy and fiscal committees
of the Legislature:
(1) Number and characteristics of participants, by regional
center.
(2) Types and ranking of services and supports purchased under the
SDS Program, by regional center.
(3) Range and average of individual budgets, by regional center.
(4) Utilization of the risk pool, including range and average
individual budget augmentations and type of service, by regional
centers.
(5) Information regarding consumer satisfaction under the SDS
Program and, when data is available, the traditional service delivery
system, by regional center.
(6) The proportion of participants who report that their choices
and decisions are respected and supported.
(7) The proportion of participants who report they are able to
recruit and hire qualified service providers.
(8) The number and outcome of individual budget appeals, by
regional center.
(9) The number and outcome of fair hearing appeals, by regional
center.
(10) The number of participants who voluntarily withdraw from
participation in the SDS Program and a summary of the reasons why, by
regional center.
(11) The number of participants who are subsequently determined to
no longer be eligible for the SDS Program and a summary of the
reasons why, by regional center.
(12) Identification of barriers to participation and
recommendations for program improvements.
(13) A comparison of average annual expenditures for individuals
with similar characteristics not participating in the SDS Program.

4686. (a) Notwithstanding any other provision of law or regulation
to the contrary, an in-home respite worker who is not a licensed
health care professional but who is trained by a licensed health care
professional may perform incidental medical services for consumers
of regional centers with stable conditions, after successful
completion of training as provided in this section. Incidental
medical services provided by trained in-home respite workers shall be
limited to the following:
(1) Colostomy and ileostomy: changing bags and cleaning stoma.
(2) Urinary catheter: emptying and changing bags and care of
catheter site.
(3) Gastrostomy: feeding, hydration, cleaning stoma, and adding
medication per physician's or nurse practitioner's orders for the
routine medication of patients with stable conditions.
(b) In order to be eligible to receive training for purposes of
this section, an in-home respite worker shall submit to the trainer
proof of successful completion of a first aid course and successful
completion of a cardiopulmonary resuscitation course within the
preceding year.
(c) The training in incidental medical services required under
this section shall be provided by physicians or registered nurses.
Training in gastrostomy services shall be provided by a physician or
registered nurse, or through a gastroenterology or surgical center in
an acute care hospital, as defined in subdivision (a) of Section
1250 of the Health and Safety Code, which meets California Children
Services' Program standards for centers for children with congenital
gastrointestinal disorders, or comparable standards for adults, or by
a physician or registered nurse who has been certified to provide
training by the center.
(d) The in-home respite agency providing the training shall
develop a training protocol which shall be submitted for approval to
the State Department of Developmental Services. The department shall
approve those protocols that specifically address both of the
following:
(1) A description of the incidental medical services to be
provided by trained in-home respite workers.
(2) A description of the protocols by which the training will be
provided. Protocols shall include a demonstration of the following
skills by the trainee:
(A) Care of the gastrostomy, colostomy, ileostomy, or urinary
catheter site.
(B) Performance of gastrostomy tube feeding, changing bags and
cleaning stoma of colostomy or ileostomy sites, and emptying and
changing urinary catheter bags.
(C) Identification of, and appropriate response to, problems and
complications associated with gastrostomy care and feeding, colostomy
and ileostomy care, and care of urinary catheter sites.
(D) Continuing education requirements.
(e) Training by the gastroenterology or surgical center, or the
certified physician or registered nurse, shall be done in accordance
with the approved training protocol. Training of in-home respite
workers shall be specific to the individual needs of the regional
center consumer receiving the incidental medical service and shall be
in accordance with orders from the consumer's treating physician or
surgeon.
(f) The treating physician or surgeon shall give assurances to the
regional center that the patient's condition is stable prior to the
regional center's purchasing incidental medical services for the
consumer through an appropriately trained respite worker.
(g) Prior to the purchase of incidental medical services through a
trained respite worker, the regional center shall do all of the
following:
(1) Ensure that a nursing assessment of the consumer, performed by
a registered nurse, is conducted to determine whether an in-home
respite worker, licensed vocational nurse, or registered nurse may
perform the services.
(2) Ensure that a nursing assessment of the home has been
conducted to determine whether incidental medical services can
appropriately be provided in that setting.
(h) The agency providing in-home respite services shall do all of
the following:
(1) Ensure adequate training of the in-home respite worker.
(2) Ensure that telephone backup and emergency consultation by a
registered nurse or physician is available.
(3) Develop a plan for care specific to the incidental medical
services provided to be carried out by the respite worker.
(4) Ensure that the in-home respite worker and the incidental
medical services provided by the respite worker are adequately
supervised by a registered nurse.
(i) Notwithstanding any other provision of law or regulation to
the contrary, the hourly rate for an in-home respite agency shall be
increased to provide a fifty cent ($.50) per hour wage increase and
an eight-cent ($.08) per hour benefit increase for the hours the
in-home respite agency is providing incidental medical services.
(j) To expand the availability of trained in-home respite agency
staff, a regional center may reimburse the in-home respite agency up
to two hundred dollars ($200) semiannually, for the provision of
training pursuant to subdivision (c).
(k) For purposes of this section, "in-home respite worker" means
an individual employed by an agency which is vendored by a regional
center to provide in-home respite services. These agencies include,
but are not limited to, in-home respite services agencies, home
health agencies, or other agencies providing these services.

4686.2. (a) Effective July 1, 2009, notwithstanding any other
provision of law or regulation to the contrary, any vendor who
provides applied behavioral analysis (ABA) services, or intensive
behavioral intervention services or both, as defined in subdivision
(d), shall:
(1) Conduct a behavioral assessment of each consumer to whom the
vendor provides these services.
(2) Design an intervention plan that shall include the service
type, number of hours and parent participation needed to achieve the
consumer's goals and objectives, as set forth in the consumer's
individual program plan (IPP) or individualized family service plan
(IFSP). The intervention plan shall also set forth the frequency at
which the consumer's progress shall be evaluated and reported.
(3) Provide a copy of the intervention plan to the regional center
for review and consideration by the planning team members.
(b) Effective July 1, 2009, notwithstanding any other provision of
law or regulation to the contrary, regional centers shall:
(1) Only purchase ABA services or intensive behavioral
intervention services that reflect evidence-based practices, promote
positive social behaviors, and ameliorate behaviors that interfere
with learning and social interactions.
(2) Only purchase ABA or intensive behavioral intervention
services when the parent or parents of minor consumers receiving
services participate in the intervention plan for the consumers,
given the critical nature of parent participation to the success of
the intervention plan.
(3) Not purchase either ABA or intensive behavioral intervention
services for purposes of providing respite, day care, or school
services.
(4) Discontinue purchasing ABA or intensive behavioral
intervention services for a consumer when the consumer's treatment
goals and objectives, as described under subdivision (a), are
achieved. ABA or intensive behavioral intervention services shall not
be discontinued until the goals and objectives are reviewed and
updated as required in paragraph (5) and shall be discontinued only
if those updated treatment goals and objectives do not require ABA or
intensive behavioral intervention services.
(5) For each consumer, evaluate the vendor's intervention plan and
number of service hours for ABA or intensive behavioral intervention
no less than every six months, consistent with evidence-based
practices. If necessary, the intervention plan's treatment goals and
objectives shall be updated and revised.
(6) Not reimburse a parent for participating in a behavioral
services treatment program.
(c) For consumers receiving ABA or behavioral intervention
services on July 1, 2009, as part of their IPP or IFSP, subdivision
(b) shall apply on August 1, 2009.
(d) For purposes of this section the following definitions shall
apply:
(1) "Applied behavioral analysis" means the design,
implementation, and evaluation of systematic instructional and
environmental modifications to promote positive social behaviors and
reduce or ameliorate behaviors which interfere with learning and
social interaction.
(2) "Intensive behavioral intervention" means any form of applied
behavioral analysis that is comprehensive, designed to address all
domains of functioning, and provided in multiple settings for no more
than 40 hours per week, across all settings, depending on the
individual's needs and progress. Interventions can be delivered in a
one-to-one ratio or small group format, as appropriate.
(3) "Evidence-based practice" means a decisionmaking process that
integrates the best available scientifically rigorous research,
clinical expertise, and individual's characteristics. Evidence-based
practice is an approach to treatment rather than a specific
treatment. Evidence-based practice promotes the collection,
interpretation, integration, and continuous evaluation of valid,
important, and applicable individual- or family-reported,
clinically-observed, and research-supported evidence. The best
available evidence, matched to consumer circumstances and
preferences, is applied to ensure the quality of clinical judgments
and facilitates the most cost-effective care.
(4) "Parent participation" shall include, but shall not be limited
to, the following meanings:
(A) Completion of group instruction on the basics of behavior
intervention.
(B) Implementation of intervention strategies, according to the
intervention plan.
(C) If needed, collection of data on behavioral strategies and
submission of that data to the provider for incorporation into
progress reports.
(D) Participation in any needed clinical meetings.
(E) Purchase of suggested behavior modification materials or
community involvement if a reward system is used.

4686.5. (a) Effective July 1, 2009, notwithstanding any other
provision of law or regulation to the contrary, all of the following
shall apply:
(1) A regional center may only purchase respite services when the
care and supervision needs of a consumer exceed that of an individual
of the same age without developmental disabilities.
(2) A regional center shall not purchase more than 21 days of
out-of-home respite services in a fiscal year nor more than 90 hours
of in-home respite services in a quarter, for a consumer.
(3) (A) A regional center may grant an exemption to the
requirements set forth in paragraphs (1) and (2) if it is
demonstrated that the intensity of the consumer's care and
supervision needs are such that additional respite is necessary to
maintain the consumer in the family home, or there is an
extraordinary event that impacts the family member's ability to meet
the care and supervision needs of the consumer.
(B) For purposes of this section, "family member" means an
individual who:
(i) Has a consumer residing with him or her.
(ii) Is responsible for the 24-hour care and supervision of the
consumer.
(iii) Is not a licensed or certified residential care facility or
foster family home receiving funds from any public agency or regional
center for the care and supervision provided. Notwithstanding this
provision, a relative who receives foster care funds shall not be
precluded from receiving respite.
(4) A regional center shall not purchase day care services to
replace or supplant respite services. For purposes of this section,
"day care" is defined as regularly provided care, protection, and
supervision of a consumer living in the home of his or her parents,
for periods of less than 24 hours per day, while the parents are
engaged in employment outside of the home or educational activities
leading to employment, or both.
(5) A regional center shall only consider in-home supportive
services a generic resource when the approved in-home supportive
services meets the respite need as identified in the consumer's
individual program plan (IPP) or individualized family service plan
(IFSP).
(b) For consumers receiving respite services on July 1, 2009, as
part of their IPP or IFSP, subdivision (a) shall apply on August 1,
2009.
(c) This section shall remain in effect until implementation of
the individual choice budget pursuant to Section 4648.6 and
certification by the Director of the Department of Developmental
Services that the individual choice budget has been implemented and
will result in state budget savings sufficient to offset the costs
associated with the repeal of this section. This section shall be
repealed on the date of certification.

4687. Consistent with state and federal law, the Legislature
recognizes the rights of persons with disabilities to have
relationships, marry, be a part of a family, and to parent if they so
choose. The Legislature further recognizes that individuals with
developmental disabilities may need support and counseling in order
to make informed decisions in these areas. In order to achieve these
goals, the following services may be made available to persons with
developmental disabilities:
(a) Sexuality training.
(b) Parenting skills training.
(c) Supported living arrangements for parents with developmental
disabilities and their children.
(d) Advocacy assistance to deal with agencies, including, but not
limited to, child protective services, and assistance in
reunification planning.
(e) Family counseling services.
(f) Other services and supports listed in Section 4685 when needed
to maintain and strengthen the family unit, where one or both of the
parents is an individual with developmental disabilities.

4688. (a) Consistent with state and federal law, the Legislature
places a high priority on providing opportunities for individuals
with developmental disabilities to be integrated into the mainstream
life of their natural communities. In order to ensure that
opportunities for integration are maximized, the procedure described
in subdivision (b) shall be adopted.
(b) Regional centers shall be responsible for expanding
opportunities for the full and equal participation of persons with
developmental disabilities in their local communities through,
activities, that may include, but shall not be limited to, the
following:
(1) Outreach to, and training and education of, representatives of
community service agencies and programs, businesses, and community
activity providers regarding the provision and expansion of
opportunities for participation by regional center consumers.
(2) Developing a community resources list.
(3) Providing assistance to case managers and family members on
expanding community integration options for consumers in the areas of
work, recreation, social, community service, education, and public
services.
(4) Developing and facilitating the use of innovative methods of
contracting with community members to provide support in natural
environments to regional center consumers.
(5) Development and facilitating the use of natural supports to
enhance community participation.
(6) Providing technical assistance to, and coordinating with,
community support facilitators who will be used to provide supports
to individual consumers for community participation, as needed.
(7) Providing sources of information relevant to individuals in
making informed choices about employment options. This information
may include, but need not be limited to, work incentive programs for
persons with developmental disabilities, access and retention of
needed benefits, interactions of earned income, asset building, or
other financial changes on benefits, employment programs and
protections, taxpayer requirements and responsibilities, training
opportunities, and information and services available through other
agencies, organizations, or on the Internet.

4688.1. (a) Notwithstanding any other provision of law or
regulation to the contrary, vendors of behavior management, activity
center, and adult development center day programs, social recreation
programs, socialization training programs, community integration
training programs, community activities support programs, creative
art programs, and work activity programs shall offer an alternative
senior program component focused on the needs of individuals with
developmental disabilities who are over 50 years of age, at a rate
not to exceed the lesser of thirty-five dollars ($35) per day or the
vendor's existing daily rate.
(1) The alternative senior program component shall be provided at
a ratio of no more than eight consumers to one staff member.
(2) Consistent with the intent of the Lanterman Developmental
Disabilities Services Act, the alternative senior program component
shall be offered within the provider's existing vendored capacity as
reflected in its program design or licensed capacity.
(b) Effective July 1, 2009, at the time of development, review, or
modification of an eligible consumer's individual program plan,
regional centers, as appropriate, shall provide information about and
offer an alternative senior program. The alternative senior program
shall be offered to eligible consumers who want to transition to a
program component focused on the needs and interests of seniors.

4688.2. (a) Notwithstanding any other provision of law or
regulation to the contrary, vendors of behavior management, activity
center, and adult development center adult day programs, community
integration training programs, and community activities support
services programs shall offer an alternative customized program
component with an appropriate staffing component to meet
individualized consumer needs.
(1) The alternative customized program component shall be offered
within the provider's existing vendored capacity, as reflected in its
program design or licensed capacity.
(2) The regional center shall fund customized programs based on
the vendor's existing rate and only fund those hours provided.
(b) Effective July 1, 2009, at the time of development, review, or
modification of a consumer's individual program plan, regional
centers, as appropriate, shall provide information about and make
available the customized program option.
(1) The alternative customized program component shall be offered
to individuals with developmental disabilities who want a program
focused on their individualized needs and interests to develop or
maintain employment or volunteer activities in lieu of their current
program.
(2) Total hours of service for this alternative customized program
shall range between 20 and 80 hours per month, per person, depending
on the support needs of the individual.

4688.3. (a) The State Department of Health Care Services and the
department shall jointly seek a federal Centers for Medicare and
Medicaid Services' (CMS) approved 1915(i) state plan amendment to
expand federal financial participation for services to persons with
developmental disabilities provided by regional centers pursuant to
Division 4.5 (commencing with Section 4500).
(b) Services provided pursuant to this section shall be rendered
under the administrative direction of the department. The department
may issue program directives to regional centers for implementing the
approved state plan amendment.
(c) If CMS approves the state plan amendment pursuant to Section
1915(i) of the Social Security Act, the Director of Health Care
Services shall execute a declaration stating that this approval has
been granted. The director shall retain the declaration and this
section shall be implemented commencing on the date that the director
executes a declaration pursuant to this subdivision.
(d) The department may adopt regulations to implement this section
and any sections in Division 4.5 (commencing with Section 4500)
necessary to implement the terms of the 1915(i) state plan amendment.
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 11349.9 of the
Government Code, and the department is hereby exempted from that
requirement. For purposes of subdivision (e) of Section 11346.1 of
the Government Code, the 120-day period, as applicable to the
effective period of an emergency regulatory action and submission of
specified materials to the Office of Administrative Law, is hereby
extended to 180 days.
(e) The department shall adopt regulations to implement the terms
of the 1915(i) state plan amendment though the regular rulemaking
process pursuant to Sections 11346 and 11349.1 of the Government Code
within 18 months of the adoption of emergency regulations pursuant
to subdivision (d).
(f) The department shall consult with stakeholders, as defined in
subdivision (k) of Section 4512.
(g) The State Department of Health Care Services shall post a copy
of, or a link to, the approved state plan amendment and any State
Department of Developmental Services regulations or program
directives, or both, issued pursuant to this section on its Internet
Web site.

4688.5. (a) Notwithstanding any other provision of law to the
contrary, the department may approve a proposal or proposals by
Golden Gate Regional Center, Regional Center of the East Bay, and San
Andreas Regional Center to provide for, secure, and assure the full
payment of a lease or leases on housing, developed pursuant to this
section, based on the availability for occupancy in each home, if all
of the following conditions are met:
(1) The acquired or developed real property is available for
occupancy by individuals eligible for regional center services and is
integrated with housing for people without disabilities.
(2) The regional center has approved the proposed ownership
entity, management entity, and developer or development entity for
each project, and, prior to granting the approval, has consulted with
the department and has provided to the department a proposal that
includes the credentials of the proposed entities.
(3) The costs associated with the proposal are reasonable.
(4) The proposal includes a plan for a transfer at a time certain
of the real property's ownership to a nonprofit entity to be approved
by the regional center.
(b) Prior to approving a regional center proposal pursuant to
subdivision (a), the department, in consultation with the California
Housing Finance Agency and the Department of Housing and Community
Development shall review all of the following:
(1) The terms and conditions of the financing structure for
acquisition and/or development of the real property.
(2) Any and all agreements that govern the real property's
ownership, occupancy, maintenance, management, and operation, to
ensure that the use of the property is maintained for the benefit of
persons with developmental disabilities.
(c) No sale encumbrance, hypothecation, assignment, refinancing,
pledge, conveyance, exchange or transfer in any other form of the
real property, or of any of its interest therein, shall occur without
the prior written approval of the department and the Health and
Human Services Agency.
(d) Notice of the restrictions pursuant to this section shall be
recorded against the acquired or developed real property subject to
this section.
(e) At least 45 days prior to granting approval under subdivision
(c), the department shall provide notice to the chairs and vice
chairs of the fiscal committees of the Assembly and the Senate, the
Secretary of the Health and Human Services Agency, and the Director
of Finance.
(f) The regional center shall not be eligible to acquire or
develop real property for the purpose of residential housing.

4688.6. (a) Notwithstanding any other provision of law to the
contrary, the department may receive and approve a proposal or
proposals by any regional center to provide for, secure, or ensure
the full payment of a lease or leases on housing based on the
availability for occupancy in each home. These proposals shall not
include an adult residential facility for persons with special health
care needs, as defined in Section 1567.50 of the Health and Safety
Code. Proposals submitted by regional centers shall meet all of the
following conditions:
(1) The acquired or developed real property is available for
occupancy by individuals eligible for regional center services and is
integrated with other housing in the community for people without
disabilities.
(2) The regional center has submitted documents demonstrating the
appropriate credentials and terms of the project and has approved the
proposed nonprofit ownership entity, management entity, and
developer or development entity for each project.
(3) The costs associated with the proposal are reasonable and
maximize the receipt of federal Medicaid funding. The department
shall only approve proposals that include a process for the regional
center to review recent sales of comparable properties to ensure the
purchase price is within the range of fair market value and, if
significant renovations of a home will be undertaken after the home
is purchased, competing bids for that renovation work to ensure that
the cost of the work is reasonable. For purposes of this subdivision,
"significant renovations" means renovations that exceed 5 percent of
the purchase price of the home.
(4) The proposal includes a plan for a transfer at a time certain
of the real property's ownership to a nonprofit entity to be approved
by the regional center.
(5) The regional center has submitted, with the proposal, the
nonrefundable developer fee established in subdivision (d).
(b) Prior to approving a regional center proposal pursuant to
subdivision (a), the department may contract or consult with a public
or private sector entity that has appropriate experience in
structuring complex real estate financial transactions, but is not
otherwise involved in any lending related to the project to review
any of the following:
(1) The terms and conditions of the financing structure for
acquisition or development of the real property.
(2) Any and all agreements that govern the real property's
ownership, occupancy, maintenance, management, and operation, to
ensure that the use of the property is maintained for the benefit of
persons with developmental disabilities.
(c) The department may impose a limit on the number of proposals
considered pursuant to subdivision (a). If a limit is imposed, the
department shall notify the Association of Regional Center Agencies.
(d) (1) The department shall charge the developer of the housing
described in the regional center proposal a reasonable, nonrefundable
fee for each proposal submitted. The fee shall be for the purpose of
reimbursing the department's costs associated with conducting the
review and approval required by subdivision (b). The fee shall be set
by the department within 30 days of the effective date of the act
that added this section, and shall be adjusted annually, as
necessary, to ensure the payment of the costs incurred by the
department.
(2) Fees collected shall be deposited in the Developmental
Disabilities Services Account established pursuant to Section 14672.9
of the Government Code and shall be used solely for the purpose of
conducting the review and approval required by subdivision (b), upon
appropriation by the Legislature. Interest and dividends on moneys
collected pursuant to this section shall, notwithstanding Section
16305.7 of the Government Code, be retained in the account for
purposes of this section. Moneys deposited in the Developmental
Disabilities Services Account pursuant to this subdivision shall not
be subject to the requirements of subdivision (i) of Section 14672.9
of the Government Code.
(3) Notwithstanding paragraph (2), for the 2008-09 fiscal year,
the Director of Finance may approve an expenditure of up to
seventy-five thousand dollars ($75,000) by the department from moneys
deposited in the account for the purposes specified in subdivision
(b). In the 2009-10 fiscal year and each fiscal year thereafter,
moneys shall be available to the department upon appropriation by the
Legislature.
(e) No sale, encumbrance, hypothecation, assignment, refinancing,
pledge, conveyance, exchange, or transfer in any other form of the
real property, or of any of its interest therein, shall occur without
the prior written approval of the department and the regional
center.
(f) Notice of the restrictions pursuant to this section shall be
recorded against the acquired or developed real property subject to
this section.
(g) At least 30 days prior to granting approval under subdivision
(e), the department shall provide notice to the chairpersons and vice
chairpersons of the fiscal committees of the Assembly and the Senate
and the Director of Finance.
(h) The regional center shall not be eligible to acquire or
develop real property for the purpose of residential housing.
(i) Unless otherwise authorized by law, a regional center shall
not use purchase of service funds to implement this section.
(j) With the exception of funds authorized in paragraph (3) of
subdivision (d), this section shall be implemented within the
department's annual budget. This subdivision shall not preclude the
receipt or use of federal, state non-General Fund, or private funds
to implement this section.
(k) The department shall establish guidelines and procedures for
the administration of this section.

4689. Consistent with state and federal law, the Legislature places
a high priority on providing opportunities for adults with
developmental disabilities, regardless of the degree of disability,
to live in homes that they own or lease with support available as
often and for as long as it is needed, when that is the preferred
objective in the individual program plan. In order to provide
opportunities for adults to live in their own homes, the following
procedures shall be adopted:
(a) The department and regional centers shall ensure that
supported living arrangements adhere to the following principles:
(1) Consumers shall be supported in living arrangements which are
typical of those in which persons without disabilities reside.
(2) The services or supports that a consumer receives shall change
as his or her needs change without the consumer having to move
elsewhere.
(3) The consumer's preference shall guide decisions concerning
where and with whom he or she lives.
(4) Consumers shall have control over the environment within their
own home.
(5) The purpose of furnishing services and supports to a consumer
shall be to assist that individual to exercise choice in his or her
life while building critical and durable relationships with other
individuals.
(6) The services or supports shall be flexible and tailored to a
consumer's needs and preferences.
(7) Services and supports are most effective when furnished where
a person lives and within the context of his or her day-to-day
activities.
(8) Consumers shall not be excluded from supported living
arrangements based solely on the nature and severity of their
disabilities.
(b) Regional centers may contract with agencies or individuals to
assist consumers in securing their own homes and to provide consumers
with the supports needed to live in their own homes.
(c) The range of supported living services and supports available
include, but are not limited to, assessment of consumer needs;
assistance in finding, modifying and maintaining a home; facilitating
circles of support to encourage the development of unpaid and
natural supports in the community; advocacy and self-advocacy
facilitation; development of employment goals; social, behavioral,
and daily living skills training and support; development and
provision of 24-hour emergency response systems; securing and
maintaining adaptive equipment and supplies; recruiting, training,
and hiring individuals to provide personal care and other assistance,
including in-home supportive services workers, paid neighbors, and
paid roommates; providing respite and emergency relief for personal
care attendants; and facilitating community participation. Assessment
of consumer needs may begin before 18 years of age to enable the
consumer to move to his or her own home when he or she reaches 18
years of age.
(d) Regional centers shall provide information and education to
consumers and their families about supported living principles and
services.
(e) Regional centers shall monitor and ensure the quality of
services and supports provided to individuals living in homes that
they own or lease. Monitoring shall take into account all of the
following:
(1) Adherence to the principles set forth in this section.
(2) Whether the services and supports outlined in the consumer's
individual program plan are congruent with the choices and needs of
the individual.
(3) Whether services and supports described in the consumer's
individual program plan are being delivered.
(4) Whether services and supports are having the desired effects.
(5) Whether the consumer is satisfied with the services and
supports.
(f) The planning team, established pursuant to subdivision (j) of
Section 4512, for a consumer receiving supported living services
shall confirm that all appropriate and available sources of natural
and generic supports have been utilized to the fullest extent
possible for that consumer.
(g) Regional centers shall utilize the same supported living
provider for consumers who reside in the same domicile, provided that
each individual consumer's particular needs can still be met
pursuant to his or her individual program plans.
(h) Rent, mortgage, and lease payments of a supported living home
and household expenses shall be the responsibility of the consumer
and any roommate who resides with the consumer.
(i) A regional center shall not make rent, mortgage, or lease
payments on a supported living home, or pay for household expenses of
consumers receiving supported living services, except under the
following circumstances:
(1) If all of the following conditions are met, a regional center
may make rent, mortgage, or lease payments as follows:
(A) The regional center executive director verifies in writing
that making the rent, mortgage, or lease payments or paying for
household expenses is required to meet the specific care needs unique
to the individual consumer as set forth in an addendum to the
consumer's individual program plan, and is required when a consumer's
demonstrated medical, behavioral, or psychiatric condition presents
a health and safety risk to himself or herself, or another.
(B) During the time period that a regional center is making rent,
mortgage, or lease payments, or paying for household expenses, the
supported living services vendor shall assist the consumer in
accessing all sources of generic and natural supports consistent with
the needs of the consumer.
(C) The regional center shall not make rent, mortgage, or lease
payments on a supported living home or pay for household expenses for
more than six months, unless the regional center finds