Central Valley Regional Center

Transcription

1 I. PURCHASE OF SERVICES A. Policy 1. Values The provision of financial assistance for the purchase of services shall be in accord with the provisions set forth in the Lanterman Developmental Disabilities Services Act, other provisions of law, and Central Valley Regional Center, Inc. s [Center] contract with the Department of Developmental Services including the State of California Standard Agreement and Amendments. The Center shall ensure to the extent possible, that services are available to enable persons with a developmental disability to live a more independent and productive life in the community and to approximate the pattern of everyday living available to non-disabled people of the same age. Such services must be consistent with the philosophical principles of normalization, the developmental principles, critical skills model and leastrestrictive methods. Services must not be experimental, unproven or potentially harmful to the person. To be considered non-experimental a service must be peer reviewed and published in a reputable professional journal such as the Journal of the American Medical Association. The Center shall strive to prevent the person's dislocation from family and community and select those services that make the most effective use of funds. All POS requests will be considered in light of the client's specific needs, relevant circumstances and whether or not the requested service is necessary to permit the individual to remain in the home. All requests must comply with state law, state regulations and board policy. Exceptions to this or any other POS policy may be made with the approval of the CVRC management. Services may be purchased for a client when it has been determined by an interdisciplinary team that such services will accomplish all, or any part, of a client's Individual Program Plan. The interdisciplinary team shall consist at a minimum of the client, the client s legal representative, a regional center representative, and when appropriate the primary care giver. There is a management review process for all financial requests to assure adherence to these standards. Families are expected to carry out the same responsibilities for their family members with disabilities as they do for family members without disabilities. When the responsibilities of caring for the family member with a qualifying condition exceed the costs and responsibilities of caring for an individual 1

2 without disabilities, funds may be considered for services to supplement that which parents are expected to provide. 2. State Guidelines Central Valley Regional Center is guided by state law (the Lanterman Act), state regulations (Title 17 of the California Code of Regulations), its contract with the state Department of Developmental Services and board policy. CVRC may purchase services and supports for eligible persons with developmental disabilities ("clients") when such services and supports will: a. Prevent or alleviate the developmental disability. b. Prevent the dislocation of a minor client from his or her home or the dislocation of an adult client from his or her home community. c. Enable the client to approximate the pattern of everyday living of a nondisabled person of the same age, or lead to a more independent, productive and normal life in the community or permit interaction with persons without disabilities in positive, meaningful ways. Clients also include infants under the age of three who have conditions which put them at risk of developmental disability, as determined by an interdisciplinary team (Welfare & Institutions Code 4501, 4502, 4646(a), 4648(a)(1)). d. General Standards effective July 2009 (i) (ii) Purchase of Experimental Treatments W&I Code Section 4648(a)(15) prohibits regional center from purchasing experimental treatments, therapeutic services or devices that have not been clinically determined or scientifically proven to be effective or safe or for which risks and complications are unknown. Experimental treatments or therapeutic services include experimental medical or nutritional therapy when the use of the product for that purpose is not a general physician practice. Maximizing Generic Resources W&I Code Section 4659(c) prohibits regional centers from purchasing any service that would otherwise be available from Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services (CHAMPUS), In-Home Supportive Services (IHSS), California Children s Services, private insurance or a health care service plan if a client or a family meets the criteria to receive the service but chooses not to pursue that coverage. 2

3 (iii) Documentation of Denial by Generic Resource for Medical/Dental Services W&I Code Section 4659(d) prohibits regional centers from purchasing medical or dental services for a client three years of age or older unless the regional center is provided with documentation of a Medi-Cal, private insurance, or health care service plan s denial and the regional center determines that an appeal by the client or family of the denial does not have merit. The law allows regional centers to pay for medical or dental services while coverage is being pursued, but before a denial is made; pending a final administrative decision on the administrative appeal if the family has provided to the regional center a verification that an administrative appeal is being pursued; or until commencement of services by Medi-Cal, private insurance, or a health care service plan. (iv) Least Costly Vendor W&I Code Section 4648(a)(6)(D) requires the IPP planning team to review the cost of providing services or supports of comparable quality by different providers and to choose the least costly available provider, including transportation, who is able to accomplish all or part of the client s IPP, consistent with the particular needs of the client and family as identified in the IPP. In determining the least costly provider, the availability of federal financial participation shall be considered. The client is not required to use the least costly provider if it will result in the client moving from an existing provider of services or supports to more restrictive or less integrated services or supports. (v) Annual Statement of Services W&I Code Section 4648(h) requires regional centers to provide, at least annually, each client, his or her parents, legal guardian, conservator, or authorized representative a statement of services and supports the regional center purchased for the purpose of ensuring that they are delivered. The statement must include the type, unit, month, and cost of services and supports purchased. (vi) Temporarily Suspended Services W&I Code Section temporarily suspends the purchase of camping services and associated travel expenses; social recreation activities, except for those activities vendored as community-based day programs; education services for children ages three to 17; and non-medical therapies, including, but not limited to, specialized recreation, art, dance and music. The regional center may grant an exemption on an individual basis in extraordinary circumstances to 3

4 3. Policy Statement permit the purchase of a service identified above when the regional center determines that the service is a primary or critical means for ameliorating their physical, cognitive, or psychosocial effects of the client s developmental disability, or the service is necessary to enable the client to remain in his or her home and no alternative service is available to meet the client s need. (vii) Uniform Holiday Schedule Impacts Day Program ILS/ILP facilities. W&I Code Section 4692 implements a 14-day uniform holiday schedule for work activity programs, activity centers, adult development centers, behavior management programs, social recreation programs, adaptive skills trainers, infant development programs, program support groups (day service), socialization training programs, client/parent support behavior intervention training programs, community integration training programs, community activities support services, and creative arts programs, This also includes transportation services. If a holiday falls on a Saturday or Sunday, the following Monday is to be deemed the holiday in lieu of the day observed. DDS may adjust the holiday schedule with sufficient notice through a program directive. (viii) Parental Fee Program W&I Code Section 4784 allows for an update to the parental fee schedule effective July 1, For children placed out-of-home prior to July 1, 2009, DDS is to determine the increase in parental fee above the amount assessed using the fee schedule in effect on June 30, The fee increase is to be implemented over three years, with one-third of the increase added to the fee on July 1, 2009, one-third of July 1, 2010, and the final third added to the fee on July 1, Some parents will no longer be required to pay a fee if their incomes are at or below the Federal Poverty Level, and some parents will have their fees reduced. The new parental fee schedule has been updated to reflect the cost of raising a child in California based upon the USDA s Report, Expenditures on Children by Families. a. It shall be the policy of Central Valley Regional Center, Inc. that: (i) (ii) Purchase of Services funds shall be used to the maximum extent feasible. Purchased services shall be included in the Individual Program 4

5 Plan (IPP), with the consent of the client and/or parent/guardian, legal representative. (iii) Unusual or very expensive funding requests shall be reviewed with upper management. (iv) W&I Code and Government Code Section was enacted September 2008 to establish within each regional center an internal review process to ensure adherence with federal and state law and regulation when considering purchase of services and supports. Additionally, the review process must consider generic resources, other funding services and sources and family responsibility for minor children, (v) When services to be purchased are the responsibility of another generic agency, efforts to obtain these services must be documented in the case file and on the POS form. (vi) The designated provider of service has completed the vendorization process and is approved for service delivery according to Title 17 regulations. (vii) The decision to renew a Purchase of Service will be based on the vendor s reasonable progress in meeting the IPP objectives. (viii) Clients are not discriminated against on the basis of age, sex, ethnic status, religion, mental or physical handicap, or residential status, in determining the need of kinds of services to be purchased. (ix) Any denial of services must be documented. Established Fair Hearing procedures shall be followed. NOTE: No assistance shall be provided for the purchase of services which are legally mandated to be provided by the public education agencies nor for the purchase of another day program in lieu of or in conjunction with the school program. B. General Comments 1. "Services and supports for persons with developmental disabilities" means specialized services and supports or special adaptations of generic services and supports directed toward the alleviation of a developmental disability or toward the social, personal, physical, or economic habilitation or rehabilitation of an individual with a developmental disability, or toward the achievement and 5

6 maintenance of independent, productive, normal lives for persons with developmental disabilities. The determination of which services and supports are necessary for each client shall be made through the Individual Program Plan/Individualized Family Service Plan ("IPP/IFSP") process. The determination shall be made on the basis of the needs and preferences of the client or, when appropriate, the client s family, and shall include consideration of a range of service options proposed by the IPP/IFSP participants and the cost effectiveness of each option (Welfare & Institutions Code 4512(b)). 2. Public resources which are available to implement any service or support and any other sources of available funding and/or voluntary provision of service and support to a client, such as the natural support of family, friends and associates, or circles of support, shall be investigated and pursued, if appropriate, prior to the Regional Center s purchase of service. Parents of minor clients may voluntarily purchase some portion of their child s care, beyond that required by law for support of minor clients; and families of adult clients may voluntarily purchase some or all of the adult client s care. In those instances where it is determined that another agency or individual should be responsible to purchase or provide a service, the Regional Center will assist the client and/or family in obtaining the needed service. While the Regional Center is pursuing funding from another agency or individual, it may purchase urgently needed services and supports until that agency or individual purchases or provides the services and supports. Any retroactive funding received from an outside agency or individual should be applied to offset the payment or payments made by the Regional Center during the time that such service or support was being pursued. (Welfare & Institutions Code 4648(a)(8), 4659, 4685(c)(6), Family Code 3900 and 3910.) 3. In identifying a minor client s service and support needs, the Regional Center shall take into account the parents responsibility to provide services to the minor client. With regard to diapers and child care, except in unusual circumstances, the Regional Center shall fund only those services and supports which are more than the parents would be responsible to provide for a child without a developmental disability. For children ages zero to seventeen living at home who do not have Medi-Cal coverage, the Regional Center must impose statutorily required parental copays for respite, camp, and day care services. The IPP/IFSP process is at the heart of the Regional Center s function to plan for and meet the needs of the client and his or her family. Services and supports may be purchased to meet a client s needs associated with a 6

7 developmental disability when such services and supports will accomplish all or any part of the goals and objectives contained in the client s IPP/IFSP. Individual Program Plans/Individualized Family Service Plans shall be prepared jointly by one or more representatives of the Regional Center, including the service coordinator, the person with a developmental disability, and where appropriate, the person s parents, legal guardian, or conservator and any other persons invited by the client or his or her parent, guardian or conservator. In some instances, a Regional Center clinician will also be a participant in determining the appropriateness of certain services and supports for a specific client (Welfare & Institutions Code 4646 and ). 4. IPP/IFSP Characteristics As further outlined in Welfare & Institutions Code 4646 and : a. Each IPP/IFSP shall contain a statement of goals, based on the client s needs, preferences and life choices, with a statement of specific, timelimited objectives for implementing the client s goals and addressing his or her needs. b. These objectives shall be stated in terms that allow measurement of progress or monitoring of service delivery. c. The goals and objectives should maximize opportunities for the client to develop relationships, be part of community life in terms of housing, work, school and leisure, increase control over his or her life, acquire increasingly positive roles in community life and develop competencies to pursue these goals. d. Each service and support must be identified in the IPP/IFSP and must be associated with one or more objectives targeted for the client. e. Each purchased treatment, service or product must be related to a condition which results from the developmental disability that qualifies the client for regional center services. f. Each IPP/IFSP shall also set forth a schedule of the type and amount of each service and support to be purchased by the Regional Center or obtained from generic agencies or other resources and shall identify the providers of service responsible for attaining each objective. g. There shall be a schedule of regular periodic review and reevaluation of the IPP/IFSP to determine if planned services have been provided and if objectives have been fulfilled within the times specified and if the client 7

8 and his or her family is satisfied with the IPP/IFSP and its implementation. (See also, Welfare & Institutions Code 4512(b), , 4646, , 4648 and 4750.) h. To the fullest extent possible, services and supports shall be provided which are culturally appropriate, integrated with mainstream community life, promote client and family empowerment and involve clients and their families in the development, implementation, monitoring and evaluation of services and supports. (Welfare & institutions Code 4501, 4502, 4512, , 4646, , 4685 and 4688.) 5. Providers of Services and Supports Services and supports may be purchased only from providers: a. who are vendored who are vendorized and meet provisions as outlined in Title 17 to provide such services and supports, and b. who have a rate of payment for vendored or contracted services provided by the Department of Developmental Services, and... c. to whom the Regional Center has issued prior authorization for the purchase of the specific service for the client involved, and... d. who adhere to the quality of care standards set forth by the Regional Center, the Department of Developmental Services, the Welfare & Institutions Code and the California Code of Regulations related to the service and support provided (17 CCR 54326). 6. Considerations in Selecting Vendors The Regional Center shall consider the following when selecting a provider of client services and supports: a. A provider s ability to deliver quality services and supports which will accomplish the specified IPP/IFSP objective b. A provider s success in achieving objectives in the IPP/IFSP c. Where appropriate, the existence of licensing, accreditation, or professional certification d. The cost of providing services and supports of comparable quality by 8

9 different providers, including a consideration of any associated transportation costs e. A provider s innovation and ability to promote cost-effectiveness, including the availability of group service provision when appropriate f. The ability of the provider to develop and facilitate services in natural environments with natural supports g. The ability of the provider to empower clients and their families, when appropriate, to make choices in their own lives, including where and how they live, their relationships with people in the community, the way they spend their time, including education, employment and leisure, the pursuit of their personal future, and program planning and implementation h. The ability of the provider to implement services and supports which result in a more independent, productive and normal life for the client. 7. Renewal of Services Continued funding of services and supports may be authorized only if the client, and where appropriate, the client s parent, legal guardian or conservator and the Regional Center agree that a. the planned services and supports have been provided as specified above, and b. reasonable progress has been made toward meeting the client s IPP/IFSP objectives. Central Valley Regional Center will not purchase any service or support which is considered by recognized professionals to be potentially harmful to clients or clinical interventions not empirically demonstrated to be effective (Welfare & Institutions Code 4502, 4503 and 4512 (b)). CVRC will not purchase services outside California unless approved by the Department of Developmental Services (Welfare and Institutions Code 4519). Persons with developmental disabilities have the same legal rights and responsibilities guaranteed all other individuals by the United States Constitution and the Constitution and laws of the State of California. Services shall be purchased for eligible clients without regard to race, color, creed, national origin, citizenship, sex, age or condition of physical 9

10 or mental disability. No otherwise qualified person, by reason of developmental disability, shall be excluded from participation in, denied the benefits of or subjected to discrimination under any program or activity which receives public funds (Welfare & Institutions Code 4502). This policy statement shall be considered together with the specific purchase of service standards set forth for each type of service. The types of services set forth herein are not all inclusive. Individual circumstances related to a developmental disability may warrant additional services not specifically stated. Exceptions to the Purchase of Service guidelines, to the types of services or to the specific standards for each type of service may be made when considering individual needs. Any such exception shall be reviewed by the Regional Center executive director or designee. If the regional center denies any written request for service or seeks to stop current services, the client, and/or his or her representative can appeal the proposed decision by making a request for a fair hearing. Additional information and assistance can be provided by the client s service coordinator (Welfare & Institutions Code 4710 and ). C. Preventive Services pursuant to W&I Code 4644(a) Individuals may be considered for the purchase of specific diagnostic studies when it is determined that there is a risk of parenting a child with a developmental disability. D. Prevention Program for At-risk Babies pursuant to W&I Code 4435 The prevention program is established for at-risk babies, birth to 36 months who are not otherwise eligible for the California Early Intervention Program and whose genetic, medical, developmental, or environmental history is predictive of a substantially greater risk for developmental disability than that for the general population. This program is funded by a separate contracted funding allocation to only provide intake, assessment, case management, and referral to generic agencies. E. Early Start Services 1. Age/Purpose Early Start services are designed specifically for infants ages 0 to 36 months to improve the child's functioning in one or more areas of delayed development and/or disability. These services ameliorate deficits in the areas of body awareness, gross and fine motor skills, communication, perception, social awareness, and self-help. The services may begin as early as birth for infants who have, or are at risk of having, a developmental disability. 2. Exceptions Some infants with a developmental disability may not require a regional center purchased program. Others may need only the programming offered through 10

11 California Children's Services or Public Educational Services. 3. Early Start-Specific Provisions a. Early Start-Use Private Insurance Government Code section 95004, enacted July 2009 requires families to use their private insurance or health care service plan for medical services identified in the IFSP, other than for evaluation and assessment, in compliance with applicable federal and state law and regulation. Regional centers must continue to ensure the timely provision of required early intervention services. b. Required Early Intervention Services and Eliminating Non-required Services Government Code Section 95020, enacted October 2009 prohibits regional centers from purchasing non-required services in Early Start, with the exception of durable medical equipment, but provides the option for referring families to other non-required services where available. F. Adult Service Programs 1. Service Definition CVRC places a high value on adults with developmental disabilities having opportunities to spend their day in constructive activities designed to enhance skill development. Skill areas addressed may include work, self-advocacy, community integration, self-care and behavioral control. This training leads to the development of abilities required to lead increasingly independent lives. Adult service programs may offer community integration experiences and/or site-based training. Types of adult service programs are differentiated by the primary focus of the training and the intensity of support services they provide. Services are individualized as set forth in the client's person-centered Individual Program Plan (IPP) as well as his or her Individual Service Plan (ISP) or Habilitation Service Plan (HSP). At the time of development, review, or modification of the IPP, regional centers must provide information to eligible clients about alternative senior programs and Custom Endeavors Options (CEO). Seniors (over 50 years of age) will have the opportunity to transition to an alternate program component focused on the needs and interests of seniors. (W&I Code Section ) Custom endeavors options (CEO) are alternative customized programs that offer eligible clients the opportunity to transition to a program component focused on their individualized needs and interests. Individuals may choose to develop or maintain employment or volunteer activities in lieu of their current program. (W&I Code Section ) 11

12 Adult service program options may include but are not limited to: a. Work Activity Program (WAP) consists of paid work and support services to facilitate work, generally in non-integrated settings, sometimes referred to as workshops. b. Supported Employment Program (SEP) provides employment in the community in an integrated setting with support services such as job coaching. (i) (ii) Group SEP consists of 3 to 8 clients usually working at an employer s work site with 100% supervision from a job coach. Group members are typically paid a percentage of minimum wage based on their individual productivity. Individual SEP participants are hired by the employer and paid at least minimum wage. The number of job coach hours is decreased as the client learns the job and can function increasingly independently in it. c. Daily Training Activity Center (DTAC) focuses on the development and maintenance of the functional skills required for self advocacy, community integration and employment. d. Adult Development Program (ADP) focuses on the development and maintenance of similar skills to those addressed in a DTAC with emphasis on self-care skills. e. Behavior Management Program focuses on the reduction of problematic behaviors preventing client participation in another adult service program. 2. Criteria for Services Adult CVRC clients no longer eligible for public education and not competitively employed or their authorized legal representatives who request adult service program services may qualify for them, in order to achieve objectives set forth in the individual's IPP. Clients who express a desire to work will be considered for a referral to the Department of Rehabilitation prior to the purchase of adult service programs. Similarly, clients who express a desire to continue their education will be referred to the appropriate publicly funded community college or adult education program prior to the purchase of adult service programs (Welfare and Institutions Code 4648(a)(8)). Clients or their authorized representatives will have choices of appropriate and 12

13 available adult service program providers. When considering cost-effectiveness of a program, the total cost, including transportation required for the client to participate, will be considered (Welfare and Institutions Code 4648(a)(6)). 3. Generic and Alternative Funding Resources The service coordinator will assist the client or authorized representative in seeking and using financial resources available to fund necessary support services. These resources may include but are not limited to: a. Department of Rehabilitation may assist clients who have the goal of independent competitive employment. b. Adult Day Health Centers funded by Medi-Cal may serve clients who have medical needs that can be served in that setting. c. Public education programs are required to serve clients until the completion of their high school diploma and applicable transition steps or until no longer eligible following their twenty-second birthday. Public school adult education programs are available in some geographic areas. d. Disabled student programs at community colleges provide an opportunity for those clients who wish to engage in post-secondary education to do so with appropriate supports and modifications (Welfare and Institutions Code 4648(a)(8) and 4659(a)(1) and Education Code and 56026). 4. Amount of Service Adult service programs are typically funded up to five days per week. These services are purchased from vendors in the client's home community (Welfare and Institutions Code 4648 (a)(1) and (a)(2)). 5. Evaluation of Service Effectiveness a. The service coordinator will maintain periodic contact with the client or authorized representative to assure that planned services are being provided (Welfare and Institutions Code , (a)(6)). b. The vendor is required to complete a semi-annual review to monitor the implementation and effectiveness of the ISP or HSP to determine that the program continues to meet the client s individual needs (17 CCR 56720,( c ) ). G. Residential Day Programs 13

14 1. Definition A residential day program is an alternative to the traditional community based adult development program or day training and activity center. It is designed for those clients who reside in a health care facility, either an ICF/DD-H or ICF/DD-N. The clients who the I.D. Team has determined need to attend such a program would do so because of their fragile medical condition or because they are unable to withstand the day-to-day stress of a community based day program. The program is provided by a health facility operator after they have applied to the Central Valley Regional Center to be vendored in this capacity. 2. Client Criteria Central Valley Regional Center will consider funding a Residential Day Program for clients when two or more of the following criteria are met: a. No other existing day program is able to meet the client's need. b. The client requires and will benefit from participation in a Residential Day Program. c. The client has a medical condition that requires additional care, for example: is fed by a G-tube. d. The client is medically fragile and cannot withstand the stress of day-to-day attendance at a community based day program. e. There is an Interdisciplinary Team (IDT) consensus that placement in a residential day program is appropriate and there is an approved Individual Service Plan (ISP). f. Client's physical condition makes it necessary to facilitate the client's transition from a SDC to a community living arrangement, transition from one Health facility to another, transition from home to Health facility. g. There is a temporary medical condition which necessitates day program services be delivered in the domicile. H. Independent Living Training (ILP) and Supported Living 1. Service Definition CVRC places a high value on opportunities for adults with developmental disabilities to live in homes that they own or lease. In order for this to be a safe alternative for the client, supported and independent living services, focusing on training and support in the areas of community access, daily living, social and behavioral skills may be necessary. These services are provided in the client s 14

15 home and natural community and should enable the client to develop relationships with non-disabled individuals to the maximum extent possible. These services may be short-term to address specific skill remediation but more often are required on an ongoing basis. Both supported living services (SLS) and independent living services (ILS) have a training and support component. SLS is generally more intensive and focused on support and care rather than instruction of the client. ILS is generally less intensive and focused to a greater extent on client training and instruction to promote increasing levels of self-sufficiency. Supported Living Services (SLS) W&I Code section 4689 requires that the planning team of a client receiving SLS confirm that all appropriate and available sources of natural and generic supports have been utilized to the fullest extent possible; that regional centers utilize the same SLS provider for clients residing in the same domicile, provided that each client s particular needs can still be met pursuant to his or her IPP; and that the client, and any roommate, make all rent, mortgage, or lease payments and be responsible for household expenses. Services are individualized as set forth in the client's person-centered Individual Program Plan (IPP). 2. Criteria for Services CVRC clients at least 18 years of age or authorized legal representatives that request care and support in a home leased or owned by the client, but not occupied by the client s parent or conservator, may qualify for supported or independent living services in order to achieve objectives set forth in the individual's IPP. Additionally, clients living in the home of their parent or conservator may receive short-term independent living skills training to assist them to develop skills necessary to move to an independent living situation (Welfare and Institutions Code 4648, (a)(1) and 17 CCR 58613). Clients or their authorized representatives will have choices of appropriate and available supported and independent living service providers. Clients will be supported in maintaining contact with their family members. Families will be encouraged to maintain contact with their relative(s) (Welfare and Institutions Code 4648(a)(6)(E)). 3. Generic and Alternative Funding Resources The service coordinator will assist the client or authorized representative in seeking and using financial resources available to fund necessary support services. These resources may include but are not limited to: Governmental programs such as Medi-Cal, Medicare, CHAMPUS, 15

16 Supplemental Security Income (SSI), and Social Security (SSA), Railroad retirement, Veteran s Administration (VA) funds, In-Home Supportive Services and public housing subsidies (Welfare and Institutions Code 4659(a)(1) and 4648(a)(8)). In-Home Supportive Services (IHSS) W&I Code Section prohibits regional centers from purchasing supportive services for a client who meets the criteria to receive, but declines to apply for, IHSS benefits, and from purchasing SLS to supplant IHSS. Between the date a client applies for IHSS and the date that a client s application for IHSS is approved, a regional center shall not purchase supportive services for the client at a rate that exceeds the IHSS hourly rate. Private resources that may include legal settlements (to the maximum extent they are liable for the cost of services), trust fund, insurance, or medical assistance to the client (Welfare and Institutions Code 4648, (a)(8) and 4659 (a)(2)). 4. Amount of Service The planning team, including a regional center representative, the client and his/her authorized representative, will determine the appropriateness of supported or independent living services and the level of service needed, taking into account the following: a. The client s ability to direct staff and make decisions in their home b. The level of support needed to find, modify, and maintain a home c. The level of support needed to address the client s social, behavioral, and daily living skills deficits d. The level of facilitation needed to achieve community integration and to build critical and durable relationships with other individuals (Welfare and Institutions Code Section 4689 and 17 CCR 58613) 5. Evaluation of Service Effectiveness a. The service coordinator will maintain periodic contact with the client or authorized representative to assure that planned services are being provided (Welfare and Institutions Code , (a)(6)). b. The service coordinator is required to complete a quarterly review to monitor the implementation and effectiveness of the IPP (17 CCR 56047). Additionally, supported and independent living vendors are required to submit quarterly progress reports to the client s CVRC caseworker. 16

17 I. Respite Services 1. Respite Program Temporary Service Standards W&I Code Section specifies the conditions under which a regional center may purchase respite services and that a regional center may not purchase more than 21 days of our-of-home respite services in a fiscal year nor more than 90 hour of in-home respite in a quarter, for a client. 2. Service Definition CVRC strives to provide essential support services designed to enable families to maintain their minor or adult children at home, when that is the preferred outcome. All family members benefit from time away from one another in order to gain rest and rejuvenation. Respite services are temporary care providing relief to families from the extraordinary duties necessary to meet the needs of a person with severe handicaps. Generally, respite is required when the client exhibits special care needs, severe medical or behavioral problems or an absence of familial resources that make increased time apart and/or a more highly skilled caregiver a necessity. Respite services are determined on the basis of individual client and family circumstances as set forth in each client's person-centered Individual Family Service Plan (IFSP) or Individual Program Plan (IPP). Respite options may include but are not limited to: a. In-home respite (agency vendor) is intermittent or regularly scheduled temporary non-medical care and supervision provided in the client s home by a caregiver selected and trained by the client s family. The respite agency conducts a criminal background check, ensures that the caregiver has CPR certification and reimburses the caregiver for services provided. Agency payment is then provided upon the submission of billing to CVRC. b. In-home respite (medical vendor) is intermittent or regularly scheduled temporary medical care and supervision provided in the client s home by a professional caregiver selected and paid by the home health agency. The agency conducts a criminal background check and ensures that the caregiver has the appropriate training and necessary certification for services provided. Agency payment is then provided upon the submission of billing to CVRC. c. Out-of-home respite is temporary (1-21 days) placement in a CVRC vendored community care facility which requires the same admissions criteria as for clients placed permanently. Agency payment is provided at DDS established rates upon submission of billing to CVRC (17 CCR 17

18 54302(a)(38)). The regional center may grant an exemption from the respite limits if it is demonstrated that the intensity of the client s care and supervision needs are such that additional respite is necessary to maintain the client 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 client (W&I Code (a)(3)(A). 3. Criteria for Services CVRC clients or authorized legal representatives that request respite services may qualify in order to achieve objectives set forth in the individual's IPP (Welfare and Institutions Code 4648(a)(1)). Respite services may be considered in order to do all of the following: a. Assist family members to maintain the client at home b. Provide appropriate care and supervision to protect the client in the family s absence c. Relieve family members from the constantly demanding responsibility of caring for a client d. Attend to the client s normal daily routine which would usually be done by a family member (17 CCR 54302(a)(38)). Clients who are minor children living with their families will be considered for respite services when that will assist the family to maintain the child in the home (Welfare and Institutions Code 4685(c)(1)). Parents of children with developmental disabilities are expected to fulfill the same obligations to them that they would for a typically developing child. Therefore, when considering funding of respite services, CVRC considers what resources are available without additional cost in the child s natural community (Welfare and Institutions Code 4648(a)(2) and 17 CCR 54326(d)(1)). Respite services are differentiated from child care that is necessary in order to provide supervision to a child while a parent is working or attending school (Welfare and Institutions Code 4685(c)(6)). 4. Generic and Alternative Funding Resources The service coordinator will assist the client or authorized representative in seeking and using financial resources available to fund respite services. These 18

19 resources may include but are not limited to: a. Governmental programs such as In-Home Supportive Services (when approved hours fulfill the same function as respite), Adoption Assistance Program funds and Medi-Cal funded nursing services (Welfare and Institutions Code 4659(a)(1) and 4648(a)(8)). b. Private resources that may include legal settlements (to the maximum extent they are liable for the cost of services) and trust fund(welfare and Institutions Code 4648(a)(8) and 4659(a)(2)). c. Those families included in the Cost Participation Program will be required to pay a portion of the fees for respite directly to the respite provider or agency (17 CCR 50257(c)). 5. Amount of Service The level of hours funded by CVRC for respite services is dependent upon an evaluation of the medical, self-care and behavioral needs of the client along with consideration of the circumstances of the family related to the client s disability. Respite services may be authorized as a planned service or in response to a short-term family need. 6. Evaluation of Service Effectiveness J. Health Care a. The service coordinator will maintain periodic contact with the client or authorized representative to assure that planned services are being provided (Welfare and Institutions Code , (a)(5)). b. At each client s annual IPP meeting, a determination will be made of whether the client continues to require supervision in the absence of family members to determine the ongoing appropriateness of respite services (Welfare and Institutions Code , (a)(1)). 1. Equipment/Pharmaceutical Medical, dental and equipment services are those services provided on an individual basis in order to improve and maintain the client's health status. Pharmaceutical provision would also be included within this service. 2. Criteria General health care needs for regional center clients are similar to the needs of all members of the community. Parents of minors are expected to provide for all medical and dental care services and equipment for their children through private insurance, California Children's Services, or other sources of health care 19

20 and funding available to the general public. The regional center may consider purchase of medical, dental and equipment services for either minor or adult clients if both of the following criteria are met: a. The needed treatment or equipment is associated with, or has resulted from the eligible regional center condition. AND b. All alternative sources of payment and provision of care have been explored and found to be unavailable to the client. These include, but are not limited to, private insurance, Medi-Cal, CCS, Medi-Care, CHAMPUS, county medical center, health departments, philanthropic organizations, and mental health agencies. 3. Maximizing Generic Resources Welfare and Institutions Code section 4659(c) prohibits regional centers from purchasing any service that would otherwise be available from Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, In- Home Supportive Services (IHSS), California Children s Services, private insurance or a health care service plan if a client or a family meets the criteria to receive the service but chooses not to pursue that coverage. 4. Medi-Cal Minor children and most adults in residential care are almost always eligible for, and are expected to utilize, the benefits of the Medi-Cal program. 5. Other A client without medical insurance, Medi-Cal or California Children's Services coverage who requires surgery, hospitalization or other complex treatment is referred to existing county medical centers. K. Behavioral Service Standards 1. At times, clients may exhibit behavioral problems or adaptive skill deficits which threaten the current living situation or limit the client s success in interacting with families, peers or other community members. Behavioral challenges can include aggression, self-injury, noncompliance, property destruction, eloping and many others. Government Code Section and Welfare and Institutions Code Section define regional center requirements for ABA or intensive behavioral intervention services. The above mentioned laws state that effective July 1, 20

21 2009, notwithstanding any other provision of law or regulation to the contrary, regional centers shall: a. 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. b. Only purchase ABA or intensive behavioral intervention services when the parent or parents of minor clients receiving services participate in the intervention plan for the clients, given the critical nature of parent participation to the success of the intervention plan. c. Not purchase either ABA or intensive behavioral intervention services for purposes of providing respite, day care, or school services. d. Discontinue purchasing ABA or intensive behavioral intervention services for a client when the client s treatment goals and objectives, are achieved. ABA or intensive behavioral intervention services shall not be discontinued until the goals and objectives are reviewed and updated and shall be discontinued only if those updated treatment goals and objectives do not require ABA or intensive behavioral intervention services. e. For each client, 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. f. Not reimburse a parent for participating in a behavioral services treatment program. 2. Group Training for Parents on Behavioral Intervention Techniques Central Valley Regional Center has found group training on behavior intervention to be beneficial to those who participate. For this reason it is the practice of CVRC to make group training the initial intervention for parents who seek assistance with changing the behavior of CVRC clients. This practice is supported by Government Code section and Welfare and Institutions Code sections 4685, (b)2 and (d)(4)(A). 3. Behavior Intervention Services CVRC will consider funding behavior intervention services which utilize positive, non-aversive behavioral techniques to reduce problematic behaviors and increase adaptive skills based on individual need as set 21

22 forth in each client's person-centered Individual Program Plan (IPP) or Individual Family Service Plan (IFSP). Behavior intervention services may include but are not limited to: Individualized behavior intervention involves a trained professional who assesses the functional behavior of a client and then designs, implements, and evaluates instructional and environmental modifications to produce socially significant improvements in the client's behavior and/or adaptive functioning through skill acquisition and the reduction of behavior. This is generally carried out in a one-on-one setting in the client s place of residence. Group-based behavior intervention involves some degree of individualized services for each client s support system with the bulk of general behavior management techniques being taught in a group setting to the care givers of a number of clients simultaneously (17 CCR 54342(a)(8),(11),(12-14)). 4. Criteria for Services CVRC clients or their authorized legal representatives may request behavior intervention services in order to achieve objectives set forth in the individual's IPP or IFSP (Welfare and Institutions Code 4648(a)(1)). Before the planning team can determine that ongoing behavior intervention is necessary, an assessment by a qualified professional must be completed. It must indicate that the client requires and would benefit from behavior intervention services. It must recommend a time-limited, specific course of treatment (Welfare and Institutions Code (a)(1), (a)(2) and (a)(4)). A client may be referred for behavior intervention services when a caregiver (parent, family member, residential service provider other than Level 4 residential services providers) indicates that the client is exhibiting problematic behavior and is not responding to current positive behavioral techniques. (Welfare and Institutions Code 4512(b) and 4685( c )(1)). 5. Generic and Alternative Funding Resources The service coordinator will assist the client or authorized representative in seeking out all available financial resources to fund therapy services. For children served in the Early Start program, review of available public or private resources should not delay delivery of services specified in the IFSP (17 CCR 52109(b)). These resources may include but are not limited to: 22

23 a. Governmental programs such as school districts, Adoption Assistance Program funds and county mental health (Welfare and Institutions Code 4659(a)(1) and 4648(a)(8)). b. Private resources may include legal settlements (to the maximum extent they are liable for the cost of services), trust funds, health insurance and aid from philanthropic agencies. c. Effective July 1, 2009, notwithstanding any other provision of law or regulation to the contrary, regional centers shall not purchase any service that would otherwise be available from Medi-Cal, Medicare, the Civilian Health and Medical Program for Uniform Services, In-Home Support Services, California Children's Services, private insurance, or a health care service plan when a client or a family meets the criteria of this coverage but chooses not to pursue that coverage (Welfare and Institutions Code 4659(c)). For children, CVRC may consider funding insurance co-pays and deductibles (Welfare and Institutions Code 4648(a)(8) and 4659(a)(2) and 34 CFR (b)(3)(I)). 6. Amount of Service a. CVRC may purchase behavior intervention services as recommended by a qualified professional in that particular discipline, taking into account the availability of services through other sources. b. Behavior intervention services are generally approved in increments of three or six months. Effectiveness of the services must be reviewed prior to approving additional funding (Welfare and Institutions Code (a)(6)). 7. Evaluation of Service Effectiveness a. The service coordinator will maintain periodic contact with the client or authorized representative to assure that planned services are being provided (Welfare and Institutions Code (a)(6) and 17 CCR 52104). b. In considering continued funding of behavior intervention services, it must be shown at each reporting interval, at a minimum of every six months, that reasonable progress towards objectives continues to be made and that additional intervention will further the client s likelihood of remaining in his or her preferred residential setting and enhance his/her ability to interact with others in meaningful ways (Welfare and Institutions Code 4648(a)(1) and (a)(7)). 23