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CDCAN State Capitol Update: Self-Determination Progrmam Funding Proposal Submitted to Fed. Gov’t


STATE CAPITOL UPDATE: “SELF DETERMINATION” PROGRAM TAKES MAJOR STEP FORWARD WITH FUNDING PROPOSAL SUBMITTED TO FEDERAL GOVERNMENT BY BROWN ADMINISTRATION

SACRAMENTO, CA [CDCAN LAST UPDATED 01/08/2015 – 09:00 AM] – A new program that is meant to give eligible persons with developmental disabilities in California more flexibility, control, and choices on their services and supports called “self determination” moved a major step forward toward implementation with the submission of a funding proposal to the federal government by the Brown Administration last week on December 31st.  The State law that authorizes the Self Determination Program requires approval of matching federal funds in order to be implemented in California.   

While the submission of the proposal to the federal government is a significant step, the normal review process could take several months or even longer before expected approval is given by the federal government and actual implementation of the program can begin in the State.  

Advocates and policymakers in the Legislature meanwhile have applauded the work of the Department of Developmental Services in bringing together stakeholders that resulted in the final proposal submitted, though some have raised concerns about the need for next steps to prepare the State for eventual full scale implementation once federal approval of the proposal is given.   

The voluntary new program, which would be initially limited to a Statewide total of 2,500 eligible persons with developmental disabilities phased in over three years (from the date of actual implementation) in all 21 regional centers, was authorized in legislation – SB 468 by Senator Bill Emmerson (Republican – Riverside, 23rd State Senate District),  – that Governor Brown signed into law on October 9, 2013 (see below for links to the bill as signed into law).

The Department of Developmental Services, the state agency that oversees the funding of services and supports to over 250,000 eligible children and adults with developmental disabilities that is coordinated through the 21 non-profit regional centers who in turn contract with local community-based organizations and individuals to provide those services, said last week that a copy of the proposal would be posted soon on the department’s webpage at: http://www.dds.ca.gov/sdp/SDPUpdates.cfm<http://cdcan.us4.list-manage.com/track/click?u=6d5ff1c64c58f56239b63cf14&id=a8be95347a&e=bb1b2a9da5>  [CDCAN will send out notice when the proposal sent to the federal government is posted on the department website and also when it is posted on the federal government website for public comment]  

The department, under director Santi Rogers, acknowledged the “significant efforts” of a stakeholder advisory group that helped to craft the proposal during the past year in numerous meetings and phone conferences.  The first meeting of that stakeholder advisory group was convened a year ago November 2013 by department director Terri Delgadillo just before her retirement from state service in December and continued in regular meetings after that headed by Nancy Bargmann, deputy director of community services, Jim Knight and other senior department officials.  That first meeting last year was also attended briefly by former Senator Bill Emmerson (Republican – Riverside, 23rd State Senate District), who authored the Self Determination Program legislation that became law.

The proposal was developed and submitted as a Medicaid Home and Community Based Services waiver application to the federal Centers on Medicare and Medicaid Services (CMS), the federal agency that oversees nationwide the Medicare and Medicaid programs. In California the Medicaid funded programs are called “Medi-Cal”.  A “waiver” granted by the federal government to a state authorizes that state to implement and test out new or innovative ways to provide Medicaid funded service or program that normally under current federal Medicaid laws would not be allowed.  

The legislation was sponsored by the Autism Society of Los Angeles and Disability Rights California (DRC), who organized a major statewide conference November 7-8, 2014 in Los Angeles to help kick off the implementation of the Self Determination Program that drew over 400 people with developmental din Los Angeles sabilities and family members from across the State including senior officials from the Brown Administration and representatives and executive directors of several regional centers and advocacy organizations.

ORIGINAL SELF DETERMINATION PILOT PROGRAM STARTED IN 1999 STILL CONTINUES

A previous self determination pilot program, funded only with state dollars, was authorized in 1998 by SB 1038 (Chapter 1043, Statutes of 1998) authored by then Senator Mike Thompson (Democrat – Eureka) that implemented in 1999 a three year pilot in five regional centers with about 200 persons with developmental disabilities.  That pilot program – which is significantly different from the Self Determination Program proposal submitted December 31, 2014 to the federal government - continues today and has largely been considered a success by those who participated in the program.  Over the coming months, the Department of Developmental Services will finalize and announce the process for those remaining participants in the original 1999 pilot program in transitioning to the new Self Determination Program, assuming approval of the proposal for funding by the federal government.

A different model of self determination proposed by the Schwarzenegger Administration, called “Self Directed Services” was authorized as part of the 2005-2006 State Budget (in a budget trailer bill, AB 131, Chapter 80, Statutes of 2005) though was never implemented in the State.  The proposal was considered controversial by many advocates who viewed that version of self determination as largely a cost savings measure to reduce access to services that included too many restrictions and barriers. Other advocates supported that proposal believing it was a reasonable first step in the right direction. While a proposal for Medicaid funding was eventually submitted, no further action was taken on it either by the federal government or by the State and is considered “dead”.

NEXT STEPS   

FEDERAL REVIEW OF APPLICATION: The federal Centers on Medicare and Medicaid Services (CMS) has 90 days from the date the application (or proposal) was submitted to review the application and take one of three actions: approve; deny; or request additional information. It is likely the Centers on Medicare and Medicaid Services (CMS) will request additional information to clarify information in the application – something that happens to virtually every proposal and application submitted to the agency - that in turn extends the review period.  The actual proposal submitted from California will be posted not only on the Department of Developmental Services website, but also on a specific webpage of the Centers on Medicare and Medicaid Services that will include the status of the application and ways to make public comments directly to the federal Centers on Medicare and Medicaid Services (CMS) on the proposal.  [CDCAN will send out the link to this page once the application is posted – as of January 8, 2015 neither site has yet posted the proposal]

ENROLLMENT:  No enrollment into the new Self Determination Program can happen until approval of federal funding is obtained, which in turn would trigger the official implementation of the program.  The Department of Developmental Services – with stakeholder advisory group members and others – has been working to develop and finalize the process of enrollment into the program, including what steps regional centers and individuals and families need to take toward enrollment. 

TRAINING AND OUTREACH: The Department of Developmental Services said last week that while review of the proposal submitted to the federal government is underway, work will continue on the development of training and informational materials regarding the Self Determination Program.

SB 468 BY FORMER SENATOR EMMERSON WAS SIGNED INTO LAW LAST YEAR AUTHORIZING THE PROGRAM   

The Self Determination Program was authorized in legislation, SB 468, authored by former Senator Bill Emmerson (Republican – Riverside, 23rd State Senate District), who resigned from the State Senate last December 1, 2013 because of “my passion has waned” to continue service in the Legislature.  The bill was passed on September 11, 2013 by the Assembly by a vote of 78 to 0 and the State Senate by a vote of 39 to 0. Governor Brown signed the measure into law on October 9, 2013 (Chapter 683, Statutes of 2013).
    For PDF Document copy (14 pages) of the bill as signed into law:
    http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0451-0500/sb_468_bill_20131009_chaptered.pdf<http://cdcan.us4.list-manage.com/track/click?u=6d5ff1c64c58f56239b63cf14&id=99b6e8fb6d&e=bb1b2a9da5>
    For HTML version of the bill as signed into law:
    http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0451-0500/sb_468_bill_20131009_chaptered.htm<http://cdcan.us4.list-manage.com/track/click?u=6d5ff1c64c58f56239b63cf14&id=9e983db48e&e=bb1b2a9da5>

FREQUENTLY ASKED QUESTIONS AND ANSWERS

The following are questions and answers from the Department of Developmental Services webpage regarding the self determination program (CDCAN made certain minor edits to define abbreviations used):

Q: What is the Self Determination Program?
A: As authorized in Welfare and Institutions Code, Section 4685.8, "the Self Determination Program (SDP) is a voluntary delivery system consisting of a mix of services and supports, selected and directed by a participant through person-centered planning, in order to meet the objectives in his or her Individual Program Plan (IPP). Self-determination services and supports are designed to assist the participant to achieve personally defined outcomes in community settings that promote inclusion."

Q: When does the Self Determination Program (SDP) start?
A: The program will start once it is approved for federal funding. The Department of Developmental Services is working with stakeholders to draft a Medicaid Home and Community-Based Services Waiver application that will be submitted for approval to the Centers for Medicare and Medicaid Services no later than December 31, 2014. Upon approval of the Waiver application, the Self Determination Program (SDP) will be implemented for up to 2,500 participants during the first three years. After this three year phase-in period, the program will be available to all consumers.

Q: How can I keep updated on the progress of the Self Determination Program (SDP)?
A: Updates will be posted as they become available on the Self Determination website. If you want to be notified when updates are made, email sdp@dds.ca.gov<mailto:sdp@dds.ca.gov> and ask to be included on the update notification list.

Q: Who is eligible for the Self Determination Program (SDP)?
A. An individual must meet the following eligibility requirements:
- Has a developmental disability and currently receives services from a regional center or is a new consumer of a regional center;
- Agrees to specific terms and conditions, which include but are not limited to, participation in an orientation to Self Determination Program (SDP), working with a “Financial Management Services” (FMS) entity, and managing Self Determination Program (SDP) services within an individual budget amount.
- An individual who lives in a licensed long-term health care facility (i.e., a Skilled Nursing Facility, Intermediate Care Facility) is not eligible to participate in the Self Determination Program (SDP). If someone lives in one of these facilities and is interested in the Self Determination Program (SDP), he or she can request that the regional center provide person-centered planning services in order to make arrangements for transition to the Self Determination Program (SDP), provided that he or she is reasonably expected to transition to the community within 90 days.

Q: What if participants are happy with their current service delivery program and do not wish to enroll in the Self Determination Program (SDP)?
A: Enrollment in the Self Determination Program (SDP) is completely voluntary. Just like any other program offered under the Lanterman Developmental Disabilities Services Act in California, an individual chooses what is best for him or her. An individual may choose to participate in, and may choose to leave, the Self Determination Program (SDP) at any time.

Q: How much responsibility will participants or their family have if they choose to participate in the Self Determination Program (SDP)?
A: The participant will need to develop a person-centered plan and select individuals or members from their planning team to help implement the plan. The participant will also need to choose a Financial Management Services (FMS) entity that will work with him or her to monitor their individual budget.

Q: What are Financial Management Services (FMS)?
A: Financial Management Services (FMS) assist the participant to manage and direct the funds contained in the individual budget, and ensure that the participant can implement his or her Individual Program Plan (IPP) throughout the year. Financial Management Services (FMS) may include bill paying services and activities that facilitate the hiring of support workers for the participant.

Q: What is an individual budget?
A:  It is the amount of money a Self Determination Program (SDP) participant has available to purchase needed services and supports.

Q: How does the individual budget amount get determined?
A: The individual budget is determined by the Individual Program Plan (IPP) team, and is based upon the amount of purchase of service (POS) funds used by the individual in the most recent 12-months. This amount can be adjusted, up or down, if the Individual Program Plan (IPP) team determines that the individual's needs, circumstances, or resources has changed. Additionally, the IPP team may adjust the budget to support any prior needs or resources that were not addressed in the Individual Program Plan (IPP).

Q:  How does the individual budget amount get determined for an individual, who is either new to the regional center, or does not have a 12-month history of Purchase of Service (POS) costs?
A:  For these individuals, the individual budget amount is determined by the Individual Program Plan (IPP) team, and is based upon the average Purchase of Service (POS) cost of services and supports, paid by the regional center, that are identified in the individual's Individual Program Plan (IPP). The average cost may be adjusted, up or down, by the regional center, if needed to meet the individual's unique needs.

Q:  Are there restrictions on what the individual budget can be used for?
A:  Yes, a participant can only purchase services and supports as described in the Self Determination Program (SDP) [Medicaid Home and Community Based Services] Waiver and in the Individual Program Plan (IPP). Services funded through other sources (e.g., Medi-Cal, schools) cannot be purchased with Self Determination Program (SDP) funds.

Q:  If I choose to participate in the Self Determination Program (SDP), will I still have the same rights?
A:  Yes, participants enrolled in the Self Determination Program (SDP) will have the same rights established under the traditional service model (e.g. appeals, eligibility determinations, all rights associated with the Individual Program Plan (IPP) process).

Q:  How can someone learn more about the Self Determination Program (SDP)?
A:  Interested participants, families, or others are encouraged to visit the Self Determination website (at www.dds.ca.gov/sdp<http://cdcan.us4.list-manage.com/track/click?u=6d5ff1c64c58f56239b63cf14&id=1c2ab4f427&e=bb1b2a9da5> ) to find out more information about the Self Determination Program (SDP). The site will be updated as more information is available.

Q:  Can I enroll in Self Determination now?
A:  The process for selecting and enrolling the 2,500 participants in the first three years has not been finalized. However, you can email (the Department of Developmental Services) sdp@dds.ca.gov<mailto:sdp@dds.ca.gov> to express your interest in the program and you'll receive notice of website updates on the progress of the Self Determination Program (SDP), including the enrollment process. Please include your name and/or the name of the person interested in enrollment and the regional center you are with in the email.

FOR MORE INFORMATION ABOUT SELF DETERMINATION PROGRAM
    DEPARTMENT OF DEVELOPMENTAL SERVICES:
    SELF DETERMINATION PROGRAM MAIN PAGE (INCLUDING WELCOME FROM DIRECTOR SANTI ROGERS):
    http://www.dds.ca.gov/sdp/index.cfm<http://cdcan.us4.list-manage.com/track/click?u=6d5ff1c64c58f56239b63cf14&id=167e3666bb&e=bb1b2a9da5>
    IMPLEMENTATION UPDATES:
    http://www.dds.ca.gov/sdp/SDPUpdates.cfm<http://cdcan.us4.list-manage.com/track/click?u=6d5ff1c64c58f56239b63cf14&id=8e0b14401d&e=bb1b2a9da5>
    FREQUENTLY ASKED QUESTIONS (Note: this was reproduced in full above):
    http://www.dds.ca.gov/sdp/SDPFAQ.cfm<http://cdcan.us4.list-manage.com/track/click?u=6d5ff1c64c58f56239b63cf14&id=5fec876536&e=bb1b2a9da5>

CDCAN - MARTY OMOTO YOUTUBE CHANNEL
    A CDCAN (Marty Omoto) youtube channel was set up and has several videos dealing with current – and previous state budget issues, disability and senior rights, and advocacy.
    To see the current videos, including March 2014 San Andreas Regional Center Aptos Legislative Breakfast, January 2014 panel discussion on services for adults with autism spectrum and related disorders in Palo Alto, and older videos including video of April 2003 march of over 3,000 people with developmental disabilities, families, providers, regional centers and others from the Sacramento Convention Center to the State Capitol (to attend and testify at budget hearing on proposed massive permanent cuts to regional center funded services, go to the CDCAN (Marty Omoto) Channel at: https://www.youtube.com/channel/UCEySEyhnr9LQRiCe-F7ELhg<http://cdcan.us4.list-manage.com/track/click?u=6d5ff1c64c58f56239b63cf14&id=8ef6ffcb79&e=bb1b2a9da5>
    More videos – including new current videos (an interview with longtime advocate Maggie Dee Dowling is planned, among others) – plus archive videos of past events – will be posted soon.

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CDCAN Reports go out to over 65,000 people with disabilities, mental health needs, seniors, people with traumatic brain and other injuries, people with MS, Alzheimer's and other disorders, veterans with disabilities and mental health needs, families, workers, community organizations, facilities and advocacy groups including those in the Asian/Pacific Islander, Latino, American Indian, Indian, African-American communities; policymakers, and others across the State.
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