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Legislative Hearing Updates from ARCA


On December 1, there were two legislative informational hearings that are relevant to the work that regional centers do. Following is a summary by Amy Westling, Director of Policy, Association of Regional Center Agencies.

First, there was a hearing on the MCO tax in Los Angeles, which covered, by and large, familiar territory and information. Sen. Hernandez (chair) welcomed all participants and attendees. He noted with disappointment that the Department of Finance declined the conference committee’s invitation. He had been particularly interested in hearing from them why the tax is needed in light of the new funds recently reported by the Legislative Analyst’s Office (LAO).

Asm. Bonta and Sen. Mitchell were also in attendance.

  *  Felix Su (LAO) provided an overview of the various tax options and background.
  *  Mari Cantwell, DHCS, reviewed the Administration’s tiered tax plan, including the original from January and the updated version presented (and broadly publicized) in September.
  *  Nick Louizos, California Association of Health Plans, presented the perspective of the health plans, which continue to prioritize a limited, non-disruptive tax (if any). They remain concerned with the various tax proposals for various reasons. Additional CAHP priorities include a sunset on the tax, an automatic end to the tax if disallowed by the federal government, legislative reporting requirements, a revenue ceiling ($1.1 billion, to backfill or improve Medi-Cal programs only), and prevent any future tax changes (increases) without legislative authorization. Program improvements, he said, could include Medi-Cal provider rate increases.

As a note of inside ball, Sen. Mitchell asked whether or not the special session would continue beyond September 2016 when the Legislature adjourns. Sen. Hernandez responded by saying “it’ll go on beyond that, I believe.”

Public comment, running just under 45 minutes, was also taken. Speakers included a range of interests, including IHSS and independent living centers. A significant proportion of testimony came from the DD community, including self-advocates and service providers. Additionally, Melinda Sullivan (Executive Director, Lanterman Regional Center) spoke to the importance of ensuring that funding reform is included in any final package.

The Los Angeles Times covered the event, and an article has been published online.

Second, in Sacramento there was an informational hearing on services for children with special needs attended by Senator Richard Pan of Sacramento. It was comprised of a number of panels that focused on various facets of specialty care for children.

Senator Richard Pan, M.D.

  *  The Committee is concerned regarding the silos of care for children with special needs.
Dr. Edward Schor, Lucile Packard Foundation for Children’s Health

  *  Provided an overview of the systems of care that serve children with special needs.
Wendy Longwell, Family Voices of California

  *  Expressed concern regarding son transitioning out of CCS, which has been very helpful in coordinating personalized care.
  *  Explained the importance of parent-to-parent support to navigate the network of complex systems that are needed to meet the needs of each child.
Jennifer Kent, Director, DHCS

  *  Developmentally disabled children average costs in the Medi-Cal program of $1,700 per month, compared to $240 for all children.
  *  The Affordable Care Act allows for 90% federal matching for health homes. A draft plan to implement this will be released by DHCS soon.
  *  It is incumbent on agencies to better coordinate services so that care appears more seamless to families.
Barbara Sheehy, Contra Costa Administrator, California Children’s Services (2002-2015)

  *  CCS ensures that children are seen by highly qualified specialists to treat their specialized conditions.
  *  Some counties have specific programs to aid in the transition of youth from CCS to adult care.
  *  The Medical Therapy Units provide direct evidence-based therapies.
  *  Current challenges include fragmentation of care, low provider rates, and the potential for the loss of specialized care in the CCS transition to Medi-Cal Managed Care.
  *  Funding for kids without full-scope Medi-Cal is split between counties and the state.
Dr. Richard Chinnock, Board President, Children’s Specialty Care Coalition
·        Pediatric subspecialty care must be provided in care centers to prevent burn-out of individual practitioners.
·        Current challenges include the need for more rational data, better transitions from CCS to adult services, better reimbursement rates, mental and physical health coordination, better coordination of primary and subspecialty care, and creating medical homes.
·        The CCS transition should proceed cautiously and retain what is working well.
Carol Gallegos , Deputy Director, California Department of Health Care Services’ Office of Legislative and Governmental Affairs

  *  Counties determine how available funding is spent to best meet local needs.
  *  Mental health agencies coordinate with other entities to meet the needs of dually served children.
  *  More work is being done on the development of a data dashboard to display information on performance outcomes for children with mental health needs.
Terry Rooney, Colusa County - Behavioral Health Director, County Behavioral Health Directors Association
·        Counties continue to provide mental health services for children because there are insufficient providers available to contract with Medi-Cal Managed Care plans.
·        Supporting children in less restrictive environments is a challenge.
Dr. Stewart Teal, Clinical Professor of Child Psychiatry, University of California at Davis, California Academy of Child and Adolescent Psychiatry

  *  Child psychiatry is a multi-disciplinary process.
  *  There needs to be a continuum of care in children’s mental health to prevent children from falling through the cracks.
  *  There needs to be a reliable way to share mental health information between counties, particularly for foster children.
Brian Winfield, Acting Deputy of Community Services, DDS

  *  Provided an overview of the regional center system, including the distinction between Early Start and Lanterman services and funding structures.
  *  DDS coordinates with other departments in the Interagency Coordination Collaborative and the BHT Medi-Cal transition.
  *  Purchase of Service dollars are distributed according to historical trend; sometimes funds must be redistributed between regional centers. Operations funding is determined largely by the number of individuals supported and staff members.
  *  No regional centers are meeting caseload ratios but centers are monitored in other ways as well.
Rick Rollens, Legislative Advisor, ARCA

  *  The function of ARCA in coordinating statewide efforts on behalf of regional centers.
  *  The role of the planning team and accessing of generic services.
  *  The limitation and subsequent restoration of the Early Start Program.
  *  The largest current challenge is severe underfunding that must be addressed through stabilization and funding reform.
Chris Drouin, Associate Director, California Department of Education Special Education Division

  *  There are 133 SELPAs and 1,700 local education agencies.
  *  $4.46 billion annually for special education services, which supplement general education funds for students.
  *  CDE is working with DDS and DOR on the blueprint for employment of youth with developmental disabilities.
  *  The potential for single assessments and planning processes for multi-agency children.
Becky Bryant, Director III, Sacramento City Unified School District

  *  Districts are funding a larger portion of special education services out of their general budget.
  *  School districts would like to be able to bill a greater number of services to EPSDT.
  *  A current challenge is implementation of the Common Core.
  *  Sacramento City Unified has had good experiences working with ACRC in jointly children with autism.
Bob Hamilton, President, California Association of Resource Specialists

  *  General education teachers and administrators are increasingly responsible for the education of children with special needs. They need additional training to meet the specialized needs of these children.
  *  There is sometimes a disconnect between schools and other agencies, including the scheduling of meetings.
  *  There are not enough credentialed special education teachers to meet the current demand.
School nurse from Tehama County

  *  Districts are not required to have school nurses and oftentimes have to fund this out of their general funds.
  *  CCS dependent counties have particular challenges with accessing services and sometimes extended delays for services.
  *  Question from Senator Pan regarding opportunities to leverage funds to pay for more school nursing.
Senator Richard Pan, M.D.

  *  The Committee will be looking at compiling data on children with special needs.
  *  The Committee will plan to find ways to leverage additional dollars and plans to continue its work for a couple of years.
Public Comment

  *  Part C funding efficiencies could be found by doing midlevel assessments rather than full diagnostics.
  *  The need for Medi-Cal to follow federal mental health parity expectations.
  *  Previous studies have been done on these topics and may be informative.

The next Special Session (informational) hearing will be held on Thursday, December 17 (ftp://www.leginfo.ca.gov/pub/dailyfile/sen/senate_Committee_Hearings_Recess.pdf#page=22), in Oakland. ARCA will provide additional updates as the hearing draws closer. The Senate Select Hearing on Children with Special Needs has not yet scheduled its next hearing, but ARCA will continue to monitor this and provide updates as they become available.