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<ns0:Id>20250AB__241499INT</ns0:Id>
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<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2026-02-20</ns0:ActionDate>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Nguyen</ns0:AuthorText>
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<ns0:Name>Nguyen</ns0:Name>
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<ns0:Title> An act to amend Sections 4474.17, 4511.5, 4512, 4519.10, and 4641.1 of the Welfare and Institutions Code, relating to developmental services. </ns0:Title>
<ns0:RelatingClause>developmental services</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Developmental services: direct support professionals.</ns0:Subject>
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<html:p>Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services to contract with regional centers for the provision of community services and supports for persons with developmental disabilities and their families. Existing law finds and declares that direct service professionals are critical to the provision of services and supports to individuals with intellectual and developmental disabilities and their families. Existing law requires the department to develop or utilize existing curriculum to implement enhanced direct service professional training that promotes services that are person centered and culturally and linguistically sensitive, and that improve outcomes for individuals with intellectual and developmental disabilities.</html:p>
<html:p>This bill would change the title of direct service
professionals to instead be direct support professionals, and would define that latter term as an individual who receives compensation to provide direct support to children or adults with intellectual and developmental disabilities, is employed by a service provider receiving regional center funding, and spends at least 50% of their working time completing direct support tasks, as specified. The bill would require the department to, on or before April 1, 2027, and subject to an appropriation of funds for this purpose in the annual Budget Act, develop the billing guidance necessary to facilitate a pay differential associated with the above-described training. The bill would also make various technical, conforming changes.</html:p>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
<ns0:BillSection id="id_59E2E977-3AA6-4A8D-A114-C8CB296EFF8D">
<ns0:Num>SECTION 1.</ns0:Num>
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Section 4474.17 of the
<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
is amended to read:
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<ns0:Num>4474.17.</ns0:Num>
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<html:p>
(a)
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The Legislature finds and declares all of the following:
</html:p>
<html:p>
(1)
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The Supplemental Report of the 2014–15 Budget Package required the State Department of Developmental Services to provide quarterly briefings to update legislative staff about the closures of developmental centers. Chapter 18 of the Statutes of 2017 expanded the scope of these briefings to include information about the development of community-based crisis services following the developmental center closures. The quarterly briefings have evolved to provide detailed information about the development of the community-based safety net, including information about the physical homes and wrap-around and mobile crisis services intended to prevent, deescalate, and treat consumers in crisis.
</html:p>
<html:p>
(2)
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The quarterly briefings have provided a valuable opportunity for the department and legislative staff to convene and discuss key issues during the developmental center closure process. They have kept legislative staff, and consequently Members of the Legislature, informed about the department’s progress, challenges, and strategies as it transitioned consumers from a developmental center or an institution into the community and developed a community-based safety net.
</html:p>
<html:p>
(3)
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The imminent final closure of the developmental centers provides an opportunity to consider the ongoing purpose of the quarterly briefings. Once the final developmental center closures are complete, the quarterly briefings can provide an avenue for the department and legislative staff to maintain an important ongoing dialogue about key issues facing the developmental services system. The quarterly briefings will
allow the department to keep legislative staff informed about its approach to, and progress in, handling various changes in policy and modes of service delivery. This will be especially important as the consumer population continues to grow and change and as the system continues to move toward consumer choice and community integration. The disposition of the developmental center properties may continue to be a point of inquiry until that subject comes to a conclusion.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
An important feature of the current briefings has been the department’s willingness to adapt the content over time based on feedback from legislative staff. Mindful of the fact that preparing materials and presentations for these briefings requires department staff resources, the ongoing nature of the quarterly briefings should also remain flexible to both meet the needs of the Legislature and the department’s capacity to prepare for the briefings. Through the briefing
discussions themselves, department leadership and legislative staff should come to an agreement about what data and information should be tracked and provided regularly at each briefing, based on what is feasible for the department to provide and considering the priorities of the Legislature. In addition, the department and legislative staff can regularly discuss the range of issues and level of detail that should be provided at briefings, recognizing that every issue cannot be covered at every briefing and that the relative importance of individual issues will shift over time.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
As the quarterly briefings related to the developmental center closures wind down in the 2019–20 fiscal year, the department and legislative staff could use some of the time in those meetings to discuss and determine the content of the subsequent quarterly briefings. Appreciating that the priorities of the Legislature shift over time, and depending on the
department’s capacity, the particular topics and level of detail provided in the briefings can be discussed and revisited on a regular basis, such as annually.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Commencing with the first planned quarterly briefing after January 1, 2020, the department shall provide information on topics at quarterly briefings with legislative staff of the appropriate policy and fiscal committees of the Legislature addressing some or all of the following, pursuant to the planning discussion described in paragraph (5) of subdivision (a):
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Consumer health and safety, including safety net and crisis services.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The person-centered approach to planning, coordinating, delivering, and receiving services, including caseload ratio updates, compliance with home- and community-based services rules, competitive integrated employment, and
housing supports.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Quality outcomes for consumers.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Efforts to identify and reduce disparities in regional center services.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
Community development through community placement plans and community resource development plans, by regional center, and difficulties or issues in the provision of services or development of resources.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
Implementation of any rate changes pending and being implemented.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
Status, efforts, and outcomes related to the department headquarter’s reorganization structure.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
Regional center accountability, transparency, and oversight efforts.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
Status on the development of Group Homes for Children with Special Health Care Needs, including information on how the needs of regional center consumers are assessed when developing new homes.
</html:p>
<html:p>
(10)
<html:span class="EnSpace"/>
Status on the implementation of the provisional eligibility requirement of paragraph (2) of subdivision (a) of Section 4512.
</html:p>
<html:p>
(11)
<html:span class="EnSpace"/>
Information pursuant to the provisions of subdivision (d) of Section 7505.
</html:p>
<html:p>
(12)
<html:span class="EnSpace"/>
Status on the development of a training curriculum for direct
support professionals, pursuant to Section 4511.5.
</html:p>
<html:p>
(13)
<html:span class="EnSpace"/>
Most recent data regarding average per capita purchase of service expenditures for all age groups, by ethnicity and other factors, in addition to any other data that will aid in the illustration of progress, toward the active closure of racial, ethnic, and other disparities.
</html:p>
<html:p>
(14)
<html:span class="EnSpace"/>
On an annual basis, status of the department’s efforts to improve oversight of special incidents, as described in subdivision (b) of Section 54327 of Title 17 of the California Code of Regulations, and respond to special incident trends. This annual status update shall include a summary of the most recent annual report regarding special incidents involving individuals with developmental disabilities served by regional centers.
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<ns0:Num>SEC. 2.</ns0:Num>
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Section 4511.5 of the
<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
is amended to read:
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<ns0:Num>4511.5.</ns0:Num>
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<html:p>
(a)
<html:span class="EnSpace"/>
The Legislature finds and declares both of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Direct support professionals are critical to the provision of services and supports to individuals with intellectual and developmental disabilities.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
In recognition of the value of the services provided by direct support professionals,
additional training and development will enhance the services they provide and foster a more sustainable workforce.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
With input from stakeholders pursuant to subdivision (c), the department shall develop or utilize existing curriculum to implement enhanced direct support professional training that promotes services that are person centered and culturally and linguistically sensitive, and that improve outcomes for individuals with intellectual and developmental disabilities.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
It is the intent of the Legislature to enhance the quality of services that consumers receive from their direct
support professionals, including, but not limited to, improving direct support professional knowledge about general health and safety issues, employing principles of self-determination in order to promote dignity of the recipient and the provider, and working to improve quality of services and quality of life, including advancing health equity for consumers of regional center services.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The training described in paragraph (1) in shall include, but is not limited to, all of the following elements:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Competency based.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Tiered training and certification.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Continuing education.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Outcome measures, as defined by the department, with input from stakeholders pursuant to subdivision (c).
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
The department shall consult with stakeholders throughout the implementation of this section. This consultation shall include facilitation of a process for providing input and comments on implementation.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Stakeholders may include, but are not limited to, the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Consumers and families across different geographic regions of the state and from diverse racial and ethnic backgrounds, diverse consumer age groups and disabilities.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Regional center
representatives.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Service providers representing a diverse range of service types and models.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
On or before April 1, 2027, the department shall develop the billing guidance necessary to facilitate a pay differential associated with the training established in this section.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Any proposed or active pay differential associated with training established in this section shall be included in the rate model review required pursuant to Section 4519.11.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
Implementation of this section is subject to an appropriation of funds for this purpose in the annual Budget Act.
</html:p>
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<ns0:Num>SEC. 3.</ns0:Num>
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Section 4512 of the
<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
is amended to read:
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<ns0:Num>4512.</ns0:Num>
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<html:p>As used in this division:</html:p>
<html:p>
(a)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
“Developmental disability” means a disability that originates before an individual attains 18 years of age, continues, or can be expected to continue, indefinitely, and constitutes a substantial disability for that individual. As defined by the Director of Developmental Services, in consultation with the Superintendent of Public Instruction, this term shall include intellectual disability, cerebral palsy, epilepsy, and autism. This term shall also include disabling conditions found to be closely related to intellectual disability or to require treatment similar to that required for individuals with an intellectual disability, but shall not include other handicapping conditions that are solely physical in nature.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
A child who is under five years of age shall be provisionally eligible for regional center services if the child has a disability that is not solely physical in nature and has significant functional limitations in at least two of the following areas of major life activity, as determined by a regional center and as appropriate to the age of the child:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
Self-care.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
Receptive and expressive language.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
Learning.
</html:p>
<html:p>
(iv)
<html:span class="EnSpace"/>
Mobility.
</html:p>
<html:p>
(v)
<html:span class="EnSpace"/>
Self-direction.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
To be provisionally eligible, a child is not required to have one of the
developmental disabilities listed in paragraph (1).
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
An infant or toddler referred for early intervention services from the regional center pursuant to the California Early Intervention Services Act (Title 14 (commencing with Section 95000) of the Government Code) may be concurrently assessed, if appropriate, to determine whether the infant or toddler is provisionally eligible for regional center services under paragraph (2) or eligible for regional center services under paragraph (1).
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
If the regional center determines that the infant or toddler qualifies for early intervention services from the regional center pursuant to the California Early Intervention Services Act (Title 14 (commencing with Section 95000) of the Government Code) but has not been found to have a developmental disability as defined in paragraph (1) or to be provisionally
eligible as defined in paragraph (2), the regional center shall assess the child at least 90 days prior to the date that they turn three years of age for purposes of determining their eligibility for regional center services under this section. If the regional center determines the child is not eligible, the regional center shall give adequate notice pursuant to Section 4701.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
A child who is provisionally eligible pursuant to paragraph (2) shall be reassessed at least 90 days before turning five years of age. The child shall meet the definition set forth in paragraph (1) to continue to be eligible for regional center services at five years of age.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
Regional center services for a child who was provisionally eligible pursuant to paragraph (2) and who does not meet the definition in paragraph (1) shall end when the child is five years of age unless an appeal was filed pursuant
to Section 4715.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
“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 maintenance of an independent, productive, and normal life. The determination of which services and supports are necessary for each consumer shall be made through the individual program plan process. The determination shall be made on the basis of the needs and preferences of the consumer or, when appropriate, the consumer’s family, and shall include consideration of a range of service options proposed by individual program plan participants, the effectiveness of each option in meeting the goals stated in the individual program plan, and
the cost-effectiveness of each option. Services and supports listed in the individual program plan may include, but are not limited to, diagnosis, evaluation, treatment, personal care, daycare, domiciliary care, special living arrangements, physical, occupational, and speech therapy, training, education, supported and sheltered employment, mental health services, recreation, counseling of the individual with a developmental disability and of the individual’s family, protective and other social and sociolegal services, information and referral services, follow-along services, adaptive equipment and supplies, advocacy assistance, including self-advocacy training, facilitation and peer advocates, assessment, assistance in locating a home, childcare, behavior training and behavior modification programs, camping, community integration services, community support, daily living skills training, emergency and crisis intervention, facilitating circles of support, habilitation, homemaker services, infant stimulation
programs, paid roommates, paid neighbors, respite, short-term out-of-home care, social skills training, specialized medical and dental care, telehealth services and supports, as described in Section 2290.5 of the Business and Professions Code, supported living arrangements, technical and financial assistance, travel training, training for parents of children with developmental disabilities, training for parents with developmental disabilities, vouchers, and transportation services necessary to ensure delivery of services to persons with developmental disabilities. This subdivision does not expand or authorize a new or different service or support for any consumer unless that service or support is contained in the consumer’s individual program plan.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Notwithstanding subdivisions (a) and (b), for any organization or agency receiving federal financial participation under the federal Developmental Disabilities Assistance and Bill of Rights Act
of 2000, Chapter 144 (commencing with Section 15001) of Title 42 of the United States Code, as amended, “developmental disability” and “services for persons with developmental disabilities” mean the terms as defined in the federal act to the extent required by federal law.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
“Consumer” means a person who has a disability that meets the definition of developmental disability set forth in subdivision (a).
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
“Natural supports” means personal associations and relationships typically developed in the community that enhance the quality and security of life for people, including, but not limited to, family relationships, friendships reflecting the diversity of the neighborhood and the community, associations with fellow students or employees in regular classrooms and workplaces, and associations developed through participation in clubs, organizations, and other civic activities.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
“Circle of support” means a committed group of community members, who may include family members, meeting regularly with an individual with developmental disabilities in order to share experiences, promote autonomy and community involvement, and assist the individual in establishing and maintaining natural supports. A circle of support generally includes a plurality of members who neither provide nor receive services or supports for persons with developmental disabilities and who do not receive payment for participation in the circle of support.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
“Facilitation” means the use of modified or adapted materials, special instructions, equipment, or personal assistance by an individual, such as assistance with communications, that will enable a consumer to understand and participate to the maximum extent possible in the decisions and choices that affect the individual’s life.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
“Family support services” means services and supports that are provided to a child with developmental disabilities or the child’s family and that contribute to the ability of the family to reside together.
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
“Voucher” means any authorized alternative form of service delivery in which the consumer or family member is provided with a payment, coupon, chit, or other form of authorization that enables the consumer or family member to choose a particular service provider.
</html:p>
<html:p>
(j)
<html:span class="EnSpace"/>
“Planning team” means the individual with developmental disabilities, the parents or legally appointed guardian of a minor consumer or the legally appointed conservator of an adult consumer, the authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, one or more regional center representatives, including
the designated regional center service coordinator pursuant to subdivision (b) of Section 4640.7, any individual, including a service provider, invited by the consumer, the parents or legally appointed guardian of a minor consumer or the legally appointed conservator of an adult consumer, or the authorized representative, including those appointed pursuant to subdivision (a) of Section 4541, and including a minor’s, dependent’s, or ward’s court-appointed developmental services decisionmaker appointed pursuant to Section 319, 361, or 726.
</html:p>
<html:p>
(k)
<html:span class="EnSpace"/>
“Stakeholder organizations” means statewide organizations representing the interests of consumers, family members, service providers, and statewide advocacy organizations.
</html:p>
<html:p>
(
<html:i>l</html:i>
)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
“Substantial disability” means the existence of significant functional limitations in three or more of the following areas of major life
activity, as determined by a regional center, and as appropriate to the age of the person:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Self-care.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Receptive and expressive language.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Learning.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Mobility.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
Self-direction.
</html:p>
<html:p>
(F)
<html:span class="EnSpace"/>
Capacity for independent living.
</html:p>
<html:p>
(G)
<html:span class="EnSpace"/>
Economic self-sufficiency.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A reassessment of substantial disability for purposes of continuing eligibility shall utilize the same criteria under which the individual was originally made eligible.
</html:p>
<html:p>
(m)
<html:span class="EnSpace"/>
“Native language” means the language normally used or the preferred language identified by the individual and, when appropriate, the individual’s parent, legal guardian or conservator, or authorized representative.
</html:p>
<html:p>
(n)
<html:span class="EnSpace"/>
“Authorized representative” means an individual appointed by the State Council on Developmental Disabilities pursuant to subdivision (a) of Section 4541 or who is an authorized representative, as defined in Section 4701.
</html:p>
<html:p>
(o)
<html:span class="EnSpace"/>
“Direct support professional” means an individual who receives compensation to provide direct support to children or adults with intellectual and developmental disabilities, is employed by a service provider receiving regional center funding, and spends at least 50 percent of their working time completing direct support tasks, including, but not
limited to, all of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Services that enhance independence and community inclusion.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Assisting with skill development, including personal and vocational coaching.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Providing assistance with activities of daily living.
</html:p>
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<ns0:BillSection id="id_84C0A884-1AE1-47FD-8317-CB6762BBEC4E">
<ns0:Num>SEC. 4.</ns0:Num>
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Section 4519.10 of the
<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
is amended to read:
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<ns0:Num>4519.10.</ns0:Num>
<ns0:LawSectionVersion id="id_A44354C2-0C95-4937-B113-685E4938854D">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
The Legislature finds and declares all of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The current service provider rate structure in the system administered by the State Department of Developmental Services lacks transparency, remains complex, is not tied to person-centered outcomes, and varies across providers who provide the same service in the same region.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
In 2016, the Legislature funded a rate study to address the sustainability, quality, and transparency of community-based services for individuals with developmental disabilities.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The department, with the help of a consultant, completed the rate study in 2019 and subsequently submitted the
study’s findings and recommendations to the Legislature. Among other things, the study recommended all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Within each service category, rate models that include components that may be regularly updated.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Regional differentials to account for regional variance in the cost of living and doing business.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Enhanced rates for services delivered in other languages, including American Sign Language.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
An optional add-on for direct support professional levels and wage differentials based on training and demonstrated competency.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
The consolidation of certain service codes.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
The rate study’s fiscal impact analysis indicated that full implementation of these rate models would cost an additional one billion one hundred million dollars ($1,100,000,000) from the General Fund, or one billion eight hundred million dollars ($1,800,000,000) of total funds, in the 2019–20 fiscal year.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The recommendations from the rate study and the associated rate models have not been implemented, even as rate study findings informed supplemental rate increases for many service categories in the 2019–20 fiscal year and three additional service categories in the 2020–21 fiscal year.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
For Medi-Cal eligible consumers, the department receives federal Medicaid reimbursements to support home- and
community-based services provided to those consumers.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
Direct support professionals employed by service providers are critical to the quality and provision of services and supports to individuals with intellectual and developmental disabilities.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
A prevailing need and challenge within the developmental services system is moving from a compliance-based system to an outcomes-based system. Outcome measures must reinforce the system’s core values of meeting individual needs based on person-centered planning. The implementation of rates, pursuant to this section, should support this person-centered transformation through consideration of incentive payments, alternative payment
models, alternative service delivery, lessons learned from the COVID-19 pandemic period, person-centered and culturally and linguistically sensitive and competent approaches, training of direct support professionals, compliance with the federal home- and community-based services rule set to take effect on March 17, 2023, and methods for assessing and reporting outcomes.
</html:p>
<html:p>
(9)
<html:span class="EnSpace"/>
To improve consumer outcomes and experiences and measure overall system performance, four goals should guide rate reform:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Consumer experience.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Equity.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Quality and
outcomes.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
System efficiencies.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Therefore, it is the intent of the Legislature to phase in funding and policies beginning in the 2021–22 fiscal year to implement rate reform, which shall include a quality incentive program, create an enhanced person-centered, outcomes-based system, and complete this transformation by July 1, 2025.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
Commencing April 1, 2022, the department shall implement a rate increase for service providers that equals one-quarter of the difference between current rates and the fully funded rate model for each provider.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Commencing January 1, 2023, and continuing through December 31, 2024, the department shall adjust rates to equal one-half of the difference between rates
in effect March 31, 2022, and the fully funded rate model for each provider, and additional funding shall be available for the quality incentive program described in subdivision (e).
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
Notwithstanding any other law or regulation, it is the intent of the Legislature that the majority of the rate increase described in this subparagraph for the 2022–23 fiscal year be used for the purpose of enhancing wages and benefits for staff who spend a minimum of 75 percent of their time providing direct services to consumers.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
Commencing January 1, 2023, a provider shall not spend a smaller percentage of the rate increase on direct care staff wages and benefit costs than the corresponding percentage included for direct care staff wages and benefit costs in the rate models for each specific service.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
A provider granted a
rate increase pursuant to this section shall maintain documentation, subject to audit by the department or regional center, that the portion of the rate increase identified in this subparagraph was used to increase wages, salaries, or benefits of eligible staff members spending a minimum of 75 percent of their time providing direct services to consumers at least at the same percentage as provided in the rate models.
</html:p>
<html:p>
(iv)
<html:span class="EnSpace"/>
For the purpose of this subparagraph, “direct services” are services, supports, care, supervision, or assistance provided by staff directly to a consumer to address the consumer’s needs, as identified in the individual program plan, and includes staff’s participation in training and other activities directly related to providing services to consumers, as well as program preparation functions as defined in Section 54302 of Title 17 of the California Code of Regulations.
</html:p>
<html:p>
(v)
<html:span class="EnSpace"/>
Commencing July 1, 2023, a vendor shall be in compliance with the home- and community-based final rule, effective March 17, 2014, or implementing a corrective action plan, to be eligible for the quality incentive program described in subdivision (e).
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
(i)
<html:span class="EnSpace"/>
Commencing January 1, 2025, the department shall implement the fully funded rate models. The fully funded rate models shall be implemented using two payment components, a base rate equaling 90 percent of the rate model, and a quality incentive payment, equaling up to 10 percent of the rate model, to be implemented through the quality incentive program described in subdivision (e).
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
Notwithstanding any other law, commencing July 1, 2024, the rate models shall be updated to account for the current and any subsequent changes to the statewide minimum wage, as established by Section
1182.12 of the Labor Code, or other relevant statute.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
Effective January 1, 2025, it is the intent of the Legislature that rates be uniform within service categories and adjusted for geographic cost differentials, including differentials in wages, the cost of travel, and the cost of real estate.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Providers who were not identified as requiring a rate increase in the rate study are not eligible for rate adjustments pursuant to paragraph (1).
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
Beginning in the 2021–22 fiscal year, the department shall implement a hold harmless policy for providers whose rates exceed rate model recommendations. The policy shall freeze a provider’s existing rates until February 28, 2026, after which time the provider’s rates shall be adjusted to equal the rates for other
providers in the provider’s service category and region.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Beginning January 1, 2025, the department shall also implement a hold harmless policy for providers whose rates in effect on January 1, 2023, exceed 90 percent of the rate model. The policy shall freeze a provider’s base rate at the rate in effect on January 1, 2023, until February 28, 2026, after which time the provider’s base rates shall be adjusted to equal the base rates for other providers in the provider’s service category and region. The provider shall be eligible for a quality incentive payment that, when added to their base rate, equals the fully funded rate model.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Notwithstanding paragraphs (1) and (2), the department may adjust rates as a result of reviews or audits.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
In conjunction with implementing rate reform, the department shall
implement a quality incentive program in order to improve consumer outcomes, service provider performance, and the quality of services.
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
The department shall, with input from stakeholders, develop quality measures or benchmarks, or both, for consumer outcomes and regional center and service provider performance. Given the time necessary to identify and develop the measures or benchmarks described in this paragraph, the department may establish quality measures or benchmarks, or both, in the initial years of the quality incentive program that focus on building capacity, developing reporting systems, gathering baseline data, and similar activities while working towards meaningful outcome measures at the individual consumer level for all services. Measures or benchmarks, or both, shall initially include process- and performance-related measures for service providers and, by the conclusion of the 2025–26 fiscal year,
shall also evolve to include outcome measures at the individual consumer level. In developing the proposed measures or benchmarks, or both, the department shall do all of the following:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
Gather public input through regularly held public meetings that are accessible both virtually and by telephone. Public meeting agendas and meeting materials shall be posted at least three days in advance of any meeting and shared by various means, including internet website updates, focus groups, and other communication.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
Provide documents, which may include, but are not limited to, updates, concept papers, interim reports, proposals, and performance and quality measures and benchmarks, and revisions to these materials, to the Legislature and post these materials on an internet website for public comment at least 30 days, as required by the Centers for Medicare and Medicaid Services, prior
to submitting a request for federal funding.
</html:p>
<html:p>
(iii)
<html:span class="EnSpace"/>
Seek input from subject matter experts to understand options for outcomes-based system structures using person-centered planning and alternative payment models.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
(i)
<html:span class="EnSpace"/>
On or before April 1, 2022, proposed quality measures or benchmarks, or both, shall be provided to the Legislature and posted for public comment, as described in subparagraph (A). After the department has considered public comments and modified the proposed quality measures or benchmarks, or both, as needed, the measures or benchmarks, or both, shall be finalized and implemented in the 2022–23 fiscal year.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
On or before April 1 of any subsequent year in which the department proposes new or revised quality measures or benchmarks, or both, the proposed measures or benchmarks,
or both, shall be provided to the Legislature and posted for public comment, as described in subparagraph (A). After the department has considered public comments and modified the proposed quality measures or benchmarks, or both, as needed, the measures or benchmarks, or both, shall be finalized and implemented in the upcoming fiscal year.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Beginning in the 2024–25 fiscal year, there will be opportunity for eligible providers to earn full quality incentive payments through one or more measures.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Beginning in the 2026–27 fiscal year, a provider shall be compliant with electronic visit verification, home- and community-based services rules, and applicable annual fiscal reviews and audit requirements as a condition of eligibility for the quality incentive program.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
The department shall
develop a quality incentive payment structure for providers meeting the quality measures or benchmarks, or both, developed pursuant to paragraph (1). The department shall issue written directives to define the way quality incentive payments will be made to service providers based on quality measures or benchmarks, or both, developed and implemented under this subdivision.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The department shall determine each provider’s quality incentive payment percentage prior to the start of the fiscal year, with the exception of the 2024–25 fiscal year, by measuring the provider’s performance against the quality measures or benchmarks for the most recently available reporting period. The department shall provide a written communication to the fiscal and policy committees of the Legislature that reports on the total amount of quality incentive payments estimated to be paid to providers pursuant to this section. This written communication shall be made as
soon as is practicable, but no later than 60 days after the quality incentive payment percentages are determined and the providers are informed of their payments.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
On or before March 1, 2024, the department shall provide a status update to the Legislature regarding progress toward implementing rate reform and creating an enhanced person-centered, outcomes-based system. The status update may include, but is not limited to, information about all of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Additional changes that may be necessary to effectively implement rate reform, including adding and amending statutes, regulations, and other departmental policies.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Compliance with rules of the federal Medicaid program, including the home- and community-based services final rule effective on March 17, 2014, and state compliance consistent with the
current federal guidance, including all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A definition of what it means to be compliant with the rules of the federal Medicaid program.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Whether there are certain service categories that are unlikely to achieve compliance due to the structure of the service, and, if so, which categories this includes.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Data about the total number of providers within each service category and the estimated number of providers that have not yet achieved compliance.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Program and system improvement efforts made as a result of the state’s home- and community-based services additional federal funding, including the one-time investment implemented beginning in the 2021–22 state fiscal year, including a description of how the department will build
on the investments.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
For purposes of this section, “rate model” means a rate model included in the rate study submitted to the Legislature pursuant to Section 4519.8.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the department may implement, interpret, or make specific this section by means of written directives or similar instructions until regulations are adopted, which shall occur no later than June 30, 2028.
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
Implementation of this section is contingent upon the approval of federal funding.
</html:p>
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<ns0:BillSection id="id_7C12639F-2F0A-4940-9BE3-4152CE07D22C">
<ns0:Num>SEC. 5.</ns0:Num>
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Section 4641.1 of the
<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
is amended to read:
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<ns0:Num>4641.1.</ns0:Num>
<ns0:LawSectionVersion id="id_2920BE3F-4435-4357-B6B1-AF1C3DC1DA9D">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
The Legislature finds and declares all of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The provision of services that are culturally and linguistically responsive to consumers is instrumental to improving access and equity in the developmental services system.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Direct support professionals are critical to the provision of services and supports to individuals with intellectual and developmental disabilities and their families.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
In recognition of the value of
effective communication between direct
support professionals and the consumers and families they serve, the provision of a pay differential for bilingual and multilingual direct support professionals will increase consumer access to staff who speak their preferred language.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
The department, subject to an appropriation, shall establish and implement a system that promotes equity in access to services for regional center consumers by providing a pay differential to direct support professionals who can communicate in a language or medium other than
English as part of their regular job duties.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Notwithstanding any other law, a direct support professional described in subdivision (b) is eligible for a bilingual or multilingual differential if both of the following conditions are met:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The duties currently assigned to the direct support professional require regular communication in a language or medium other than English with an individual that has a developmental disability, and when appropriate, their families.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The direct
support professional passes an examination certifying their ability to communicate in the language or medium other than English.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
For the purpose of this section, “medium other than English” includes, but is not limited to, American Sign Language and other sign languages and augmentative and alternative communication.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
The department may adopt emergency regulations to implement this section. 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 11349.6 of the Government Code. The department is exempted from the requirement that it describe specific facts showing the need for immediate action.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
Prior to implementation, the department shall provide a report to the Legislature detailing its plan to implement a wage differential for bilingual and multilingual staff.
</html:p>
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