Saturday, May 4, 2013

News Alert: California & Self Determination...Who Should Choose? RC's or You?

Self Determination is back in the spotlight and the community is divided.

If you don't know what self determination is, now is a good time to find out. In brief self determination let's families and individuals with developmental disabilities take greater control and determine for themselves what services are right for them.  The pro's want control of "how" the budget for their children's interventions is spent. They see benefit in control over what therapies they can select and the ability to choose the provider of their choice without being limited to Regional Center pre approved interventions and providers.

The con's mostly agree this is a good program for very proactive families who have the time and resources to research agencies, and monitor interventions and programs. The con's worry that the lack of controls will leave many families to fall victim to poorly managed programs, loosened guidelines and high risk and or snake oil type interventions without consistent Regional Center oversight to keep folks in check.

Here's the latest information from ASLA's website detailing Self Determination and upcoming legislation. 


The Autism Society of Los Angeles along with Disabilities Rights California are sponsoring 
California Senate Bill No. 468: Self-Determination Program for Individuals with Developmental DisabilitiesClick here to view the content of Senate Bill No. 468. Use this link to determine your State Senate and Assembly representatives.
Introduced and supported by Senators Emmerson and Beall, this bill would allow individuals with developmental disabilities (with the support of family, friends, and professionals) to take charge of their future by gaining control over the services, supports and resources they need to reach their life goals. Learn more.
What is self-determination?

Self-determination provides an alternative to the traditional method of providing regional center services to consumers. 
Self-determination helps individuals with developmental disabilities gain a life that:
  • Respects their own choices and fulfills their hopes and dreams.
  • Fosters independence while encouraging interdependence.
  • Allows them to choose services and supports that are not bound by what is currently available.
  • Reaches farther than meeting basic needs and toward creating a meaningful life.
  • Has services and supports based on their changing needs.
  • Is not unique to individuals with disabilities.

Has California ever had a self-determination program?
Yes. In 1998, the California Legislature (SB 1038) amended the Lanterman Act to include a Self-Determination Pilot Project. The highly successful program was piloted in five regional centers across California and included 200 participants. The program continues to exist for the original pilot participants as long as they choose self-determination. This legislation will offer the self-determination program to consumers throughout the state.
Do other states have self-determination programs?
Yes. Self-determination has been enacted in some form in almost every other state. It has garnered international and bi-partisan support as a delivery model that provides consumers and families with greater control over their services and their future. Self-determination as a service delivery model is also being used with other service systems (elder care and veterans, for example) in many states.
Will consumers be required to be part of self-determination?
No. Self-determination will be a voluntary option, and individuals with developmental disabilities may choose to be part of the program. No one will be forced in or out of the self-determination program.
Can we have a statewide self-determination program without changes in current law through the Individual Program Plan (IPP) process?
No. The current IPP process limits consumer choice based on program restrictions imposed by the Legislature in the budget and regional center contracting procedures. Self-determination moves the decision-making responsibility to the individual and his or her team. The relationship between the individual and the suppliers of services and supports (vendors) changes in that the vendor is now working for and accountable to the individual and not the regional center. Self-determination should lessen differences between regional centers and move from a system that is similar to managed care to one that is driven by consumer need and choice.
What is a “Person-Centered Plan?”
The individual with the developmental disability must be at the center of the plan and of the plan development. This planning process can be led by an independent facilitator who is experienced in the broad range of services and opportunities in the community to assist the consumer in reaching their life goals. This process will lead to short and long-term goals, including laying out the types of services and supports that an individual will need to work toward their goals in the next year. 
What is an Independent Facilitator?
An Independent Facilitator is not associated with any regional center or service provider and would work directly for the consumer and family with no conflicts of interest. Independent Facilitators will be trained by the Local Advisory Committees. A consumer and family can choose to use an Independent Facilitator to assist them in the following ways: 

  • Designing their person-centered plan.
  • Participate in the budget negotiation process with the regional center.
  • Assist them in selecting appropriate individuals, programs, and services in the community that will help them reach their life goals.

What is a Fiscal Intermediary?
The fiscal intermediary is like an accounting and/or bookkeeping service. The fiscal intermediary actually receives the funds to be used to support the implementation of the individual’s plan, disburses the funds in accordance with the plan and rules, and maintains financial records as required. The fiscal intermediary needs to be accessible to the individual being served and the Independent Facilitator, if one is used. The fiscal intermediary will know the program requirements and be approved as a vendor by the state.
Will self-determination cost the State more money? 
The legislation specifically states that the program must be cost-neutral in the aggregate. The budget for the regional centers will be the same, but for some consumers, there will just be a different way of distributing it. Self-determination will redirect existing resources and allow individuals to have more control of the way state dollars are being spent on them. In addition, self-determination programs around the country have shown a cost savings over time because the services are more directly meeting the needs of consumers and they have better outcomes and need fewer supports in the future.
What will be the role of the regional centers with consumers in the self-determination program? 
Self-determination should be considered as an alternative within the regional centers to the traditional or case managed system of care that is now used throughout California. Regional center staff will still hold Individual Program Plan (IPP) meetings and will work together with consumers and families to determine a reasonable budget for the individual to work toward their life goals for the following year. This negotiation process should be cooperative and collaborative. Regional centers, however, will not be able to select specific services or providers for consumers in the self-determination program.
What if emergencies happen and a consumer’s budget is not sufficient?
Self-determination recognizes that consumers’ needs may change. If they do, consumers can request an IPP with their regional center to adjust their budget to address the emergency or significant changes. The person centered plan will be appropriately amended or redeveloped and a new or revised budget established.
How can we ensure that low-income and traditional minority consumers take advantage of this option? 
The bill requires that self-determination be available to consumers and their families who reflect the diversity of consumers served by the regional centers. Because self-determination allows for flexibility, the model will likely be of interest to individuals who because of their culture or disability prefer different services. SB 468 calls for special outreach to underserved communities to make sure that consumers and families are aware of the self-determination option and to provide them orientation and training that is culturally competent.
How will the program prevent fraud and abuse?
In the pilot, there was very little evidence of fraud or abuse. In addition, all services provided through self-determination will have to be HCBS waiver eligible and meet certain federal requirements. Independent facilitators will be trained on the types of programs and services that qualify. All payments will be made by a fiscal intermediary who will also understand the program requirements and whose work is subject to audit. 
What kind of oversight will be provided?
Person centered plans may be audited either individually or collectively. Budgets will be reviewed and are subject to audits. The work of the fiscal intermediary is also subject to audit. The regional centers and DDS have oversight over the program. Since Medicaid funds will help fund the services and supports, federal requirements also must be met.
Are people who choose Self-Determination going to get more services from the regional center than people who stay in the traditional system?
Self-determination is not about getting more or less services – it is about getting the right services. It is about how services are accessed and controlled. 
What is the role of the Local Advisory Committees?
The bill establishes local advisory committees to provide oversight of the entire program, including the role of the regional centers, the budget negotiation process, and consumer outcomes. The committee will also train Independent Facilitators. Members of the Local Advisory Committees will be appointed by the Area Boards, the Office of Clients’ Rights, and the regional center. The majority of the committee should consist of consumers and family members and reflect the make up of the surrounding community.
How is this different from a voucher program?
Consumers and families will not be receiving any vouchers. All programs and services will bill the fiscal intermediary who will pay them directly. 
What is the difference between this Self-Determination Program and Self-Directed Services or the Individual Choice Budget?
This legislation expands statewide the Self-Determination Pilot Project with its philosophy of consumer choice and control. The Self-Directed Services and Individual Choice Budget programs have different structures and have never been implemented.
Click here to view the content of Senate Bill No. 468.

To determine your State Senate and Assembly representatives, visit this link: 
http://findyourrep.legislature.ca.gov/

6 comments:

  1. Oh my gash. DO NOT be tricked by this scam! California Regional Centers are going upside down because of their own inside corruption, so the state's answer to this is to shift the burden of finding supports and services onto already burned out and stressed out parents of disabled people. Do not be tricked into a self determination nightmare. Make these regional centers do their dang job. It is their duty to secure services for families of developmentally disabled children. It should not be the parent's burden, unless the parents have a very high functioning developmentally disabled child. Parents of children who are severely disabled and need a daily, intensive support system will not benefit from self determination because it's Regional Center's trick to shift all the responsibility to provide all these complex supports onto the family, so they don't have to. Parents BEWARE...The Lanterman Act. Disability Rights. Protection and Advocacy should know better. They should know by now how these Regional Centers aren't doing their jobs with the most severely disabled who need the most complex services. These Regional Centers are only set up to serve the easiest cases. They have few people working in these regional centers who have any real experience in the more complex needs of the severely disabled regional center clients. If your child has a mild disorder or needs a few respite hours, great, go for it, but if your child is very severe and requires intensive services, BEWARE, don't get sucked into this scam, so that your family is saddled with the responsiblity to find supports and services that all these Regional Centers are paying their employees to do. Why even have 21 Regional Centers if they are slowly passing the job duties onto the families??????

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