Budget changes impacting people with developmental disabilities

California FlagPrepared by Area Board 10 — Summary of Trailer Bills that directly impact people with developmental disabilities for 2012 / 2013 budget

CHILDREN

Insurance coverage for behavioral services for children with autism and PDD
While this law was passed a year ago, full implementation began July 1, 2012.
This law requires most private health insurance companies to provide coverage of medically necessary behavioral services (such as ABA therapy) to children with autism and pervasive developmental disorder. Medi-Cal is excluded from this provision.
In practice there are no clear requirements on issues such as what determines medical necessity, how much therapy insurance providers must cover, and if regional centers will cover co-pays. However there are some things you need to know:

  1. If you refuse to pursue therapy through your insurer, regional center is not obligated to pay
  2. If denied by your insurer, you do not have to exhaust every appeal before regional center becomes responsible
  3. While you await a decision from your insurer either on your initial request or on appeal, regional center is permitted to pay for services.

Some strategies to get behavioral services:

  1. Make sure these services are identified in your child’s IPP.
  2. Request therapy from your health insurer by getting a prescription for it from your child’s doctor.
  3. Ask the regional center to fund the services until your health insurance provider makes a determination.
  4. If denied by your insurer, be prepared to go through at least one level of appeal.
  5. Keep your documentation in good order in anticipation of appeals and/or hearings.

Early Start and insurance
While families may voluntarily ask their private health insurers to cover the cost of various therapies for their young children in Early Start, the use of private health insurance to pay for early intervention services may not result in any of the following:

  • The loss of benefits for the child or family
  • Difficulty in obtaining health coverage
  • Increased premiums for health insurance for the child and/or family

The bottom line is that your child’s or family’s health insurance may only be used to pay for early intervention services if it will not create a negative impact on your health insurance situation.

ADULTS

Supported Living – a new assessment process
The assessment process for supported living has changed. As always, the agency that will provide the service will conduct a needs assessment. However, DDS has developed a standard questionnaire for the regional center to use at a team meeting in order to maximize the use of generic resources and ensure an accurate assessment of the person’s needs. This is applicable to all SLS recipients. The questionnaire is posted on the DDS website.

The requirement introduced in 2011 to obtain an outside assessment for individuals who receive high cost SLS services has been rescinded.

GENERAL

Language change
The state legislature has replaced the term “Mental retardation” with “developmental disability.”

In-Home Supportive Services
IHSS recipients currently have a 3.6% reduction in IHSS hours that was intended to expire in June 2012. This cut has been extended for the next year; there will be no further reduction in hours.

Rate reduction and Regional Center caseloads
For the last two years regional center service providers had their rate reduced by 4.25%. Regional Center operations budget also saw a 4.25% reduction. Starting July 2012 those reductions will be a 1.25% cut instead.

Because of the continued funding reduction, the requirements limiting service coordinator caseloads continue to be suspended. This means that caseloads are unlikely to change in the foreseeable future.

Healthcare coordination – Medi-Cal, Medicare, IHSS, and long term care
In an attempt to make healthcare more efficient and cost-effective, there is a phased in shift of Medi-Cal and Medicare recipients from fee-for-service to managed care health plans. There are multiple factors that determine when an individual will shift to managed care. This year most people who have both (called Dual-Eligibles) will be assigned to a managed care plan. Regional Center dual-eligible consumers will not be required to shift to managed care this year but will in the future. Additionally, management of long term care and IHSS hours will be taken on by these managed care health plans.

DDS and Regional Centers – transparency in use of funds
In order to increase transparency and identify discrepancies on how DDS funds are being spent, DDS and each regional center are required to compile data on how their purchase of services money has been spent. This data must be posted on the regional centers’ and DDS’ websites by March 31, 2013. This information will include data on persons served, in the following categories:

  • age
  • race/ethnicity
  • primary language
  • disability types

Additionally, each regional center must hold a public meeting explaining the data within three months of compiling it.

Developmental center admissions, use of mental health facilities and out-of-state placements.
DDS and the regional centers have great difficulty in serving individuals with complex and severe challenges. They have often resorted to placements in Developmental Centers (DC), locked mental health facilities and out-of-state facilities to meet the immediate needs of these individuals. Beginning July 2012 the use of such facilities will be discontinued or severely limited. Only Fairview DC will be used for acute crises and only if court ordered. Such a placement will be for a short term until stabilization and community supports are in place. Individuals with forensic issues will be managed using a different set of criteria. If this is an area of concern for you, the following document is recommended:
http://www.dds.ca.gov/Budget/Docs/TBL_652_ConsumersChallengingServicesNeeds.pdf

Trigger cuts
If state revenues are not what they are projected to be halfway through the budget year, the developmental services system will take another 50 million dollar cut.

California Budget Crisis

Matrix is providing families with information on the current budget crisis that will affect the special needs community so that they may learn how to get involved and give valuable input.

State Budget: DDS Changes to Services for Infants and Toddlers (yet again) | The State has changed the services available for infants and toddlers at risk for developmental delays. This change follows on the heels of the change made in 2010 which created a Prevention Program for these children. Now, effective July 2011, children at risk for a developmental disability who are not eligible for the Early Start Program will be served through Prevention Resource and Referral Services (PRRS). The Family Resource Centers of California will provide PRRS, which consists of referrals to community resources and support for parents to monitor their children’s development. Matrix is the Farmily Resource Center serving Marin, Solano, and Sonoma counties. For more information, visit the DDS website.

Historic Cuts: California budget reduces Regional Center services to people with disabilities | During 2009, many changes were made to the law that directs how services can be delivered by the regional centers for people with developmental disabilities. For families with children of any age and for adults who receive these services, it is important to know what the changes are and what rights you have. Disability Rights California has 28 Fact Sheets in seven languages describing these service reductions and the protections that are available. These are available at www.disabilityrightsca.org

Getting Involved Want to stay up to speed on current budget news? You can receive up to date information from The California Budget Project at www.cbp.org. Their website is very informative and there are updates on the budget cuts to all human and social services and education areas (SSI, Medi-Cal, CALWorks, IHSS, education, etc.) You also can receive weekly updates from The Arc of California as well as information on disability services updates from www.disabilityrightsca.org. For educational updates you can check the website for the California Department of Education Newsroom and Hot Topics at www.cde.ca.gov.