Report 2021-120 All Recommendation Responses

Report 2021-120: In-Home Respite Services: The Department of Developmental Services Has Not Adequately Reduced Barriers to Some Families' Use of In-Home Respite Services (Release Date: August 2022)

Recommendation for Legislative Action

The Legislature should amend state law to require regional centers to include in their annual disparity reports to DDS—which show demographic data about the users of in-home respite services—specific, measurable actions to reduce barriers and disparities in the use of these services. At a minimum, these reports should identify the following:

- Concrete, measurable actions the regional center will take to improve access to in-home respite services.

- Timelines for completing those actions, including specific intervals for periodic updates on progress.

- Specific outcomes the regional center plans to achieve through these actions.

Description of Legislative Action

As of March 27, 2023, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of 6-Month Status: No Action Taken

Description of Legislative Action

As of October 21, 2022, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of 60-Day Status: No Action Taken

Recommendation for Legislative Action

The Legislature should amend state law to require DDS to submit a plan to the Legislature during the annual budget process that outlines the specific and measurable actions it will take to reduce barriers and disparities in the use of in-home respite services.

Description of Legislative Action

As of March 27, 2023, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of 6-Month Status: No Action Taken

Description of Legislative Action

As of October 21, 2022, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of 60-Day Status: No Action Taken

Recommendation for Legislative Action

To ensure that DDS takes adequate actions to verify that regional centers address barriers, the Legislature should amend state law to do the following:

- Require DDS to annually follow up with regional centers by instructing the centers to produce a status report each year on steps they have taken to reduce barriers to using in-home respite services.

- Require corrective actions from regional centers that DDS determines have failed to take sufficient action.

Description of Legislative Action

As of March 27, 2023, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of 6-Month Status: No Action Taken

Description of Legislative Action

As of October 21, 2022, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of 60-Day Status: No Action Taken

Recommendation for Legislative Action

To promote transparency and accountability, the Legislature should require DDS to promulgate regulations establishing a standard method—similar to the assessment tool used by some regional centers—for regional centers to document their rationale for determining the amount of in-home respite hours they authorize.

Description of Legislative Action

As of March 27, 2023, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of 6-Month Status: No Action Taken

Description of Legislative Action

As of October 21, 2022, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of 60-Day Status: No Action Taken

Recommendation for Legislative Action

The Legislature should require DDS to, every two years, determine whether the current reimbursement rates for in-home respite services are sufficient to attract an adequate number of respite workers statewide and to adjust the rates accordingly.

Description of Legislative Action

As of March 27, 2023, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of 6-Month Status: No Action Taken

Description of Legislative Action

As of October 21, 2022, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of 60-Day Status: No Action Taken

Recommendation for Legislative Action

The Legislature should require DDS to, every two years, evaluate, develop, and implement incentives, as necessary, to attract in-home respite workers with skills and abilities that can reduce barriers, including the shortage of respite workers who are bilingual or who are trained in dealing with specific behaviors.

Description of Legislative Action

As of March 27, 2023, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of 6-Month Status: No Action Taken

Description of Legislative Action

As of October 21, 2022, the Legislature has not taken action to address this specific recommendation.

California State Auditor's Assessment of 60-Day Status: No Action Taken

Recommendation #7 To: Developmental Services, Department of

To ensure that it has sufficient data to better identify usage barriers and disparities, DDS should update its in-home respite data by February 2023 to periodically track the amount of respite hours authorized and used by each regional center, and the usage of each service delivery option (Agency, EOR, or FMS). DDS should use this information and the data it already collects from the regional centers to identify potential limits, trends, and disparities related to in-home respite services. DDS should, at a minimum, analyze the usage of and authorization for in-home respite services across the categories we list in the report. That analysis should identify any disparities statewide, at individual regional centers, or among regional centers. If DDS identifies problematic disparities that suggest barriers to the use of in-home respite services, then it should take action to address them. For example, DDS should direct regional centers with low FMS usage to conduct additional outreach to ensure that families are aware of the benefits of this option.

1-Year Agency Response

The Uniform Fiscal System Modernization Project (UFSM) and the Consumer Electronic Records Management System Project (CERMS) have both completed the development of the Request for Information (RFI) for requesting vendor information about their ability to meet some or all of the requirements we gather. This RFI is the primary tool for gathering our market research efforts so we could determine what solutions are currently available on the market and the estimated cost for these solutions. We received interest from eighteen vendors and completed packages from fourteen of them. This was followed by two weeks of scheduled presentations from thirteen vendors that the team recorded for later reference. The team used this information for completing their Project Approval Lifecycle Stage 2 documentation. DDS anticipates moving ahead with Stage 3 Detailed Requirements definition with stakeholders beginning in August, 2023.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

The Uniform Fiscal System Modernization Project and the Consumer Electronic Records Management System Project have both completed the collection of the "as is" requirements and "to be" requirements with a selected primary team of system stakeholders. The "as is" requirements define the business requirements as are required under the scope of the current systems. The "to be" requirements include functions and features that go above and beyond that which is defined for today's systems. In addition, the team has validated the "as is" requirements with the larger scope of stakeholders and are currently active with validating the "to be" requirements with this larger stakeholder group. In parallel with this process, the team is developing the Request for Information for requesting vendor information about their ability to meet some or all of the requirements we gather. This will be a key part of our market research efforts so we can determine what solutions are currently available on the market and the estimated cost for these solutions. DDS anticipates completing this market research effort in July 2023 and use that information to update our mid-level requirements.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

As noted in the response to the audit report, DDS is already implementing sub-recommendations (a), (b) and (c). Additionally, the UFS and CERMS projects are progressing through stage two of the Project Approval Process. As part of Stage 2, project teams are collecting information on the current systems' functionality. The teams will next move into the "to be" requirements which include functions and features that go above and beyond that which is defined for today's systems.

California State Auditor's Assessment of 60-Day Status: Pending

We look forward to DDS providing us with details and support for how it is addressing this recommendation in its six-month response.

Recommendation #8 To: Developmental Services, Department of

DDS should review the policies of all 21 regional centers by October 2022 to ensure that they do not contain provisions imposing overall limits on the amount of in-home respite service hours authorized for families to receive each quarter and require revisions as necessary.

1-Year Agency Response

DDS has completed the actions described in the Department's response to audit report.

California State Auditor's Assessment of 1-Year Status: Pending

DDS recently informed us that it maintains its original response to our finding and believes that the policies that impose a limit are consistent with the statute and case law, so long as the policies include exceptions processes. As we stated in our audit report, we disagree with DDS's practice of approving policies that specify a limit on the amount of in-home respite hours as long as there is an exceptions process to authorize additional hours. Although we acknowledge that case law and statute require review and consideration of each individual's needs and circumstances, we state that, because the Legislature removed hourly caps, policies that reference limits on respite hours are inconsistent with the intent of the Legislature and risk creating the impression among consumers, families, and regional center staff that an hourly cap is still in place. Moreover, such policies create additional barriers to families accessing respite services by imposing an hour limit and requiring a family to seek an exception. Thus, we stand by our conclusion that an exceptions process is not sufficient to comply with the Legislature's intent in repealing the hourly cap.

6-Month Agency Response

DDS has completed the actions agreed to in the Department's response to audit report.

California State Auditor's Assessment of 6-Month Status: Pending

DDS recently informed us that it maintains its original response to our finding and believes that the policies that impose a limit are consistent with the statute and case law, so long as the policies include exceptions processes. As we stated in our audit report, we disagree with DDS's practice of approving policies that specify a limit on the amount of in-home respite hours as long as there is an exceptions process to authorize additional hours. Although we acknowledge that case law and statute require review and consideration of each individual's needs and circumstances, we state that, because the Legislature removed hourly caps, policies that reference limits on respite hours are inconsistent with the intent of the Legislature and risk creating the impression among consumers, families, and regional center staff that an hourly cap is still in place. Moreover, such policies create additional barriers to families accessing respite services by imposing an hour limit and requiring a family to seek an exception. Thus, we stand by our conclusion that an exceptions process is not sufficient to comply with the Legislature's intent in repealing the hourly cap.

60-Day Agency Response

DDS reviewed the respite policies of the 21 regional centers, and has identified that 11 of those policies impose either quarterly or monthly limits on the number of authorized service hours. Each of these 11 policies also provides allowable exception language, as described in our initial response to the audit report.

California State Auditor's Assessment of 60-Day Status: Pending

As we stated in our audit report, we disagree with DDS's practice of approving policies that specify a limit on the amount of in-home respite hours as long as there is an exceptions process to authorize additional hours. Although we acknowledge that case law and statute require review and consideration of each individual's needs and circumstances, we state that, because the Legislature removed hourly caps, policies that reference limits on respite hours are inconsistent with the intent of the Legislature and risk creating the impression among consumers, families, and regional center staff that an hourly cap is still in place. Moreover, such policies create additional barriers to families accessing respite services by imposing an hour limit and requiring a family to seek an exception. Thus, we stand by our conclusion that an exceptions process is not sufficient to comply with the Legislature's intent in repealing the hourly cap.

Recommendation #9 To: Developmental Services, Department of

DDS should develop standard outreach materials by February 2023 that present key information about each respite service delivery option, including a description of each option and its benefits and drawbacks. It should provide these outreach materials in multiple languages on its website and to all regional centers to include on their websites and disseminate to all of the families that use centers' services so that they have the knowledge and opportunity to select the option that best fits their needs.

1-Year Agency Response

DDS has developed the outreach materials and intends on publishing them on our website by September 30, 2023.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

DDS is continuing to develop outreach material and intends on coordinating with individuals and their families to gain feedback. We anticipate finalizing and completing the materials by August 2023.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

DDS has begun drafting/updating outreach materials regarding respite options and anticipates completion by February 2023.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #10 To: Developmental Services, Department of

DDS should amend its contracts with the 21 regional centers by February 2023 to require all regional centers to have a plan for ensuring that they have an adequate number of service providers for all in-home respite service delivery options, including the FMS option.

1-Year Agency Response

DDS has completed the review of regional center Community Resource Development Plans, and therefore has completed the actions described in the Department's response to the audit report.

California State Auditor's Assessment of 1-Year Status: Pending

DDS provided guidelines to regional centers for FY 2022-23 and 2023-24 that included the priority of increasing additional Financial Management Services (FMS) providers. However, it did not amend its contracts with the 21 regional centers to require all regional centers have a plan for ensuring they have an adequate number of service providers for all in-home respite service delivery options, including the FMS option. The evidence DDS provided of the regional center Community Resource Development Plans did not show that all 21 regional centers have plans for ensuring they have adequate providers. Rather, the evidence they provided only showed that two out of the 21 regional centers included plans that identified increasing FMS providers. As we note in our report, at 13 out of the 21 regional centers very few families use the FMS option. Thus, DDS should amend its contracts with the 21 regional centers to require them to have a plan for ensuring that they have an adequate number of FMS providers.

6-Month Agency Response

DDS is in the process of reviewing and approving Community Resource Development Plans submitted by regional centers.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

Consistent with our response to the audit report, the Fiscal Year 2022-23 Community Placement Plan and Community Resource Development Plan Guidelines, released September 29, 2022, include the priority of increasing additional Financial Management Services providers that support self-determination and participant directed services.

California State Auditor's Assessment of 60-Day Status: Partially Implemented

Although DDS implemented a plan that includes the priority of increasing additional Financial Management Services (FMS) providers that support self-determination and participant directed services, it still has not amended its contracts with the 21 regional centers to require all regional centers to have a plan for ensuring that they have an adequate number of service providers for all in-home respite service delivery options, including the FMS option.

Recommendation #11 To: Developmental Services, Department of

DDS should amend its contracts with the 21 regional centers by February 2023 to direct them to train their service coordinators to explain the benefits of each of the in-home respite service delivery options so that families can determine which option will work best for them.

1-Year Agency Response

DDS will coordinate with regional centers and their Participant Choice Specialists as they implement outreach and training plans and gather information on the impact of these positions. DDS will provide additional information by August 31, 2024.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

DDS continues to coordinate with regional centers and their Participant Choice Specialists as they implement outreach and training plans and will provide additional information by August 31, 2023.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

As detailed in our response to the audit report, DDS is coordinating with regional centers as they implement outreach and training plans to increase stakeholder awareness of PDS options.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2021-120

Agency responses received are posted verbatim.