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Advisory Guide to Regional Center Services (2016)

Advisory Guide to Regional Center Services

Download RegionalMenuofServicesGuides.pdf

 

THIS IS AN ADVISORY GUIDE

 The purpose of this guide is to provide you information on the types of services which may be available at your designated Regional Center. Each Regional Center adopts a Purchase of Service Policy which can factor into the services available at your designated Regional Center.

Healthcare

Service Criteria Duration
Counseling or Therapy Services: Short term counseling and/or therapy services

necessary to improve the consumer’s status or preferred living situation or to allow the individual greater independence, provided by qualified and licensed professionals (i.e. clinical psychologists, clinical workers, and marriage and family

therapists).

1. All alternative funding sources and generic services must have been considered.

2. RC will consider the purchase of counseling/therapy services only when no other source of payment is available.

Based on the evaluation or recommendation done before the service is requested.
Health, Medical or Dental Services: Health services, supports, and adaptations which are specialized (directed toward the alleviation of a developmental disability) can be supplied under exceptional circumstances. Emergency Room treatment, and routine health services not usually included unless it is an exceptional circumstance, which will be reviewed on a

case-by-case basis.

RC will consider the purchase of health/medical/dental services only when no other source of payment is available.  
Medical Equipment: Medical Equipment like wheelchairs, adaptive devices, lifts, medical machines, and monitors can be provided.** NEED PRESCRIPTION 1. A consumer of any age may be eligible to buy medical equipment with the help of RC if he/she needs the equipment to keep his/her health and or physical status or to allow the consumer greater independence.

2. The medical equipment must be prescribed by a licensed professional.

3. The need for the equipment must have been evaluated by a professional and the results of the evaluation reviewed before buying the equipment.

4. Other funds such as private insurance and Medi-Cal must be considered before resorting to an RC purchase.

 
Medical Supplies: Medical supplies (i.e. dressing supplies, ostomy supplies, catheters, and nutritional supplements) which are prescribed by an appropriately licensed physician can be provided when it is medically necessary to maintain the

consumer’s health or allow consumer greater independence. **NEED PRESCRIPTION

1. Consumer is eligible if the medical supplies are

required in order to maintain consumer’s health

status or to allow for greater independence.

2. The amount of service will be based on evaluation results and review of appropriate recommendations. The service shall also be reviewed by the physician consultant

3. In some cases, more than one type of supplies may be explored.

 

 

Physical Therapy: Helps consumers manage pain, improve motor function (the movements it takes to thread a needle or play a video game, etc.), and maintain physical performance. 1. RC may provide PT services only when all other sources of funding have been exhausted. PT must be provided by a licensed and qualified specialist.

2. An adult consumer may receive PT services if he or she needs the therapy to maintain his/her current status and to prevent regression of his/her physical condition.

3. As of July 1, 2009, a child between the ages of 3-17 cannot receive PT through RC unless there are extraordinary circumstances (the service is critical to prevent physical, cognitive, or

psychosocial effects of the consumer’s disability or the service is necessary to keep the consumer in his/her home and no other alternative is available).

4. School-age consumers may be eligible for PT under special circumstances if it is needed to prevent regression during school breaks or other circumstances arise that prevent the

school from providing services.

Amount and duration of service will vary and shall be based on current recommendations, family input, and available evaluations. An evaluation may be requested before the funding of this service to determine the appropriate amount and duration of the service, and service can be reviewed by the appropriate clinical consultant.
Prescription Drug Services: Can be paid for by RC if the prescription drugs are prescribed by a licensed physician, dispensed by a licensed pharmacy, are not available over-the-counter, and if their use is related to the consumer’s developmental disability, and the consumer must take the medication to maintain his or her health.

**NEED PRESCRIPTION

1. Beginning July 1, 2009, RC cannot purchase any service that would otherwise be available from Medi-Cal, Medicare, IHSS, the Civilian Health and Medical Program, California Children’s Services, private insurance, or a health care service plan when a consumer or family meets the criteria of the above programs but chooses not to accept coverage.

2. RC may purchase prescription drugs when all other alternative forms of funding have been exhausted. Services may be provided on a temporary basis while medical coverage is being pursued, pending an administrative decision after an appeal, or until the commencement of Medi-Cal services.

3. Prescriptions must be supported by medical evaluation which indicate the consumer’s diagnosis and symptoms the drug is designed to treat. The medical evaluation must substantiate the need for the drug and provide a way to

monitor medication levels.

As according to prescription. If prescription is for longer than one year, another evaluation is needed.

 

Life Skills

Service Criteria Duration
Adult Day Program: Provides training in pre-vocational skills, community integration, adaptive skills, and behavior management for consumers who have graduated or are no longer eligible for school services (over age 22). 1. 18 years or older and are no longer receiving school or habilitation funded services.

2. Program is able to meet the consumer’s needs and appropriate for the consumer’s choice.

3. Program is able to operate within parameters of the licensing and vendorization requirements.

4. Consumer’s eligibility for day program services has been identified in the IPP.

Typically 5 days a week for 25- 30 hours per week.
Assistive Technology: Provides specialized services and supports such as computers, electric speech enhancers, reaching devices, etc., which are directed toward the alleviation of the social, personal, or physical daily functioning of a consumer with a developmental disability. 1. Consumers must have a documented communication, cognitive and/or physical impairment related to a developmental disability in order to be eligible for regional center funding.

2. Consideration will be given to age appropriate equipment as well as ensuring the equipment enhances rather than inhibits the consumer’s natural abilities.

3. For school-age children, all requests for assistive technology whether evaluation or equipment should first be addressed with the educational system through the IEP process or CCS as

appropriate.

 
Behavioral Intervention Services: A qualified behavior specialist provides services based on Applied Behavioral Analysis (ABA) to alleviate or eliminate behaviors of a consumer that prevent social development and increasing independence. When at Least One of the Criteria is Met:

1. The consumer engages in behavior that may be a barrier to his/her remaining in the least restrictive environment or participating fully in community life.

2. The consumer displays behaviors that may be a threat to his/her health or safety or the health or safety of others.

3. The consumer has failed to acquire developmentally-appropriate adaptive or functional skills, such as toileting, dressing, and feeding, that are fundamental to the attainment of social inclusion and increased independence.

Additionally: Parent or primary caregiver direct participation is required throughout the period during which services are being considered,

assessed, developed, and implemented.

Services vary in intensity and are provided on a continuum
Occupational Therapy: Helps consumers participate in everyday activities by modifying the environment to better support the consumer’s participation in his or her environment. 1. RC may provide OT services only when all other sources of funding have been exhausted. OT must be provided by a licensed and qualified specialist.

2. An adult consumer may receive OT services if he or she needs the therapy to maintain his/her current status and to prevent regression of his/her physical condition.

Amount and duration of service will vary and shall be based on current recommendations, family input, and available evaluations. An evaluation may be requested before the funding of this service to

determine the appropriate

 

  3. As of July 1, 2009, a child between the ages of 3-17 cannot receive OT through RC, unless there are extraordinary circumstances (the service is critical to prevent physical, cognitive, or psychosocial effects of the consumer’s disability or the service is necessary to keep the consumer in his/her home and no other alternative is available).

School-age consumers may be eligible for OT/PT under special circumstances if it is needed to prevent regression during school breaks or other circumstances arise that prevent the school from

providing services.

amount and duration of the service, and service can be reviewed by the appropriate clinical consultant.
Speech Therapy: Assists consumers with speech and language disorder by providing services such as assistance with speech, language, cognition, communication, voice, swallowing, and fluency. Includes screening to diagnose such disorders, treatment to prevent such disorders from manifesting, and corrective treatment. 1. RC will not purchase a service that would otherwise be available from Medi-Cal, Medicare, IHSS, or other program or resource.

2. RC may purchase speech therapy for an adult consumer when it is necessary to maintain the consumer’s mental/health status and to prevent regression. All supporting

documentation from consumer’s health

providers should be current within 6 months,

recent IEP’s and written denial/documentation shall include that all resources for payment have been exhausted.

3. Under special circumstances, speech therapy may be provided to a school-age consumer if supplemental services are required to prevent significant delay in therapy, to prevent significant regression on behalf of the consumer if services are not provided, or other circumstances prevent the school from

providing services.

Amount and duration of service will vary and will be based on current recommendations and evaluations, which should be requested prior to funding of this service, to determine the appropriate amount and duration of the service.

Service shall also be reviewed by the appropriate clinical consultant.

Social Skills Training: Assists consumers with developmental disabilities and social deficits in improving interpersonal skills, social interactions and pragmatic language. Program requires detailed curriculum with

meaningful and measurable outcomes and parent participation.

· Social skills training should be time limited (i.e. no more than one calendar year) with the

intention of improving the consumer’s social

skills and training parents/caregivers.

 

 

Independent Living

Independent Living Services: A program that is community-based, and is aimed at developing the functional skills (i.e. skills which enable a consumer to interact with others, perform practical tasks at home, etc.) necessary for the consumer to secure a self-sustaining independent living situation in the community, and/or the support to maintain those skills. Also focuses on providing opportunities for consumer to integrate with the community and interact with non-disabled peers (i.e.

pay for a snack at the store).

1. Consumers who are living in their own house or apartment and in need of functional skills training in order to maintain a self-sustaining, independent living situation.

2. If the consumer so chooses, depending upon his/her commitment, motivation to live independently, and assessment of needs.

3. Due to the time-limited nature of ILS, if the consumer is living in the parental/family home at the time of the request for ILS, there must be a plan of action with mutually agreed upon deadlines set for a move out date.

Authorized for 6 months at a time, and can be renewed if still needed after review.

 

Supported Living

Service Criteria Duration
Supported Living Services: Supported Living Services are provided to assist consumers, who choose to live in homes they own or lease, in selecting and moving into a home, choosing housemates and personal staff, buying furniture, participating in common daily living activities, and managing personal financial matters. 1. Beginning July 1, 2009, RC may not purchase any service that would otherwise be provided through other resources such as private insurance, Medi-Cal.

2. Beginning July 28, 2009, the planning team of a consumer receiving Supported Living Services, must confirm that all appropriate sources of support have been used as much as possible. RC may require that the most cost effective vendor services are utilized.

3. To receive SLS services, a consumer must be at least 18 years old, eligible for regional center services, must be living in his/her preferred

living arrangement, consumer’s choice is

identified through the IPP process, and risks to

health, safety, and wellbeing are minimized.

Services can be provided as often and as long as needed, regardless of degree of disability, as long as the requirements are met.

 

Respite Care

Service Criteria Duration
In-home Respite Care: Temporary non- medical care and supervision provided in an individual’s home, and intended to assist family members take care of consumer at home by relieving family members from the constant and demanding responsibility of caring for the consumer (i.e. respite worker will help consumer with his basic self-help needs, socialization, and continuation of daily routines that would normally be performed with family members). Can be requested

as-needed, or be regularly scheduled.

1. The individual must reside with a family member to be eligible for respite services.

2. In-home respite services are considered when an individual’s needs are beyond the support of family, friends, natural supports and community resources, and when the in-home respite service is identified as needed on the individual’s IPP.

3. As of 2009, RC can only purchase respite services when the care and supervision needs of the individual exceed that of an individual of the same age without developmental

disabilities.

Can only purchase no more than 90 hours in a quarter per consumer.
Out-of-Home Respite Care: Temporary

care provided outside the consumer’s home by a vendored service provider (i.e. adult day care centers, child care centers, residential facilities serving adults or children, intermediate Care Facilities, etc.) in order to assist the family in securing temporary outside support in providing appropriate care and supervision of the consumer. Can be scheduled as-needed, or regularly scheduled.

1. Consumers who live with a family member may be eligible for out-of-home respite services when: there are occasional consumer needs are more than the support of friends, family, or others can provide (may include when family is on vacation, hospitalizations, emergencies),

out-of-home respite is request by the family or consumer and the option is a preferred option on the IPP, and when the consumer’s needs exceed that of an individual without a developmental disability.

2. RC cannot purchase more than 21 days of out- of-home respite services in a fiscal year, unless additional respite is needed to keep the consumer in his/her family home or there is an extraordinary event that affects the family’s ability to care for the consumer.

3. Before RC purchases out-of-home respite services, other sources of support must be explored, such as IHSS, private insurance, and

Medi-Cal benefits.

May not purchase more than 21 days of services in a fiscal year.

 

Transportation

Service Criteria Duration
Mobility Training Services (focuses on consumer’s behavior, to help consumer know how to travel as independently as possible): Focuses on helping consumers be more independent when travelling within their local communities by training consumers in how to travel safely as pedestrians, how to use public

transportation, pays for driver’s education classes, and helps to coordinate with

transit providers

1. All RC consumers who are over the age of 18 may be able to receive Mobility Training

Services if the service is listed in the consumer’s IPP, mobility training is not already being given by a day program, school, or other service (although RC may retrain a consumer), and the training is given in the consumer’s community.

May purchase up to 20 hours per month, or more if team wants a certain number of hours increase (must request it first).
Transportation Services

(focuses on means/modes of transportation, i.e. cars, taxis, etc.): Identification, arrangement, and purchase of public or private methods of travel can be provided to allow consumer to obtain needed services identified in the IPP (i.e. medical appointments).

1. Adult consumers may qualify to receive specialized transportation funding when all other funds for transportation have been explored and are not available.

2. RC will use the least restrictive method of transport and may use the least costly method as well.

3. The need for transportation must directly relate to the consumer’s disability and the need for transportation must be documented in the

consumer’s IPP.

4. RCs will not provide transportation for school age children in educational settings (unless there is written documentation to show that there is a significant barrier disabling a family to

provide transportation for their child).

 

 

Recreational:

Service Criteria Duration
Camp Services: Provides a supervised experience that may be either day or residential in nature which promotes peer interactions, enhances leisure skills and develops social growth.

and marriage and family therapists).

RC may purchase Camp for consumer when:

1. Camp is deemed appropriate for the consumer by agreement of the planning team.

2. The consumer’s ability to participate does not

compromise his health and safety.

3. The selected camp is vendored for the current fiscal year and has current fire and health

department clearances

 
Recreational: Opportunities which provide the consumer the means to develop and enhance personal enjoyment, social interaction, participation in family and group activities in the home, and recreational activities in the community. Such activities may be provided by public/private agencies/organizations (parks, churches, schools, etc.), circles of support, vendored agencies, or other resources. 1. As of July 1, 2009, RCs are not allowed to purchase social recreational activities unless they are vendored by the community-based day programs. An exemption to the suspension may be granted if RC determines that the service is critical to maintain physical, cognitive, or

psychosocial effects of the consumer’s disability or the service is necessary to allow the consumer to stay in his/her home and no other alternative is available to meet the consumer’s needs.

2. Before granting services, RC will first explore other resources of support such as family members, parks, school, SSI, or other resources.

3. If an exemption is granted, RC may purchase the activity if it is not available through community resources, the activity is provided in the consumer’s community, is cost-effective, and the least costly vendor is used (a consumer cannot be required to use the least costly provider if it will require him/her to move to a more restrictive service). The consideration of

the family’s responsibility for giving similar

services for a minor child without disabilities

has been exhausted.

 

 

Other

Service Criteria Duration
Crisis Response: Crisis Intervention Services consist of immediate, intensive, brief (time-limited) professional assistance/support to help a person return to a previous level of functioning or emotional state enabling him/her to maintain community living arrangements and other life activities of his/her choice without being at imminent risk of endangering him/herself or others. Crisis Intervention Services may include but are not limited to: temporary care in a community psychiatric hospital for the purpose of short-term stabilization; time- limited counseling or psychotherapy as a component of either outpatient or inpatient mental health psychiatric care; temporary care in a licensed community residential setting for the purpose of short-term stabilization; time-limited

one-to-one supports in the current living setting

RC may purchase Crisis Intervention Services for a client only if the following criteria are met:

1. an assessment is made by RC approved personnel which indicates that the crisis intervention service is needed to return the client to his/her previous level of functioning or emotional state and also indicates that the intervention is likely to enable the client to maintain his/her community living arrangement;

2. the client is not eligible for a crisis intervention, or substantially similar service provided by MediCal, private insurance, or any other third party payer; and

3. the crisis intervention service does not exceed the time limits specified in the IFSP/IPP.

As dictated in the IFSP/IPP
Client Rights Advocacy (OCRA): provides legal services to consumers of all 21 regional centers and their families throughout California. This is done by having a Clients’ Rights Advocate (CRA) designated for each regional center catchment area. The CRA can help with legal problems, providing information about client rights and services, conducting trainings, investigate denials of rights in a facility, and represent client in hearings.

Some of the issues that OCRA can assist (not exhaustive) are: Abuse/Neglect, Conservatorship and Alternatives, Criminal Matters, Community Transition, Discrimination, Guardianship, In-Home Support Services (IHSS), Medi-Cal, Mental Health, Privacy, Private Insurance, Regional Center Services, School Services, Social

Security, Voting, and etc.

ORCA legal services may be initiated by:

· Regional center consumers

· Families of regional center consumers

· Interested community members

ORCA may be directly contacted at the client’s regional center or by calling one of the following toll free numbers

· Northern CA: 800-390-7032 (TTY 877-669-

6023)

· Southern CA: 866-833-6712 (TTY 877-669-

6023)

Advocacy decision will be based upon:

· Merit of case

· Client’s ability to self-advocate

· Availability of OCRA resources

· Availability of other advocacy resources

Duration of service will be depend upon the type and length of investigation regarding the case/service at issue, that is brought forth to OCRA’s attention

 

Attachment RegionalMenuofServicesGuides.pdf

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