California APSE

1722 Professional Dr.

Sacramento CA 95825

Via Email

June 2, 2021

Will Lightbourne, Director

California Department of Health Care Services

Nancy Bargman, Director

Department of Developmental Services

RE: Use of Funds for American Rescue Plan (ARP)

Dear Directors Lightbourne and Bargman:

The California Chapter of the Association of People Supporting Employment First (CA APSE) submits the following recommendations for California’s use of the additional funding for Home and Community Based Services (HCBS). APSE is the only nationwide organization that promotes equitable employment for all people with disabilities. More information about our principles and platform can be found at www.apse.org.  For information about our local chapter, you can find us at www.californiaapse.org.

With the right support, ALL people with disabilities can work, and should be offered the opportunity to work regardless of disability or residential setting, and have access to best practice strategies such as Customized Employment, Individual Supported Employment, and business ownership. Currently, individuals using HCBS funds to seek and prepare for employment have few choices when it comes to finding providers who utilize these best practices.

CA APSE recommendations are as follows:

Advance Competitive Integrated Employment

1. Invest HCBS dollars in ensuring that there are quality providers of individualized employment support throughout the state and readily available to work with individuals who want to find and keep a job. This will lead to increased outcomes with the HCBS compliance mandate that is less than two years away.
2. Support 14(c) license holders and other non-HCBS compliant programs that provide employment services to transform their model through a training and mentorship program.

o   Fund training from a list of nationally recognized experts using evidence-based customized employment models, such as Griffin-Hammis or Marc Gold & Associates.

o   Select employment agencies with demonstrated competency in successfully supporting individuals with complex needs in CIE, and fund them to serve as mentors to former 14(c) license holders.

o   “Transformation funding” could also go to mentee agencies, with payments being made in stages upon completion of transformation checkpoint criteria to incentivize mentees to persevere through the stages of transforming their business model.

3. Provide increased customized employment funding for any program that provides individualized and integrated employment supports for individuals who previously worked in a sub-minimum wage or segregated setting.

o   Increase provider rates for the two components of customized employment currently funded by regional centers (discovery and planning for customized employment) by up to 50% for individuals exiting sub-minimum wage settings.

o   Increase the number of allowable hours for discovery and planning by up to 50% for individuals exiting sub-minimum wage settings.

4. Prioritize outcome-based rate structures that incentivize movement to CIE.

• Rates for employment services should incentivize individualized services in order to comply with HCBS regulations.
• Employment services are not limited to “supported employment.” All employment services, regardless of service code, should be promoted and compensated accordingly.

• The current funding model supports employing people with the least amount of needs (individuals eligible for supported employment and can fade supports to 20%). Individuals with more or the most needs are ignored.

• Remove Title 17 requirements that force supported employment vendors to be vendors of  Department of Rehabilitation. Many DDS vendors have been turned away by DOR due to an oversaturation of providers, thus, are unable to provide Supported Employment Services to our population. Many of these vendors will not accept other rates for employment services. For example, 1:1 service code 055 community integration services that are employment focused have rates that are 32% lower than supported employment.
• Job development should be a separate service.  Job service hours should not be capped at an arbitrary level detached from individual needs.
• Collaboratively fund CIE supports across state agencies. Braiding funds promotes the most efficient use of limited funds for the accomplishment of shared CIE goals.

5. Regardless of residential settings, individuals should have equal access to employment opportunities.  Individuals residing in group homes or other similar settings should have opportunities for competitive and customized employment, even when the work hours do not fall within the typical day program hours.

• Residential providers need to be able to accommodate flexible employment support schedules, and be compensated appropriately when they have to provide supports during times a person served may be in their traditional day program.

Advance Competitive Integrated Employment through Self-Determination

6. Invest in Self-Determination as all services purchased through the Self-Determination service model must comply with the HCBS rules, and if employment is a goal, those services must support full integration and inclusion of individuals with disabilities on career paths and in the workplace.

o   Services such as customized employment and other individual supported employment supports can be prioritized and utilized through the use of Self-Determination program dollars, and CA APSE supports this use of funds to enhance our Employment First efforts.

o   Fully fund the Self-Determination service delivery model as it becomes available to all 350,000+ regional center clients come June 2021. Start-up funding is needed to assist each participant to create a person-centered plan, negotiate their budget and create a spending plan, all in order to enter the program.

o   Invest in assisting current providers to transition to the SDP model. At present, providers in California continue to have few reasons to seek full compliance with HCBS, but under Self-Determination those providers who pivot to providing individualized, person-centered services will be sought after by participants.

o   Group settings and facilities will remain closed and not fully operational for many months to come, while individualized services, especially when service providers and people with disabilities have been vaccinated, can be happening right now!      

7. As a result of the flexibility created by Self-Determination, participants are able to directly hire their own staff, with some clients creating jobs for one to five or more other individuals, through the use of their budgeted funds. This job creation phenomenon, in addition to the fact that ONLY HCBS-compliant services can be purchased with Self-Determination funding, creates a perfect opportunity for growth of a promising new service delivery model that fully integrates individuals into the community around them, which includes working in real jobs for real wages.

Advance Workforce Development

8. Pilot the recruitment and development of new direct service professionals trained specifically to serve regional center consumers in ways that (a) utilize person-centered planning and discovery; (b) comply with the HCBS Final Settings Rule; and/or (c) support consumers’ participation in Self-Determination.

Incentivizing the employment-related service delivery system to provide individualized services will empower people with disabilities, strengthen our local businesses and bring money into our economy. Any questions or further discussion related to these comments can be addressed to Katherine Sanders at ksanders@sarc.org.  

Sincerely,

Katherine Sanders

Suad Bisogno

Rebecca LaBoriel

Carole Watilo

Debra Jorgensen

Lara Okunubi

Brittany Robinson

Vivian Haun

Amanda Timpson

Lily Handley

Karen Navarro

Board of Directors, California APSE