Report 2021-120 Recommendation 8 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 #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.

Annual Follow-Up Agency Response From March 2025

DDS maintains its position that the CSA's interpretation is incorrect, as statute (WIC section 4620.3) permits regional centers to establish policies that include limits on in-home respite service hours, provided there is a timely process for granting exceptions to meet an individual's needs. It is also important to note that before the implementation of WIC section 4686.5—which temporarily imposed caps on respite hours in response to a budget crisis—statute did not address caps. With the implementation of trailer bill language SB 138 (FY 2023-24) and WIC section 4435.1(c), DDS will continue working with regional centers to establish standardized processes for respite services, including reviewing and modifying regional center purchase-of-service policies as necessary.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Our recommendation was made because the use of default limits or "caps" on the number of respite hours that are available to consumers can create the impression among consumers, families, and regional center staff that the limits that formerly existed in statute are still in place. Notwithstanding the availability of an appeal process or exceptions to standard caps, this policy creates additional barriers to access to services for consumers and is not consistent with the Legislature's intent to ensure that regional centers promote appropriate levels of service based upon individual program planning and the unique needs of families. The Department of Developmental Services, in complying with SB 138, is required to establish standardized policies across all regional centers that include individual assessments for respite services. The Department's deadline for establishment of such policies is June 30, 2025. (see Welfare and Institutions Code, section 4435.1, subd. (c)(1).)

We continue to recommend that the Department ensure that state-wide policies for regional centers do not contain provisions imposing overall limits on the amount of in-home respite service hours authorized for families to receive each quarter. The establishment of standardized policies and processes pursuant to SB 138 is an opportunity to comply with this recommendation.

Annual Follow-Up Agency Response From August 2024

DDS continues to disagree with the CSA, as statute (WIC 4620.3) does allow regional centers to have policies indicate a limit on the amount of in-home respite service hours provided there is a timely process for the regional center to allow exceptions to authorize additional hours when needed to meet an individual's needs. It should also be noted that prior to the implementation of the statute (WIC 4686.5) that placed caps on respite hours (this statute was approved in response to a budget crisis), statute did not speak to caps. As part of the implementation of trailer bill language SB138 (2023-2024), and WIC 4435.1(c), DDS will work with regional centers on establishing standardized processes for the provision of respite services including making any modifications to regional center purchase of service policies.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

DDS indicates that it believes that statute allows it , 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.

As DDS indicates, recent changes to statute require DDS to work with regional centers on establishing standardized processes for the provision of respite services. As part of this process to standardize the provision of respite services and modify policies, we believe DDS should follow our recommendation to ensure that policies do not contain limits on respite hours.

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.

All Recommendations in 2021-120

Agency responses received are posted verbatim.