Monday, April 14, 2008

What's not in the DDS Report, Controlling Regional Center Costs, Part I

OK, first of all, my purpose in adding this post is not to cut off commentary in the post below. Feel free to read and comment on either (or neither.) But I am in the mood to expand on my own snarky comment regarding socialism. Here is the first of some ideas I would have added to the DDS report had it been my honor to write it. This will be the first in a series of one or more proposals to control regional center costs and improve service through deregulation.

Eliminate vendor codes: Whatever the intention of the vendor codes, the principle functional purpose they rightly serve is to limit the breadth of service a single provider can offer, lowering the quality of the services vendors provide. The (likely) unintended function is to foster service denials by implying, at least sometimes, false redundancies. This reduces the flexibility of Regional Centers. A tertiary function of the service code is to waste regional center operations budgets on distractive, unproductive idiocies which then discredit the notion that non-profit boards provide guidance.

Finally, vendor codes probably add administrative costs needlessly by requiring different needs to be met under separate administrative arrangements. For example, if a person receives job-coaching but also needs help budgeting, cleaning their apartment and socializing, that person will generally be helped by three different agencies or at least three separate divisions of one agency with separate staff for the employment assistance, living skills and social assistance. This means the state pays for the liability insurance three times, the administration three times and the training and recruitment three times at the vendor side and the quality assurance three times, the service coordination three times and the billing three times on the regional center side. (Plus all the unproductive time spent by core staff at regional centers trying to cleverly craft changes to the purchase of service policies and get them rubber-stamped by glassy-eyed board members.)  Meanwhile, the client gets possibly triple the number of people to work with and is at risk that some need will not be met due to limitations placed on the vendor categories.

The vendor codes help the regulations to address specific service designs that address specific needs specifically but there are two reasons this might not actually be helpful. First, if you read the service standards portion of the California Welfare and Institutions Code, Title XVII - Division 2, Chapter 3 which defines the service codes and cross out all the regulations that are not typically monitored or enforced, too vague to provide clear guidance or that essentially self-repeal (cf section 56742 (a)(3-4)) you might easily be left with nothing but paragraph numbers and the vendor codes themselves anyway. The second reason this might not be important is that it is a fundamentally agency-centered approach and directly contrary to the person-centered approach we pretty much all claim is holiest and most efficient. (Note: This last point is the commonest hypocrisy in our system and your correspondent is usually guilty of it before swallowing the lees in his first cup of coffee.)

(Anecdote warning) My biggest regret from all my time in this field is this: Once upon a time, when I had done this work for about a year, a man who gave his name as Michael called and said he wanted to hire ¡Arriba! using his own money because he was living in a group home and the "independent living training" he got from the home wasn't helping him to move out (!) on his own. He said he had asked for ILS training from Lanterman Regional Center and been told that ILS services were not available to people who live in group homes because the group homes were supposed to provide that help. The thought of letting a client pay privately for services the regional center center should have provided was appalling but I have regretted ever since not asking his full name or offering help to get ILS into his IPP. This anecdote serves two purposes in this post: The first is as a caution that sometimes it can be a very good idea to have more than one agency provide services to the same individual, such as when there's a conflict in interest like expecting a residential facility to help an individual move out. Second, that while I sadly do not know the details of this case and there may have been logic to the regional center decision, it is not hard to imagine a case where a situation far better for an individual and far less costly to the State was foiled by a policy defined in terms of vendor code. Can anyone imagine a case where needless expenditures are reduced or client value added through categorizing services?

Advantages/Disadvantages: Advantages of this option include (1) Cost-savings through reduction of unnecessary administration, (2) improving the flexibility of service providers including regional centers and their vendors to be of use to clients, (3) simplifying the regulations, (4) a key step toward value-based rather than cost-based budgeting, (5) a person-centered approach to service design, coordination and implementation and (6) reduction in greenhouse gas emissions. Disadvantages include (1) costs related to retraining senior management at several regional centers to do something productive or replacing same, (2) creepy feeling that once-reliable service boundaries are giving way to free love and poetry slams, (3) priestly positions lost, some unionized and (4) loss of scale economies related to optimum use of the boards' rubber-stamps.

Total Savings: Indeterminate.

Hey, look, the DDS folks get paid to do this. You have to admit, though, green for advantages and red for disadvantages was inspired.

**UPDATE:  A good friend who is also scary smart just emailed that CMS requires service codes for the waiver, which is either a deal-breaker or a proposal-changer, depending on A) what level of definition CMS regulations require of the service code and B) how the service codes are required to be applied.  California defines programs by service code, but if CMS does not require that it may be possible to code for instance, activities or needs rather than programs after the fact.  This was how hospital billing was often done back when I knew about hospital billing.  Also, depending on CMS' definition of service code, it may be possible at least to broaden the definition to achieve some of the goals in this proposal.  For example if there were one service code for housing and supervision, one for medical supplies, one for each regulated professional service and one for all others including SLS, day programs, ILS, supported employment, respite, social/recreational, waste, fraud and abuse.

27 comments:

stanley said...

There was a DDS response to 2001 Service Delivery Reform (SDR) report...so

Suppose in the works is Providers Response To 2007 DDS Report; Users Response To DDS Report; and ARCAs Response...separate reports to show the different perspectives.

The response should include whats not in DDS report...eg eliminate vendor codes...as should be a status report on 2001 SDR recommendations...ie, answer to “is anyone better off”

For our information...

[2001 SDR say] The goals of this review were threefold: first, and foremost, to identify how services delivered in the community could better support the desired outcomes of consumers and family members; secondly, to propose a way to effectively link funding for services to real improvement in the lives of consumers and their families; and thirdly, to develop a method of paying providers to promote achievement of consumer and family outcomes. The need for service delivery reform had been evolving for a number of years.

Were these goals met...

[2001 SDR also say] “is anyone better off?” means we need to explore and understand the outcomes of our service delivery. Shifting to an outcome-based service delivery means we need to think differently about how services are provided, funded, and evaluated.

What was/is the answer...

further, another question must be asked: will anyone be better off as result of DDS Cost Control recommendations???

stanley seigler

Doug said...

Brer Stanley, I have no doubt there will be a half-dozen white papers written in response to the DDS report. I'm just not sure there should be. What was the result of SDR report? Nothing. What will be the result of this one? a half dozen white papers responding. Do the half dozen white papers, or this blog for that matter, accomplish anything more than the original report?

And just as a reminder, the legislature required DDS to produce this report. If it is harmful, we should thank DDS for 6 months of grace between the statutory deadline and publication.

Andy said...

Doug wrote: "You have to admit, though, green for advantages and red for disadvantages was inspired."

Inspired, is it? . . . and I thought my inspirations were modest. Perhaps I would have been more impressed if my screen colors were more spot on. The green and red weren't discernable as such . . . Advantages appeared as "light black," and disadvantages as a "stomach-flu brown."

Inspirational effects aside, I like where you're going with this. I'm trying to think of some disadvantages (some real ones!) but can't come up with any except the complications associated with actually doing what you propose.

The most commonly used service codes are tied to somewhat standardized rates that, once upon a time, seemed to be related to some notion of expertise (the gaping difference in rates between 1:1 respite and 1:1 ILS, for example). Doing away with codes, or a radical consolidation, would likely open a large can of worms.

Considering the impact of our past efforts in system reform, I'm not sure we can handle even one tiny can or worm. We seem to find it easier to start something completely new (with a brand new service code) than changing, fixing, refining, or improving anything that already exists.

But I do like the idea, code breaker!

--Andy

stanley said...

[doug say] What was the result of SDR report? Nothing

[andy say] Doing away with codes, or a radical consolidation, would likely open a large can of worms.

maybe we need to open a large can of worms...

does NOTHING mean “no one is better off”...does this mean the DDS did NOTHING to implement the proposed system...if so:

who is responsible for maintaining the unacceptable status quo...DDS, RC/provider boards, advocates...individuals in leadership positions.

BTW the below “the Department will” items seems applicable to either current or a proposed system

[SDR 2001 report clip]

To assure that the proposed system is fair and equitable, the Department will:

**Establish statewide standards and evaluation protocols for certification.

**Develop criteria consistent with the quality assurance system to be used in the evaluation and approval of appropriate third party accreditation systems.

**Establish a statewide academy to provide training to ensure the competencies of the certification teams and consistent application of the standards.

**Monitor and evaluate the performance of all entities that are approved to determine certification or accreditation

**Establish an appeals process to address and resolve issues regarding provider attainment of certification.

**Resolve conflicts between government entities.

stanley seigler

Doug said...

Thanks, Andy. I ain't scared of no worm.

Stan, I think SDR went unimplemented because the legislature didn't give DDS authority or funding to do anything. Various proposals went into various pieces of legislation that weren't passed. DDS, the regional centers, vendors, families and clients had no authority to implement any of the changes except those that we could always do. I guess the responsible parties would be the legislature and, through them, the advocacy community.

stanley said...

[doug say] I think SDR went unimplemented because the legislature didn't give DDS authority or funding to do anything [...] I guess the responsible parties would be the legislature and, through them, the advocacy community

perahps we all are responsible...butbutt

most of the recommendations were just basic good business practices and were authorized by Lanterman...back to an earlier comment from movie, “A Few Good Men”...do you need a manual [legislative regs] to tell you where the mess hall is.

Seems of SDR recommendations (Tabs A thru G) at least four of seven Tabs could be implemented without legislative authority or added funding...and

indeed DDS says have been incorporated into the Department’s Strategic Plan...see clip.

BTW DDS say: “By Spring of 2002, develop a supplemental report to this report that would provide the Administration and Legislature the results of the above two efforts [see clip]”

What does this report say...

stanley seigler

xxxxxxxxxxxx

[clip, DDS response to SDR]

The Department's responses are keyed to the topics and lettered tabs contained in the May 15, 2001 draft report.

Tab A: Values and Principles: These have been incorporated into the Department’s Strategic Plan.

Tab B: Personal Outcomes: These also have been incorporated into the Department's Strategic Plan.

Tab C: Quality Enhancement: The Department supports the overall concept, principles and goals of the committee’s recommendations for a quality enhancement system. [...] The Department is committed to continuing its efforts to achieve this outcome.

Tab D: Performance Measures: The Committee did excellent work in this difficult area. The Department supports the recommendation of evaluation of consumer outcomes through the use of personal outcome evaluations and satisfaction surveys. The Department believes this may be an area where some progress can be made within existing resources. [...] If any provider wishes to voluntarily demonstrate an approach to performance measurement in their area of service delivery, the Department will be glad to assist in any way possible. If you are interested in this, please contact Margaret Anderson at (916) 651-6312.

Tab E: Personnel Model This subject produced much comment and debate and the Committee presented exceptional recommendations. The Department strongly supports a personnel model [...] Additionally, the model is tied directly to a rate model and cannot be implemented until such time as additional resources are available. It may take more than one year to secure the necessary resources and the Department is committed to continue its efforts to achieve this outcome.

Tab F: Service Requirements The Department continues to believe that service requirements need to be reviewed and enhanced [...] Changes to service requirements must be supported by an adequate rate setting system.

Tab G: Modeled Rate Systems In order to meet the legislative mandates to develop rate models that would provide sufficient resources for providers to enable them to meet consumer outcomes

The Department decided not to move forward on phase two of the contract, given the mixed feedback from provider organizations and the fiscal restraints now facing the State. Instead, the Department has decided to do the following to still fulfill the Legislative mandates:

1) Meet with representatives of residential providers to determine if the rate model developed by the contractor would work in this service area. If not, discuss with the workgroup what other alternatives would be available to address the problems in the current residential rate model.

2) Establish three committees (Day/Infant, Supported Living, and Respite) to determine what alternatives are available in addressing the problems with the current rate model, or looking at other alternative model(s).

3) By Spring of 2002, develop a supplemental report to this report that would provide the Administration and Legislature the results of the above two efforts.

Doug said...

Stan, I appreciate your point and, without the report in front of me have to qualify that I probably agree. But we are talking about DDS which can only require in regulations what it has statutory authority to require. If you want to know why I as a provider or a service coordinator or an rc board don't implement better business practices we have a report to guide us toward, that's completely fair, but I suspect the answer for why DDS didn't implement SDR is that they can't.

stanley said...

[doug say] I suspect the answer for why DDS didn't implement SDR is that they can't.

I speak with complete lack of understanding the bureaucratic maze (aks bs)...that said;

I suspect it has to do with leadership...as it seems many, perhaps the majority, of the SDR recommendations are items that could be addressed by administrative directives with Lanterman as the authority...eg; DDS say many have been incorporated in their strategic plan.

maybe an analogy...who do we blame for the conduct of the Iraq war...the company commanders (RC/provider boards, advocates) or Bush and Gen Petraeus (DDS leadership)...butbutt

Guess nuff said for now...hope some of the white paper responses to the 2007 DDS Controlling RC Cost will address lack of 2001 SDR implementation...as improvements to system should be implemented before cost control considered...DDS should have recommended no cuts.

BTW these are rhetorical wonderings for pondering...no answer expected...

stanley seigler

Andy said...

I believe a pattern has developed. Doug introduces a new topic . . .

DOUG: For a long time, an old friend has been begging me to put forth the topic of the bifurcation of Newtonian and Cartesian discourse when it arrives upon the concept of “methodic doubt” and its obvious application to heretofore unproposed rate-setting determinations for California’s most common service configurations, assuming the inherent efficiencies actually are inherent (pun most certainly intended).

As my old friend intones, . . . etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. . . . of course, we all agree that’s fine, until we find ourselves facing a Munchausen Trilemma of our own making until . . . etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. . .. which puts DDS in the unenviable position of exercising its statutory, if not moral, mandates . . . etc. etc. etc. etc. etc. etc. etc. etc. etc. . . . could correlate POS policies with outcomes as regional centers are forced to make . . . etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. . . a source of allegedly irreducible predicates.

More thorough and boring details will be provided in the next few posts. Until then, what say you?


STANLEY: [doug say] DDS in the uneviable postion of exercising . . .

position of exercising is “uneviable” because of the benign neglect of regional centers, DDS, PAI . . . but but but . . . etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. . . . MLK, RFK . . . etc. etc. etc. etc. etc. etc... 99% happy campers . . . etc. etc. etc. etc. etc. etc. etc. etc. etc. . . but, but . . . etc. etc. etc. etc. etc. etc. etc. etc. . . . Lanterman promise . . . etc. etc. etc. etc. etc. . . . Eleanor Roosevelt . . . old fools like me . . .but but but . . . etc. etc. etc. etc. etc. etc. etc. etc. BTW [ . . .] etc. etc. but but but . . .

DOUG: Brer Stanley, your comments suggest neo-Aristotelian leanings and presupposes you to be a disciple of Aquinas, wherefore . . . etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. . . . and presages the contention that a greater percentage of campers are less than happy . . . etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. and far funnier when it is ontologically irreducible, Stan.


PAUL: Doug, your position as stated is edifying and salubrious and makes me think, cognito, ergo sum. . . etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc.. etc. etc. etc. etc. . . . unless, like Stanley, dubito, ergo cognito, ergo sum! etc. etc. etc. etc. etc. etc. . espiritu santu mogadishu, as I often say . . . etc. etc. etc. etc. etc. etc.. . . and the only question can be quisnam quis quadium?

STANLEY: [paul say] ergo sum . . .

[ . . .] but, but . . . BTW, you want sum of dis? etc. etc. etc. etc. etc. etc. etc. etc. . . . VV, SLS, ADA, BTW . . . etc. etc. etc. etc. etc. “broken homes” . . . but but . . . happy campers . . . etc. etc. etc. etc. etc. etc. etc. etc. . . . I subscribe to the sf chronicle . . . does DDS, PAI, regional centers, VV? and and and but but . . .

[doug say] neo-Aristotelian

but but . . . BTW RFK, MLK . . .

ANDY: A man walks into a bar with a parrot on his shoulder . . . etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. . . . a rabbi, a priest and a minister are cast adrift in a rowboat . . . etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. . . once, when I worked in a day program, one of the clients we (supposedly) served came up to me and . . . . etc. etc. etc. etc. etc. etc. etc. etc. etc. . . . and that, I think, without doubt, is, I’m certain, indisputable!

DOUG: Andy, I’m not sure I understand how your story of the client in the day program relates to the topic, but I appreciate . . . etc. etc. etc. etc. etc. etc. etc. etc. etc.

Paul, salubriousness is my middle name, as is phenomenologism, as well as . . . etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. etc. . . . and I’ll back you on that!

Brer Stanley, these campers of whom you speak, are they funded under the respite service code or the old camp code that DDS . . . etc. etc. etc. etc. etc. etc. etc. etc. . . . which leads me to a new topic I will soon post.

THE COLLECTIVE THOUGHT OF THE BLOG’S READERS WHO RARELY POST, IF AT ALL: Please, please, please a new topic, please!

stanley said...

[andy say] etc. etc. etc.

you gotta stop associating w/ don julio, etc. etc.

stanley seigler

stanley said...

I ask a most reliable source her opinion of DDS authority to implement...as a former Mass DDS director, Mary Cerreto's opinion provides insight into the role of DDS leadership (in my opinion)...so rather than plagiarize...I asked and received permission to post her comments.

[clip fr her email] By the way, Doug's comment about reducing the number of vendor codes is superb. I think we [Massachusetts] had four: Residential Services and Support; Work and Work Training; Emergency Services and Transportation. Our waiver was constructed so that, for example, Residential Services and Supports covered every type of living arrangement, parent behavior supports, and a ton of other things. You can rewrite the Waiver services descriptions to define their categories as you wish, and we did. With few codes, you don't need to do a lot of paperwork or approvals to move persons to better living situations or work situations. The lack of a gadzillion codes means that people flow where they need and desire to be in a system. [end clip]

stanley seigler

xxxxxxxxxxxxxxxxxxx

Mary’s email

[not sure how hi-lite or underlined text shows up on blog]

Well, I [Mary] do think the CA DDS director has the authority to implement, including many of the aspects of the 2001 Service Delivery Reform (SDR) report. I opened the report thinking, "Geez, what good is a report that is seven years old," and then I found it very visionary. Much of what is in it would bring California up to par with some of the other top states.

One major aspect of the plan would have been money, but DDS has the ability to move money from the institutions into the community as people move. It also has the ability to revamp services in the institutions to release money to community services (the waiver) by doing more contracting for things like laundry and meals.

I also did my homework and read aspects of the W&I codes, Ch 17 DDS regulations and the Lanterman Act. It has been my contention that DDS does not use the authority that it has:

The Department of Developmental Services is responsible under the Lanterman Developmental Disabilities Services Act for ensuring that persons with developmental disabilities receive the services and supports they need to lead more independent and productive lives and to make choices and decisions about their lives. The Department ensures coordination of services to persons with developmental disabilities; ensures that such services are planned, provided, and sufficiently complete to meet the needs and choices of these individuals at each stage of their lives, regardless of age or the degree of their disability; and, to the extent possible, accomplishes these goals in the individual's home community.

This is from the Lanterman Act; I would use this highlighted sentence to do anything I needed to do.

The Department sets broad policy and provides leadership for developmental services statewide; establishes priorities, standards, and procedures within which the developmental services program operates; monitors, reviews, and evaluates service delivery; and ensures remediation of problems that arise. Services are delivered directly through Developmental Centers and state-operated community facilities, and under contract with a statewide network of 21 private, nonprofit, locally-based community agencies known as regional centers.

This is exactly what a DDS should do -- come in at the beginning, providing policy and leadership, setting standards and procedures and come in at the end to monitor, review and evaluate service delivery.

Section 4501 of the Lanterman Act states: "The State of California accepts a responsibility for persons with developmental disabilities and an obligation to them which it must discharge. Affecting hundreds of thousands of children and adults directly, and having an important impact on the lives of their families, neighbors and whole communities, developmental disabilities present social, medical, economic and legal problems of extreme importance."

Section 4620 states "In order for the state to carry out many of its responsibilities as established in this division, the state shall contract with appropriate agencies to provide fixed points of contact in the community for persons with developmental disabilities and their families, to the end that such persons may have access to the facilities and services best suited to them throughout their lifetime. It is the intent of this division that the network of regional centers for persons with developmental disabilities and their families be accessible to every family in need of regional center services.

It is the intent of the Legislature that the department
monitor regional centers so that an individual consumer eligible for
services and supports under this division receive the services and
supports identified in his or her individual program plan.

It is the intent of the Legislature that agencies
serving persons with developmental disabilities shall produce
evidence that their services have resulted in consumer or family
empowerment and in more independent, productive, and normal lives for
the persons served. It is further the intent of the Legislature
that the Department of Developmental Services, through appropriate
and regular monitoring activities, ensure that regional centers meet
their statutory, regulatory, and contractual obligations in providing
services to persons with developmental disabilities. The
Legislature declares its intent to monitor program results through
continued legislative oversight and review of requests for
appropriations to support developmental disabilities programs.

The State Department of Developmental Services and the State
Department of Mental Health shall jointly develop and implement a
statewide program for encouraging the establishment of sufficient
numbers and types of living arrangements, both in communities and
state hospitals, as necessary to meet the needs of persons served by
those departments. The departments shall consult with the following
organizations in the development of procedures pursuant to this
section:
(a) The League of California Cities, the County Supervisors
Association of California, and representatives of other local
agencies.
(b) Organizations or advocates for clients receiving services in
residential care services.
(c) residential care services.

The department shall be responsible, subject to the
availability of fiscal and personnel resources, for securing,
providing, and coordinating training to assist consumers and their
families, regional centers, and services and support providers in
acquiring the skills, knowledge, and competencies to achieve the
purposes of this division.

Ch 17

Verification of compliance with other provisions of applicable statute, regulations, contracts, or agreements governing the service program and/or the provision of services to persons with developmental disabilities.

It is my opinion that DDS needs no more authority than it has to implement anything, including the SDR report.

By the way, Doug's comment about reducing the number of vendor codes is superb. I think we [MA] had four: Residential Services and Support; Work and Work Training; Emergency Services and Transportation. Our waiver was constructed so that, for example, Residential Services and Supports covered every type of living arrangement, parent behavior supports, and a ton of other things. You can rewrite the Waiver services descriptions to define their categories as you wish, and we did. With few codes, you don't need to do a lot of paperwork or approvals to move persons to better living situations or work situations. The lack of a gadzillion codes means that people flow where they need and desire to be in a system. When you go to individual budgets, you no longer worry about the cost of particular type of residence. Some in the residence may be there at a $60,000 total cost and others at a $90,000 total cost.

Did I address your question?

You can plagiarize all of this! Love, Mary

Anonymous said...

“…up to par with some of the other top states…” Gee, maybe we could be like Massachusetts and establish priorities for services.
6.07: Prioritization for Supports

(1) Priority Determination.
(a) Except as to individuals who have special eligibility pursuant to 115 CMR 6.05, all supports, including assessments, planning and the development and implementation of Individual Service Plans, are subject to the availability of resources. The Area Director shall determine priority for supports on the basis of criteria set forth in 115 CMR 6.07.
And maybe we should allow DDS and the regional centers sole discretion in determining clinical assessments:
(b) Assessments.
1. The determination of need for supports shall be based upon an assessment of the individual’s functional limitation(s), cognitive impairment, medical needs and behavioral needs as well as generic resources and natural supports available to meet the individual’s needs. The Department shall, in its sole discretion, determine which clinical assessments it deems necessary to determine the individual’s need for all categories of requested supports as well as the qualifications needed to administer the assessments. The Department shall conduct such assessments in accordance with the standards set forth in 115 CMR 6.22.

(b) Priority for the allocation of available supports provided, purchased or arranged by the Department shall be determined by the Area Director, based on the severity of the child's and family's needs. The following priorities will apply to individuals who are younger than 18 years of age and to individuals ages 18 through 21 who are in the care or custody of, committed to, subject to court-ordered supervision of, or eligible for or receiving 24-hour residential services from or through another Massachusetts public agency, including, but not limited to the Department of Social Services, the Department of Youth Services, the Department of Mental Health, the Department of Public Health, and state or local education agencies;
We certainly don’t want any out of home placement for children, even if they don’t fall in the funding priority:
provided, however, that in no case shall the Department provide residential supports to children younger than 18 years of age or to individuals ages 18 through 21 years of age and eligible for or receiving residential services from a local educational authority, local school district, or any other public agency. The failure of an individual to apply for or the voluntary refusal of services that may be available from another public agency and for which an individual is otherwise entitled shall not constitute ineligibility to receive those services for the purpose of establishing priority to receive Department services under 115 CMR 6.07.
1. First Priority. Provision, purchase, or arrangement of supports available through the Department is necessary to meet one or more disability-related needs which, if not met, is likely to result in serous or immediate threat of harm to the child or others and the child is not otherwise eligible for the support(s) required to meet such needs from another public agency;
2. Second Priority. Provision, purchase or arrangement of supports available through the Department is necessary to meet the needs of the child or his or her family and the child is not otherwise eligible for the support(s) required to meet such needs from another public agency;
3. Third Priority. Provision, purchase or arrangement of supports available through the Department will enhance the family’s capacity to meet the needs of its members, or will facilitate or promote the inclusion of the child in community life and the child is not otherwise eligible for the support(s) required to meet such needs from another public agency;
(c) Fourth Priority. The child is eligible but is currently in the care or custody of, committed to, subject to court-ordered supervision of or is eligible for or receiving 24-hour residential services through another public agency, including, but not limited to the Department of Social Services, Department of Youth Services, Department of Mental Health, Department of Public Health, and state or local education agencies. If another agency is providing such services to a child who is otherwise eligible for Department supports, the Department will presume that such agency is providing supports which are necessary and sufficient to ensure the appropriateness and adequacy of the child’s placement.
(3) Prioritization for Adult Services.
(a) The Area Director shall determine priority for supports provided, purchased or arranged by the Department to eligible adults age 18 or older based upon the severity of the individual’s needs.
(b) Community 24-hour Residential Supports. For individuals who are determined to need 24-hour community residential supports the following priorities shall apply:
1. First Priority. Provision, purchase, or arrangement of supports available through the Department is necessary to protect the health or safety of the individual or others;
2. Second Priority. Provision, purchase, or arrangement of supports available through the Department is necessary to meet one or more of the individual’s needs or to achieve one or more of the needs identified in his or her Individual Service Plan.
(c) Community Living Supports. For individuals who are determined to need community living supports the following priorities shall apply:
1. First Priority. Provision, purchase, or arrangement of supports available through the Department is necessary to protect the health or safety of the individual or others;
2. Second Priority. Provision, purchase, or arrangement of supports available through the Department is necessary to meet one or more of the individual’s needs or to achieve one or more of the needs identified in his or her Individual Service Plan.
(d) Supportive Services. For individuals who are determined to need supportive services, the following services shall apply:
1. First Priority. Provision, purchase, or arrangement of supports available through the Department is necessary to protect the health or safety of the individual or others;
2. Second Priority. Provision, purchase, or arrangement of supports available through the Department is necessary to meet one or more of the individual’s needs or to achieve one or more of the needs identified in his or her Individual Service Plan.
But don’t worry, if California were a top state like Massachusetts, consumers could always appeal. Well, Sorta:

6.31: Subject Matter of an Appeal

The following issues may be appealed under 115 CMR 6.30 through 6.34:
(1) Whether the decision of the Department as to the individual's eligibility for supports is consistent with the standards and procedures stated in 115 CMR 6.01 through 6.10;

(2) Whether the Department's assignment of priority of need is consistent with the standards set forth in 115 CMR 6.07;

(3) Whether the assessments performed or arranged by the Department or the provider to serve as the basis for the development and review of an individual's ISP were sufficient for that purpose;

(4) Whether the goals identified in the ISP pursuant to 115 CMR 6.23(4)(e)1., are consistent with and promote the outcomes described in the quality of life areas set forth at 115 CMR 6.23(2).

(5) Whether the types of supports identified in the ISP are the least restrictive, appropriate and available supports to meet the goals stated in the ISP;

(6) Whether the use of behavior modification procedures, medication, and limitations of movement are consistent with the requirements of 115 CMR 5.01 through 5.16;

(7) Whether the recommendation of the ISP team with regard to the individual's ability to make personal and financial decisions is consistent with the available evidence and whether the type of decisionmaking support recommended is consistent with the standards set forth at 115 CMR 5.07;

(8) Whether the ISP was developed, reviewed, or modified in accordance with the procedures set forth in 115 CMR 6.20 through 6.25; and

(9) Whether the ISP is being implemented.

Apeal as long as the consumer can establish the guilt of the state:
(2) Burden of Proof. The burden of proof shall be on the appellant except that, with respect to appeals based on the restrictiveness of supports pursuant to 115 CMR 6.31(5), the burden of proof shall be on the party advocating the more restrictive alternative.

But at least, if we were in a top state, like Massachusetts, we could get a full array of services and supports. Or, could we only get residential, work, day, and respite? You tell me:
Home. Refers to the house, apartment, or other place in which the individual lives in the community.

Residential Supports. Refers to the routine provision of supports and services at home and in the community in accordance with an individual's ISP that are designed to foster rights and dignity, individual control, community membership, relationships, personal growth and accomplishments, and personal well-being (health, safety, and economic security). Residential supports may be provided by a public or private provider or by a person who is recruited, trained, supervised, or paid by the provider for the purpose of providing such supports either in his or her own home or in the home of an individual served by the Department.
Residential supports may be provided on a 24-hour basis or for less than 24 hours.

24-Hour Staffing. Refers to any set of supports or services which require the presence of staff at the home whenever an individual is at the home.
24-hour staffing does not refer to 24-hour supports provided to individuals by their family members.

Work/Day Supports. Refers to the routine provision of supports and services provided in accordance with an individual's ISP that are designed to support the individual in paid employment, to foster vocational skills to assist in the movement toward paid employment, to support retirement activities, or to assist the individual to gain the social and leisure skills for increased presence and independence in the community.

Individual Supports. Refers to the provision of supports, intermittent or ongoing, that assist an adult individual to achieve outcomes in rights and dignity, individual control, community membership, relationships, personal growth and accomplishments, and personal well-being, and that are not part of a comprehensive set of residential and work/day services.

Family Supports. Refers to those supports and services which are provided at home on an intermittent or ongoing basis to enable the family to stay together and to be welcomed, contributing members of their home communities. These include, but are not limited to the following:
(a) Respite Supports. Refers to family supports provided or purchased by the Department for the purpose of increasing or maintaining the capacity of the individual to remain in his or her own home. Such respite supports include the following types of supports:
(b) Family Respite. Refers to respite supports provided in the home of the individual by a person recruited, supervised, and paid by the family.
(c) Home-based Respite. Refers to respite supports provided by any person who is recruited, trained, supervised, and paid by a placement agency for the purpose of providing respite care either in the provider's home or in the home of the individual.
(d) Site-based Respite. Refers to any respite supports provided by a provider in a location that is not the home of the individual or of a provider who resides in the home.

Placement Services. Refers to an agency that is contracted with by the Department to locate, recruit, train, supervise on a 24 hour basis, and pay persons to provide residential supports and services to one or more individuals in the home of the person providing the supports.

Home Provider. Refers to a person who is recruited and paid by a placement agency to provide residential supports and services to an individual in the provider's own home.


PART I. ADMINISTRATION OF THE GOVERNMENT

TITLE II. EXECUTIVE AND ADMINISTRATIVE OFFICERS OF THE
COMMONWEALTH

CHAPTER 19B. DEPARTMENT OF MENTAL RETARDATION

Chapter 19B: Section 13. Development and maintenance of community mental retardation services

Section 13. The department shall develop and maintain, subject to appropriation and in accordance with its standards, comprehensive community mental retardation services including specialized services for both children and adults.
Major consideration shall be given to: (a) diagnostic, evaluation and reevaluation services; (b) various treatment services; (c) various training programs; (d) preschool clinical services; (e) long and short-term day and night care residential services for various purposes; (f) mental retardation consultation and education services to community agencies and professional personnel; (g) employment opportunities for department clients; (h) locally-based service delivery; and (i) support services to enable clients to live in apartment housing in the community.

Doug said...

Stan, where do we look for leadership? If DDS doesn't lead what are we supposed to do?

Andy, that was a great time-saver but you have to play out the game.

Stan, I'm flattered that you shared this with Ms. Cerreto but I do think a lot of this has been litigated and the power of DDS to coerce regional centers limited.

Anonymous, I caught that, too. The fact is there are always complaints against every state's system and very few frivolous ones. Feel free to summarize the code in the future, though.

stanley said...

[doug say] where do we look for leadership? If DDS doesn't lead what are we supposed to do?

call DDS on their lack of leadership...lack of enforcing Lanterman...stop "heck of a job brownie" mentality.

[anon say] Gee, maybe we could be like Massachusetts and establish priorities for services

[doug say] This will be the first in a series of one or more proposals to control regional center costs and improve service through deregulation.

Gee thanks for the education re MA regs and the warning CA should not consider “priorities for services”...has anyone suggested it...don’t recall it in 2001 SDR report.

No one (doug, mainly) said we had to stay on point...but this (facetious discussion of MA regs) addresses improvement of CA service through deregulation...HOW...

further;

how does it address What's not in the DDS Report...how does it address lack of implementation of visionary reports...how does it address possibility DDS has authority to implement, but hasn’t...

how does dwelling on possible MA negatives, bring CA up to par...seems focus on any positives would be more productive...eg, that MA (perhaps others) have fewer vendor codes...

how does it stop the insanity of repeating same thing over and over again and expecting different results

or is anon’s point CA is really up to par with the best (MA may or may not being one of them)...is CA system the model to which others aspire (as one advocate said)... http://groups.yahoo.com/group/DDRIGHTS/message/2661

maybe anon didn’t really mean earlier comment: “outcomes are pathetic in traditional services...when do we say enough is enough...isn't this the definition of insanity to do the same thing over and over again and expecting different results”...and CA is currently up to par with the best...

in any event and sarcasm aside;

the issue is not CA v MA...surely the discussion will not approach the sad level of DC v community pot/kettle debates...where advocates...shot self in foot...and denied deplorable conditions in the community existed.

the issue is a system that works for all...NOT just members of the affluent society; provider/RC board members; or those w/ strong advocates.

maybe anon's point missed...if so HELP!

stanley seigler

Doug said...

Stan, I didn't stay people had to stay on topic and I didn't say there would be no sarcasm but I don't think Anon's comment isn't fair. Comparisons have risk and its worth taking a closer look.

For a while it seemed like getting more money out of the HCBS waiver would be our salvation and I remember snarky comments from various quarters (One moment, please- I found a hoofprint on my halo, there we go: nice and shiny) about the regional centers and DDS were providing poor leadership because New York was getting much more federal funding participation (FFP) than California. Since that time we have learned two hard lessons, the first is that New York gets better FFP because they use the same definition of developmental disability as the federal government meaning that to accomplish the same feat California would have to exclude about half the people we now serve. The second hard lesson is that having increased FFP significantly during the time I've been watching, the California system as a whole seems to suck the life out of $3 billion with the same pulmonary aplomb it sucked the life out of $2.

Likewise, I think it is worth, having brought comparative virtues of Massachusetts into the conversation, to look at the other differences. One possible difference I brought up regarding Ms. (Dr.?) Cerreto's authority is the fact that DDS has, as I understand it, had their authority to push changes on regional centers reviewed by the courts under the Lanterman Act and been told they don't have that much power. Anonymous brought some code in to suggest another difference, that some of the authority the Commonwealth of Massachusetts gives to its department to exclude people that DDS can't exclude.

I do appreciate your bringing Massachusetts and Ms/Dr Cerrento into this discussion. And I was sincere when I said it was flattering to have this conversation considered by her. But as for ground-rules for talking here, I would say there are these:

1) We are here to discuss policy not to attack people.
2) Sarcasm is mother's milk. Expect some, subject to rule #1.
3) "We do not have a high priest." When I post my ideas here it is with the understanding that everyone who reads here is entitled to find fault with them. Likewise, any comment left here is fair to also critique.

So, "Doug/Stanley/Anonymous/DDS is once again claiming the authority of heaven for an idea so dumb the moles in my garden would know better" is probably fair. "Doug/Stanley/Anonymous/DDS is a hippogriff with the head of a pig, the wings of a moth and the teeth of baline whale" is probably not fair, even if true. Is that fair?

Nota Bene: I think in one post I accused a certain regional center director by name of infernal commerce, so the caveat to the rules above is we all err and should be willing to forgive each other a little but try to play by the rules in general.

stanley said...

[doug say] but I don*t think Anon*s comment isn*t fair. Comparisons have risk and its worth taking a closer look.

It is definitely OK to make any observation (fair or not) one wants ...at least as far as i am concerned...all should be done to encourage participation...encourage dissent...and certainly comparison should be made and looked at closely...but comparing apples seems more productive vice apples/oranges...ie;

where is the comparison between CA regs giving DDS authority to implement and MA regs re prioritization, appeals and full array of support...eg;

**But don*t worry, if California were a top state like Massachusetts, consumers could always appeal. Well, Sorta: 6.31: Subject Matter of an Appeal [compares how]

**...up to par with some of the other top states...* Gee, maybe we could be like Massachusetts and establish priorities for services. 6.07: Prioritization for Supports [compares how]

**But at least, if we were in a top state, like Massachusetts, we could get a full array of services and supports. Or, could we only get residential, work, day, and respite? [compares how]

how is putting MA down re prioritization, appeals and full array compared to and address DDS lack of implementation...perhaps;

this was comparing apples...but this majority of one just doesnt get it.

my observation was/is there were several examples of existing CA legislation giving DDS the authority to implement...which were ignored...instead a left handed defense of CA (evidently model system others aspire to) was presented...

MA regs were taken on as not so hot and seems implied therefore, the CA regs giving authority to DDS had no relevance as to why visionary recommendation (2001 SDR) were not implemented.

OTOH maybe even comparing apples/oranges could be of value...it might provide insight into CA inability to implement positive recommendations...the insight being, vice holding accountable...we tend to excuse...*heck of a job brownie* seems to prevail.

[doug] One possible difference I brought up regarding Ms. (Dr.?) Cerreto*s authority is the fact that DDS has, as I understand it, had their authority to push changes on regional centers reviewed by the courts under the Lanterman Act and been told they don*t have that much power.

Is there a ref(s) that supports your understanding that DDS, regardless of what the law says, does NOT have the authority to implement...anything specific to 2001 SDR...eg; recommendations DDS said would be incorporated into their strategic plan...

the only court ruling of which I am aware strengthened Lanterman and the ability to implement...eg;

http://groups.yahoo.com/group/DDRIGHTS/message/3653

[PAI say] The Court explained that the Lanterman Act is: A comprehensive statutory scheme to provide a pattern of facilities and services sufficiently complete to meet the needs of each person with developmental disabilities, regardless of age or degree of [disability], and at each stage of life...The Lanterman Act tells DDS to contract with regional centers to provide services to you and other persons with developmental disabilities. DDS remains responsible for monitoring the regional centers and ensuring implementation of the Lanterman Act.

[doug] we have learned two hard lessons, the first is that New York gets better FFP because they use the same definition of developmental disability as the federal government meaning that to accomplish the same feat California would have to exclude about half the people we now serve

is the use of same definition the only reason...the comparison of NY (whoever) better FFP than CA might be a blog topic

excluding just one person we now serve or will serve is unacceptable...so changing definitions may be another discussion topic...as you are aware DDS did change definition (2003) as a cost containment measure...

[timeline say] The Department agrees that Title 17, Section 54000(a) should be amended to be made consistent with the definition of *Developmental Disabled* as found in Welfare and Institutions Code Section 4512(a). The Department initiates a rulemaking to accomplish this amendment. Aligning State and Federal Eligibility Definitions A $2.1 million General Fund reduction by redefining the State*s definition of *substantial disability,* which is used to determine whether individuals are eligible for service. The redefinition will further align the State and federal definitions http://www.geocities.com/pes37262/

[doug] I think in one post I accused a certain regional center director by name of infernal commerce

not sure i understand most of your comments so may have missed your and anon's points...and certainly didnt know there was a RC director named Infernal Commerce...

point: many pluses to email discussions...but w/o a beer, coffee or tea...and body/facial emotions...specific comments can be misinterpreted...

stanley seigler

Doug said...

Stanley, we probably all could make our comments more clear. You probably deserve a more authoritative response than this, but here is my reasoning behind my (conditional) comment is that it is my understanding that at some point, DDS took over East Bay Regional Center and the case was litigated and a judge ruled that EBRC had to be released from DDS control within a very short time (I recall 4 months.)

So, the way I see it is that

1) It is nearly impossible to make real change in 4 months in an organization that size.
2) There are no unenforceable mandates (See AB 2424.)
3) The main enforcement mechanism DDS has is pulling contracts from regional centers.
4) The executive branch cannot fund anything without legislative approval so if it costs money, they really aren't able.

That's why I think DDS' power is limited in spite of the language of the Lanterman Act. And I'll add, I remember some of the dingy suggestions DDS put forward under the Davis administration and don't often wish DDS had more authority. RCs and Vendors can be dumb enough, thank you.

Now, since she gave the courtesy of reading my suggestion, is it Dr. or Ms.?

stanley said...

[doug say] You probably deserve a more authoritative response

stanley deserves nothing...children/aduts w/ special needs deserve more than a system where no one is responsible...no one has to obey the law...

someone (law say DDS) should be responsible for a system about which a leading provider (on this blog) say: “the outcomes are pathetic in traditional services...when do we say enough is enough...isn't this the definition of insanity to do the same thing over and over again and expecting different results.”

Indeed when.

[doug say] 4) The executive branch cannot fund anything without legislative approval so if it costs money, they really aren*t able.

There are providers who implement positive outcomes with current funding...what accounts for this...leadership maybe...BTW they should be rewarded...and;

DDS say: During these fiscally challenging times the Administration has continued its commitment to the Lanterman Developmental Disabilities Act by fully funding services and supports for persons with developmental disabilities in both the 2006-07 and 2007-08 budgets.
http://groups.yahoo.com/group/DDRIGHTS/message/2968

fully funded, really...seems DDS should have asked for funding to implement...if this was a reason for lack of not implementing.

Further, perhaps overlooked but where in 2007 DDS Controlling Cost report is funding ask to implement...or where was funding ever asked for to implement, eg, 2001 SDR.

[doug say] 3) The main enforcement mechanism DDS has is pulling contracts from regional centers.

The main enforcement is leadership...eg, when brownie was replaced positive implementation happened (of course not enough)...but addressing your point: in 20 years how many contracts has DDS pulled...

[doug say]
1) It is nearly impossible to make real change in 4 months in an organization that size.
2) There are no unenforceable mandates (See AB 2424.)

not sure your points...but did DDS make ANY changes in 4 months...is there a ref re reason for take over and court action...was reason lack of positive outcomes or mishanding of funds.

as mentioned anon’s and this discussion in general may have provided (as if we didn't know) insights...insights being we tend to accept and excuse vice holding accountable...and over the years the rationalizations have paved the road to hell for those w/o strong advocates.

re: Dr or Ms...both

stanley seigler

paul said...

I remember as a child being cautioned against plucking Gods law from his book. An “eye” for an “eye” might seem attractive at times, but it does not end there. The same holds true, if not more, of our law, including the Lanterman Act.

A person should be cautioned if they find an affinity to pick a few sections of code to carve onto a sword, or a shield. “Sections” of code and regulation are often refined by case precedents, and as Doug has pointed out the Appellant court as given us great insight in ARC v. DDS. Other decission have given us insight as well. It is somewhat frustrating to me that "advocates" have not taken the free advice.

In any regards, even if there is a single section, line, or word of law that seems to give an executive “plenary” authority (a best case scenario) that authority MUST be exercised in “good-faith”. While an executive may have the authority to say close down any service provider that, in the opinion of the executive, has violated the law – that does NOT mean that an executive has the authority to close down ANY provider for ANY reason.

An executive must not only be able to “exercise” his or her authority under the law, but “justify”. If they cannot do the latter, they may very well find themselves in the hot seat.

Doug said...

Actually, Paul, Regional Centers now have the authority to close down agencies to protect the health and safety of clients from severe neglect or abuse. There is almost no accountability for defining the danger, which means for any reason, a bad reason or no reason. The only real accountability in the regs I read is that if too many regional centers abuse the authority someone might change the regs. That was one of my least favorite well-intended pieces of rule-making.

paul said...

I do not doubt your assertion that the Regional Centers may have a history of closing programs "for any reason, a bad reason or no reason." However, you state this is the reality because "There is almost no accountability for defining the danger" not because there is no reasonable definition, under the law or regs., of "abuse" or danger.

The fact that someone or something is NOT held accountable to the law does not mean they do not violate that law. What the law actually says, the “authority” can be vastly different than the “exercise” of that authority or accountability.

I would argue that your post is another anecdote to support the assertion that it is NOT the system that has failed consumers, but the people in that system that have failed consumers.



Actually, Paul, Regional Centers now have the authority to close down agencies to protect the health and safety of clients from severe neglect or abuse. There is almost no accountability for defining the danger, which means for any reason, a bad reason or no reason. The only real accountability in the regs I read is that if too many regional centers abuse the authority someone might change the regs. That was one of my least favorite well-intended pieces of rule-making.

Doug said...

Now, a favor: I have a hard time following where "[Doug say]" ends and your comments begin. That's probably a listserv standard, but here on blogs we can make it easier to follow. So, free of charge, a formatting lesson: You can format text in comments by putting a code between a "<" and a ">" with no spaces between, and undo that format with the same pattern adding a "/."

So, you could bold your own commentary by starting it with "< b > and ending with < / b >" (minus the spaces.) You can also italicize the quotations by writing them in between "< i >" and "< / i >" (again minus the spaces.) And, I'd appreciate it if you did.

Actually, Paul. I didn't mean to assert that regional centers have a history of shutting down agencies for good, bad or no reasons. I was pointing out that when you say reason X is a sufficient purpose to allow regional centers to close an agency and then don't mandate review and accountability for closures do to reason X, then anything can be reason X. It's basically the Guantanamo Bay solution. To my knowledge that power has never been misused but it shouldn't have been granted. I can't remember why that seemed germane when I brought it up, but I'm certain it must have been.

paul said...

"Actually, Paul. I didn't mean to assert that regional centers have a history of shutting down agencies for good, bad or no reasons..

...And you didnt - just reading too quickly - a bad habit of mine.

paul said...

“I was pointing out that when you say reason X is a sufficient purpose to allow regional centers to close an agency and then don't mandate review and accountability for closures do to reason X, then anything can be reason X.”
Doug

I understand the angst. But – this approach to problems is not novel or unprecedented.

When an entity [carbon based unit (RC director) or corp] does something that violates public policy, and society believes the type of violation is the kind that warrants “review and accountability” by society it is called a CRIME, or is dealt with under criminal statutes.

When a entity [carbon based unit (RC director) or corp] does something that violates public policy, and society believes the type of violation is NOT the kind that warrants “review and accountability” by society, it is not considered a crime and falls into other areas of public policy.

Where to render the dividing line is a matter of choice. It is a balance of values. On one side public policy expresses what we believe to be right and wrong, and the other side expresses which areas and how much we want government to be responsible for expressing those values.

While we want the police to arrest the bank robber, we do not ask the police the arrest the neighbor that has a leaking septic tank, or the business partner that has violated an agreement. However, the fact that the police don’t arrive and don’t arrest does not mean there is no recourse for either Mr. Septic tank or Mr. Breacher.

So – the fact the the government does not “mandate review and accountability for [leaking septic tanks and contract breachers, does not then mean that the neighbor and business partner is free to do “anything”. While a property is free to use his or her property as they see fit this does not give the neighbor plenary power to be a nuisance. However, if ALL the neighbors look the other way then for all practical purposes the neighbor might be able to build a cold fusion reactor without consequence.

While business partners should stick to their agreements a partner is free to violate any agreement if he or she chooses. That does not then mean there is no accountability – no recourse for the victim. The other partner has recourse, but they CAN choose to do nothing, in which case the “violator” is not held accountable.

In a sentence: Just because the law, society, does not, “mandate review and accountability” does not mean there is absolutely no means of “review and accountability” it just likely means that it is in someone else’s hands, and some else’s responsibility and – choice.

Should a provider find themselves on the end of a closure for reason X, they can ask WHY, and ask the RC to justify, and the RC will likey have to do so. If they cannot, and if there is evidence of malice there may be additional recourse under societies public policy, just not via Lanterman. This recourse alone preclude “anything [from being] reason X.”

Of course, I understand that small providers do not have the resources of the Seattle/Oklahoma SuperSonics, but they are not impotent, and unfortunately my experience tells me that many live in a delusional netherworld created for them by “advocates” and “regional centers”, a place where even the laws of physics seem not to apply at times.

However - with all my prating now complete I understand that there may be a need to remove this authority from the RC, or create some oversight from the Government. Once again - it depends.

Doug,

If my memory serves me correctly are you not of the political conservative persuasion?..As in small government and privatization? Of course, nothing is black and white, but removing this authority from the RC (which means it has to go to the Gov.), or mandating over sight from the Gov. is a BOTH moving away from privatization and towards BIG government – No?

Doug said...

Paul, reading too quickly is a good habit when I write too long. I think I'm also missing my emphasis, I am not in favor of taking away the regional centers' authority to move clients out of dangerous vendored situations nor am I in favor of taking away the authority to devendorize neglectful, abusive or sucky vendors. My issue with that piece of rule-making is that it basically said If you say that you are taking these steps due to dangerous neglect or abuse, then you don't have to prove your case, even through a post-mortem review. Which means the carbon unit running a regional center can close an agency for not placing a shrine to said executive director in a prominent enough place and call it dangerous neglect. Lack of transparency and accountability is my issue with that rule

As far as I can tell, the current popular definition of Conservative is as follows: CONSERVATIVE, adj. Favoring broad and invasive regulation by a government controlled by Republicans. I'm not a Republican, so, no. But you are correct that my political philosophy is fairly much what was called conservative during the previous millennium.

The following definitions, for normative purposes, apply here:

CONSERVATIVE, n. In the United States, a recent convert to large government, federal supremacy, nation-building as foreign policy, protectionism and the regulation of personal behavior. A lifelong adherent to traditional principles.

LIBERAL, adj. Committed to the proposition that all men and women are endowed by their creator with certain inalienable traits and that among these are asexuality, dispossession and atheism.

REPUBLICAN, n. An American Partisan committed to a government at, to and upon the people.

DEMOCRAT, n. An American partisan commited to a centralized government of, by and for marginalized people.

PARTISANSHIP, n. The fountain of loyalty, river of punditry and the mud of effluent hypocrisy.

stanley said...

purpose of this post is to see I can make the i and b format work

[doug, paul, etal, say] whatever...

gosh it's hard to keep up great minds...perhaps if post started with a brief summary, eg,

In a sentence: Just because the law, society, does not, “mandate review and accountability” does not mean there is absolutely no means of “review and accountability” it just likely means that it is in someone else’s hands, and some else’s responsibility and – choice.

but all worth a read...cause I do pick up humorous phrases which I think I get and enjoy, eg, the mud of effluent hypocrisy.

stanley

Doug said...

Nice work, Brer Stanley.