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HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 4237


The Commonwealth of Massachusetts




House of Representatives, June 30, 2014.

BILL #:  H4063

BILL STATUS:  Favorable with Amendment





For the committee,


HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 4237

By [SPONSOR PREFIX] [SPONSOR NAME] of [SPONSOR CITY], a petition (accompanied by bill, House, No. 4237) of [PETITIONERS LIST] [BACKING TEXT].  Senate Ways and Means. 


The Commonwealth of Massachusetts



In the Year Two Thousand Fourteen



An Act relative to real lives.


              Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

              SECTION 1.  Chapter 19B of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by inserting the following 3 sections:-

              Section 19. (a) As used in this section and sections 20 and 21, the following words shall have the following meanings:-

              “Department”, the department of developmental services.

              “Fiscal intermediary”, a financial management service or fiscal intermediary to assist an individual who self-directs in disbursing funds allocated to an individual in their individual budget and in accordance with their person-centered plan. The intermediary shall work at the direction of the individual or an appointed designee identified in the person-centered plan.

              “Individual”, an individual eligible to receive services through the department of developmental services.

              “Individual budget”, a dollar amount for goods, services and supports specified in the person- centered plan that is under the control and direction of the individual.

              “Person-centered plan”, a plan of service for individuals who elect to participate in self-direction.

              “Self-determination”, an approach to providing services that underpins a self-direction model of service delivery.

              “Self-direction”, a model of service delivery in which services and supports are person-centered, person-defined and person-controlled.  Self-direction in a service delivery system includes features ensuring that:

              (1) the individual is central to and directs the decision making process that will determine which supports are utilized;

              (2) the individual has easy access to information, options, services and supports to enable the individual to self-direct;

              (3) the service system is flexible so that the individual can tailor their support to meet their unique needs.

              “Support broker”, a person chosen by an individual participating in self-direction to assist as dictated by the individual in the development and execution of the person-center plan. This role can include but is not limited to adviser, advocate, facilitator and support staff.

              (b) The department shall establish a self-determination advisory board to evaluate and advise the department on efforts to implement self-direction and to participate in educational outreach efforts on self-direction. The board shall include individuals participating in self-direction, family members of individuals participating in self- direction, providers, service brokers, and representatives of advocacy organizations, including but not limited to: The Arc of Massachusetts, Massachusetts Developmental Disabilities Council, Massachusetts Families Organizing for Change, Massachusetts Advocates Standing Strong, Advocates for Autism of Massachusetts, Massachusetts Down Syndrome Congress, Disability Law Center and the Association of Developmental Disabilities Providers.

              (c) All persons eligible for services through the department shall be eligible for self-direction, including persons with complex medical or behavioral conditions, persons with profound intellectual impairments and persons eligible for services through special eligibility.

              (d) The department shall provide information about self-direction to all persons eligible for services through the department upon: (i) the notification to a person of their priority for services; (ii) the beginning of the development of an individual support plan; (iii) the beginning of the renewal of an individual support plan; and (iv) the annual notification of persons who have declined an individual support plan of their option to participate in the individual support plan process.

              (e) The department shall publish information on self-direction options annually and shall make this information available to the public on the department’s website and shall release any addition information upon request. The department, in collaboration with the advocacy organizations represented on the self-determination advisory board, shall hold educational forums with families and individuals to provide information about self-direction annually in each service region.

              (f) The department, in collaboration with the advocacy organizations represented on the self-determination advisory board, shall hold meetings annually with providers to discuss self-direction, how providers can participate, what it means to the present purchase of service system, and how the department can work with providers to establish self-directed choices within the service system The department may offer introductory and on-going training to providers and provider staff on the subjects of self-determination, self-direction and the related elements of person-centered planning and individual budgeting.

              (g)The department shall educate all staff, except for staff classified as janitorial, maintenance, or secretarial, on self-direction annually.

                (h) For individuals who choose self-direction, the department shall implement a person-centered planning process. The individual shall direct the development of the person-centered plan and select who is involved in the planning process.

              (i) Individuals who choose to self-direct shall receive an allocation of resources based on their assessed needs. The amount of allocation and development of an individual budget shall be determined through a person-centered plan. The individual or a legal representative designated by the individual shall be able to utilize resources allocated to them through the individual budget to choose which services and supports best serve the individual’s needs and are consistent with meeting goals developed in line with a person-centered plan.

              (j) At the time an individual budget is determined, case managers shall inform the individual that he or she has control over his or her individual budget. The individual shall then have the choice to self-direct services. Case managers shall provide informational materials to individuals as developed by the department about self-direction. Individuals may choose to self-direct all, part, or none of their budget. If the individual declines self-direction in any service need, the individual supports plan procedures will be used to identify the supports needed.

              (k)(1) Individuals who choose to self-direct shall have access to a support broker to assist in the development of a plan of service and an individual budget in the person-centered planning process, to assist in the purchase of services and to assist in monitoring expenditures through the year. The support broker shall be made available through the department or through a qualified private sector broker of the individual’s choice. The department shall establish basic competencies that must be met in order to qualify private sector or public sector support brokers in consultation with the self-determination advisory board. (2) Individuals who choose to self-direct shall have access to a state-designated or other qualified fiscal intermediary of the individual’s choice to assist in the execution of the purchase of services. (3) If an individual chooses to utilize a private sector support broker, an allocation for the purchase of this service shall be included in the individual’s budget. If an individual chooses to utilize a private sector fiscal intermediary, an allocation for the purchase of this service shall be included in the individual’s budget.                           

              (l) Individuals who choose to self-direct shall be surveyed at least once annually about their experiences with self-direction and potential improvements to the self-direction model and its overall operation.

              (m) The department shall provide an annual report, after consultation with the self-determination advisory board, to the joint committee on children, families and persons with disabilities documenting progress in terms of numbers served through self-direction, ongoing improvements to the department’s self-direction program and challenges related to the department’s self-direction programs. The annual report shall include an analysis of the annual survey of individuals participating in self-direction mandated in subsection (l) and strategies to address the issues identified in these surveys.

              (n) The department shall utilize the Home and Community Based Waivers to maximize federal reimbursement for services rendered through self-direction and related models. As necessary, the department and executive office of health and human services shall amend the waiver and take any other steps to ensure that activities or services can be implemented to achieve goals under person-centered plans for individuals.             

              Section 20. The department shall establish a contingency fund to assist: (1) individuals in need of services; (2) individuals who participate or wish to participate in self-direction or self-determination; (3) individuals with unanticipated, emergency or changing needs; (4) in the case of an individual who chooses to leave a group living arrangement, in order to mitigate impact to providers. The fund shall be comprised of 40% of the savings from the closure of Templeton and other funds as they may be available within the department’s budget and at its discretion. The department shall make every effort to ensure that the fund retains sufficient funds for individuals utilizing self-determination and provider mitigation throughout the fiscal year.  The department shall develop a policy related to the fund for individuals utilizing self-direction with the assistance of the self-determination advisory board.

              Section 21. (a) Individuals and their guardians shall have choice of department services or qualified providers and shall be free to change the individual’s services or service provider.  When an individual or their guardian requests a change, the department shall initiate the process for requested changes as soon as possible.

              (b) Upon receiving a request from an individual or their guardian for a change of service or service provider, the individual or their guardian and the provider shall take steps to see if a resolution to the situation can be reached. If, at any time, the individual feels that a resolution to the situation cannot be reached, the individual or their guardian can request that the following process be initiated within 7 days of the individual or their guardian notifying the department: (1) the department shall assist the individual in developing an alternative living situation, and both the department and the individual will make a good faith effort to determine a suitable alternative; (2) the department shall work in conjunction with the individual to transfer to an available alternative as expeditiously as possible and taking no longer than 90 days; (3) as necessary, the department will work with the provider of the residence or group living situation to ensure stability, including the use of the contingency fund for mitigation established in section 20 of this chapter.

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