June 14, 2016:

For the past several months, the future of the Sonoma Developmental Center has been a major topic of discussion in Sacramento as part of the state’s annual budget process. The state fiscal year runs from July 1^st-June 30^th, and the Legislature is set to vote this Wednesday on a $122 billion budget framework for Fiscal Year 2016-2017 that includes a number of important provisions related to the closure of SDC.

In October of last year, the Department of Developmental Services (DDS) released their “Plan for the Closure of the Sonoma Developmental Center.” In order for the Plan to become effective, it requires Legislative approval. Since the Legislature returned in January, there have been numerous budget hearings and a special oversight hearing co-chaired by Senator Mike McGuire on the state’s plan to close SDC by the end of 2018. In addition to formal legislative hearings, DDS has also initiated a dialogue with the Transform SDC Coalition that has resulted in a series of facilitated conversations about key issues connected with the closure of the Center. Major topics of discussion include:

• State staffing: How can SDC retain essential health care personnel over the next few years as the Center closes, and staff start to leave for either retirement or other job opportunities? Also, how can the state create financial incentives for SDC staff to transition to working in community care facilities where their expertise is needed?
• Availability of adequate community care services: How are DDS and regional centers—California’s network of 21 independent, non-profit regional centers that coordinate services for California’s over 280,000 people with developmental disabilities—going to ensure that SDC residents leaving SDC will receive “appropriate services and support” as required by the Closure Plan? This includes housing suited to each person’s particular needs, and an array of specialized health care services.
• Health Care Services on the SDC Site: Will DDS support retention or expansion of care services for people with developmental disabilities on the SDC campus after closure? Concepts include an integrated health care center providing outpatient services, an acute crisis clinic to help stabilize individuals who have reached a crisis point in their community setting due to severe behavioral and/or psychiatric conditions, and a “placement center of last resort” to provide housing for those individuals who simply cannot succeed in community care settings.
• Site Planning: What are the state’s plans for SDC after closure? The Department of General Services (DGS) has requested $2.2 million in the FY 2016-2017 state budget for a site assessment (i.e. historical, architectural, environmental, engineering and economic) and to conduct “master planning” and an analysis of reuse alternatives for the property.

Federal Government Terminates ICF Funding

As we have known for many months, the state is committed to closing SDC by the end of 2018. One of the major reasons for the expedited closure timeline is the federal government’s termination of funding for SDC residential units that serve clients with intellectual and behavioral disabilities due to repeated findings of violations in care standards. Under threat of a complete withdrawal of federal funding for these “Intermediate Care Facility” (ICF) units, DDS entered into a settlement agreement last year with the Center for Medicare and Medicaid Services (CMS) that established the December 2018 closure date. Matters were made worse in February of this year when CMS found additional violations during inspection of care units. On May 13^th, CMS announced a termination of federal financial support effective June 30, 2016, resulting in a loss of approximately $26 million in annual funding. In response to this withdrawal of funding, the Legislature approved an additional $32.4 million in General Fund expenditures to ensure continued operation of the ICF units.

Summary of State Budget and Policy Decisions

As part of the budget process, the Legislature develops “trailer bills” that contain specific funding and policy directives for different agencies. This year’s trailer bill that addresses SDC closure and DDS oversight of community care services is SB 834. In summary, the legislation will require the following:

• Requires DDS to include an update as part of next year’s budget of how they will ensure access to crisis services after a DC closure, and how the state will maintain its role in providing residential services to those whom private sector vendors cannot or will not serve.
• Requires DDS to post on its Web site a monthly progress report regarding the development of residential capacity by each regional center.
• Requires DDS and DHCS to coordinate the transition of health care services for Medi-Cal eligible consumers transitioning from a DC.
• Requires DDS to develop and implement a plan to monitor, evaluate, and improve the quality of community-based services through the use of a “performance dashboard.”  Requires DDS to work with stakeholders on the development of the dashboard.
• Prohibits residential care homes from using physical restraints or containment for more than 15 consecutive minutes.
• Requires regional center vendors that provide crisis or residential services to report on a monthly basis their use of seclusion, restraints and involuntary emergency medication to control a client’s behavior.
• Authorizes DC employees to become regional center vendors prior to termination of their state employment with a goal of encouraging well-trained and experienced DC employees to become community service providers and assist with continuity of care.

What Happens Now?

At this point, DDS and the Legislature are very focused on how to expand and improve community services to absorb residents moving from SDC and other developmental centers that are closing in California. There have been no major breakthroughs yet in terms of an agreement for continuing services on site, but Supervisor Gorin, the Sonoma County Department of Health Services and the Transform SDC Coalition will continue to push for the vision of a health resource center on the SDC campus (See April 14^th blog post). The Northern STAR Acute Crisis Center will be funded for at least another year, so that provides some hope that we can work with the state to retain at least some health care services on the campus.

In addition, our facilitated dialogue with DDS will next take up the issue of a “placement center of last resort.” This concept was first acknowledged in the January 2014 DC Task Force Report issued by DDS and Health and Human Services Secretary Diana Dooley. The Report stated that “there must be a “placement of last resort” for individuals with significantly challenging behaviors. Consumers in crisis must always have a place to go when in need.” We are pushing for SDC to be the location for this type of facility.

Finally, the Department of General Services (DGS) will be expanding their site assessment of the SDC campus starting in early 2017. They are currently funding a historical resource assessment of the SDC buildings, and a “Phase 1” environmental assessment that looks at potential hazardous and toxic materials located on the SDC property. DGS has informed us that they intend to issue a request for proposals to qualified consulting firms to conduct the comprehensive site assessment in late 2016, with a goal of having a firm under contract by early 2017. We will report more about the site assessment process in a future blog post.

Please let us know if you have any questions or concerns about where things stand with SDC. You can email either Samantha Thomas (Samantha@sonomalandtrust.org) or John McCaull (johnm@sonomalandtrust.org) and we will be happy to get back to you with more information.