Regional Center Coordination
- Participating Physician Groups (PPG)
- Los Angeles
- San Diego
- San Joaquin
Regional centers are private, non-profit corporations under contract with the California Department of Developmental Services (DDS). Their purpose is to provide or coordinate services and support for individuals with developmental disabilities. They provide a local resource to help find, plan, access, coordinate, and monitor the services and support to individuals and their families.
Primary care physicians (PCPs) must provide eligible Medi-Cal members identified with, or suspected of having, developmental disabilities with all medically necessary screenings, primary preventive care and diagnostic and treatment services. For members at risk of parenting a child with a developmental disability, Health Net covers genetic counseling and other prenatal genetic services.
Prior to receiving services from a regional center, a member must be eligible under one the following categories:
- Developmental disability - A developmental disability originates before an individual reaches age 18, continues, or can be expected to continue, indefinitely, and is a substantial disability. Developmental disabilities include intellectual disabilities, cerebral palsy, epilepsy, autism, and disabling conditions closely related to intellectual disabilities or requiring treatment similar to that required by people with intellectual disabilities.
- Infants and toddlers (ages 0-36 months) who are at risk of having developmental disabilities or who have a developmental delay may also qualify for the prevention program.
- Individuals at risk of parenting a child with a developmental disability may be eligible for genetic diagnosis, counseling and other preventive services.
There is no financial eligibility requirement for regional center services; however, parents are required to pay based on a sliding fee scale for out-of-home placement for children under age 18. Families are responsible for primary medical and health care for their children as well as those services normally provided to a child without disabilities. All members receiving services must be California residents and must apply to the regional center in whose catchment area they reside.
The regional center must accept for evaluation and eligibility assessment members believed to have a developmental disability. The initial intake must be performed within 15 business days following a request for assistance. Assessment must be performed within 120 business days, or within 60 days if a delay in initiating services would have a serious, negative effect on behavioral or physical development.
Determination of regional center eligibility is the responsibility of the regional center interdisciplinary team. The interdisciplinary team must include the service coordinator, a physician and a psychologist. The assessment includes collection and review of available medical history, diagnostic data, provision or procurement of necessary tests and evaluations, and summarization of developmental, intellectual and adaptive levels of functioning, as well as service needs.
Primary care physicians (PCPs) must assist the regional centers in obtaining medical records, diagnostic tests and specialty consultations needed to form a complete diagnosis.
If a member is not accepted by the regional center, Health Net's Medi-Cal Health Services Department confers with the referring physician and the family and coordinates referral to the Health Net public programs administrator for resolution.
Primary care physicians (PCPs) provide the following services to members who are clients of a regional center:
- Refer members to specialists and sub-specialists for treatment of complex medical problems
- Refer members to mental health care providers for diagnosis and treatment of mental health disorders outside the scope of the PCP's practice
- Refer members in need of prenatal genetic diagnostic services to state-approved prenatal diagnostic services
- Document all activities related to the referral in the member's medical record
Regional center staff determine eligibility and provide care management services to clients. Health Net public programs administrators resolve disputes that arise between the regional centers, Health Net and primary care physicians (PCPs). During the resolution period, Health Net's Medi-Cal Health Services Department and the PCP or specialty physician continue to manage the member's medical care.
Health Net's public programs administrators maintain routine interaction with the regional centers.
In situations where the child is eligible for both California Children's Services (CCS) and regional center services, the first referral is to CCS if diagnosis or treatment for CCS-eligible conditions is the major concern. The provider may want to notify CCS and the regional center simultaneously if both medical and early intervention services are necessary.
Individuals having, or suspected of having, a developmental disability may be referred to the regional center nearest the applicant's residence. Referrals from the primary care physician (PCP) are directed to the intake coordinator at the regional center and must include the reason for referral, complete medical history and physical examination, including developmental screens, the results of developmental assessments and psychological evaluations, and other diagnostic tests.
When the Health Net Medi-Cal Health Services Department or health assessment coordinators identify a member as eligible for regional center services, they contact the PCP or specialist to determine whether the member and his or her family have been informed of the available regional center services.
If a member was previously referred to or accepted by the regional center, the care manager assesses the case to determine whether further coordination services are needed. If services are no longer required, the Health Net Medi-Cal Health Services Department contacts the parent or guardian for approval to discuss the member's case with the regional center. At the request of the parent or guardian, the Health Net Medi-Cal Health Services Department may coordinate the family service plan with the regional center's case manager or service coordinator.
Regional centers are not responsible for providing direct medical or health care services, but do provide care management or service coordination for their clients, assuring health, developmental, social, and educational services throughout the lifetime of members who have a developmental disability. The following are some of the services and support provided by the regional centers:
- Information and referral
- Assessment and diagnosis
- Lifelong individualized planning and service coordination
- Purchase of necessary services included in the individual program plan
- Resource development
- Assistance in finding and using community and other resources
- Advocacy for the protection of legal, civil and service rights
- Early start program
- Genetic counseling
- Family support
- Planning, placement and monitoring for 24-hour out-of-home care
- Training and educational opportunities for individuals and families
- Community education about developmental disabilities