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Gov’s budget continues the cuts

January 30, 2012 Leave a comment

With a few exceptions, Governor Patrick’s proposed budget for the coming fiscal year, which he unveiled last week, appears to continue the trend in recent years of cutting funding for care for the intellectually disabled.

We see little to change our longstanding contention that the Department of Developmental Services community-based system, in particular, is not benefiting from the closures of four developmental centers.   A few years ago, Health and Human Services Secretary JudyAnn Bigby promised that as a result of the phasedowns and closures of the Fernald, Monson, Glavin, and Templeton developmental centers, some $45 million a year was going to be plowed back into the community-based system of care.

There’s no question but that the developmental centers line item (5930-1000) has been cut deeply as the state facilities have been phased down in recent years.  Under the governor’s FY 13 budget, this line item would be cut by an additional $20 million next year, a 13.1 percent reduction.  This brings the total cuts in funding for the developmental centers to $55 million since FY 09. 

But that found money does not appear to have benefited key community-based accounts such as Adult family supports, Turning 22, and the Salary Reserve to increase the static wages of direct-care human services workers in the community system.

First, let’s look at what would be increased in the governor’s FY 13 budget proposal for DDS and related accounts:

  • The  Community Day and Work line item (5920-2025) and the previous Transportation line item (5911-2000) would jointly be increased by $9.6 million under the governor’s proposal over current year spending.  It’s hard to compare these line items with last year, however, because they have been merged together for some reason in the governor’s budget for next year.  The Massachusetts Arc and the Association of Developmental Disabilities Providers are saying that the transportation component of the new line item is “short” by $3.1 million.  We’re not exactly sure what they mean by that.
  • The Community Residential Supports line item (5920-2000) would be increased by $31.6 million or 4.2 percent, while the State-Operated Group Home line item (5920-2010) would be increased by $12.9 million or 7.8 percent.  As we understand it, however, the increases in these line items are intended primarily to accomodate residents being transferred from developmental centers targeted for closure.  It’s unclear that anyone else in the community system will benefit from the increases.  The Arc/ADDP are saying the state-operated group home account is still “short” by $4.1 million.  Again, not sure what they mean.
  • The DDS Administrative line item (5911-1003) would be increased by $2 million or 3.4 percent.  This line item funds service coordinators, who arrange for services for clients in the community system.  But it’s not clear whether there would be any benefit in that increase to the service coordinators, who have faced layoffs in recent years as their caseloads have skyrocketed.  According to SEIU Local 509, a state employee union, the $2 million increase will cover negotiated salary increases within the DDS administration as well as office rental increases, while essentially level-funding staffing.

The rest of the DDS and DDS-related line items appear to be either cut or level-funded, which amounts to a cut relative to inflation.  They include the following: 

  • The Adult Family Supports line item (5920-3000) would be cut by $5.5 million or 11.8 percent.  This comes on top of cuts totaling 26.9 percent since FY 09.  Those cuts were only partially restored last year through supplemental funding.  The governor’s FY 13 proposal would wipe out that restoration.  We’re not sure why this account always gets cut so badly because it would provide funding for families to keep people at home, which was a critical component of the governor’s Community First initiative, as we understand it.  The Arc/ADDP are saying this reduction will hurt 2,000 families.
  • The Turning 22 line item (5920-5000) would be level-funded at $5 million.  This program has been cut by $2.7 million since FY 09.  The ARC/ADDP are saying the program needs $10.5 million (more than double its current appropriation) to fully serve 710 additional intellectually disabled students expected to graduate from school next year.
  • The Autism line item (5920-3010) would be essentially level funded at $4.6 million next year.
  • The Salary Reserve line item (4000-0017) to boost the pay of direct-care workers would once again receive zero in funding under the governor’s FY 13 budget.  The Arc/ADDP are calling this situation “devastating.”
  • The Department of Education/DDS line item (5948-0012) would be cut by $50,000 from current-year spending.  This is a joint program for youths with disabilities.
  • The Massachusetts Rehabilitation Commission Supported Employment line item (4120-3000) would be cut by $369,400 or 15.1 percent. 
  • The Massachusetts Day Habilitation and Adult Foster and Family Care accounts (4000-0700), which are funded by MassHealth, would be “funded at maintenance,” according to the Arc/ADDP.   This appears to mean that these programs would be maintained at their current levels next year.  They have both been sharply cut in recent years.

The bottom line line is that while the administation has seen the need to  continue its policy next year of cutting a wide range of community-based programs for the intellectually disabled, it hasn’t helped matters with its single-minded policy of closing the developmental centers.  Not only hasn’t the closure policy provided more community-based funding, but it has clearly delayed community-based placements for thousands of people waiting for that care.

 
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DDS stonewalling on cost, care information

January 24, 2012 1 comment

(Part 2 of 2-part series on transparency issues in the Patrick administration)

The Patrick adminstation contends it is striving to be “transparent” in the way it conducts the public’s business, and touts its Open Checkbook website among other initiatives.

But when it comes to getting public information from individual agencies within the administration, the record of transparency doesn’t always live up to the billing.  We think our own recent experience with the Department of Developmental Services is a case in point.

We’ve been fighting with DDS for several years over public information requests, but the agency’s disinclination in recent months to provide requested information seems to have gotten worse. 

It now takes months to get even the most minimal public records in response to our requests.   And DDS recently cited the letter of the Public Records Law in claiming they have no obligation to answer any questions about records that they have provided to us.  Also, in two cases in the past year, DDS cited confidentiality requirements in refusing to release what we think, in at least one of the cases, are clearly public documents.

Meanwhile, even a state lawmaker has been unable to get information out of DDS on deaths in the agency’s system.  State Rep. Anne Gobi, a Democrat from Spencer, wrote to DDS Commissioner Elin Howe in mid-October, asking for information on the number of residents who had been transfered from the developmental centers to community-based group homes and how many of those residents had died after the transfers.  As of this month, Gobi’s staff said she had not received any response to her inquiry.

Here are some more details about our efforts to get records and information from both DDS and the Executive Office of Health and Human Services:

  • In October, COFAR submitted a request similar to Gobi’s to DDS for information and public records concerning the number of developmental center residents who have been transferred to group homes since 2008 and the number of those residents who have died.

In that request, COFAR also asked for the number of community-based group homes that have been built to house former developmental center residents.  In early November, a DDS attorney responded that the agency was in the process of searching for the requested records.  There has been no further word since then.  We wrote to DDS on January 17, seeking an update on the status of our request, but have received no response to it.

  • In October, the DDS general counsel denied a request COFAR had first made in July for records detailing the costs of medical, nursing, clinical, and therapeutic services for individuals in a group home program operated by the May Institute, Inc.

COFAR initially filed the request for the records concerning the May Institute with both DDS and EOHHS.  In August, an EOHHS official responded that that agency was in the process of searching for the records.  Then, in September, a DDS attorney stated that DDS was searching for the same documents.

There has been no further word from EOHHS since August regarding the records.  In October, however, the DDS general counsel appeared to reverse the Department’s September position by stating that documents detailing funding for medical or clinical services for individuals would be part of their individual client records and therefore exempt from disclosure under the Public Records Law.

COFAR appealed the denial to the Supervisor of Public Records in October,  suggesting that DDS redact any names or any other information that might identify individual clients.  In the October appeal, COFAR maintained  that it was seeking only to find out the total cost to taxpayers of care for community-based clients such as those in the May Institute program.  Should DDS refuse to provide that information, “the public will have no way of knowing basic details about the provision and funding of these kinds of public services,” COFAR’s appeal added.

To date, the Public Records supervisor has not ruled on COFAR’s appeal.

DDS similarly denied a request in July from COFAR for information about the death of a man in a group home earlier that month, four days after he had been transferred there from the Templeton Center.   In that case, the Public Records Supervisor upheld DDS’s denial, accepting the Department’s argument that the information was private.

  • In July, COFAR asked DDS for detailed budgetary information regarding the Monson, Templeton, and Glavin developmental centers, which have been targeted by the administration for closure.  In response, DDS in August provided only a single line item amount for each facility, representing the total spending for that facility.  There was no budgetary breakdown of the line item for any of the facilities. 

 After COFAR appealed to the Public Records Supervisor, DDS, in late October, provided an “aggregated” spreadsheet containing numerous line items for all three developmental centers.  However, this time there was no separate breakdown for each facility.   Moreover, the total aggregated spending amounts for each of three fiscal years in the October response did not correspond with the totals provided in the August response.

As a result, COFAR sent an email to DDS asking why there was such a big difference, in particular, between the $176.3 million in total spending listed in the October spreadsheet for the three facilites  in FY 2009, and the $57.8 million listed in the August response for the same three facilities.

In a letter sent to COFAR in response, a DDS assistant general counsel wrote that the agency “is not required to answer questions…” under the Public Records Law.  So much for letting us, and the public, in on the inner workings of the state’s finances.

Earlier this month, an attorney with the Public Records Division, sent us a nice email, apologizing for the delay in responding to our October appeal regarding the May Institute documents, and saying:

I know that you are working very hard to help those in the Commonwealth who are the most in need, and that receiving records from custodian’s, like DDS, is a crucial part of assisting those individuals. 

Now, if only DDS wouldn’t balk at simple requests for information, and showed a dedication to following through on the administration’s claims of transparency.

Open Checkbook could be more open

January 19, 2012 1 comment

(Part 1 of a 2-part series on transparency issues in state government)

Despite its promises of greatly increasing government transparency, the Patrick administration’s new  Open Checkbook website  seems to me to fall a little short of the hype.

Open Checkbook was launched in December with lots of claims made about how it was going to give the average Internet user a powerful new lens into the inner workings of public finances.  The state budget office in conjunction with the Comptroller and Treasurer jointly instituted the website in response to legislation that sought to upgrade the state’s  relatively low ranking  in a state-by-state transparency survey by MassPIRG.

Open Checkbook is divided into two major sections, State Vendor Spending and Payroll & Pension Spending.  I found the vendor spending section to be  disappointing in one major respect.  It displays a lot of about where the money to vendors comes from, which is very good, but no information on where the money goes, i.e., how the vendors spend it.  (I haven’t yet tried out the Payroll & Pension Spending section.)

I used the vendor portion of Open Checkbook to look up one specific company, the May Institute, Inc., for Fiscal Year 2010.  This is the same nonprofit provider for which COFAR has unsuccessfully sought cost information lately from the Department of Developmental Services. 

I clicked on one particular category of funding for that vendor and got a long list of dates followed by  payment amounts.    By clicking on July 14, 2009, for instance, I was able to find out that DDS paid the May Institute $367,000 on that date for residential and day services.  It doesn’t appear to be possible to find out much more detail about that payment. 

What is good is that I was able to do a refined search, based on the residential and day services account, and find that a total of $26.9 million was paid to the May Institute under this account by DDS in FY 2010.

The bad news, as noted, is there is no way to track where the money goes after it gets to the vendor.   For instance, there there appeared to be no way to view administrative expenses for the May Institute or to find data on the compensation of executives of the agency.   It would seem that a checkbook should tell you about both incoming and outgoing funds.

Also, the site doesn’t display contracts, as some similar state sites do; and the data on Open Checkbook doesn’t go back before Fiscal Year 2010.  An official with the state budget office said displaying actual contracts is “on our list” for improving the site, but that hasn’t been decided yet. 

It’s also worth noting that much of the information available on Open Checkbook is available as well on the state’s longstanding Uniform Financial Report website for vendors.  In fact on the UFR website, you can find total payments to vendors broken down by government agency as well as spreadsheets that do show where the money is going, including amounts paid to executives of the vendor agencies.  (That salary information may be incomplete, in several cases, as we have reported.  But at least some of it is available.) 

The UFR site, for instance, shows that a total of $30.29 million was paid by DDS to the May Institute in FY 2010 as part of a total of $104.4 million in revenue to the vendor.  Admittedly, the information on the UFR site isn’t nearly as up to date as the Open Checkbook site.  But you can find a lot of information on the UFR site that isn’t available on Open Checkbook, such as the fact that the May Institute had $101.6 million in expenses in FY 2010, including $396,716 in compensation to its CEO and $56 million on direct care salaries.  Also the UFR information goes back to FY 2002.

What the UFR site doesn’t appear to show, which Open Checkbook does, is a breakdown of funding going to vendors per budgetary account, such as the Residential and Day Services account.

One other problem I had with Open Checkbook has to do with its presentation of a large amount of abbreviated or otherwise highly techical information.  For instance, the the funding listed for the May Institute was broken down into five categories on the site, including Grants to Nonpublic Entities, Legal Support Services, Medicaid, Purchased Human and Social Services for Clients/Non Medical, and a fifth and largest category dollarwise, titled “PurchH&Ss For Clit.Med/HC Rel (MM3).”    Spending under this category was listed as $23,047.235.83.  What exactly does “Clit.Med/HC Rel (MM3)” stand for?

I was able to hover my cursor over the acronym, and up came the following definition, which didn’t clear up the confusion very well.  The definition was:

Payments pursuant to contracts with organizations to purchase social services or programs with medical or healthcare related components on behalf of specifically identified clients or a specific target group.  Includes services rendered by an individual with payment to a corporate entity.  Federal funds are reported as sub-recipient payments.

The “MM3” part of the acroym is an object code classification for the payments.  The Open Checkbook site FAQ page states that individual object codes are defined in the “Expenditure Classification Handbook” maintained by the Comptroller’s Office.  But unfortunately, the link on Open Checkbook FAQ page  to the Comptroller’s Handbook didn’t work.

As administration officials have said, Open Checkbook is a work in progress.

Alleged assaulter of disabled man is a no-show on trial date

January 10, 2012 3 comments

Sheila Paquette’s  long-running quest to bring the man who allegedly assaulted her intellectually disabled brother to justice took yet another turn this week.

After months of delay, Monday, January 9, marked the date for the trial of John Saunders, a former care worker in the group home in which Paquette’s brother, John Burns, lives. 

The bad news is Saunders was a no-show at Falmouth District Court, to which Paquette and five witnesses in the case had traveled from their homes in western Massachusetts.  But Paquette was not deterred or defeated.  The good news is that the judge in the case ruled that Saunders had defaulted on his bail and should not be released prior to trial if he is picked up on a violation of any kind.

Saunders allegedly hit John Burns in the face while toileting him, causing two black eyes and other injuries.  The alleged incident occurred in June 2010, during an outing on Cape Cod on which Burns and other residents of his West Springfield-based group home had been taken.  Burns was subsequently fired by the group home, which is operated by the Center for Human Development, Inc.
 
The assault charges were filed in July 2010 by Burns’ sister and co-guardian, Sheila Paquette, after she became frustrated with the slow pace of state and law enforcement authorities in investigating the alleged assault.  Saunders, who is represented by a public defender, has previously denied the charges.  
 
“We were prepared for trial,” Paquette said this week.  The witnesses included a housemate of Burns who had witnessed the alleged assault.
 
Paquette said Monday’s court date marked the fourth time she has traveled from her home in western Massachusetts to attend pre-trial hearings scheduled on the case in Falmouth District Court.  “I asked the court how long can I afford to keep coming?”  she said.  “Everyone else gets paid to show up.  They get mileage and accommodations.  The victim pays.”
 

But Paquette said the judge’s ruling was “a really positive thing for us.  If he (Saunders) gets picked up, he’ll be in jail and there is no way he can avoid showing up for trial again.”  The question is when, if ever, Saunders will be picked up.  Police are unlikely to go looking for someone wanted for allegedly assaulting a disabled man.

Nevertheless, Paquette believes she is proving by sticking with the case that the system can be made to work for crime victims, even when those victims are intellectually disabled.  “The state and the public should know that we will take these cases to court,” she said.   She said she has started a legal fund to raise money not only to pursue her brother’s case, but to help others pursue similar prosecutions of assaults against people with disabilities.  “It’s a difficult process, and I think a lot of people are intimidated by it,” she said.   

The Disabled Persons Protection Commission concluded there was reasonable cause to believe Saunders had used excessive force and had physically assaulted Burns.  The Commission recommended that Saunders no longer be permitted to work with Department of Developmental Services clients, and cited Burns’ group home for failing to identify his injuries before sending him to his day program the morning after the alleged assault.
 

Paquette said her main concern now is that her brother may have become depressed in recent months and that his condition may be connected to the assault.  “It’s one more assault he couldn’t manage,” she said, noting that her brother had been assaulted on two occasions in group homes prior to the alleged assault by Saunders. 

 

Do we really want managed care for the disabled?

January 5, 2012 2 comments

Hang Lee struggled to get his words out in testifying on Wednesday morning before a packed public hearing in Boston on a proposal by the Patrick administration to introduce managed care into the delivery of services for the disabled.

Hang said he is concerned that under the proposal, he and thousands of other disabled people who are eligible for both Medicaid and Medicare, will see reduced funding for medical equipment and services they currently need and might need in the future. 

Hang suffers from cerebral palsy and scoliosis, debilitating and progressively worsening diseases of the spine and nervous system that he anticipates will leave him completely immobilized in a few years.  “I am in constant pain and emotional agony,” said Hang, his face contorted with the effort to speak each sentence.

He said he anticipates he will evenually need a body brace, which costs thousands of dollars.  “A cut in services means a reduction in funding for the brace,” he said.  

Hang was one of dozens of people, who are dually eligible for Medicaid and Medicare-funded services, who testified at the hearing held by the Executive Office of Health and Human Services.   Under the EOHHS proposal, private vendors, known as Integrated Care Organizations (or ICOs) would be hired to manage medical, prescription drug, and disability services to thousands of those people.

Medicaid helps fund a range of residential, employment, and other services for persons with disabilities, while Medicare funds medical care and prescription drugs for many of those same people.   The EOHHS maintains that their proposed system would cut costs of care by eliminating overlap, redundancies, and a lack of coordination between Medicaid and Medicare.  Medicare and Medicaid will spend a projected $3.85 billion in 2011 on health care for dual eligible adults ages 21-64 in Massachusetts, according to EOHHS.

COFAR and the SEIU Local 509 state employee union called for exempting the management of residential care, day and transportation, service coordination and other services from the proposal.    SEIU representative Stu Dickson maintained that while the union “agrees with the need to address needless costs of medical procedures, tests abuse, billing and administrative redundancies, etc., this is profoundly different than the care of human beings.”   Dickson contended that  in implementing the proposal, Massachusetts would compete with other states in a “race to the bottom” in care for the disabled.

“This proposal appears to be another step in this administration’s quest to privatize key services to the state’s most vulnerable people and to remove government from its responsibilities in that area,” I testified on behalf of COFAR.  

Even the human service providers are not sold on further privatization in this area.  In a December 16 email to members, the  Association of Developmental Disabilities Providers stated that “the Arc (of Massachusetts) and ADDP do not believe there is current research available that validates significant cost savings attained by turning over large parts of State Medicaid programs to  managed care companies.”

As did Hang, many in packed hearing on Wednesday said their main concerns were the retention of consumer choice and access once a corporate entity was making decisions on who gets what services. 

Other speakers maintained that they had spent years, in some cases, in finding doctors and therapists for their conditions and might lose those specialists under a managed care system.  “My doctors all work together,” one woman testified.  “My concern is I’m enrolled in a managed care plan and my doctors are not enrolled in it, what do I do?”

“We have to make sure the big corporations don’t just look at the bottom line,” said one man who relies on Medicaid-funded personal care attendants for his disability.

Others called for more planning for oversight of the ICOs, and more accountability.   Dale Mitchell of Ethos, a nonprofit provider of services to the elderly and disabled, called for an “independent care management entity” that would oversee the managed care system and prevent it from “chipping away at consumer control and input.”

Victoria Pulos of the Mass. Law Reform Institute said the involvement of consumer-based organizations is needed to establish “accountability systems” to oversee the ICOs.  And Laurie Martinelli of the National Alliance on Mental Illness maintained that the “role of families needs to be spelled out” in the EOHHS proposal, in addition to more planning for issues such as transportation of clients.

Let’s hope the folks at EOHHS are listening to all this.

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