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Archive for April, 2015

The HW&M budget has great news for sheltered workshops, not so good news for state care in general

April 20, 2015 2 comments

The great news is the House Ways and Means Committee re-inserted protective language last week in the proposed Fiscal Year 2016 state budget that would protect vital sheltered workshops from closure.

Representative Brian Dempsey, chair of the committee, who was instrumental last year in keeping the workshops open, has renewed his commitment to those facilities in this year’s budget go-round with the administration.

The bad news is that the House Ways and Means budget continues to squeeze state-run programs for the developmentally disabled and maintains the administration’s disproportionate increase in proposed funding for the corporate, provider-run group home system.  But let’s look at the good news first.

Last spring, after a lobbying campaign by advocates of the workshops, Dempsey placed language in the House Ways and Means version of the current-year budget, stating that DDS “shall not reduce the availability or decrease funding for sheltered workshops serving persons with disabilities who voluntarily seek or wish to retain such employment services.”  The protective language survived a House-Senate conference committee in June, largely due to Dempsey’s support.

While that protective language in the budget appeared to offer the workshops an indefinite reprieve, the proposed fiscal 2016 budget submitted by Governor Charlie Baker in March removed the language.  As a result, the workshop supporters went to work once again in the past month, calling Dempsey’s office and urging their local legislators to reinstate his language.

Dempsey did reinstate the language; and in a conference call last week concerning the House Ways and Means budget plan, DDS Commissioner Elin Howe indicated that the administration did not intend to file any amendments to remove the language from the budget legislation.  It also appears that organizations representing corporate DDS providers, such as the Association of Developmental Disabilities Providers, have not filed amendments to close the workshops.

It is now up to the Senate and specifically to Senator Karen Spilka, the chair of the Senate Ways and Means Committee, to follow Rep. Dempsey’s lead and insert the same protective language in the Senate budget.

The workshops first came under attack from the administration of then Governor Deval Patrick, which targeted them for closure as of this coming June, arguing that they were “segregating” disabled persons from their peers in the mainstream workforce.  But families of the workshop participants fought back.  They maintain that the facilities are fully integrated into the surrounding communities and provide the participants with meaningful activities and valuable skills.

Sheltered workshops provide developmentally disabled persons with a range of assembly jobs and other types of work, usually for a small wage.

Meanwhile, the bad news we were talking about largely concerns funding for DDS group homes, remaining developmental centers, and service coordinators.  The House Ways and Means budget proposal would cut the developmental center line item even deeper than Governor Baker has proposed and would reduce the service coordinator line item below the amount proposed by the governor.  It would also fund the state-operated group homes at a level below what DDS considers a “maintenance level.”

While the state has closed three of six existing developmental centers since 2008 and is in the process of closing a fourth, funding appropriated to run the remaining three centers may have dropped too fast to maintain existing services in those facilities.  As we recently noted,  years of cuts in the developmental-center line item have lately resulted in the closing of several cottages at the Wrentham Developmental Center, requiring residents to be moved from long-time residential locations.

The Wrentham Center has become a major destination for persons transferred from the developmental centers that have been closed in recent years.

While Governor Baker’s fiscal 2016 budget would cut the developmental center line item by about $375,000 from projected spending, the House Ways and Means budget would cut it by $1 million beyond that.

DDS-operated group homes would get the same amount in fiscal 2016 under the House Ways and Means budget as under the governor’s version of the budget, which amounts to a $2 million reduction from what DDS considers a “maintenance budget.”

Also, the House Ways and Means budget would fund the DDS line item that pays service coordinators at a level $538,000 less than what Baker has proposed.   In March, DDS Commissioner Howe had said Baker’s budget would fund the service coordinator line item at $1.8 million below what DDS had requested.  So the House Ways and Means budget further reduces that proposed funding for the service coordinators next year by more than half a million dollars.

The service coordinators, whom Howe has referred to as “the heart and soul” of DDS, are responsible for ensuring that clients throughout the system are receiving services to which they are entitled.  The service coordinators have seen their caseloads rise dramatically in recent years.

In last week’s conference call, Howe noted the shortfalls in funding under the House Ways and Means budget for the developmental centers, DDS-operated group homes, and service coordinators.  But in what may be a sign of the priority that this administration places on these services, Howe said the Department did not plan to seek amendments to the House budget to increase that funding.

At the same time, the House Ways and Means budget preserves a major funding increase to the corporate providers in the coming fiscal year.  The Ways and Means plan provides for the same $35 million increase from the current year for the DDS corporate residential line item that Baker has proposed.  As of July, this line item will have been increased by more than 28 percent since the filing of a lawsuit by the corporate providers in June 2014 against the then Patrick administration.

While we understand that direct-care workers in corporate, provider-operated group homes are woefully underpaid, it’s not clear how much of the additional funding being sent to the providers is, or will be, going to those workers.  As we have noted, the hundreds of executives working for those provider agencies in Massachusetts have been making out quite well.

The Baker administration is apparently fine with that state of affairs. Terming the House Ways and Means plan “a very reasonable budget,” Howe pointed out that it would add $17 million to the DDS bottom line compared to the governor’s budget.  Under the House Ways and Means budget, the Community Day and Work line item would be almost $10 million higher than what the governor proposed.

The House Ways and Means budget also would provide $12.4 million under a new DDS line item to implement the expansion of DDS eligibility to people with autism, Prader-Willi, and Smith-Magenis Syndrome.

While that expansion of eligibility funding is certainly needed, the Senate has a lot of other work in store for it as well.  We hope that in addition to protecting the sheltered workshops, the Senate begins to address the imbalance in the budget between corporate and state-run DDS care.

Human service providers’ lawsuit boosts their state funding despite deficit

April 7, 2015 4 comments

While programs and services are being cut throughout state government as a result of projected budget shortfalls, corporate human services providers have gotten hundreds of millions of dollars in additional state funding due, at least in part, to a lawsuit they filed against the state.

The irony is that the U.S. Supreme Court has just ruled in a separate case that providers cannot sue to raise Medicaid service rates. So, it’s not clear to us that the Massachusetts providers were on solid legal ground in filing their lawsuit.

In June 2014, the providers sued the then Patrick administration, arguing that the administration was not boosting state funding to them fast enough to satisfy a timetable set in a 2008 law known as Chapter 257.  Chapter 257 established formulas and timetables for increasing provider funding rates.

As a result of the lawsuit, both the Patrick administration and the incoming Baker administration approved major funding increases to the provider-run group-home line item in the Department of Developmental Services budget, even as it was becoming clear the state was facing major budget shortfalls in the current and coming fiscal years.

In a press release issued on March 4, the day he submitted his Fiscal Year 2016 budget to the Legislature, Governor Baker stated that his administration had allocated $30 million “to resolve litigation and adjust Chapter 257 rates for human service providers.”

The $30 million referred to in the governor’s press release may have understated the impact of the lawsuit. Baker’s proposed funding for the provider group-home line item in the DDS budget for fiscal 2016 is more than $230 million higher than the amount appropriated for that line item in fiscal 2014 when the provider lawsuit was filed.  That is a 28 percent increase.

In contrast, the line item for the state developmental centers would be cut in that same period by almost 9 percent, and state-operated group homes would get an increase of about 13 percent in that time period.

In what sounds like a similar lawsuit to the the litigation in Massachusetts, service providers in Idaho had argued in federal court that Idaho had failed to raise Medicaid payments to them as outlined in a federally approved formula.   But the U.S. Supreme Court ruled on March 31 that private providers cannot sue for higher Medicaid reimbursement rates.

In the suit filed by the Massachusetts providers, state Superior Court Judge Mitchell Kaplan ruled in January that the state had violated Chapter 257 by not setting higher rates for providers.  In response to the suit, the then Patrick administration had initially argued that Chapter 257 could be fulfilled only if the state itself had adequate revenues to do so.

But Judge Kaplan ruled that the state had to comply with the higher rates required under Chapter 257 regardless of whether the funding was available or not.  That would mean that in order to fulfill the requirements of Chapter 257, funding would have to be cut in other areas, which is what has happened.

Like the Idaho providers, the Massachusetts providers had argued that the inadequacy of the state funding was causing them to fail to keep up with rising costs and was resulting in lower paid staff and high staff turnover as well as poorer quality services.  We have maintained, though, that the funding has been adequate to support high salaries for executives running the provider corporations.  Close to $100 million a year is spent on those executive salaries in Massachusetts.

As we’ve noted before, the major funding increases in the provider line item in the past year have increased an already existing imbalance in funding between that line item and accounts for state-run services.

One example of that imbalance is the state-run developmental center line item, which will be some $10.6 million less under Baker’s fiscal 2016 budget than it was in fiscal 2014.  This has led to the necessity of closing several cottages at the Wrentham Developmental Center in the past several months, requiring residents to be moved from long-time residential locations.

An April 2 memo sent to Wrentham Center staff referred to an “immense challenge” in meeting budget constraints facing the Center in the current fiscal year, and a “yet another difficult budget forecast for Fiscal Year 2016.”

At the time the Massachusetts providers filed their suit, a spokesman for the providers explained that they had rejected an offer from the then Patrick administration to meet them more than part-way by providing 90 percent of the full funding increase specified under Chapter 257 as of January 2015.

“…in the end, it wasn’t enough,” the spokesman for the providers said. “At this point, we’ve been as patient as we can be and the law is the law and we want the Commonwealth to abide by the law. Every day that full implementation is delayed, the imbalance and the unfairness grows.”

The providers and the Baker administration, however, do not seem to be as concerned about the continuing and growing imbalance in funding between provider and state-run services.

Following the money on three new DDS-related laws

More than five months ago, three important pieces of legislation affecting people with developmental disabilities were ceremonially signed into law with a lot of fanfare by then Governor Patrick; but there has been little information since about the status of these new laws.

We are attempting to find out via Public Records law requests to the Department of Developmental Services what is being done to implement these laws, how much it all will cost, and where the money is going.  The Department does not seem eager to part with that information voluntarily.

1.  National Background Check law: This new law authorizes national criminal background checks for persons hired to work in an unsupervised capacity with persons with developmental disabilities.  It will ultimately require that both current and prospective caregivers in the DDS system submit their fingerprints to a federal database maintained by the FBI.

We previously reported that the requirements under this law have been delayed by up to four years.

On March 2, we sent in information request to DDS, asking what steps the Department had taken to implement the law and whether the Department has finally applied for grant funds available since 2010 from the federal Centers for Medicare and Medicaid Services under the Affordable Care Act to design a national background check program.

To date, despite a follow-up email on March 30, we have received no response from the Department to our questions.  As a result, we submitted a Public Records request to the Department on March 31, asking for all reports, memoranda, and other records that concern those issues.  Legally, state agencies do not have to respond to information requests, but they do have to respond within 10 days to requests for public records.

More than a year and a half ago, a DDS administrator said the Department had not applied for an ACA grant, which can be as high as $3 million per state, because the legislation authorizing national background checks in Massachusetts had not yet been passed.

 2. The ‘Real Lives’ law:  This law introduces what is called “person-centered planning” in providing care and services to persons with developmental disabilities.

On March 3, we submitted a Public Records request to DDS, seeking records pertaining to all payments made by the Department in Fiscal Years 2014 and 2015 to a company called Public Partnerships, LLC.  According to a DDS website PowerPoint document, Public Partnerships has begun contracting with DDS to provide “individualized fiscal intermediary” or financial management services to participants in the Real Lives program.

While the Real Lives law is touted as providing individuals with more choice and “self determination” in the services they receive from DDS, we are concerned the law will transfer decision-making authority from guardians and family members of disabled individuals to private financial management companies.

Thus far, it is unclear exactly what services Public Partnerships has or will provide under the law and how much it has or will be paid to do so.  The DDS PowerPoint states that the financial management services “may include” fiscal accounting, tax withholding, criminal background checks, and other services.  The PowerPoint provides no specifics, however.

As of early March, it did not appear that DDS had yet developed policies or regulations regarding the Real Lives law, and more specifically concerning the nature of the financial management services that will be used under the law.  The most recent policy statement from DDS concerning “self-determination” is dated January 2010.

Public Partnerships is not new to contracting with DDS.  The firm received $14 million in funding from DDS in Fiscal Year 2014, according to an online state site that tracks spending on human services contractors. It was not clear what services Public Partnerships provided to DDS in fiscal 2014.

The state’s Open Checkbook website listed a total of $10.9 million in DDS payments to Public Partnerships so far in the current fiscal year. The website, however, also does not specify the services provided for that funding.

Public Partnerships bills itself on its website as “a full-service financial management services firm dedicated solely to providing fiscal/employer agent, third party administrator, and related support services to public agencies.”  The site adds that the firm helps state, county, and local public agencies “implement a participant-directed service model.”

Audited financial statements for the company and a Colorado affiliate, available on the state contractor site, disclose that Public Partnerships and its Colorado affiliate received more than $1 billion in total revenues in fiscal 2014.  Public Partnerships is a subsidiary of Public Consulting Group, a Boston-based consulting firm, which has received $3.3 million so far in the current fiscal year from several agencies in the Executive Office of Health and Human Services.

3. The DDS eligibility law:  In September 2014, we first asked DDS for information on the funding available to carry out this new law, which requires that the Department expand services to include persons with autism and conditions known as Prader-Willi and Smith-Magenis Syndrome. We received no response to that request for information.

Then on March 2 of this year,  we sent an email to the DDS commissioner, asking whether the Department has developed a cost estimate for expanding services under the new law and what that estimate might be.  Having received no response to that question, we have asked in a Public Records request for reports, memoranda, and other documents that concern the potential cost of the new law.

You may wonder why we have even bothered to send information queries to DDS, given that they don’t seem to respond to them.  The answer is they have, at times, responded to those queries.  In the past year or so, it seems, they’ve stopped responding.  It’s hard to say why. Maybe they they’ve adopted a new policy of circling the wagons and cutting off information.

But the way an agency such as DDS chooses to — or is required to — spend taxpayer dollars is its most basic function and a subject of overriding public interest.  Keeping information bottled up may serve the interest of some administrators, but it is not in the public interest.