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Posts Tagged ‘cost of care’

Update on our requests for cost records

September 16, 2011 3 comments

After a month and a half, it’s troubling that the Patrick administration is apparently still unable to locate cost records we requested pertaining to a single community-based group home contract.

I just received a letter from the Department of Developmental Services, dated September 14, that they are in the process of searching for the documents, which I had requested on July 29.   Meanwhile, the MassHealth Privacy Office in the Executive Office of Health and Human Services has been searching for these same records since August 9.

To recap, we’ve been trying to find out the sources of state funding for medical, nursing, clinical, and therapeutic services in a single DDS group home program run by the May Institute, a private provider.  We have a copy of a $1.2 million contract with the May Institute, which provides for 24-hour residential services under the program for 14 individuals in four residences in the DDS Central Middlesex Area.

The FY 2009 contract, however, only provides for direct care and limited nursing services for the 14 residents.  It does not mention medical, extended nursing, clinical or therapeutic services.

From what we’ve been able to determine, the administration has been basing its $20 million annual cost savings estimate in closing the Templeton, Monson, and Glavin Developmental Centers on a comparison of their budgets with the cost of community-based group contracts such as the May Institute contract.  But here’s the rub.  Our understanding is that the Templeton, Monson, and Glavin budgets do provide for medical, extended nursing, clinical, and therapeutic services. 

Naturally, the community system will appear to be less expensive than the developmental centers if certain community-based costs are not taken into account.  That’s why we want to find out exactly how much is being paid to fund those additional services to which the May Institute residents are reportedly entitled, and where that money is coming from.

By the way, we originally asked DDS on July 7 for the budgets of the Monson, Templeton, and Glavin Centers.   A month later, we received a one-page document from the department with single, line-item amounts representing the total annual spending for each facility.  There was no budgetary breakdown whatsoever for the facilities.

We appealed to the state’s Public Records Division for help, explaining that a budget of a state facility involves more than just a single line item.  As a result, I received a second letter from DDS, also dated September 14, stating that the department was in the process of searching for the “additional (budgetary breakdown) information” I had requested. 

I guess DDS considers a budget and a “budgetary breakdown” to be entirely separate concepts.  Stay tuned.

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Once again, we’re waiting for the administration’s cost records

August 30, 2011 1 comment

It has been more than a month since we asked Secretary of Health and Human Services JudyAnn Bigby for public records detailing the costs of specified services in a particular group home program for intellectually disabled persons in Massachusetts.

It has been almost two months since we asked Commissioner of Developmental Services Elin Howe for the budgets of the Templeton, Monson, and Glavin developmental centers.

To date, we’ve received neither set of records.

As we’ve previously noted here, we’ve been attempting to compare the cost of an apparently typical vendor-run group home program with the three developmental centers.  We wanted to see whether the Patrick administration was comparing apples to apples in claiming to the Legislature in the last two fiscal years that closing the Templeton, Monson, and Glavin centers will save tens of millions in state funds.

As we reported,  a group home contract, which we did receive last May from DDS, specified a yearly cost per resident of $104,400.  In its cost savings analysis, the administration compared a very similar residential cost based on group home contracts with an average calculated cost of care at Templeton, Monson, and Glavin.

The potential problem with the administration’s analysis that we found in examining the single group home contract was that it specified budgeted costs for only direct-care, supervisory, and minimal nursing staff.  What about the extensive nursing, medical, clinical, and therapeutic staffing that exists at the developmental centers and to which the residents of DDS group homes are entitled? 

The fact that those additional medical, clinical, and therapeutic costs were not in the group home contract we examined appeared to raise the question whether the administration’s savings analysis was accurate.   One immediate question was: if those additional costs are not paid through DDS contracts, how are they paid?  Secondly, what is the total amount of those community-based costs that the administration may have missed in its analysis?

Once we get the answers to those questions, we can determine for ourselves whether there would be a savings or not in closing the developmental centers.

On July 29, we sent Public Records requests to both Secretary Bigby and Commissioner Howe, asking for copies of any documents detailing funding for medical, nursing, clinical, and therapeutic services for individuals residing in the community-based group home program we had selected for review.  About three weeks prior to that, we had asked DDS for the Templeton, Monson, and Glavin budgets for the same time periods as the group home contract. 

On August 9, I received a letter from the records custodian at EOHHS, stating that the agency was in the process of identifying the records we had requested regarding the group home contract.  Last week, I called the records custodian, and was told EOHHS was still working on our request.  He wasn’t able to tell me when the records would be found.

We’ve appealed to the Public Records Division for the Templeton, Monson, and Glavin budget documents.  We’re close to filing an appeal for the group home contract records.

But one piece of useful information may have emerged here.  The fact that the August 9 response to our request came from EOHHS and not from DDS does appear to confirm that it is not DDS, but some other source at EOHHS, that funds medical, clinical, and therapeutic services in the DDS vendor-run group home system.  We believe that other source of funding is MassHealth. 

In any event, it’s getting clearer and clearer that the administration wasn’t counting all the community-based costs of care it incurs when it told the Legislature there would be major savings in closing the developmental centers.