Another full day of activity surrounded the Blue Ribbon Commission as we gathered at MDH on February 21. The disability services sector was on the docket for the day so I was ready to go as we launched into the various topics. Below you will find a summary of the issues and the outcome of the discussion
Curb the Growth and Use of Residential Services: This strategy included multiple sub-strategies to reduce use and curb the growth of residential services in the disability waiver programs.
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Align corporate residential billing with rate framework: This sub-strategy would place limits on the number of billable days for Corporate Foster Care and Supportive Living Services to align with the absence factor in the rate methodology. DWRS establishes service rates through a formula comprised of cost components such as staff wages, employee benefits, programs costs and administrative costs. The absence and utilization factor is a cost component in the DWRS frameworks intended to cover the costs incurred by a provider when the person is gone from the home and the provider cannot bill for services as planned. The factor accounts for approximately 14 absence days per year. While the rate methodology increases the daily rate to account for these absent days a provider is able to bill the increased rate regardless of how many absent days actually occur. If a person is in the home 365 days a year the provider can bill every day even though they receive compensation for assumed absences. This sub-strategy would ensure that if a person was in the home for more than 351 days in a year the provider would only bill for 351 days to be consistent with the rate methodology. I was the only BRC member who voiced opposition to keeping this on the table for further discussion. I spoke out against this proposal but others on the BRC thought that we needed additional information before we remove it altogether so for now it remains as a strategy that we need to further explore. Estimated savings of $20 million.
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Curb customized living service rate growth: So many questions, not enough answers. This strategy calls for placing limits on the number of discrete units allowable to determine the daily rate to prevent future rate growth from occurring. DHS reports a double digit grown in people receiving unit based services but were not able to adequately explain where the growth is coming from or why. DHS will investigate further and consider bringing it back this Spring for additional consideration by the BRC. Estimated savings $1-$10 million.
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Support planning for people who want to move: Providing additional support planning assistance to people receiving disability waiver services who indicate that they prefer to move out of CFC or customized living. There was consensus that there were many barriers identified that it’s likely that this strategy is not achievable in the timeframe that the BRC has to work with so it’s unlikely that this topic will remain on the table. Estimated savings undetermined.
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Bed closure targets and rate reform for foster care: This strategy proposed that we would need to update the rates statute to derive cost savings from individual bed closures. DHS would achieve a defined cost savings target by reducing current corporate foster care capacity and the statewide corporate foster care moratorium maximum. I spoke out strongly against this strategy and in the end the other BRC members agreed with me and we moved this off the table for any additional discussion.
Discontinue grant programs: There are two grants that no longer serve the purpose under which the legislature authorized them. There was consensus from the BRC that there was merit to keeping the strategies on the table for possible inclusion in the Action Plan.
Absence factor in day services: The recommended strategy calls for a reduction in the absence factor for day services from 9.4% to 4.5% with an estimated savings of $6 million. I voiced my concerns that were expressed in a very detailed letter submitted by MOHR as well as two day service providers (MSS and Rise). In the end the BRC kept this strategy on the table for further consideration.
Family Foster Care Rate Reform: This strategy calls for replacing the rate methodology with a new tiered rate structure for family foster care providers because, according to a January 2020 report from DHS, the current rate methodology does not appropriately reflect the nature of the service. Rates would be automatically assigned to one of six tiers according to a person’s level of needs. There was also an additional strategy that called for supporting the implementation of a new Life Sharing model. The FFC Rate reform strategy will remain on the table for further consideration. Estimated savings are $10-$20 million.
Sue Schettle
sschettle@arrm.org