June 2008 News

Announcements

• DelARF Holds Annual Meeting of Members: DelARF’s Annual Meeting will be held on Thursday, August 7th at the Christiana Hilton from 9:30 to 12:00. (Note new date, times, and location.) At the meeting, we will elect new officers, have a “year in review” and hear from our guest speaker, John Kemp, CEO of ACCSES, a national disability organization. ACCSES has taken the lead within the disability community in advocating for moratoria on the new CMS regulations described later in this newsletter. Mr. Kemp is widely respected for his many achievements. As a person born without legs and arms, Mr. Kemp has 30 years of experience in the disability community with a strong emphasis on government relations. He will talk to us about his work to delay the CMS regulations and ways for DelARF and its members to strengthen our government relations efforts here in Delaware. To reserve your spot, please send an email to Tina at tmoncrief@delarf.org. Thanks and I look forward to seeing you at the event.
• The first ever Disabilities Gubernatorial Forum: DelARF has joined with a coalition of organizations of and for people with disabilities throughout the state to offer the “first-ever” gubernatorial forum for all declared candidates for governor. The event will be held on July 17 from 5:00 to 7:00 pm at Terry Campus Conference Center in the Education and Technology Building at Delaware Technical & Community College, Terry Campus, in Dover. To date, John Carney, Jack Markell and Mike Protack have confirmed their attendance. Registration is now closed.
• Gubernatorial Candidate Jack Markell Releases Disability Plan: Gubernatorial candidate, Jack Markell, unveiled his “Plan for Improving Community Living for Delawareans with Disabilities” on June 17 at United Cerebral Palsy’s Camp Manito in Wilmington. He pledges to do the following if elected Governor:
  
  
  • Support the five-year plan of the Commission on Community-Based Alternatives for Individuals with Disabilities.
  • Improve access to and quality of home- and community- based long term care.
  • Provide grant funding so that local park and recreation offices and private fitness centers can improve accessibility for people with disabilities.
  • Ensure that Delaware disaster preparedness plans meet the needs of people with disabilities.
  • Start a statewide training program based on the nationally recognized Community Support Skills Standards.
    
  • Improve housing for Delawareans with disabilities.
  • Improve transportation for Delawareans with disabilities.
  • Increase state employment opportunities for people with disabilities.
  • You can read the full plan on our website.
• Calendar of Events: Our meeting schedule for June and trainings offered by our members can be found in our Calendar section. We update this monthly on our website so feel free to check in often.
• Commission Update: As a membership organization, much of our work and value comes from participation by members in our commission meetings. By attending, you will gain valuable information in a timely fashion AND will have an opportunity to share strategies with your colleagues. Now more than ever, this is important. For information about the role of each of our commissions, go to our Commission section.
  
  News from the May/June Commission Meetings: These meetings are open to all DelARF members and are listed on our calendar. Below you will find just some of the topics the groups discussed and their strategies going forward:
• Behavioral Health: The group held a brief business meeting and then welcomed DSAMH Division Director, Renata Henry who responded to a series of issues identified by the group and sent to her in advance. The topics included the following:
  
  
  • Status of FY09 Budget – What Providers Can Expect: For FY09 contracts, the division will be issuing them at the FY08 level based on the spending for the first 10 months of the year. Providers will be asked to provide an “impact statement” that will tell the department how this level of funding will impact services, e.g. a waiting list, etc. She encouraged members to not hesitate to tell her what the ramifications of this level of funding will be on those we serve.
  • DSAMH Plans for 09 and Beyond: She anticipates that many of the cost cutting measures will continue into FY10 but there may be some loosening on hiring. 2009 will bring many changes and we may see some “structural changes” where the departments and divisions take a closer look at duplication of services and some collapsing of administrative entities. There will also be a greater emphasis on outcomes and their measurement. A new governor may ask “what am I getting for the funds I am dispensing?”
  • How Providers Can Help with the Planning Process in the Future: The group discussed the current budgeting process and its inherent problems. Ms. Henry referenced the division’s strategic planning process and said that providers should be more assertive in getting involved in that planning process. Connie sent the current plan to members of the BeHC for their review. Ms. Henry said she would be happy to entertain any suggestions we have to create a more inclusive planning process.
    
  • Status Report on Licensure Standards: The new standards will be issued in their final form in the near future. Members welcomed the opportunity to respond to them and make suggestions.
  • Ms. Henry presented a series of issues that she sees evolving in the near future that will impact the way services are provided. They include:
    
    
    • SAMSHA is focusing more on:
      
      
      • Person-centered planning
      • Health Wellness and the integration of health and mental health services.
      • Prevention and Early Intervention – better coordination between public health and mental health so that we serve people before they become seriously ill.
    • Greater use of medications in treatment.
    • Drug Appropriate Treatment – matching treatment to the age cohort.
    • Finding a workforce – This is and will continue to be a major issue for the field.
    • Data, Outcomes, and Return on Investment will be major theme of funders.
    • Workforce Training – This is an area that providers and DSAMH can partner. She will be convening a work group to tackle this issue.
    • Veterans – Ms. Henry was asked about the future needs of veterans, many of whom are coming back from Iraq and Afghanistan with head injuries and mental health and addictions problems. DSAMH has plans to work with veterans. They are learning about their current system and expect to have some information about that system and those needs at the Summer Institute.
  • Ms. Henry concluded her remarks and the group thanked her for her participation. She volunteered to meet with the Behavioral Health Commission in September when the budget picture has been finalized.
• Business Services: The Commission has worked very hard to retain funding for our contracts that employ people with disabilities through the state’s Use Law. For many of them, these contracts are their first opportunity to work in a community setting. If they are laid off, they will need to return to day programs where the cost to the state will be much higher. Preliminary reports indicated that there would be significant cuts on the custodial contracts. Faced with the possibility, DelARF staff negotiated with and sent letters to our major contractors. As of this date, no cuts in funding or services have been instituted. We are hopeful that we will be able to maintain our current levels of service and funding for FY09.
• Developmental Disabilities: At the May meeting, attendees discussed the DDDS RFP Notice, the Fleet Vehicle Issues and the new “Employment First Initiative.” They also discussed a strategy and approach for appropriate levels of funding for FY10. They noted that there is legislation at the Federal level that supports a “living wage” for Direct Support Professionals. At the June meeting Connie announced that Marianne Smith has agreed to meet with her on a monthly basis and the Commission quarterly. The group also discussed contracting issues for FY09. The July meeting will focus on issues of concern to share with the Division Director AND how providers can partner more effectively with the state in the delivery of services. Please come out and join us.
• Government Relations: The group reviewed the chart of current legislation, an ever changing DelARF document that lists all legislation relevant to the disability community in the current session. Connie gave a status report on the regulatory changes recommended by CMS. A series of Action Alerts were sent by DelARF to members explaining the various regulations and the advocacy community’s attempts to gain moratoria for one year on the implementation of these seven new rules. Connie provided background information on the state budget. She also discussed the legislative initiative proposed and approved at the last meeting and once again urged members to contact their own legislator to invite them out for a tour and conversation. The group also discussed DelARF’s legislative approach and plan for the future: Invite legislators to attend GRC meetings; hold GRC meetings at Legislator’s offices; hold a Legislative Breakfast for Legislators. They concluded that DelARF needs to develop a more organized approach to bringing state legislators to the table for discussions with the provider community.
• Physical Disabilities: DSAAPD has contracted with a new agency to provide Attendant Services so that individuals will have more choice in selecting caregivers. The group discussed the state’s budget crisis, the Medicaid moratoria and the impact on services if they are not delayed, and the MFP program.
• Vocational Services: At the May meeting, the group started a dialogue around work incentives and the DE Medicaid waiver.  Guest speaker Michael Walling explained specific Social Security incentives and how other providers or states have used IRWE (Impaired Work Related Expenses) and PASS (Plan to Achieve Self Supports) plans to supplement services.  At the June meeting, there was a discussion about the revised Ticket to Work program. New regulations have been issued that attempt to provide reimbursement for training providers at an earlier time in the training/placement process. The Commission also agreed to help develop a generic referral form for DVR. All agreed to forward their current plan to DelARF to start the work.

News from Dover

• State Budget Predicament: Thanks to a $63 million dollar windfall from a corporate tax payment, the state is able to lessen the pressure on members of the Joint Finance Committee somewhat. That group along with the financial leadership known as the “big head” committee has been meeting daily, often behind closed doors, to carve out the $217.3 million needed to balance the FY09 budget. I have sat in on several of these sessions and have been surprised at the level of the cuts. Some are in the $500 to $600 range. One of the most significant cuts appears to be in the Medicaid budget where $15 million has been removed with the promise that it will be made whole by the imposition of a “provider tax” on hospitals. We are watching this development closely.
• DEFAC Reports: The June 17 DEFAC (Delaware Economic and Financial Advisory Council), shows continued erosion in income for FY09. The report can be found here.
• Current Situation: As of June 17, the state’s projected budget gap for FY09 moves from $217.3 million to $151 million. By Monday the JFC had eliminated $85 million and was attempting to trim another $32 million more. With the infusion of this one-time money, the total gap is now $65 million. But now there is debate as to whether to use the funds for operating and “push the problem into FY10” or apply it to capital projects. There are still cuts to be made or revenue enhancers to be passed; and there are also only seven legislative days left in the session.
  

News from Washington

• Medicaid Update: Previous updates to our members have told you about the various changes that the Centers for Medicare and Medicaid Services (CMS) are trying to push through. All of these initiatives will shift costs to the states and some will disenfranchise significant numbers of individuals and families. Since 42% of all Medicaid funding supports people with disabilities, this is a funding source we will monitor for our members. For a full review of these regulations and how they may impact YOUR PROGRAMS, please see the March Monthly Mailing for more information. As noted last month, new legislation was introduced in the House to put a one year moratorium on the implementation of these regulations. Click this link to view this legislation. To see what Congress is doing about the regs and how they impact each state (including Delaware) go here.
  
• Current Situation on Passage of CMS Regulations: In April, the House overwhelmingly passed Protecting the Medicaid Safety Net Act of 2008 with a veto-proof vote of 349-62. That bill included a moratorium on the implementation of all 7 CMS regulations. In the Senate, an amendment was attached to the Iraq war supplemental spending bill that included moratoria on all 7 regulations. That also passed with a veto proof margin. Unfortunately, because these were two different pieces of legislation and the supplemental has a House and Senate version, the bills had to be “reconciled.” Now, we are learning that they may pass one year moratoria on some of the regulations and not others. National associations are predicting that the Rehab Services Option will be delayed for one year but the Targeted Case Management regs will not. Here is a description of the possible changes being recommended in the TCM regulation:
  
  
  • “The proposed rule published by CMS addresses the provisions in the DRA {Deficit Reduction Act} but also includes some provisions not specified in the DRA legislation. To the extent that the proposed rule has generated controversy, this relates to the provisions not addressed by the statutory changes enacted by the Congress. The DRA did not address transitional case management, but the proposed rule would eliminate the post-Olmstead standard of 180 days of coverage to a maximum of 60 days of transitional assistance, with shorter coverage for short stays in an institution. Payment would also not be available unless and until an individual successfully transitioned to the community. Additionally, the proposed rule would impose a fixed limit of only one case manager per person, without regard to individuals with co-morbid conditions wherein one case manager may not be properly equipped to manage services across systems. For example, a person with an intellectual disability, mental illness, and HIV/AIDS could be assigned a case manager familiar with mental health services, but with no expertise in HIV/AIDS programs or services for people with developmental disabilities. The proposed rule would restrict access to services based on an integral component (i.e. intrinsic element) test; restrict states flexibility to determine payment methodologies by imposing payment based on 15 minute times increments of service, prohibit child welfare agencies and their contractors from serving as Medicaid case managers; and would restrict school-based case management services for some children with disabilities."
  • Impact: The change is expected to reduce federal Medicaid spending by $1.3 billion over 5 years.
  • Source: Kaiser Commission on Medicaid and the Uninsured: Medicaid Overview and Impact of New Regulations, January 2008. Read it online.
    
• State Fiscal Crises Across the Nation: According to a newly updated study from the Center for Budget and Policy Priorities, at least 29 states plus the District of Columbia, including several of the nation’s largest states, faced or are facing an estimated $48 billion in combined shortfalls in their fiscal year 2009 budgets (which begins July 2008 in most states.) Two other states expect budget problems in fiscal year 2010, although some of those gaps may occur earlier than expected. To see the latest report click here.
  

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