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Council testifies on Rates for Community-Based Day Support Services (114.4 CMR 15.00)

On Friday, October 14, the Providers' Council delivered the following testimony to the Division of Health Care Finance and Policy regarding 114.4 CMR 15.00 - Rates for Community-Based Day Support Services.

For more information, please contact Bill Yelenak.

To: Áron Boros, Commissioner, Division of Health Care Finance & Policy

From: Michael Weekes, President/CEO, Providers' Council

CC: Catherine Mick, Chief Administrative Officer, EOHHS

Re: Testimony on 114.4 CMR 15.00 – Rates for Community-Based Day Support Services

Date: October 14, 2011

Commissioner Boros and members of the Division of Health Care Finance and Policy, thank you for this opportunity to submit testimony on 114.4 CMR 15.00, Rates for Community-Based Day Support Services. The Providers' Council is a statewide association of home- and community-based caregivers that contract with state purchasing agencies to deliver a wide array of human and social services.

The Providers' Council appreciates receiving data from the Division of Health Care Finance & Policy in response to our request for a copy of the rate-setting methodology. This information was helpful in formulating our testimony and communicating about the new regulations to our membership.

Community-Based Day Support Services

The Providers' Council feels it is important for the Division of Health Care Finance & Policy to understand the individuals that this service will help. Currently, there are 105 programs across Massachusetts that provide this service. These programs help individuals with intellectual and developmental  disabilities, individuals who are blind, hard of hearing or deaf, and individuals with behavioral, psychiatric or other challenges.

These individuals, for whom our members provide the highest possible quality of services, receive needed care and are able to find work during the day that help them be productive members of their community. With support from dedicated staff members across the Commonwealth, these individuals are able to remain in the community and make a living, consistent with the Community First policy.

Concerns with proposed rates

The Providers' Council joins many of our member organizations and several other trade associations in expressing strong concerns regarding the proposed rates for 114.4 CMR 15.00. We believe that more consideration must be given to landmark rate-setting legislation (Chapter 257 of the Acts of 2008), the timing of these proposed rates (the state is currently forming a Chapter 257 commission), a funding reduction to many impacted programs, and a lack of resources for transportation funding or staffing.

Chapter 257

In 2008, Governor Deval Patrick signed into law Chapter 257, An Act Relative to Rates for Human and Social Service Providers. This law – passed unanimously by the Legislature – was created to bring fairness, adequacy and transparency to the Commonwealth's purchase of service system.

In October 2007, an EOHHS report said: "…it is in the Commonwealth's interest to ensure that provider organizations are financially stable and that the industry's workforce is paid a fair living wage." Section 4 of Chapter 257, which passed less than a year after this report, requires EOHHS to establish rates of payment for social service programs that are reasonable and adequate and ones which meet the costs which are incurred by efficiently and economically operated human service programs in conformity with federal and state law, regulations, and quality and safety standards. Chapter 257 also asked that the rates of payment be adjusted to take into account:

  • The reasonable cost to social service program providers of any existing or new governmental mandates; and
  • A cost adjustment factor to reflect changes in reasonable costs of goods and services of social service programs including those attributed to inflation; and geographic differences in wages, benefits, housing and real estate costs in each metropolitan statistical area of the Commonwealth, and in any city or town therein where such costs are substantially higher than the average cost within that area as a whole. It is unclear, what – if any – effort was made to determine calculations for the different geographic areas of the state.

Timing of proposed rates

The Providers' Council has concerns about proposing these rates at this time. Rates being proposed for community-based day support services could affect other rates that may come under consideration by the Division of Health Care Finance & Policy. The Council and its membership, however, remains concerned that DHCFP is proposing these rates while the Chapter 257 Commission, created by Governor Deval Patrick, will soon be meeting to discuss how best to implement the law.

The Collaborative – a group consisting of the Association of Developmental Disabilities Providers, the Association for Behavioral Healthcare and the Providers' Council – met with senior administration officials over the past two years to discuss the Chapter 257 implementation and the best way to ensure the spirit of the law is followed in establishing rates. We ask the Division of Health Care Finance and Policy to not adopt rates for these services until the commission begins its work.

Reduction in funding to impacted programs and forcing layoffs

The solution being put forth by the Division of Health Care Finance and Policy would reduce funding to 48 of the 105 programs, shifting that funding to 57 other programs. This will cause more than 46 percent of these programs to lose funding, shifting that money to the other 57 programs. These programs that lose revenue will be forced to reduce salaries, lay off qualified staff members and potentially be forced to serve fewer clients – particularly those with complex needs.

We would hope that the Division of Health Care Finance and Policy does not feel it is meeting the spirit of Chapter 257 simply moving money from some providers to other providers. Many of these programs have gone more than 20 years without even so much as a basic cost-of-living adjustment, and more must be done to comply with the provisions of Chapter 257. While we do appreciate the increase of funding by more than $424,000 in the first year – and about $1.2 million over three years – this is simply not enough to ensure the provisions of Chapter 257 are adequately met.

In the discussion of reduced salaries and layoffs, we express a further concern: the growing disparity between the salaries of state employees and our community-based direct care providers who perform similar functions. The different salaries these employees receive – to do roughly the same work – is hurting our system of care and hampering the ability of community-based providers to recruit and retain the best and the brightest. With the fixed state contracts, community-based human services providers are unable to match the salaries the state pays to workers, and this is both extremely unfortunate and creates a two-tiered system of care. We feel strongly that employees at these community-based organizations doing the same work as state employees should receive equal salary and benefits.

Lack of resources for transportation or staffing

The Council expresses further concerns over a lack of resources for transportation or staffing. We have members who have specifically developed these programs around small staffing ratios, ensuring people with complex problems are able to receive the support that they need. Our concern surrounds an assessment tool that the Division of Health Care Finance & Policy might use to determine staffing ratios; we would hope this would be done in consultation with providers, as they best know what type of staffing levels are needed to provide clients and consumers with proper care and support.

We are also concerned regarding the lack of funding for transportation in these new rates.

Transportation funding, which we believe was about $1.2 million, has been removed. Under the new proposal from the Division of Health Care Finance & Policy, how will providers and individuals receive transportation? With a well-documented and troubling lack of funds in the human services sector, there is simply no money to pay for transportation without it being included as part of a contract. Needless to say, access to services is a critical component of providing services to this vulnerable population.

These two gaps in possible funding to providers could cause difficulty in continuing to provide the same high-quality services that these clients and consumers have received. We would hope to see this funding gap addressed and rectified before the Division of Health Care Finance & Policy accepts these proposed rates.

Conclusion

We respectfully request that you delay adopting these proposed rates for Community-Based Day Support Services until the issues raised by the Providers' Council and other community provider organizations have been successfully resolved. To move ahead without addressing these concerns would cause unnecessary consumer disruption with the potential to create staff layoffs and destabilize the community system of care.

In the interim, we urge you to prepare revised rates that better incorporate the directives of Chapter 257 to provide proper funding for our programs that is reasonable and adequate. There is also a need to provide proper funding to ensure programs meet safety and quality standards, and we would like to see this explicitly factored into the proposed rate.

We also support the testimony provided to you by our partner in The Collaborative, the Association of Developmental Disabilities Providers. We share many of this organization's questions and concerns and would hope, as they have requested, that the Department of Health Care Finance & Policy might arrange a forum where organizations with questions about the Community-Based Day Support could raise concerns and receive clarifications. We thank you for your time, and we appreciate your thoughtful consideration of our testimony.