The Association of Developmental Disabilities Providers: News

News

Keep FMAP focused on HHS

As has been reported in previous updates, ADDP has repeatedly expressed our concern that state decision makers first use the recently enacted six month extension to stabilize health and human service programs before considering any use of Medicaid funds for programs outside of the realm of the Executive Office of Health and Human Services.

The Massachusetts State House News reported in August: "The state's two-month old budget is at least $300 million short in its Medicaid account and could be as much as $500 million shy, budget analysts said Thursday, complicating legislative plans to distribute federal funds across a wide range of programs, including redistricting, State Police overtime and housing subsidies. With recessionary pressures forcing caseload growth, the roughly $10 billion Medicaid program is on pace to spend far in excess of prescribed appropriations this year, chewing into the $450 million in federal funds gifted to the state earlier this month."

It is the belief of ADDP and other human service advocates that Medicaid caseload expansion should not be regarded by state leaders as unexpected. In fact, the primary reason for the FMAP expansion in both the original ARRA bill and the six month extension is to address expected caseloads and economic demands during a recessionary period.

While ADDP believes the Governor and Legislative Leaders understand the concerns of health and human service advocates and are working together to appropriately address the state's use of FMAP dollars. However, it is clear that Beacon Hill is under tremendous pressure from all sectors to spread the limited FMAP dollars to more areas than may be possible.

ADDP and other disability advocates remained concerned that any effort to reduce current Medicaid services or health & human service programs while accepting the FMAP extension could violate the Congressional and Presidential intention in providing these dollars.

In her August 16, 2010 letter to the nation's governors, U.S. Department of Health and Human Services Secretary Kathleen Sebelius noted the intent of the FMAP extension stating:

"...President Obama signed into law the Education Jobs and Medicaid Assistance Act, which will provide states and territories with an estimated $16.1 billion to support their Medicaid programs. This new federal funding can stave off the deep cuts to Medicaid that many had feared, and sustain jobs in hospitals, health centers, and communities across the country. They will also support Title IV-E foster care programs."

Further noting the intent behind FMAP, Sebelius further noted in her letter to the nation's governor's:

"The assistance is essential for states as they support health care services for their residents, and for state budgets more broadly. By reducing the need for budget cuts and layoffs in health, education, public safety, and other vital state services, the additional federal Medicaid assistance will support a variety of public and private economic activities.

ADDP acknowledges that the Governor and the Legislature clearly have the authority to spend excess FMAP dollars in any area of the state budget, however we hope that state leaders will note Secretary Sebelius' emphasis that the first priority of the FMAP extension is to protect Medicaid and health & human services.

In the FY 11 Conference Committee Report, legislators appropriated hoped for excess FMAP dollars to a number of worthy programs, both inside EOHHS and in other budget areas. Due to the failure of Congress to pass the FMAP extension by July 1, 2010, Governor Deval Patrick vetoed all spending tied to the six month extension. Legislators and the Governor are under pressure to either override or reallocate dollars to those programs.

The dilemma facing Governor Patrick and the Legislative leadership is how to allocate the expected $506 million (Center on Budget Priorities estimate) and how to address Medicaid caseload increases, while also responding to programs whose funding was vetoed. If the Governor and Legislature choose to fund all areas previously vetoed by the Governor, there may not be sufficient dollars to address the Medicaid caseload increase. Not addressing the caseload increases may not be an available option for legislators seeking to be in concert with Congressional and Presidential intent.

ADDP continues to urge legislators and the Governor to use the six month FMAP extension for its intended purpose: to protect health and human services.

Finally! FMAP Passes House

Massachusetts' Share: $506 Million
President Obama has signed bill into law

After months of debate, thousands of email pleadings, letters and phone calls, both houses of Congress have now passed the six month FMAP extension. Following up on the Senate August 4th passage of the extension, the House gave its approval by a 247-161 vote at 3:26 p.m., on Tuesday, August 10.

The extension will grant an additional $16 billion to states whose revenue receipts have been devastated by the Great Recession that began in October of 2008 during the final months of the Bush Administration.

According to the Center on Budget and Policy Priorities, Massachusetts will receive $506 million in extended FMAP funds. The extended funds will be for January 2011 to June 2011.

Originally the House and Senate had passed a $25 Billion FMAP extension that would have brought over $750 Million to the Commonwealth, however Republican Senators, including Massachusetts Senator Scott Brown refused to allow that to become law through the use of a filibuster, preventing a final vote on the state aid package.

The GOP filibuster cost the state of Massachusetts over $250 million in lost federal assistance.

The filibuster was finally ended with the support of the two moderate Republican Senators from Maine, Susan Collins and Olympia Snowe, plus conservative Democratic Senator Ben Nelson of Nebraska. The three changed their earlier votes supporting the filibuster to ending the filibuster preventing a Senate vote. Brown voted to continue the filibuster and subsequently voted no on the FMAP extension.

Due to the late timing of the FMAP passage, Governor Deval Patrick vetoed over $400 million in FY 11 expenditures that had been funded by expected revenue from the original $750 million FMAP package.

There remains some disagreement among state leaders regarding how the incoming FMAP revenue will be distributed to state programs. Though regarded as a political statement and not a strong position, some Massachusetts GOP legislators have suggested that the State not accept or allocate the six month extension.

Both the Governor and the legislative leadership have expressed gratitude to Members of Congress for the six month extension, yet have not completely signaled how the funds will be distributed. With the Governor's veto of programs that were partially funded by the original expected $750 million FMAP package, there is no automatic provision for the incoming $506 million to be restored to those individual accounts, thus the Governor and Legislature will need to come to an agreement on how these funds will be distributed.

Options could include a special session of the legislature, supplemental budgets adopted early next year or adoption through informal sessions (though unlikely since one member could object). There also may be some degree of executive authority in the receipt of the funds with regard to the additional education dollars that will were part of the Congressional action.

ADDP will be urging state decision makers to:

Preserve the use of FMAP (extended Medicaid) first and foremost for health and human service programs.
Fund the Governor's DDS FY 2011 errata budget for Residential Services to ensure that people with developmental disabilities do not lose their homes.
Preserve human service workforce jobs.
Fund DDS Day/Employment Services to ensure that people with developmental disabilities do not lose their jobs or day services.

ABI Waiver information for providers

ADDP has made available the following information for organizations looking to provide non-residential services through the Acquired Brain Injury Waiver currently being rolled out in Massachusetts. For more information and links to forms, click here. ABI Waiver Information
forms provided by UMass, updated on July 20, 2010

Informational Sessions will be held from 1:00-3:00 PM at: University of Massachusetts Medical School administration building, 333 South Street, Shrewsbury, MA 01545

DATES
August 11, 2010
August 18, 2010
August 25, 2010

*Provider Application Packets will be available at the sessions.

Please RSVP to Johana Stewart indicating whether or not you plan on attending one of the above mentioned sessions and which session you plan to attend.

If you have any questions about this session please contact:

Johana Stewart
ABI Waiver Unit
University of Massachusetts Medical School

More information is available on the MassHealth Web site.

Provider Information Overview
Writable Version- MassHealth ABI Waiver Provider Application
Writable Version - Massachusetts Medicaid Program Provider Agreement
Writable Version- Data Collection Form and Registration Instructions
MassHealth Trading Partner Agreement
Form W-9 (Massachusetts Substitute W-9 Form)
Authorization for Electronic Funds Transfer (EFT)
Writable Version - Credentialing Supplement
Federally Required Disclosures
MRC Standards

OpEd: MetroWest Daily News

Washington fiddles as state services burn
By Gary Blumenthal, Guest columnist

Read the editorial here.
With public approval of the job Congress is doing at an all-time low, it's hard to imagine that our nation's leaders could do anything more to offend public sensibilities, but they've shown resilience in this area with their recent behavior.

After years of looking the other way as the last administration promoted fiscal policies that left the nation's economy in ruins, Congressional leaders have had to come face to face with their own financial record of mismanagement and enact efforts to rebuild the economy. Such was the effort behind the enactment of the American Restoration and Recovery Act of 2009 (ARRA). That act began the process of providing a massive stimulus to rebuild our nation's economy including state government budgets devastated by a precipitous drop in state revenue collections.

States benefited by the ARRA provision that provided enhanced Medicaid reimbursements for the last two fiscal years. Those dollars helped protect essential state supports and services for many vulnerable and disabled citizens, as well as keeping education and local government services intact. However, as the national economy has inched slowly towards recovery, individual states have continued to suffer dramatic drops in state revenue and have thus been required to make deep cuts to human service and disability programs, as well as education and public safety programs.

Thus, President Barack Obama and the majority of Congress proposed continued critical aid to states to help in their recovery and protect essential safety net services. Through a six month extension of the Federal Medical Assistance Percentages (FMAP) program, Congress promised fiscal aid to the states. In fact, both the House and Senate passed bills in 2009 and 2010 that promised these dollars would be coming to the nation's 50 states. Massachusetts, along with 30 other states believed in the word of Congress and based their Fiscal Year 2011 budgets on this forthcoming revenue.

However, along the way, members of Congress could not resist the temptation to engage in its seemingly eternal partisan conflict and turned an economic recovery plan into a Democrat-Republican struggle over who could set the stage for the other's political destruction in the November elections.

Neither Democrats nor Republicans are completely innocent in this battle. The GOP, including Massachusetts Senator Scott Brown, have stubbornly stuck to a filibuster preventing a majority of the Senate from enacting the FMAP and unemployment extensions, while Democrats have been less than enthusiastic about finding common ground with their Republican colleagues.

In the meantime, people are suffering. The states are burning while Washington fiddles with who can be better positioned to annilate the other party.

Gov. Deval Patrick was forced to veto over $500 million of safety net spending and aid to towns and cities that will result in massive layoffs of essential personnel. For people with developmental disabilities, hundreds will lose their day services, jobs, homes and family supports.

There is still time to avert this fiscal disaster. Senator John Kerry has been a consistent leader in ending the ongoing filibuster to allow Congress to keep its word, and allow an up or down vote on FMAP assistance. Senator Brown, while having supported the filibuster, has opened the door to an alternative proposal to provide aid to states with his own FMAP and Unemployment Extension Bill.

It's time for our leaders to come together on behalf of the people they represent. It's time for Senators Kerry and Brown, and Gov. Deval Patrick to come together with a single plan to protect the interests of the people of the Commonwealth.

Gary Blumenthal is the President/CEO of the Association of Developmental Disabilities Providers, headquartered in Waltham. He was appointed in December 2009 by President Barack Obama to be a Member of the National Council on Disability.
Copyright 2010 The MetroWest Daily News. Some rights reserved

Calling on our leaders

Dear Governor Patrick, Senator Kerry and Senator Brown,

We are writing to you today with an urgent plea on behalf of the 33,000 Commonwealth citizens with intellectual and developmental disabilities, their thousands of family members and the 100,000 Massachusetts workers who provide supports and services to people with disabilities.

We plead with the three of you, as our state's leaders, to meet in advance of the National Governors Association (NGA) Annual Meeting, which will be held here in Boston this week.

Your meeting should develop a unified Massachusetts position on behalf of the Commonwealth that will successfully result in the enactment of the six-month extension of enhanced Medicaid (FMAP) that has previously passed both the House and Senate.

We thank each of you for your diligent attention to this issue. We are appreciative of the efforts of Governor Deval Patrick for his work within the NGA to secure the passage of this extension and we appreciate his careful and cautious stewardship of the Commonwealth's budget during these trying fiscal times.

We equally are grateful for the efforts of Senator John Kerry in his repeated votes to secure these dollars and to end the filibuster that has blocked its passage. We respect the fact that the majority of the Senate is in support of providing FMAP dollars to the states as demonstrated by the 56 Senators who have supported this measure and the effort to end the filibuster.

We are also grateful to Senator Scott Brown for his actions earlier last week in helping to keep this issue alive by acknowledging the importance of maintaining the safety net for people with disabilities in Massachusetts by introducing an alternative FMAP proposal.

We now implore the three of you to meet and develop a unified Massachusetts approach to this crisis. You have an opportunity, with the top decision-makers in the United States in our city, to again showcase Massachusetts as a bipartisan leader.

As you know tens of thousands of people with disabilities and their families are facing the catastrophic loss of services and supports caused by the failure of the Congress to keep its promise to enact the FMAP extension.

Unless the dollars tied to the FMAP extension are received by the Commonwealth, these people - your constituents -will begin to see their safety net dismantled.

This will result in the loss of homes, jobs, family support and other related services. Our offices have been flooded with calls from terrified families who are fearing the worst.

This catastrophe does not need to happen. We believe that the three of you can form an effective team of both Republicans and Democrats to resolve this crisis. By joining together, you can be an effective role model for the rest of the nation. Please use your talents to work together on behalf of Massachusetts.

You are our elected leaders. We place our hope in you. Please help us in this time of crisis.

Sincerely,

Leo Sarkissian
Executive Director, The Arc of Massachusetts

Gary Blumenthal
President & CEO, ADDP

Legislators ask: Does it make sense to close state developmental disabilities institutions?

Yes, it does. Closing state institutions and expanding community programs is best practice recommended by 30 years of practice and endorsement by disabilities professionals and embraced by the rest of the nation; and as the result of litigation by disabilities advocates motivated by a lack of options and services for people living in the community and civil rights advocates disturbed by patterns of past abuse & neglect in institutions across the country.
Massachusetts stands out as one of only a handful of states that has resisted closing excess state institutions. In fact there are only seven state institutions in all of New England, six of which are in Massachusetts.

As Massachusetts legislators are struggling to put together the FY 11 budget, they are once again facing the perennial discussion regarding the State's plan to close four of the state's six state institutions for people with developmental disabilities.

In December 2008, Governor Deval Patrick accepted a recommendation from EOHHS Secretary JudyAnn Bigby and DDS Commissioner Elin Howe to reduce the state's operation from six to two institutions, noting that the system, which once housed over 10,000 people with developmental disabilities had dwindled to serving less than 900 people, while the community system had grown to serving more than 30,000 people in both the private provider system and state operated programs.

The recommendation to close state institutions has been one supported by the developmental disabilities professional community, national family advocacy organizations, such as the Arc of the U.S. and UCPA-US, and notably the National Conference of State Legislatures (NCSL). In fact, for several years NCSL has recommended de-institutionalization and closure to its members.

I know this from personal experience as a former Member of the Kansas House of Representatives for 11 years, as the former chairperson of the NCSL Task Force on Developmental Disabilities and as the executive director of the President's Committee on Mental Retardation for President Bill Clinton.

Reasons for closure include support for community integration, the high cost of maintaining a dual (both community and state institutional) system, and the documented studies that validate that equal or better care is available in community settings; as well as the desire to provide people with developmental disabilities with the right to live in community settings.

NCSL, in a landmark analysis, concluded that the overall cost of community care is substantially higher in state institutions, while serving essentially the same people as community programs. NCSL further noted that state institutional operating costs will continue to increase as the census of such programs continue to dwindle (NCSL:Deinstitutionalization of Persons with Developmental Disabilities:A Technical Assistance Report for Legislators by DeWayne Davis, Wendy Fox-Grage, and Shelly Gehshan).

Despite these strong factors supporting complete closure of state institutional programs, the DDS Closure Plan chose a moderate plan that did not close all of its state institutions. Instead, DDS opted to provide families preferring institutions with a guarantee of one, and perhaps two permanent state institutions.

The DDS Plan is focused on aligning facility capacity to better reflect a system focused on current capacity which is around 798 individuals, rather than a former system which owns sufficient land, resources and buildings reflective of its former 10,000 person capacity.

The DDS plan, which is expected to close Fernald Developmental Center in 2010, does not expand the private provider system.

Instead the State is consolidating its operations into two remaining institutions and expanding its state operated community program as an alternative choice for residents and their families.

Expanding the state operated programs was an accommodation sought by some families who wanted a choice between state operated & POS programs; and state employee unions seeking to transfer member jobs from closed state institutions into the succeeding state operated community program.

Under the DDS plan, very few families have moved into the POS private provider system, instead focusing on the State's expanding state operated and state owned system. ADDP believes the more appropriate expansion should have been the community private provider system which provides in Massachusetts and in other states, a more cost effective, efficient and inclusive opportunity for people with disabilities and their families.

Observers monitoring the DDS budget have noted the incongruity of DDS having to cut community services to hundreds of consumers, while maintaining a 10,000 person capacity campus system that serves less than 800 people.

For the last three budget cycles, the State has endured a precipitous drop in state revenue resulting in the Commonwealth jettisoning many essential elements of the State's social services safety net. Thus, legislators seeking to keep expensive, excess state institutional capacity seem to out of touch with the Commonwealth's economic troubles.

Advocates ask how can the Commonwealth shred every other element of the state safety net and all other state programs, while a few legislators work aggressively to keep whole an obsolete service model that drains millions of dollars to maintain six campus settings, including dozens of empty buildings that are still draining funds from other individuals needing DDS services and supports?

Why are some people trying to stop closure?
There appear to be a variety of motivations for those opposing closure including some family members who are comfortable with existing state institutions and see no reason to change a system that has operated for their family for several years.

Some of these families are afraid that community programs may not offer the same level of quality, while some simply only know the institutional provider option, and are unfamiliar with community service opportunities.

Study after study, after study, conducted by professionals including the American Association on Intellectual and Developmental Disabilities (AAIDD), and others, have verified outstanding quality in community settings, and many studies indicate high levels of satisfaction by families and consumers who have moved from institution to community based systems.

Other reasons for opposition tend to be both economic and political.

Throughout the nation, closure of state institutions have frequently been hampered by state employee labor unions, capitalizing on the fear of families. In fact, some unions have sought to equate system change with job losses. Some have tried to equate job security as equal to consumer interests. Such opposition has often been described by advocates as disheartening and cynical moves by labor unions placing a higher premium on its members jobs than on the individual receiving service. Not all state employee unions have taken this position. SEIU 509 has been a noteworthy exception to this tactic. Other states have mitigated this concern with programs allowing displaced state employees the opportunity to obtain other state jobs; or by expanding state operated community programs and then transferring state employees into union member jobs on the state payroll, though not on a large and costly campus.

ADDP recommended to the State the expansion of the private provider community system, however DDS chose to expand its state operated and state owned group home system. ADDP continues to believe that the most successful, efficient and inclusive system is the private provider system. In fact, ADDP has established a Closure Committee which is seeking to provide support to families and consumers who wish to choose a private provider option rather than transfer to the remaining state institutions or a state owned and operated community group home.

Additional opposition to institutional closure can be strictly parochial including opposition from local legislators who represent communities with limited employment opportunities, thus the closure of the state institution may feel like a major economic drag. Regardless, holding people with disabilities hostage to local economic concerns is viewed by advocates as inappropriate treatment of people with disabilities.

Some well meaning legislators believe that institutions are the only venue available to serve highly medically fragile or behaviorally challenged individuals; however the data simply doesn't support this belief. In fact, there are dozens upon dozens of community programs that support individuals with medical and behavioral needs just as challenging as those residing in state institutions.

Legislators who would like to see specific programs that provide support to medically fragile or behaviorally challenged individuals should feel free to contact the ADDP office and a tour can be arranged.

Again, as a former State Legislator, I understand the concerns of legislators who wish to be responsive to their constituents; and who believe they are advocating on behalf of the best interests of people with disabilities.

Furthermore, legislators who try to prevent closure due to perceived economic impact, or potential job losses, may actually be doing their constituents a major disservice, causing taxpayers greater costs in the long run, subjecting families to continual uncertainty and delaying inevitable contraction of a system that is increasing in expense while decreasing in census. And legislators who suggest that the State can continue to afford a 10,000 person campus for a census of 798 (and dwindling) may be out of touch with the economic realities of the Commonwealth in 2010.

What did the Massachusetts House do regarding closure?
The Massachusetts House adopted Amendment 116 which prevents DDS from conducting any further work on institutional closure. The amendment directs DDS to "take no action to reduce the client population of any state residential-based facility for the mentally retarded, including intensive individual supports, for the purpose of closing said state institutions, and no steps shall be taken to close said institutions through attrition, layoffs or any other means until a study of any such reduction or closing shall be completed..." The report must be completed no later than December 1, 2011.

The effect of this amendment is costly to the Commonwealth and is unfunded by the House.

Immediate costs would include an additional infusion of $13 million to make up for lost savings and continued operation of Fernald Developmental Center. And there are even greater costs, noting that DDS has already begun the building and expansion of state operated group homes that will be funded but empty if DDS is forced to abide by this amendment.

While on the surface the amendment seems to be asking for just one more study, it is important to note that the Department has been asked on numerous times to make such reports and has complied with each request coming to the same conclusion each time.

In the meantime, the Senate now faces an FY 11 budget which, unless amended will cause up to 195 people with developmental disabilities to lose their residential services (including private and state operated programs; and 225 people to lose their day & employment services. The average age of these individuals exceeds 40 years. Shuttering their group homes, and day activities will mean returning them to their 60, 70, 80 and 90 year old parents. Surely that is not an option in line with the compassion of the people of the Commonwealth.

Is there any problem in having both state institutions and community programs?
NCSL addresses this concern in it's landmark report, (NCSL:Deinstitutionalization of Persons with Developmental Disabilities:A Technical Assistance Report for Legislators by DeWayne Davis, Wendy Fox-Grage, and Shelly Gehshan).The Report warns legislators that states can ill afford a dual track system.

NCSL notes: " As long as states continue to operate large public facilities, state funds will be used to support those facilities, per capita costs of operating facilities will continue to increase and expansion of community programs of community services will decline."

This pattern is one factor in the tremendous tension that exists between those who disapprove of keeping six state institutions for 700 people remaining in them, and those in the community who see people being denied service, cut from existing programs and having to fight every session for the limited dollars for a maintenance budget, while hundreds go without services.

In this time of economic uncertainty can we afford to continue to fund an oversized and increasingly obsolete service model?

Is it fair to take services away from hundreds of people currently receiving services in community programs while supporting an institutional and cost inefficient campus system built for 10,000?

--Gary Blumenthal is the President & CEO of the Association of Developmental Disabilities Providers

Budget Shortfall Jeopardizes Brain Injury Programs

Joint Announcement from BIA-MA and ADDP

Our two associations are gravely concerned about the pending FY 11 budget fund allocation to residential and other services and supports for people with brain injuries.

The Massachusetts Rehabilitation Commission administers the Statewide Head Injury Program, also known as BISSCS. This division of MRC is unique in that it is funded through two sources: the 4120-6000 line item, and the Head Injury Treatment Services Trust Fund (HITS).

In recent years, the HITS Trust Fund has delivered less dollars derived from a surcharge on speeding, DUI and reckless driving fines; as a result, funds for brain injury services from this source have been diminishing.

This month, MRC/BISSCS announced that programs under its jurisdiction would be likely to encounter an aggregate $2.3 million loss in funding. For many providers operating brain injury programs this will represent a destabilizing cut to the operating base of their programs.

Thus BIA-MA and ADDP are encouraging the House and Senate to restore $2.3 million in appropriations to MRC.

In addition, BIA-Ma and ADDP are supporting an amendment to current law to alter the formula by which citation surcharge fees are distributed into the HITS Trust Fund. Such an amendment would go a long way toward restoring the Trust Fund to its previous levels.

The combination of the line item reduction and the dramatic shortfall in the HITS Trust Fund puts vital services in double jeopardy.

What kinds of services are in jeopardy?

MRC's Brain Injury and Statewide Specialized Community Services Program (BISSCS) is the official name of what the provider community knows as "SHIP." Each year, thousands of individuals and their families are supported through BISSCS.

Working with community partners, MRC purchases services including:

•    Assistive Technology
•    Community-Based Residential Services
•    Community-Based Supports for Independent Living
•    Head Injury Centers
•    Respite Services
•    Family Assistance Programs
•    Social/Recreation Programs
•    Substance Abuse Treatment
•    Technical Assistance for Public and Private Agencies and Programs
•    Technical Assistance Program for Schools
•    The TBI Multicultural Outreach Project
Unless funding is fully appropriated to Line Item 4120-6000, these programs could be dramatically scaled back or discontinued.

Kennedy, Patrick Inspire at ADDP Conference

Governor Deval Patrick and keynote speaker Ted Kennedy, Jr. inspired the 700 people gathered at the ADDP Conference & Expo last month.
See media coverage of our event!

Event Photos: Still photos by Jamie Fountain

Telegram & Gazette article by Jacqueline Reis

Boston Herald article by Peter Gelzinis

Video Clips of Mr. Kennedy's presentation may be found by clicking below:

1. Fox 25 News

2. WCVB, Channel 5 Boston

3. NECN, New England Cable Network

4. Channel 7 Boston News

View past articles

To read past articles, columns and editorials associated with ADDP, please click here .