Testimony before the Senate Finance Subcommitteeon HHR
Waiver ReDesign
September 29, 2015 - Karen Tefelski, Executive Director

Mr. Chairman, members of the committee and other interested parties – Good Evening. My name is Karen Tefelski and I am the Executive Director of the Virginia Association of Community Rehabilitation Programs Dba vaACCSES. On behalf of our membership, thank you for the opportunity to talk with you today.

Established in 1977, vaACCSES is a not-for-profit association of community-based organizations that provide quality services including employment, day support, residential, benefits assistance and work incentives, and other community-based support services to Virginians with all types of disabilities. Our members include both private providers and our CSB partners that provide day support and employment services. Currently, our 39 member organizations serve over 16,800 Virginians with disabilities on an annual basis.

Overall Waiver Redesign

VaACCSES is committed to supporting a successful waiver redesign that will transform our service delivery system to flexibly support a full array of quality service options that address an individual’s strengths, needs, abilities and capabilities consistent with his or her person-centered plan. We are committed to changing the services delivered versus changing the individual’s plan to fit within a pre-determined service package. We want individuals to be engaged in and connected to their community through employment and other integrated services.

This is a once in a generation opportunity. We all either seize the opportunity or settle for incremental change. Compliance as a goal is not enough – excellence should be our goal. VaACCSES, our colleagues in advocacy, DMAS and DBHDS staff are committed to making this happen.

We agree on the “why” but continue to work on the “how”. As you know, there is no shortage of frequently moving parts in waiver redesign. Despite our best efforts and the DBHDS and DMAS “open door” policy, we are divided on a couple of issues on how best to achieve the goals of waiver redesign.

We support the Person-Centered Planning process to drive the system not a prescriptive supports package determined by the SIS. We support a quality management system, good quality assurance mechanisms and data collection to help drive system evaluation and service delivery. We do not support systems management proposals that are onerous, are adversarial in nature, and do not add true overall value to individuals served.

We have made a commitment to work closely with DMAS and DBHDS to overcome our differences so that we can achieve shared success in waiver redesign and goals articulated in the ADA, the Virginia DOJ Settlement Agreement and implementation of the CMS rules in Virginia.

We want waiver redesign to be successful.

Rate Methodology and Rate Models

We applaud the development of a rate methodology that clearly lays out the elements that build a rate that addresses basic operating costs of waiver providers. The building of the rate methodology with DBHDS was inclusive and vetted by providers and advocates. The methodology supports where we need to go and how to move Virginia forward – to strengthen the path for individuals with ID/DD to achieve greater community integration, employment and increased independence.

While we embrace the rate methodology developed by DBHDS and Burns & Associates, we do have major concerns regarding the assumptions plugged into the methodology that developed the current proposed rates.The three most important are the following:

  • Direct Staff Base Wage Assumptions

A rate based on an inadequate base wage ends up being an inadequate rate.
A 50%-ile base wage from the Bureau of Labor Statistics (BLS) of the U.S. Department of Labor was used to form the foundation from which all individual rate models were built. The 50%-ile base wage for community-based day services, group day services and group supported employment represents ten to fifteen percent (10-15%) above the federal poverty level for a family of three and under the federal poverty level for a family of four. The proposed congregate group home base wage is at the federal poverty level for a family of three. This wage level makes direct service professionals in the ID/DD waiver eligible for a myriad of government assistance programs including food stamps and FAMIS, as well as eligible for a subsidy under Obamacare.

While we agree that provider rates need to be reasonable for the tax payers of Virginia, setting up a system where we intentionally develop provider rate models based on paying direct service professionals at poverty or just above poverty wages does not make sense – and, actually adds additional costs to the overall state budget by increasing the cost of other state assistance programs.

Low wages create a barrier for the recruitment of qualified staff. There is a difference between competency and capacity. Low wages generates excessive staff turnover which dramatically impacts a provider’s bottom line – and, most important, influences the quality of service to individuals served under the ID/DD waiver. We ask a lot of staff – training, documentation, maintaining the health and safety needs of individuals, as well as supporting individuals with significant behavioral and complex medical needs. But, most important, a revolving door of ever-changing staff does not provide consistent, dependable and a quality service for individuals with ID/DD and their families.

What does this say about how we value the individuals that provide support to one of our most vulnerable populations – individuals with ID/DD? Although, some might believe that this is a state funding issue – it’s really a philosophical issue about people. What would we expect if we hired an individual to care for our aging parents for a just above poverty wage? What would we expect?

At this pivotal moment, don’t we want to make sure that we provide at least a living wage for the staff that is the backbone of our service system? Low wages undercut all of our efforts in increasing quality of services and building service capacity of providers. Your Return On Investment (ROI) will be an experienced, well trained, competent and consistent workforce that meets the support needs of Virginians with disabilities.

We recommend using the 90%-ile BLS base wage but no less than the 75%-ile BLS base wage.

  • Proposed Rate Models Do Not Meet the Need of High Cost Area of Northern Virginia

A detailed letter signed by 34 northern Virginia Delegates and Senators was delivered to Senate Finance during the 2015 General Assembly session supporting adoption of the existing northern Virginia rate setting methodology. In place since 2007, the regional rate methodology is vetted by local government and recognizes the true market costs of northern Virginia waiver services. We presented this methodology to DBHDS and Burns & Associates during the rate development process but it was not considered. Although the current rate models include the current NoVa differential of 15% in most cases, the 15% differential has been in effect since 2008 is not a true differential. The 15% differential was set based on the amount of funding that was available to provide a differential. The true differential for state government is 25-30% depending upon the agency. For example, the differential for the Department of Aging and Rehabilitative Services in northern Virginia is 25%.

Recommend adoption of the region’s existing northern Virginia regional rate setting methodology. Adoption is necessary to resolve the regional disparities and achieve a successful transition to community-based services under the DOJ settlement agreement. The proposed rate models do not solve disparities and special circumstances in NoVa.

  • Attendance Assumptions for Day Services and Group Supported Employment (GSE)

The assumption used to reflect participant attendance of individuals in community-based day services, center-based day services and group supported employment services is too high at 88%. Historical vocational (DARS) statistics over the last ten years range from 75% to 78%. The current northern Virginia regional rate setting process uses 80%.

We recommend using an attendance rate of 78%.

Conclusion

Thank you for your time and consideration.

We look forward to working with Senate Finance Committee members and staff as well as continuing to work with our advocacy colleagues, DMAS and DBHDS to resolve any unresolved issues and creating a quality waiver system that meets the support needs of Virginians with disabilities consistent with the principles of informed choice and person-centered planning.

VA Association of Community Rehabilitation Programs dba vaACCSES  703-200-7660 

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