Holly Center in Salisbury, MD, is an Intermediate Care Facility and home for people with profound intellectual and behavioral disabilities, medical fragility, and other medical and psychiatric problems who benefit from the comprehensive services available there.
In an opinion piece, “Does Holly Center have a future?”, 3/29/16, Mark Engberg asks the question, “Who controls our government? Who determines what services our state provides to its citizens?”
He goes on to say,
“I am incredibly perplexed that despite strong support for the services offered at Holly Center in Salisbury from so many people from our community – individuals, civic groups, faith-based groups, state and local legislators, local leaders including the Greater Salisbury Committee and local businesses – the Maryland Department of Health and Mental Hygiene and its sub-agency, the Developmental Disabilities Administration, turn a deaf ear to earnest, well-reasoned pleas to keep this facility operational.”
Mark’s sister Beth was a resident of Holly Center from 1984 until she passed away in 2004. His family will be forever grateful for the care she received there. Why, he asks, is Maryland so set on eliminating Intermediate Care Facilities?
“Is it cheaper? No. The cost of care for profoundly disabled citizens in group homes is not cheaper.
“Is it mandated by law? No. Federal Medicaid law clearly states: 'The individual or their representative be given the choice of either institutional or home and community based services.' I have contended for many years Maryland is in violation of the federal statute (42 C.F.R. §441.302) and a legal opinion letter in 2004 confirmed this, but once again – deaf ears.
“Why does this go on? It’s all about the money. The developmental disabilities lobby captures more than 90 percent of a $1.1 billion annual budget. Overall, The Maryland DD Coalition is well-intentioned, but its fanatical belief that facilities are horrible and group homes are the only answer is not only extreme, but harmful to our most vulnerable citizens.”
He concludes that for Holly Center residents and their families, the system is broken.
In another opinion piece, “It’s wrong to deny patients appropriate care”, 3/29/16 by Aimee Zuccarini, Aimee, the mother of a Holly Center resident, says, “One visit to Holly Center would show how the facility and staff humanize a unique population of all ages in ways community living cannot.” She goes on to describe how her son’s life changed when he was finally admitted to the facility:
“Profoundly autistic with severe intellectual disabilities, Ethan also had myriad health and behavioral issues, some so harrowing that by the time he was an adolescent, I lost count of visits to the ER.
“At Holly Center, a monumental transition began for Ethan by way of an ambitious individualized service plan. He would also become part of the larger community of Salisbury; developing, for the first time in his life, intrinsic relationships - bonds that still endure.
“But that said, the Maryland Developmental Disabilities Administation has continued its efforts during the years to dislocate Ethan from Holly Center. Recently that ongoing initiative has intensified: They insist Intermediate Care Facilities like Holly Center are segregated, isolated, restrictive and expensive – and if I’m not quick about choosing a ‘good one’ then no decent group homes will be left.
“The truth is most of the homes I’ve evaluated for Ethan have been terrifying. They are loosely regulated and supervised, often understaffed and offer a fraction of the services he currently receives.”
To express an opinion on this issue, call or email Maryland Governor Larry Hogan at 410-974-3901 or governor.mail@maryland.gov .
See also a survey from VOR "Giving a Voice to Families and Guardians" .
4/1/16 Update: This is an update from WMDT47 ABC TV. The state claims that Holly Center is not slated for closure, but this is a common refrain from states where facility closures are challenged by families of residents in hopes of getting families to back off their criticisms. The state says that no closure is "planned" and then they close the facility or move all the residents out and use it for other purposes.
News, information, and commentary for families and friends of people with developmental disabilities.
Thursday, March 31, 2016
Wednesday, March 30, 2016
Information on Sub-minimum wages for people with disabilities and appeal rights, PART 2
How to file a complaint with the U.S. Department of Labor, Wage and Hour Division regarding sub-minimum wage certificates:
This is a flyer listing the type of information you need to include with your complaint. It states that, "All services are free and confidential, whether you are documented or not. Please remember that your employer cannot terminate you or in any other manner discriminate against you for filing a complaint with WHD."
The complaint should be filed through a local Wage and Hour Division office. Here is a map that shows you where the district offices are located in your state.
Michigan has two district offices:
Detroit, MI, 48228
211 W. Fort St.
Room 517
TEL: (313) 309-4500
Grand Rapids, MI 49503
800 Monroe Ave., NW
Suite 315
TEL: (616) 456-2004
The Midwest Regional Office that includes Michigan is here:
Midwest Regional Office
230 S. Dearborn Street, Room 530
Chicago, Illinois 60604-1757
Karen Chaikin, Regional Administrator
(312) 596-7180
Here is information on how to make a Freedom of Information Act request from the Wage and Hour Division of the Department of Labor.
If it were me filing a complaint, I would want to know more about the procedures and timelines for filing. People at your local Hour and Wage Division should be willing to answer questions about the investigation and how you proceed with your challenge to a wage certificate. Ask for a copy of the wage certificate that applies to you or where you can obtain a copy of it.
Reach out to your state Protection and Advocacy Agency for advice and assistance. Here is a map to locate Protection and Advocacy in your state.
You may want to consider requesting changes to your "Individual Plan of Services" (IPOS) by scheduling a Person-centered Planning meeting to discuss alternatives to your current work situation. This may include looking into supported employment services that provide support for working in an integrated, competitive work setting and other alternatives.
This is a flyer listing the type of information you need to include with your complaint. It states that, "All services are free and confidential, whether you are documented or not. Please remember that your employer cannot terminate you or in any other manner discriminate against you for filing a complaint with WHD."
The complaint should be filed through a local Wage and Hour Division office. Here is a map that shows you where the district offices are located in your state.
Michigan has two district offices:
Detroit, MI, 48228
211 W. Fort St.
Room 517
TEL: (313) 309-4500
Grand Rapids, MI 49503
800 Monroe Ave., NW
Suite 315
TEL: (616) 456-2004
The Midwest Regional Office that includes Michigan is here:
Midwest Regional Office
230 S. Dearborn Street, Room 530
Chicago, Illinois 60604-1757
Karen Chaikin, Regional Administrator
(312) 596-7180
Here is information on how to make a Freedom of Information Act request from the Wage and Hour Division of the Department of Labor.
If it were me filing a complaint, I would want to know more about the procedures and timelines for filing. People at your local Hour and Wage Division should be willing to answer questions about the investigation and how you proceed with your challenge to a wage certificate. Ask for a copy of the wage certificate that applies to you or where you can obtain a copy of it.
Reach out to your state Protection and Advocacy Agency for advice and assistance. Here is a map to locate Protection and Advocacy in your state.
You may want to consider requesting changes to your "Individual Plan of Services" (IPOS) by scheduling a Person-centered Planning meeting to discuss alternatives to your current work situation. This may include looking into supported employment services that provide support for working in an integrated, competitive work setting and other alternatives.
Information on Sub-minimum wages for people with disabilities and appeal rights, PART 1
At its April 5th, 2016 meeting, the Michigan Developmental Disabilities Council will be discussing a recommendation to support amending current state legislation to prohibit the ability under the state law of employers to pay less than the minimum wage to persons with physical or mental disabilities, without regard to an individual’s productivity and earning capacity.
The controversy over sub-minimum wages is usually framed as a difference of opinion and ideology between people who believe disabled workers have the same right as everyone else to the protection of minimum wage laws, against those who believe that a subsidy to employers through sub-minimum wage certificates is justified to assure appropriate work experiences. For people who would otherwise not be employable in integrated, competitive work environments, wage certificates assure the availability of suitable alternatives.
The problem is that the two sides in this argument are talking about different people in different circumstances who cannot be categorized by sweeping generalizations about people with disabilities. Individually, each person with a developmental disability has a right to appropriate services and a right to be protected from discrimination in the workplace. The federal law and regulations as they are now written do both, even though enforcement of the law and how it is interpreted may be open to question.
*********************************
Below are references to federal regulations that define under what circumstances employers can apply for sub-minimum wage certificates for people with disabilities. These certificates are used primarily in facility-based programs or sheltered workshops that often provide an array of services beyond employment. Without the wage certificates, many of these programs would not be able to continue operating.
From the Wage and Hour Division of the U.S. Department of Labor:
§525.1 Introduction.
The Fair Labor Standards Amendments of 1986 (Pub. L. 99-486, 100 Stat. 1229) substantially revised those provisions of the Fair Labor Standards Act of 1938 (29 U.S.C. 201) (FLSA) permitting the employment of individuals disabled for the work to be performed (workers with disabilities) at special minimum wage rates below the rate that would otherwise be required by statute. These provisions are codified at section 14(c) of the FLSA and:
(a) Provide for the employment under certificates of individuals with disabilities at special minimum wage rates which are commensurate with those paid to workers not disabled for the work to be performed employed in the vicinity for essentially the same type, quality, and quantity of work; [emphasis added]
(b) Require employers to provide written assurances that wage rates of individuals paid on an hourly rate basis be reviewed at least once every six months and that the wages of all employees be reviewed at least annually to reflect changes in the prevailing wages paid to experienced individuals not disabled for the work to be performed employed in the locality for essentially the same type of work;
...
(d) Permit the continuance or establishment of work activities centers; and
(e) Provide that any employee receiving a special minimum wage rate pursuant to section 14(c), or the parent or guardian of such an employee, may petition for a review of that wage rate by an administrative law judge. [emphasis added]
Definitions:
Worker with a disability for the purpose of this part means an individual whose earning or productive capacity is impaired by a physical or mental disability, including those relating to age or injury, for the work to be performed. Disabilities which may affect earning or productive capacity include blindness, mental illness, mental retardation, cerebral palsy, alcoholism, and drug addiction. The following, taken by themselves, are not considered disabilities for the purposes of this part: Vocational, social, cultural, or educational disabilities; chronic unemployment; receipt of welfare benefits; nonattendance at school; juvenile delinquency; and, correctional parole or probation. Further, a disability which may affect earning or productive capacity for one type of work may not affect such capacity for another.[emphasis added]
Special minimum wage is a wage authorized under a certificate issued to an employer under this part that is less than the statutory minimum wage…
Commensurate wage is a special minimum wage paid to a worker with a disability which is based on the worker's individual productivity in proportion to the wage and productivity of experienced nondisabled workers performing essentially the same type, quality, and quantity of work in the vicinity in which the individual under certificate is employed. For example, the commensurate wage of a worker with a disability who is 75% as productive as the average experienced nondisabled worker, taking into consideration the type, quality, and quantity of work of the disabled worker, would be set at 75% of the wage paid to the nondisabled worker. For purposes of these regulations, a commensurate wage is always a special minimum wage, i.e., a wage below the statutory minimum.
Wage payments:
§525.5 Wage payments.
(a) An individual whose earning or productive capacity is not impaired for the work being performed cannot be employed under a certificate issued pursuant to this part and must be paid at least the applicable minimum wage. [emphasis added] An individual whose earning or productive capacity is impaired to the extent that the individual is unable to earn at least the applicable minimum wage may be paid a commensurate wage, but only after the employer has obtained a certificate authorizing payment of special minimum wages from the appropriate office of the Wage and Hour Division of the Department of Labor.
§525.9 Criteria for employment of workers with disabilities under certificates at special minimum wage rates.
(a) In order to determine that special minimum wage rates are necessary in order to prevent the curtailment of opportunities for employment, the following criteria will be considered:
(1) The nature and extent of the disabilities of the individuals employed as these disabilities relate to the individuals' productivity;
(2) The prevailing wages of experienced employees not disabled for the job who are employed in the vicinity in industry engaged in work comparable to that performed at the special minimum wage rate;
(3) The productivity of the workers with disabilities compared to the norm established for nondisabled workers through the use of a verifiable work measurement method (see §525.12(h)) or the productivity of experienced nondisabled workers employed in the vicinity on comparable work; and,
(4) The wage rates to be paid to the workers with disabilities for work comparable to that performed by experienced nondisabled workers.
(b) In order to be granted a certificate authorizing the employment of workers with disabilities at special minimum wage rates, the employer must provide the following written assurances concerning such employment:
(1) In the case of individuals paid hourly rates, the special minimum wage rates will be reviewed by the employer at periodic intervals at a minimum of once every six months; and,
(2) Wages for all employees will be adjusted by the employer at periodic intervals at a minimum of once each year to reflect changes in the prevailing wages paid to experienced nondisabled individuals employed in the locality for essentially the same type of work.
The issuance of a sub minimum wage certificate review and appeals:
§525.18 Review.
Any person aggrieved by any action of the Administrator taken pursuant to this part may, within 60 days or such additional time as the Administrator may allow, file with the Administrator a petition for review. Such review, if granted, shall be made by the Administrator. Other interested persons, to the extent it is deemed appropriate, may be afforded an opportunity to present data and views. [Administrator means the Administrator of the Wage and Hour Division, U.S. Department of Labor, or the Administrator's authorized representative.]
§525.19 Investigations and hearings.
The Administrator may conduct an investigation, which may include a hearing, prior to taking any action pursuant to these regulations. To the extent it is deemed appropriate, the Administrator may provide an opportunity to other interested persons to present data and views. Proceedings initiated pursuant to this section are separate from those taken pursuant to FLSA section 14(c)(5) and §525.22.
§525.23 Work activities centers.
Nothing in these regulations shall be interpreted to prevent an employer from maintaining or establishing work activities centers to provide therapeutic activities for workers with disabilities as long as the employer complies with the requirement of these regulations. Work activities centers shall include centers planned and designed to provide therapeutic activities for workers with severe disabilities affecting their productive capacity. Any establishment whose workers with disabilities are employed at special minimum wages must comply with the requirements of this part, regardless of the designation of such establishment.
The controversy over sub-minimum wages is usually framed as a difference of opinion and ideology between people who believe disabled workers have the same right as everyone else to the protection of minimum wage laws, against those who believe that a subsidy to employers through sub-minimum wage certificates is justified to assure appropriate work experiences. For people who would otherwise not be employable in integrated, competitive work environments, wage certificates assure the availability of suitable alternatives.
The problem is that the two sides in this argument are talking about different people in different circumstances who cannot be categorized by sweeping generalizations about people with disabilities. Individually, each person with a developmental disability has a right to appropriate services and a right to be protected from discrimination in the workplace. The federal law and regulations as they are now written do both, even though enforcement of the law and how it is interpreted may be open to question.
*********************************
Below are references to federal regulations that define under what circumstances employers can apply for sub-minimum wage certificates for people with disabilities. These certificates are used primarily in facility-based programs or sheltered workshops that often provide an array of services beyond employment. Without the wage certificates, many of these programs would not be able to continue operating.
From the Wage and Hour Division of the U.S. Department of Labor:
§525.1 Introduction.
The Fair Labor Standards Amendments of 1986 (Pub. L. 99-486, 100 Stat. 1229) substantially revised those provisions of the Fair Labor Standards Act of 1938 (29 U.S.C. 201) (FLSA) permitting the employment of individuals disabled for the work to be performed (workers with disabilities) at special minimum wage rates below the rate that would otherwise be required by statute. These provisions are codified at section 14(c) of the FLSA and:
(a) Provide for the employment under certificates of individuals with disabilities at special minimum wage rates which are commensurate with those paid to workers not disabled for the work to be performed employed in the vicinity for essentially the same type, quality, and quantity of work; [emphasis added]
(b) Require employers to provide written assurances that wage rates of individuals paid on an hourly rate basis be reviewed at least once every six months and that the wages of all employees be reviewed at least annually to reflect changes in the prevailing wages paid to experienced individuals not disabled for the work to be performed employed in the locality for essentially the same type of work;
...
(d) Permit the continuance or establishment of work activities centers; and
(e) Provide that any employee receiving a special minimum wage rate pursuant to section 14(c), or the parent or guardian of such an employee, may petition for a review of that wage rate by an administrative law judge. [emphasis added]
Definitions:
Worker with a disability for the purpose of this part means an individual whose earning or productive capacity is impaired by a physical or mental disability, including those relating to age or injury, for the work to be performed. Disabilities which may affect earning or productive capacity include blindness, mental illness, mental retardation, cerebral palsy, alcoholism, and drug addiction. The following, taken by themselves, are not considered disabilities for the purposes of this part: Vocational, social, cultural, or educational disabilities; chronic unemployment; receipt of welfare benefits; nonattendance at school; juvenile delinquency; and, correctional parole or probation. Further, a disability which may affect earning or productive capacity for one type of work may not affect such capacity for another.[emphasis added]
Special minimum wage is a wage authorized under a certificate issued to an employer under this part that is less than the statutory minimum wage…
Commensurate wage is a special minimum wage paid to a worker with a disability which is based on the worker's individual productivity in proportion to the wage and productivity of experienced nondisabled workers performing essentially the same type, quality, and quantity of work in the vicinity in which the individual under certificate is employed. For example, the commensurate wage of a worker with a disability who is 75% as productive as the average experienced nondisabled worker, taking into consideration the type, quality, and quantity of work of the disabled worker, would be set at 75% of the wage paid to the nondisabled worker. For purposes of these regulations, a commensurate wage is always a special minimum wage, i.e., a wage below the statutory minimum.
Wage payments:
§525.5 Wage payments.
(a) An individual whose earning or productive capacity is not impaired for the work being performed cannot be employed under a certificate issued pursuant to this part and must be paid at least the applicable minimum wage. [emphasis added] An individual whose earning or productive capacity is impaired to the extent that the individual is unable to earn at least the applicable minimum wage may be paid a commensurate wage, but only after the employer has obtained a certificate authorizing payment of special minimum wages from the appropriate office of the Wage and Hour Division of the Department of Labor.
§525.9 Criteria for employment of workers with disabilities under certificates at special minimum wage rates.
(a) In order to determine that special minimum wage rates are necessary in order to prevent the curtailment of opportunities for employment, the following criteria will be considered:
(1) The nature and extent of the disabilities of the individuals employed as these disabilities relate to the individuals' productivity;
(2) The prevailing wages of experienced employees not disabled for the job who are employed in the vicinity in industry engaged in work comparable to that performed at the special minimum wage rate;
(3) The productivity of the workers with disabilities compared to the norm established for nondisabled workers through the use of a verifiable work measurement method (see §525.12(h)) or the productivity of experienced nondisabled workers employed in the vicinity on comparable work; and,
(4) The wage rates to be paid to the workers with disabilities for work comparable to that performed by experienced nondisabled workers.
(b) In order to be granted a certificate authorizing the employment of workers with disabilities at special minimum wage rates, the employer must provide the following written assurances concerning such employment:
(1) In the case of individuals paid hourly rates, the special minimum wage rates will be reviewed by the employer at periodic intervals at a minimum of once every six months; and,
(2) Wages for all employees will be adjusted by the employer at periodic intervals at a minimum of once each year to reflect changes in the prevailing wages paid to experienced nondisabled individuals employed in the locality for essentially the same type of work.
The issuance of a sub minimum wage certificate review and appeals:
§525.18 Review.
Any person aggrieved by any action of the Administrator taken pursuant to this part may, within 60 days or such additional time as the Administrator may allow, file with the Administrator a petition for review. Such review, if granted, shall be made by the Administrator. Other interested persons, to the extent it is deemed appropriate, may be afforded an opportunity to present data and views. [Administrator means the Administrator of the Wage and Hour Division, U.S. Department of Labor, or the Administrator's authorized representative.]
§525.19 Investigations and hearings.
The Administrator may conduct an investigation, which may include a hearing, prior to taking any action pursuant to these regulations. To the extent it is deemed appropriate, the Administrator may provide an opportunity to other interested persons to present data and views. Proceedings initiated pursuant to this section are separate from those taken pursuant to FLSA section 14(c)(5) and §525.22.
§525.23 Work activities centers.
Nothing in these regulations shall be interpreted to prevent an employer from maintaining or establishing work activities centers to provide therapeutic activities for workers with disabilities as long as the employer complies with the requirement of these regulations. Work activities centers shall include centers planned and designed to provide therapeutic activities for workers with severe disabilities affecting their productive capacity. Any establishment whose workers with disabilities are employed at special minimum wages must comply with the requirements of this part, regardless of the designation of such establishment.
Friday, March 25, 2016
Crisis in Care: Direct Support Workers earn poverty wages; solutions needed to stabilize support services
"The Cost of Compassion" from the Oregon Rehabilitation Association
In Michigan, a 2015 survey by the Partnership for Fair Caregiver Wages shows that employers can't attract Direct Service Providers with the current reimbursement rates:
"In the spring of 2014, the Michigan Legislature passed a law to increase the standard minimum hourly wage, via annual increases, from $7.40 to $9.25 by January 1, 2018. The Legislature did not provide any additional funding for the wages of direct-support workers, the employees of state-funded programs that care for and support some of the most vulnerable people in our state.
"An estimated 44,000 direct-support jobs are funded through Medicaid appropriations to support and serve people with intellectual and developmental disabilities, mental illnesses, and substance use disorders. Employers of these workers depend on Medicaid funding provided through the Michigan Department of Health and Human Services, and unlike other businesses, have little or no ability to increase revenues to meet increased staff costs.
"Even before the increases in the minimum wage, staffing shortages tied to low wage rates were creating soon-to-be-crisis-level consequences." [Emphasis added]
High Turnover Rate: "Among those surveyed, a 37 percent turnover rate = loss of 6,308 employees in a single year. "
Direct-Support Workers Earn Poverty Wages
2,600 direct-support workers are needed now.
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The Partnership for Fair Caregiver Wages is a coalition of state-wide organizations advocating for persons with disabilities, direct support staff, and employers as well as regional community mental health boards and individual employers. This coalition is seeking sufficient public dollars to raise the wages of direct support staff in Medicaid-funded programs supporting people with intellectual and developmental disabilities, mental illness, and substance use disorders.
For more information, please contact Hollis Turnham at hturnham@PHInational.org or Robert Stein at rstein@miassistedliving.org.
*****************************
What is a "Living Wage" in your state? Find out here.
Thursday, March 24, 2016
MI DD Council to consider elimination of sub-minimum wage for DD
I want to personally encourage the public to participate in this discussion of the issue of sub-minimum wages, their affect on people with DD, and the availability of appropriate programs and services to meet the diverse needs of the DD population. The DD Council will be taking up this issue at the April 2016 meeting. To give the public and especially individuals with DD and their families a chance to weigh-in, the council anticipates hearing from people during the public comment period and will also accept written comments that will be distributed to council members for their consideration. The DD Council always schedules time for public comments at their meetings and welcomes public participation.
*********************************
The Michigan Developmental Disabilities Council wants to hear from you on the issue of sub-minimum wage certificates and whether the DD Council should support amending current legislation to prohibit the ability under the state law of employers to pay less than the minimum wage to persons with physical or mental disabilities, regardless of an individual’s productivity and earning capacity. For people with DD, sub-minimum wage certificates are used primarily by employers for sheltered workshops (facility-based employment or skill-building services). [For more information, see below.]
The DD Council will be considering this issue at its next meeting on:
Tuesday, April 5th, 2016
10:45 am to Noon
at the Lewis Cass Building,
320 S. Walnut Street between Washtenaw and Kalamazoo
Lansing, MI
This is a new location for the DD Council.
The opportunity for public comment is usually at the beginning of the meeting. The exact wording of the recommendation before the council may change slightly, but the main idea is the same as stated above. If you plan to attend public comment, please notify Dee Florence at FlorenceD1@michigan.gov or (517) 284-7293 by Thursday, March 30, 2016.
Send written comments to Yasmina Bouraoui at bouraouiy@michigan.gov or Dee Florence at FlorenceD1@michigan.gov by Friday, April 1st, 2016. These will be distributed to DD Council members.
MORE INFORMATION:
What are sub-minimum wage certificates?
The federal Fair Labor Standards Act currently allows employers of people with disabilities to apply for “authorizing certificates” from the U.S. Department of Labor to pay special minimum wages (SMWs) “to workers with disabilities whose productive and earning capacities are impaired for the work being performed.”
“An SMW must also be a commensurate wage, based on the individual productivity of the worker with a disability (no matter how limited) in proportion to the productivity of experienced workers who do not have disabilities that impact their productivity when performing essentially the same work in the same vicinity.”
For people with developmental disabilities, wage certificates are used primarily by sheltered workshops (facility-based employment or skill-building programs) as an incentive to hire people who might otherwise not be employable. These facility-based programs often provide an array of services beyond employment. Without the wage certificates, many of these programs would not be able to continue operating. In integrated Supported Employment work settings, disabled workers receive at least minimum wage along with support services; the wage certificates are not used.
The DD Council staff determined that states may pass legislation eliminating the use of wage certificates by employers for people with developmental disabilities and looked into the feasibility of doing so. See Staff Report here.
For more information on the effect of eliminating the choice of facility-based employment, especially for people with more severe disabilities, with the primary alternative being integrated supported employment, see The DD News Blog. APSE, The Association of People Supporting Employment First, supports phasing out the use of facility-based work programs in favor of integrated, competitive employment for all.
Friday, March 18, 2016
Iowa to switch to Medicaid managed care; 25,000 people receiving Home and Community-Based Services affected
“Problems With Medicaid Privatization Plague Other States Ahead of Iowa's Switch” is a TV news report from Cedar Rapids, Iowa, looking into a similar plan in Kansas that has been in effect for three years. Kansas has had multiple problems with managed care affecting people with developmental and other disabilities. Here is a link to a video of the report and the written story from 2/29/16.
According to KCRG.com, the problems that Kansas has encountered include “a lack of meaningful oversight, confusing reimbursement requirements from the three managed care organizations, or MCOs, who are contracted with the state, and cuts to care.” In Iowa and Kansas, two of the managed care organizations (MCOs) are the same - “Both companies are facing accusations in Kansas of systematically denying claims to turn a profit.”
For people who receive Home and Community-Based Services (HCBS) (13,000 in Kansas and 25,000 in Iowa), the threat of service cuts is a significant problem. According to Sharon Spratt, CEO of Cottonwood, Inc., a provider of long-term community-based care in Lawrence, Kansas, round-the-clock services are not cheap and it has been a constant battle to maintain them:
“We understood there could be some efficiencies on the medical side,” Spratt said. “But the right service at the right time doesn’t cure our folks. Our folks have lifelong disabilities.”
Spratt said Cottonwood often deals with the same problem of denied or unpaid claims, but most levels of care have remained the same. But following our Feb. 19 interview, Cottonwood received its first notice of an MCO denying all residential care for one of its clients. Cottonwood plans to appeal the decision.
Despite the warnings from Kansas, Iowa is poised to take the plunge into privatization and managed care. Whether Iowa has any better chance of success, remains to be seen.
More dysfunction from Kansas: A couple with a 21-year-old daughter with intellectual and developmental disabilities, autism, and a seizure disorder has been waiting since 2008 for state-funded services. 3,450 people are on the waiting list. On a lighter note (?), a woman whose daughter needed a new wheelchair and receives state services, says the state covered the wheelchair, but not the wheels.
According to KCRG.com, the problems that Kansas has encountered include “a lack of meaningful oversight, confusing reimbursement requirements from the three managed care organizations, or MCOs, who are contracted with the state, and cuts to care.” In Iowa and Kansas, two of the managed care organizations (MCOs) are the same - “Both companies are facing accusations in Kansas of systematically denying claims to turn a profit.”
For people who receive Home and Community-Based Services (HCBS) (13,000 in Kansas and 25,000 in Iowa), the threat of service cuts is a significant problem. According to Sharon Spratt, CEO of Cottonwood, Inc., a provider of long-term community-based care in Lawrence, Kansas, round-the-clock services are not cheap and it has been a constant battle to maintain them:
“We understood there could be some efficiencies on the medical side,” Spratt said. “But the right service at the right time doesn’t cure our folks. Our folks have lifelong disabilities.”
Spratt said Cottonwood often deals with the same problem of denied or unpaid claims, but most levels of care have remained the same. But following our Feb. 19 interview, Cottonwood received its first notice of an MCO denying all residential care for one of its clients. Cottonwood plans to appeal the decision.
Despite the warnings from Kansas, Iowa is poised to take the plunge into privatization and managed care. Whether Iowa has any better chance of success, remains to be seen.
More dysfunction from Kansas: A couple with a 21-year-old daughter with intellectual and developmental disabilities, autism, and a seizure disorder has been waiting since 2008 for state-funded services. 3,450 people are on the waiting list. On a lighter note (?), a woman whose daughter needed a new wheelchair and receives state services, says the state covered the wheelchair, but not the wheels.
Wednesday, March 16, 2016
The Revolving Door : Sharon Lewis from the Administration on Community Living moves on to a private sector consulting firm
Sharon Lewis, like so many government appointees before her, has left her job at the federal Administration on Community Living (ACL) and has moved on to a position in a private sector consulting firm. The ACL is an agency under the U.S. Department of Health and Human Services that administers programs for people with disabilities and older adults. Her departure from the agency was announced in December 2015. She is now employed by a Healthcare consulting and research firm called Health Management Associates.
Sharon Lewis was the Principal Deputy Administrator and co-founder of the Administration on Community Living. She has collaborated with multiple federal and state agencies and led controversial reforms in Home and Community-Based Services (HCBS) policy and regulations. Over the years she has also worked closely with disability advocacy groups.
There is apparently nothing untoward or improper about her accepting a position with a consulting firm. Her experience and contacts will make her an unusually valuable addition to the team.
The idea of “The Revolving Door”, however, raises questions about the people in Washington overseeing programs for people with disabilities. Are they working for us or are they angling for their next job? Maybe a little of both? The greatest conflict of interest that I see is when advocates for people with disabilities move back and forth between government agencies and advocacy groups. Their watchdog role in monitoring government for people with disabilities is inevitably compromised by the interests of the federal agencies that pay them. These conflicts need to be disclosed regularly and individuals and groups that operate independently of government need to be assured of the opportunity to be heard so as not to be drowned out by federally-funded advocates.
Michiganders may be interested in knowing that Health Management Associates has a Michigan component that includes Steve Fitton, a former State Medicaid Director, and Rich VandenHeuvel, a behavioral health executive with several community mental health agencies and regional Prepaid Inpatient Health Plans (PIHPs).
See more on the Revolving Door.
The Center for Responsive Politics at OpenSecrets.org is a non-partisan, independent and nonprofit group that tracks money in politics and its effects on elections and public policy. Of the “The Revolving Door”, the organization says, “…[it] shuffles former federal employees into jobs as lobbyists, consultants and strategists just as the door pulls former hired guns into government careers…While officials in the executive branch, Congress and senior congressional staffers spin in and out of the private and public sectors, so too does privilege, power, access and, of course, money.”
Sharon Lewis was the Principal Deputy Administrator and co-founder of the Administration on Community Living. She has collaborated with multiple federal and state agencies and led controversial reforms in Home and Community-Based Services (HCBS) policy and regulations. Over the years she has also worked closely with disability advocacy groups.
There is apparently nothing untoward or improper about her accepting a position with a consulting firm. Her experience and contacts will make her an unusually valuable addition to the team.
The idea of “The Revolving Door”, however, raises questions about the people in Washington overseeing programs for people with disabilities. Are they working for us or are they angling for their next job? Maybe a little of both? The greatest conflict of interest that I see is when advocates for people with disabilities move back and forth between government agencies and advocacy groups. Their watchdog role in monitoring government for people with disabilities is inevitably compromised by the interests of the federal agencies that pay them. These conflicts need to be disclosed regularly and individuals and groups that operate independently of government need to be assured of the opportunity to be heard so as not to be drowned out by federally-funded advocates.
Michiganders may be interested in knowing that Health Management Associates has a Michigan component that includes Steve Fitton, a former State Medicaid Director, and Rich VandenHeuvel, a behavioral health executive with several community mental health agencies and regional Prepaid Inpatient Health Plans (PIHPs).
See more on the Revolving Door.
The Center for Responsive Politics at OpenSecrets.org is a non-partisan, independent and nonprofit group that tracks money in politics and its effects on elections and public policy. Of the “The Revolving Door”, the organization says, “…[it] shuffles former federal employees into jobs as lobbyists, consultants and strategists just as the door pulls former hired guns into government careers…While officials in the executive branch, Congress and senior congressional staffers spin in and out of the private and public sectors, so too does privilege, power, access and, of course, money.”
Tuesday, March 15, 2016
Michigan reverses course on privatization of the mental health system
When the Michigan budget for Fiscal Year 2017 was released earlier this year, it included the now infamous Section 298 that would have turned Medicaid funding over to Medicaid Health Plans that would have in turn contracted with local community mental health agencies to provide services to people with developmental disabilities, mental illness, and other disabilities.
Currently, mental health services are funded separately as a “carve-out” to assure that these vulnerable populations are taken care of appropriately. The Michigan Department of Health and Human Services contracts with regional administrative community mental health agencies (PIHPs) that distribute funds to local CMH agencies to provide services. PIHPs would have been eliminated and Medicaid Health Plans, many of them for-profit, would have taken over, reducing the amount in the total budget available for services. The difference in overhead with the current PIHP System is striking: for Medicaid Health Plans, overhead costs for administering these plans is 15 - 17 % of the total funding. The Michigan PIHP system costs for overhead are only 6%.
By March 3, 2016, there was enough of an uproar over the proposed budget that the Michigan House Subcommittee on Judiciary and the Department of Community Health changed course, at least for now.
This is an email from Alan Bolter, Associate Director of the Michigan Association of Community Mental Health Boards (MACMHB), on 3/4/16:
...Today, Rep. VerHeulen issued the following statement regarding Section 298 of the Executive Budget request for the Department of Health and Human Services (MDHHS) Budget:
"After spending several weeks reviewing the proposed language in Section 298, I want to ensure stakeholders, patients, and Michiganders that the language will not be included in the House MDHHS budget.
“I appreciate the work of the Department of Health and Human Services in exploring new and innovative ideas to enhance the care of beneficiaries in the state of Michigan. Mental health is one of the most critical aspects of our health care system, and it is important that we carefully review proposed changes.
“The language in Section 298 will be removed in the House MDHHS budget. I am always open to proposed changes that prioritize more efficient and effective mental health care. I appreciate the workgroup process that has been initiated by Lieutenant Governor Calley and MDHHS, and look forward to analyzing the results of that workgroup process.
“The House Appropriations MDHHS Subcommittee will continue to work to craft a budget that ensures a high level of responsible care for Michiganders. Health care will remain a pressing issue, and the subcommittee looks forward to tackling the other challenges we face with Michigan's health care and social safety net systems."
#####
Alan Bolter, Associate Director
MACMHB
426 S. Walnut St.
Lansing, MI 48933
(517) 374-6848
************************
This is far from over, but at least there is a considered effort underway to analyze and study proposed changes to the way services to people with DD and other disabilities are funded and delivered before those changes are enacted into law.
Here is more information on Section 298 and proposals that would have made drastic changes in Michigan's mental health system.
Currently, mental health services are funded separately as a “carve-out” to assure that these vulnerable populations are taken care of appropriately. The Michigan Department of Health and Human Services contracts with regional administrative community mental health agencies (PIHPs) that distribute funds to local CMH agencies to provide services. PIHPs would have been eliminated and Medicaid Health Plans, many of them for-profit, would have taken over, reducing the amount in the total budget available for services. The difference in overhead with the current PIHP System is striking: for Medicaid Health Plans, overhead costs for administering these plans is 15 - 17 % of the total funding. The Michigan PIHP system costs for overhead are only 6%.
By March 3, 2016, there was enough of an uproar over the proposed budget that the Michigan House Subcommittee on Judiciary and the Department of Community Health changed course, at least for now.
This is an email from Alan Bolter, Associate Director of the Michigan Association of Community Mental Health Boards (MACMHB), on 3/4/16:
...Today, Rep. VerHeulen issued the following statement regarding Section 298 of the Executive Budget request for the Department of Health and Human Services (MDHHS) Budget:
"After spending several weeks reviewing the proposed language in Section 298, I want to ensure stakeholders, patients, and Michiganders that the language will not be included in the House MDHHS budget.
“I appreciate the work of the Department of Health and Human Services in exploring new and innovative ideas to enhance the care of beneficiaries in the state of Michigan. Mental health is one of the most critical aspects of our health care system, and it is important that we carefully review proposed changes.
“The language in Section 298 will be removed in the House MDHHS budget. I am always open to proposed changes that prioritize more efficient and effective mental health care. I appreciate the workgroup process that has been initiated by Lieutenant Governor Calley and MDHHS, and look forward to analyzing the results of that workgroup process.
“The House Appropriations MDHHS Subcommittee will continue to work to craft a budget that ensures a high level of responsible care for Michiganders. Health care will remain a pressing issue, and the subcommittee looks forward to tackling the other challenges we face with Michigan's health care and social safety net systems."
#####
Alan Bolter, Associate Director
MACMHB
426 S. Walnut St.
Lansing, MI 48933
(517) 374-6848
************************
This is far from over, but at least there is a considered effort underway to analyze and study proposed changes to the way services to people with DD and other disabilities are funded and delivered before those changes are enacted into law.
Here is more information on Section 298 and proposals that would have made drastic changes in Michigan's mental health system.
Saturday, March 5, 2016
Conflicting regulations on contamination endanger public health
Since the country has been made aware of the poisoning of the Flint Michigan water supply with lead from corroded pipes, stories about lead contamination have been popping up everywhere. The danger with this is that the public becomes numb to the consequences of water contamination and the problem seems too big to solve. We throw up our hands and check off another reason to distrust government solutions to big problems.
The fact is that the old lead pipes in Flint can be replaced and should be, starting now. It will be a long and expensive slog to correct the problem and there may not be any way to make the children exposed to lead poisoning completely whole again, but we have to start somewhere. Despair is not a solution.
An op-ed in the New York Times, “Blame HUD for America’s Lead Epidemic” by Emily Benfer, 3/4/16, exposes conflicting federal regulations that have resulted in the acceptance of high levels of lead exposure for residents of public housing.
According to Benfer, the standards for public housing from the Department of Housing and Urban Development (HUD) sets the level that defines lead poisoning three to four times higher than that set by the Centers for Disease Contol and Prevention (CDC): “While the C.D.C. recommends intervention for lead poisoning at 5 micrograms per deciliter, HUD regulations do not call for action until after a child’s blood lead level is 20 micrograms per deciliter, or 15 to 19 micrograms per deciliter over three months — levels that cause severe and permanent brain damage.”
She continues: “These regulations are the most egregious contributors to the epidemic of lead poisoning in public and low-income housing. I have spent six years working with Loyola University Chicago law students, the Erie Family Health Center and civil legal aid organizations on cases involving low-income families living in unhealthy housing. We have seen firsthand how chipping, cracking lead paint creates toxic living conditions.”
The solution to this problems is within reach of us mere mortals by getting Congress and federal regulatory agencies to bring standards into alignment and start correcting the problem that causes children to suffer from our neglect.
In another regulatory mismatch much closer to home, the conflict between standards for dioxane contamination in groundwater between the State of Michigan and the federal Environmental Protection Agency has resulted in children and their families being exposed to unacceptably high levels of a carcinogen because the state failed to correct its standards for groundwater contamination to conform with the EPA.
An article in the Ann Arbor News, “Family with poisoned well finally getting municipal water services”, by Ryan Stanton, 3/4/16, describes the plight of a family that has been using contaminated well water for over two years because they were assured by the Pall Corp. that took over ownership of the company that originally caused the contamination, that “the water was safe to drink with dioxane concentrations at 17 parts per billion because it's below the state's 85 ppb standard.” They were not told, however, that the federal EPA standard shows that dioxane at 3.5 ppb in drinking water poses a 1 in 100,000 cancer risk, the standard that the state sets at 85 ppb.
According to the article, “local officials have been fighting for years to convince the state to move to a stricter standard to reflect the latest findings about dioxane published by the U.S. Environmental Protection Agency in 2010. The DEQ [Department of Environmental Quality] was required by law to update the standards by December 2013, but Lansing politics and technical problems have been blamed for repeated delays and missed deadlines.”
State officials acknowledge the problem and “the Michigan Department Environmental Quality is proposing to move to a single-digit standard sometime this year.”
The Pate family that has been living with dioxane-contaminated well water has retained an attorney.
Heather Pate is quoted in the article: "Too many times politicians get away with stuff… They're not going to get away with this one. We're not going to let it happen. And we're not doing this for money. I want them in prison. I want them doing time."
This sounds about right to me.
The fact is that the old lead pipes in Flint can be replaced and should be, starting now. It will be a long and expensive slog to correct the problem and there may not be any way to make the children exposed to lead poisoning completely whole again, but we have to start somewhere. Despair is not a solution.
An op-ed in the New York Times, “Blame HUD for America’s Lead Epidemic” by Emily Benfer, 3/4/16, exposes conflicting federal regulations that have resulted in the acceptance of high levels of lead exposure for residents of public housing.
According to Benfer, the standards for public housing from the Department of Housing and Urban Development (HUD) sets the level that defines lead poisoning three to four times higher than that set by the Centers for Disease Contol and Prevention (CDC): “While the C.D.C. recommends intervention for lead poisoning at 5 micrograms per deciliter, HUD regulations do not call for action until after a child’s blood lead level is 20 micrograms per deciliter, or 15 to 19 micrograms per deciliter over three months — levels that cause severe and permanent brain damage.”
She continues: “These regulations are the most egregious contributors to the epidemic of lead poisoning in public and low-income housing. I have spent six years working with Loyola University Chicago law students, the Erie Family Health Center and civil legal aid organizations on cases involving low-income families living in unhealthy housing. We have seen firsthand how chipping, cracking lead paint creates toxic living conditions.”
The solution to this problems is within reach of us mere mortals by getting Congress and federal regulatory agencies to bring standards into alignment and start correcting the problem that causes children to suffer from our neglect.
In another regulatory mismatch much closer to home, the conflict between standards for dioxane contamination in groundwater between the State of Michigan and the federal Environmental Protection Agency has resulted in children and their families being exposed to unacceptably high levels of a carcinogen because the state failed to correct its standards for groundwater contamination to conform with the EPA.
An article in the Ann Arbor News, “Family with poisoned well finally getting municipal water services”, by Ryan Stanton, 3/4/16, describes the plight of a family that has been using contaminated well water for over two years because they were assured by the Pall Corp. that took over ownership of the company that originally caused the contamination, that “the water was safe to drink with dioxane concentrations at 17 parts per billion because it's below the state's 85 ppb standard.” They were not told, however, that the federal EPA standard shows that dioxane at 3.5 ppb in drinking water poses a 1 in 100,000 cancer risk, the standard that the state sets at 85 ppb.
According to the article, “local officials have been fighting for years to convince the state to move to a stricter standard to reflect the latest findings about dioxane published by the U.S. Environmental Protection Agency in 2010. The DEQ [Department of Environmental Quality] was required by law to update the standards by December 2013, but Lansing politics and technical problems have been blamed for repeated delays and missed deadlines.”
State officials acknowledge the problem and “the Michigan Department Environmental Quality is proposing to move to a single-digit standard sometime this year.”
The Pate family that has been living with dioxane-contaminated well water has retained an attorney.
Heather Pate is quoted in the article: "Too many times politicians get away with stuff… They're not going to get away with this one. We're not going to let it happen. And we're not doing this for money. I want them in prison. I want them doing time."
This sounds about right to me.
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