Washtenaw County, MI : 2nd Town Hall Meeting on Community Living Services and Self-Determination, 5/7/15

Second Washtenaw CMH Town Hall Meeting Scheduled

Recent Updates on Community Living Supports (CLS) and Self-Determination

Thursday, May 7, 2015
5:30 to 7:00 P.M.
St. Luke Lutheran Church

4205 Washtenaw Ave
(near the intersection of US 23 and Washtenaw Ave.)

Ann Arbor, MI 48108

Click here to download a printable flyer

In response to the Town Hall Meeting held on April 14, 2015, the following items are posted on the WCHO Website:

Washtenaw County Customer Service e-mail

Washtenaw County Behavioral Health Task Force FAQ on the future of the WCHO (Washtenaw Community Health Organization)

CLS PowerPoint Presentation from the 4/14/15 meeting (open from this page on the WCHO Website ; click on Townhall/CLS Announcement)

CLS FAQ

Washtenaw County Legislators

Summary of 4/14/15 meeting on community living services in Washtenaw County, MI

The 4/14/15 meeting in Ann Arbor was sponsored by the Washtenaw Community Health Organization (WCHO) and Community Supports and Treatment Services (CSTS) to discuss the future of community living support services. These local Community Mental Health (CMH) agencies provide Medicaid-funded services to people with disabilities, including people who are developmentally disabled and mentally ill and their families. 

The meeting was attended by about 100 [make that 180!] people eager to hear whether the WCHO [facing a budget deficit of $3.8 million] and CSTS had plans to cut services that allow individuals and their families to survive and thrive in community settings.

The meeting began with a PowerPoint presentation on “Utilization Management”, a fancy term for assuring that public funds are spent for the purposes intended by law and policy. The full presentation can be linked to here on the WCHO Website. [Click on “Town Hall Announcement” and then “CLS PowerPoint Presentation”] . The emphasis was on “medically necessary” services and a plan to review and evaluate Individual Plans of Service (IPOS’s), looking at those plans with the highest utilization rate first. These reviews may or may not result in cuts to services for individuals. 

There was nothing new as far as CMH agencies' obligation to be fiscally responsible and to provide Medicaid services that are "medically necessary".  Here is a blog post from The DD News Blog with the definition of medical necessity. The definition does not limit recipients of services to what would ordinarily be considered strictly medical services. It includes services to maintain or improve functioning and allow a person to live in the community.

As is usually the case, the most interesting part of a public meeting is the public and the questions and observations of people who went out of their way to attend the meeting. Here are some of the issues that were raised by the crowd:

The letter that went out to recipients of services under “Self-determiniation” arrangements announcing a decrease in the pay rate for direct service providers: 

• This was not the main topic of the 4/14 meeting, but the explanation for decreasing the pay was that Washtenaw County wants pay rates to conform to rates in the other counties in the 4-county affiliation of the Community Mental Health Partnership of Southeast Michigan. 
• Someone pointed out that there is no requirement that pay rates for every county be the same and that Washtenaw has the highest cost of living in the four-county region.  
• It is ironic that pay rates for direct service providers under self-determination living arrangements are being cut, while the Federal government through its rule on Home and Community-Based service settings encourages these kinds of living arrangements over congregate care and is applying pressure on states to move in this direction. Cutting pay rates is a sure way of making it harder for individuals to hire direct care staff who are competent and reliable.

The CSTS PowerPoint emphasizes the success of the WCHO and CSTS in cutting hospitalization times for people with mental illness. An audience member spoke of talking to family members of people with severe mental illness who say that hospital stays are way too short and do not allow people to adjust to new medications and to transition back to the community.

There were also complaints that families were already being threatened with service cuts, including people needing care and supervision 24 hours a day. Some were told there was no appeal of service cuts, even though there is both a local and state appeals process required by law. For more information see Recipient Rights and page 24 and 25 of the Guide to Services.

More meetings:

Check the announcements page of the WCHO Website for more information on a meeting scheduled for May 7, 2015 at St. Luke Lutheran Church in Ann Arbor.

The WCHO Board of Directors meets on the third Tuessday of every month.

The new pay rates for direct care workers for Self-determination go into effect on May 15, 2015, but there will be a meeting before that date to discuss concerns of consumers.

Washtenaw County, MI : CMH to announce rate decrease for Community Living Services

Update 4/16/15: About 100 people attended the WCHO/CSTS meeting on Tuesday, April 14, 2015 to discuss Community Living Services and potential cuts in services when they are found on further evaluation to not meet "medical necessity" criteria. The above letter was for people who hire providers through "Self-determination" arrangements. Although this was not the main subject of the meeting, it did come up. There will be future meetings on the "Self-determination" decision and on other Community Living Services. Stay tuned.

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The Washtenaw Community Health Organization and Community Supports and Treatment Services are holding a meeting tonight to discuss plans affecting Community Living Supports for people with disabilities. These include staffing for people in their own homes.

According to a letter sent to consumers (individuals with disabilities and their families who receive services), the rate of pay for these direct care workers will be reduced to $13.88 per hour, which includes worker’s compensation, transportation, community participation, taxes, and training. The letter says that “While this is not a reduction in your current level of services, it may reduce the amount you can pay staff.” WCHO also encourages consumers to meet with their clinical teams and consider options, “including the option to use one of our contracted providers for CLS services”.

The change will go into effect on May 15, 2015.

People whose services are funded through Medicaid Waivers, especially those with exceptionally high needs, find themselves extremely limited by the allowable amount of funding available to pay service providers. The higher the needs, the more skilled and reliable direct care workers need to be to fulfill those needs. Reducing the hourly wage of workers who, if they do their jobs well, take on tremendous responsibility to do difficult work leads to diminishing returns: a high turnover rate, poorer care, and sometimes no care at all.

The change in rate is justified as “necessary to ensure that Washtenaw County’s rate is the same as our regional partners and to ensure that we are being fiscally responsible.” Another way of looking at it is that both these things might be accomplished by raising the rate of our regional partners and ensuring a more stable and reliable workforce all the way around.

Washtenaw County: Town Hall meeting on mental health services for DD

from the Washtenaw County Community Health Organization (WCHO):

Community Supports and Treatment Services (CSTS) Town Hall

Tuesday, April 14, 2015
 
5:30 p.m. to 6:30 p.m.

Join us for a presentation and open discussion on potential changes to your Community Living Support services (staffing in your home).

United Way Building
2305 Platt Rd.
(South of the Platt Rd. intersection with Washtenaw Ave.)
Ann Arbor, MI 48104

View map on United Way Website for location.

For additional information, call 877-779-9707

Key Performance Indicators: Reading between the lines

I read reports, so you don't have to…

Here are some interesting tidbits of information from a Third quarter Review of Key Performance Indicators for Community Supports and Treatment Services (CSTS) for fiscal year 2011 to 2012. CSTS is the service arm (as opposed to the administrative arm) of our local Community Mental Health Agency. It primarily serves people with Developmental Disabilities and Mental Illness under a managed care system that mandates that all eligible people who qualify for Medicaid must receive services suitable to their condition.

The report admits to some major problems that I attribute to the poor economy, the atmosphere of hostility toward public employee unions, and an aging workforce that sees early retirement as the best option available: "… there has been an abnormally high retirement rate at the beginning of the calendar (middle of the fiscal year), resulting in significant turnover through all levels in the organization.  This turnover can attract new and enthusiastic staff members and it can also result in a relationship disruption for the consumer. Finally, CSTS has had a difficult time competing for exceptional staff due to economic conditions. "

Then there is this:



According to this graph, less than 30% of the developmentally disabled adults (DD.a) who live in the county receive services through CSTS. Some of them might receive services through other agencies, although it is doubtful that many do. Where are the missing 70% of people who, by definition, have significant disabilities, but do not receive services?

Last but not least, there's this:



The report claims that the "organization does an exceptional job serving individuals in a community setting and minimizing the use of a restrictive setting.  Those adults who are in restrictive settings require that level of care, a structured milieu and constant supervision and monitoring.  "

This means that 16% of adults with developmental disabilities (DDa) who are served by CSTS live in group homes. 84% of those served are in "nonrestrictive settings" and you can bet that most of those live at home with their families. For my sons who need a lot of care and 24/7 monitoring, caregivers who are themselves monitored and given support and backup, a group home is not restrictive. We don't know if the agency is doing an exceptional job until we talk to the families who might want a decent group home for their adult family members to live in, but do not trust the system to provide good care or don't know it is available.