Update on Efforts to Ensure DD Service Rates are Rebased and Restored
The Community Provider Association’s (CPA) number one legislative and public policy priority is to ensure that rates for DD service providers are restored and rebased. Major progress was made last legislative session (i.e. funding for the night rate, and funding for the enhanced rate), but we recognize that it is not nearly enough, especially when many of you are struggling to keep your doors open. The CPA hears you. Therefore, by way of this correspondence, we are providing you with an update on some of the recent steps we have taken to get the rates fully restored and rebased.
Dr. Laura Brackin, CPA Executive Director, along with Representative Scott Simon, CPA member Sylvia Bush, and CPA Lobbyist Kevin Hayes, met with representatives from the Louisiana Department of Health (LDH). The focus of the meeting was on restoring and rebasing the rates. The following individuals from LDH participated in the meeting:
Dr. Rebekah Gee, LDH Secretary
Mark Thomas, LDH Deputy Secretary
Julie Foster Hagen, OCDD Assistant Secretary
Frank Opelka, LDH Medicaid Program Manager – Rate and Audit
Tonya Joiner, LDH Director of Legislative Relations
The results of the meeting are:
Restoring and Rebasing Rates: Dr. Gee stated that LDH will include funding to fully rebase and restore rates in the department’s budget request for next fiscal year. The CPA is currently working with the department to identify the specific dollar amounts needed to restore and rebase the rates. That information will be shared with you in a future correspondence and/or posted to the CPA website.
Night and Enhanced Waiver Rates: The increase in the IFS night rate, of $11 per hour, went into effect on August 1, 2018. In addition, LDH is working on implementing an Enhanced Rate for individuals with high medical or behavioral needs. The proposed reimbursement rate for the Enhanced Rate is $38.88 per day (for each individual who warrants an enhanced rate due to his or her high medical or behavioral needs). This equates to approximately $14,000 per year per individual. The target date for implementation is January 1, 2019. However, there are two things that need to occur to make this happen. First, the Enhanced Rate must first be approved by the Center for Medicare and Medicaid Services (CMS), which takes about 90 days. Second, the department must publish an official rule regarding the Enhanced Rate. The good news is that LDH has already secured approval to issue an emergency rule for the Enhanced Rate, as opposed to issuing a regular rule (which would take longer). Therefore, as soon as LDH receives approval from CMS they can move quickly to implement the Enhanced Rate.
ICF Rates: LDH has agreed to meet with ICF providers on a monthly basis (until the rates are rebased). The purpose of these monthly meetings will be to identify program, policy, or other changes that the department can possibly make NOW that will provide some financial relief to ICF providers. The first meeting is tentatively scheduled for October 1st. ICF providers will receive an invitation to the meeting from LDH. Between now and then the CPA will be working closely with the department on some possible changes that have already been identified.
Changes are happening to the developmental disability service system. These changes include the conversion of all current HCBS waivers to one consolidated waiver and the establishment of a value-based payment system beginning January 1, 2019.
CPA members will have the opportunity to provide input regarding these changes and access to up-to-date information on these changes.
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Newly appointed OCDD Assistant Secretary shares her priorities at LA-AAIDD
During the 2018 LA-AAIDD annual meeting Julie Foster Hagan, the newly appointed Assistant Secretary for OCDD, shared her priorities for the department. The priorities include: (1) the consolidation of all HCBS waivers to one single waiver, and (2) the establishment of a value-based payment system by January 1, 2019. The CPA Executive Committee will be meeting regularly with OCDD leadership to provide input related to these initiatives. Members of the CPA will receive monthly updates on the progress made toward these initiatives.
Louisiana Office for Citizens with Developmental Disability to Implement Tiered Waiver Program.
The Louisiana Department of Health (LDH) received approval from the Centers for Medicaid and Medicare Services (CMS) to change how individuals with a developmental disability receive Home and Community Based Waiver Services (HCBS). Previously, these services were offered on a first come, first served basis.
The new plan, or Tiered Waiver, means that individuals with a greater urgency of need will now be prioritized for receiving the most appropriate home and community-based services.
Due to multifaceted job requirements, vast work demands, and strikingly low wages, turnover rates for the workforce average around 45%, with vacancy rates at 9%. The failure to address this long-standing issue has led to high administrative costs for recruiting and training new Direct Support Professionals (conservatively estimated at roughly $2.4 billion annually). Furthermore, a revolving door of unprepared workers has had a negative impact on the quality of support and lead to increased occurrences of abuse, neglect, mistreatment and death.
A common underlying issue for this systemic failure is the lack of a Standard Occupational Code (SOC) through the Department of Labor’s Bureau of Labor and Statistics. Currently, DSPs are misclassified in labor reports as Personal Care Assistants or Home Health Aides, job classifications that do not adequately represent the skill requirements of a Direct Support Professional. To confront this, the National Alliance for Direct Support Professionals (NADSP) is leading a nationwide effort to Establish a Direct Support Professional Standardized Occupational Code.
Please sign NADSP’s petition to show that you believe a Direct Support Professionals’ work is important.