Funding for DDS clients falling through the cracks
There are few burdens greater than having to care for a loved one with a severe intellectual disability, particularly when the state declines to provide any help.
At a public hearing earlier this week, members of the Legislature’s Children, Families, and Persons with Disabilities Committee heard stories from a number of people whose loved ones have fallen through the cracks in the system.
The Committee is considering a number of bills intended to help people who find themselves just outside of the Department of Developmental Services’ strict eligibility standards, or for whom, there just hasn’t been any funding for community-based residential, day, work, and other programs due to years of budget cuts. There’s some hope that a recent uptick in state revenues will translate into some additional funding of these programs.
Linda Boucher testified that her son attended special education programs from the time he was 3 until he reached the age of 22. At that age, special education services end, and people needing services must apply to DDS, which uses a “rigid” standard to determine eligibility. If a person’s IQ measures above 70, eligibility is denied even if the person has significant problems in adaptive functioning, including very low conceptual, practical, and social skills.
Boucher’s son scored 75 on an IQ test and was denied DDS services. He had been in a day program, she said, but has been home ever since. Boucher has a full time sales job that often requires her to be away from home for as much as 10 hours at a time, and sometimes requires her to be away from home overnight. It’s as if her son is under house arrest, she said.
“Where do I go? I need help,” Boucher said, her voice cracking with emotion. Ironically, Boucher worked in the Department of Mental Health during the Dukakis administration and helped develop many of the community-based programs for persons with intellectual disabilities that are now being cut. She said no one from DMH or DDS will now return her phone calls.
One bill before the Committee (H. 3527 ) would require the DDS to use a less restrictive standard in determining whether a person has an intellectual disability and is therefore eligible for DDS services. The bill would bring the state in line with the American Association on Intellectual and Developmental Disabilities, in establishing eligibility for DDS services for IQ scores of “approximately” 70 or below. This would prevent the rigid cutoff now used by DDS in excluding people from services.
One woman testified that she is concerned she will be forced to quit her job to care for her son, who is now 21 and needs one-on-one supervision. He is not intellectually disabled, his mother said, but nevertheless lacks most social skills. He currently attends a special education facility and is able to hold down a job. But because he is not able to control his behavior, he must be supervised at all times.
Another bill before the Children and Families Committee (H. 983) would provide an additional $23.4 million in funding for DDS community-based programs for persons with special needs who are either turning 22 or have graduated from high school.
However, this bill would also direct that funds from the sale of developmental center properties be earmarked for community-based programs for persons turning 22. We would support that language if the proponents of the bill would, in turn, support the continued operation of the developmental centers for those who choose to live in them. Unfortunately, there’s not much chance of that happening.
It’s not only persons with disabilities who slip through the cracks in the DDS system. There are also the direct-care workers who tend to be underpaid and under-trained, particularly in privately run group homes that operate under contracts with DDS. One bill (S. 45) would establish a state task force to study the average compensation, level of training and turnover of these workers.
Lisa Gurgone, Executive Director, of the Mass. Council for Home Care Aide Services, noted that direct-care workers tend to struggle to make ends meet, and termed those workers “a piece of the puzzle left out of health care reform in Massachusetts.” She and other speakers maintained that with the numbers of elderly and disabled people projected to grow rapidly in coming years, the state needs to develop a new workforce strategy to meet the demand. The task force is a first step in that direction, they said.
One other bill, which COFAR supports, would provide easy public access to a wide range of information about direct-care worker turnover and compensation as well as compensation of top executives of DDS contractors. The bill (H. 975) would require all of that information to be published on the DDS website. (The Arc of Massachusetts, which is heavily funded by DDS contractors, predictably opposes this bill.)
Finally, COFAR strongly supports H. 2683, a bill filed by Rep. Angelo Scaccia, which would establish an independent office of quality assurance that would monitor the care of intellectually disabled persons throughout the DDS residential care system. COFAR has raised a number of questions in recent weeks about the current DDS licensure and certification system for community-based group homes. (The Arc, of course, opposes this bill as well.)
Trying to make sense of DDS’s budget numbers
It’s hard to figure out what to make of the administration’s spending decisions when it comes to providing services to people with intellectual disabilities in Massachusetts.
On the one hand, since Fiscal Year 2009, the administration and Legislature have cut most community-based line items, including adult family supports (26.9% cut), community transportation (17.6%), community day and work (3.8%), Turning 22 (35%).
Not suprisingly, the developmental centers line item in the budget has been cut since FY 09 by $45.4 million, or 24.2%. (In fact, based on a set of numbers provided by the Department of Developmental Services, the budgets of the Templeton, Monson, and Glavin developmental centers alone were cut by almost 70 percent between FY 09 and FY 11.)
Yet, at the same time, the community residential line item (which funds contract-based care in privately operated group homes) has been raised since FY 09 by $182.2 million, or 32%. In addition, the state-operated group home line item has been boosted by $27.4 million, or 19.9 percent, in that time.
These two community residential and state-operated group home line items have been boosted by a total of $209.6 million, while the cuts have totaled $87.4 million during the same period (not counting the planned phase-out of funding under the Boulet lawsuit). The bottom line is the grand total of all DDS line items is $34.6 million higher in the current fiscal year than it was in FY 09.
What exactly has been going on here? We’ve asked DDS for information on where residents of the developmental centers targeted for closure have been transferred. We don’t believe very many residents have opted to live in privately operated group homes. So it remains a mystery to us just why the administration has needed to boost the community-residential line item by more than $180 million.
It’s true there are potentially thousands of people waiting for community-based residential care. But if indeed more than $180 million in new state dollars have been put toward accomodating people waiting for residential services, why has the administration been cutting funds for transportation, day programs, family support, Turning 22 and other programs for those same people?
It would seem that had the administration pared back the increase in the community residential line item to a modest $100 million increase since FY 2009, they could have prevented the cuts in the other community line items at at least held them harmless. It’s strange because the administration’s funding decisions have left it open to the charge from the Association of Developmental Disabilities Providers that the administration has failed to back its “professed interest in Community First,” an initiative intended to boost community-based services choices and spending.
In the meantime, DDS has denied a request by COFAR for records detailing community-based costs of a particular community-based residential program. We’ve been seeking to compare costs and services under this particular contract with the budgets of the Templeton, Monson, and Glavin Centers from FY 2009 to the present. (We don’t believe that the cuts in the developmental center budgets will save money in the long run because these same services must be funded in community-based accounts if they aren’t funded under the developmental center budgets.)
We asked for both a breakdown of the Templeton, Monson, and Glavin budgets and records detailing the costs of medical, nursing, clinical, and therapeutic services provided to residents of the group home program. In a letter dated October 23, DDS’s general counsel stated that the documents we requested concerning the group home program are part of DDS clients’ records and are therefore exempt from disclosure.
COFAR has appealed the denial to the state Division of Public Records, arguing that we are not seeking information that identifies any specific individuals. What we want to find out is which agency or agencies both fund and provide the medical, nursing, clinical, and therapeutic services under this contract, and how much these services cost state taxpayers in total.
We believe DDS can provide the information we are seeking without violating the privacy rights of the individuals in this program. Should DDS refuse to provide this information, the public will have no way of knowing basic details about the provision and cost of these kinds of public services.
Where’s the beef in Community First?
We’ve long maintained that the Patrick administration’s agenda of phasing down and closing state developmental centers would ultimately fail to free up additional funding for the community based system.
It’s been nearly three years since the administration announced its plan to close the Fernald, Templeton, Monson, and Glavin Centers and reportedly plow back as much as $45 million a year in the “savings” into beefing up the largely privatized community-based system of care. That $45 million savings projection was a cornerstone of the administration’s “Community First” initiative.
So far, the administration has succeeded in moving hundreds of residents out of developmental centers, starting with Fernald, which is now emptied of all but 14 of its residents, who have filed appeals of their transfers. But nothing remotely close to the $45 million in savings has materialized. In fact, the opposite has been the case — the administration has continued to cut community-based line items in the Department of Developmental Services budget.
In a November 20 email to members and other advocates, the Association of Developmental Disabilities Providers, which has wholeheartedly supported the closures of the developmental centers, stated the following :
For the last four fiscal years, in order to cope with the effects of the economic collapse of 2008, the Commonwealth’s budget has:
- deeply cut Family Support programs, leaving 10,000 families without service,
- inadequately addressed Chapter 257 rate reform by not introducing sufficient funding to rate making but instead forcing existing programs to redistribute already inadequate funding
- failed to address historically low salary needs of the community workforce (though the Legislature has recently added the first salary reserve dollars in four years)
- continued to require community programs to implement state mandates without sufficient funding, including closing sheltered workshops without funding to replace this model in favor of a more inclusive and empowering model.
- not backed it’s professed interest in Community First and Employment First with funding to make these efforts successful. (my emphasis)
Not exactly a ringing endorsement of the success of the administration’s community-based care delivery model and its promised use of of the savings from the developmental center closures. We hope the ADDP and the Arc of Massachusetts will reach the next logical step in their argument and urge the administration to cease and desist from closing the centers.
Unfortunately, the ADDP and the Arc of Massachusetts are supporting H.984, known as “The Real Lives Bill,” which appears to continue to rely on the premise that DDS clients should not be given the choice of living in developmental centers.
The bill, sponsored by Rep. Tom Sannicandro, is intended to provide for more choice for persons with intellectual disabilities. But it appears to specifically deny consumers the choice of “congregate services.” In other words, everyone should have a choice, as long as they choose only small, community-based settings. We believe, however, that the congregate services provided by developmental centers are appropriate for certain people who are unable to benefit from community based care. And now we’re seeing that closing the congregate care centers is not freeing up community-based funding.
Sannicandro’s bill does appear to recognize that the community-based system has not thus far benefitted from the developmental center phase-downs. The bill’s text reads:
Too many people are not receiving the assistance they need. The public Medicaid system is reeling from cost pressures. The time has come for individuals with disabilities, families, advocates and providers to work together with policy makers in the administration and legislature in crafting a support system that both increases quality and on average reduces costs whenever possible.
We agree with the language in Sannicandro’s bill on that last point. We just disagree that closing the developmental centers is the right way to go about it.
Our questions about the DDS provider licensure system
How effective is the Department of Developmental Services’ licensing and certification system for operators of community-based group homes in Massachusetts?
We reviewed 30 online licensure and certification reports and DDS’s revamped licensure and certification manual. We also reviewed a 2008 licensure survey report by the state Department of Public Health of the state-run Fernald Developmental Center.
Our review found that the federal-state certification process for state developmental centers appears to be significantly more rigorous and comprehensive than the DDS licensing and certification process for state and privately run group homes. This difference would appear to have implications for the relative safety and wellbeing of clients in the widely dispersed, community-based group home system.
DDS licenses and certifies providers that operate more than 2,700 24-hour residential programs in the state, according to figures provided by the department.
State-run developmental centers, which must meet strict federal standards of care, are surveyed by state DPH staff, which follows requirements established by the federal Centers for Medicare and Medicaid Services. The community-based group homes are surveyed by staff of the DDS’s Office of Quality Enhancement, supplemented by volunteer surveyors.
Here are some of our findings. (Additional information about our review can be found in the October 2011 issue of The COFAR Voice):
- Under the DDS’s licensure and certification process for group home providers, only 25 percent of those group home sites are inspected or surveyed by licensing staff during each two-year licensing period. This means that a provider can receive a two-year license to operate even though 75 percent of its homes were not inspected.
- While two of the licensure survey reports we sampled contained detailed findings of deficiencies in care and procedures in the providers’ group homes, the majority of the reports appeared to focus on whether the providers were working to achieve broad and often vaguely worded goals such as “maximizing independence” and “supporting people to live healthy and active lives.” One of the most frequently cited problems in the licensure reports was the makeup of the providers’ human rights committees, whether they had bylaws, and how frequently they met.
In contrast, the 2008 survey report on the Fernald Center contained 56 pages of detailed findings about treatment and care, based on direct observation by surveyors as well as on resident records. Observed injuries were noted in the CMS-DPH report, as well as direct observations that certain residents were not receiving adequate treatment.
While the Fernald Center had some 180 residents in 2008, many of the group home providers whose reports we reviewed provided services to that many or more individuals in their individual networks of group homes.
- Few of the DDS provider reports, most of which were only a few pages in length, appeared to mention the results of direct observations about the care provided to individuals in the residences. None of the reports contained findings of observed signs of injuries to residents or of abuse or neglect. Yet, the state’s Disabled Persons Protection Commission receives some 1,500 complaints of abuse and neglect each year in the community system, more than one third of which are substantiated, according to agency figures.
- In many cases, the DDS licensure surveyors appeared eager to say positive things about the providers, but even those statements usually did not refer directly to observed care issues.
For instance, the DDS licensure report for Fidelity House, Inc., stated that a “remarkable” example of “the way people were valued in their homes” was that “confidential records had one page profiles which carefully described each individual in the first person.” In a number of cases, the survey reports contained the vague statements that the particular provider being reviewed “takes great pride” in its programs or facilities or, in one case, that the provider’s services were “founded upon a values-based mission.”
- All of the DDS provider reports reviewed indicated that the providers were granted licenses to operate, even in the relatively rare cases in which potentially serious problems were cited. In one case, a provider, Behavioral Associates of Massachusetts, was given a one-year conditional license to continue operating even though the license survey found that only two out of six required “quality of life areas” had been achieved. Among the problems noted by the surveyors were that residents’ confidential records were altered and that the provider’s day program was inappropriately operating in the basement of one of the residences.
In another case, the Center for Human Development received a two-year license to operate even though there had been three instances in the previous two-year licensing period in which reportable incidents of abuse or neglect in its residences had not been reported to the Disabled Persons Protection Commission as required.
In October 2010, the Kennedy Donovan Center received a recommendation for a “deferred license” for its residential services after failing to meet the standard on 20 indicators of care and services. The surveyors found that residents in six different group homes had gone more than a year without a physical exam, with two residents having gone 18 months and two having gone 17 months without an exam. One resident who didn’t have a dental exam for more than two years was later was found to need several fillings and extractions, the report stated. Another resident, who had had pneumonia was not provided with a follow-up review by a physician.
A deferred license means the agency can continue operating, but has 60 days to correct the problems. There was no information online to indicate whether those corrections were made.
- Of the 30 online reports surveyed, fully one third were out of date on the DDS website, some by as much as two years. It wasn’t clear whether the DDS has simply been slow in posting licensure reports on its website or whether the licenses may have expired for some of the providers reviewed.
- The DDS licensure and certification procedure was revamped in July 2010, based on input from the providers themselves. In 2009, the Association of Developmental Disabilities Providers stated that it was working with DDS to revamp the licensure system and that it was seeking to reduce the number of group home sites surveyed and the time spent surveying in each location.
Among the changes made by DDS in 2010 were a reduction in the licensure survey time spent in group homes from one to two weeks down to 5 working days, according to the online licensure manual.
- Both the old and revamped reports did not always specify the total number of clients served by each provider or even the total number of group homes run by the provider. Some reports listed all relevant indicators while others didn’t.
We plan to bring our findings to the attention of state legislators who deal with DDS issues, many of whom may be unaware that there is any difference in the state’s oversight of developmental centers and community-based care settings. The claim that the community system provides equal or better care than the developmental centers doesn’t mean much if the oversight of the two systems is not equal.
Another forgotten cost of closing developmental centers
One of the costs of closing developmental centers for the intellectually disabled, which rarely gets considered in budgetary “savings” analyses, is the cost to affected communities in lost economic activity, jobs, and tax revenues.
Two studies done in Kansas and Illinois have each projected economic impacts of tens of millions of dollars annually on local communities in closing a developmental center in each state. We have yet to locate such a study in Massachusetts, even though the Patrick administration has targeted the Fernald Developmental Center in Waltham, the Glavin Regional Center in Shrewsbury, the Templeton Developmental Center, and the Monson Developmental Center in Palmer for closure by the end of the coming fiscal year.
Developmental centers provide both direct economic benefits to their surounding communities from employee salaries and so-called ripple or multiplier effects. Ripple effects include “indirect” sales and jobs in area businesses such as food distributors and office supply firms that provide goods and services to the developmental centers. And those ripple effects include “induced” sales and jobs supported by the developmental center employees when they patronize restaurants, gas stations, banks, grocery stores, computer stores, convenience stores and much more.
An August 2011 report to the Illinois Department of Human Services by the Institute of Government and Public Affairs at the University of Illinois concluded that closing the Jacksonville Developmental Center in Jacksonville, Ill., would affect 591 jobs and have a ripple effect on $47 million of economic activity in Morgan County and $17 million in the city of Jacksonville.
In addition, according to the University of Illinois report, the closure of the Jacksonville Center would result in $590,000 in lost state sales and income taxes paid by employees who were laid off and by suppliers to the facilities.
A September 2009 report prepared for the Greater Topeka Chamber of Commerce on the impact of the Kansas Neurological Institute on the economy of the Topeka area during Fiscal Year 2010 found a direct economic impact of $28 million from the developmental center and an additional ripple effect of $37 million. Taking into account the KNI’s 570 workers, the developmental center supports a total of 1,311 jobs in the local community, the report said.
The KNI report, written by Impact DataSource, a Texas-based economic consulting and research firm, added that the Kansas developmental center generates some $447,000 a year in local sales taxes and $3.3 million in local property taxes.
In testimony last February to a Kansas legislative committee, Christy Caldwell, a spokeswoman for the Topeka Chamber of Commerce stated:
If the motive for closing KNI is saving the state dollars, we respectfully ask your very careful consideration of whether there will be real cost savings. We ask that you consider the economic impact on Topeka; a significant loss for this community, should there be closure.
In Massachusetts, a Department of Developmental Services working group recommended in 2002 that prior to closing any developmental centers, DDS undertake an analysis of the multiplier effect of the closures on the local economies. The working group also recommended consideration of other factors, such as the community use of the facility and the grounds, cost implications of the use of facility space by other government agencies, projected mothballing costs, and projected “ramp-up” costs for new community programs.
We’ve checked with state legislators in whose districts the Fernald, Templeton, Glavin, and Monson developmental centers are located, and with local chambers of commerce, and haven’t yet found any such economic impact studies done of the potential closures of the facilities. We’ve filed a Public Records request with DDS, asking for any such analyses that may have been done.
The University of Illinois study noted that in additional to quantifiable economic impacts of the Jacksonville center’s closure, there are many less quantitative impacts such as the effect on charitable contributions – both time and money – by the facility employees and the impact of the re-location of facility employees and their families on school district enrollments. “All of these more qualitative impacts contribute to the fabric of the local community and may be valued just as highly – even if they are more difficult to measure,” the report stated.
There is, of course, the question whether the loss of economic benefits from the closures of the developmental centers might be outweighed by the potential for reuse of the properties. But those benefits in reusing the properties are largely speculative compared with the concrete benefits provided by the developmental centers themselves. Caldwell stated in her testimony that the previous closure of the Topeka State Hospital “did not garner the private interest and investment (in the former hospital land) that many believed could be gained when the facility closed.”
In addition to undertaking economic impact analyses prior to closing the four developmental centers in Massachusetts, policy makers in this state should reassess the value of the properties involved and what they could reasonably expect to receive for those properties, given the current state of the economy.
One way to avoid cutting Medicaid
The Patrick administration’s “Community First” approach to caring for people with intellectual and other disabilities depends on a huge, $2.6 billion, state and federally funded network of nonprofit contractors.
Many of these contractors or providers are excellent; but, all too often, we hear about cases of abuse, neglect, mismanagement, and fraud, such as the allegations this past weekend by Attorney General Martha Coakley that Adlife Healthcare and three other companies had bilked the state’s Medicaid program out of $10 million.
Adlife Healthcare would seem on the surface to be a shining example of the Community First approach. The company’s website states that it tailors its health care programs for disabled persons in a manner that “maximizes the client’s independence and dignity.” The program, the website states, allows clients to remain in the “familiar comfort” of their own homes, and begins with a visit from a registered nurse who then arranges for services from additional nurses, physical therapists, case managers, and home health aides.
All well and good, except that, as Coakley alleges, Adlife charged Medicaid for services without having provided them, including billing for people who had died. Ultimately, the company over-billed the state by $5.5 million, according to Coakley.
Medicaid, which is one of the state’s largest sources of budgetary spending, funds a wide range of services, from health care for both low income families to care and services for persons with intellectual disabilities in both the state developmental centers and community-based system. Because of its sheer size, Medicaid nationally is likely to be a source of at least $1.2 trillion in revenue cuts that the “super committee” in Congress is required to recommend by November.
But there are experts around who argue that a significant portion of those cuts would not be necessary if the state and federal governments did a better job in preventing and detecting the kind of fraud that providers such as Adlife are accused of perpetrating in the Medicaid system.
In his 1996 book, “License to Steal: Why Fraud Plagues America’s Healthcare System,” Malcolm Sparrow maintains that if the health care industry:
learns the art of fraud control, then the industry will have learned a discriminating way to save money — by investing in the capacity to distinguish between legitimate and illegitimate claims. The alternative is to use less discriminating methods, such as across-the-board reductions in benefits, further restrictions on eligibility, or lower reimbursement rates for providers.
State Auditor Suzanne Bump has reportedly decided to follow Sparrow’s advice. According to The Globe, she plans to intensify her office’s focus on Medicaid fraud and has appointed a former federal prosecutor to head those investigations. One Medicaid fraud expert told The Globe that most Medicaid fraud is perpetuated by “providers who take advantage of loopholes in regulations to process claims that would be detected by more rigorous analysis.”
Last week, COFAR President Tom Frain and I met with three members of Bump’s staff, to urge them to investigate the state’s human services provider system, particularly the contracting network funded by the Department of Developmental Services. We hope Bump’s intensified focus on Medicaid fraud will include the DDS contracting system.
We fully support the community-based system of care in Massachusetts; but as the Adlife and too many other examples show, it is a system that is all too vulnerable to waste, fraud, and abuse and needs much better governmental oversight than is currently the case.
Update on our requests for cost records
After a month and a half, it’s troubling that the Patrick administration is apparently still unable to locate cost records we requested pertaining to a single community-based group home contract.
I just received a letter from the Department of Developmental Services, dated September 14, that they are in the process of searching for the documents, which I had requested on July 29. Meanwhile, the MassHealth Privacy Office in the Executive Office of Health and Human Services has been searching for these same records since August 9.
To recap, we’ve been trying to find out the sources of state funding for medical, nursing, clinical, and therapeutic services in a single DDS group home program run by the May Institute, a private provider. We have a copy of a $1.2 million contract with the May Institute, which provides for 24-hour residential services under the program for 14 individuals in four residences in the DDS Central Middlesex Area.
The FY 2009 contract, however, only provides for direct care and limited nursing services for the 14 residents. It does not mention medical, extended nursing, clinical or therapeutic services.
From what we’ve been able to determine, the administration has been basing its $20 million annual cost savings estimate in closing the Templeton, Monson, and Glavin Developmental Centers on a comparison of their budgets with the cost of community-based group contracts such as the May Institute contract. But here’s the rub. Our understanding is that the Templeton, Monson, and Glavin budgets do provide for medical, extended nursing, clinical, and therapeutic services.
Naturally, the community system will appear to be less expensive than the developmental centers if certain community-based costs are not taken into account. That’s why we want to find out exactly how much is being paid to fund those additional services to which the May Institute residents are reportedly entitled, and where that money is coming from.
By the way, we originally asked DDS on July 7 for the budgets of the Monson, Templeton, and Glavin Centers. A month later, we received a one-page document from the department with single, line-item amounts representing the total annual spending for each facility. There was no budgetary breakdown whatsoever for the facilities.
We appealed to the state’s Public Records Division for help, explaining that a budget of a state facility involves more than just a single line item. As a result, I received a second letter from DDS, also dated September 14, stating that the department was in the process of searching for the “additional (budgetary breakdown) information” I had requested.
I guess DDS considers a budget and a “budgetary breakdown” to be entirely separate concepts. Stay tuned.
The Globe gets it right on nonprofit contractors
An editorial in today’s Boston Globe begins to get at an expensive and pervasive state problem — the relative lack of oversight of the state’s nonprofit human services contracting system.
The editorial calls for more power to the State Auditor and Inspector General to investigate financial practices in this system. It refers specifically to recent allegations by State Auditor Suzanne Bump and Inspector General Gregory Sullivan of financial abuses by the Merrimack Special Education Collaborative and a related nonprofit, the Merrimack Education Center. The nonprofit, the editorial notes, is subject to “far less scrutiny” than the public collaborative, and therefore has been able to “hide” millions of dollars in extra salaries, bonuses, and pensions, according to the Globe.
But the editorial expands its focus beyond just special education. Here’s the key statement in the editorial in this respect:
Massachusetts law is generous to private contractors who take state money, whether they are nonprofit or for-profit. While government agencies are subject to full financial scrubs, private subcontractors are largely outside the purview of the government’s watchdog officials, State Auditor Suzanne Bump and Inspector General Gregory Sullivan.
As much as we like to criticize government for its lack of transparency (and believe me, we’re having our problems with DDS right now in that regard), at least government agencies operate somewhat within the reach of watchdog agencies and within the public purview via the Public Records Law.
But nonprofit and for-profit contractors are largely exempt from the Public Records Law and their records are even beyond the reach of the Inspector General’s subpoena power, for instance. Nonprofits are required to file financial information with the state’s Operational Services Divsion and the Attorney General’s Public Charities Division. But, as we’ve pointed out, the information filed with those two entities doesn’t always match up. And the information available is quite limited.
Yet, it’s not as if these contractors are concerned solely with the private and for-profit sectors in which they like to be categorized. In Massachusetts, they receive billions in state and federal human services dollars every year. The Department of Developmental Services alone contracts with hundreds of such contractors to run thousands of group homes and day programs and provide other services.
We have called on Bump and Sullivan to expand their probe of the special education system to include the entire DDS contracting system. One of the things we’d like to see investigated is what we see as an expensive and risky lease program that DDS has entered into with private contractors to develop group homes around the state. There are numerous other opportunities out there for investigation as well.
Once again, we’re waiting for the administration’s cost records
It has been more than a month since we asked Secretary of Health and Human Services JudyAnn Bigby for public records detailing the costs of specified services in a particular group home program for intellectually disabled persons in Massachusetts.
It has been almost two months since we asked Commissioner of Developmental Services Elin Howe for the budgets of the Templeton, Monson, and Glavin developmental centers.
To date, we’ve received neither set of records.
As we’ve previously noted here, we’ve been attempting to compare the cost of an apparently typical vendor-run group home program with the three developmental centers. We wanted to see whether the Patrick administration was comparing apples to apples in claiming to the Legislature in the last two fiscal years that closing the Templeton, Monson, and Glavin centers will save tens of millions in state funds.
As we reported, a group home contract, which we did receive last May from DDS, specified a yearly cost per resident of $104,400. In its cost savings analysis, the administration compared a very similar residential cost based on group home contracts with an average calculated cost of care at Templeton, Monson, and Glavin.
The potential problem with the administration’s analysis that we found in examining the single group home contract was that it specified budgeted costs for only direct-care, supervisory, and minimal nursing staff. What about the extensive nursing, medical, clinical, and therapeutic staffing that exists at the developmental centers and to which the residents of DDS group homes are entitled?
The fact that those additional medical, clinical, and therapeutic costs were not in the group home contract we examined appeared to raise the question whether the administration’s savings analysis was accurate. One immediate question was: if those additional costs are not paid through DDS contracts, how are they paid? Secondly, what is the total amount of those community-based costs that the administration may have missed in its analysis?
Once we get the answers to those questions, we can determine for ourselves whether there would be a savings or not in closing the developmental centers.
On July 29, we sent Public Records requests to both Secretary Bigby and Commissioner Howe, asking for copies of any documents detailing funding for medical, nursing, clinical, and therapeutic services for individuals residing in the community-based group home program we had selected for review. About three weeks prior to that, we had asked DDS for the Templeton, Monson, and Glavin budgets for the same time periods as the group home contract.
On August 9, I received a letter from the records custodian at EOHHS, stating that the agency was in the process of identifying the records we had requested regarding the group home contract. Last week, I called the records custodian, and was told EOHHS was still working on our request. He wasn’t able to tell me when the records would be found.
We’ve appealed to the Public Records Division for the Templeton, Monson, and Glavin budget documents. We’re close to filing an appeal for the group home contract records.
But one piece of useful information may have emerged here. The fact that the August 9 response to our request came from EOHHS and not from DDS does appear to confirm that it is not DDS, but some other source at EOHHS, that funds medical, clinical, and therapeutic services in the DDS vendor-run group home system. We believe that other source of funding is MassHealth.
In any event, it’s getting clearer and clearer that the administration wasn’t counting all the community-based costs of care it incurs when it told the Legislature there would be major savings in closing the developmental centers.
COFAR blog 