Posts Tagged ‘Patrick administration’

Questions surround the governor’s budget plan for DDS

January 28, 2013 Leave a comment

In a conference call with advocates last week, Department of Developmental Services Commissioner Elin Howe put what seems to be a highly optimistic spin on the governor’s FY 14 budget plan for her department.

Howe said that, “I think we’re entering into this (budget process) in better shape than in a considerable period of time.”   Last spring, she similarly described the plan for the current-year DDS budget, as it emerged from the House Ways & Means Committee, as “the best budget the Department has had in five years.”

Governor Patrick’s $1.5 billion, FY 14 budget plan for DDS appears to be typical of his overall budget proposals for human services, but we aren’t ready to make too many rosy projections about it.

First, there’s the  question whether the governor’s budget proposals are realistic, given that they depend on passage of his plan to raise taxes.  And as was the case last year, Howe seems to be focusing on the brightest spots in a budget for her department that appears to have many dark spots as well.

Howe did begin the Wednesday call by noting that the governor’s proposed budget (H1) depends on legislative passage of his proposal to increase the income tax rate to 6.25 percent.  The state’s current revenue estimate for the coming fiscal year “doesn’t support all of what we’re trying to do,”  she said. 

Howe said, though, that she had no figures on what might happen to the DDS line items for FY 14 if the Legislature were to balk at the governor’s tax plan, which seems a good possibility.

Secondly, while Howe noted that H1 calls for increasing a number of DDS line items, she acknowledged there are also a number of projected shortfalls and cuts in it.  Among the line items in H1 with projected shortfalls are DDS Administration (which funds service coordinators), State-operated group homes, and Community-based Transportation programs.

Also, the community-based Adult Family Supports and Turning 22 accounts would be only level-funded under H1, while the Autism Division account would be cut by a small amount. 

In addition, the state-run developmental center line item would be cut by $10.4 million, bringing the total amount cut from this account by the Patrick administration to nearly $80 million since FY 2009.  As we’ve said many times before, we have yet to see how that cut in developmental center funding has provided much in the way of benefits for the average DDS client in the community system.

Moreover, Howe said there is no money in the H1 budget for the developmental center account for the continued operation of the Fernald Center in the coming fiscal year, meaning the Department will once again have to ask for supplemental funding for Fernald.

The following is a line-item breakdown for DDS, under H1  for FY14:

DDS Administration and service coordinators  (5911-1003):

H1 would increase this line item by $1.7 million, to $64.7 million.  However, Howe said this increase is the result of salary increases due to collective bargaining with the SEIU state employee union.  Without an additional $500,000 in the account, 10 to 12 service coordinator jobs could be lost, she said.

Service coordinators have the critical task of making sure DDS clients are receiving the right services in the community system, and their caseloads are growing out of control.  SEIU is asking for an additional $2.5 million in the administrative line item in order to restore 50 service coordinator jobs out of the 82 jobs lost since 2007.

Community Transportation (5911-2000):

H1 would increase this account by $537,000, to $13 million.  However, Howe said this increase will still result in a shortfall in the transportation account of $500,000.

Community Residential (5920-2000):

H1 would increase this account by $71.7 million, to $860.3 million.  Howe said some of this increased funding is the result of  “Chapter 257,” a 2008 “global payment” initiative, which established pre-set rates for DDS residential service vendors.  The Arc of Massachusetts says the Chapter 257 increase amounts to $55 million and is a “down-payment” on a total $175 million increase in funding that is expected to be given to the vendors.

State-operated Residential (5920-2010):

H1 would increase this account by $10.6 million, to $191.4 million.  Howe noted that this increase is largely for the operation of new state-run group homes for residents from developmental centers marked for closure.  Overall, she said, the increase in this account is $3.5 million less than what DDS requested, meaning the Department is once again projecting a shortfall in needed funding.

Community Day and Work (5920-2025):

H1 would increase the amount by $28.4 million, to $161.9 million, which is good news.

Adult Family Supports (5920-3000):

H1 would level-fund this account at $49.5 million, which is not good news.

Autism Division (5920-3010):

H1 would cut this account by $22,166, to $4.6 million. Bad news.

Turning 22 (5920-5000):

H1 would level-fund this account at $6 million.  However, it would increase the annualized amounts for Turning 22 clients in the community residential, community day programs, and community transportation accounts.  Mixed news.

Facilities (developmental centers) (5930-1000):

H1 would cut this account by $10.4 million, to $123 million.  The Facilities account has been cut by nearly $80 million since FY 09.

Templeton Retained Revenue (5982-1000):

H1 would level-fund this account at $150,000

Non-DDS line items:

EOHHS Salary Reserve (1599-6901):

It does not appear that H1 contains any funding for the salary reserve for wage increases for direct-care workers employed by DDS vendors.   In November, Patrick froze $20 million that had been placed in the fund for the current fiscal year.

Disabled Persons Protection Commission (1107-2501):

H1 would increase this account by $23,000, to $2.3 million.  The effect, however,  is level-funding of the agency, which has been level-funded since FY 2009.  The DPPC is an independent state agency charged with investigating complaints of abuse and neglect of people with intellectual and other disabilities.

We’ll stay tuned of course to see what the House and Senate do with the governor’s budget for DDS.  All in all, we don’t share the assessment that we’re entering into this budget process in great shape.

We are no doubt well into an era of reduced public services and of having to do more with less.  Unfortunately, the administration doesn’t appear to have put much thought into how to accomplish that.  It’s main initiative has been to close developmental centers, which hasn’t boosted funding to most community-based accounts.

Are they really cutting that program?

March 14, 2012 1 comment

“I want to shake you all,” the woman said through an interpreter.

It was a plea to the impassive panel before her of members of the House and Senate Ways and Means Committees, none of whom could really have more than an inkling of what it must be like to live, as this person does, with both deafness and blindness.

I didn’t catch the name of the woman, who testified at a hearing on the state budget in Gardner auditorium at the State House on March 9.  But her message was clear.  She wanted to stop the yearly cycle of budget cuts that continually threaten her lifeline to the outside world.  

Specifically, she was referring to the proposed elimination in Governor Patrick’s Fiscal Year 2013 budget of $450,000 for a program to provide her and other deaf and blind people with community-based support services.  Yes, $450,000 for a program to provide interpreters and other assistance in daily living to people who are both deaf and blind.  It’s apparently something this administration can’t bring itself to support, despite its claim to be a pioneer in developing community-based services for the disabled.

“Can you imagine being deaf and blind and trying to go food shopping without any help?” the woman asked the committee. “If this program is eliminated, I will be suicidal.”

Apparently, some of the members of the Ways and Means panel were beginning to imagine that.  There were expressions of assurance that the funding for the program will be found.  Representative Martha Walz of Boston, a member of the House Ways and Means Committee, responded that “it is the governor who proposes to cut these programs every year and the Legislature that restores it year after year.”

March 9 state budget hearing before the House and Senate Ways and Means Committees


But even if the Legislature restores the $450,000, the promise of “Community First” will be far from realized, even for the estimated 500 people in the state who are both deaf and blind.  Chris Emory, a member of the deaf-blind community, maintained that the program in question is able to provide services for only about 70 of those people.

(By the way, the administration committed $45.8 million to the Community First Initiative for FY 09, and termed it the first year of funding under this initiative.  I haven’t been able to find any subsequent appropriations under that line item.)

Also testifying at the March 9 hearing was David Berkeley, who urged that the Legislature add $7 million in funding for “clubhouses” that provide a range of community services to people with mental illness.  Berkley said the program, which has been level-funded by the governor and Legislature for the past 12 years, has kept him from needing hospitalizations for his own disability.  Before he received help from the program, he had been hospitalized more than 50 times over an 11-year period, at a total cost of $750,000.

Reva Stein, executive director of the Massachusetts Clubhouse Coalition, said the flat funding for the program has, in effect, amounted to a budget cut because the clubhouses serve 1,200 more people than they did just seven years ago.  The Clubhouses offer a wide range of services to the mentally ill, including job training, employment placement, benefit counseling, housing support, homeless prevention, and social opportunities, according to a Coalition fact sheet.

According to testimony at the hearing, the governor’s budget would provide additional funding to the Department of Mental Health for residential services, but the money would be earmarked only for people being transferred from Taunton State Hospital, which has been targeted by the administration for closure.

Similarly, the governor’s budget provides additional funding for community residential services for intellectually disabled people being transferred from four developmental centers targeted for closure.  Other community-based programs would be level-funded or cut, however.

I delivered testimony to the Ways and Means panel on behalf of COFAR that time is running out on the Fernald, Templeton, Monson, and Glavin developmental centers.  The number of residents left in them has been reduced from roughly 475 in 2008 — when the administration first announced they would be closed — to about 165 today.  Yet, no independent cost analysis has ever been done of the closures of those facilities.

It so happens that a bill (H. 3964) requiring such an independent analysis of the costs of closing three of the developmental centers — Templeton, Monson, and Glavin — is currently before the House Ways and Means Committee.  The bill was sent to the committee last month after having sat in the Children, Families, and Persons with Disabilities Committee for more than a year. 

These developmental centers provide a safety net for a small segment of the state’s intellectually disabled population that cannot function successfully in community-based group homes Even the Association of Developmental Disabilities Providers, which represents state contractors that operate the group homes, acknowledges that the closures of the developmental centers have so far not produced promised fiscal benefits to the community-based system of care.

I said all of this to the members of the House and Senate Ways and Means panel.  They listened impassively, as they had to everyone else.   But when I was done there were no assurances provided and no questions.

I was left thinking that the Legislature in this state will indeed often find the money to undo some of the most egregious damage caused by the administration in care for our most vulnerable residents.  But it is essentially a Band-Aid solution.  The Legislature appears less interested in addressing or questioning the overall policy this state has been following of cutting and privatizing vital human services.

DDS stonewalling on cost, care information

January 24, 2012 1 comment

(Part 2 of 2-part series on transparency issues in the Patrick administration)

The Patrick adminstation contends it is striving to be “transparent” in the way it conducts the public’s business, and touts its Open Checkbook website among other initiatives.

But when it comes to getting public information from individual agencies within the administration, the record of transparency doesn’t always live up to the billing.  We think our own recent experience with the Department of Developmental Services is a case in point.

We’ve been fighting with DDS for several years over public information requests, but the agency’s disinclination in recent months to provide requested information seems to have gotten worse. 

It now takes months to get even the most minimal public records in response to our requests.   And DDS recently cited the letter of the Public Records Law in claiming they have no obligation to answer any questions about records that they have provided to us.  Also, in two cases in the past year, DDS cited confidentiality requirements in refusing to release what we think, in at least one of the cases, are clearly public documents.

Meanwhile, even a state lawmaker has been unable to get information out of DDS on deaths in the agency’s system.  State Rep. Anne Gobi, a Democrat from Spencer, wrote to DDS Commissioner Elin Howe in mid-October, asking for information on the number of residents who had been transfered from the developmental centers to community-based group homes and how many of those residents had died after the transfers.  As of this month, Gobi’s staff said she had not received any response to her inquiry.

Here are some more details about our efforts to get records and information from both DDS and the Executive Office of Health and Human Services:

  • In October, COFAR submitted a request similar to Gobi’s to DDS for information and public records concerning the number of developmental center residents who have been transferred to group homes since 2008 and the number of those residents who have died.

In that request, COFAR also asked for the number of community-based group homes that have been built to house former developmental center residents.  In early November, a DDS attorney responded that the agency was in the process of searching for the requested records.  There has been no further word since then.  We wrote to DDS on January 17, seeking an update on the status of our request, but have received no response to it.

  • In October, the DDS general counsel denied a request COFAR had first made in July for records detailing the costs of medical, nursing, clinical, and therapeutic services for individuals in a group home program operated by the May Institute, Inc.

COFAR initially filed the request for the records concerning the May Institute with both DDS and EOHHS.  In August, an EOHHS official responded that that agency was in the process of searching for the records.  Then, in September, a DDS attorney stated that DDS was searching for the same documents.

There has been no further word from EOHHS since August regarding the records.  In October, however, the DDS general counsel appeared to reverse the Department’s September position by stating that documents detailing funding for medical or clinical services for individuals would be part of their individual client records and therefore exempt from disclosure under the Public Records Law.

COFAR appealed the denial to the Supervisor of Public Records in October,  suggesting that DDS redact any names or any other information that might identify individual clients.  In the October appeal, COFAR maintained  that it was seeking only to find out the total cost to taxpayers of care for community-based clients such as those in the May Institute program.  Should DDS refuse to provide that information, “the public will have no way of knowing basic details about the provision and funding of these kinds of public services,” COFAR’s appeal added.

To date, the Public Records supervisor has not ruled on COFAR’s appeal.

DDS similarly denied a request in July from COFAR for information about the death of a man in a group home earlier that month, four days after he had been transferred there from the Templeton Center.   In that case, the Public Records Supervisor upheld DDS’s denial, accepting the Department’s argument that the information was private.

  • In July, COFAR asked DDS for detailed budgetary information regarding the Monson, Templeton, and Glavin developmental centers, which have been targeted by the administration for closure.  In response, DDS in August provided only a single line item amount for each facility, representing the total spending for that facility.  There was no budgetary breakdown of the line item for any of the facilities. 

 After COFAR appealed to the Public Records Supervisor, DDS, in late October, provided an “aggregated” spreadsheet containing numerous line items for all three developmental centers.  However, this time there was no separate breakdown for each facility.   Moreover, the total aggregated spending amounts for each of three fiscal years in the October response did not correspond with the totals provided in the August response.

As a result, COFAR sent an email to DDS asking why there was such a big difference, in particular, between the $176.3 million in total spending listed in the October spreadsheet for the three facilites  in FY 2009, and the $57.8 million listed in the August response for the same three facilities.

In a letter sent to COFAR in response, a DDS assistant general counsel wrote that the agency “is not required to answer questions…” under the Public Records Law.  So much for letting us, and the public, in on the inner workings of the state’s finances.

Earlier this month, an attorney with the Public Records Division, sent us a nice email, apologizing for the delay in responding to our October appeal regarding the May Institute documents, and saying:

I know that you are working very hard to help those in the Commonwealth who are the most in need, and that receiving records from custodian’s, like DDS, is a crucial part of assisting those individuals. 

Now, if only DDS wouldn’t balk at simple requests for information, and showed a dedication to following through on the administration’s claims of transparency.

Open Checkbook could be more open

January 19, 2012 1 comment

(Part 1 of a 2-part series on transparency issues in state government)

Despite its promises of greatly increasing government transparency, the Patrick administration’s new  Open Checkbook website  seems to me to fall a little short of the hype.

Open Checkbook was launched in December with lots of claims made about how it was going to give the average Internet user a powerful new lens into the inner workings of public finances.  The state budget office in conjunction with the Comptroller and Treasurer jointly instituted the website in response to legislation that sought to upgrade the state’s  relatively low ranking  in a state-by-state transparency survey by MassPIRG.

Open Checkbook is divided into two major sections, State Vendor Spending and Payroll & Pension Spending.  I found the vendor spending section to be  disappointing in one major respect.  It displays a lot of about where the money to vendors comes from, which is very good, but no information on where the money goes, i.e., how the vendors spend it.  (I haven’t yet tried out the Payroll & Pension Spending section.)

I used the vendor portion of Open Checkbook to look up one specific company, the May Institute, Inc., for Fiscal Year 2010.  This is the same nonprofit provider for which COFAR has unsuccessfully sought cost information lately from the Department of Developmental Services. 

I clicked on one particular category of funding for that vendor and got a long list of dates followed by  payment amounts.    By clicking on July 14, 2009, for instance, I was able to find out that DDS paid the May Institute $367,000 on that date for residential and day services.  It doesn’t appear to be possible to find out much more detail about that payment. 

What is good is that I was able to do a refined search, based on the residential and day services account, and find that a total of $26.9 million was paid to the May Institute under this account by DDS in FY 2010.

The bad news, as noted, is there is no way to track where the money goes after it gets to the vendor.   For instance, there there appeared to be no way to view administrative expenses for the May Institute or to find data on the compensation of executives of the agency.   It would seem that a checkbook should tell you about both incoming and outgoing funds.

Also, the site doesn’t display contracts, as some similar state sites do; and the data on Open Checkbook doesn’t go back before Fiscal Year 2010.  An official with the state budget office said displaying actual contracts is “on our list” for improving the site, but that hasn’t been decided yet. 

It’s also worth noting that much of the information available on Open Checkbook is available as well on the state’s longstanding Uniform Financial Report website for vendors.  In fact on the UFR website, you can find total payments to vendors broken down by government agency as well as spreadsheets that do show where the money is going, including amounts paid to executives of the vendor agencies.  (That salary information may be incomplete, in several cases, as we have reported.  But at least some of it is available.) 

The UFR site, for instance, shows that a total of $30.29 million was paid by DDS to the May Institute in FY 2010 as part of a total of $104.4 million in revenue to the vendor.  Admittedly, the information on the UFR site isn’t nearly as up to date as the Open Checkbook site.  But you can find a lot of information on the UFR site that isn’t available on Open Checkbook, such as the fact that the May Institute had $101.6 million in expenses in FY 2010, including $396,716 in compensation to its CEO and $56 million on direct care salaries.  Also the UFR information goes back to FY 2002.

What the UFR site doesn’t appear to show, which Open Checkbook does, is a breakdown of funding going to vendors per budgetary account, such as the Residential and Day Services account.

One other problem I had with Open Checkbook has to do with its presentation of a large amount of abbreviated or otherwise highly techical information.  For instance, the the funding listed for the May Institute was broken down into five categories on the site, including Grants to Nonpublic Entities, Legal Support Services, Medicaid, Purchased Human and Social Services for Clients/Non Medical, and a fifth and largest category dollarwise, titled “PurchH&Ss For Clit.Med/HC Rel (MM3).”    Spending under this category was listed as $23,047.235.83.  What exactly does “Clit.Med/HC Rel (MM3)” stand for?

I was able to hover my cursor over the acronym, and up came the following definition, which didn’t clear up the confusion very well.  The definition was:

Payments pursuant to contracts with organizations to purchase social services or programs with medical or healthcare related components on behalf of specifically identified clients or a specific target group.  Includes services rendered by an individual with payment to a corporate entity.  Federal funds are reported as sub-recipient payments.

The “MM3” part of the acroym is an object code classification for the payments.  The Open Checkbook site FAQ page states that individual object codes are defined in the “Expenditure Classification Handbook” maintained by the Comptroller’s Office.  But unfortunately, the link on Open Checkbook FAQ page  to the Comptroller’s Handbook didn’t work.

As administration officials have said, Open Checkbook is a work in progress.

One way to avoid cutting Medicaid

October 3, 2011 2 comments

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

September 16, 2011 3 comments

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.

Once again, we’re waiting for the administration’s cost records

August 30, 2011 1 comment

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.

Identifying the missing costs

July 27, 2011 2 comments

The Patrick administration claims that the average per-person cost of Department of Developmental Services vendor-run group homes  is less than the average per-person cost of state developmental centers for persons with intellectual disabilities.

But we’ve now identified some specific missing group home costs that we think the administration overlooked in its analysis.

An apparently typical DDS vendor contract, which we have reviewed, did not specify any psychological or therapeutic services, and only specified minimal nursing services.  Developmental center budgets, on the other hand, do provide for all of those services.

This appears to be the first major confirmation we’ve been able to obtain, after months of Public Records Law requests from DDS, that the Patrick administration’s savings claims in closing four developmental centers in Massachusetts are based on an apples-to-oranges comparison.  The administration has not fully responded to our follow-up questions about these costs.

I asked DDS Commissioner Elin Howe on June 16, after we had first reviewed the $1.2 million contract, whether medical, clincal, and therapeutic services were available to the residents of the program, and, if so, how those services were funded.

The email I received in response from DDS General Counsel Marianne Meacham, dated July 2, stated the following:

With regard to your questions regarding clinical services available to individuals in the particular…program site, as you know, a full array of clinical services (medical, physical therapy, speech therapy, occupational therapy, psychological, etc.) are available to the individuals in the program through community providers as needed and set forth in the individual’s individual support plan. 

This carefully worded answer states only that medical, clinical, and therapeutic services “are available to individuals in the program,”  but it doesn’t say how those services are funded — in other words, where the money comes from.  Here’s why that is a key question:

In July 2010, the adminstration provided a cost analysis to the Legislature, which claimed a $20 million annual savings in closing the Templeton, Monson, and Glavin Developmental Centers and transferring most of their residents to vendor and state-operated group homes.  In the cost analysis, the administration specified a “community residential” cost per client of $107,689.  After adding an average “day services” (work and daily living skills programs) rate to that cost and an average transportation rate, the administration computed a total “community services cost” of $140,955 per client.

The administration then compared that $140,955 total community cost to an average per-person cost at the Templeton, Monson, and Glavin centers of $233,902.  The administration’s conclusion was that serving a client in the community was $92,947 less expensive than in a developmental center.

After we asked DDS, starting last December, for all documents supporting its community residential cost figure, DDS provided, among other things, a spreadsheet listing total costs of close to 1,000 vendor contracts in FY 2009.  We selected one of those contracts for closer review and asked DDS for a copy of it.

The Fiscal Year 2009 vendor contract with the May Institute, Inc. specified 24-hour staffing in a program serving 14 individuals.  The contract further stipulated a rate per client of $286 per day, or $104,400 per year.  This was quite close to the $107,689 community residential rate in the administration’s analysis.

However, as noted, the $104,400 community residential cost did not include clinical, therapeutic, or full medical costs of care available to community-based residents.  The budgets of the Templeton, Monson, and Glavin centers do provide for those services.

On July 6, I emailed back to Meacham at DDS, asking once again how the medical, physical therapy, speech therapy, occupational therapy, psychological, etc. services available to residents of the May Institute program were funded for the residents of the May Institute program.  To date, I’ve received no reply to my question.

This is why we need an independent study of the cost of closing the Templeton, Monson, and Glavin Centers.

Compelling testimony in support of a facility cost study

July 22, 2011 1 comment

Introductory note:

A proposal for an an independent cost study prior to the closures of the Templeton, Monson, and Glavin developmental centers may have run into a legislative roadblock last spring, but the idea isn’t dead yet.

State Representative Anne Gobi of Spencer is continuing to push for the measure, which was shot down by the legislative leadership during the state budget debate in April and May.

A bill filed by Gobi, which would specify that the study be done by an independent, non-governmental entity appointed by the state Inspector General, was heard by the Committee on Children, Families, and Persons with Disabilities on Tuesday, July 19.

“I’ve heard from officials who would like to close these facilities,” Gobi stated in a press release, “but I have also spoken with the families of patients at these centers – and they have presented evidence that suggests that there would be no cost savings with closures, yet there would be a reduction of services.

“Frankly, I think it is best that an independent study be conducted before any further decisions are made,” Gobi added.

The Patrick administration has produced two virtually identical cost studies in closing Templeton, Monson, and Glavin, which have concluded that  closing the centers will save more than $20 million annually.   However, the administration’s cost analyses have been seriously flawed.

In testimony submitted on July 19 to the Children and Families Committee, COFAR noted that the administration has thus far been asked to produce after-the-fact analyses of the costs and benefits of a previously announced policy of closing the centers.  An independent review of this policy is needed.

The most compelling testimony in favor of Gobi’s bill was not about the cost issue per se, though, although cost is always present as a backdrop to any dicussion about public sector services.  That compelling testimony came from family members of developmental center residents.  Here is one example of the testimony submitted to the Children and Families Committee:

…I would like to share with you the story of our brother, Danny Healey, and what his life at Fernald meant to him and to our parents.  I realize that this letter is long and I appreciate your taking the time to read it.  I have also enclosed a copy of Danny’s eulogy, which I trust will offer further proof of the benefit of residential settings for some people.

Danny was diagnosed with Down Syndrome and a host of other problems months after his birth on June 14, 1958.  For fourteen years he lived in a two-family house in Somerville with his parents, grandmother, great-grandmother, and four siblings.  A great-aunt and her husband lived in the apartment downstairs.  Unable to speak, feed himself, drink from a cup, or use the toilet, Danny needed help with every aspect of life. Our parents cherished him and, despite the constant care that he required, they planned to keep him home forever.

Danny’s doctor, however, pointed out that his self-destructive, repetitive behaviors (gouging his ears, banging his head against the wall and windows, etc.) could lead to permanent injury or even death.  He suggested firmly that Danny would be better served at a state school like Fernald.  My parents were devastated.  How could they send their precious child to strangers at an institution known to provide inferior care?  But they trusted the doctor, so with heavy hearts they enrolled Danny at Fernald.

Two wonderful people gave them hope that they had not consigned their son to hell.  The first was a middle-aged direct care worker, Mary Meaney, who had been sent to Fernald as a child and who had never known any other life.  Unlike Danny, who was best served in a residential setting, Mary was someone who could have been well served in a community based group home.  She promised my parents that she would protect Danny as if he were her own child, and that is what she did, for years, until he moved to Cottage 13, where he remained, surrounded by people whom he loved, until he died.  The second blessing in Danny’s life was Judge Tauro, who put the entire school under judicial oversight.  His action was the catalyst for a series of positive reforms at Fernald that allowed Danny to live there happily and safely for 28 years.

The direct care staff and professionals at Fernald were among the finest individuals I have ever been privileged to know.  Their respect for the residents was awe-inspiring.  Together they created genuine homes for some of the most developmentally challenged and vulnerable citizens of the Commonwealth.  Danny thrived there, to the best of his limited abilities.  Every year when we attended his annual evaluation, we would leave filled with admiration for the staff who gave unstintingly of themselves for the benefit of the residents.  Because my parents didn’t drive, my siblings and I would pick up Danny for regular home visits throughout the years, and at the end of his life, when it was difficult to care for him in our homes, we would visit him at Fernald, drive him around the campus, then feed him his favorite treat of cake crumbled up and mixed with pudding.  For twenty-eight years at least one of us was at the school almost every week, and we can attest, from extensive personal experience, that for people like our brother, facility-based care is the optimum choice. 

As Danny weakened in the last years of his life, the rumors about Fernald’s closing became more strident and frequent.  My parents were in a panic.  They knew that Danny would never be able to function in a group residence and that for him the only alternative was a nursing facility, where he would pine for his friends and caregivers.  They actually prayed that Danny would go to God before he had to endure such a fate.  As Danny’s neurological condition worsened, the staff provided loving and attentive care until he slipped away on January 15, 2001.  At his wake and funeral, which were attended by hundreds of people, we celebrated his life as well as the devotion of those who provided him with such a rich and nurturing environment at Fernald.  And we were grateful to God that we never had to watch him wither away in a nursing home setting where his physical and emotional needs could never have been met.

I grieve for the families of profoundly limited individuals like Danny who watch helplessly as facility-based care is eliminated for their loved ones.  I implore you to consider the value of such an option for those with severe medical and intellectual disabilities.  I know firsthand what a difference it made in Danny’s life and I hope that it can be available for others who need it.

Thank you.


Margaret Chisholm

 Another example of testimony submitted on Tuesday to the Children and Families Committee:

I am guardian for my third cousin, Thomas Doherty (DOB 2/25/2951), a native of Woburn, MA. Tommy has lived at Templeton Developmental Center (TDC) since 1973, when he turned 22 yrs.  and was discharged from a residential program where he had been since age 10.

To summarize, Tommy has been in care for 50 years, 38 of which have been at TDC, which Tommy refers to as “my school.” Tommy, an only child, was cherished by his parents, who struggled to provide safe, competent and nurturing care for their troubled, developmentally disabled son who could not be managed in their Woburn community in the 1950s and 60s.  When they found Templeton, Tommy and his parents were relieved that his needs could be met in such a caring, state of the art facility with strong vocational, behavioral and physical support provided by a dedicated staff.

Throughout his adult life, Tommy has worked in the cow barn under supervision of a watchful staff. He lives with several other men in a lovely cottage, and his medical needs, which include catheterization twice daily and administration of psychotropic medication, are provided without incident. His nutritional needs are monitored, and his diet is adjusted frequently. Tommy knows staff and residents, making frequent visits to “favorites” each day.

When a beloved staff member died, Tommy delivered a heartfelt eulogy. Tommy, cognitively impaired and emotionally disabled, enjoys loving and meaningful relationships with his extended family. Tommy is puzzled by the loss of friends as they are moved from their TDC home, and he is most anxious about his own fate. His mother, prior to her death 14 years ago, requested that I be Tommy’s guardian. This is an honor, with much gratification from my relationship with Tommy. His joy in seeing cousins, however distant, is disarming. His memories of his parents are filled with delight. Tommy’s pleasures are simple…the Red Sox, the Beatles, his picture albums, a good day at work, coffee, a cigar now and then, and his home at TDC.

Mary Ann Ulevich

One more example from a non-family member:

 My name is Mark Zanger. I live in Jamaica Plain and work as a Family Partner in mobile crisis intervention on mental health. I wish to register my support and evidence on behalf of H1859, requiring a study before closing the Glavin, Monson, and Templeton Developmental centers, and for S28, requiring the continuing use of state property at Templeton for the care and education of persons with intellectual/developmental disability.

I do not have a relative with ID/D, but became familiar with these
facilities while working for the Coalition of Families and Advocates.  As newsletter editor, I visited all six developmental centers then in operation with families and met with staff and residents…

Massachusetts has capacity for more than 100 adults with
MR/MH diagnoses at the Glavin Center, a modern facility built and staffed for that purpose. It was never an overcrowded “state school” and families there were not plaintiffs in Ricci v. Okin, and residents are not Ricci class members. The family members I met there have similar stories — their loved one was dually diagnosed as a child in the 50s and 60s and 70s, poorly served by the mental health systems of that era (which relied on talk therapy and crude medication for a population which is not often articulate about feelings or side effects), were not successful in the new group homes, and by enormous family efforts and political interventions were able to secure a place
at Glavin, where their loved ones have thrived and recovered with comprehensive and specialized treatment. Some Glavin residents returned to the community every year since it was founded, but in recent years people with more complex issues have failed expensively to make such moves.

Until higher level specialized mental health services for persons with ID/D are developed and available across the state, the Glavin residents cannot be safely or economically supported in the general community or even in state operated group homes, except for a few just off the Glavin property which rely on back-up services from the regional center.

I believe that these same arguments apply substantially to the Monson Center, specializing in MR complicated by seizure disorders, and even more so to the Templeton facility, specializing in persons who might otherwise be imprisoned. Templeton is a beautiful place, a working farm with meaningful work much enjoyed by the residents, a property long dedicated to the support of persons with ID/D, and one with little potential as commercial real estate — another tactical consideration that must be brought to light if the legislature is to make wise decisions.

Many states which are reducing or eliminating
other forms of congregate facilities have in fact invested in and
expanded those, like Templeton, with a mission to serve “forensic
cases.” Some of these individuals will be in secure treatment whether DDS provides or not, and the annual cost of a prison bed (not reimbursed by Medicaid or SSI) in Massachusetts may be larger than the state contribution to an ICF/MR bed at Templeton, Glavin or Monson.

It is the complexities of social accounting which drive my support for Rep. Gobi’s bill, which I personally would like to see amended to have the closure studies done independently. Even before I followed this question closely, wildly differing cost estimates, per person or per facility, were published periodically. A collection of these estimates over time would confound a Madoff accountant. On the snowy weekend of the Governor’s announcement of the plan to close four facilities, his press release included two different figures for the annual savings
anticipated, and no reconciliation.  A commission appointed by
Governor Romney likewise issued several conflicting estimates.

The administration has a quiet agenda to shift all state human services to Medicaid, Section 8, Food Stamps, SSDI, SSI and other federal budgets or cost shares. Leaving aside the intention of both major parties in Washington to cut Medicaid in the coming years; leaving aside the populations entitled to services who are not eligible for Medicaid or other federal services; leaving aside the dilution of specified comprehensive services under Medicaid’s ICF/MR standards; leaving aside the social accounting of what families must give up to keep multiply disabled people at home,  accurate and comprehensive accounting of the costs of evicting and relocating  these long-termresidents from familiar homes has never  been placed before the Legislature or the public. There are individual cases and academic studies indicating that there are few if any savings to the taxpayers.
There is growing public impatience with the outsized salaries paid to private contractors when compared even with the generous benefits of veteran state managers. There is accumulating anecdotal evidence that the land purchases and contracts to build new group homes to replace state facilities, some old and decaying, some reasonably modern and efficient, are not untainted by political dealings and overpriced bailouts in the acquisition and building business — entirely separate
and obscure expenditures of low-income housing loans outside the DDS budget.

 In several instances, anecdotal but indicative, persons have
been moved from facilities to group homes shortly before their deaths, wasting considerable sums to break up relationships and disorient people who might have been permitted to live out their lives in longterm homes.

…I would like to end with two overarching reasons to study carefully the closing of three more state facilities for people with ID/D (and in my own advice, not to do so), and to specifically reserve the property at Templeton for the future needs of this population.

The first reason is demographic. According to the Coleman Institute “State of the States” reports, more than half the clients of DDS are living with parents now 60 years old or older. This is a demographic triple-whammy (better life expectancy for disabled people; the baby boom caretakers aging; the baby boom consumers also aging into increased disability) which has already gridlocked DDS residential services. This year’s budgets do not fully cover residential services for the most disabled youth turning 22, and ArcMass has suggested a supplemental budget request for them.

To see the housing shortage issue in the most realistic terms, it is
important to compare the absolute number of persons served by DDS with the predicted number of qualified people in the Commonwealth, based upon the IQ 70 definition, two standard deviations from mean IQ.  The math would suggest that DDS has reached fewer than half the eligible individuals. There are some life expectancy reasons to assume that the reality is a little better than that, but there are still tens of thousands of disabled people outside the gates (perhaps fully as many as double the present enrollment if one adds in the barely ineligible, a fatter slice of the bell curve).

Some of these people are in nursing homes despite the Rolland case, some are in prisons, where DDS has no outreach; many are evident in any visit to a homeless shelter; some are transient, some are enslaved (as we learned in the “Raynham House of Horrors” case in the late 1990s); probably the largest unserved
group are quietly supported in homes and families, often those of
immigrants and minorities, to which there is no outreach, or where government services are unknown or culturally stigmatized.

Our team periodically finds children and youth in all these invisible categories, and they too are part of the reason the Legislature needs careful study before closing residential options at any level.

This is simply not the time to close any viable residential options
for people with ID/D, and certainly not the ICF/MRs supported by hundreds and hundreds of families who struggled to obtain such excellent placements for their loved ones.

 The second overarching reason to study facilitiy closures, to delay and avert facility closures, and to secure the permanent use of the Templeton property is the proven mortality that ensues when very disabled people are moved from sheltered settings into “community settings” with increased transportation, unfamiliar and rotating staff, and waits for use of the group home van for medical appointments. You can read a summary of studies of these dangers in the records of Massachusetts by former US Attorney Michael Sullivan that I wrote when working for COFAR at this Internet address:

The definitive Shavelle et al study of de-institutionalization in
California is footnoted in that article. Shavelle found mortality 47% higher than predicted even after throwing out deaths within six months of moving, to avoid the controversy over “transfer trauma.”

The most recent international meta study, by Kozma et al, advocates of community-based treatment, freely admits that outcomes (including mortality) remains one of three (out of ten examined) areas in which facility treatment remains superior to existing community-based systems studied. The other two areas where community systems all over the world are falling short are “challenging behaviors” and “overuse of psychotropic medication.” (You can read the full text at

I am fortunate in my job to wrestle small problems one family at a
time. I do not envy the Legislature its choices in this difficult
financial environment. We must all be penny-wise. But this is exactly when an independent study of a key decision in the largest human services budget is penny-wise, shilling-smart, and not a bit pound-foolish. To steal from the most vulnerable people served by the Commonwealth is not the right way to get through a budget crisis, even one of long duration.

Why study what has been studied before? So we don’t have a concrete block or a lamp falling on someone’s car. So we
don’t parole killers who kill again. So we don’t have another Raynham House of Horrors.

Nonprofit vendor salaries drawing increased attention

July 11, 2011 1 comment

Organizations such as the Massachusetts Providers Council may still be defensive  about suggestions that scrutiny be applied to the sometimes excessive salaries drawn by executives of human service providers in Massachusetts and elsewhere.

But it’s becoming clear in the wake of the fallout over the recent  $4.2 million severance package for a Blue Cross Blue Shield CEO and a number of other similar cases, that even in the nonprofit community, responsible voices are beginning to be raised urging serious consideration of the appropriateness of executive pay levels.

Here’s Ruth McCambridge, editor in chief of the influential Nonprofit Quarterly, discussing in an email to subscribers the Blue Cross severance package to former CEO Clive Killingsworth:

 This case is a poster child for why the public does not trust our considerations of pay levels. While most of us are, of course, well within or below reasonable limits for pay, there are these high fliers among us, and in this case the money that Killingsworth walked away with came very directly from millions of families’ pockets, some of whom are legitimately concerned about such stuff as getting by from day to day.

Meanwhile, in an interview  with the Nonprofit Quarterly last week, Paul Light of the Wagner School of Public Service at New York University, had this to say: 

I think the nonprofit sector has an obligation to get the very best talent it can at the most reasonable cost appropriate to its role in the public service—more broadly defined. Yet you can’t simply say, “We’ve got to pay whatever the market demands, and that’s the only criteria we can use.”…

I don’t think you have to take that vow of poverty, but at the same time I wonder if the sector is obligated to set itself out there as being more a part of the community that it serves—obligated by basic issues of fairness to set reasonable market-sensitive pay, but also stay in touch with the world we serve.

Here in Massachusetts, State Senator Mark Montigny of New Bedford came closer this year than ever before in gaining passage of proposed legislation that would limit pay for both nonprofit executives and board members to $500,000 (a pretty generous threshold in our view, particularly for board members).  Versons of Montigny’s measure passed the House and Senate in the form of budget amendments last month, but the measure was ultimately knocked out of the budget conference committee.    However, the measure is still alive in the form of a bill before the Judiciary Committee, but has not yet been scheduled for a hearing.

Montigny’s bill is supported by Attorney General Martha Coakley, who has been investigating compensation of nonprofit board members, and found that several health insurers were paying tens of thousands of dollars to their trustees annually.  Coakley’s spokesman, Brad Puffer, told The Globe last month that Coakley and her staff are concerned about situations in which “board members of any charity (nonprofit) are paid.”

Massachusetts already limits the amount of state funds that can be earmarked to pay for nonprofit salaries to $143,900.  COFAR has reported that in a number of cases, state and federal records regarding salaries subject to that compensation limit don’t match each other.

Meanwhile, Coakley, along with Massachusetts State Auditor Suzanne Bump and Inspector General Gregory Sullivan have been investigating questionable financial practices, including high executive salaries, of nonprofit organizations involved in the state’s special education program.  COFAR has called on Bump and Sullivan to expand their probe to examine the entire human services vendor system for persons with intellectual disabilities.

In sum, this is an issue that isn’t going away soon and can’t be ignored.  Salaries and financial practices of human service vendors, insurers and other nonprofit organizations should be a major focus of state oversight.  The other major focus should be on quality of care and services.  To the extent that there are problems or a lack of state oversight in one of these two areas, we believe there are likely to be problems in the other.

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