On Wednesday March 15th, Executive Director Shannon McCracken testified on HCR100 before the Senate Health and Welfare Committee, chaired by Senator Julie Raque Adams. Immediately following H&W, the bipartisan (statutory) Program Review and Investigations Committee voted to include the SCL Program Review and Cost Study (as detailed in HCR100 sponsored by Leader Shell) to their official agenda.
KAPP will now begin preparing members and non-members to effectively participate in this program review. It is an unprecedented opportunity for SCL providers to inform the process and assist in an independent study by the LRC to give a true picture of cost and utilization! Stay tuned!
Direct the Program Review Committee to complete a study of the KRS 142.363 and the Supports for Community Living Waiver Program reimbursements for private providers; encourage joint and statutory committees to further discuss 1915(c) waivers and steps to ensure the financial viability of the program.
Feb 21, 2017 – to Health and Family Services (H)
Mar 01, 2017 – posted in committee
Mar 02, 2017 – reported favorably, 1st reading, to Calendar
Mar 03, 2017 – 2nd reading, to Rules
Mar 06, 2017 – posted for passage in the Regular Orders of the Day for Monday, March 6, 2017; 3rd reading, passed 93-0; received in Senate
Mar 07, 2017 – to Health & Welfare (S)
Legislative Day Talking Points and Facts
With the new administration in Washington and in Kentucky there is an opportunity for significant Medicaid reform. KAPP’s role is to be at the table to inform and ensure that the transformation is positive for the people we serve. These changes will dramatically impact the lives of Kentucky’s most vulnerable citizens who depend on Medicaid home and community-based services. Our job is to ensure it is a positive impact.
• Support funding/rate increases in the 2018/2019 Kentucky Biennial Budget.
o This is needed to stabilize services and ensure an adequate direct support professional workforce.
o KAPP was grateful to hear CHFS Secretary Glisson tell the Interim Joint Committee on Health and Welfare, as she presented the Cabinet’s overview and agenda, the need to address the 13-year-old rates for our 1915c Medicaid waivers, which serve Kentucky’s most vulnerable.
• That no changes to Kentucky’s Medicaid be considered until stakeholders (like KAPP) are engaged.
o Any decisions to alter Medicaid as a whole would have direct and immediate consequences for people with intellectual and developmental disabilities and their families who rely on home and community-based services, as well as the thousands of Kentuckians who provide their direct care.
Kentucky’s system of support for persons with intellectual/developmental disabilities is deteriorating and in crisis. The businesses that provide direct support personnel to the system, are failing from inadequate funding needed to stabilize and support the caregiver workforce. In the past 3 years:
- 85% have refused referrals due to inadequate funding.
- 41% have downsized their services and another 46% are considering/anticipating downsizing.
- 91% have/are providing services despite not being paid for billed claims.
- 58% have/are providing services for one or more individuals they are unable to adequatelysupport because regulations will not permit discharge.
- 69% have had to call police and 56% have taken individuals to ERs because they could notadequately ensure safety of the person and felt they had no other options.
- Thousands of Kentucky’s most vulnerable citizens who have moved out of costly institutions are at RISK of being re-institutionalized or displaced.
- Thousands of Kentucky’s direct support professionals are moving to other work for higher pay, better benefits, less responsibility, etc.
- Thousands of Kentuckians have been on Waiting Lists for years: (SCL 2,300+ and Michelle P 5,000+)
- Kentucky’s providers are limiting services, closing sites, refusing referrals and going out of business.
o Many of them cannot sustain the increase of fixed expenses in a climate of 13 years of no funding increases.
- Medicaid is the ONLY funding source for services for people with intellectual & developmental disabilities.
- Kentucky’s 1915c (fee for service) waivers have been thoughtfully and intentionally carved out of Managed Care.
- Providers cannot raise prices or shift costs to cover the shortfalls in their budgets caused by incremental increases in wages, increasing costs and federal mandates.
- Kentucky’s Medicaid waiver rates have not increased in 13 years; during this time, agencies have incurred continued increases in operating expenses, e.g., salary and benefits; utilities; etc.
- Unfunded mandates: costly increase in training requirements, increased background check requirements, costly nursing services required without ability to bill for them, additional CMS Final Settings Rule requirements and many more.
- The rebalancing of our waiver services and rates in 2012 (budget neutral) resulted in a failed attempt to increase supported employment and community access. From 2012 to 2015 the amount of Medicaid revenue billed per participant for non-residential SCL services declined by nearly one-third.
- Provider rates are determined by individual states and MUST be included in the state’s Medicaid Plan, which is ultimately reviewed by the U.S Department of Health and Human Services’ Centers for Medicaid and Medicare Services (CMS).
- Increased expenses without corresponding increase in funding, has resulted in reduced pay and benefits to the workforce, increased turnover, and reduction of services and quality supports for people with disabilities.
Direct Support Professionals (DSP) are the cornerstone of Kentucky’s long-term care system, and the quality and stability of this workforce is of fundamental importance to the well-being of the thousands of waiver recipients who rely on them for essential care, services and support. They are the first line for ensuring health, safety and welfare for some of Kentucky’s most vulnerable citizens. (DSP’s are also often referred to as direct care staff, aides, home health assistants, and personal care attendants.)
- In 2015 Kentucky’s providers experienced an average 45% turnover rate of Direct Support Professionals.
- 38% of those leaving are valuable trained staff with over one year of experience.
- The median starting wage of DSP’s is $9.00/hour and the overall median wage is only$10.00/hour. These are not competitive wages for this absolutely critical workforce.
- Many Direct Support Professionals must access the very Medicaid funds that are also utilized bythe participants they serve. Over 30% report getting benefits through the Medicaid expansion.
- In 2015 Kentucky lost 3,500 DSPs due to turnover. At an estimated cost of $3,500 to replaceeach of them, providers had to collectively take over $12,000,000 out of Medicaid-paid direct support resources just to replace staff.What your Kentucky Association of Private Providers is doing to stem the crisis:
- KAPP leadership and representatives are available any time to the Cabinet, Administration and Legislature for consultation, resources and input on any matters in the field of disabilities and Kentucky’s support systems.
- KAPP continuously communicates to its members, with a major effort to share and get feedback on regulatory, payment, service and any other requests from the Cabinet to Kentucky’s largest provider communication network. That feedback is timely and concise.
- KAPP is engaged in national professional organizations that focus on home and community based services for people with disabilities and all aspects of regulation, business practices, best practices and innovative designs.
- KAPP membership comprises over 54% of Kentucky’s businesses providing IDD service, but those members provide supports to an estimated 80% of all Kentuckians receiving services for intellectual, developmental and acquired disabilities in the community.
- KAPP member businesses provide services and employment throughout all of Kentucky and to constituents in every Kentucky Congressional District.