Are you ready for the changes in your operations, expenses, and revenue?

workingWhile increasing costs and frozen rates push providers toward a financial cliff, policy initiatives from the federal government compel the state and its providers to change program models and to look at the delivery system for those with developmental disabilities.

The Home and Community Based Settings Rule, from the federal Centers for Medicare and Medicaid Services (CMS), establish new requirements for settings of residential, day, and employment services, which will require California to make dramatic changes to the Department of Developmental Services/Regional Center System. Philosophically, it maximizes personal choice and community integration for consumers. It also sets up circumstances under which the federal Medicaid dollars will NOT be allowed absent evidence of compliance.

California has secured initial approval of its “HCBS State Transition Plan” through the Department of Health Care Services to cover all eight of the state’s waivers under Home and Community Based Services (HCBS).  The waiver with the largest population is the DDS waiver, so DDS organized an HCBS Transition Plan Advisory Group (which includes CDSA representatives) that is addressing how to evaluate programs and identify what services can reach compliance, as well as how to communicate about the transition process to consumers, families, and providers.

The State needs CMS final approval for the Transition Plan by March of 2019, and the plan must be implemented by March of 2022.  This plan will include a self-assessment process by providers, selected site reviews, and increased scrutiny for sites that seem more institutional in character.  This process will lead to changes in programs with restrictive settings or potential loss of client placement and funding.

The second initiative is the Workforce Innovation and Opportunity Act (WIOA), which changed federal policy regarding both job training programs and vocational rehabilitation programs and their funding.  As a result, the US Department of Labor and US Department of Education have new policies that prioritize access to integrated competitive employment (at or above minimum wage) for youth and adults with disabilities.  New reporting and outcome measures have prompted state government to undertake new service and program designs to show they are responding to the new mandates.  Now, the Department of Education is re-considering the definitions in the WIOA regulations, new legislation has been introduced to amend WIOA.

In California, the Department of Rehabilitation has implemented new requirements for educating clients about their employment options and focused on making competitive integrated employment the preferred outcome for clients 18 to 22 years old.  We are sorting out how these requirements are implemented and working with state policymakers about apparent confusion of WIOA and HCBS requirements at the implementation level.

The 21st Century Cures Act mandates implementation of Electronic Visitor Verification (EVV) by January 2019, despite the fact that the Centers for Medicare and Medicaid Services (CMS) only issued guidance on the provision in May 2018, and the guidance leaves many questions unanswered.

California has declared that it won’t be able to comply in January 2019, but it will make a good faith effort to comply as soon as it can.  Providers are left unclear what the requirements are, whether their current systems can be integrated, and who will pay for changes and additions.

The next few years are going to be years of retooling and redesigning services for all persons with disabilities in California, including those under the DDS community service system. The caseload in California far exceeds most states, so the work ahead is daunting and fraught with confusion and fiscal risk.

The Department of Developmental Services has now embarked on a rate study that could establish new rates for services and change all the methodologies for rate adjustments and increases.  CDSA participates in the stakeholder group for the process and addresses issues as they arise.

If there ever was a time when providers need information, communication and participation, this is it! CDSA is the statewide association already established and committed to staffing, advocating, and building the provider voice across service lines in California. It’s time to join this effort if you want to understand what’s coming and want to participate in shaping it.  Having colleagues and peers to share ideas, information and advocacy will provide you with much needed support and prompt feedback. Not only are many program operations in potential jeopardy but critical feedback from consumers and families will allow you to make the best business decisions to survive the biggest changes proposed in the Lanterman Act system in California in over 40 years!