CDSA members are actively engaged in developing and implementing policies that shape the IDD service delivery system. While we are involved in any policy that affects member programs, some major changes are on the horizon.
As California responds to the COVID-19 outbreak, IDD service providers face unique challenges delivering services, maintaining operations, and navigating regulatory changes. In this unprecedented situation, service providers must learn as they go and adapt to an ever shifting landscape. Guidance from state agencies and regional centers is not always clear or implemented consistently. Counties and cities have issued their directives, further complicating compliance to state and federal reimbursement requirements. CDSA keeps members informed about outbreak news and analysis that matters most, and advocates for IDD service system sustainability and answers to urgent member questions.
RATE MODEL IMPLEMENTATION
In 2016, the California legislature ordered a rate study regarding community-based services for people with IDD. The final rate study was published in January 2020 and found a funding gap of at least $1.8 billion. Burns & Associates, the research firm that performed the study, developed rate models that change reimbursement structures and increase rates for the majority of services. Despite the state’s $3 million investment in this study and the stark findings of underfunding, no plan has been offered to fund and implement the rate models.
CDSA and our members have been involved in every step of this process. We pushed for the study, provided hundreds of pages of input to correct faulty assumptions in the first draft, and won supplemental rate increases to address the study’s initial findings. Now, we are advocating for the most important step: Implementing the rate models to fill the $1.8 billion funding gap.
Decades of underfunding for IDD services has turned most direct support professional (DSP) careers into minimum wage jobs. The current process for adjusting rates when the state minimum wage rises is burdensome at best and inaccessible at worst. Providers serving the most populous cities and counties in the state cannot use this funding mechanism at all due to local minimum wages or high cost-of-living. Low wages and increased strain on already tight operations make it increasingly difficult for providers to recruit and retain high-quality DSPs.
The direct support profession is too critical a service to be paid based on minimum wage. CDSA, in collaboration with coalition partners, developed a new process for adjusting rates that would allow providers in every community to raise wages in alignment with the spirit of state minimum wage increases. Not only does our proposal simplify the process, eliminating administrative burden for providers and the state, but it will put California back on the path of recognizing and compensating DSPs as the professionals they are.
The Home and Community-Based Services (HCBS) Settings Rule promulgated by the Centers for Medicare and Medicaid Services (CMS) in 2014 affects a variety of programs that people with IDD depend on – from residential services to social activities to employment. Federal funding for those services is in jeopardy if the state fails to comply with the rule. Even with a deadline extension to March 2022, California is considerably behind in the required assessment and heightened scrutiny procedures, leaving programs little time to resolve any identified compliance issues. In the meantime, programs find themselves subject to inconsistent assumptions and interpretations by regional centers, advocates, and policymakers. CDSA is an active voice in the HCBS implementation process, serving as an advocate for our members, and helping guide the state toward compliance to safeguard service continuity for people with IDD.
The Lanterman Act affirms that Californians with IDD have the right to choose their own life goals. CDSA members deliver services to support those goals, and we are dedicated to preserving individual choice. Our advocacy to legislators and other policymakers always supports our members’ vision for a diverse, innovative service delivery system that meets the needs of all clients. When Federal policy changes like the HCBS Rule or Workforce Innovation and Opportunity Act (WIOA) are implemented in California, we work with the Administration to ensure that no one is left without the services they need.
ARE YOU READY?
There are many other policy changes in the works. The CMS Electronic Visit Verification (EVV) Rule remains to be implemented. State policies that harm program funding like the uniform holiday schedule are merely “suspended” and threaten future services. HCBS compliance, changing expectations for employment, and the high cost of housing all require retooling and redesigning services. Our state caseload far exceeds most states, and it’s growing more quickly than the general population, so the work ahead is daunting and fraught with fiscal risk. We keep CDSA members informed about and engaged in these decisions that will shape the future of their programs.