RI Senate Leaders Launch Drive to Raise DD Workers' Pay to $15 in Next Five Years

By Gina Macris

DiPalma outlines Plan for $15 hourly wage in five years

Rhode Island Senate leaders have announced a five-year drive to lift wages of caregivers for adults with developmental disabilities to $15 an hour, with the chairman of the Senate Finance Committee saying Oct. 28 that the existing labor force is “so tenuous it is on the verge of collapse.” 

At a press conference in Warwick, Sen. Louis DiPalma, D-Middletown, the architect of the plan, said it would start with an additional $6.8 million in Medicaid funding – half of it state revenue- in the fiscal year beginning July 1, 2017. 

The plan also calls for legislation that would commit the state to additional wage increases in each of the following four fiscal years, although the total cost has yet to be determined, DiPalma said. 

The General Assembly added $5 million in Medicaid funding to the current budget late in the 2016 legislative session, under pressure from Governor Gina Raimondo and from a federal court order reinforcing a consent decree mandating integration of individuals with developmental disabilities. 

The U.S. Department of Justice and an independent court monitor had expressed concern that low salaries prevented service agencies from attracting workers with the necessary skills to implement the consent decree. 

The $5 million added to the current budget – including $2.5 million in state funds - raises the average worker’s hourly wage by 36 cents, from $10.82 to $11.18, according to DiPalma. The $6.8 million in the next budget would add another 76 cents, for a new average hourly rate of $11.94, he said. 

Similar yearly hikes would be needed during the following four years to reach $15 an hour, DiPalma said, although the increments do not have to be evenly divided as long as the state reaches the goal by July 1, 2021, the start of the 2022 fiscal year. 

He plans to introduce legislation in the next session of the General Assembly calling for raises over multiple years. 

The effort has the support of the Senate President, Teresa Paiva Weed, and the Senate Finance Committee Chairman, Daniel DaPonte. DiPalma is first vice-chairman of the Senate Finance Committee.

 Late Friday, David Ortiz, press secretary to Governor Raimondo, said that while the current budget gave workers their first raise in several years, “we must do more to stay competitive with neighboring states. “ 

“The Governor looks forward to partnering with Senator DiPalma and Senate President Paiva Weed to continue to invest in better outcomes for families and help ensure all of our workers can make it in Rhode Island,” Ortiz said. 

Massachusetts has agreed to pay personal care attendants a minimum of $15 an hour by 2018.  Enacted in 2015, it was the first such state-wide agreement in the nation. 

New York recently adopted legislation spelling out a multi-year plan to phase in a $15 minimum wage for all workers, with different schedules for various regions of the state. 

In a statement in Warwick Friday, DaPonte said that DiPalma’s plan “addresses an important part of the wage inequity problem, and helps improve outcomes for the individuals they serve. 

“At the same time, we need to continue to review the methodology for compensating all those direct care workers who serve our children, homebound elderly, and individuals with disabilities through other types of provider agencies,” he said. 

During the press conference at West Bay Residential Services on Knight Street, DaPonte talked about a constituent who approached him at his son’s soccer game and complained that his recently-widowed, elderly mother was not receiving the 20 hours of home care to which she was entitled. 

The constituent wanted DaPonte to introduce legislation to require home health aides to show up on the job. 

But DaPonte said he told the man that the workers were so poorly paid the agencies “can’t find people to show up.” 

“Now we’re at the point where the system is so tenuous it’s on the verge of collapse,” he told an audience of about 50 that filled a conference room at the headquarters of the agency, which specializes in support for individuals with significant physical limitations.  

Data shows Pay Inequities, Particularly for Women

DiPalma’s plan emerged from a four-month long study that showed stark inequities in the pay of direct care workers since the General Assembly cut a total of $26 million from the developmental disability budget in the fiscal year that began July 1, 2011. 

With that sweeping action, workers saw double-digit pay cuts, to an average of $10.65 an hour, according to DiPalma’s data. At the time, the minimum wage was $3.25 lower, or $7.40 an hour. 

Since then, however, the state’s minimum wage has increased 30 percent, to $9.60 an hour, while the average pay of direct care workers has remained stagnant. 

In the fiscal year which ended June 30, Rhode Island’s direct care workers made an hourly average of $10.82 an hour, while those doing comparable work in Massachusetts were paid $13.02,  and those in Connecticut made $12.19, according to statistics from the U.S. Department of Labor. 

The figures pertain to employees of private agencies providing direct care. In Rhode Island, a parallel, state-run system pays its entry-level workers $17.15 an hour, for an annual salary of $35,668. These workers also get thestate employee benefits package, according to DiPalma’s statistics.  

With longevity, the average direct care worker in the state system makes $42,278 a year, he said. 

DiPalma also presented the results of a 2015 survey of direct care workers conducted in 2015 by the Community Provider Network of Rhode Island, an association made up of most of some three dozen private agencies in Rhode Island that serve about 4000 adults with developmental disabilities. 

With 1,439 responses, the survey found that:

•  More than half the workers were female heads of households
• · Many received food stamps and other government assistance geared toward low-income workers
• ·87 percent worked fulltime
• ·41 percent worked more than one job to make ends meet
• · 62 percent said they want to leave the developmental disabilities field because of the low pay 

The turnover among employees of private agencies is 33 percent a year, three times the turnover rate of 11 percent in the parallel state-run system, according to DiPalma’s study. 

Higher wages would mean greater stability and improved performance in the workforce, DiPalma said. 

Picking up where DiPalma left off, the director of the Sherlock Center on Disabilities at Rhode Island College said research shows those two factors correlate with a better quality of life for the recipients of support services. 

Anthony Antosh said a better quality of life is measured by improved health and safety, more interpersonal relationships and greater self-determination among individuals with developmental disabilities. 

Jim Petrone works his communication board

Jim Petrone, who receives support from West Bay Residential Services, used a communication board to tell the audience that he could not have made it through a health crisis in 2015 without the support of his staff and family. 

“Now I have a second chance at life,” he said. 

Diane Scott, who has worked at West Bay Residential Services for 26 years, reminded the audience that those who provide direct care come to learn the most intimate details about a person’s life. 

“Imagine,” she said, “if staff showered you or bathed you.” 

“No sooner do you decide to trust these staff than they continue to leave. Regulars work extra hours to compensate for yet another staff vacancy,” Scott said. 

Antosh said direct care workers should be treated not as short-term custodial staff but as professionals, who are on a career ladder, and who provide comprehensive support to people with very complex needs.  

THREE-STATE COMPARISON OF MINIMUM WAGE AND HOURLY RATE FOR ATTENDANTS

CHART COURTESY OF RI SENATE 

Friends of the Disabled to Hold Forum in Newport on DD Services in Rhode Island

By Gina Macris

Friends of the Disabled, organized by Newport County families who have members with intellectual or developmental disabilities, will host a forum on the future of Rhode Island’s disability service system Wednesday, Oct. 5, from 5 to 8 p.m. at the Newport campus of the Community College of RI. 

Candidates for the General Assembly have been invited to attend and address several questions about adult services that are provided by the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), according to Chris Semonelli of Middletown, co-director of the group.  

Most of the issues of concern to the parents are related to a history of declining funding.  The General Assembly, under pressure from the U.S. Department of Justice, the U.S. District Court, and Governor Gina Raimondo, added about $11 million to developmental disabilities for the current fiscal year to comply with a federal consent decree requiring community-based employment and day services. 

Wednesday's program will cover current and future options for both daytime and residential services. 

The consent decree does not apply to residential services, although parents have expressed concern about the future availability of group home placements, which have been hard to come by in recent years. 

Since January, BHDDH has been emphasizing shared living arrangements, in which adults with developmental disabilities live in private homes. BHDDH should provide better supports to families providing shared living, according to Jane Gallivan, who until Sept. 30 served as Interim Director of Developmental Disabilities. 

Gallivan's Short Stint in RI Brings Plenty of Change, Starting with Plans for Better DD Assessment

Jane Gallivan   Photo by Anne Peters

By Gina Macris

In just the few months she has served as interim director of Rhode Island’s Division of Developmental Disabilities, Jane Gallivan has been instrumental in changing the state’s approach to providing services for individuals with intellectual challenges.

On the most concrete level, she has set plans in motion to adopt an improved version of a controversial assessment – the Supports Intensity Scale (SIS) – to more accurately determine the needs of clients.

With help from the Executive Office of Health and Human Services, Gallivan also has shifted strategies for presenting the division’s budget so that the state Budget Office and the General Assembly better understand what it means to support individuals with developmental disabilities.

The initiatives Gallivan has begun, and the tone she has set, are expected to continue after her role changes Friday, Sept. 30, to that of long-distance consultant.

Gallivan, 68, is taking her 101 year-old mother to Florida for the winter, a commitment she made before Rhode Island officials approached her for short-term help in leading the developmental disabilities division.

She will continue to monitor and guide reforms and will serve on the committee that will screen applicants for the division’s permanent chief.

A former state-level director in Maine and Delaware, Gallivan already has been spreading the word about the director’s job through her nationwide contacts in the field of developmental disabilities.

As she prepared to end her full-time role in Rhode Island, Gallivan shared her perspective on the future of developmental disability services in Rhode Island.

Major Changes Coming to Every State

Gallivan says all state developmental disability service systems are in the midst of a sea change because of sweeping new Medicaid regulations.

The rules say that all services for the elderly and individuals with all types of disabilities must be provided in the least restrictive setting that is therapeutically appropriate, which is presumed to be the community.

After March, 2019, Gallivan said, Medicaid will no longer pay for sheltered workshops or segregated day programs after March, 2019.  Sheltered workshops don’t fit the Medicaid’s definition of “community,” she said.

Federal Medicaid dollars pay for half the cost Rhode Island’s developmental disability services.

The federal consent decree requiring Rhode Island to shift to community-based jobs and activities may put the state ahead of the curve, she said.

Both the consent decree in Rhode Island and the changed Medicaid regulations nationwide get their authority from the 1999 Olmstead decision of the U.S. Supreme Court, which is in effect a desegregation order for individuals protected by the Americans with Disabilities Act. 

Individuals and families who struggle to find appropriate services may not yet see any change in their lives.

Gallivan says she worries about a caseload ratio that is “way too high” - one social worker to every 205 clients.

Social workers are “really concerned about helping people out,” she said, “but like any other service system, they are often, because of the ratios, dealing more with people in crisis”  or those just entering the system, rather than “supporting the people who are not the squeaky wheel.”

“No one wants to expand state government,” but state government must still “figure out how we’re going to put more resources into case management,” Gallivan said.

A New Way to Assess Service Needs

Since taking the interim director’s job in July, Gallivan has been “looking under the hood,” as she put it, to understand the barriers that need to be removed to allow “people to really get out and enjoy activities in the community, to get better connected, to explore new job options and so forth.”

She’s been searching for hindrances in state regulations, the way programs are funded, and the way clients have been assigned individual funding based on “tiers,” or levels of need.

The Supports Intensity Scale, (SIS) is a lengthy questionnaire used since 2011 to determine the individual level of funding according to “tiers” labeled A through E, with E being the costliest.

In the last few years, the SIS been the single most emotional flashpoint for families, many of whom have complained bitterly not only about results that yield insufficient funding, but that interviewers argued with them or recorded answers different than the ones they gave.

In the next several months, Gallivan said, the state will move to what she hopes will be a more accurate version of the assessment, with additional questions focusing on medical and behavioral needs.

SIS Interviewers will be retrained in the new version by representatives of the organization which developed the SIS, the American Association on Intellectual and Developmental Disabilities (AAIDD).

Gallivan said training also will be offered to family members and representatives of service provider agencies, who attend the interviews and help answer questions.

The state will monitor the new approach to determine whether it leads to a reduction of a high number of exceptions now granted to the assessment results. 

The exceptions, in which a client may have more funding than warranted by the official level of support, have raised numerous questions in the General Assembly about how the Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH) manages its budget. 

Gallivan offered some background on the SIS, which is used in Rhode Island as a basic building block of the developmental disability budget.

On its face, the SIS is a better assessment than some others in use across the country because it frames questions in terms of an individual’s strengths and the supports he or she may need to achieve a particular goal, rather than focusing on deficits, Gallivan said.

But it has its limitations, she readily acknowledged. It is recognized nationwide that the SIS does not address extensive medical needs or behavioral issues, Gallivan said.

“You also have to be sensitive to people who are very independent, but they may get themselves into trouble with the law,” or in some other way, because of their disabilities, she said.  For example, some individuals may appear independent, but if they don’t have the proper support and guidance, they may end up at a homeless shelter, or picked up by police for shoplifting.

The SIS was developed as a tool for planning individualized programs of support, not as a funding mechanism, although many states use it for budgeting, Gallivan said..

As a result of the gaps inherent in the original assessment, the state of Oregon developed a number of questions on behavioral and medical support needs that were tried out by other states and ultimately incorporated into a new version of the questionnaire called the SIS-A, Gallivan said.

“Everyone came to the conclusion that these supplemental questions really did add a more robust, accurate assessment,” she said.

AAIDD released the SIS-A in 2015, according to the organization’s website.

Gallivan said arrangements are being made for AAIDD representatives to come to Rhode Island for training in the SIS-A. At the same time, the consultants who developed the formula for turning SIS scores into individual funding levels have been asked to revise that algorithm to correspond to the SIS-A, she said.

Disability Services: a Lifetime Commitment

Meanwhile, Gallivan has tried to set a different tone for presenting the needs of individuals with developmental disabilities to the state Budget Office. 

“I’m not saying that people don’t know” what the Division of Developmental Disabilities does, “but a lot of people really don’t know,” she said with a chuckle.

“So I think it’s really important to paint a picture” of the service system and the people in the middle of it, Gallivan said.

Budget officials should know who the division serves, whether they live with their families or elsewhere, the kinds of services they receive, why the services are important to them and their families, the actual costs of providing those services, and the expected outcomes, Gallivan said.

That’s a different approach than seeing the system as a list of line items, she said.

It’s important for the fiscal arm of state government to understand that “we are the long-term care system,” Gallivan said.

“People think of the elderly as being the long-term care system, but they’re only in there for a few years,” she said.

“We’re talking birth to 100” in developmental disabilities, she said.

Legislators must understand that they can’t take money from individuals with developmental disabilities and give it to someone else, Gallivan said.

“In this system, everyone who comes through the door will have a life-long need for some kind of support because of the nature of their disability,” she said.

It’s not analogous to the mental health system, where funds may be shifted because one person is in recovery and another is not, Gallivan said.

A Focus on Families

In any presentation she makes, Gallivan said, she tries to emphasize the need to support families who have a member with developmental disabilities living at home with them.

Many families want their loved one at home, she said. "Ffrom a bureaucratic perspective, it’s (generally) the safest place they’ll be,” she said, “and the cost of services in the family home will be less than they will be anywhere else.”

“So how can we invest in families and recognize them as caregivers? We talk about people as caregivers of those with Alzheimer's, but we have people who are caregivers of people with developmental disabilities who face a lot of challenges” and have their own need for support, Gallivan said.

She suggested families should have access to more respite care and should be able to get financial support for modifications like wheelchair ramps.

Gallivan also indicated technology might help families keep tabs on their loved ones, although options like bedroom cameras might not be universally welcome in some homes.

The full range of supports for families “need to become a very strong focus,” Gallivan said, “and the type of planning we need to do with families is very different.”

“You need to talk about the whole family and what the family needs are,” she said.  

Families and individuals who advocate for themselves must be part of the conversation, Gallivan said.

Judge, DOJ Praise RI's Compliance Efforts In DD Case; Contempt Hearing Avoided, For Now

By Gina Macris

The state of Rhode Island has done more in the last six months to comply with a federal consent decree aimed at ending the isolation of adults with developmental disabilities than the previous state administration did in the first two years of the agreement. 

That assessment came from the U.S. Department of Justice Sept. 16 in a conference on the status of the 2014 agreement before U.S. District Court Judge John J. McConnell, Jr.   

Because of those efforts, McConnell deferred, for now, a request by DOJ lawyer Nicole Kovite Zeitler that he hold contempt proceedings in early October over the state’s failure to hit specific targets in the order McConnell issued last spring to force compliance with the consent decree.

By signing the consent decree in 2014, the state promised, over a ten-year period, to establish a system of community-based, integrated work and leisure activities for individuals with developmental disabilities that would replace sheltered workshops and segregated day programs. The transition is mandated by the Olmstead decision of the U.S. Supreme Court.  

While acknowledging the state’s intensive efforts, led by Jennifer Wood, Deputy Secretary of Health and Human Services, Zeitler cited two non-compliance issues: the scarcity of young adults with developmental disabilities holding jobs, and the state’s failure to distribute increased reimbursement rates to private service providers by Aug. 1 as the judge had required.  

Wood said rate increases would be implemented Oct. 1. That is the date the computer system will be adjusted to reflect a 36-cent hourly increase, from $11.55 to $11.91, in the average reimbursement rate paid to private service providers.  

Approximately 4000 workers at private agencies will get raises, retroactive to July 1, after their employers start receiving the higher reimbursements. 

Mary Madden, the state’s consent decree coordinator, elaborated on the lack of job placements for young adults. 

Of a total of 151 individuals with intellectual disabilities who left school in the 2013-2014 or 2014-2015 academic years, 99 are receiving adult services, including 79 who are receiving employment-related services and 29 who are actually employed, Madden said. 

She did not have data for the 2015-2016 academic year. 

The employment number is “not where anyone wants it to be,” Madden said.   

Of the 151 identified, 52 individuals are not enrolled for any services. 

Later, Zeitler said the notion that 52 young adults have not been connected with adult services is a serious concern. 

Charles Moseley, the independent monitor in the case, said he wanted to echo both Zeitler’s concerns and her praise of the state’s efforts so far. 

He said he “wrestled with the idea of a show-cause hearing,” a proceeding that might lead to a contempt order, but decided against recommending it, because he believes the state can work with him to plan and provide employment services. 

While McConnell noted that a missed deadline in a judicial order is a serious issue, he deferred to Moseley’s confidence that he can work things out with the state. 

“I tend to be a ‘half-full’ kinda guy,” McConnell said, explaining his decision. 

“Some may call me Pollyanna-ish,” he said, but the compliance effort put forth by the state in the last six months “deserves a compliment and a thanks.”  

McConnell said state government doesn’t move quickly, even with court sanctions hanging over its head, as they were after McConnell issued a 22-point compliance order May 18. 

The fact that the Governor and the General Assembly acted late in the legislative season to add $11 million to the developmental disabilities budget should be acknowledged, McConnell said. He also thanked Health and Human Services Secretary Elizabeth Roberts, Deputy Secretary Wood, and her administrative team. About half a dozen of them attended the hearing.  

“We wouldn’t be here if it weren’t for the Department of Justice,” McConnell continued, praising its “tenacity and advocacy in taking on an incredibly complex task for those who wouldn’t otherwise have a voice.” 

But McConnell said he wasn’t about to unfurl a “Mission Accomplished banner” just yet.  

A report that the monitor filed with the court on the eve of the hearing outlines a plan to put the state on short-term deadlines for developing employment strategies for young adults and making sure all those eligible for services are identified. The employment-related strategies are due Oct. 1. 

 Moseley gave the state until Nov. 15 to identify all young adults who have left school in the last three academic years who are eligible for developmental disability services, but he wants to hear how it will approach that problem by Sept. 30. 

The effort will require cooperation by the state Department of Education, the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, and the state Office of Rehabilitation Services. 

Moseley has expressed concern that the state is missing those who do not have an intellectual disability but are eligible because of a developmental delay.   Depending on the individual, a young adult on the autism spectrum may fall into the latter category. 

With the average cost of services at about $59,000 a year per person, Moseley’s directive for better identification of eligible young adults has the potential to add significantly to the developmental disabilities budget. 

For example, it would cost an estimated $3 million a year to serve the 52 young adults who have been identified but who are not enrolled in developmental disability services. 

Moseley, meanwhile, reflected on concerns expressed by the DOJ about the need for quality career development planning, a newly-implemented exercise that is intended to drive thoughtful, individualized job searches. 

“Person-centered planning, person-centered thinking, is a challenge that is facing all states. It needs to be done on an ongoing basis,” he said. 

Earlier in the hearing, Deputy Secretary Wood said the new chief employment specialist, Tracey Cunningham, had personally trained more than 200 people in how to write career development plans. 

But Moseley said it’s not a matter of one training. “You have to learn it and live it,” he said. 

RI Officials Correct Figure in Monitor's Report; Say Rate Hike Will Go To DD Service Agencies

By Gina Macris

All the workers who provide direct support services to adults with developmental disabilities in Rhode Island won’t be getting raises to at least $11.55 an hour, as indicated in the most recent report of a federal court monitor in the so-called “sheltered workshop” consent decree case.

The report from the monitor, Charles Moseley, says that the state Department of Behavioral Health, Developmental Disabilities and Hospitals (BHDDH) “will adjust all rates for Direct Support Professionals to a base rate of $11.55 an hour.”

 In reality, BHDDH will raise the “base rate” the state pays to the private agencies from $11.55 to $11.91 an hour, an increase of 36 cents; the private agencies, in turn, must use that new hourly figure to cover both salary increases and fringe benefits for their employees.

That was the word Sept. 13 from Mary Madden, the state’s consent decree coordinator, and Jennifer Wood, Deputy Secretary of Health and Human Services.

Wood also said it is impossible to determine how much of an hourly wage increase each worker will actually receive.  

 Approximately 4,000 workers staff the private agencies serving Rhode Islanders with developmental disabilities under contracts with the state. These direct support workers now make an average of about $10.75 an hour, although starting pay is typically minimum wage, or $9.60 an hour.

Different agencies have different pay scales and different arrays of benefits, Wood said. The General Assembly set aside about $5 million in the current budget for raises to direct support workers and for increased employer costs, but did not specify how much was to go into each category, she said.

One part of an order issued in May by U.S. District Court Judge John J. McConnell, Jr., required the state to “appropriately increase salaries, benefits, training, and supervision for Direct Support Professionals and Job Coaches” by Aug. 1.

The increases, retroactive to July 1, have not yet gone into effect, but Moseley, the monitor, said the judge’s order had been “provisionally met” because the state had submitted a plan that describes how the increases would be handled.

Before Moseley will sign off completely, he said, he needs more documentation in the plan, as well as confirmation that BHDDH has disbursed the money for the rate increases to developmental disability service agencies.

The issue of pay for workers was one of numerous points covered in Moseley’s report, submitted to McConnell Sept. 9 in anticipation of the judge’s review of the case Sept. 16. The session begins at 2 p.m.

Task Force Commentary on Monitor’s Report

Meanwhile, the monitor’s report also prompted criticism at a meeting of the Employment First Task Force Sept . 13.

Claire Rosenbaum questioned Moseley’s conclusion that the state had met the Judge’s Aug. 1 deadline for making it easier for providers to offer employment-related services to adults with developmental disabilities.

“I haven’t seen anything that offers supported employment services for my daughter, and we’re a month and a half past the implementation date,” Rosenbaum said. She serves on the task force as Adult Supports Coordinator for the Sherlock Center on Disabilities at Rhode Island College.

Nor did her daughter’s counselor at the state Office of Rehabilitation Services (ORS) know anything about career development planning, Rosenbaum said, even though the monitor said ORS, as well as BHDDH, and the Rhode Island Department of Education (RIDE) had all implemented training in the process of career development planning by the end of July as required by the judge’s order.

The judge’s order included several mandates related to supported employment, all with an Aug. 1 deadline.

 The requirements included a change in the model for reimbursing provider agencies, and a change in the financial authorizations made to individuals to pay for what Moseley called the “Person Centered Supported Employment Services Program.” 

The current authorization method requires individuals seeking job-related services to trade in time allocated to another category of support.

Madden acknowledged that the model for changing reimbursement to service providers had not yet been put into practice.

“What irks me,” Rosenbaum said, “is this status report says ‘provision met’, when it clearly has not been met.”

The state has said the reimbursement model would change for clients of agencies chosen to participate in a pilot program of performance-based contracts intended to provide the supports necessary to enable individuals with developmental disabilities to find and keep regular jobs.

BHDDH is not yet accepting applicatios for that pilot program, although Moseley said he is satisfied with the state's plan for the program . The state's lawyer will file the detailed plan with the court some time this week, according to Wood. 

In any event, the judge is requiring performance-based contracts for all service providers in the state by Dec. 31. 

Kevin Nerney, the task force chairman, took issue with the term “Person Centered Supported Employment Services Program” to describe what supported employment services are supposed to provide.

Such individualized, employment-related services have not been rolled out to direct support staff at provider agencies, he said. Until employment-related services have been put in place, he said, they should not be elevated with an important-sounding title.

The task force was created by the 2014 federal consent decree, in which the state agreed to correct violations of the Americans with Disabilities Act by moving from segregated sheltered workshops and day programs to supports for community-based employment and activities for adults with developmental disabilities.

The consent decree envisioned the task force as a bridge between state government and the community, although the group is still exploring how its role will play out.  Its next meeting is scheduled for Oct. 11.

Federal Court Hearing Sept. 16 Could Test RI's Compliance With DD Consent Decree

By Gina Macris

The status of Rhode Island’s compliance with a federal consent decree mandating integration of adults with intellectual and developmental disabilities is scheduled to go before U.S. District Court Judge John J. McConnell, Jr., on Sept. 16.

In response to McConnell’s active involvement in the case, which began in January, high-ranking state officials have begun an intense effort to lay the groundwork for compliance with the consent decree, which was signed in April, 2014.

On May 18 of this year, McConnell issued an order that held the state to numerous deadlines in July and August.

Whether the state has made sufficient progress over the summer may become clear during the upcoming review of the case in open court.

Prior to the Sept. 16 court session, the U.S. Department of Justice  and the independent court monitor can be expected to file written reports with the judge on their view of compliance issues, which they’ve done in the past.

They also may ask the judge to impose sanctions on the state if they believe it has not met the requirements of McConnell’s very prescriptive order of May 18.

The DOJ and Charles Moseley, the monitor, have been checking compliance with the consent decree on the basis of files they have selected from a list the state has provided of all individuals who fall under the purview of the agreement, about 3,000 people in all. The individuals are identified by a code that protects their privacy.

The case is extremely complex, with many related steps needed to achieve the long-term goal of the consent decree – to allow persons with disabilities the choice to participate as much as possible in regular employment and community activities. The agreement remains in effect until Jan. 1, 2024.

A July 1 Deadline for Supported Employment

One of those steps, spelled out in the consent decree itself, is a requirement that the state would find supported employment by July 1, 2016,  for all eligible individuals who left high school during the 2015-2016 school year. 

That population is estimated at a minimum of 74 individuals by the Rhode Island Department of Education (RIDE). 

In an interview Aug. 18, a state official could not say whether the employment requirement has been met because it does not have employment data as recent as July 1.

For now, the state is getting employment statistics from an “Employment and Day Activity Outcomes Survey” for adults with developmental disabilities that is done on a quarterly basis by the Sherlock Center on Disabilities at Rhode Island College.

The latest survey is a snapshot of what adults with disabilities were doing during their daytime hours in March, according to Jennifer Wood, Deputy Secretary of Health and Human Services.

Wood said statistics for July won’t be available until September.

Supports necessary for individuals to access regular employment vary with the needs of the person. They may include transportation, extra training that breaks down the job into small steps, or even a job coach who stays with the employee for the entire work shift. Typically, individuals with intellectual or developmental disabilities employed in the community work part time.

A Pay Raise For Direct Service Workers

During July, the state has submitted numerous documents that could have a bearing on the September court session, which is officially termed a “status conference.” 

Among the state’s filings is a progress report on what Wood has described as the “huge mathematical exercise” of delivering $5 million in pay raises- an average of $600 a year per person before taxes  – to direct service workers and job coaches.

Pay raises have been described as essential to stabilize a workforce of direct service workers who are asked to do demanding jobs for less than they would make at a fast food restaurant. Turnover ranges from about 35 percent to 80 percent annually, according to testimony before the General Assembly earlier this year.

At a recent community forum, Jane Gallivan, the interim Director of Developmental Disabilities, said workers should have checks by Oct. 1 that incorporate retroactive pay going back to the start of the current fiscal year, July 1.

The judge’s order gave the state until Aug. 1 to “appropriately increase salaries, benefits, training and supervision for Direct Support Professionals and Job Coaches.”

Performance-Based Bonus Plan Outlined

Another money issue involves government reimbursement paid to the  agencies themselves.

The state has filed a progress report with the court on plans to use $6.8 million in performance-based bonuses approved by the General Assembly in a two-phase program during the current fiscal year.

The program is initially planned to reward service providers when they place clients in jobs, after the workers have been employed for three months, and again at the six-month mark.  

These incremental bonuses would total an average of $15,750 per person, although the number of incentives and the dollar amounts may be adjusted, Wood has said. 

The state has not yet begun taking applications from providers to participate in the program, according to a spokeswoman for the Executive Office of Health and Human Services.

The incentive program is to be piloted until December with a limited number of private service providers.

The judge’s order required the state to implement the initial phase of the program by Aug. 1, and to turn in evidence that all providers have signed performance-based contracts by Dec. 31.

A Call For A New Reimbursement Model

McConnell also called on the state to implement a new reimbursement model by August 1 that is “sufficiently flexible to allow providers to be reimbursed for services rendered, including, but not limited to career exploration discovery services, vocational situational assessments, work trials, development of job seeker profiles, job search and placement, job training and support, support coordination, and transportation services.”

There is similar language in the consent decree, which specified that providers should be paid for job-related and job counseling work that is “not face-to-face with the client.”

Although performance bonuses will be an added “layer” of payment to service providers in the incentive program,  according to Wood, she has said that the current reimbursement model will remain in place.

“The unit service model is the unit service model,” she said in a recent interview.

For daytime services, this model requires providers to document the time workers spend with clients, face to face, in 15-minute increments. Providers are not paid for time clients are absent for any reason, even though they must staff their programs at the same level, regardless of varying attendance.

The judge’s order says the state must now have a “new service package design” that includes up-front individual financial authorizations for supported employment services.

Wood has said specific authorizations for supported employment services will be awarded to individual clients of providers enrolled in the performance bonus program – an estimated 200 people in all.

Except for that group, clients will continue to have to trade in other types of authorizations, like generic day services, to get employment-related supports, she said.

The State's Other Progress Reports

To comply with other requirements of the court order, the state has submitted:

• ·An overall project management plan involving the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), RIDE, and the Office of Rehabilitation Services (ORS) in the state Department of Human Services

• ·A transition timeline covering services to young people with developmental disabilities aged 14 to 21, including details on which agency and the type of worker who will provide the respective supports. 

• A comprehensive communications plan, including details on relaying the status of pending applications for adult developmental disability services to applicants and their families.

There are now 224 pending applications for adult services, a slight reduction from a backlog of about 237 reported in mid-May.

As of last Friday, however, eligibility workers had screened all but four of the 224 applications and assigned them to one of three categories; “likely eligible, likely ineligible” or “need further documentation,” Wood said.

This screening process sets the stage for decisions on applications in the first two categories to be made within 30 days, she said, enabling the state to retire the backlog by the end of September.

The screening also enables eligibility workers to promptly notify those who need to submit more information. 

In the past, those who needed to gather additional documentation might not have known it until their cases got to the top of the pile and were reviewed by the eligibility workers – an indefinite time period. 

The initial assessment makes the decision-making process much more efficient, Sophie O’Connell, a spokeswoman for EOHHS, said in a follow-up email.

EOHHS, which has taken over management of the Division of Disabilities at BHDDH since the beginning of the year, has heightened its oversight of the application screening process during the summer and used “data and performance management to keep our efforts on track,” O’Connell continued.

“The team met every day in the morning and the afternoon to set goals, review progress and problem solve as needed” during the screening process, she said.

At a hearing in April, the DOJ presented evidence that some individuals turning 21 were waiting extensive periods of time to receive notice of eligibility for adult services and then had trouble finding programs suited to their needs.

The consent decree requires that community-based services, including supported employment, be in place for individuals with developmental disabilities when they reach the age of 18. 

State law also says that individuals with developmental disabilities are eligible for adult services at age 18, although as a practical matter, it is not uncommon for them to remain in high school until age 21.

Nevertheless, the consent decree anticipates a seamless and individualized transition between school and the adult world.

McConnell will hear the status of consent decree compliance at 2 p.m. Sept. 16 in Courtroom 3 on the second floor of the federal courthouse on Kennedy Plaza in Providence, according to a notice in the case file. 

Parental Concerns Over RI Consent Decree Persist; State Says No One With DD Will be Forced Into Job

 All Photos by Anne Peters

Jeanne Connery, mother of a young adult on autism spectrum, talks about a job trial that did not go well for her daughter during Wednesday's public forum at the Buttonwoods Community Center in Warwick.

By Gina Macris

“You threw the baby out with the bathwater when you eliminated sheltered workshops,” Brian Newton, the father of a woman with developmental disabilities, told Rhode Island officials at a public forum in Warwick Aug. 17.

In reality, most, but not all, sheltered workshops in Rhode Island closed abruptly in the wake of U.S. Department of Justice findings in 2014 that segregated employment – at sub-minimum wage – violated the Americans With Disabilities Act (ADA).

“What happened to my daughter’s right to work in a sheltered workshop?” he asked. She and her friends “were happy making 5, 7, 12 dollars a week,” Newton said.

“You have to admit there’s a certain population that will never work” at a regular job, he said.

Newton looked straight at Jane Gallivan, Rhode Island’s interim Director of Developmental Disabilities, who happens to have three decades’ professional experience in Maine and Delaware and a national reputation among her peers as an innovator.

Gallivan smiled as she looked back at Newton and slowly shook her head from side to side, kindly but firmly.

“Not to go there,” said Gallivan, who has extensive experience promoting job opportunities for individuals facing intellectual challenges.

Newton persisted, saying there’s a “certain percentage” that won’t be  “bagging groceries or doing piece work.” 

“I hope not,” Gallivan replied. “I hope it’s customized to what they can do.”

Newton:  “They have to have somebody with them.”

Gallivan

Gallivan: “People have job coaches now. You can have a job coach for a very long time.”

 Jeanne Connery, the mother of a 20-year-old woman on the autism spectrum, said her daughter has a high aptitude for math and science but does not connect with people.

She was placed in a job trial in a retail store, where she tagged and stocked shoes and boots, an experience which was not a good match for her, Connery said.

What her daughter needed was the Job Club at the Groden Center, a group that talked about the social and behavioral pointers that do not come intuitively to people on the autism spectrum, Connery said.

That job club did not have the capacity to take on another group member, according to Joseph F. Murphy, administrator in the state Office of Rehabilitation Services.

Mary Madden, Rhode Island’s Consent Decree Coordinator, said, “The bottom line is that this is a free country. Nobody is going to make your son or daughter go to work at a job that isn’t appropriate to them. I just want to say that there are a lot of misconceptions out there.”

There are now “400 people working in the community,” Madden said.

Most of them “are not bagging groceries or working at Home Depot,” Madden said. “We haven’t done a good job getting stories out” about individuals with unique skills matched to the needs of a company.

In fact, one person with a unique job was in the audience. Mark Susa of Warwick, with the help of his father, John Susa, and paid support staff, trains peers with disabilities – readers and non-readers alike -  to use public transportation independently.

Mark Susa also serves on the Board of Directors of the Rhode Island Public Transit Authority. 

Madden, meanwhile, said that regardless of the 2014 consent decree which mandated integration of individuals with intellectual and developmental disabilities,“people should be doing meaningful things every day.

Jennifer wood

“Not everyone is in the community all of the time. People only tend to work 10, 15, or 20 hours a week. They should be able the rest of the time to do something meaningful,” she said.

Gallivan, Madden and others, including Jennifer Wood, Deputy Secretary of Health and Human Services, gave an audience of about 75 people progress reports on budgetary and programmatic fronts since the last community forum in late April.

Among other things, front line support staff will see wage increases in their paychecks by October 1, along with a lump sum retroactive to July 1.

The General Assembly earmarked $5 million for wage increases to some 4,000 direct support staff in the current budget. The increase will average about 30 cents an hour, or about $600 a year, before taxes, based on a 40-hour work week.  

Another $6.8 million in the budget will be set aside for performance bonuses as private service providers meet certain benchmarks in moving clients into jobs in the community and helping keep those jobs.

During the last two months, there has been nearly a complete turnover in the leadership of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, with two key positions yet to be filled.

The state is looking for a new departmental director to succeed Maria Montanaro, who left at the end of June, as well as a permanent Director of Developmental Disabilities to replace Charles Williams, who retired at the end of July.

In the meantime, the deputy BHDDH director, Rebecca Boss, serves as acting director. She attended the community forum.

Gallivan said she can remain as Interim Director of Developmental Disabilities only until the end of September.

Recently retired from the top developmental disabilities post in Delaware, Gallivan had promised her mother, now 101 years old, that she could spend winters with her in her home in Florida. That was before Rhode Island came calling. Gallivan's mother is spending the summer on Cape Cod. 
“How many more winters are we going to have together?” Gallivan said. “That’s why I’m not going to continue much longer” than September, she said.

Wood, the Deputy Secretary of Health and Human Services, quipped that Gallivan’s mother has, in effect, set the timeline for filling the developmental disabilities director’s job.

Gallivan said the challenges Rhode Island faces are “not very different than in many of the other states.”

“We need to have a strong vision of what it is we want to have in Rhode Island,” Gallivan said. “That’s my task when I’m here.”

She indicated there are conflicting internal and external pressures on state government with regard to developmental disabilites.

“Internally, there’s a lot of pressure to deal with rising costs. Externally, the federal Centers for Medicaid and Medicare Services,  “who give us 50 percent of the money, wants us to look at services differently.”

By 2019, all states must provide Medicaid and Medicare services in all categories in the least restrictive setting that is appropriate, according to the latest rules of the CMS. The rule change is in keeping with the Olmstead decision of the U.S. Supreme Court, which clarified a mandate for integrated community-based services in Title II of the Americans With Disabilities Act.

The Olmstead decision also forms the legal basis for the 2014 consent decree in Rhode Island, which affects only daytime supports for individuals with intellectual or developmental disabilities.

Gallivan was asked about the Supports Intensity Scale, (SIS) a controversial needs assessment questionnaire that is used to develop individual funding allocations.

She said the Division of Disabilities “has begun to take a close look” at variability in the scores of the SIS at it has been administered in Rhode Island.

For an individual with developmental disabilities, the results of periodic reassessments are supposed to be relatively stable, because the need for support generally does not change dramatically over a lifetime.

However, analyses of SIS scores performed by a healthcare consulting company under contract to the state show that 46 percent of individuals who were re-assessed showed changed levels of need – and funding.

The review of the use of the SIS is “high on the agenda,” Gallivan said.

Sue Joinson  asked whether there will be an “opening of restrictions on residential placements,” which appear to be available only to families who are in crisis.

“Why is it that I can’t get a concrete plan” for the transition of the younger of her two daughters with developmental disabilities? she asked. She is 60 and her husband is 70, Joinson said.

Gallivan said residential services have been identified “as a need.”

“We need to evaluate all residential options” including shared living, “and move slowly,” she said.

Wood, meanwhile, said that the legal framework of the “least restrictive environment” in the ADA means that state policy does not assume that a group home is the most appropriate residential setting for an individual with developmental disabilities.

The state must offer a “continuum” of options suited to individual needs, she said.

RI Official Describes How Nearly $12 Million in DD Budget Responds to Consent Decree

By Gina Macris

Rhode Island is poised to offer financial rewards to agencies that meet certain performance goals in delivering supported employment services to adults with intellectual and developmental disabilities, according to the Deputy Secretary of Health and Human Services.

At a meeting of the Employment First Task Force on Aug. 9, Jennifer Wood explained how the state will use a total of nearly $12 million in funding authorized by the General Assembly in the current budget to implement the two year-old federal consent decree which mandates that adults with developmental disabilities have access to regular jobs in their communities.

A total of $6.8 million will be set aside for the supported employment bonuses –an estimated average of $15,750 after a client has been employed for six months. An additional $5.1 million has been earmarked for modest wage increases to about 4,000 agency staff who work directly with clients.

Ultimately, it is up to Judge John J. McConnell, Jr. of U.S. District Court to say whether these measures conform with a detailed order he issued in May requiring Rhode Island to lay the groundwork for long-term compliance with the consent decree, which remains in effect until Jan. 1, 2024.

At some point, the independent court monitor in the case, Charles Moseley, is expected to report to the court on whether he believes that state’s latest compliance efforts meet the requirements of the court order.

The May 18 order said that by Aug. 1, the state had to:

• implement performance-based contracts for supported employment services

• implement a flexible reimbursement model that pays service providers for the actual cost of providing services

• implement individual financial authorizations for clients receiving services that include specific allocations for supported employment services 

• increase salaries, benefits, training, and supervision for direct service workers and job coaches.s

The Task Force, made up of representatives of individuals with developmental disabilities, their families, and community organizations, was created by the consent decree as a bridge between government and the community. It met in the offices of the Community Provider Network of Rhode Island on Jefferson Boulevard in Warwick, 

Wood told Task Force members that the private agencies employing the workers will get lump sums for raises retroactive to July 1, but she could not say exactly when that will happen. Figuring out the payments has been a huge mathematical exercise, she said, and still requires changing the programming on state computers.

Based on current average pay of $11.55 an hour, the raises would be an average of $.30 an hour, Wood said, although actual salaries vary from one agency to another.

In a report to the court on July 29, the state said that it will require service providers to show that the money went to workers who have direct contact with clients, as the General Assembly intended.

Wood told Task Force members that state officials have been working with private service providers on the incentive program.

The July 29 report to the court said the incentive program will be implemented from August through next June, although the state has not yet begun taking applications from service providers. The program will serve a minimum of 200 clients with developmental disabilities. according to the filing with the court.

These clients will receive specific allocations for supported employment services as part of their individual financial authorizations from the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), Wood said in a brief interview after Tuesday’s meeting.

Others served by BHDDH who are not part of the supported employment incentive program will not be affected. That means that if they want supported employment services, they must continue to trade in hours from another category of daytime support.

The bonuses will be paid in stages; when a client gets a job and after three months and six months on the job respectively, according to the report to the court. It also said the dollar amounts and numbers of incentives may be adjusted.

Wood told the Task Force that the experience of the first six months of the program would be used to make improvements for the second half of the fiscal year.

After the meeting, she said the incentive program would be an added “layer” over the current reimbursement model, which requires agencies to document clients’ face-to-face interaction with direct service workers in 15-minute increments during the day. 

That “unit service model” will remain in place, she said.

Because the reimbursement system does not pay an agency when a client is absent, for whatever reason, the provider cannot collect the full amount of the client’s authorization for daytime activities.

The consent decree found fault with this method of payment. It required the following change:

“The State will ensure that its reimbursement model for day activity services is sufficiently flexible to allow providers to be reimbursed for costs (e.g. transportation to the job site, employer negotiation, counseling clients by telephone) that are: (1) directly related to providing Supported Employment Services to individuals in the Target Populations, and (2) provided when service provider staff is not face-to-face with a client. “

Monitor Gives RI Mostly Passing Grades, Except for Failure to Pay Bills

By Gina Macris

Update: At the close of business July 26, all nine developmental disability service providers owed money for start-up costs in converting from sheltered workshops to supported employment had received payment in full, according to a spokeswoman for the Rhode Island Executive Office of Health and Human Services. A list of the agencies and the amounts appear at the end of this post.

With one exception, the state of Rhode Island largely has met the latest deadlines of a federal court order which spells out how it must lay the groundwork for long overdue compliance with a 2014 consent decree meant to desegregate adults with intellectual and developmental disabilities.

The state has until Friday, July 29, to pay up to $800,000 in start-up costs, as specified in the consent decree, for nine private service providers converting to community-based services from sheltered workshops, according to the court monitor in the case, Charles Moseley.

If that deadline is not met, Mosely said in a new report to U.S. District Court Judge John J. McConnell, Jr., the judge should impose fines of $5,000 a day, with an additional $100 per day for each person protected by the consent decree whose employment or integrated day services are delayed or interrupted as a result of the violation.

Those fines, with a maximum of $1 million per year, were set forth in the order McConnell issued May 18.  It is the second time in three months that the state has faced the prospect of fines for failing to pay its bills in relation to implementing the consent decree.

Moseley said he had received assurances from Jennifer Wood,  the Deputy Secretary for Health and Human Services, Jennifer Wood, that the Friday deadline will be met.

The plans for converting sheltered workshop operations to integrated employment services had been approved by the state and the bills for start-up costs had been submitted by the agencies at least three months ago.

The start-up activities are necessary to enable the service providers to meet employment targets in the consent decree. Moseley noted, adding that this point was made during April 8 evidentiary hearing, which McConnell used as the basis for his order, issued May 18.

According to an investigation of the U.S. Department of Justice, the sheltered workshops violate Title II of the Americans with Disabilities Act, which says, in effect, that individuals with intellectual or developmental disabilities cannot be relegated to segregated settings simply because they are disabled.

In the 2014 consent decree, the state agreed to change its services to emphasize integrated employment paying minimum wage or higher and other community-based activities over a ten-year period.

Moseley’s most recent status report was submitted to the court last Friday, July 22.

In it, he said that the budget enacted by the General Assembly, a total of $246.2 million for developmental disabilities, will provide sufficient funding to meet requirements of the consent decree during the current fiscal year, which ends June 30, 2017.

The budget is still a little more than $11 million more than Raimondo had originally requested.

Budget provisions specifically related to the consent decree include:  

• A total of $9.1 million for wage increases and performance-based contracts for providers offering integrated employment supports.

• Funding for four state (staff) positions focused on consent decree implementation, including chief transformation officer, consent decree coordinator, employment specialist, and program development director.

Although the General Assembly did not approve Raimondo’s request for $5.8 million for a caseload increase, citing flat enrollment, Moseley noted that the legislature left the door open to reconsider if the numbers changed.

The monitor said 125 new cases had been approved during the fiscal year which ended June 30, although most of them were still in high school and were not expected to need a full array of adult services during the coming fiscal year. (According to the state's report, these cases encompassed ages 17 to 24.) 

Mosely did ask the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) to report to him on any individuals protected by the consent decree “whose acceptance into the adult DD system is delayed or deferred due to lack of funding.”

McConnell’s order required the state to develop a management plan for accomplishing consent decree goals and tasks, and while Moseley said the plan met basic criteria, he found it lacking in detail on organizational strategies within BHDDH  and on interagency cooperation.

The lack of specificity is “understandable,” he said, given that three key positions at BHDDH are vacant. They are the department director, the director of the division of developmental disabilities and the chief transformation officer.

Moseley recommended that the state have until December 1 to expand and strengthen the management plan.

Other comments in Moseley’s status report focused on high school students with developmental disabilities who are 14 years and older and of particular concern to federal officials because they are at risk for segregation as adults if they are not afforded transitional services.

He secured a commitment that state employees from BHDDH or from the state Office of Rehabilitation Services in the Department of Human Services would be available to attend all Individual Education Plan meetings for special education students with developmental disabilities who are at least 14 years old.

Moseley noted that BHDDH has developed a protocol for timely communications with individuals having developmental disabilities and their families concerning applications for adult services.

He also recommended that BHDDH develop and distribute a description of the process for determining eligibility that is “clear, easy to access, user-friendly and written in plain language,” including contact information for BHDDH employees who would be able to answer additional questions.

“It is important to note that the eligibility determination process frequently is associated with a great deal of anxiety and concern among individuals with disabilities and their families,” Moseley said.

“By its nature, the process is technical, complicated, and difficult for a lay person to understand. Direct contact with an eligibility determination staff member offers an important opportunity for famelies to learn about the process and have their questions answered,” he said. 

Click here to read the monitor's full report

Service providers that received start-up costs for supported employment, as required by the monitor 

ri executive office of health and human services

Task Force Members Say Interviews to Assess DD Needs in RI Apparently Used to Cut Funds

By Gina Macris

Four Rhode Islanders with developmental disabilities who all need nearly constant attention have had their residential funding cut by a total of about $125,000 a year.

The most recent scoring on an extensive questionnaire that is supposed to assess their support needs says they have become much more self-sufficient. Instead of having extensive needs, they now require only moderate supports, according to the results of the questionnaire, the Supports Intensity Scale, or SIS. 

But Tom Kane, the CEO of the agency that runs the men’s group home, says that if he withdraws $125,000 worth of residential staff hours for these men, “someone will get hurt.” 

“It’s not a position these four men should be in, nor should the agency be in this position,” Kane told state officials at a meeting of the Employment First Task Force July 12. 

Professionals acknowledge that, barring a traumatic event, the needs of a person with intellectual or developmental disabilities remain relatively stable over the course of a lifetime. 

Yet one chart prepared in 2015 by a healthcare consulting company under contract with the state shows the level of need changed for 47 percent of clients who had been re-assessed since the Supports Intensity Scale was introduced in 2011. 

For AccessPoint RI, a private service provider, those changes have resulted in a cumulative loss of $970.000 in developmental disability funding, roughly 12 percent of the budget, Kane said. 

If the tool is reliable, the score shouldn’t change dramatically,” Kane said. “Either the tool is not reliable, or you know it was all manipulated” to reduce pressure on state spending, he said.

Jane Gallivan, the interim Director of Developmental Disabilities in the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, said, “We definitely will take a hard look.”

Claire Rosenbaum, Adult Services Coordinator for the Sherlock Center on Disabilities at Rhode Island College, said she has received numerous reports that social workers conducting the SIS interviews challenge the accuracy of answers family members give to specific questions. 

Or, said Mary Beth Cournoyer, a parent member of the Employment First Task Force, the interviewer does not argue with family members’ answers but merely substitutes other ones.  This becomes apparent, she said, when parents review the completed assessment and see that the ratings on needs differ from the ones they had given. 

Cournoyer said parents need training on what to expect from a SIS questionnaire because the answers they give could have unexpected ramifications.  

For example, parents may say that their sons or daughters can dress themselves, when the reality is much more nuanced. Without someone to put away the out-of-season clothes so they are out of reach, individuals with disabilities may dress inappropriately for the weather, she said. They may be capable of dressing themselves, but may sometimes refuse to do so.

Cournoyer indicated that parents don’t realize they need to completely remove from the picture the supports they and other family members provide naturally before they say whether their sons or daughters can perform a particular task. 

Jennifer Wood, the Deputy Secretary of Health and Human Services, said “no topic has come up with more regularity than the SIS. We should have some focus groups.”  

Under order of the U.S. District Court, and to avoid a possible contempt hearing, BHDDH changed its SIS policy July1 –nearly two years after it first agreed to do so -to divorce the assessment of need from funding considerations. 

That new language is intended to resolve a conflict of interest noted by the U.S. Department of Justice in its 2014 findings that the state’s sheltered workshops and segregated day programs violatedthe integration mandate of the Americans With Disabilities Act, The 1999 as spelled out by the  1999 Olmstead decision of the U.S. Supreme Court.  

In a subsequent consent decree designed to remedy the ADA violations, the state agreed to change its SIS policy by Sept. 1, 2014. 

The policy then in place said, in part: “Starting January 1, 2013 BHDDH will assign service tiers (funding allocations) based on the results of an individual SIS assessment. 

A year later, the DOJ said in its findings: 

“Our investigation revealed that BHDDH staff maintains primary responsibility for administering the Supports Intensity Scale, and they are also part of the agency that administers the statewide budget for developmental disability services.This is a seeming conflict of interest because the need to keep consumers’ resource allocations within budget may influence staff to administer the SIS in a way that reaches the pre-determined budgetary result.” 

The DOJ  referred to similar warnings from the American Association on Intellectual and Developmental Disabilities, which created the SIS.   

The consent decree prohibits the SIS from being used as a funding mechanism.  

The new state policy, adopted July 1, reads, in part: “All decisions involving SIS tier assignments (levels of need) and any changes to SIS tier assignments are made solely on the basis of individual support needs as indicated by the SIS assessment in a manner that is consistent with individual’s support needs, separate and apart from resource allocation considerations.” 

How the change in policy will play out in practice is not yet clear.

According to a monitor’s report to the court in August, 2015, the state reported making the necessary changes in the administration of the questionnaire, including the re-training of interviewers, but complaints from parents have persisted. 

The disagreements over the SIS have resulted in families filing appeals. Most appeals are granted, according to Charles Williams, who retires as Director of Developmental Disabilities July 22. Data on the number of appeals, successful or otherwise, is not readily available. 

Wood and Gallivan promised members of the Employment First Task Force they would get to the bottom of the issue.                               

The Employment First Task Force, created by the consent decree, consists of members representing community organizations, adults who themselves have disabilities, and parents.   The task force, which holds public meetings, is intended to serve as a bridge between state government and consumers and families. 

The next meeting is August 12 at 2 p.m. at the Community Provider Network of Rhode Island, 110 Jefferson Blvd., Warwick.

General Assembly Approves $15.4 Million Increase For DD; Worker Raises Are Assured

By Gina Macris 

Rhode Island’s developmental disability budget for the next fiscal year includes assurances that aa total of $9.1 million in Medicaid money will be spent to raise pay for direct support workers and to begin transforming the state’s system of services for those with intellectual challenges.

Shortly after 1:30 am on Saturday, June 18, The Senate approved total developmental disability funding of $246.2 million beginning July 1 in concurrence with the House vote taken Wednesday. That total, almost all of it state and federal Medicaid funds, is nearly $15.4 million more than the General Assembly approved last year at this time for the current budget, which closes on June 30.

New budget language ensures that $4.5 million in state revenue earmarked for worker raises and performance-based contracts can’t be used for anything else in the overall appropriation of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) in the fiscal year that begins July 1.

The language is significant. In the recent past, as much $9 million has been budgeted in a single year to raise the wages of some 4,000 workers who provide direct support services, but the money has gone instead to help close deficits in the BHDDH budget.

The workers make an average of about $11.50 an hour, often less than the clients they support in jobs in fast food restaurants. Many of the direct support staff receive public assistance,  according to testimony presented to the House and Senate finance committees during the current legislative session.

The big difference between this year and past legislative sessions has been a federal court case aimed at enforcing a 2014 consent decree in which Rhode Island agreed to transform sheltered workshops and segregated day programs into a community-based system of services over a 10-year period. The decree settled a U.S. Department of Justice investigation that found the sheltered workshops violated the integration mandate of the Americans with Disabilities Act and the 1999 so-called Olmstead decision of the U.S. Supreme Court which clarified that requirement.

In late January of this year, Judge John J. McConnell, Jr. of U.S. District Court became actively involved in monitoring the state’s compliance with the consent decree. In May, he issued an order putting the state at risk for contempt if it does not meet any one of nearly two dozen specific goals.

One of the requirements in the order is that the state adopt increased funding sought by Governor Gina Raimondo for developmental disabilities in the next fiscal year “in order to fund compliance with the Consent Decree.” The order does not mention a specific dollar amount.

Several other requirements in the order collectively set an August 1 deadline for implementing appropriate raises for direct support staff, regular supervision of workers, and a pilot group of performance-based contracts for supported employment services.

It’s not yet clear how much money the raises will add to the workers’ pay, or what the incentives will be in the performance-based contracts.

Initially, Raimondo’s budget proposal included a little more than $5 million for raises of 45 cents an hour, but that sum was not considered enough to provide performance initiatives to the private agencies that provide most of the developmental disability services in Rhode Island. .

After improved state revenue projections in May, Raimondo added another $4 million to wages and other increases to providers. .  

Raimondo sought protective language to segregate state revenue budgeted for pay increases for developmental disability workers, but that wording was eliminated in the budget passed by the House Finance Committee.

Sometime before the June 15 vote on the House floor, however, new and more detailed language was inserted, a House spokesman confirmed Friday night. 

The new language says that $4.5 million of general revenue “shall be expended on private provider direct support staff raises and associated payroll costs to include targeted increases associated with performance-based contracting and system transformation incentives” authorized by BHDDH.

Because funding for developmental disability services is part of the state’s Medicaid program, the $4.5 million in state revenue set aside for raises would be matched by federal funds, for a total of slightly more than $9 million..

Raises also must be approved by the Office of Management and Budget and the Executive Office of Human Services, according to the budget language. Changes in reimbursement methods must be approved by the Governor’s office and OMB.

RI House Passes DD Budget Unchanged From Finance Committee Recommendation

By Gina Macris

(Correction: While the House did not change the appropriation recommended by the House Finance Committee, language was inserted prior to the floor debate that makes sure $5 million in state revenue cannot be used for anything else other than wage increases for direct support workers and performance incentives for the private agencies that employ them.) 

Rhode Island's developmental disability budget passed the House unchanged from the last week's finance committee recommendation in a floor vote shortly before midnight June 15. The House sent the entire $8.9 billion state budget to the Senate.

In developmental disability spending, the bottom line would be $246.2 million, part of $1.4 billion in human services expenses for the fiscal year beginning July 1.

 In June, 2015, the General Assembly authorized $230.9 million in developmental disability spending for the current fiscal year, which ends in two weeks.  As part of its action late Wednesday night, the House added nearly $9.6 million to that figure as a supplemental appropriation. 

The bottom line difference between the start of Fiscal Year 2016 and Fiscal Year 2017, which takes effect July 1, is nearly $15.4 million.

The new budget would include $9.1 million to raise the pay of staff of private providers who work directly with adults having developmental disabilities and to change the way the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) reimburses service providers.

These steps are necessary to satisfy some of the requirements of a federal court order issued in May to enforce a 2014 consent decree requiring a shift from sheltered workshops and segregated day programs to supported employment and community-based activities that comply with the Americans With Disabilities Act.

Pay increases would be coupled with yet-to-be negotiated performance-based contracts between the state and private agencies that help their clients get regular jobs and enjoy integrated leisure activities. 
 
Governor Gina Raimondo had proposed language that would specifically allocate $2.5 million in state funds for the raises. Each of those dollars would be matched by roughly an equal amount of federal Medicaid funding, for a total of about $5.1 million.

The House Finance Committee, however, removed the protective language around the $2.5 million in state funding, meaning that if BHDDH runs a deficit – as it has for the last eight years – the money set aside for raises could be used to help close the gap. (See correction at top of story.) 

Raimondo originally sought to pay for requirements of the consent decree in both the current fiscal year and the new fiscal year by using savings that would result from encouraging group home residents to move to less expensive shared living arrangements in private homes, but that initiative fell far short of its goal.

Her initial budget figured on saving $3.1 million in the current budget and $16.6 million in the next budget, by making as many as 500 new shared living arrangements.

However, the slow pace of these transfers led the governor to ask the General Assembly to put back all $3.1 million in group home costs in the existing fiscal year, and to reduce savings by $10.2 million in group home costs in the budget beginning July 1. The House agreed.  As a result, BHDDH is expected to save $6.4 million in group home costs in Fiscal Year 2017.

The House refused Raimondo’s request to add $5.8 million to the next budget for a caseload increase, with the finance committee recommendation saying the caseload has been stable at about 4,000 persons.

The House budget language adds extensive reporting requirements intended to keep the General Assembly abreast of BHDDH compliance with the federal consent decree, Rep. Eileen Naughton, D-Warwick, said on the House floor.

BHDDH is already required to provide key fiscal officials in the General Assembly and the governor’s office monthly reports on the developmental disability caseload and expenditures.

The new language encompasses not only information required by the U.S. District Court but other factors affecting the budget. It says:

“The department (BHDDH) shall also provide monthly the number of individuals in a shared living arrangement and how many may have returned to a 24-hour residential placement in that month. The department shall also report monthly any and all information for the consent decree that has been submitted to the federal court as well as the number of unduplicated individuals employed, the place of employment and the number of hours working. The department shall also provide the amount of funding allocated to individuals above the assigned resource levels, the number of individuals and the assigned resource level and the reasons for the approved additional resources.  The department shall also provide the amount of patient liability to be collected and the amount collected as well as the number of individuals who have a financial obligation.”

(This article has been updated.)

• UPDATE: The Rhode Island House passed the developmental disabilities budget unchanged June 15 and sent it to the Senate. Details to come. 

DD Service Provider Takes 'Wait and See' Attitude on Budget, Citing History of Disappointment

By Gina Macris

Until Rhode Island’s appropriation for developmental disabilities is released to the agency that administers it, the amount of money that is finally approved by the General Assembly will be  “just a number,” according to a member of the Employment First Task Force who follows legislative affairs.

photo by anne peters 

Tom Kane, (left), CEO of AccessPoint RI, a provider of developmental disability services, said that in the past several years, there have been three unsuccessful attempts to raise the pay of support staff for adults with developmental disabilities.

All the extra money, between $4 million and $9 million in a single fiscal year, has gone instead to fill a structural deficit in the budget of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), Kane said.

On Wednesday, June 15, the House is expected to vote on an appropriation that would add $9.1 million for raises for about 4000 workers and create a new reimbursement method for some two dozen agencies providing most of the direct services for individuals with intellectual or developmental disabilities.(

The budget proposal voted out of the House Finance Committee, however, does not include Governor Gina Raimondo’s request for $5.8 million for a caseload increase.

Kane indicated that amount of money could also represent the structural deficit in the next fiscal year's developmental disability budget. BHDDH officials say the deficit averages $4.6 a year.

Based on past experience, the money set aside for raises could once again be reserved to fill the deficit, Kane told the group.

The Employment First Task Force was created by a 2014 federal consent decree to serve as a bridge between the community and state governmental agencies that administer developmental disability services. The decree resulted from a federal investigation that found Rhode Island’s sheltered workshops violated the the integration mandate of the Americans with Disabilities Act., clarified in the 1999 Olmstead decision of the U.S. Supreme Court.

Mary Madden, the state’s consent decree coordinator, said, “People at the General Assembly are not into the consent decree at all.”

They don’t understand why developmental disability services cost so much, she said,  because they don’t understand “what it is to provide support 24 hours a day.”

Whatever figure is adopted – the current proposal has a bottom line of about $246 million dollars – the U.S. Department of Justice and an independent court monitor will review it. If either of them has the opinion it is not enough for the state to comply with the consent decree, they could ask the judge in the case to hold a show-cause hearing as to why the state should not be held in contempt.  

More Money for Developmental Disability Services; Is it Enough to Satisfy the Court?

By Gina Macris

The Rhode Island House Finance Committee’s recommended budget for developmental disabilities could represent a glass half full or a glass half empty. 

Neither description is likely to satisfy the U.S. District Court, which recently issued an order saying, in effect, that the state must provide developmental disabilities programs a full glass.  

The House Finance Committee would give Governor Gina Raimondo most of what she asked for in the next fiscal year, including $5.1 million to raise the pay of direct care workers making poverty wages and another $4.1 million to restructure the way private service providers are reimbursed. 

But the recommended budget also is built on two iffy assumptions – that the developmental disability agency will be able to save $6.4 million in housing costs and that the caseload will remain the same, with about 4,000 people receiving services. Raimondo’s budget asked for a $5.8 million increase for 100 new cases. 

If either assumption misses the mark, there might not be enough money in the budget to shore up the private service providers, putting at risk at least some of a total of $9.1 million set aside for the raises the service providers want and performance-based contracts the state wants in order to restructure the way it reimburses the private agencies and satisfy part of the U.S. District Court order. 

All of the Governor’s request – a total of  $16.9 million in added federal and state Medicaid revenue-  is needed to correct chronic underfunding in the budget of the Department of Behavioral Health, Developmental Disabilities and Hospitals (BHDDH), the department director, Maria Montanaro, told the House Finance Committee in a recent hearing.

 For the last eight fiscal years, including the current one, the bills BHDDH gets from service providers have exceeded budgeted amounts, Montanaro said. 

Raimondo sought to protect wage increases by specifying in her original proposal that $2.5 million of general revenue “shall be expended on private provider Direct Support Staff raises” in the next fiscal year. That sum would be matched by federal Medicaid dollars for a total of $5.1 million that would pay for 45-cent hourly wage increases.

 The protective language around the $2.5 million in state revenue has disappeared from the House Finance Committee’s recommendation. 

With the protective language gone, there could be a replay of the current budget, in which $4 million was originally set aside to boost workers’ pay but never made it into their pockets, going instead to help narrow a hole in the budget. 

Raimondo herself is counting on the first assumption, that BHDDH will save $6.4 million in the next fiscal year by convincing group home residents that they would be happier living with able-bodied housemates in private homes in the community. These are called shared living arrangements. Simply relocating people would run counter to federal law.

The $6.4 million in savings represents a fraction of Raimondo’s original estimate. In February, when she first released her budget for the 2017 fiscal year, she proposed saving $16.6 million by moving 400 group home residents to shared living in 12 months’ time. The House Finance Committee agreed with her subsequent request to restore $10.2 million of that total. 

The prospects of achieving even $6.4 million in savings are not strong if the efforts of the past six months are any indication.  What BHDDH director  Montanaro describes as a “full court press” to increase the number of shared living arrangements in the second half of the current fiscal year has yielded results that are about the same as the first half. There were 11 new shared living arrangements from July to December of 2015 and 10 new placements since January.

The governor’s budget proposal called for $3.5 million in group home savings during the current fiscal year with 100 new shared living arrangements,  but the actual savings will be more like $200,000, Montanaro told the Senate Finance Committee at the end of April.  

The House Finance Committee’s recommended budget acknowledges this development by adding $3.5 million back into to the department’s supplemental appropriation for the current fiscal period, which ends June 30. 

While approving major elements of the governor’s developmental disabilities budget proposal, the House Finance Committee rejected a $5.8-million request to cover an estimated caseload increase of 100 in the coming fiscal year, saying that the developmental disability caseload has been stable at about 4,000. 

Yet there is a backlog of about 240 individuals who have applied for an eligibility determination, according to a BHDDH spokeswoman. Two thirds of them are under the age of 21, according to another BHDDH official. That would mean that roughly 80 are over 21.   

And the numbers of young adults with developmental disabilities who are turning 21 and leaving school - 74 in the current academic year alone – suggest that the caseload should be growing. 

Persons with developmental disabilities between the ages of 14 and 21, who are at risk of segregation as adults, are one of the main concerns of the U.S. Department of Justice in enforcing a 2014 consent decree requiring community-based adult services, with an emphasis on supported employment. 

The consent decree, in effect until Jan. 1, 2024, resulted from a DOJ investigation that found the state’s sheltered workshops and segregated day centers for adults with disabilities violated the integration mandate of the Americans With Disabilities Act (ADA), which was clarified in the 1999 Olmstead decision of the U.S. Supreme Court.. 

In a hearing in April in U.S. District Court, the DOJ presented evidence that BHDDH does not determine eligibility until a few months before an applicant turns 21. 

State law says that persons with developmental or intellectual disabilities are eligible for services when they turn 18. 

Newly eligible young adults and their families often have trouble finding appropriate services, according to the evidence presented in court.  

Many of the two dozen private service providers in the state are not accepting new clients because they say they are operating at a deficit.  Montanaro has confirmed that assertion, telling the House Finance Committee recently that the private agencies have opened their books to BHDDH. 

With the federal court case continuing under terms of a judge’s order, there is likely to be pressure on the state to make sure that all applicants for adult services get timely consideration and an appropriate array of supports, a factor that could push up the caseload numbers. 

In its budget recommendation, the House Finance Committee said it would reconsider its refusal of a caseload increase if the numbers do go up. 

It is possible that decision was at least partly influenced by frustration in the House leadership with a history of poor record-keeping at BHDDH, something that also has worked against the department in the U.S. District Court case. 

The House Finance budget added extensive language requiring BHDDH to report monthly on a variety of statistics, including everything submitted to the court as part of the consent decree requirements. 

After the court experienced delays in getting an accurate count of individuals protected by the consent decree, Judge John J. McConnell issued an order May 18 that requires the state “to create a live database that will allow for efficient and effective tracking of each member of each target population outlined in the Consent Decree and all related and required services and outcomes.” The order then describes all the reporting requirements in extensive detail. 

In all, the order contains 22 requirements, most of them with deadlines in July and August. In the event of a violation of any part of the order, the DOJ or an independent court monitor in the case could ask McConnell for a show-cause hearing as to why the state should not be held in contempt. Fines start at $1,000 a day and max out at a total of $1 million for the year.

The first requirement of the order is that “the State will appropriate the additional money contained in the Governor’s budget for fiscal year 2017 in order to fund compliance with the Consent Decree.” No dollar amount is cited.  

Charles Williams to Retire; Second RI Developmental Disabilities Official to Announce Departure

By Gina Macris

Williams                                          Image courtesy BHDDH

Charles Williams, Director of the Division of Disabilities of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), confirmed today (June 3) that he will retire July 22.

 Williams is the second high-profile figure within BHDDH to announce his departure in two days. On June 2, the department director, Maria Montanaro, announced her resignation effective June 24. 

Williams, who joined BHDDH in 2005, said he had always planned to remain in state government for ten years, long enough to become vested in the state pension system. Williams marked his 10th anniversary in state government last October and celebrated his 71st birthday in January. 

In a telephone interview, Williams said that his retirement has nothing to do with either the federal government’s ongoing intervention in daytime programs for adults with developmental disabilities or the recent death of a resident in a group home that is both licensed and run by the state. 

He said the department plans to hire a chief operating officer and an employment specialist to fill out an administrative team in the developmental disabilities unit. Those moves, he contended, will help ensure continuity as BHDDH complies with a 2014 federal consent decree. 

Another position created by BHDDH to respond to the consent decree is that of chief transformation officer. 

Reached by phone, Andrew McQuaide, the transformation officer, declined any comment on whether he will stay with the department. 

BHDDH must comply with a series of strict deadlines in the coming months to start helping more persons with intellectual or developmental disabilities find regular jobs and enjoy activities in their communities, or face possible contempt hearings in U.S. District Court over violations of the Americans With Disabilities Act. 

Title II of the ADA, reaffirmed by the 1999 Olmstead decision of the U.S. Supreme Court, is a sweeping mandate requiring states to offer services to people with intellectual or developmental disabilities in the least restrictive environment appropriate for each individual.  

The developmental disabilities division also faces scrutiny of 25 group homes that are both licensed and run by BHDDH. In addition to supervising the developmental disabilities division, Williams heads the residential unit, called Rhode Island Community Living and Supports (RICLAS.) 

A native of Connecticut, Williams had worked as head of preventive services in mental health, behavioral healthcare and developmental disabilities for the state of Missouri before coming to BHDHHD to take a similar position.  

Montanaro put Williams in charge of developmental disabilities when she became Department director, in February, 2015, but did not select a new chief for RICLAS. 

Since early April, it has become evident that Jennifer Wood, Deputy Secretary of Health and Human Services, has taken the lead on the state’s response to the consent decree, providing much of the state’s testimony during a day-long evidentiary hearing on compliance issues in U.S. District Court. 

More recently, when state Senator Louis DiPalma (D-Newport, Middletown, Tiverton and Little Compton) asked for information about BHDDH, he said he was invited to a meeting hosted by Wood; transformation officer McQuaide; the Consent Decree Coordinator, Mary Madden; and Dacia Reed, policy director of the Rhode Island Children’s Cabinet. 

Madden’s job was created at the insistence of the court monitor in the federal case as a secretary-level position with authority to enforce cooperation among three agencies responsible for compliance with the consent decree. Madden reports to the Secretary of Health and Human Services, Elizabeth Roberts, who is also head of the Children’s Cabinet, which was revived by Governor Gina Raimondo in 2015. 

The Children’s Cabinet has an interest in the consent decree because the decree is designed to protect teenagers with developmental disabilities as well as adults. Teenagers often struggle with the transition from special education in high schools to the adult system of developmental disability services. 

Asked about Wood’s future role in connection with developmental disabilities, a spokeswoman for EOHHS issued this statement today: 

“We remain fully committed to meeting the goals of the Consent Decree to provide integrated, community based services for Rhode Islanders living with developmental disabilities. Compliance with the Consent Decree has improved significantly under Director Montanaro’s tenure, and EOHHS Deputy Secretary Jennifer Wood will continue to work with Secretary Roberts and the team at BHDDH, under the leadership of Interim director Becky Boss, to ensure all requirements are met going forward. 

Additionally, Governor Raimondo has included significant funding in her proposed budget, including investments in integrated services. In the weeks ahead, Director Montanaro is committed to working with leaders in the General Assembly to secure the additional funding that Governor Raimondo has recently advocated for to provide higher-quality services for Rhode Islanders living with developmental disabilities.”

Maria Montanaro to Step Down from RI Department of Behavioral Healthcare, Developmental Disabilities and Hospitals

By Gina Macris

Maria Montanaro, director of Rhode Island's Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) since February, 2015, will resign from her post effective June 24, according to a statement from the Executive Office of Health and Human Services. 

Montanaro

 "Montanaro will continue to work tirelessly in the weeks ahead to secure the additional funding that Governor (Gina) Raimondo has advocated to support the requirements of a 2014 federal consent decree and provide higher-quality services for Rhode Islanders living with developmental disabilities," the statement said.

Health and Human Services Secretary Elizabeth Roberts named Rebecca (Becky) Boss, the deputy director of BHDDH, to lead the department during a transition to new permanent leadership, the statement said. 

In a letter to friends and colleagues, Montanaro said that the governor and Roberts "have been 'very supportive' of my decision, which as you can imagine, I have come to with mixed emotions."

She said she had "every hope" of seeing through the changes that have begun in BHDDH, "but the demands of the job, coupled with the constraints facing the Department have led me to conclude that my personal and professional priorities would be better met by returning to the private sector."  

Montanaro, a native Rhode Islander and an experienced health care administrator, had never worked in state government before taking the BHDDH job.

In her letter, Montanaro said, "I am sorry to leave my role after such a short tenure, but I must follow my own wisdom in determining what is right for me at this stage of my life." 

"I have been very honored to serve the State at Governor Raimondo's request. I think the work we have undertaken at my direction sets the Department and its various divisions on the right road" to ensure the agency's clients get the services they need and the care to which they are entitled, Montanaro said in the letter.  

In the EOHHS statement, Raimondo said, "Over the past 18 months, Maria has worked tirelessly to address inherited challenges at BHDDH that are holding us back from providing safe, high-quality care to some of Rhode Island's most vulnerable residents."

"While our work is far from over, with Maria's leadership we have made substantial progress and built a solid foundation for future reform," the Governor continued. "Maria has also played a critical role in our work to develop and implement an action plan to save lives from drug overdose. I am grateful to her for making BHDDH a stronger agency and positioning us for success in the next phase of reforms," she said. 

Roberts said, "I am thankful for Maria's strong and effective leadership of BHDDH."

"Under her tenure, we have strengthened the leadership team at Eleanor Slater Hospital, improved compliance with the Consent Decree to provide integrated, community based services for Rhode Islanders living with developmental disabilities, and taken swift action to ensure safety and improve accountability and transparency at our state-run group homes." 

 Montanaro was president and CEO of Thundermist Health Center in Rhode Island from 1997 to 2011.  Sheworked as a senior advisor at Blue Cross Blue Shield of Rhode Island briefly before taking a job as CEO of Magellan Behavioral Care of Iowa in September, 2012.  Montanaro returned to Rhode Island in February, 2015 as Raimondo’s nominee to run BHDDH.

This article has been updated.  

RI House Finance Chairman Asks Whether DD Services Really Need Money; Gets Emphatic Yes in Reply

Maureen Gaynor uses assistive technology to testify before the Rhode Island House Finance Committee May 26. She says people with disabilities want the same thing everyone else does; a job, a role in their communities, and purpose in their lives. To her left is Lisa Rafferty, executive director of Bridges, a disability service provider.

By Gina Macris

Rhode Island’s developmental disability agency needs more revenue in the next fiscal year because it will not come close to saving a target of $16.2 million in group home expenses, the agency’s director, Maria Montanaro, told the House Finance Committee in a hearing May 26.

Montanaro emphasized that after eight years of cost-cutting in the developmental disability budget, the state now needs to add revenue to ensure that Rhode Island residents who live with intellectual challenges get the Medicaid-funded services to which they are entitled by law.

The Committee chairman, Rep Marvin L. Abney, (D-Newport), wasn’t necessarily convinced by Montanaro’s testimony, asking rhetorically, “Is money really the problem?” 

ABNEY                                          Image by Capitol TV

“We’re going on and on and on and on,” Abney said. “I’ll leave you with this thought. It’s not a question, but we are concerned,  is money really the problem? When we’re talking about efficiencies to the system, is money always the answer to that? You don’t need to respond, but just think of that as a director,” he said.

Montanaro did not reply, but other witnesses did say a lack of money is a key factor in ongoing federal court oversight of the state’s compliance with a two-year-old consent degree in which Rhode Island agreed to bring its disabilities services in line with the Americans With Disabilities At (ADA).

The agreement, with the U.S. Department of Justice, requires the state to enable more persons with disabilities to work in regular jobs, rather than in “sheltered workshops.” The decree also requires the state to help persons with disabilities participate in other community-based activities.

In an order issued May 18, Judge John J. McConnell, Jr. laid out 22 short-term deadlines the state must meet. Missing even one of them could trigger a contempt of court hearing. If the state is found in contempt, the judge would require the state to pay a minimum of $1,000 a day for violations of the consent decree, or as much as $1 million a year.  

The first requirement in McConnell’s order is that “the State will appropriate the additional money contained in the Governor’s budget for fiscal 2017 in order to fund compliance with the Consent Decree.”

The subject of the House Finance Committee’s hearing was Governor Gina Raimondo’s proposed budget amendments for the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH),  for 2016-2017 fiscal year, which begins July 1.

In all, Raimondo has requested $18.7 million in added revenue for developmental disabilities, offset by an accounting shift of $1.8 million in home health aide services from BHDDH to the Executive Office of Health and Human Services.

Also on the table is a proposal for about $6.8 million in additional appropriations in the current fiscal year to address a current budget deficit in developmental disabilities. 

If the General Assembly approves the supplemental appropriation, the bottom line in BHDDH’s Division of Developmental Disabilities would increase from $230.9 million to $237.7 million before June 30. Raimondo’s request for an additional $16.9 million in the coming fiscal year would push the overall disabilities budget up to $254.6 million, with about half that amount coming from state coffers. 

In fiscal 2016-2017, Raimondo seeks to make up $10.2 million of the $16.2 million she originally envisioned saving in reduced group home costs.

The governor also wants an additional $9.2 million in funding to raise salaries for staff who work with adults with intellectual challenges, or $4.1 million more than she asked for in February. 

In addition:

• $180,000 would be set aside for an ombudsperson to protect the rights of persons with developmental disabilities

• ·4.4 million would be restored to the BHDDH budget to prevent the inadvertent loss of professional services like occupational and physical therapy for some persons with developmental disabilities.

All the money comes from Medicaid, with a roughly dollar-for-dollar match in federal and state spending.

Montanaro, the BHDDH director, said adequate funding of developmental disabilities in the next budget would prevent BHDDH from running a deficit every year.

The developmental disability caseload, 4,000 to 4200 annually, also should be included in calculations of the state’s semi-annual Revenue and Caseload Estimating Conference to prevent unexpected surprises in the budget, she said. 

Montanaro                                                               Image by Capitol TV

The twice-yearly conference is a forum for top fiscal advisors to the Governor, the House and the Senate to reach consensus on the state’s revenues and Medicaid caseload expenses for the coming budget year.  

Montanaro said the $9.1 million in raises for direct care workers are necessary to satisfy the consent decree.

Without being able to offer higher pay, the private agencies that provide most of the direct services won’t be able to re-direct their efforts toward supporting their clients in jobs as the consent decree requires, Montanaro explained.

Workers make an average of about $11.50 an hour, often less than the clients they support in jobs in fast food restaurants, according to testimony at the hearing.

BHDDH originally counted on achieving $16.2 million in savings in the next fiscal year by convincing hundreds of group home residents to move into less expensive shared living arrangements with individual families, Montanaro said.

However, that effort has encountered resistance by individuals and families who find safety and security in group home living, she said.

Since BHDDH began what Montanaro described as a “full court press” on shared living at the beginning of this year, 10 group home residents have moved into private homes with host families, according to BHDDH statistics.

There are now 288 adults with developmental disabilities in shared living – an option that has been available for a decade in Rhode Island – and about 1300 persons living in group homes in Rhode Island.

Tobon                                                           Image by Capitol TV 

When Montanaro originally testified in January about the plan to shift to shared living, it was in the context of closing a projected $6 million deficit in the current fiscal year.

Recalling that testimony, Rep. Carlos E. Tobon, (D-Pawtucket), a Finance Committee member, said he had been “really concerned” about the timetable.

“You had to sit over there and pretty much, not  convince us, but tell us that this is what you were going to do,” Tobon said. “What was your confidence in actually achieving that?”

“I think I was very clear with the committee that it was a very aggressive approach,” Montanaro replied.

“But the problem, Representative, that I want you to understand, is that we are mandated by (state) law to come up with a corrective action plan” to close a budget deficit, she said.

The choice was either to continue the eight-year pattern of cutting benefits or eligibility, while the federal court watched “the crumbling of that system,” Montanaro said, or to try to get savings by encouraging persons with disabilities to move into more integrated living arrangements.

Montanaro described it as a “Sophie’s Choice,” a dramatic allusion to a forced decision being forced to decide between two terrible options.

 “We knew we might have to come back and tell you our actual experience with that,” she said alluding to the fact that the short-term shared living effort has fallen far short of the goal.

 A gradual shift toward shared living is in keeping with a broad, long-range federal mandate to desegregate services for individuals with a variety of disabilities, but it does not address the Rhode Island consent decree, Montanaro said.

 
In the past several months, as the federal court watched BHDDH spending nearly all its efforts to try to save more money instead of working on the employment requirements of the consent decree, Montanaro said, the judge and the court monitor in the case became “very worried.”

The monitor, Charles Moseley, has said that timing is critical.

Unless the state meets certain benchmarks now, Moseley has said in reports to the court, it will not be able to fulfill the long-range requirements of the consent decree, which calls for a ten-year, system-wide shift from segregated to integrated day time supports for adults with developmental disabilities to comply with the ADA. The decree, signed April 8, 2014, expires Jan. 1, 2024. 

Montanaro said that concerns of the monitor and the judge over the state’s emphasis on cost-cutting instead of the consent decree requirements prompted a recent court order that spells out conditions under which Rhode Island could be fined as much as $1 million this year for contempt. 

In her testimony before the House Finance Committee, Montanaro drove home her point.

“The last thing I’ll say about it is that we really can’t afford to direct all of our departmental activity toward an effort that isn’t actually the effort that the consent decree is obligating us to pay the most close attention to, which is the employment issue,” Montanaro said.

“Judge McConnell and the court monitor want to see the state of Rhode Island make the necessary financial investments in transforming the system, and you can’t transform everything at once,” she said, alluding to Moseley’s concerns about timing.

Montanaro continued to explain, but that’s when Abney, the committee chairman, interrupted, asking his rhetorical question: “Is money really the problem?” 

Later in a hearing that lasted nearly two hours, Tom Kane, CEO of a private service agency, and Kevin Nerney, associate director of the Rhode Island Developmental Disabilities Council, each told Abney that “it is about the money.”

Nerney said, “Whether I think it’s about money, or whether anyone else thinks it’s about money, there’s a federal court judge that thinks it’s about money, and the Department of Justice does, as well.”

Kane, CEO of AccessPoint RI, said “The reason the DOJ is here is a money problem,” he said. “We have jobs available for people (with disabilities) waiting to work,” he said, but providers of developmental disability services can’t hire the support staff “to make that happen,” he said.

Of 77 job applicants at AccessPoint RI during the month of April, 35 refused a job offer because of the low pay, Kane said. “They tell me they can make more sitting home collecting” unemployment benefits, he said.

Serpa                                                  Image by RI Capitol TV 

As he has testified at previous State House hearings on the developmental disabilities budget, Kane said private service providers operate at an average loss of about $5,000 a year for each person they employ. 

Rep. Patricia A. Serpa, (D-West Warwick, Coventry and Warwick), asked whether executives of developmental disability agencies have received raises while their workers have been paid low wages in recent years.

Kane said he gave all AccessPoint RI employees a 3 percent raise in January, the first time since 2006. At the start of the 2011-2012 fiscal year, after the General Assembly voted to cut $24 million from the developmental disabilities budget, everyone took a 7.5 percent pay cut, he said.

Donna Martin, executive director of the Community Provider Network of Rhode Island, CPNRI, said all the member agencies that cut pay that year started at the top.

A review of IRS reports from organizations exempt from taxes shows that executives of developmental disability agencies with budgets less than $5 million make 25 percent less than those of other non-profit agencies in Rhode Island, Martin said.

In developmental disability agencies with budgets greater than $5 million, the executives make 30 percent less than those of other non-profit organizations in the state, she said.

Kane, meanwhile, asked the committee to think of the governor’s budget proposal as a “jobs request.”

KanE                                                    ImAge by Capitol TV 

Kane submitted a copy of research done by the University of Massachusetts Amherst which indicates that every million dollars invested in disability services in Rhode Island creates a total of 25 jobs. Based on that research, Kane said later, the $9 million Raimondo has requested to raise pay for direct care workers would translate into a total of 225 jobs.

Kane also said the state should “braid” funding from BHDDH with the Office of Rehabilitation Services of the state Department of Human Services (ORS) to fund “employment teams” that would be more effective than the two agencies working separately to try to do the same thing.

That idea came out of recent discussions between state officials and private agencies about a system-wide redesign of services, Kane said.

Bob Cooper, executive secretary of the Governor’s Commission on Disabilities, said he would add the state Department of Labor and Training (DLT) as another “braid” in Kane’s analogy.

Federal rehabilitation dollars channeled through DLT reimburse the state 78 cents for every dollar the state spends; a better deal than the 50-50 match from the Medicaid program, he said.

The federally-funded Disability Employment Initiative, a workforce development demonstration grant run by DLT, “was making a difference” before the grant ended and the program shut down March 30, Cooper said.

If the state is to comply with the consent decree, disability-related job supports involving BHDDH and ORS must be merged with DLT, the state’s primary economic development agency, Cooper said.

RI Governor's New Request for More DD Funding To Go Before House Finance Committee Thursday

By Gina Macris

Rhode Island Governor Gina Raimondo has proposed adding nearly $16.9 million in state and federal revenue funds during the next fiscal year to shore up the state’s developmental disability system, which is under a federal court order to expand participation of adults with intellectual challenges in work and leisure activities in their communities to comply with the Americans With Disabilities Act (ADA). 

The addition of these funds, in four disability-related categories, will be heard by the House Finance Committee May 26, along with dozens of other proposed amendments Raimondo submitted in light of positive revenue estimates made a few weeks ago by state fiscal analysts. 

The new revenue reflects a change in the Governor’s approach to budgeting for developmental disability reforms, which originally depended on cost-shifting within the Division of Disabilities in the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH).

The disability-related amendments are:

•  An additional $4 million - about equally divided between state and federal funds – to raise the wages of some 4,000 direct care workers for private agencies that provide most of the services to adults with developmental disabilities. The amendment would raise the total allocation for worker raises from $5 million to $9 million.

• A $10 million increase in reimbursements to private providers, including $5 million in additional state revenue, to restore most of the cuts in housing costs made in the Governor’s original budget. That proposal projected 500 adults with developmental disabilities would move from group homes to shared living arrangements with individual families by June 30, 2017, although those estimates were later lowered to 300.  A total of 21 individuals have moved during the current fiscal year, according to the latest figures released by BHDDH. The added revenue will enable BHDDH to take a “more appropriate, more deliberative approach to transition individuals from group homes to shared living arrangements” in the future, according to Michael Raia, a spokesman for the Executive Office of Health and Human Services.

• A total of $170,000 in state and federal funding for an ombudsman who would protect the rights of adults with developmental disabilities. Legislation has been introduced in both the House and Senate to define the office and its duties, in response to the death of a resident of a state-run group home in February.

• Restoration of $4.4 million in state and federal funds used to pay for professional services like physical therapy in day centers, In February, the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) sought to shift the entire $2.2 million to Medicaid managed care organizations, but families complained that services had in fact been denied. The action was rescinded in March.

One of many provisions of a U.S. District Court order issued by Judge John J. McConnell, Jr. on May 18 is that “the State will appropriate the additional money contained in the Governor’s budget for fiscal year 2017 in order to fund compliance with the Consent Decree.” 

Any violation of that or any other requirement in the 21-point court order would allow the U.S. Department of Justice or the independent court monitor in the case to ask the judge for a contempt hearing. If the state is found in contempt, it will be fined a minimum of $5,000 a day for the duration of the violation, up to $1 million a year. 

In a telephone interview May 25, BHDDH director Maria Montanaro emphasized the need for the total $9 million Governor Raimondo has earmarked for wage hikes for direct care staff in the private service system, in addition to the other adjustments.  

Part of what the court wants is a redesign of reimbursement rates, which is more complicated than only raising wages, Montanaro said. The changes in reimbursement that the judge wants, however, can’t be accomplished without paying the workers more, she said. 

Raimondo’s budget originally envisioned an increase of $5 million in state and federal funds to pay for a 45-cent hourly wage increase for a workforce now making an average of roughly $11.50 an hour, according to testimony in recent House and Senate committee hearings. 

Montanaro could not say exactly how the additional $4 million in federal and state funds would further affect wages, but it would allow BHDDH management and agency representatives to discuss factors like the salaries of supervisors of direct care staff and the cost of employer taxes and benefits, she said. Those discussions would be held after the budget is adopted, she said. 

 Currently, private agencies are not fully reimbursed for those employer costs, spokesmen for the service providers have testified at recent budget hearings, and they operate at loss for each person they employ.  

Judge Orders RI to Fund Disabilities Reform; State Faces Possible Contempt, Fines

By Gina Macris

U.S. District Court Judge John J. McConnell Jr. today (May 18) ordered the state of Rhode Island to appropriate the money necessary to fund the so-called “sheltered workshop” consent decree. The judge also set short-term deadlines for a series of incremental steps needed to begin changes in the developmental disability system.

 In the case of any missed deadlines or other violations of the order, either the court monitor in the case or the federal government may request a show-cause hearing to determine whether the state should be held in contempt.

 If the Court finds Rhode Island in contempt, the state will pay into a Consent Decree Compliance Fund at the rate of $5,000 a day for each day it is remains out of compliance and $100 a day for each person whose integrated day services are delayed or interrupted by a particular violation. The fund is capped at $1 million a year.

 The judge did not spell out how much the state must budget to fund the consent decree.

 The order comes after an April evidentiary hearing which showed the state had made little progress in gearing up for system-wide changes needed to offer job-seeking services and other community supports for adults with intellectual and developmental disabilities who want them.

 Between 2009 and 2011, the state budget for developmental disabilities sustained an overall cut of about 20 percent and has not yet recovered. Since 2013, expanding caseloads have continuously outpaced increased appropriations, leaving a system of private service providers that operate at a loss.

 McConnell’s order largely follows recommendations of the U.S. Department of Justice, although he reserved for himself the right to decide whether the state must pay into the compliance fund.                                                                                                         

The DOJ would have allowed the court monitor to make the determination, arguing that a contempt finding shouldn’t be needed to trigger payments to the fund.

 In his order, McConnell disagreed on that point.

 He also responded to arguments made by the state that the series of deadlines and other provisions of the proposal originally made by the DOJ “contains ambiguous terms and mandates that are not defined.”

 McConnell’s order says that If the state believes any term “is ambiguous or any mandate ill defined,” it must immediately seek clarification with the DOJ and the court monitor. If the state is still not satisfied, it must promptly ask the court for a hearing on the matter, McConnell said.

 Governor Gina Raimondo’s budget proposal for the remainder of the current fiscal year and the next one would put an additional $24.1 million into the network of private agencies that provide most of the services to adults with intellectual and developmental disabilities.

However, a Senate fiscal report raises doubts that projected revenue and expenses in the budget of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals will balance out. In question is a projected $19.3 million in savings from a reduction in group home costs that depends on voluntary moves by residents into private homes with families throughout the state. 

Click here for Judge McConnell's order