Rhode Island's BHDDH Makes Streamlining Efforts in DD Application Process But Backlog Persists

By Gina Macris

 At any given time during the past several years, roughly 250 individuals with intellectual or developmental disabilities have been caught in a backlog, waiting for the state to determine whether they are eligible to seek a variety of support services.  

During an interview in late May, Andrew McQuaide, the Chief Transformation Officer at Department of Behavioral Health, Developmental Disabilities and Hospitals (BHDDH), confirmed the size of the backlog. 

 McQuaide said that it’s “troubling” that eligibility workers have not been able to break through the backlog, even though there has been a “fairly consistent inflow and outflow of applications” for the last four years.

 Historically, younger adults have found it difficult to get eligibility decisions much before their 21st birthdays - the age they are no longer eligible for school-based programs in districts throughout the state.  Most of the backlog came from applicants aged 21 and older.

In some cases, according to evidence provided the U.S. District Court in April, delays in screening applicants has led to their turning 21 and sitting at home, waiting for appropriate services to be put in place.

That evidence was significant for two reasons:

• A two year-old federal consent decree requires meaningful options for integrated work and other community-based activities to be in place by age 18 for individuals who are at risk for segregation once they leave school.

• State law says individuals with developmental disabilities qualify for adult services at age 18.

In a new report to the U.S. District Court, which is overseeing enforcement of the consent decree, the state says the makeup of the “pending cases” has changed from predominantly older to predominantly younger applicants.

As of mid-April, more than 70 percent of pending applications came from individuals 16 to 21, most of whom are not planning to leave school soon, according to the report.

The report on eligibility issues is included in the state’s new communications plan, which the court ordered to be submitted by July 1. 

 The report on eligibility says that the “former practice and understanding within the community that applications would only be accepted at age 21 has demonstrably changed, mostly due to BHDDH’s engagement and commitment to transition planning for youth.”

 During the last year, the eligibility unit at BHDDH has given priority to deciding cases from transition-age applicants, according to the report.

Nevertheless, a chart with a breakdown of the 125 individuals aged 17 to 24 who were found eligible during the 12 months ending in June shows that 108 of the approvals were made in the 21-24 age group.

Eighty-six are turning 21 this year, and 22 other applicants are turning 22, 23, or 24. Among the younger applicants, 14 are turning 20 and 3 are turning 19.

No 17 or 18 year-olds were found eligible.

The report, while acknowledging that the “number of pending applications has remained relatively consistent,” makes no reference to a backlog. 

Data on the number of applications and the number of eligibility decisions prior to 2012 is hard to come by, McQuaide said, although he understood the number of new cases approved had slowed to a “trickle” from 2008 to 2011. 

McQuaide acknowledged the widespread belief among service providers and families during that period was that BHDDH stalled eligibility decisions in an attempt to reduce spending.

 In 2011, the General Assembly controlled the budget by cutting reimbursements to private service providers by 16 percent. 

“There’s absolutely zero evidence” that eligibility was delayed as a cost-cutting tool, McQuaide said, but “unfortunately, that perception still persists.“ 

McQuaide emphasized that the eligibility unit is working as hard as possible, making 250 to 300 decisions a year.

He said the responsibilities of the three caseworkers and support and supervisory personnel go beyond eligibility determinations to include other tasks associated with applicants transitioning into the service system, such as:

• Attending Individual Education Plan meetings for high school students in special education

• Facilitating applications for individuals’ Medicaid funding to the Department of Human Services

• Coordinating a referral to the BHDDH assessment unit, where the level of funding is decided

• Writing a “referral narrative” that can be used by service providers to better understand the needs of prospective clients.

McQuaide said during the May interview that that one option for addressing the backlog might be to increase the size of the staff for a limited period of time.

The Executive Office of Human Services has not responded to repeated requests for additional information on the backlog and clarification on related issues.

The communications plan says the eligibility unit underwent a continuous improvement, or LEAN exercise, in June that was coordinated by the Office of Management and Budget.

As a result, eligibility workers will begin meeting with potentially eligible high school students and their families 18 months before they anticipate leaving school to make sure they have at least begun the application process for adult services and to encourage them to start learning about potential service providers.

Once an application is received, the eligibility unit will have 30 days to screen it and make a decision as long as no additional information is needed.

 (The document says in one place that applicants have 60 days to submit additional information and in another place that they have a 45-day deadline.)

 Applications that remain incomplete are removed from consideration and the applicant must begin the process again. This practice will prevent incomplete applications from “sitting for extended periods of time, in some cases years, waiting for documentation,” according to the report.

After an eligibility determination, the assessment unit must determine a level of funding for the individual, and an individual service plan must be written before services can begin.

RI Leadership in Developmental Disabilities Starts With Office of Health and Human Services

Jennifer Wood    Photo by Anne pETERS

Gina Macris

Jennifer Wood, a longtime state policy wonk with an exacting work ethic and a broad reach, is orchestrating an effort to usher in a new era for Rhode Islanders with intellectual and developmental disabilities. 

And she’s creating a brand new management team to help her do it,  including Brian Gosselin, a veteran of former Massachusetts Governor Deval Patrick’s administration, to serve as Chief Strategy Officer.  

Wood is the Deputy Secretary of Health and Human Services, the top aide and top lawyer to Secretary Elizabeth Roberts, and a former chief of staff at the state Department of Education. 

Since January, when a federal judge agreed to oversee Rhode Island’s compliance with a consent decree, Wood has emerged at the forefront of the state’s response to the court case.

Wood says she is working “all day and every day” to fulfill the state’s pledge to integrate Rhode Island adults with intellectual and developmental disabilities into the larger community of work, living and leisure. 

That pledge was made two years ago when then-Governor Lincoln Chafee signed the consent decree, promising the federal government that Rhode Island would end the segregation of more than 3,400 adults, most of them working in sheltered workshops or spending their days in isolated programs.

The consent decree gets its authority from the 1999 Olmstead decision of the U.S. Supreme Court, which says individuals with intellectual or developmental disabilities must receive supports in the least restrictive setting that is therapeutically appropriate.

 In a recent interview, Wood emphasized that the goals of the consent decree “are the changes we should and would be making anyway, and it’s just beneficial in certain ways that we’re doing it within that structure.”

Wood presented most of the state’s testimony during a day-long evidentiary hearing on compliance before Judge John J. McConnell, Jr. in U.S. District Court in April.

Other evidence before McConnell included statements from families and advocates recounting failures in service and the opinion of a court monitor that Rhode Island must immediately lay groundwork to implement the consent decree if it is to achieve its ultimate goals by the time the agreement expires in 2024.

McConnell subsequently ordered the state to complete nearly two dozen tasks - each with a short-term deadline - or face contempt of court proceedings. (Read the order here.)

Several deadlines occurred July 1, and a new wave will hit at the end of the month or the beginning of August.

In the meantime, two top developmental disabilities officials announced their departure. Maria Montanaro, the director of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) left June 24. Charles Williams, Director of the Division of Disabilities, will retire July 22. 

A third official, Andrew McQuaide, the Chief Transformation Officer at the Division of Disabilities, recently announced that he, too, will leave July 22. (Read related article here. ) 

“There’s a lot of change going on, especially in the leadership area,” Wood said.

“We’re the stability factor,” she said of the Executive Office of Health and Human Services.

Wood said she is building a very skilled management team, with leadership and authority coming from the Executive Office of Health and Human Services, to work on the consent decree and begin transforming a system mired in myth or what she calls “urban legend.”

“I use the metaphor that we’ve got a lot of plates spinning, and we need to move on all of these fronts at one time,” she said.

“We’ve got to prioritize the specific deadlines and commitments made in Court, but none of those things happen without a lot of other pieces being in place,” like getting “basic payment systems in place; getting basic communication systems in place with our own staff.”

 According to the consent decree itself, the appropriate staff were to have been trained in how to carry out its provisions by Sept. 1, 2014.

 “Our own staff, I think, need substantial orientation and awareness of what the consent decree actually requires, as opposed to what everyone says and thinks it requires, which are two different things,” Wood said.

“In the absence of clear and transparent communication, and authoritative communication, then, always, rumor, innuendo, and urban legend will rule the day,” she said.

Wood says the state needs to do better with its external communications because, “Families are out there wondering: What are you doing? When are you doing it?”

A communications plan - one of the tasks McConnell wanted done by July 1 - has been submitted to the federal court. Like the staff training, the communication plan should have been in place nearly two years ago, according to the consent decree. 

Wood emphasized that the communications plan is not a “static” document but a blueprint for action.                                                        

Much of what she and her staff have had to confront in trying to implement the consent decree is “gaps in basic management systems at BHDDH,” Wood said.

“I find it wholly unacceptable that sometimes what we’re talking about in court is: ‘Did an invoice get paid?’ ” Wood said.

 “One embarrassing example, which I shouldn’t even bring up, is ‘Can you get the consent decree monitor paid?’ ” Wood said.

 “I don’t trivialize the bureaucratic and administrative processes, because when those don’t work, nothing works,” Wood said.

 “Before I get out of bed in the morning, that should just be done,” she said, “but you know what? It’s bureaucracy, so you don’t always have that in place.”

McConnell’s detailed order, issued May 18, gave the state 12 calendar days to get itself up to date with payments due the court monitor, Charles Moseley, and the Consent Decree Coordinator, Mary Madden. The judge also said the state must never again miss a payday for either of them as long as their respective contracts run.

The order touched the tip of an iceberg, for the state pays its bills so slowly that many direct service providers must borrow to meet payroll while they wait for the reimbursement to which they are entitled.

“I hate to hear those stories, but, of course, I’ve heard those stories,” Wood responded.

The focus should not be on paying the bills, but on “transforming basic services that are fundamental to the success of our clients,” Wood said.

Initially, “we had struggles in getting people working together, to have everyone pointed in the same direction as to what the consent decree meant and how it should be implemented,” Wood said.

 Besides BHDDH, two other state agencies are directly involved in implementing the consent decree:  the Rhode Island Department of Education and the Office of Rehabilitation Services at the Department of Human Services.

(According to testimony during budget deliberations, there is a growing opinion that the Department of Labor at Training also should be at the table.)

Each agency is a like a silo with its own way of doing things, and the purpose of the Executive Office of Health and Human Services is to get them to function as an “integrated whole,” Wood said.

Wood explained the role of each member of the management team:

• Brian Gosselin, new Senior Strategy Officer at EOHHS, will focus exclusively on developmental disabilities for the foreseeable future. He is an expert on performance-based contracting, which must be in place by August 1, according to McConnell’s order. Raises in staff wages and several other changes related to the financial arrangements the state has with private service providers also must be in place by Aug. 1. Gosselin is a fellow in the Government Performance Lab at the Kennedy School of Government at Harvard University. The Performance Lab, along with the National Association of State Directors of Developmental Disabilities Services, has consulted with the state in developing the new payment methods McConnell implemented. An accounting professional, Gosselin worked his way up in the Massachusetts budget office to the position of Chief of Staff in the Executive Office of Administration and Finance.

• Dacia Read, until now the director of the Children’s Cabinet, has taken on an expanded role as Interagency Policy and Implementation Director at EOHHS. In that capacity, she is providing analysis and support for key initiatives at BHDDH and other agencies, according to a spokeswoman for Wood. 

• Kim Paull, Director of Analytics at EOHHS, is working with Consent Decree Coordinator Madden and others to create an interim data solution to a requirement in McConnell’s order that the state make available client-specific information on employment and other services by the end of July.

• Mary Madden was hired in January as EOHHS Consent Decree Coordinator in response to pressure from the court monitor and the U.S. Department of Justice that the implementation of the consent decree lacked leadership. Wood said she works closely with Madden on a daily basis.

• Jane Gallivan, who will serve as acting Director of the Division of Developmental Disabilities, is newly retired from the same post in Delaware and has extensive experience in the equivalent position in Maine, where she led the implementation of a long-running federal consent decree in a de-institutionalization case..

• BHDDH recently hired Tracey Cunningham as an Employment Specialist to lead a shift toward the supported employment services required by the consent decree. McConnell’s order gives the state until August 1 to hire a Program Developer or Quality Improvement Officer who will lead improvements in services and supports for clients. An existing quality improvement unit at BHDDH investigates neglect and abuse.

• The Division of Disabilities at BHDDH will also have a new Transformation Officer and a yet-to-be named Chief Operations Officer.

• Fiscal support will come from Christopher Feisthamel, the chief financial officer at BHDDH, and Adam Brousseau, the department’s fiscal analyst.  

Andrew McQuaide to Become Senior Director at Perspectives Corp. in North Kingstown, RI

By Gina Macris

Andrew McQuaide, the Chief Transformation Officer who has been identified with reforms in the Rhode Island's developmental disability services for the last three years, will join the state’s largest direct service provider, Perspectives Corp., as a senior director.

McQuaide’s last day in the Division of Disabilities at the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) will be July 22.

McQuaide has worked for the state in various capacities in connection with consent decree implementation ever since U.S. Department of Justice secured an initial agreenent to close a sheltered workshop in North Providence in 2013. A statewide agreement to settle violations of the Americans with Disabilities Act followed a year later. 

McQuaide, who has two siblings with developmental disabilities and is a board member of a national sibling leadership organization, said he wants to develop well-rounded professional experience while helping Perspectives expand and improve its integrated services.

A resident of Charlestown, he was the youngest member ever elected to the Charlestown School Committee and is a graduate of the University of Rhode Island. McQuaide also has a master’s decree in public administration from Syracuse University.

Jane Gallivan, Experienced Administrator of DD Services, To Help RI With Transition

By Gina Macris

Jane Gallivan, a veteran state-level administrator of developmental disability services, will guide Rhode Island’s compliance with a federal consent decree mandating greater integration of adults with intellectual challenges in their communities.

Gallivan, who was instrumental in shaping compliance with a long-running federal consent decree in a de-institutionalization case in Maine, has agreed to serve as a consultant through December, according to Jennifer Wood, Deputy Secretary of Health and Human Services.

Wood said in a recent interview that it is not yet clear whether Gallivan would also agree to work as an interim director of developmental disabilities while the state searches for someone to succeed Charles Williams, who will retire July 22.

It was under Gallivan’s watch in Maine in 2010 that a federal court dismissed the second of two consent decrees resulting from a 1978 class action lawsuit over conditions at the Pineland Center in New Gloucester, an institution for individuals with disabilities that closed in 1996.

The original consent decree was succeeded in 1994 by another decree that focused on expanding community-based services. Gallivan served as Director of the Office of Cognitive and Physical Disability Services in Maine from 1982 to 2011, according to her LinkedIn profile.

From Maine she went to Delaware, where she directed developmental disability services until her retirement in February of this year.

Last December, she was honored by the National Association of State Directors of Developmental Disabilities Services (NASDDDS) for her pioneering work in both Maine and Delaware, and as a member of the NADDDS Board.

Gallivan began her career working directly with persons with developmental disabilities, according to NASDDDS.

In addition to her familiarity with consent decrees, she has experience developing other innovations that Rhode Island wants to implement, according to Deputy Secretary Wood.

These areas include:

•        Supports for community-based employment

•        Shared living arrangements

•        Introducing electronic records

Wood said Maria Montanaro, the outgoing director of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), was referred to Gallivan through her involvement in NADDDS.

Montanaro made arrangements with Gallivan to serve as a consultant before Williams announced that he is retiring as director of the BHDDH Division of Developmental Disabilities, Wood said.

EOHHS is searching for successors to both Williams and Montanaro. 

(This article has been updated to reflect the length of Gallivan's contract.)

Montanaro Says Rhode Island DD Services Have a Long Way to Go; She Won't Miss the Politics

Photo by Anne Peters 

By Gina Macris

When she became director of Rhode Island’s developmental disability agency in February,  2015,  Maria Montanaro inherited a budget with no relation to actual costs that was destined to run a deficit.

 She had to work with a state­-run system of group homes resistant to change, which she said exists to preserve jobs and not to serve clients.

And she had virtually no high-­level staff to form the leadership team necessary to move forward on compliance with the 2014 federal consent decree that requires Rhode Island to transform its services for adults with disabilities from segregated programs to integrated, community­-based supports.

A little more than a year into the job, as she was trying to reduce costs to hit a budget target that seemed plucked out of thin air, Montanaro realized that working in state government was not for her.

She said Governor Gina Raimondo and the Secretary of Health and Human Services, Elizabeth Roberts, have been very supportive. After favorable state revenue estimates in May, Raimondo added to her budget request for developmental disabilities, and the General Assembly gave her most of what she wanted.

Nevertheless, the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) needed everything the governor asked for - a total of $16.9 million in new Medicaid funding, Montanaro said.

In March, Raimondo had asked her to stay on until the budget process was complete, Montanaro said, and she agreed.

In the end, the political aspect of running  BHDDH proved to be ‘very draining,” said Montanaro. Her last day at BHDDH is June 24.

“It takes an enormous amount of effort to move the levers” of state government, she said in a recent interview. Formerly CEO of Magellan Behavioral Healthcare in Iowa and the Thundermist Health Center in Rhode Island, Montanaro had never worked in state government before she came to BHDDH.

In public statements in recent weeks, Montanaro has helped start a new conversation about splitting up BHDDH – a change that could not come without legislation enacted by the General Assembly.

Accustomed to dealing with budgets as professional challenges, Montanaro said she found that trying to get funding in the right places is also a political issue in state government. That was “very difficult for me,” she said.

It was “enormously frustrating,” she said, to inherit a system of fragmented services and balance sheets always running millions of dollars in the red. (The deficit has averaged about $4.6 or $4.7 million for the past eight years.)

 She offered a frank analysis of what’s wrong at BHDDH, and the reasons the Division of Developmental Disabilities should be a separate entity, with its own commissioner, working hand in hand with the state’s Medicaid administrator.

 “Politics aside, there is a responsibility to adequately fund the system,” Montanaro said.

Actually, there are two systems of care in Rhode Island for adults with developmental disabilities, and Montanaro indicated that is one of the problems.

One division of BHDDH operates a network of 25 group homes serving roughly 150 adults with a staff of less than 400 employees. The division is known as Rhode Island Community Living and Supports (RICLAS).

BHDDH also contracts with about two dozen private agencies which, in turn, hire some 4000 workers to serve roughly  3,600 clients day and night, including some 1,120 adults with intellectual challenges who live in about 250 group homes.

Montanaro said the one good thing about the state­-run homes is that employees are paid adequately. Their pay ranges from $15 to $25 an hour. Direct support workers in the private sector make minimum wage or a little higher -  an average of about $11.50 an hour. Burnout is high, and turnover runs an average of about 35 percent, according to testimony presented to the House Finance Committee last month.

 “RICLAS as a provider system needs to make changes, and it’s very hard to enact change with a unionized workforce with very rigid views on change,” she said. “We have a lot of limitations in negotiating those changes. Do we need a state-­run residential system?” Montanaro says she thinks not.

“Why not do that in the private sector; use contracts and incentives in the private sector to make sure we get people what they need,” Montanaro said.

“We should not be running a system to employ people. We should be running a system to serve clients,” Montanaro said.

Services for adults with developmental disabilities are all funded by Medicaid, Montanaro said, and the future costs can be projected fairly accurately by looking at the state’s costs for the past three years.

Montanaro contends that the social support services funded by Medicaid through the Division of Disabilities probably avoid medical costs in the long run. The social supports, like job coaching and other services, “allow them to live their best life, doing meaningful work and having a meaningful personal life,” Montanaro said. People who are more active and engaged in their communities are not as sick, using fewer medical services, Montanaro said.

“That is why I am arguing to change the structure,” she said, She envisioned a separate unit run by a commissioner of developmental disabilities – someone like Charles Moseley, a developmental disability career professional who formerly served as commissioner in Vermont.

Moseley is now the federal court monitor for compliance with the 2014 consent decree which requires Rhode Island to transform its segregated system into an integrated one over a 10-year period in accordance with the 1999 Olmstead decision of the U.S. Supreme Court. That decision clarified the integration mandate of the Americans with Disabilities Act (ADA).

Together, Rhode Island’s developmental disabilities commissioner and the state Medicaid administrator “should have a sight line over the whole experience,” so they are able to see how day supports affects utilization of medical services, Montanaro said.

“It’s pretty easy to look at caseload and utilization and set your budget,” she said. This exercise should be carried out as part of the state’s twice yearly caseload estimating conference, she said. Prior to Governor Raimondo, every administration has set an arbitrary budget target that did not reflective of projected costs, and BHDDH has responded by either lowering rates paid to private providers or running a deficit without worrying about the consequences, Montanaro said.

There’s an assumption in state government that the Division of Developmental Disabilities can lower costs by better managing the utilization of services, she said, but that’s not true.

 “The population is “fairly static,” and the needs of clients are stable, she said. Individuals who meet certain criteria are entitled by law to residential services and employment and other social supports.

The only way to reduce costs is to cut reimbursement rates to providers, which has been done in the past, she said. 

Montanaro said it appears that prior to her arrival, BHDDH may have created bureaucratic delays to save money by delaying the adjudication of appeals.

“We tried to terminate unfair practices,” she said. “We have a responsibility to plan for the service to clients.” In nearly 18 months at BHDDH, Montanaro said, her team “removed those operational barriers that we found in place here."

"Were they in place deliberately, or were they here because the department was wildly inefficient, with eligibility delays and claims lagging as a result? I won’t speculate on that,” she said.

The amount of time and effort necessary to bring about change in the state bureaucracy leads to “a lot of crisis management,” Montanaro said. “It’s designed to protect institutions from constant, fast change that could come with changes in administration every four to eight years,” she said.

In addition to having a realistic budget, Montanaro said the ideal developmental disability agency would be staffed by experts needed to move reforms forward.

As it is, she said, “the Division of Disabilities has lacked critical leaders in critical roles for all the years far back that I can see.”

For about 16 months, Charles Williams, the outgoing director of developmental disabilities, has split his time between that job and running RICLAS. His professional expertise is in mental health services rather than developmental disabilities, Montanaro said.

As a result of the consent decree - and Montanaro's efforts - BHDDH now has a chief transformation officer, Andrew McQuaide, and has just hired Tracey Cunningham of the James L. Maher Center in Newport as an Employment Specialist.

Funding has been authorized for a quality improvement officer to focus on programmatic improvements for BHDDH staff and private service providers. In addition, a high-level chief operations officer will be hired to round out the leadership team.

As for her own future, Montanaro, 58, said she will take the summer off to recharge. She plans to visit her son and daughter-in-law in France, where the couple are expecting their first child.

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.

Former Nurse Pleads Guilty to Assaulting Developmentally Disabled Boy in RI

By Gina Macris

Kimberly Faneuf, 49, of Cumberland, RI, formerly a licensed practical nurse, pleaded guilty in RI Superior Court June 14 to one count of assault on a severely impaired person, a nine year-old boy with developmental disabilities who is prone to seizures.

After a plea agreement, reached with the approval of the victim’s family, Judge Netti C. Vogel sentenced Faneuf to five years in  prison with 18 months to serve, and the remainder suspended with probation, according to the office of Attorney General Peter F. Kilmartin. 

In addition, Vogel ordered Faneuf to perform 50 hours of community service, seek mental health counseling, and have no contact with the victim.

The state Department of Health stripped Faneuf of her nursing license shortly after she was arrested by Cranston police, nearly three years ago.

The parents of the boy, a Cranston couple, hired Faneuf to care for their son July 29, 2013, while they went out to a rare dinner alone, according to Kilmartin’s spokeswoman.

While they were at dinner, the couple checked in remotely with a camera they had placed in their son’s bedroom to monitor him in case of a seizure.

They saw an image of Faneuf “grabbing their son roughly, assaulting him, and tossing him on to his bed,” according to the spokeswoman for Kilmartin.

The couple rushed home, confronted Fanuef, and took their son to Hasbro Children’s Hospital, where doctors found a bruise on his arm, a bump on his head, and a blood spot in his left eye.

After her arrest, Faneuf  “offered no acceptable reasons for her behavior towards the boy, except to say she was overworked and tired, and admitted the care was ‘not up to standards’  that evening,” according to Kilmartin’s spokeswoman.

Kilmartin said of the case: “This young boy needed care and compassion, but in a fit of rage and anger, his caretaker physically assaulted him. As a professionally trained LPN, her actions are even more troubling. The developmentally disabled are among our most vulnerable population, often unable to report an assault or abuse. Had it not been for his loving parents installing a video camera to monitor their son’s health, this assault very well may not have been reported and this defendant free to assault more patients.”

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.  

RI House Finance Committee Gives Raimondo Part of Her DD Budget Request for Next Fiscal Year

By Gina Macris

Rhode Island Governor Gina Raimondo would get about $11 million of an added  $16.9 million in combined federal and state Medicaid revenue she requested to fund developmental disability services in the next fiscal year, according to an early morning vote June 8 by the House Finance Committee. 

One thing that is clear is that much of the added revenue would be used to restore money for  unrealized savings envisioned in Raimondo’s budget proposal.  A planned shift of as many as 500 individuals from group homes to less costly shared living arrangements will not materialize, at least not in a single budget year, according to the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.  

 The committee specifies that about $4 million be targeted for activities to comply with a federal consent decree intended to correct violations of the Americans With Disabilities Act by providing more community-based supports to help adults with intellectual challenges find regular jobs. 

Meanwhile, the Finance Committee denied Raimondo’s request to carry forward into the new fiscal year, starting July 1, a total of $5.8 million for a caseload increase, saying that developmental disability caseloads historically remain stable.

What impact that denial might have on the rest of the BHDDH plans for developmental disability spending is  not clear. 

A more complete picture of what the House Finance vote means to developmental disabilities programs is expected to emerge in the days to come. 

The vote occurred about 1:30 a.m., with aides scrambling to distribute copies of various budget articles to committee members just moments before they were asked to weigh in on an overall total of $9 billion in state spending.

 The full House is expected to vote on the budget June 15. The budget then would be transmitted to the Senate. 

 The state is under a federal court order to meet nearly two dozen benchmarks by the end of this year to comply with a federal consent decree requiring the state to reorganize its services for adults with developmental disabilities around regular jobs and other community-based activities. 

One of the requirements of the court order, issued May 18 by U.S. District Court Judge John J. McConnell, Jr., is that the state adopt Raimondo’s budget request for developmental disability services. 

The order mentions no dollar amount, but it appears - without the $5.8-million carryover - that the committee-approved budget is not in compliance. 

If the U.S. Department of Justice finds the allocation is insufficient to achieve court-ordered goals, it may ask the judge to hold a contempt hearing, according to the order.  The order provides for penalties starting at $1,000 a day, with a ceiling of $1 million for the current calendar year. 

The House Finance Committee also would require BHDDH to report monthly on a number of data points, including all the consent decree compliance information reported to the federal court, as well as other information intended to enable the legislature to keep better track of funding for adults with intellectual and developmental disabilities.

RI State Senators Want EOHHS Review, Oversight of State-Run Group Homes

By Gina Macris

 Reacting to the recent death of a group home resident in Providence, Rhode Island, State Senator Louis DiPalma is seeking a thorough review of state-run housing for adults with developmental disabilities.

Dipalma                                       image by ri capitol tv

DiPalma put his intentions in a legislative resolution that unanimously passed the Senate Committee on Health and Human Services May 31. The committee chairman, Sen. Joshua Miller, (D-Cranston and Providence) and three other committee members are co-sponsors. 

The resolution needs a floor vote in the Senate before it is submitted to Elizabeth Roberts, the Secretary of Health and Human Services.

The measure asks the Executive Office of Health and Human Services to review the “structural, programmatic and policy changes needed to best address the licensure, regulation, and oversight” of the 25 group homes run by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) under the name Rhode Island Community Living and Supports (RICLAS). EOHHS would report back to the Senate by Jan. 4, 2017.

HHS Secretary Roberts recently acknowledged that the conflict between BHDDH licensing and investigating its own group homes must be eliminated.

A total of 155 people live in the 25 state-run homes as of June 1, according to a BHDDH spokeswoman.  In contrast, there are about 1,118 in the private system.

The resolution asks EOHHS in its oversight role to make sure that individuals with intellectual and developmental disabilities have high-quality residential services that are both cost-efficient and safe.

The death of Barbara Annis at the former College Park Apartments highlighted health and safety issues within RICLAS, but there also have been concerns about the high cost of operating the state system, particularly when BHDDH has admitted it does not pay enough to cover the actual expenses of private agencies providing most of the residential and day services.

The BHDDH-licensed and operated RICLAS homes cost an average of $544 a day for each resident, more than twice the average daily cost of $197 per person in the private group home system, the BHDDH director, Maria Montanaro, told the House Finance Committee recently.

After the May 31 HHS Committee meeting, Miller, the chairman, questioned whether those figures were accurate, saying he didn’t think they reflected the more complex needs of residents in RICLAS homes.

Spokespersons for private group home operators and BHDDH itself dispute the notion that RICLAS residents have greater needs than those in the private group homes. Both systems have about the same proportion of clients who require extensive services, said the BHDDH spokeswoman, Linda Reilly, although RICLAS homes tend to have older residents. 

Montanaro, the BHDDH director, has said that the state created RICLAS for former residents of the Ladd School, the state institution for adults with developmental disabilities, which was closed in 1994.

Montanaro said RICLAS was envisioned as a temporary measure until the state could grow a private network of service providers to serve adults with a wide range of needs.

The privately-run system is now fully developed, she said, but the state has continued to run RICLAS, albeit with fewer homes than there were years ago.

The union representing state workers in RICLAS homes, Council 94 of the American Federation of State, County and Municipal Employees, vigorously defended its members when it appeared early in the current legislative season that Montanaro might reduce the number of RICLAS homes by convincing residents to move to less costly shared living arrangements in the community. That shift has not materialized, at least not in the short term. 

Asked about DiPalma’s resolution seeking a review of RICLAS, Jim Cenerini, the union spokesman, said he would withhold comment until after the study is completed.

Besides DiPalma and Miller, other co-sponsors of the resolution are Senators Gayle L.Goldin, (D-Providence), Cynthia A. Coyne, (D-Barrington, Bristol and East Providence) and Adam J. Satchell, (D-West Warwick). DiPalma, a Democrat, represents Newport, Middletown, Tiverton and Little Compton.

Among other things, the resolution asks EOHHS to make sure all residents of state-run group homes have up-to-date individual service plans, detailed formal agreements between clients and the state that serve as foundations or “blueprints”  spelling out the goals of each person supported by BHDDH and the services and needed to help each one make progress.

Some residents of RICLAS homes do not have current individual service plans, which are supposed to be revised annually, according to a BHDDH spokeswoman.  

These plans are also necessary for compliance with a 2014 federal consent decree between the state and the U.S. Department of Justice intended to give persons with disabilities choices in how they lead their lives.

In an interview, DiPalma talked about another worrisome issue, that of pay disparity between the state and private systems.

He said RICLAS employees make between $15 and $25 an hour, while workers in the private system make poverty wages, ranging from $10 to $13 an hour.

The union for RICLAS employees negotiates pay scales with the state. 

Direct care workers in the private sector were making as much as $15 an hour until 2011, when the General Assembly cut a total of 13 percent - $26 million – from payments to private disability service agencies.

Budget increases enacted since that time have been used to close chronic deficits in developmental disability spending. 

Governor Raimondo’s proposed budget would allow private agencies to give raises of no more than 60 cents an hour, DiPalma said.

“That’s still not enough for people who do God’s work,” he said. 

DiPalma said he is determined to press for a minimum of at least $13.97 an hour for direct care workers in developmental disabilities, with future raises linked to the consumer price index.

A bill he sponsored establishing that $13.97 minimum appears to have died in committee this year, because it would have cost tens of millions of dollars to implement, but he said he plans to do additional research and reintroduce the legislation in the next session.

What the state pays private-sector workers for extremely difficult jobs “is just not right,” he said.

In a telephone interview, DiPalma said that what happened at the state-run College Park Apartments can never happen again. He referred to the death Feb. 15 of Annis, a 70-year-old resident who had a leg fracture that went untreated long enough for an irreversible infection to set in. College Park has since been closed by BHDDH.

“We need to be proactive and figure out what the issues are,” he said.        

Without outside oversight of the RICLAS homes, the state will not be able to ensure that individuals receiving state services get “quality care at the right time at the right place,” he said.  

Meanwhile, as a result of Annis’ death, five employees of College Park Apartments were placed on paid leave and the home was closed March 25. Both the Rhode Island State Police and the Medicare Fraud and Patient Abuse Unit of the state Attorney General’s Office have launched criminal investigations.

Between December and March, there were two other reports of alleged patient abuse or neglect at College Park. In one, a woman complained that a staff member assaulted her, and in the other an 89-year-old woman was found unconscious with head and shoulder injuries and revived, according to internal BHDDH reports.

There was a nine-hour delay before the 89-year-old woman was sent to the hospital for a check-up.  She was held overnight – and neither that incident nor the alleged assault was reported promptly as required to internal BHDDH investigators.

The internal BHDDH reports were released by the Attorney General in response to a request by Developmental Disability News under the state Access to Public Records Act. The office declined further comment on the two incidents, saying the cases are still open.

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.  

Newly Disclosed Details About Group Home Indicate Delays in Care and Incident Reporting

By Gina Macris

COLLEGE PARK APARTMENTS

Newly-disclosed incidents at College Park Apartments in Providence, the state-run group home closed after the death of a resident, indicate a troublesome pattern of delay in treating injuries and reporting alleged abuse or neglect.

The incidents were disclosed in documents obtained through a reporter’s request under the Rhode Island Access to Public Records Act. (APRA).

While the reports fill in some detail about the kinds of problems that prompted the state’s Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) to close College Park Apartments, they raise as many questions as they answer.

In addition, the internal BHDDH reports highlight different interpretations of the public’s right to know, in that they were denied in a reporter’s records request to BHDDH, but they were released in response to the same reporter’s request to the Rhode Island Attorney General.

In the aftermath of the death of the College Park resident, the state Secretary of Health and Human Services, who oversees BHDDH, recently acknowledged that the department’s privacy laws are overly restrictive and that there needs to be a better balance between confidentiality and government transparency.

The troubles at College Park surfaced after 70 year-old Barbara Annis died on Feb.15, 2016 at Roger Williams Medical Center. A leg fracture had gone untreated and a massive infection set in. Two criminal investigations into her death are still underway, one by the Medicaid Fraud and Patient Abuse Unit of the Attorney General’s Office, and another by the Rhode Island State Police.

The newly released documents obtained by Developmental Disability News disclose three other incidents. 

On March 8, 2016, the staff of College Park found an 89 year-old woman unconscious, with a bloody mouth and other unexplained head and shoulder injuries. Although the resident was discovered at 5 a.m. and needed oxygen to regain consciousness, it wasn’t until nine hours later – at 2 p.m.-  that she was taken to the hospital.

She was admitted and held overnight at Roger Williams Medical Center, returning to College Park the next day. That incident remains an open case in the Attorney General's files, according to a spokeswoman.

Two months before Annis died, on Dec. 11, 2015, another woman who lived at College Park complained that a staff member had assaulted her. All reports of suspected abuse or neglect must be made promptly to the internal investigatory unit of BHDDH, but that one did not reach investigators until Dec. 28, more than two weeks after the fact.

According to an internal report, two supervisors at College Park were involved with the complaint and each believed the other had called the patient abuse hotline. The same resident complained she had been assaulted a year earlier, and in each instance, she accused the same staff member. That case also is still open with the Attorney General, according to spokeswoman Amy Kempe. 

A separate report involved a complaint from a nursing home to the Alliance for Better Long Term Care, apparently about bedsores on a terminally ill College Park resident the nursing home had treated. The bedsores worsened during the last nine months of her life, a period when she was hospitalized twice. A family member or guardian, whose name was redacted, also expressed dissatisfaction with hospital care, according to the report. This case has been closed by the Attorney General because there was not enough evidence to warrant criminal prosecution, according to spokeswoman Kempe. 

It appears that Annis’ death on Feb. 15, combined with the issues raised by the other internal investigations into College Park –particularly the unexplained injuries three weeks later - prompted the BHDDH director to ask Day One for an outside report on the operations of the group home.

Day One, the sexual assault and trauma center, was chosen for its expertise in interviewing children and adults with limited communications skills.

The BHDDH director, Maria Montanaro, and the Executive Office of Health and Human Services kept under wraps the fact that a group home resident had died for a month while Day One completed its report. BHDDH and EOHHS have declined to release that report, citing privacy laws.

Montanaro announced on March 18 that five College Park employees had been placed on paid leave and that BHDDH had revoked the group home’s license. The last residents moved March 24 and the doors closed for good the following day.

Questions Persist

The internal BHDDH reports released by the Attorney General’s office, while disclosing other incidents at College Park, still leave many questions unanswered.

The reports responded to an APRA request for all reports from BHDDH involving suspected neglect or abuse that had been forwarded to the Attorney General’s Office for review during 2015 and the first three months of 2016.

No group homes other than the state-run College Park were mentioned in the information released by the Attorney General’s office.

BHDDH is required to share allegations of neglect, mistreatment or abuse with the Attorney General’s office.

BHDDH itself declined to release these same reports in response to a separate, voluminous APRA request for information on the safety of individuals living in group homes for persons with developmental disabilities.

The department did, however, summarize complaints about College Park Apartments during 2015 and the first three months of 2016, ending March 22.

In a letter responding to the APRA request, BHDDH lawyer Thomas Corrigan said that there were a total of 17 complaints about College Park during that period. The letter said: 

• Six investigations were opened.
• Five have been closed and one remains open.
• Two did not require corrective action. 
• Three cases which required corrective action focused on staff training, employee discipline, incident reporting, management challenges, security, staffing, review of individual support plans (blueprints for each person’s program of services) clarification of management and staff roles, improved documentation and equipment and hygiene inspections.

Corrigan also provided statistics about complaints regarding College Park during 2013 and 2014, with the caveat that BHDDH began to change its incident reporting and classification system in January, 2014, and numbers before and after that date cannot be compared accurately.

 Corrigan’s letter did not say how many complaints from 2013 and 2014 warranted investigations or corrective action plans. He said there were 32 complaints in 2013 and 17 calls in 2014.

Collecting this information was a time-consuming process. Corrigan said in a telephone interview. BHDDH is not required to keep aggregate data on complaints as standard operating procedure, he said.  

Corrigan also responded by telephone to other questions about the operation of College Park and more than two dozen state-run group homes.

In the interview, Corrigan was asked why BHDDH did not change the staff, rather than closing the home and further disrupting the lives of the remaining residents – 13 individuals.

He said, “There were too many unknowns about what was happening at College Park, as opposed to going where we know there isn’t a problem.”

At state-run group homes, operated by a division of BHDDH called Rhode Island Community Living and Supports (RICLAS), each nighttime shift is staffed by a nurse and direct care workers. Supervisors are not present at night, but two coordinators for all the homes - more than two dozen facilities - are available by telephone, he said.

College Park was divided into three self-contained units or “apartments”, each one with four or five residents, Corrigan said.

BHDDH released several hundred pages of redacted staff logs from College Park that indicated it operated much like a nursing home.

One supervisory note warned staff not to falsify time sheets – they are kept on paper, not electronically. Other notes reminded staff to stay in their self-contained “apartments” for their entire shifts.

The staff logs contain a notice for Barbara Annis’ funeral service Feb. 24 at the Russell Boyle Funeral Home on Smith Street in Providence. Burial was to be in North Burial Ground off North Main Street.

There was no public obituary or death notice. Corrigan said Annis had no next of kin and her estate was not sufficient to pay for a notice.

Ombudsperson Could Provide Transparency

Elizabeth Roberts, Secretary of Health and Human Services, cited overly restrictive privacy laws about a week ago, when she appeared before the Senate Health and Human Services Committee and presented the results of 30 unannounced group home inspections  that were conducted jointly by the state Department of Health  and BHDDH investigators in the wake of Annis’ death and other problems at College Park.

L TO R: MARIA MONTANARO AND ELIZABETH ROBERTS AT THE STATE HOUSE.

Alluding to media inquiries prompted by the College Park situation, Roberts highlighted the fact that “current statutes restrict BHDDH from releasing information most other – if not all other – licensing bodies would be obligated to release.”

“The original intent of these restrictions was most likely a well-meaning effort to protect individuals’ privacy, but we can protect residents’ privacy and ensure that the public – especially families who count on these residential services – are aware of issues with resident safety,” she said.

Later in the week, a spokesman for Roberts said the Secretary sees the potential for an ombudsman for persons with intellectual or developmental disabilities to serve as a “conduit” for releasing information of public interest that otherwise would remain shielded.

A bill creating such an ombudsperson was prompted by Annis’ death and its aftermath. The bill, H-8038, was introduced by state Rep. Eileen Naughton, D-Warwick, and has been referred to the House Finance Committee.

Eileen Naughton 

As the bill is now written, however, the ombudsperson may not be able to provide the transparency that Roberts envisions. The ombudsperson would be required to make annual public reports on the activities of his or her office. But the legislation does not contain specific details about the extent of that reporting. Files maintained by the ombudsperson would be confidential, according to the bill.

The ombudsperson would be appointed by the Governor from a list of candidates recommended by a nominating committee. The new office would be part of the state Department of Administration.

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

DOJ: No Merit to Rhode Island's Objections to Compliance Fund

By Gina Macris

Saying Rhode Island’s objections have no merit, federal lawyers for a second time have urged a U.S. District Court judge to set aside state dollars to fund the so-called “sheltered workshop” consent decree – or to fashion whatever remedy he sees fit.

“The State’s objection to funding the Consent Decree is concerning and brings into questions its commitment to making the changes required,” lawyers for the U.S. Department of Justicewrote in a May 16 filing with the Court.

“Thus this Court must act to provide adequate incentive to the State to fund theConsent Decree, which it undoubtedly has the power to do,” the DOJ lawyers wrote to Judge John J. McConnell, Jr.

The DOJ’s plan would require the state to pay $5,000  each day it misses various compliance deadlines, and an additional $100 a day for each person whose services are delayed or interrupted as a result of inaction, with a cap of $1 million a year.

As an alternative to paying into the proposed Consent Decree Compliance Fund , the DOJ lawyers suggested that McConnell  come up with his own remedy.

The government’s remarks came in a filing in which it expressed surprise that the state is now offering “meritless objections” to paying into the proposed fund to  fulfill its responsibilities under provisions of the Americans with Disabilities Act (ADA).

In 2014, a DOJ investigation found the state for decades had illegally segregated adults with disabilities in sheltered workshops that paid sub-minimum wage, and in day programs cut off from the community. Rhode Island then agreed to federal supervision over a ten-year period to transform its system to emphasize supported employment in the community, adopting an “Employment First” policy.

The 2014 agreement marked the first such consent decree in the nation aimed at turning around daytime services that violate the 1999 Olmstead decision of the U.S. Supreme Court.

But the decree is just one part of a much broader, aggressive push begun by the Obama administration in 2009 to enforce the  Olmstead order, which said that Title II of the ADA requires agencies to serve individuals with a variety of disabilities, day and night, in the least restrictive environment that is appropriate.

In Rhode Island, the DOJ’s civil rights division earlier in May asked McConnell to put the court monitor in the case in charge of a Consent Decree Compliance Fund, citing the state’s continued failure to implement reforms.

The court monitor, Charles Moseley, would decide how to spend the money to benefit adults with disabilities.

Marc DeSisto, the state’s lawyer, objected, saying, in part, that the proposal amounts to a contempt order without the procedural rights enabling a defendant to show it made its best efforts to comply but was thwarted by forces beyond its control.

On May 16, the DOJ replied that “a finding of contempt would be appropriate at this juncture,” but its proposal does not ask for that. Instead, the Consent Decree Compliance Fund is envisioned as a vehicle for funding the consent decree, something the state said it wanted to do, according to the latest DOJ arguments.

During the last few months, all sides have agreed – in open court – that the developmental disabilities system does not have enough money to meet the consent decree requirements.  

Moseley, the monitor, told McConnell at one point that if the state didn’t meet certain benchmarks now, it would be impossible to achieve overall compliance by the time the decree expires on Jan. 1, 2024.

It was the state’s lawyer, DeSisto, who initially approached the DOJ and the monitor to ask for an evidentiary hearing so that the judge could gauge the state’s progress on compliance and decide what yet needed to be done to put the state on track to meet long-term goals.

At the hearing, held April 8, the state could not provide an accurate census of the individuals covered by the consent decree, the DOJ noted, but it did present evidence about a plan for achieving compliance going forward.

Now, the state is objecting to its own plan,  the DOJ lawyers said.

“After two years of noncompliance,” federal lawyers wrote, “it is appropriate and necessary, in the absence of commitment by the State to the basic compliance measures outlined in the Proposed Order, for the Court to take action.”