Legislative Alert #3 - Action Required

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The legislative session is in full swing and both the House and Senate have cuts slated for Developmental Disabilities.

Please read below action item highlighted in yellow and contact the legislators listed at the bottom of this email.

Developmental Disabilities

Legislative Session Report #3

By Kingsley Ross

k.ross@...

Summary: Week 3 of this year’s legislative session turned out to be busy and notable for people interested in developmental disabilities (DD). A delegation of self-advocates, parents, and staff gathered at the Capital to help make legislators more aware of the needs of people with DD. In addition, there was action on managed care and appropriations.

Action during week 3:

House and Senate Appropriations Subcommittees released their chairman’s recommendations. The House’s position is substantially better than the Senate’s. The House covers this and next year’s deficit and, with two exceptions, does not cut the Medicaid Waiver. The Senate did not cover either this or next year’s deficits at all and requires an overall Waiver rate cut of 5% along with the two cuts the House took.

Proposed Cuts for the Agency for Persons with Disabilities (APD)

House

(n millions)

Senate

(in millions)

5% across the board Waiver provider rate cut

0

-42.8

Cut So FL geographic rate differential – in half for Palm Beach, Broward & Dade; Monroe by more than 80%

-2.9

-2.9

Reduce service rates to “individual rates†vs. corporate rates. Effects companion & several other services.

-34.0

-34.0

Freeze cost plans

0

-6.9

Other reductions including administration

-4.8

-3.5

Cover Waiver deficit for FY 2010-11 ($169.2 mil) and 2011-12 ($110.4 mil)

+279.6

0

Reduce private Intermediate Care Facilities for DD (ICF/DD) by 3% (House) or 5% (Senate)

-6.3

-10.5

In addition, the House Appropriations Committee heard the House’s managed care Medicaid reform bills and passed them out of committee after major revisions. These changes included limiting liability claims for medical care (tort reform) and directing that excess profits (from managing services to people with DD) are to be used to serve the waiting list.

Finally, Disability Rights Florida (formerly the Advocacy Center) filed a Federal class action suit against the state for not serving people on the waiting list and APD announced a freeze on all cost plan changes except for emergencies.

Anticipated Action in Week 4: The House and Senate Appropriations Committees will receive their subcommittee budgets and the House will take up its managed care bill on the floor.

Action Needed. Contact your Senators (especially appropriation members). Tell them that cutting rates means cutting services. Providers will have to cut staff and that means less service.

Please see the committee member list below.

Background Analysis:

The House and Senate appropriation committees are already in the process of getting ready for conference which will not take place until the final weeks of the session. To do this, they are setting up key differences in their budgets that they can “trade†off with each other to get close to what they want. This posturing process occurs every year. Advocates at this point try to minimize the differences so there is little to trade off. In our case, the House budget is very good compared to the Senate’s for people with DD so pressure must be put on the Senate to change its position. What kind and how much pressure will work becomes a key question. This year, it appears that the best chance of succeeding is to remind members of the Senate appropriations subcommittee on HHS about the needs of the people with DD and that rates cannot be reduced without negatively impacting services.

For his part, Senator Negron has stated repeatedly that people with DD are his highest priority. He is in the unenviable position of receiving a substantially smaller allocation than his counterpart in the House to meet the needs his subcommittee must cover. Nevertheless, based on his statements, Negron believes that rate cuts do not equate to cuts in services and he has ignored the fact that the cuts he has recommended are cumulative. In addition, so far he has been unwilling to accept suggestions for saving money elsewhere in APD’s budget, such as privatizing one or more of the state’s institutions.

The action in the House on Managed Care is of some concern. Adding tort reform language in the eyes of some lobbyists sets up the possibility of a trade then not be in the interest of people with DD. The trade that these lobbyists envision is that the two chambers will agree to accept the House’s managed care language and the Senate’s tort reform language. Since services to people with DD are in the House’s managed care language, we will have a more difficult time being “carved outâ€.

In addition, the idea of using excess profits for the waiting list sets up a new dynamic. Until now, if a managed care organization (e.g. HMO) generated excess profits, they would simply lose them back to the state. There would in effect be no incentive for the state to encourage excess profits and, theoretically, more money could end up being used for services. With this change, the state now has an interest in encouraging excess profits since that will be used to help resolve the waiting list.

Another factor that has surfaced is that some elements of the Governor’s Office are suggesting that a managed care Community Based Care (CBC) model may be a better way of administering services. The CBC model is a system of non-profit lead agencies that purchase services from other providers in a specific geographic area (e.g. Miami-Dade County) for the consumers in that area. This is the model that is currently being used to serve dependent children in Florida. In our case, a new set of lead agencies would have to be established. As currently envisioned, these lead agencies would receive a capitated rate for each consumer they served based on an algorithm similar to that developed for the iBudget. All services would have to be managed within those funds.

Whether this is a better model remains to be seen but clearly the Governor’s Office is supporting a managed care solution for services to people with DD.

Finally, the class action suit for the waiting list may further complicate the chances of staying out of managed care. While the suit has been welcomed by many advocates, launching it now with the legislature in session and the House already looking at managed care as part of the solution for the waiting list, the class action suit could serve as another rationale for not carving out services to people with DD.

Another complicating event is that when the Governor spoke at the DD awareness day event, he was heckled by self-advocates and others chanting “No More Cutsâ€. He was also booed as he left the event by a small group of people. The Governor’s office staff took this to mean that the consumers had been manipulated by providers. There is no doubt that the event left a “bad taste†in the mouths of the Governor and his staff. A news video of the event can be seen at http://www.wtxl.com/mediacenter/local.aspx?videoid=2320831 and an audio clip on the rally can found at http://www.publicbroadcasting.net/wfsu/news.newsmain/article/0/4046/1779546/State.News/Disability.advocates.rally.against.cuts. (The Governor speaks at the end of the audio clip).

Senators – Health & Human Services Appropriations Subcommittee

First Name

Last Name

District City

District Phone

Tallahassee Phone

Email Address

Don

Gaetz (D)

Destin

gaetz.don.web@...

Rene

®

Hialeah

garcia.rene.web@...

Steve

Oelrich

Gainesville

oelrich.steve.web@...

Nan

Rich

Sunrise

rich.nan.web@...

Garrett

Richter

Naples

richter.garrett.web@...

Eleanor

Sobel

Hollywood

sobel.eleanor.web@...

Regards,

Ven Sequenzia

President

Autism Society of America

State of Florida Chapter