(Cross-posted from the COFAR blog)
After a month and a half, it’s troubling that the Patrick administration is apparently still unable to locate cost records we requested pertaining to a single community-based group home contract.
I just received a letter from the Department of Developmental Services, dated September 14, that they are in the process of searching for the documents, which I had requested on July 29. Meanwhile, the MassHealth Privacy Office in the Executive Office of Health and Human Services has been searching for these same records since August 9.
To recap, we’ve been trying to find out the sources of state funding for medical, nursing, clinical, and therapeutic services in a single DDS group home program run by the May Institute, a private provider. We have a copy of a $1.2 million contract with the May Institute, which provides for 24-hour residential services under the program for 14 individuals in four residences in the DDS Central Middlesex Area.
The FY 2009 contract, however, only provides for direct care and limited nursing services for the 14 residents. It does not mention medical, extended nursing, clinical or therapeutic services.
From what we’ve been able to determine, the administration has been basing its $20 million annual cost savings estimate in closing the Templeton, Monson, and Glavin Developmental Centers on a comparison of their budgets with the cost of community-based group contracts such as the May Institute contract. But here’s the rub. Our understanding is that the Templeton, Monson, and Glavin budgets do provide for medical, extended nursing, clinical, and therapeutic services.
Naturally, the community system will appear to be less expensive than the developmental centers if certain community-based costs are not taken into account. That’s why we want to find out exactly how much is being paid to fund those additional services to which the May Institute residents are reportedly entitled, and where that money is coming from.
By the way, we originally asked DDS on July 7 for the budgets of the Monson, Templeton, and Glavin Centers. A month later, we received a one-page document from the department with single, line-item amounts representing the total annual spending for each facility. There was no budgetary breakdown whatsoever for the facilities.
We appealed to the state’s Public Records Division for help, explaining that a budget of a state facility involves more than just a single line item. As a result, I received a second letter from DDS, also dated September 14, stating that the department was in the process of searching for the “additional (budgetary breakdown) information” I had requested.
I guess DDS considers a budget and a “budgetary breakdown” to be entirely separate concepts. Stay tuned.
It’s becoming more apparent that the Patrick administration’s and DDS’s facilities vs. community-based group home comparisons are not apples for apples. One side of the scale is a pint of blueberries. On the other, a watermelon.
There are two things to find here, and neither may be in the right place.
Since this is a private provider home, it is unlikely to have individuals as old and disabled as the average person in a Massachusetts Developmental Center. Thus one would have to control for the individuals in the home. However, since there are 14 residents, it would appear to be four group homes in one contract, and they would be clustered in this way possibly to provide for such disabled people.
Assuming one controls for that, some of the most expensive services provided most efficiently in an ICF — medical, dental, individual OT, ST, PT — are in the MassHealth and Medicare budgets, and sorted by the individual person. It will take quite a long time, almost as long as doing an honest cost study as mandated by the FY2010 budget and deleted from the 2011 language, to figure it out.
It should be easier, but apparently isn’t, to sort out what the taxpayers have subsidized to build this home via low-interest loans, because the providers account that separately, and often in holding companies subsidiary to something like May Institute.
Then, of course, there are some services provided in ICFs which simply cannot be provided by group homes, medicare, or medicaid. The Glavin Center, specializing in people with both ID/D and mental health diagnoses, can offer extended in-patient mental health treatment even for people who have been hospitalized outside the center in a crisis. This is a level of service DMH has almost entirely shut down (and DDS clients by regulation are excluded from DMH services) and Medicaid and Medicare cannot buy, because they do not otherwise exist in Massachusetts. I have met a few people served by DDS who have had this level of service as youth under 21, but it was provided in specialty wards out of state. Outside of the Glavin Center, where 60 empty beds are presently wasted in a gridlocked MR/MH system, the only other place I know where an adult DDS client can have an extended in-patient stay is a small specialized (and award winning) unit at the Hogan Center.
used to live in a group home run by this same contractor emailed us to say that 1) there was virtually no nursing care in the residence and 2) she paid for physical therapy for her daughter through her insurance. That’s apparently why DDS believes there will be a savings in eliminating ICF care.
Who are the best people to write to?
State Senator Michael Rodrigues
State House
Room 213B
Boston, MA 02133
Phone: 617-722-1114
Fax: 617-722-1498
Email: Michael.Rodrigues@masenate.gov
and Rep. Kay Khan
Room 146
Boston, MA 02133
Phone: 617-722-2011
Fax: 617-722-2238
Email: Kay.Khan@mahouse.gov
They are the co-chairs of the Children, Families, and Persons with Disabilities Committee, which is currently considering Rep. Anne Gobi’s bill (H1859) that would require a new cost analysis prior to closing the Monson, Glavin, and Templeton Developmental Centers. Urge them to report out this bill favorably, and to make sure it contains language requiring an independent study by a non-governmental entity selected by the state Inspector General.
The bill has been in the committee since January.