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Commonwealth of Pennsylvania House of Representatives Human Services Committee Hearing State Capitol Harrisburg, Pa Capitol East

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Commonwealth of Pennsylvania House of Representatives Human Services Committee Hearing State Capitol Harrisburg, Pa Capitol East COMMONWEALTH OF PENNSYLVANIA HOUSE OF REPRESENTATIVES HUMAN SERVICES COMMITTEE HEARING STATE CAPITOL HARRISBURG, PA CAPITOL EAST WING ROOM 60 MONDAY, JUNE 4, 2012 10:30 A.M. PRESENTATION ON IMPACT OF POLICY AND PAYMENT PROCEDURES ON HOME AND COMMUNITY-BASED SERVICES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES BEFORE: HONORABLE GENE DiGIROLAMO, MAJORITY CHAIRMAN HONORABLE SHERYL M. DELOZIER HONORABLE MARCIA M. HAHN HONORABLE SUSAN C. HELM HONORABLE THOMAS H. KILLION HONORABLE THOMAS P. MURT HONORABLE MICHELLE F. BROWNLEE HONORABLE MADELEINE DEAN HONORABLE PAMELA A. DeLISSIO HONORABLE EDDIE DAY PASHINSKI HONORABLE KEN SMITH * * * * * Pennsylvania House of Representatives Commonwealth of Pennsylvania 2 1 I N D E X 2 TESTIFIERS 3 * * * 4 NAME PAGE 5 KEVIN FRIEL DEPUTY SECRETARY, 6 OFFICE OF DEVELOPMENTAL PROGRAMS, PA DEPARTMENT OF PUBLIC WELFARE..................4, 61 7 GENE BIANCO 8 PRESIDENT AND CEO, PA ASSOCIATION OF REHABILITATION FACILITIES........................41 9 GABRIELLE SEDOR 10 COMMUNICATIONS DIRECTOR, PA ADVOCACY AND RESOURCES FOR AUTISM 11 AND INTELLECTUAL DISABILITIES.......................49 12 LINDA DRUMMOND POLICY SPECIALIST, 13 PA COMMUNITY PROVIDERS ASSOCIATION..................53 14 BRIAN BAXTER CONSULTANT, INTELLECTUAL DISABILITIES 15 AND AUTISM SERVICES COALITION OF PA.................58 16 MARK J. MURPHY CEO, DISABILITY RIGHTS NETWORK OF PA................75 17 18 19 20 21 22 23 24 25 3 1 P R O C E E D I N G S 2 * * * 3 MAJORITY CHAIRMAN DiGIROLAMO: Good morning, 4 everyone. If I could have everybody's attention. 5 The hour of 10:30 having arrived, I'd like to call 6 the meeting of the Human Services Committee to order and ask 7 everybody to rise for the Pledge of Allegiance. 8 9 (The Pledge of Allegiance was recited.) 10 11 MAJORITY CHAIRMAN DiGIROLAMO: Okay. Good morning 12 to everyone, and welcome to the committee meeting. And we 13 would like to remind everyone that the cameras are on and we 14 are being recorded. 15 And the first order of business, maybe I'll allow 16 the Members to just give a short greeting and identify 17 themselves. 18 Representative Killion. 19 REPRESENTATIVE KILLION: Tom Killion from Delaware 20 and Chester Counties. 21 REPRESENTATIVE HAHN: Marcia Hahn from Northampton 22 County. 23 REPRESENTATIVE HELM: Good morning. 24 Sue Helm, Dauphin County. 25 MAJORITY CHAIRMAN DiGIROLAMO: Gene DiGirolamo, the 4 1 Republican Chairman from Bucks County. 2 REPRESENTATIVE MURT: Tom Murt, Philadelphia and 3 Montgomery Counties. 4 REPRESENTATIVE DEAN: Madeleine Dean -- good morning 5 -- Montgomery County. 6 REPRESENTATIVE BROWNLEE: Good morning. 7 Michelle Brownlee, Philadelphia County. 8 REPRESENTATIVE DeLISSIO: Pam DeLissio, representing 9 parts of Philadelphia and Montgomery County. 10 MAJORITY CHAIRMAN DiGIROLAMO: And Representative 11 Delozier has just arrived also. 12 I think we'll just get right down to business, and I 13 just have, you know, I'd like to ask the first panel to come 14 up, which is Kevin Friel and John Cox. 15 DEPUTY SECRETARY FRIEL: I'm sorry, John could not; 16 he's unable to join us. 17 MAJORITY CHAIRMAN DiGIROLAMO: Okay. 18 Kevin, just briefly, before we begin, I mean, we had 19 in December a committee meeting, back in December, and we heard 20 from some of the providers and the Department of Public Welfare 21 on the issues arising from the changes in policy and funding at 22 the direction of the Federal Government, and as a follow-up to 23 that meeting, today's participants want to discuss the 24 continued impact of the funding and the policy changes on 25 consumers with intellectual disabilities. 5 1 Last week, I believe you have a copy or you've seen 2 a copy of a letter that I addressed to Secretary Alexander 3 with, you know, the four topics -- the residential rates for 4 room and board and the costs associated with them; second is 5 the fee schedule rates; third is the occupancy factor in 6 setting residential rates; and the fourth is the RAF, the rate 7 adjustment factor. 8 Policy: I posed some questions in that letter to 9 Secretary Alexander, and it would be my hope and expectations 10 that you might be able to answer some of them questions today. 11 DEPUTY SECRETARY FRIEL: Sure. 12 MAJORITY CHAIRMAN DiGIROLAMO: So whenever you're 13 ready, you know, please begin your testimony. 14 DEPUTY SECRETARY FRIEL: Okay. Thank you. 15 What I'd like to do, if I could, is summarize the 16 testimony. Obviously we had submitted it so we do have enough 17 time for others and also for any of the questions that you 18 referred to. 19 So I'll start with good morning. It's a good way to 20 start. I say good morning to all and to all the Members. 21 My name is Kevin Friel. I think the last time I was 22 here, as the Representative said, was back in December. I say 23 thank you for having us here this morning to give you an update 24 on rate-setting for the coming fiscal year and also talk about 25 some of the events of the past year in the Office of 6 1 Developmental Programs. 2 As you're aware, the program office provides 3 services for persons with intellectual disabilities, important 4 services to an obviously very vulnerable population. We are 5 committed to ensuring the program can provide these services 6 now and well into the future. 7 ODP services have altered significantly over the 8 course of the years, moving from delivery in State institutions 9 to a system primarily offering a wide array of services in the 10 community, and then more recently, that system obviously 11 changed itself about 3 years ago, in July of 2009, when it 12 moved from a county-based to a State-operated program. 13 The transition, while necessary to comply with CMS 14 requirements and continue receiving matching funds, has been 15 challenging and has led to rapidly increasing costs through a 16 combination of limited fiscal controls and managerial 17 accountability. 18 The process, known as revenue reconciliation, 19 something intended to ease the transition from the county-based 20 to the State-based system, was paying beyond units of service 21 billed. And in some, as we finished our analysis over the last 22 2 years, for fiscal years '09-10 and '10-11, and again, for 23 that second year, some dollars were spent from the '11-12 24 budget, that total now is in excess of a quarter of a billion 25 dollars. 7 1 As I mentioned in previous testimony, we performed a 2 forensic scrub in order to reach a point where the office could 3 not only understand what we had spent but more clearly 4 understand where we were going, not only in terms of spend or 5 projected spend but to understand across the system, in the 6 different administrative entities or counties or regionally, 7 what was going on in terms of authorizations of service and 8 also utilizations as well. 9 The process was also important to inform us to 10 understand the impact of several policy decisions that have 11 been made since inception of the PPS, including, for example, 12 paying for empty bed days beyond Federal match and Federal 13 requirements. The review itself was necessary to make the 14 informed decisions about the program and to ensure viability 15 for those who need the services now as well as for those who 16 need the services in the future. 17 Admittedly, the road has been bumpy. People in 18 positions of responsibility, we have seen over several years 19 that the additional dollars did not equate to additional 20 services or, unfortunately, necessarily additional people 21 served. The administration takes seriously its legal and moral 22 obligations to help provide for those in need, especially 23 persons with intellectual disabilities, and do it in a way that 24 is effective, efficient, and compassionate. 25 The good news that I can report to this committee 8 1 today is that this department took prudent, sometimes difficult 2 steps, and our collective efforts today should focus on the 3 future. 4 Addressing the waiting list is a priority of this 5 administration. We look forward to working with you and others 6 in the Legislature to find and devote the resources to begin to 7 provide needed services to persons on the waiting list. After 8 nearly a year and a half, the department finally has a basis 9 for making decisions, both programmatic and financial, that 10 will enable us to begin to move forward towards a program to 11 provide services to persons on the waiting list, helping them 12 to achieve their goals. This should be our collective goal. 13 It is our hope that the budget discussions in front of us will 14 enable us to quickly roll out this initiative. 15 My staff and I have met with self-advocates, with 16 families, providers, and other stakeholders, all of whom have 17 provided excellent ideas on best practices for dealing with the 18 waiting list. This administration and the Governor on down is 19 committed to helping persons on the waiting list lead full and 20 productive lives. 21 The department is also actively pursuing alternative 22 proposals, including an expansion of the Shared Living Program, 23 which has been in existence for awhile, to open it up to allow 24 for family members themselves to be caregivers of the service 25 for loved ones. We believe that this would open up the 9 1 program.
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