Mr. (And Mrs.) Imagine! Go To Washington

In early June, some members of Imagine!’s Executive Team are traveling to Washington D.C. to attend The American Network of Community Options and Resources (ANCOR) 2011 Conference: Leading Cultures of Innovation and Advocacy. There are several reasons for us attending beyond the opportunity to network and learn new ideas from providers from across the nation: a couple of our team members will be presenting at this prestigious conference, and Imagine!’s very own Linda Rogers will be on hand to receive her award for being selected as ANCOR’s Direct Support Professional of the Year for the state of Colorado.

We thought we would take advantage of the opportunity to meet with some of Colorado’s legislators while we were in our nation’s capitol. We have been arranging meetings and it looks like we will be able to meet with several of our State’s Senators and Representatives when we are out there.

While we are finalizing those details, we have also prepared some brief talking points about issues surrounding the funding and delivery of services for individuals with developmental disabilities that we think warrants attention at the highest level. Today, I would like to share those ideas with you. You can read them below.

But don’t just be a passive reader! Let us know what issues you think our State’s leaders should be aware of. Feel free to comment below – and you can comment anonymously if you prefer. The more we can hear from interested readers, the better prepared we can be when we’re making the rounds in the halls of Congress.

Here’s our current talking points:

Medicaid

Medicaid is the lifeline for most people with significant disabilities, including developmental disabilities, as it is the largest funding source for healthcare and long term supports. Colorado has seen considerable cuts to funding for Medicaid services over the past several years. This has resulted in a decrease in services for individuals with developmental disabilities. If Medicaid funding continues to be the only option for individuals with developmental disabilities, Imagine! encourages Colorado and the Centers for Medicare and Medicaid Services (CMS) to consider the financial, economic, and service impacts of future decisions when considering substantive changes.

Over the past five years Colorado was mandated by CMS to change from a case rate (bundled rate) funding system, managed by not-for-profit community boards, to a fee-for-service system managed at the state level. This change has resulted in a reduction in both the quality and quantity of supports, increased administration costs, increased regulation, and budget shortfalls. The current CMS models do not effectively support individuals with developmental disabilities.

We do not support the current proposal to block grant Medicaid funding. Block funding will negatively impact funding for future services and increase already large waiting lists.

Instead, Imagine! supports the service options identified in the Affordable Care Act’s (ACA) Community First Choice Option, because it encourages person centered approaches that are an alternative to more expensive institutional level care.

We believe further federal research and better data collection is warranted to develop a long term approach that focuses on cost effective and outcome based models to better meet the needs of individuals with disabilities, as well as to address concerns of growing waiting lists.

Imagine! encourages the use of more technology in service provision. Technology has been shown to be a cost effective method to support consumers, families, and service providers in meeting health and safety needs, as well as enhancing activities of independent or supported daily living. In addressing the use of technology, consideration must be given to offering incentives that encourage providers and families to use technology, along with provisions for clear reporting requirements of outcomes when implemented.

In order to help build the case for incorporating technology into services, Imagine! has designed and constructed two SmartHomes. The SmartHomes provide permanent housing for individuals with physical, cognitive, and developmental disabilities. The SmartHomes are serving as a model for the future of care for people with cognitive disabilities.

We support the recent efforts to encourage the use of electronic health records (EHR). There is an increasing amount of research that demonstrates the benefits of EHRs. The recent incentives were primarily for clinical sites. We believe that expanding these incentives to community based long term care services would prove equally beneficial.

Conflict Free Case Management

Imagine! is aware of the provisions of the Affordable Care Act and its references to structural changes for states. One of the subjects brought up in the suggested structural changes is conflict free case management services, including development of a service plan, arranging for services and supports, supporting the beneficiary (and, if appropriate, the beneficiary’s caregivers) in directing the provision of services and supports for the beneficiary, and conducting ongoing monitoring to assure that services and supports are delivered to meet the beneficiary’s needs and achieve intended outcomes.

We support the concept of conflict free case management, realizing this may assume many different forms.

We would like to see service planning as close to the end-user as possible, as well as case management services delivered in the most efficient and effective method possible. Therefore, we do not support any Federal initiative that would require separating case management from other types of service provision, which would likely result in more costs to an already cost burdened system.

HUD

Imagine! supports continued funding for the HUD 811 program. The 811 program helps to provide affordable housing to individuals with developmental disabilities. Affordable housing becomes even more critical as Medicaid waiting lists are growing. In Colorado an estimated 12,000 individuals are waiting for services. Of those 12,000, approximately 6,000 are living with caregivers who are 60 years or older. As future growth in Medicaid will be limited, it is necessary that funding for the 811 program continue to help meet the expanding service needs of individuals with developmental disabilities. The HUD 811 program is the primary program that provides individuals with developmental disabilities with options for affordable housing. Reducing funding for this program could jeopardize the health and safety of some of our most vulnerable citizens.