March 4, 2009

Action DD’s Presentation to the Washington State Legislature

2009

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 The U.S. Supreme Court in the Olmstead decision stated –  

“We emphasize that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings

 ----Nor is there any federal requirement that community-based treatment be imposed on patients who do not desire it.

  Nothing in this part shall be construed to require an individual with a disability to accept an accommodation…which such individual chooses not to accept…Persons with disabilities must be provided the option of declining to accept a particular accommodation.

The Olmstead DecisionThe Law

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 FEDERAL LAW AND Medicaid Waivers Federal requirements for states using waivers under Section 1 915c of the Social Security Act are codified in 42 Code of Federal Regulations, Chapter IV, Sub-part G – Home and Community Based Services.42 CFT Chapter IV: Paragraph 441.302. State Assurances  HCFA will not grant a waiver under this subpart and may terminate a waiver unless the Medicaid agency provides the following satisfactory assurances to HCFA:  (d) Alternatives – Assurance that when a recipient is determined to be likely to require the level of care provided in an SNF, ICF, or ICF/MR, the recipient or his or her legal representative will be – (1) Informed of any feasible alternatives available under the waiver; and (2) Given the choice of either institutional or home and community-based services.

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The Centers for Medicare and Medical ServicesWashington Medicaid Assessment ReportCommunity Alternatives Program Waiver

Control Number 0050.90R2   …We also found the State had adopted laws and policies inappropriately limiting access to Medicaid State Plan services provided by intermediate care facilities for the mentally retarded.  This placed the state in noncompliance with federal law and Washington’s Medicaid State Plan. Non-compliance of this nature could jeopardize future federal funding of the State’s Medicaid program. Doctors complain of the inadequate care in the community and inability to get patients admitted into RHCs. Nurses are in short supply all over our state – resulting in community homes with inadequate care, unskilled, non-medical personnel that act as custodians.

“The Federal Investigator”

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 CAP WAIVER CAP stands for the Community Alternatives Program, a Medicaid program for people with developmental disabilities. The CAP waiver is available for both institutional and community settings. “To be or not to be…outside the RHC? What are the cost comparisons of the different choices of living arrangements? A difficult question as the cost comparisons are not computed. All costs are computed for the RHCs but in computing the costs in the community programs, the following costs are not included: Medical or DentalDSHS allocated overhead costsDDD allocated overhead costsDepreciation of DSHS & DDD headquartersBond InterestFixed Asset Depreciation

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While Residential Habilitation Center costs are all inclusive, (including a considerable amount of DSHS overhead, depreciation, transportation, medical, and the like), the stated Residential Contract Rates for the community do not include all the costs.

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Guiding Principles for this Analysis of Yakima Valley School

1.Protect most vulnerable populations2.Maximize federal dollars3.Form better partnerships with local governments-align goals san set parameters4.Capture and critique returns on investment5.Invest early-on to prevent chronic health issues such as mental health, substance abuse, and obesity6.Use existing research to evaluate programs7.Invest in Health Care system8.Find opportunities for consolidation and transformation9.Ensure delivery systems are effective and efficient10.Avoid cuts that will have negative long-term impact

Rep. Eric PettigrewDec. 11, 2008

The state invests $178 per day for care of each of the 103 vulnerable citizens at the Yakima Valley School

The Feds and the residents invest an additional $263 per day to care for the 103 residents.

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Cost of living at Yakima Valley School Fiscal year 2007

Total Operating Costs fy 2007: $16,613,438 Total Reimbursable Costs: 17,784,060 Contribution to General Fund…………………………………$ 470,054

Federal Investment: $8,613,302Medicare D 408,275Other 272,750Resident Rent 618,436Total Other (Non-State) Investment ………………… $9,912,763

State Investment: $6,700,675Number of residents 103Cost per year for state $65,055Cost per day for state $178

This state investment leverages an investment of $9,912,763

148% Return on the State’s Investment.

:

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ECONOMIC IMPACT OF State Investment in Yakima Valley School

On Selah and the Yakima Valley

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The state invests $6,700,675 in the Yakima Valley School…The Other Investors: $9,912,763

Total revenue contributed to the Yakima Valley Community:

$16,613,438

148% ROI

THE ECONOMICS OF INVESTING IN YAKIMA VALLEY SCHOOL

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ECONOMIC CHURN

With a rate of churn of 2.5, this state/federal /citizen partership’s investment nets the Selah economy 275 living wage jobs with an economic Impact of $41,533,595 which in turn creates additional jobs.

The Yakima Valley Development Association has over the past three years been able to create 1200 jobs, about 400 per year given their very best efforts.

We do not need to reduce that amount by putting the Yakima Valley School out of business.

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11% UNEMPLOYMENT IN YAKIMA VALLEY

The Yakima Valley economy has one of the highest unemployment rates in the state and would be reeling from another $41 million decline in economic activity and loss of jobs.

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11.1

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It is the third largest employer in the City of Selah.

275 people work at the Yakima Valley School.

These 275 workers support about 1100 family members.

Unemployment in Yakima is running in the double digits. The unemployment lines wind around the Work Source Office in Yakima for unemployment checks. Workers then go to other offices to sign up for food stamps, public assistance, medicaid and other essential social services.

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The state has invested in the specialized training of the staff who operate the Yakima Valley School. This investment must be perserved!

We are all in this economic crisis together and we will all come through it together and show the world an example of the kindness, the respect and the dignity of the citizens of the State of Washington. We truly believe that the golden rule is the principle upon which we found our economic recovery.

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Cost of Living at Fircrest ICF/MR Fiscal Year 2007

Total Operating Costs fy 2007 $22,513,281 Total Reimbursable Costs: 25,387,426Net Contribution to General Fund $667,078

Federal Investment: 12,309,989Resident Investment: 694,326Medicare D: 538,128Other Investments : 313,598 Total Other Investment: $13,856,041State Investment: 8,657,240

Number of Residents: 107Cost per year for state: $80,902Cost per day for state: $222

State Investment of $8,657,240 leverages $13,856,041

RETURN ON INVESTMENT: 160%04/22/23 17