 September 20, 2018
Dear
Interested Stakeholder,
Yesterday,
Department of Social and Health Services (DSHS) Secretary, Cheryl Strange,
announced the submission of the DSHS proposed budget to the Office of Financial
Management (OFM) which included ALTSA’s budget proposal.
ALTSA’s
mission is to transform lives by promoting choice, independence, and safety
through innovative services. The vast majority of individuals in need of long-term
services and supports (LTSS) prefer to receive services in their home or other community
settings and our funding priorities are aligned to support that choice. Prioritizing our funding requests this way
helps assure we maintain our robust LTSS system as evidenced by our continued
AARP ranking as a national leader in providing services to older adults, people
with disabilities, and family caregivers.
Our
administration’s main goal is to maintain our current high level of quality
services by ensuring we are able to maintain a viable infrastructure focused on
protecting adults who are vulnerable and providing them with a variety of
choices in services that meet each individual’s unique needs and preferences. In
developing our budget priorities, ALTSA used the following principles which
reflect our mission and values:
- Continuing to
invest in the level of choice and quality of long-term services and supports
that have gained the State of Washington national recognition and support our
priority of preparing for aging Washingtonians.
- Preserving access
to needed long-term services and supports for clients served under Medicaid and
state-only programs
- Protecting home
and community-based services, which is where the vast majority of clients
prefer to receive services.
- Making critical
investments needed to strengthen our capacity to serve and protect vulnerable
adults, including those with behavioral health needs.
Understanding the
proposed budget and our priorities:
The
agency submits two types of proposals for the next biennium’s budget:
maintenance level and policy level requests. Maintenance level reflects
the increased or reduced costs of mandatory caseload changes, inflation, and
other costs mandated under current law that need to be accounted for in the
upcoming budget. Policy level requests include funding or savings for
things like new programs and services or a change in the way existing services
are delivered, some of which may require a change in statue.
ALTSA Maintenance
Level Budget Requests:
State Hospital
Investigations – Adding
four investigators to the Residential Care Services team to conduct
investigations of client abuse, neglect, or exploitation reported at Western
State Hospital. ($1.4 M GF-State; 4.0
FTE)
Consumer Directed
Employer (CDE) Initiative – The legislature enacted ESSB 6199 in the
2018 session, the most significant change to the delivery of in-home services
in our state in the last two decades.
This funding will continue the implementation of the CDE, which will
become the employer for all Individual Providers as of July 2020. ($8.2M total funds; $7.4M GF-State; -6.7 FTE)
Transitions to
Community Care – Continue
creating new community alternative options for clients who are ready for
discharge from the state psychiatric hospitals but who have additional
long-term or developmental disability needs as required by SSB 5883 (Section
206(17) enacted by the 2017 Legislature.
($17.2M; $9.4M GF-State; 3.2 FTE)
Medicaid
Transformation – ALTSA
continues to leverage federal funding under the five-year Medicaid
Transformation Waiver approved by the Legislature in 2017. This funding provides
services for people who are eligible for Medicaid, but choose not to receive
services from paid caregivers and offers some targeted services to people who
are functionally eligible, but not currently financially eligible for
Medicaid. ($30.1M; $0 GF-State; 10.3
FTE)
ALTSA Policy Level
Requests:
Vulnerable Adult
Abuse Registry: The
proposed legislation will create a process for petition for name removal from
the abuse registry. Name removal from
the registry may occur:
- After
a period of time, as approved by the Department; and
- Only
for certain allegations of low severity of behavior/harm to the vulnerable
adult.
DSHS
will implement a process and utilize an Internal Review Team to review cases
and ensure that there are no subsequent findings prior to removing names from
the registry. Those people who have their names removed from the registry may
potentially be able to have unsupervised access to vulnerable adults and work
in the Medicaid long-term care system.
($656,000; $459,000 GF-State; 3.0 FTE)
In-Home Personal Needs Allowance: Decreasing in-home client cost of care requirements will
increase the amount clients can keep to spend on housing, allowing them to
remain as independent as possible with in-home personal care supports while
avoiding placement in a more expensive residential setting. ($24.7M; $10.9 GF-State)
Electronic Visit
Verification (EVV):
Home care agency rates are increased
to cover the cost of electronically verifying and reporting the delivery of
personal care services as required under the federal “21st Century Cures Act.” States
that fail to implement an EVV system by January 1, 2020 will be subject to a
loss of federal funding through an escalating reduction in the federal match
rate. ($12.5M; $5.5M GF-State)
Increase in provider rates: To
maintain client access and choice, and to promote cost efficient delivery of
care across the entire system, rate increases are proposed for contracted home
and community nursing services, nursing facility rates (increasing the Quality
Enhancement component of the rate and changing rebasing from every two years to
annual) and assisted living facilities.
($94.8M ($45.1M GF-State)
Supported Living
Investigators:
The Supported Living investigation workload has increased without corresponding
staff increases, resulting in the Department struggling to meet its statutory
responsibility to investigate complaints about provider practice by reassigning
staff from other areas. The proposal will
fund 5.4 new investigators through a certification fee. ($2.1M; -2.3M GF-State; 5.4 FTE)
Quality
Improvement Consultants: Additional
staff for the Residential Care Services division will provide quality
improvement consultation to residential facilities and supported living (SL)
providers. This technical assistance
will improve the quality of care and help the providers comply with statutory
and regulatory requirements. ($6.2M; $3.1M GF-State; 19.0 FTE)
Please
remember that this is just the first step in our budget process. Using the information sent from DSHS and
other agencies, the Governor will develop and submit a budget. Then the House
and Senate will provide their budgets and from there a final conference budget
will be released.
Thank you
for the work you do to support individuals in Washington who are in need of
long-term services and supports. For
additional details on the ALTSA budget request, click
here.
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