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G-FAN

Gateways Family Advocacy Network

Hi All:


This email contains details on the Three Hot Topics for 2022 from Community Support Network, Inc. (CSNI is the association for the ten area agencies in NH):


  1. Wait List
  2. Workforce Rate Increase
  3. BDS System Redesign
  • The next BDS Information Session is October 6. See the details below for how to register.
  • BDS is also holding hybrid in-person/Zoom Family Forums. See the details below for how to register for the Manchester Family Forum happening on October 11.


Also, the general election is on November 8. This is a very important year for us and every vote can make a difference. You can visit the NH Department of State website to find information on your polling place, times, and sample ballot for your location.


Will

Wait List


What is the Developmental Disability & Acquired Brain Disorder (DD/ABD) Wait List?


The Wait List is how we identify those who need funding to receive services for a developmental disability or an acquired brain disorder. Typically, individuals are placed on the wait list when:


  • They graduate or exit their local school system
  • They are a new resident to NH
  • There is a significant change in the individual's condition or family situation that requires additional services.


Why We Need to Continue to Fund the Wait List!


Wait list funding in the state budget does two main things: first, it allows individuals to begin to receive services and supports as they leave school and enter adulthood. Second, wait list funding enables existing services to be adjusted and enhanced when necessary and appropriate.


RSA 171-A: The Law!


RSA 171-A is the law created to emphasize supports and services be provided to individuals in the community. It supports individuals to have choice in their services, allow an opportunity for gainful employment and to build meaningful relationships. A section of this law states that individuals that are found eligible for services shall not wait longer than 90 days to receive them. When there is not enough funding, some individuals wait longer than the 90 days that the law outlines, thus, creating a wait list.


Individuals are consistently entering the system with the rise of students receiving special education services as well as caregivers aging and being unable to care for their adult son or daughter.

 

Looking Forward


In the past 10 years, there has been strong bipartisan support by Governors and the Legislature to support full funding of the wait list.


As a result, the Department of Health and Human Services has reported that no individuals have had to wait for service funding in the past two years (there has been nobody waiting on the wait list since September 2020).


It is critical that the next state budget build upon the strong record of support for developmental services in our state.

Workforce Rate Increase


Many retail stores and fast-food restaurants pay higher wages, including benefits, to workers with less responsibilities than DSPs caring for another person's life.


As of June 30, 2022, there were 220 individuals with developmental disabilities who had funding available but were unable to hire staff to begin their services.


What is a Direct Support Professional (DSP)?


Direct Support Professionals (DSPs) provide critical services to people with developmental and intellectual disabilities to help them live as independently as they can. They provide:


  • Assistance with activities of daily living
  • Support in the workplace and the community
  • Encouragement for the individual to lead self-directed lives


DSPs are the unsung heroes of the developmental services system.


Health Care Workforce Rate Increase


Developmental services did not receive a Medicaid rate increase in the current biennial budget that concludes on June 30, 2023. A Medicaid rate increase was not a part of the current state biennium budget.


At the same time, the inflationary pressure on wages in health care/human services has been tremendous. It is critical that the Governor and Legislature prioritize increases to the rates paid to Area Agencies and other providers in the developmental services system as they craft the next two- year budget.


Medicaid Rate Increase for DSP Living Wage in New Hampshire


A Medicaid Rate Increase will make an enormous difference in the lives of direct support professionals and the vulnerable people they support daily.


A Medicaid Rate Increase would provide a much-needed boost to agencies struggling to recruit and retain essential workers such as direct support professionals.


It is vital for a Medicaid Rate increase to support DSP Living wage.


What is a Living Wage?


A living wage is the minimum amount that an individual must earn to successfully pay for all the expenses for an individual or family. Expenses such as rent/mortgage, transportation, healthcare, food, gas, utilities and more.


The current living wage for New Hampshire, as calculated for 2022 by MIT’s Living Wage calculator, for a single person, with no children, working full time is $17.23 per hour. (https://livingwage.mit.edu/states/33)


Direct Support Professionals (DSP) base hourly wage in New Hampshire is around $15.00. This hourly wage amount varies by region. (https://www.indeed.com/career/direct-support-professional/salaries/NH)


A rate increase for the DSP workforce is needed for DSP reimbursement to be competitive with other industries and ensure the state can honor individuals’ state-approved service agreements and the need for services outlined therein.


Help Wanted for All Positions


NOTE: The need for direct support professionals is highlighted here but there are many open positions across Area Agencies. From office managers to service coordinators Area Agencies are looking to hire and retain qualified people.

BDS System Redesign


“Nothing about us, without us” must be honored.


What has happened so far?


The NH Bureau of Developmental Services (BDS) is spearheading a system transformation effort driven by a need for federal compliance and a want of improving efficiencies. Recommendations were created by a national consulting firm, Alvarez and Marsal (A&M). The A&M recommendations have become decisions.


To achieve Federal compliance the state must:

  1. Have Conflict Free Case Management and
  2. Implement direct billing by July 1, 2023 (requiring a redesign of reimbursement rates).


The Center for Medicare and Medicaid (CMS) recognizes the stress that the national system is currently under and has demonstrated a willingness to extend other deadlines in the past.


At the same time, BDS moved forward with a full system redesign, during a pandemic and an unprecedented workforce crisis.


The stated goal of the redesign is equity for eligible individuals, cost savings and administrative ease. Current estimated cost savings with system redesign is less than $200,000 per year in an over $300 million dollar system.


What is happening now?


An Advisory Committee and four workgroups have been convened for waiver design, rate development, communications and DSP job design.


These workgroups are comprised of individuals, family members, advocates, providers and area agencies to work on aspects of these efforts and offer input. These groups are only Advisory in nature and DHHS and BDS does not have to enact any suggestions from these groups.


What are the greatest concerns?


  • Speed of decisions being made and timeline of implementation. It would be sensible to slow the implementation down so change to the system can be done right.
  • Inadequate attention being paid to operational changes causing confusion and poor service.
  • Ensuring new rates don’t decrease services or destabilize the system.
  • Bringing in an additional Supports waiver to control utilization.
  • Creating a cap and limiting service options.


What can you do?


Contact Will Walker at wwalker@gatewayscs.org

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