DDA 3.5% Rate Increase Restored

House Budget Language and Narrative:

1. DDA Implementation of New Waivers: The Department of Health and Mental Hygiene (DHM) proposes to implement two waiver programs. The community services waiver will provide funding of $25,000 per individual to support nonresidential services in the community. People on the waitlist on the crisis resolution and the crisis prevention priority categories would be eligible for this funding. The family support waiver would provide funding of up to $12,000 per family per year for children under the age of 21 and their families to secure supplemental wraparound services to those provided by the State Department of Education. Both waivers are pending the approval of the Centers for Medicare and Medicaid (CMS). The budget committees request that DHMH submit a report on the status of implementing the two new capped waivers including an update on CMS approval, how many individuals are expected to receive funding by the end of the fiscal year and if DHMH expects to use all funds budgeted for the program in fiscal 2018. Report due December 31, 2017.

2. DDA Report on Direct Support Wages: The budget committees request that the DHMH submit a report on wages for direct support workers, including:

a. The wage levels needed to ensure a quality direct support workforce in each jurisdiction, taking into account differences in local minimum wages
b. The funding needed to achieve the wage levels; and
c. Recommendations to ensure that direct support wages become and remain competitive on an ongoing basis.

1. In addition to any evaluation completed by DDA’s rate-setting consultant, DDA shall gather input from stakeholders, including the Maryland Association of Community Services, People on the Go of Maryland, and The Arc Maryland. Report due July 1, 2017.

3. Office of Health Care Quality: Provided that $100,000 of the general fund appropriation of the program made for the purpose of administration may not be expended until the DHMH submits a three-year plan to the budget committees outlining how DHMH will fully staff the Office of Health Care Quality. The report should include (1) an analysis of appropriate compensation for recruitment and retention of nurse surveyors; and (2) an assessment of strategies other than salary that the federal government and other states use to retain nurse surveyors. This report shall be submitted by October 1, 2017 and the committee shall have 45 days to review and comment. Funds restricted pending the receipt of the report may not be transferred by budget amendment or otherwise to any other purpose and will revert to the General Fund if the report is not submitted.

4. Department of Human Resources (DHR) Review of Services Available to Parents with Disabilities: DHR does not remove children from their home solely due to a parent’s disabilities. Caseworkers work with parents to assess the services needed for a child to remain in the home or to be reunified with their parents if the child has been placed in out-of-home care. DHR has funding for some types of services, such as in-home aide services. The Title IV-E Waiver presents an opportunity to support additional family preservation and post-reunification services including services specific to parents with disabilities. However the committee is concerned about whether adequate resources exist in communities to address the needs of parents with disabilities, including both physical and developmental disabilities, such as alternative styles of parenting courses that address different learning styles of needs. Therefore, the committees request DHR, in consultation with the Maryland Department of Disabilities, submit a report (1) identifying services availability in the community to address family preservation or post-reunification needs for parents with disabilities; (2) identifying gaps in services and options for addressing the gaps; and (3) reviewing best practices in providing family preservation and post-reunification services to parents with disabilities. Report due November 15, 2017.

5. Budget Amendment: Placement Determinations for Children with Complex Medical Needs – Budget Amendment
$100,000 of the general fund appropriation within the DHR and $100,000 of the general fund appropriation within the MSDE (Senate adds: ‘and $100,000 of the general fund appropriation within the Governor’s Office for Children) may not be expended until DHR and MSDE (Senate: and GOC) submit a report to the budget committees detailing:

1. 1. The processes in place to ensure coordination between DHMH, MSDE, DHR, and the hospitals serving children in Maryland to find appropriate community placements for children and adolescents with mental illness, developmental disabilities, or complex medical needs.
   2. The  processes in place to ensure coordination between DHMH, MSDE, DHR, and the hospitals serving children in Maryland to find out-of-home placements for children and adolescents with mental illness, developmental disabilities, or complex medical needs.
   3. The availability by jurisdiction of the following resources for children and adolescents with mental illness, developmental disabilities or complex medical needs:
      a. Dedicated child and adolescent impatient psychiatric beds in acute general and specialty hospitals;
      b. Therapeutic foster care;
      c. Residential treatment center services;
      d. Transportation assistance; and
      e. Any other community-based treatment service designed to meet the needs of children and adolescents with severe mental illness, developmental disabilities, or complex medical needs.

   Recommendations, based on an analysis of the data, to improve community placement processes for children and adolescents with severe mental illness, developmental disabilities, or complex medical needs including availability of treatment options based on the payer, that will facilitate increased community-based care and decrease inpatient lengths of stay beyond what is medically necessary. The report shall be submitted by November 15, 2017, and the budget committees shall have 45 days to review and comment. Funds restricted pending the receipt of the report may not be transferred by budget amendment or otherwise to any other purpose and shall revert to the General Fund if the report is not submitted.

2. 6. Out-of- State Placement Determinations and Monitoring

1. $100,000 of the general fund appropriation within the DHR and $100,000 of the general fund appropriation within the MSDE (Senate adds: ‘and $100,000 of the general fund appropriation within the Governor’s Office for Children) may not be expended until DHR and MSDE (Senate: and GOC) submit a report to the budget committees detailing:
   1. The processes in place to determine whether to place children in out-of-state placements when in-state resources cannot meet the needs of the child;
   2. The processes in place to determine in which out-of-state facilities children are placed;
   3. The frequency of the review of the out-of-state placement to determine whether or not the needs of the child can be met through an in-state provider;
   4. The current process in place between DHR and MSDE to ensure that the out-of-state facilities in which children are placed are compliant with the Individuals with Disabilities Education Act;
   5. The current processes for monitoring children in out-of-state placements and any plans to alter these monitoring practices to ensure the safety of children in out-of-state placements; and
   6. The resources that would be necessary (both funding and number and type of placements) to move all children in out-of-state placements to in-state placements.
3. The report shall be submitted by August 15, 2017, and the budget committees shall have 45 days to review and comment. Funds restricted pending the receipt of the report may not be transferred by budget amendment or otherwise to any other purpose and shall revert to the General Fund if the report is not submitted.

Senate Budget Language and Narrative:

1. DDA: It is the intent of the budget committees that if funding for the proposed capped family supports waiver or community supports waiver cannot be utilized in fiscal 2018, the DDA shall use the funding to provide services for individuals on the waitlist. (This language ensures that if CMS fails to approve the new capped waivers, the funds will be used to provide services for individuals on the waitlist and not reverted to the General Fund.)

2. Budget Amendment: DDA Community Services: Add the following language to the general fund appropriation, provided that $400,000 of this appropriation may only be spent to provide funding for the PACT Helping Children program. Funds restricted for this purpose may not be transferred by budget amendment or otherwise to any other purpose and if not expended for this purpose shall revert to the General Fund. (This language is relative to the $3M provided for CSLA conversion to Personal Supports.)