Disability Services Committee Has Big List of Recommendations

/ February 5, 2019

By Janet Shouse

About the Author

Janet Shouse is a parent of a young adult with autism, and she is passionate about inclusion, employment of people with disabilities, medical issues related to developmental disabilities, supports and services, public policy, legislative initiatives, advocacy, and the intersection of faith and disability. She wears many hats at the Vanderbilt Kennedy Center, including one as a disability employment specialist for TennesseeWorks.

Our hope is that this weekly blog will offer information you want to know, so if you have a question you want answered about employment for people with disabilities or other mysteries of the world of work, please email me at janet.shouse@vumc.org.

 

As many of you know, the Tennessee General Assembly created a Joint Ad Hoc Disability Services Committee in late 2017 to evaluate and review services for people with disabilities in Tennessee, to determine if gaps existed and to examine ways that our state might improve the quality, access and affordability of those services.

You can read Committee Co-Chair Sen. Becky Duncan Massey’s blog post about the creation of the committee here.

The committee, which has been co-chaired by Rep. Debra Moody after Rep. Kevin Brooks stepped down, met monthly and heard presentations from the various state departments that provide services to Tennesseans with disabilities, such as the Tennessee Council on Developmental Disabilities, the Department of Intellectual and Developmental Disabilities, the Department of Mental Health and Substance Abuse Services, the Department of Education and the Department of Human Services, which includes the Division of Rehabilitation Services and Vocational Rehabilitation. The committee also heard from several disability organizations and from a national organization focused on employment of people with disabilities.

Then the committee sought out the personal experiences of people with disabilities and their families, holding listening sessions in Jackson and Knoxville.

On Monday, Jan. 28, the committee met to discuss its final recommendations to the governor, which will be submitted to Gov. Bill Lee in a report soon.

If you want to watch a video of this final committee meeting, you can do so here.

Below is a very rough list of the recommendations that were discussed. Many were approved, and some were determined to need more research before possibly moving forward. I am sharing this list now, rather than waiting for the formal report, because Disability Day on the Hill is scheduled for Tuesday, Feb. 12, and I believe many of us who plan to attend the Day on the Hill would appreciate having this list in hand when we talk with our legislators.

These are the recommendations passed by the committee:

• Create a statewide “Disability Services Concierge” to allow a seamless entry into services. Have a “no wrong-door policy” within state government, so that no matter where an individual with a disability or their family member goes seeking services, they get consistent information that guides them to the services and supports that are appropriate.
• Ensure better coordination between services and departments. Possibly create a Disability Subcabinet made up of commissioners from each of the departments providing disability services.
• Funding for direct support staff is a critical issue not exclusive to Tennessee. Make last year’s non-recurring funds, which were targeted to DSP wages, recurring funds as promised. Institute cost-of-living wage increases for DSPs that are tied to state employee pay increases. (If you wish to read a summary of the report by the state’s Office of the Comptroller about the targeted funding for DSP wages, it can be found here.)
• Create a pure Katie Beckett waiver. Tennessee currently has pathways for children whose parents’ income exceeds eligibility limits to become eligible for Medicaid – if the child needs the level of care that would otherwise be provided in an institution. One recommendation was that parameters be established to enroll only those who do not qualify through a pathway now in the Employment and Community First CHOICES program. (When the Katie Beckett bill is filed, I will share additional information about this proposal.)
• Disability services after an individual turns 21. Recommend that the authorization of 24/7 services begin between the ordering physician and the health care company (MCO) – if a physician is being asked by a family to write an order for 24/7 care, or if the physician thinks it may be warranted, a full assessment should first be conducted, and services discussed. (I believe this refers to services, such as private-duty nursing, that are provided to children on TennCare under the Early and Periodic Screening, Diagnostic and Treatment provisions of Medicaid. There are a number of services that end when the person turns 21.)
• The state will consider including the ability to use “consumer direction” for applicable services in the DIDD Statewide Waiver and the Comprehensive Aggregate Cap Waiver, and also consider expanding the types of services that can be consumer directed. (Consumer direction is currently available only in the Self-Determination Waiver among the three DIDD waivers. If you are not familiar with the term “consumer direction,” it allows the person with IDD to employ the people who give some of their support services—they work for the person receiving services. This means that the person receiving services must do the things an employer would do – like hire, train, schedule, supervise, and even fire workers. They also have to be able to manage the services they need within their approved budget for each service. If they can’t do some or all of these things, they can choose a family member, friend, or someone close to them to help them OR do these things for them.)
• Reduce redundant services. There is a Memorandum of Understanding in place between TennCare and Vocational Rehabilitation to prevent redundancy of employment services for people in the ECF CHOICES program. The state is encouraged to move toward having the employment services in the DIDD waivers align more with those in ECF CHOICES. The recommendation includes that DIDD and VR enter into a MOU to prevent redundancy in services. Align program requirements and develop cohesiveness in the different programs between ECF CHOICES and the DIDD waivers. The committee heard that the three MCOs and DIDD require different things for the same outcomes, and this increases the cost of services. These include staff training, billing, incident reporting, and quality assurance monitoring, to name a few.
• Reopen the 1915(c) Statewide Waiver for individuals with the most significant disabilities. Use the funding (either all or part) from attrition. (Attrition in the Statewide Waiver occurs when a person supported by that waiver either moves out of Tennessee or dies.)
• Develop in-state residential options for individuals with complex behavioral needs. (This recommendation came after committee members heard very personal, impassioned pleas from a number of families.)
• Streamline the re-entry process into waiver services for individuals receiving acute, in-patient treatment.
• Allow those with accessible parking placards be allowed in the renewal process to have a sticker or decal for their license plate.
• Make the appeals process in the ECF CHOICES waiver program more accessible and user friendly.
• Expand the reimbursement options for consumer-directed services to include services received from state-licensed programs providing comparable services to those included in the ECF CHOICES/ DIDD services categories.
• Appropriate more funding to support more people. Address the waiting list or what is now called the referral list. There are still about 7,000 individuals on the referral/waiting list.
• Develop policies to make the state of Tennessee government a model disability employer. This would include the establishment of specific hiring goals and fast-track hiring of individuals with disabilities.

These are recommendations that the committee determined need additional research:

• Re-authorize day centers as an option for those who cannot go out in the community all day every day. The option of being in the home when not in the community is more isolating. (Concerns were raised that this proposal might violate the federal Centers for Medicare and Medicaid’s Home and Community Based Settings rule.)
• A requirement that providers of medical equipment and supplies provide their goods to families of persons with disabilities at a price equal to that which they sell these items to TennCare enrollees. Several committee members felt the idea of a mandate on business is not pleasant, but members see this need is huge. Paying “retail” for these items only compounds the financial difficulties for these families. It will take a combined public and private effort to up the services to those with disabilities and their families.
• Move Vocational Rehabilitation Services, which is currently in the Department of Human Services, to DIDD. Also, increase the number of VR counselors to meet the need for these services.

I want to thank members of Sen. Massey’s office for helping me clarify my rather jumbled notes from the committee meeting. (That saved me from having to watch the entire hearing again!)

I also want to thank all of the members of the Joint Ad Hoc Disability Services Committee for taking the time to learn about the service delivery systems for Tennesseans with disabilities. They are:

• Becky Massey, R-Knoxville, co-chair
• Debra Moody, R-Covington, co-chair
• Mike Bell, R-Riceville
• Sabi Kumar, R-Springfield
• Sara Kyle, D-Memphis
• Darren Jernigan, D-Old Hickory
• Kerry Roberts, R-Springfield
• David Hawk, R-Greeneville
• Janice Bowling, R-Tullahoma
• Ron Lollar, R-Memphis (Rep. Lollar passed away in July.)

As the committee members found out, ours is a complex system with many entry points, with many departments involved, and with many barriers for people with disabilities and their families. They heard about many good things our state is doing, but they also heard about many people who are struggling—physically, mentally, emotionally and financially—because there are significant funding and service gaps in our state.

I appreciate the recommendations that this committee will be sending to our governor, and I hope that Gov. Lee and the General Assembly listen and strongly consider these proposals.

As always, if you have questions or concerns, please email me at janet.shouse@vumc.org. I may not have the answers, but I can try to track them down. Thanks for reading!