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Can this happen?

 
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hoosiermama



Joined: 24 Oct 2005
Posts: 8

PostPosted: Mon Oct 24, 2005 9:45 pm    Post subject: Can this happen? Reply with quote

Thanks for starting this forum. The individual in question is one that currently receives and needs 24/7 supervision. Here's my question.

Is it ok for a residential provider to contact a guardian and say, "I'm preparing the November staff schedule and wanted to let you know that due to the cuts in reimbursement, you're loved one will not have staff for seven hours on Saturday and seven hours on Sunday as of 11/1"?

I would hope not.
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WaiverWatch



Joined: 21 Oct 2005
Posts: 35

PostPosted: Mon Oct 24, 2005 10:56 pm    Post subject: Reply with quote

Thanks for your post, Hoosiermama. We are hearing about other providers who are planning to cut services starting Nov. 1, even though that is not what the state is saying providers should be doing in the wake of the rate changes.

The statement by your provider contradicts what Peter Bisbecos, Director of DDARS, said in his letter to families on September 22:

"Our first priority is to assure you that these modifications are designed to be administrative in nature and should not result in a reduction in service for you or your family member."

Although the Notice of Action you should have recently received closes with, "This is a notification of rate change only. The provider continues to be responsible for meeting the service needs of the individuals they serve," there doesn't seem to be accountability in the new Annual Plan that would red flag providers who are imposing reductions in services.

What to do about this is another matter. Have you talked to the case manager? You might also try calling Mr. Bisbecos to explain what is happening and ask him what can be done to make sure this individual receives the services he needs. Contact information for Mr. Bisbecos is in the Resources section.

You might also want to appeal. Note that if you want to freeze your services at the current level during an appeal, you must file before the effective date of Nov. 1st, which means filing this week. You can find directions on how to appeal in the Action! section under “APPEALS.”

Good luck, and keep us posted on your progress!
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Julie



Joined: 27 Oct 2005
Posts: 1

PostPosted: Thu Oct 27, 2005 11:23 pm    Post subject: Reply with quote

I would also contact your area OMBUDSMAN and inform them of the situation. They may be willing to attend a team meeting with family/customer, case manager and provider.

I would also encourage you to talk to your case manager about your loved one's ISP. Ensure that all support needs are outlined in the ISP and then get the team together around those needs to brainstorm creative ways to reduce costs without compromising health, safety and quality of life. Yes, I said it, QUALITY. You can't put a $ on it but for those with physical and mental limitations it often requires a creative effort and the dedication of support professionals to achieve. Where is the motivation to provide quality services in all of this mess?

It is my hope that providers will also encourage support teams to get together around the needs specified in the ISP before implementing drastic cuts in service hours.
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WaiverWatch



Joined: 21 Oct 2005
Posts: 35

PostPosted: Fri Oct 28, 2005 12:39 am    Post subject: Reply with quote

Sound advice, Julie. Thanks for your post.

We had the state's ombudsman's contact information listed under Medicaid contacts, but it is now a separate category as well under "Resources". The number is 1-800-622-4484.

We're not familar with an ombudsman in different areas of the state, though. If you have information on how someone can contact a local ombudsman, we encourage you to post it in the Resources area. Thanks!

-WW
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Provider1



Joined: 31 Oct 2005
Posts: 17

PostPosted: Mon Oct 31, 2005 12:21 pm    Post subject: Reply with quote

WaiverWatch wrote:
Thanks for your post, Hoosiermama. We are hearing about other providers who are planning to cut services starting Nov. 1, even though that is not what the state is saying providers should be doing in the wake of the rate changes.

The statement by your provider contradicts what Peter Bisbecos, Director of DDARS, said in his letter to families on September 22:

"Our first priority is to assure you that these modifications are designed to be administrative in nature and should not result in a reduction in service for you or your family member."

Although the Notice of Action you should have recently received closes with, "This is a notification of rate change only. The provider continues to be responsible for meeting the service needs of the individuals they serve," there doesn't seem to be accountability in the new Annual Plan that would red flag providers who are imposing reductions in services.

What to do about this is another matter. Have you talked to the case manager? You might also try calling Mr. Bisbecos to explain what is happening and ask him what can be done to make sure this individual receives the services he needs. Contact information for Mr. Bisbecos is in the Resources section.

You might also want to appeal. Note that if you want to freeze your services at the current level during an appeal, you must file before the effective date of Nov. 1st, which means filing this week. You can find directions on how to appeal in the Action! section under “APPEALS.”

Good luck, and keep us posted on your progress!


I think what is being said here is also being contradicted by what has been said most recently...We are to work as a team to meet the needs of the consumer in a more efficient manner. This may include more family involvement such as natural supports, or weekend visits with family. There is no way with the cuts made to the overall amount of money that the state has allowed that providers can provide the same amount of services for less reimbursement. We have not cut the wages of our employees. How can we provide 200 hours per month and only get paid for 180 hours per month as an example. The old plan of care supported 200 hours a month...This was a budget. The new rates take into account what was actually paid to support an individual over the past fiscal year. This amount is what it actually cost to serve someone...This is what the rate is based on. If I provided a consumer 190 hours on average the state only provided that much, and then may have even cut some of that amount. What we are able to provide is what we have and are able to provide. We are not trying to cut hours arbitrarily.
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El LoBo



Joined: 31 Oct 2005
Posts: 2

PostPosted: Thu Nov 03, 2005 11:08 am    Post subject: Reply with quote

Provider1,
I hear what you are saying, but that is a question that should have been posted before Nov. 1 to the state. They have been very clear about "services not changing". I will admit that these changes seem to benefit larger corporations that can deal with the cuts and swing staff sharing possibilities. As for the people in homes, the state is simply expecting the families to "take in the slack". I have had a few families ask what would happen if they refused to provide services for their child. They could no longer take it before the cuts. This still has not been approved by CMS at a national level. Here is an excerpt from an email I received today: "

This is the e-mail I got from Dan Burton's office confirming that the Feds have not approved this yet, however, Dan Burton's office won't/can't do anything since it is a state administered program (just Federally funded)! So, now I have to call the CMS office in Baltimore MD at 1-877-267-2323 and ask them to review the DD waiver amendment going into effect in the state of Indiana on November 1, 2005 and ask them not to approve it.

Mail address:
CMS
7500 Security Blvd.
Baltimore, MD 21244-1850
1-877-267-2323
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WaiverWatch



Joined: 21 Oct 2005
Posts: 35

PostPosted: Thu Nov 03, 2005 5:02 pm    Post subject: Reply with quote

Thanks for the post, El Lobo. I would like to remind everyone to please copy Leslie Campbell at CMS on all correspondence, too, as she is the CMS financial liason to Indiana. Her contact information again is:

Leslie Campbell
Centers for Medicare and Medicaid Services
233 N. Michigan Ave., Suite 600
Chicago, IL, 60601
(312) 353-1557
(312) 353-3866 (fax)
LCampbell@cms.hhs.gov or leslie.campbell@cms.hhs.gov

-WW
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