The State Must Balance Caring for Tennesseans with Intellectual Disabilities and Responsibility to the Taxpayers
NASHVILLE - The Tennessee Department of Intellectual and Developmental Disabilities (DIDD), which administers Tennessee’s Home and Community Based Services (HCBS) waiver programs serving 7,500 people with intellectual disabilities, faced some tough choices when the State faced a shortfall and all departments were asked to reduce their budgets for Fiscal Year 2011.
Officials in the Department considered every option except for disenrollment. “The goal of the Department was to keep people on the program and to reduce services rather than eliminate them so, the decision was made to propose changes that had the maximum monetary benefit but impacted the fewest people,” said Jim Henry, Commissioner of the Department of Intellectual and Developmental Disabilities.
These changes are based on waiver amendments approved by the Centers for Medicare and Medicaid (CMS) on February 15, 2011. The recent changes limit the amount of one-on-one Nursing services to 12 hours per day and Personal Assistance services to 215 hours per month-still generous benefits when compared to most States. Also, these services are in addition to home health (including nursing) services that persons may be eligible to receive from their TennCare Managed Care Organization (MCO).
Personal Assistance (PA), primarily hands-on care and supervision, was established as a service to assist families in keeping their loved one with a disability at home, with the expectation that individuals receiving PA services would be independent for at least part of the day or have family members or other natural supports contributing to their overall care.
Currently, some people actually have 2 assistants providing their PA services at the same time. The cost of 24/7 PA at the higher 2-PA rate is nearly twice the cost of the standard one PA rate, which in some cases amounts to over $230,000 per person, per year. DIDD proposed to stop providing this level of reimbursement because it is extraordinarily expensive, and the Department could find no other state in the country that provides payment for 2 assistants to support 1 person at a time. Most importantly, there are more cost-effective ways to provide care to people with these intensive needs, which in the long run, allows limited funding to be spread across more people and families who need assistance.
Likewise, Nursing services were intended to offer assistance in performing skilled nursing tasks to family members caring for loved ones at home. It was never expected to become a 24/7 one-on-one service, at a cost of nearly $300,000 per person, per year when provided by a Registered Nurse.
“Personal Assistance or Nursing services were never intended to be a 24 hour one-on-one alternative to residential placement, day services, or to completely supplant caregiving by family members and other natural supports. One-to-one services are extremely costly and limit the State’s ability to serve others who need care,” said Henry.
Where family members are unable to assist with care, the programs offer an array of small, community-based homes (not institutions), where people with intellectual disabilities are integrated into their communities, and can choose to fully participate in community life, from supported employment to recreational activities.
For people currently receiving services in excess of the new limits, services will not be reduced until the Independent Support Coordinator or Case Manager has conducted an individualized assessment of whether any changes are needed in the person’s plan of care in order to ensure his/her needs will continue to be safely met in the waiver. The State firmly believes the needs of those affected by these changes can continue to be safely met in the community within the very comprehensive array of services still available under these waivers.
The Department of Intellectual and Developmental Disabilities and the Bureau of TennCare are committed to providing quality services which ensure the health, safety and welfare of waiver participants. At the same time however, the State must continue to find more cost-effective ways to deliver such care in order to live within the State’s resources and not overburden taxpayers; and consider the needs of not just those who are fortunate enough to be receiving services, but also the 6800 Tennesseans with intellectual disabilities who are currently on the waiting list for services.