House Appropriations Sub Committee on SRS
Representative Brenda Landwehr, Chair
February 26th, 2003
Submitted by Gina McDonald
These are the recommendations I suggested last evening during testimony.
1.Create One Waiver. Look at combining all waivers into one waiver. The Waiver would have three services.
The first services would be training. It would be outcomes based, meaning the purpose would be to teach consumers tasks that would allow them to perform tasks independently. Documentation would need to exist for why a consumer could not learn a task.
The second would be personal assistance services (PAS). This would be services for people who cannot perform tasks due to the level of disability. Every effort will be made to provide training and/or Assistive devices to minimize the amount of PAS required for long periods. However this service is a necessary component.
The third would be Assistive Services. This would include durable medical equipment and other devices that would be approved when they assist a consumer in performing tasks more independently and would reduce or eliminate the need for PAS.
All Plans of Care would be reviewed by a neutral third party to assure the following:
2. Equalize rate reimbursements for self directed and non self directed personal assistance services on all waivers.
This would reduce costs and KACIL’s preference would be to put those savings back into the program to get more people off the waiting list.
3.Research methods to increase the pool for health
care.
One option would be to increase who would be eligible to get a medical card, recognizing the aspect of “Buy In”. In other words, more people who want to “Buy In” to using a medical card would be eligible, but they would pay premiums.
The second option may be easier to negotiate and could be done without any federal oversight. The health care system available to state employees could be available to people using services from the state and they could buy into that plan. That is already a large pool. A number of years ago this legislature opened the state health care and retirement plan to not for profit organizations such as CDDO’s. This concept would open that plan up to consumers of state services, as well as other providers. In theory, it could also be open to those “working poor” individuals who cannot currently afford health care for themselves and/or their families. Instead they wind up in emergency rooms where the cost is extremely high. Because the pool is so large, again, in theory, the premiums should be able to be lower, thus making it affordable.
4. Consolidate the activities of the Department on Aging and SRS into one Department. SRS could have a commission on aging within SRS. It would eliminate administrative costs and duplications. The federal government requires we have one Medicaid agency to oversee costs in facilities as well as the community. We don’t look at costs for Nursing Facilities along with HCBS services because they are in separate agencies. Putting aging services back under SRS would have all budgets in one department.
5. KACIL encourages you to support SB161, the elimination of tax exemptions on certain independent living units for elderly. This will save money for the state and equalize housing costs for all elderly. This is an exemption for those who can most afford to pay taxes and is unfair to those who have less income and resources.
6. Encourage SRS and DOA to establish regulations allowing dollars to follow people from Nursing Facilities back into communities.
This would simply require a movement of funds from the Nursing Facility budget to the HCBS budget. That would require budget department regulations, which are way beyond my area of expertise. But I am aware that it is easier to accomplish if the total budget for facilities and HCBS waivers were in one department.
The example that comes to mind is when SRS downsized institutions for people with mental retardation. They moved money from institutions to a program called community reintegration demonstration project. It occurred before the DD Reform Act. We are not aware of any legislative activities.