In keeping with the first principle listed below, the Board has approved asking for an amendment to the Budget for rate increases as shown below:
|Service||Increase||Cost in GF|
|Group Day||25.62%||$14.1 M|
|Group Supported Employment||21.86%||$820,000|
|Group Home – 5 < 8 beds||29.25%||$28.1 M|
These would be in addition to those already included in the budget and shown in the Post of 17 December, 2021. While these services are not considered “preferred” by DOJ, they are essential services which, especially in the workforce shortage we are currently experiencing, are absolutely necessary to maintain the level of access to services which is expected by individuals and their families and by the Commonwealth.
Presentation on Priorities
HWI Committee – 13 December, 2021
Our agenda is at this point in the process is still being finalized and, as in every year when the Governor changes (especially from one party to another) and/or when the legislative majority changes in one chamber or both, we will be more reactive than proactive.
Our principles will be as follows:
- Adequately fund all services (BH, DD & SUD) to mitigate the impact of the increase in minimum wage and the extraordinary pressure of the workforce crisis which has affected recruitment and retention at all levels
- Limit the development of “reforms” to allow the system to stabilize and scale up the services in the existing array offered in the DD Waivers, BRAVO and ARTS.
- Resist administration efforts to impose additional oversight or regulatory controls which, while perhaps well-intentioned, add cost and administrative burden which in this time cannot be absorbed into provider operations.
Agenda for the ARPA Special Session
Building and/or Maintaining the Workforce
80-85% of the cost for any provider is for personnel (payroll, benefits, taxes, etc) and currently there are multiple factors which are driving that cost up in an unsustainable way:
- A critical shortage in the workforce which in impacting many industries from hospitality to education, but is most certainly impacting the human service/health care industry.
- Extraordinary competition for employees with industries that have much more flexibility in how they structure their budgets because they have more options for how they fund their businesses.
- Overwhelming regulatory control which sets standards that are not only administratively burdensome, but are also unnecessarily restrictive of who can be hired (barrier crimes) and who can perform the assigned tasks (mandatory training, ongoing assessments which, if staff lacks “proficiency” in a single skill, threatens the provider’s ability to bill for services , etc.
- And, most critically, the impact of the long overdue increases in the minimum wage which are not funded in the Medicaid rates structure.
The workforce, at all levels including professional staff, is key to building and/or maintaining the capacity of the system. Lacking that, the next steps will not come to fruition and Virginia’s most critical needs – reducing the pressure on the state hospital system and reducing the waiting list for DD Waiver Services – will not/can not be addressed.
One item to note that would easily fall in the realm of supporting recruitment/retention would be to fund the development of multiple commercial grade PSAs to promote the opportunities which are available especially in DD services. A statewide effort would have greater impact.
Streamlining the Administrative Components of the Systems
Recognizing the ARPA Funds are essentially “one-time” funds and can not easily be used for ongoing commitments, the greatest long-term impact could be felt by focusing attention of the systems which impact provider operations with the greatest frequency and at the most significant level:
- Hire a consultant to rework the contractual agreements with the six MCOs which provide oversight for the CCC Plus and Medallion 4 services (soon to be a combined into Cardinal Care) to mandate the adoption of a universal credentialing system, a single/universal set of services authorization forms, a single set of annual training requirements and adoption of a single tool (DLA-20) to measure the efficacy and success of the services provided.
- Hire a data systems consultant to reduce redundancy, establish a single set of definitions and terms, create a data set which is more transparent and available to multiple classes of users, and is recognized by both regulatory and payor entities. The goal would be to restructure all data collection/reporting systems to one multifaceted system that only required single entry by the end user.
FMAP as a “bridge” to the “rates rebase” which will, at the earliest, be available July 2022 (six months after the next minimum wage increase)
This provision, on its face, seems very straight forward. And while there may be a variety proposals for the funds, VNPP is strongly recommending the following:
- Pay providers the increased “rate” quarterly beginning on August 1st based on claims billed and paid for any of the eligible services for the period of April 1 through June 30. Repeat that process for subsequent quarters of July 1 – September 30, October 1 – December 31 and January 1 (2022) – March 31.
- Require documentation of the appropriate use to be confirmed in a subsequent QMR review; utilize the guidance to be provided by CMS as the options for appropriate use.
This methodology recognizes several realities:
- Every provider has different needs – for example, many outside of Northern Virginia are facing a significant challenge to meet the pay increases which will be necessary to remain competitive in the job market after the minimum wage increases in May 2021.
- To date all of the COVID relief funding, both State and Federal, has required a complex application process requiring significant effort with strict limitation on options and funds have arrived (if at all) months later.
- This methodology is also relatively simple to implement and will require less administrative effort on the part of DMAS staff.