Colorado Cross-Disability Comments on “Straw Man: Dual Eligible Proposal
These comments are the official comments of the Colorado Cross-Disability Coalition (CCDC) on the “straw man” proposal for the Dual Eligible Demonstration proposed by the Department of Health Care Policy and Financing (HCPF). CCDC is the largest disability rights organization in Colorado and the only statewide disability rights organization that is run by and for people with all types of disabilities. These comments are relevant for the information that is available as of early February 2012. Our position may change as more details become available.
CCDC tentatively supports the direction of HCPF and believes that with a few changes we can enthusiastically support this project. CCDC applauds the Department for not going with a capitated managed care model and for not succumbing to the pressure to dump the health care of the most vulnerable clients into the hands of out of state corporations that have no local accountability. We saw in the late 1990’s that those models do not work. We are pleased that HCPF realizes that one size cannot fit all. We also support the HCPF goal to not disrupt existing relationships. We believe that using primary care case management and trying to integrate care between the various platforms such as primary and behavioral health care is a good idea, however the devil is in the details.
We have a few preliminary concerns that we would like addressed in the very near future:
1) Throughout the proposal some existing care coordination models are mentioned and others are not. We are pleased that HCPF does not want to disrupt existing relationships if they are working and that HCPF supports allowing clients to choose the appropriate care coordination setting. There are two current programs serving dual eligible clients (PACE and CAHI) but only PACE is mentioned. CAHI is the ONLY consumer controlled care coordination entity and their prominent placement in the proposal, whether directly or as a required contractor within the RCCO model, is necessary to secure the full endorsement of CCDC.
2) The proposal aptly mentioned that people with developmental disabilities have a need for integration with long term services and supports including supported employment, day habilitation, assistive technology and transportation. This is true for people with ALL TYPES of disabilities. It is imperative that employment supports be a component of whatever is done in this demonstration, particularly for those under 65 but even for seniors who choose to work. In order to have a reasonable employment program people must be able to access both acute and long term services and supports in a seamless manner. This will require assuring that the Medicaid buy in implemented per HB 1293 is fixed so that it includes LTSS. The document claims that there has been coordination with the Medicaid Infrastructure Grant (MIG) and this committee has been adamant that LTSS must be part of the Medicaid buy in. Any proposal must have the ability to integrate long term services and supports. Any dual eligible project must be done in concert with waiver consolidation.
3) Consumer directed services are not mentioned. CCDC requires that any proposal have a consumer directed component and must include CDASS as a benefit with NO interference or reduction. CCDC would be open to discussing piloting alterations to the program that are voluntary to experiment on better ways to provide consumer directed services as long as no alteration removes freedom and choice from the person with a disability. Moreover, any alteration cannot reduce benefits or allocations. Examples of appropriate alterations to pilot might include combining skilled versus unskilled services into one rate, or allowing care managers to act as authorized representatives or reinstatement of the fund for additional services as a mechanism to encourage cost savings. CCDC needs an assurance that consumer direction will be a required component and that any care coordination provider will give clients full notice about their right to self direct services.
4) There should be specific mention about compliance with the Americans’ with Disabilities Act requirements. These requirements include but are not limited to
a. The requirement to make reasonable modification of policy, practice and procedure when needed to provide services in the most integrated setting or to avoid discrimination.
b. Requirement to provide effective communication –this includes not only effective communication for people who have obvious disabilities such as those who are blind or Deaf but also for people with brain injury and mental disabilities who may have other effective communication needs. CCDC believes that training is necessary for most if not all health care systems to do this properly.
c. Requirement that RCCO and other contractors have fully accessible web sites.
d. CCDC believes that each RCCO or other provider should have an ADA compliance policy that is easy to find and use.
5) There are many other details such as grievance and appeal rights that need to be addressed. Until we see the details we do not know the level of changes we require. We do know that we will require appeal rights that are no less than what we currently have and hope that we can create a better system that is more respectful of due process.
6) Public Input: CCDC appreciates that the department is engaging “stakeholders” and wants to remind the department that clients must be a primary part of this process. Clients are more than “stakeholders” because how these services are provided have a direct impact on the day to day lives, independence and survival of clients. CCDC requests that HCPF use the guidelines that CCDC created for HCPF under contract with the MIG for running accessible meetings and for outreach to people with disabilities when engaging with our community. This includes making sure that there is adequate advance notice of meetings. CCDC believes that client involvement must be part of any contractual obligations. Any entity receiving public money to provide services to this population that does not have representation from this population on their governing boards should explain how they are going to develop the competencies to work with dual eligible clients. CCDC expects that RCCOs will need to spend money to appropriately engage clients.
7) CCDC appreciates the need to share information among various providers. CCDC urges HCPF to be mindful that some of our citizens are extremely sensitive about privacy.
8) Outcomes must be based on functional and medical metrics. Functional metrics might mean something like assuring the client can engage in usual or preferred activities, such as employment or volunteer work. Many dual eligible clients, especially those under 65, will have positive outcomes if they are supported to have a typical life. Services such as CDASS and high quality DME are imperative. Mental health services that are respectful of the individual and empowering are also important.
Thank you for providing adequate time to respond to the “Straw Man” proposal. If there are any questions about the CCDC comments please contact email me or call me at or 303-667-4216.