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People with disabilities face big changes to services

Counties won’t be allowed to provide help to those whose cases they also manage.


A Montgomery County agency has stopped accepting new clients into its programs for people with developmental and intellectual disabilities as it prepares to comply with sweeping federal rule changes.

By 2024, the Montgomery County Board of Development Disabilities Services expects to phase out its adult day services, employment services and non-medical transportation programs, transitioning clients into privately run programs.

The change is expected to impact hundreds of local residents with developmental and intellectual disabilities, as well as their families, private providers and some county board employees.

County boards of developmental disabilities across the state and country are being required to take the same or similar steps to meet federal guidelines for services paid for using federal money.

The transition could be challenging because the current supply of private service providers is inadequate to meet the future need, officials said.

“We didn’t initiate this,” said Bill Linesch, president of the Montgomery County Board of Developmental Disabilities Services. “But we’re doing our best to put a plan together that will be in the best interest of our clients.”

Starting on Jan. 1, the Montgomery County Board of Developmental Disabilities Services ceased admitting new clients into its programs for day services, employment services and transportation.

Enrollment is only available to individuals at residential facilities with whom the board has a contractual agreement.

The state has directed county boards to close their door to new clients, local officials said.

About 695 people with developmental and intellectual disabilities participate in day support services at the board’s Calumet, Jergens, Kuntz, Liberty and Northview centers.

About 629 clients receive non-medical transportation to day services and work programs.

About 300 people are enrolled in the board’s employment-services programs, which include mobile work crews and competitive job opportunities. The agency offers job placement, job coaching, supported employment and community employment.

The county board has a $55.7 million budget for 2016 and employs 551 workers.

The county board’s decision to halt new admissions came from a state directive and was prompted by a rule enacted by the Centers for Medicare and Medicaid Services.

The federal rule prohibits organizations from providing direct services to individuals with disabilities with federal waivers if they also provide their case management.

About 36 percent of clients participating in the county board’s adult day and employment services do not receive waiver support, which are matching federal funds. About 30 percent of people enrolled in transportation services do not get waivers. The county helps fund services using levy dollars.

The federal agency says removing decisions about care and services from organizations that provide them will eliminate any conflict of interest.

By 2020, 70 percent of people statewide already receiving federal waiver funds through Medicaid must be transitioned to private providers.

By 2024, the county board must be in full compliance with the “conflict free” case management regulations.

The board will remain in charge of case management, also called service and support administration. It will help coordinate services for residents with disabilities.

But nonprofit groups and other private entities will have to provide services to people who are supported by federal dollars.

This transition will be challenging and will require attracting and developing new providers. Officials said there are simply not enough private providers to serve all of the county’s clients.

“We’re committed to working with providers and people who are interested in providing services to expand and develop service opportunities in our county,” said Janice Rice, spokeswoman for the county Board of Developmental Disabilities Services.

The board’s leadership is working to develop a plan to guide the transition and it is gathering stakeholder input from clients, families, private providers and other community members, Rice said.

The county board is sharing information with providers and people interested in becoming providers about what services clients and their families want and need, Rice said.

The agency also has created a new position to focus on growing the number of providers in the county, Rice said.

Jayne Weikel’s 30-year-old son, Phillip, receives day habilitation services at the Liberty Center about two days a week.

He used to participate in services at the center four to five days each week. But for the last six months, Phillip’s received services a few times each week through a private provider in preparation for the upcoming transition.

Phillip is nonverbal and the services he receives expand his cognition and teach him work skills, and he also interacts and socializes with others, said Weikel, a retired teacher in Centerville.

Weikel said her son has enjoyed and benefited from the privately provided programming, but change is difficult for him.

Weikel said she is worried about how private providers in the community will be monitored. She said she fears there may be a lack of quality control.

She said some parents are scared about how their loved ones with disabilities will respond to new settings.

“I am concerned about his quality of life and his participation,” she said.

By the end of 2016, the county board set a goal of reducing the number of clients on waivers it serves by 5 percent. The board this year also plans to work to increase the number of new private providers and expand the capacity of existing providers.

United Rehabilitation Services in Dayton is one of the larger private providers in the county, serving on average about 115 adults each day.

URS plans to increase its capacity to serve about 175 to 200 people daily by the end of 2017, said Dennis Grant, URS’ executive director.

“This is tremendous shift from a model we’ve been following for decades, and I think that families and individuals will really struggle with this,” Grant said. “But we’re looking for a seamless transition.”

County boards across the state operate differently, but many face similar or identical challenges.

The Greene County Board of Developmental Disabilities plans to search for private service providers to run its adult day services and employment workshop programs, said Superintendent John LaRock.

The board successfully privatized transportation services several years ago, and it will work diligently to transition its 174 clients in county-run facilities to private services without disruption, he said.

“The people who receive services won’t notice any difference,” LaRock said.

An adult day care facility run by the Butler County developmental disabilities board is slated to close or be turned over to a private entity by 2024 to comply with the federal mandate, officials said.

The Montgomery County Board of Developmental Disabilities Services serves far more people than many other county boards, some of which have been working for years to transition to private providers, said Nancy Banks, the board’s superintendent.

She said the changes will be enacted in stages.

“We promised our stakeholders that this will be over a period of time and it won’t occur all at once,” she said.


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