Final report of the Joint Legislative Committee on the Administration and Reorganization of the Department of Economic Security

              FINAL REPORT
OF THE
JOINT LEGISLATIVE COMMITTEE ON THE
ADMINISTRATION AND REORGANIZATION OF THE
DEPARTMENT OF ECONOMIC SECURITY
MARCH, 1992
Members
Representative Ruth Eskesen
Cochairman
Senator Nancy Hill
Cochairman
Representative Lisa Graham Senator Jaime Gutierrez
Representative Sandra Kennedy Senator Matt Salmon
Marti Lavis, Executive Director
Governor's Office for Children
Executive Summary
The Joint Legislative Committee on the Administration and
Reorganization of the Department of Economic Security was
established by HB 2246, Chapter 127, Laws of 1991. The mandate of
the Committee was to study the need for and feasibility of
reorganizing the administration of services in the following areas:
... cDchhiiivlliddsr iesonun'p sop fos rDeter evvneiflcooerpscm peermnoetgnartla pDmrisos garbaiml ity DES- administered state and federal job training programs.
The Committee held 12 meetings including many hours of
testimony and discussion of issues and recommendations. Since the
repeal date of Chapter 127 was January 31, 1992, the Committee had
no time to consider the issue of children's services. Therefore,
legislation will be introduced to extend the Committee's mandate to
December 31, 1992.
The report contains the following sections:
1. Background
2. Child Support Enforcement Program
.. BSaucmkmgarroyu nodf tiensftoirmmoantyi on
Recommendations submitted by the public and
agencies
3. Overview of the Welfare Reform and Job opportunities and
Basic Skills Training Program
4. Division of Developmental Disabilities
Overview of the Division
Summary of testimony including recommendations
. Rseucbommimtetnedda btyi otnhse s puubbmliitcte d by agencies
5. Appendices
The final recommendations of the Committee are included in the
pages immediately following.
FINAL RECOMMENDATIONS REGARDING THE
CHILD SUPPORT ENFORCEMENT PROGRAM
Leqislative Recommendation:
. The Committee recommended legislation to enable any county
clerk of the court and county attorney to implement a
demonstration project for a four- year period for the purpose
of performing the following child support functions:
1. Intake and assessment for aid to families with dependent
children and nonpublic assistance cases.
2. Initial location of nonpayors and alleged fathers.
3. Establishment of paternity.
4. Financial assessment under the state child support
guidelines.
5. Establishment of support orders.
6. Enforcement of support orders.
7. Investigation.
8. Modification of orders.
Administrative Recommendations:
The Committee:
. endorsed the CSEA plan to establish performance- based
contracts with the five county attorneys participating in the
program, with an increased share of the " state share of
retained earningsff ( SSRE) of AFDC collections to enhance their
programs ;
. endorsed the privatization projects already underway within
CSEA and soon to be expanded;
. reinforced the importance of CSEA, the Maricopa County
Demonstration Project, the privatization and county attorney
contracts all operating under the same guidelines, standards
and goals to ensure valid evaluation outcomes;
stressed the importance of CSEA not relinquishing any
authority mandated by the federal government;
. endorsed the appointment of a study committee by the
legislative leadership to investigate a family court model.
This committee should consist of no more than eight people
representing consumers, members of the Judicial and
Legislative branches and other experts.
Recommendations to Conqress and Department of Health and Human
Services:
The Committee:
. recommended that the Governor's office, Legislature and DES
contact the Arizona Congressional Delegation to request a
change in the federal rules that mandate the CSEA collect on
all cases;
. recommended that the Congressional Delegation and federal
officials be encouraged to implement stricter guidelines to
increase interstate enforcement.
Final Recommendations Regarding the DD Division and Programs
Lesislative Recommendations:
The Committee recommended:
. develop a " mission statementl1 for the Division to be inserted
into ARS 36- 551, Article 1;
. revise the definition section ( 36- 551) to coincide with the
mission statement;
change all statutory references from lldevelopmentallyd isabled
personsI1 to I1people with developmental disabilities; I1
. insert definitions for " medically needyf1a nd Itcasem anager1! in
statute :
in 36- 551( 15.), delete " Habilitation includes programs of
formal education as defined in 15- 761,( 5) and training.";
. revise ARS 36- 553 regarding the DD Advisory Council. Duties
and membership will be drafted in legislation;
. in 36- 554 ( 4. ) , amend to read: " License community residential
settings for health and safety pursuant to this chapter.";
add new paragraph in 36- 554 ( Powers and duties of director)
giving the director responsibility for assessment of program
quality assurance;
exempt the Division from the rule making process for two
years ;
. re- insert a fee schedule in statute for state- funded clients.
. support the creation of a separate Department of Developmental
Disabilities.
Administrative Recommendations:
The Committee recommended:
the Division appoint a group of experts including some case
managers fo develop rules on the role of case managers, client
ratios, degree of decision- making authority, and other issues
relating to case managers;
the Division develop a brochure on DD services for clients and
families, including a description of the grievance procedure,
eligibility requirements, contact phone numbers, and other
consumer- related information;
the Division simplify the licensing process and explore
performance- based contracts and innovative reimbursement
projects ;
the Division continue working on providing child care to
special needs children and removing barriers to child care;
the Division appoint a committee to develop a fair tool of
assessment of needs for state- wide use. Families should be
included in the assessment.
BACKGROUND
Backsround
The Joint Legislative Committee on the Administration and
Reorganization of the Department of Economic Security ( DES) was
established by HB 2246, Chapter 127, Laws of 1991, as a result of
legislative concern regarding administrative policies and
procedures as they relate to several service programs.
Specifically, the Committee's mandate was to study the need for and
feasibility of reorganizing the administration of services within
the following:
.... Dcchehiivlelddlr oespnum'epsnp tosareltr Devinisfcaoebrsic plerimotegynr taD pmirsvo; ig sriaomn;; DES- administered state and federal job training programs.
See Attachment 1 for a copy of HB 2246 and the organizational chart
for DES.
Previously there had been a House study committee on the
Department of Economic Security Reorganization which met during the
summer and fall of 1990. However, the committee terminated with
many continuing concerns and unanswered questions, and thus
recommended further study into most of the issues.* Therefore, HB
2246 was drafted to focus more specifically on the issues and
complete the study through a joint committee.
The joint committee held 12 meetings from September 1991,
through February 1992, focusing on all the issues listed above
except the children's services programs. Due to lack of time
during this period, the latter topic will be studied later if
legislation is approved to continue the committee. In addition, a
presentation was made explaining the Interagency Coordinating
Council on Infants and Toddlers ( ICC) and its interaction with the
DD Division and programs.
Hours of testimony were presented on both the Child Support
Enforcement and DD programs from parents, consumers, advocates,
providers and agency representatives. The following sections
include a summary of issues, problems, and recommendations
presented on each of the programs studied by the committee.
* A copy of this 1990 report is available in the House Clerk's
Office.
CHILD SUPPORT
ENFORCEMENT PROGRAM
CHILD SUPPORT ENFORCEMENT PROGRAM
Backsround
The Child Support Enforcement Administration ( CSEA) is under
the Division of Family Support in DES. The organizational chart is
contained in Attachment 2. Its primary function is to establish
paternity and secure child support for public assistance recipients
( IV- D cases), as well as provide services to anyone who applies who
is not receiving public assistance, and collect and distribute
support payments on behalf of the foster children. Other federally
required activities are listed in Attachment 3.
There is a federal financial participation match of 66 cents
to 34 cents for the state or counties to fund CSEA activities.
These matching funds are passed through to any county attorney
office that performs the legal CSEA functions. The participating
county attorneys also receive a share of federal incentives
received by the state based on cost- effectiveness ratios. As an
additional incentive to county attorneys to improve their programs,
CSEA intends to share a portion of State Retained Share Earned
( SSRE) on AFDC collections that generate the llSSRE1dlo llars.
Currently there are five county attorneys who contract with the
state to do this: Gila, Cochise, Navajo, Pima and Pinal.
Arizona ranks the highest among the states in caseload ratios,
with 2890 cases per case worker. This explains many of the
problems brought out in the hearings. ( See Attachment 4.)
The following factors partially explain some of the strengths
and weaknesses in the Arizona System:
Factors Endemic to Arizona
PROS:
Wage assignment law
Expedited paternity establishment
Evolving automated system
Expedited rupport order procerr
CONS:
High mobility of population
Indian reservation8
international border state
Low state medim income
High divorce rate
In spite of the problems and funding restraints, CSEA
productivity has increased considerably in FY 1990 to FY 1991, as
shown in the following chart:
ARIZONA PRODUCTIVITY
SFY 1990 TO SFY 1991
COLLECTIONS:
AFDC ($ 5.4 to $ 7.1 million) - up 31%
NPA ($ 25.5 to $ 30.5 million) - up 20%
Total ($ 33.3 to $ 40.6 mlllion) - up 22%
PATERNITY:
Established ( 1,272 to 2,360) - up 86%
Support Orders ( 419 to 829) - up 98%
SUPPORT ORDERS:
Established ( 299 to 731) - up 146°/ 0
ENFORCEMENT:
Activity ( 2,623 to 7,331) - up 191%
The following charts indicate the single most factors
impacting on the staters child support programs according to a
survey of all 50 states done by the DES Child Support Enforcement
Office.
SINGLEMOST IMPACT ON
SUCCESS
Good Legls. Support 6
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S t i l l ~ o rlly ~ ~ pnotlron - I
Irlc: leaserl s t a f f l r l g 2 (-; red11 I ~ ~ JIIt 1 2O1 1 ~:' I ~ J
It SINGLE MOST IMPORTANT
FAILURE
The CSEA is in the process of converting all the counties to
the ATLAS ( Arizona ~ racking and Locate ~ utomated System) which will
increase the capability for much higher support collections. The
chart on page 5 indicates the increases in FY 90 - FY 91, which
coincide with the phase- in implementation of ATLAS since March,
1990. Attachment 5 includes the conversion schedule.
Summary of Testimony
Testimony from parents and political action groups centered
around not only the state CSEA, but also the county clerk level and
the judicial system. The following is a breakdown of the most
common issues raised as well as the CSEA responses.
Common complaints about CSEA:
1. CSEA changes caseworkers frequently.
Accuracy: True.
Reason: High turnover and high caseload ratio.
2. CSEA does not return all phone calls or answer all
letters.
Accuracy: True.
Reason: CSEA does not have enough staff to return all of
the 20,000 calls received per month, or to answer all of
the 12,000 pieces of mail per month.
3 . CSEA does not initiate case- status reports to applicants.
Accuracy: True.
Reason: Not enough staff to initiate reports on each of
240,000 cases.
4. CSEA/ AG does not initiate enough contempt and criminal
prosecutions.
Accuracy: True.
Reason: Not enough staff. However, CSEA did initiate
high- profile roundups ( contempt) beginning in 1989 and
established a criminal prosecution unit in the AG's
office in 1990. The 1989 roundup brought in 216 people
and resulted in $ 881,000 in child support payments.
5. CSEA/ AG has not initiated criminal extradition of non-payors
from out of state.
Accuracy: Almost true.
Reason: Because of inadequate funding, CSEA/ AG did not
have a criminal prosecution until 1990. CSEA now has
the capacity to extradite and papers have been prepared
in one case. Extradition, which is expensive, usually
becomes unnecessary when civil remedies are used as an
alternative.
6. CSEA, Clerk, AG, Sheriff, and Court do not work well
together in Maricopa County to make the system work.
Accuracy: The system could work better.
Reason: The child support enforcement system in Arizona
is heavily dependent on the judicial system and requires
the cooperation of various entities. CSEA and the AG
prepare and file cases. The Court enters orders. The
Clerk receipts and distributes legal documents and
payments. The Sheriff arrests violators of orders. If
any one of the components fails to do its job in a
timely, efficient and committed manner in any one case,
the system fails.
CSEA is attempting to improve the contract relationship
with the AG.
CSEA is submitting new legislation to improve the flow of
wage assignments and interstate payments in the Clerk's
office.
Common complaints about the Clerk's office:
1. Filing fees are too high.
2. Time delays in wage assignment and payments process.
3. Calls not returned.
4. Not enough information given about fee waivers.
Note: CSEA does not charge fees, and legislation is being
submitted to expedite the wage assignment process and payment
promptness in the Clerk's office. The automated system should
speed up payment processing in 1992.
Common complaints about Judses:
1. Judges are not strict enough with non- payors.
2. Judges continue cases too often.
Note: CSEA recently has had good experience with high- profile
contempt actions ( roundups) . The experience with common
contempt actions with no publicity has not been good.
Common complaints about the svstem qenerallv:
1. Very difficult, if not impossible, to make self- employed
absent payors pay.
Accuracy: True.
Reason: Wage assignments often are not effective with
the self- employed. However, CSEA has the " professional
licensestt law, and is initiating new legislation for
self- employed reporting.
2. No one is accountable to make the system work.
Accuracy: Not true for all entities.
Reason: CSEA/ DES answers to the Governor, the
Legislature and to Congress, and may suffer financial
sanctions, if the program is ineffective.
3. There is no intervention/ counseling as a part of the
system.
Accuracy : True.
Reason: Arizona statutes provide for enforcement
remedies for child support. Other issues, such as
visitation and custody disputes are not part of the
process. However, CSEA is submitting legislation to
intervene in paternity establishment at the hospital
level.
Essence of messases by political action qroups:
National Organization of Women
League of Women Voters
Association for Children for Enforcement of Support, Inc.
The system is not working well. The system needs more funding
and/ or reorganization. But in any event, do something.
Options and Recommendations Presented to the Committee
At the committee's invitation, Robert Williams, Ph. D.,
Executive Director of Policy Studies, Inc., Denver, Colorado,
presented an analysis of organizational options of IV- D programs
across the country. He focused on the pros and cons of court- based
systems, revenue department models, attorney general models,
privatization and social services department models. Attachment 6
lists the pros and cons and examples of each model. * The committee
decided to focus attention on the court model, privatization, and
strengthened social services ( DES) models.
Recommendations submitted from public testimony centered
around three key areas:
. State and local svstem
- Improve access to the system and communication with
consumers; - encourage and utilize input for location of
delinquent parent; - conduct local hearings to identify system problems
- peearrmliyt; the non- custodial parent to receive credit
- doenc rteaaxs re etutrhnes ; amount of time required for
implementation of wage assignment; 45 days is too
- lioncnrge; a se number of caseworkers and decrease the
turnover rate. Improve training and pay scale to
retain workers;
- decrease the use of strategies for avoidance of
payment, i. e., declaration of bankruptcy,
unemployment, self- employment.
. Courts
- Limit the number of continuances and repetitious
hearings ; - use extradition proceedings to return delinquent
parents to this state.
. Clerks of the courts
- Decrease fees for paperwork - improve access to consumers for assistance on
cases, returned phone calls, and information about
the system.
* The text of Dr. Williamst testimony is available in the House
Clerk's Office.
Proposal from Maricopa County Clerk of the Superior Court
The Clerk of the Superior Court proposed a state-administered,
county- operated model which permits each
county's board of supervisors to designate a central
county authority from among three options:
1. county attorney's office;
2. a new agency designated by the board of supervisors
3. clerk of the court.
The model would allow each county to customize the
program to their particular needs and include a full
range of services including intake, locate, establishment
of paternity and support obligations, enforcement,
collection and receipt of support payments. The county
authority would be enabled to subcontract to provide any
of these services.
Proposal from DES
ISSUE: What is the best structure to enhance Arizona's IV- D Child
Support Enforcement Program to ensure maximum collections for
children and reimbursement of state AFDC grants?
BACKGROUND: Historically from 1975, the Arizona IV- D Child Support
Enforcement Program suffered from fragmented control and weak
accountability, which resulted in low achievement and poor ratings
by the public. A series of events occurred in recent years that
allowed DES to exert a stronger administrative leadership role and
to assume more responsibility for day- to- day operations in most
counties. As a result, the program is much more responsive to the
public, and collections have greatly improved.
Since 1985, annual collections have risen from $ 14.6 million
to over $ 45 million ( including unreported collections revealed
by ATLAS) .
. The 1985 federal audit failure with penalties has been
corrected.
. In the last year reported performance indicators are up:
- AFDC collections by 29% ($ 7.8 to $ 10.1 million);
- total collections by 22% ($ 33.3 to $ 40.8 million);
- paternity establishment by 86% ( 1,272 to 2,404);
- established support orders by 114% ( 718 to 1,560)'; - enforcement activity by 191% ( 2,523 to 7,331).
Partial implementation of the ATLAS system has allowed CSEA to
report over $ 2 million in previously unreported and increased
collections.
Future success will depend on how well DES can continue to
strengthen the foundation upon which the program rests. The
foundation must have three solid cornerstones:
( 1) strong, effective central leadership;
( 2 ) an appropriate and effective structure within DES
supported by a good automated system; and
( 3 ) legislative support; funding and laws.
To be effective, DES must require commitment by participating
county and state entities to the mission of the program, direct the
appropriate use of resources, and receive support from all
governmental entities. DES must continue to make the program and
its automated system a priority.
Options
( 1) Attorney General/ Court Model. State administered and state
operated. This model incorporates various aspects of the
structures in Michigan, Pennsylvania and Oregon. These long
established systems perform well. However, to bring all or parts
of this model to Arizona would require changes in state law and
perhaps the Arizona Constitution. The administrative office of the
court would replace DES as administrator of the program, the
Attorney General would establish paternity and support orders, and
an arm of the superior court ( like the probation department or a
newly created " friend of the courtff) would enforce court orders.
A new bureaucracy would have to be created at substantial cost.
( 2) Privatization. State administered and privately operated
state wide. A newly created state board would oversee the
establishment and enforcement activity of a private vendor, who
would administer and operate the program. Although a design for
this model was created for Montana, no state has taken the risk of
implementing this untried model state wide. However, the state of
Tennessee is piloting a privatized four- county region and is
experiencing good results.
( 3) Strengthen the program within DES. There are three possible
variations that may be under consideration:
( a) CSEA as a division. State administered and state
operated with operating exceptions for presently
participating counties. CSEA would be elevated to the
level of a member of the director's executive staff.
( b) CSEA as an autonomous division. ( Virginia model.) State
administered and state operated, no exceptions. CSEA
would control many support aspects to the program
presently controlled by other DES divisions. Because of
duplication of support activities, costs would probably
increase.
( c) CSEA as a separate entity. ( Vermont model.) State
administered and state operated. CSEA would control all
support aspects presently controlled by other DES
divisions and state agencies, and would be only loosely
linked to DES. The creation of independent support units
would increase costs.
Recommendation
Leave the program in DES pursuant to ( 3) ( a). Strengthen the
program's foundation in three areas: clear authority for strong
and stable central leadership, effective and appropriate structure
and accountability, and continued legislative support.
( 1) Authority for leadership.
( a) CSEA will be established as a separate division within
DES .
( b) The program will remain state administered and state
operated with the exception of those county attorneys
presently participating. CSEA should continue to
establish local services in those counties where county
attorneys are not participating.
( c) CSEA will establish performance- based contracts with
county attorneys still participating in the program. The
state will share the retained state share ( SSRE) of AFDC
collections with the county attorneys to provide funds to
enhance their programs. A transition plan will be
completed by May 1, 1992.
( 2) Effective administrative structure and accountability.
( a) DES/ CSEA will continue implementation of its automated
system. The benefits of the system are expected to
significantly exceed the cost of the system by 1995.
( b) In spite of no provision in federal regulations for
waivers from performance standards, in coordination with
other states CSEA will explore and request a waiver from
federal program performance requirements that emphasize
form over substance. CSEA will evaluate and balance the
risk between federal audit penalties for violation of
form and allocation of its limited resources to the
primary substantive goal of maximizing collections for
children and reimbursement to the state for AFDC grants.
( c) DES/ CSEA will develop workload measurements and standards
which will allow management to determine the adequacy of
budgets and quality of resource deployment.
( d) As resources allow, CSEA will expand its customer service
unit to ensure responsiveness to the public.
( e) CSEA will explore innovative projects to improve services
more cost effectively. CSEA has already used
privatization to improve location efforts, and will soon
use privatization to collect old child support debts owed
to the state. In the near future, CSEA will continue
this direction and propose to the Legislature a pilot
privatization project with a budgeted request for funding
for a geographical area of Arizona.
( f) Because of the many changes required in program functions
by the Family Support Act of 1988, the impact of the
ATLAS system, and various other changes in state laws and
the operation of the program, CSEA will submit a new
three- year strategic plan incorporating these
recommendations to the Legislature beginning July 1,
1992.
( g) CSEA will request a waiver from Department of
Administration rules for one year for hiring and
classification of staff.
Legislative support.
( a) CSEA will propose legislation that will increase the cost
effectiveness and the ability of the program to increase
collections, including long- range changes in the
enforcement systems to allow CSEA to shift to more
administrative processes.
( b) CSEA will continue to propose legislation that improves
the effectiveness of the program and the systems
presently used. Please see the attached documents
describing most of the legislative agenda being offered
this year for consideration.
The Department will introduce two child support enforcement
proposals. The first will provide for administrative
process and technical changes and the second for statutory
changes.
CHILD SUPPORT ENFORCEMENT ADMINISTRATION ( CSEA)
A d m i n i s t r a t i v e and T e c h n i c a l Changes
birth resistration; social security number
Require the submission of both parent's social security
numbers when registering the child's birth certificate.
Currently, registration of a birth certificate may be,
but is not required to be, accompanied by the social
security numbers of the mother and the father. P. L.
100- 485, Section 125, mandates each state having
administrative responsibility for the registration of
birth certificates to require each parent to furnish
their social security number( s) unless the state finds
good cause for not requiring it. Obtaining the social
security numbers would allow DES to increase
enforcement actions and collections/ revenues.
Prohibits Department of Health Services from issuing
birth certificates when social security numbers are not
provided and requires Department of Health Services to
adopt rules allowing a good cause exception in certain
cases when social security numbers cannot be provided.
Appropriates $ 39,845 to the Department of Health
services to obtain the social security numbers.
hospital paternitv testinq
Provide a process for unwed mothers and fathers to sign
a paternity affidavit in the hospital. his method is
currently used in Virginia.
Arizona currently has an expedited process in which
paternity may be established outside of the judicial
process. By further enabling the mother and father of
the child born out of wedlock to voluntarily sign a
written statement of paternity at the time of birth,
one of the biggest obstacles to obtaining support for
the child is overcome.
senetic testins in court
Create a presumption of paternity based on the results
of Human Leukocyte Antigen ( HLA) testing at 97%
probability.
Arizona law currently allows for one presumption of
paternity; that is, if the mother is married at the
time of birth, the husband is the presumed father.
his proposal would create a presumption of paternity
based on scientific technology which has an advanced
degree of reliability that courts can rely on as a
resource. It further creates a more equal balance of
justice for both parties in a paternity issue since the
decision is based on scientific fact.
birth certificates; photocopies
Allows the DES/ Child Support Enforcement Administration
( CSEA) to use a photocopy of a birth certificate for
purposes of child support enforcement.
The Department of Economic Security/ Child Support
Enforcement Administration routinely requests certified
copies of birth certificates from the Department of
Health Services to obtain information necessary for
child support proceedings. Ninety five percent of the
time a photocopy would be sufficient to obtain the
needed information. This proposal would authorize the
Department of Economic Security to photocopy a
certified copy or original record from a parent or
request photocopies of an original birth certificate or
record from the State Registrar.
orders of assiqnment
Allows the DES Child Support Enforcement Administration
( CSEA) to send orders of assignment in IV- D cases
directly to employers rather than through the clerks of
the court. Provide for an administrative review by
CSEA when the agency issues an order for assignment.
The intent of this proposal is to streamline the wage
assignment process for IV- D child support enforcement
cases.
Currently, an order of assignment must be sent to the
Clerk of the Court for filing. The Clerk forwards the
filed document to the employer who has ten ( 10) days to
send the payment to the Clerk once monies are withheld
from wages. If a payor disagrees with the order,
he/ she can request that it be stopped or modified and
the court sets a hearing. These steps cause delays in
having the order go into effect.
This proposal would:
a. Allow the IV- D agency, in IV- D cases, to issue an
Order for Assignment and provide a copy of the order to
the Clerk of the Superior Court for placement in the
courtst file;
b. Allow the person alleged to be in arrears to
request an administrative review before the issuing
agency, and if dissatisfied with the decision, a
hearing in Superior Court.
child suwvort collections
Change the reporting date for the CSEA expenditure plan
from April 1 to September 1.
Current law requires the Child Support Enforcement
Administration to report to the legislature on April 1
of each year on its expenditure plan for monies
collected in the next fiscal year. At that point in
time only two ( 2) quartersf reports are available with
the actual figures. Changing the reporting date to
September 1 would allow four ( 4) quarters of data to be
available on which to project collections and
expenditures for the following fiscal year.
11. Statutory Changes
clearinshouse; supvort vavments
Direct that all IV- D support payments, regardless of
when the order was issued, be made through
clearinghouse. Require clerks of the court to provide
payment histories and legal documents to child Support
Enforcement Administration ( CSEA) within ten days of a
request.
Current statute cites a specific date, which is no
longer relevant, after which all the ~ itle IV- D support
payments must be directed through the clearinghouse.
The proposal deletes the date and instead requires
directing payment through the clearinghouse on the
notification that a county has converted to the
statewide automated child support system to ensure a
more accurate picture of collections. Also specifies a
time limitation for transfer of payment histories and
legal documents to the clearinghouse.
parental failure to vav suv~ ort
Increase the penalty for non- payment of child support
from a class 6 to class 5 felony and change the
statutory presumption regarding non- support to an
inference.
Currently, the statute provides for a presumption of
guilt, which has been declared unconstitutional by
~ rizona courts. This proposal would bring the statute
into conformity with the constitution by designating
inability to pay as an affirmative defense. It further
changes the presumptions to inferences, except for non-custodial
parents under the age of 18 who are still
attending high school. Increasing the penalty class
would ensure that a parent who knowingly fails to
provide support for their child( ren) would be treated
as severely as a theft of $ 500-$ 750.
attorney fees; ~ aternity actions
Prohibit the assessment of attorney's fees against the
state in child support cases and allow the state to
collect attorney fees against defense attorneys who
bring frivolous actions in cases in which the state has
an interest.
This proposal exempts the state from attorney's fees in
actions brought by the state to establish paternity or
to establish, enforce or modify a support order in the
Title IV- D cases in which any party other than this
state, or a city, town or county prevails by an
adjudication. Currently, the state relies on the sworn
statement of a third party in pursuing child support
enforcement cases. The state would not be assessed
attorneyfs fees when acting on the testimony and sworn
statements of a third party.
iudment on arrears
Codify that past due support payments are automatically
a judgment
Arizona case law provides that any past due payment is
a judgment; however Arizona Statute remains unclear.
Providing for the entry of an ex- parte judgment on
arrears is consistent with the 1986 federal Bradley
Amendment which requires each past due payment be
recognized as a judgment without further court
activity. This proposal would not change the absent
parent or the person alleged to be in arrearsf right to
a judicial review of the judgment.
prioritv of action and iudments
allow the placement of liens on personal property in
order to collect on past due child support payments.
Currently, ~ rizona law allows a lien to be placed on
the real property ( homes, land, etc.) of an individual
who owes a debt reduced to a judgment for past due
support payments. his proposal provides for a wider
range of assets to be attached, including judgments
constituting a lien on the certificate of title of
vehicles. Actions establishing or enforcing payment of
support or maintenance obligations are given priority
over all other civil actions except for mortgages,
deeds of trust, contracts, conveyances or security
agreements.
em~ lownent income disclosure
Requires employers, payors of funds or self- employed
persons to report, upon request, income of the obligor
to a person or IV- D agency entitled to receive support
or maintenance.
Currently, there is no provision for requiring a self-employed'person
or payor of funds to report to a person
or IV- D agency entitled to receive support or
maintenance, such information concerning a person who
owes or is alleged to owe support as social security
numbers, present and past employment status, earnings,
assets, availability of health insurance coverage and
health insurance benefits paid or applied for. This
proposal would require the payor of funds or self-employed
person to notify the IV- D agency or person
within ten ( 10) days of the request for information and
imposes a penalty for knowingly failing to respond to
the request for information.
WELFARE REFORM
AND
JOB TRAINING
Welfare Reform and Job Traininq
One meeting was held to review the status of welfare reform
and the Job Opportunities and Basic Skills ( JOBS) Training Program.
The Committee had no intent to reorganize this program which is
cooperatively administered by four divisions under the Office of
Budget, Policy Planning and Project Control ( see chart # 3, page
26).
The following section summarizes these programs.
WELFARE REFORMIJOBS
JOINT LEGISLATIVE COMMITTEE
ON REORGANIZATION OF DES
November 12,1991
r-,-
Handout # I Major Provisions of Family Support Act
Handout # 2 Chronological Development of Welfare Reform in Arizona
Handout # 3 DES Family Investment Initiative
Handout # 4 Governor's Task Force Recommendations
Handout # 5 Overview: AFDC Caseload
Handout # 6 Map of JOBS Locations
Handout # 7 JOBS Referral Process and Client Flow
Handout # 8 Federally Mandated Components
Handout # 9 Resource Coordination
Handout # I0 JOBS Program Participation Data
Handout # I1 JOBS Status Summary Update
I
i I j
I
- Handout # I 1-
I I I
Major Provisions of the Family Support Act of 1988
( Amends Title IV of the Social Security Act)
Title I Child Support Enforcement
Strengthens requirements for establishing paternities, requires courts to
use standard guidelines in setting child support payment amounts, re-quires
automatic wage withholding of court ordered payments, and re-quires
improved timeliness in collecting and distributing child support
payments.
Title II Job Opportunities and Basic Skills Trainina ( JOBS) Proaram
Requires states to establish a system of comprehensive education, train-ing,
and employment services for recipients of Aid to Families with De-pendent
Children ( AFDC). States are given incentives to target services
to the hardest- to- serve welfare clients; teen parents, long- term recipi-ents,
and others at risk of chronic dependency. States were allowed to
start their JOBS programs as early as July 1, 1989, but must have begun
them no later than October 1,1990, and must fully implement the pro-grams
statewide by October 1, 1992. The legislation mandated that the
program be administered by the State IV- A agency and created Title IV- F
of the Social Security Act.
Title Ill Supportive Services
Requires states to guarantee child care assistance and supportive serv-ices
( e. g. transportation, work and training related expenses) for AFDC
persons participating in JOBS or other approved education or training
programs, or who need such assistance in order to accept or maintain
employment. Requires states to establish transitional services in the
form of extended child care and medical assistance for up to 12 months
to families who leave AFDC due to employment or increased earnings.
Title IV Related AFDC Amendments
Requires states to provide AFDC benefits to two- parent families in which
the primary wage earner is unemployed. Allowed states certain options
in how they implemented this program. Required states to increase the
amount of earned income of on AFDC recipient which is disregarded in
the benefit calculation.
Title V Demonstration Projects
Authorized service demonstration projects that states could apply for,
but did not fund these projects.
-- Hanaout # 2
+
I
I CHRONOLOGICAL DEVELOPMENT OF
WELFARE REFORM IN ARIZONA , I
I
1 September 1988 - I Governor convened a Task Force on Welfare Reform.
I
~ 1 October 1988 - President signed Family Si~ pporAt ct of 1988.
I January 1989 - Governor's Task Force on Welfare Reform submitted
recommendations to Governor.
1 989 Legislative - State Legislature passed Senate Bill 1138
Session appropriating start up funds for JOBS automation and
to begin transition services. Also included some
requirements for implementation of JOBS in Arizona.
October 1989 - Department of Health and Human Services issued
JOBS regulations.
April 1990
May 1990
- DES began providing transitional services ( child care
and medical assistance) to families leaving AFDC due
to employment or earnings.
- DES placed welfare reform effort under project control
and entitled it the " Family Investment Initiative".
1990 Legislative - State Legislature appropriated funds to begin the
Session JOBS program effective October 1, 1990, the AFDC
Unemployed Parent program, and the remainder of the
child care provisions.
July 1990 - DES received federal approval of an Advance Planning
Document and funding to implement a JOBS
Automated System.
September 1990 - DES received federal approval of Arizona's State Plan
for the JOBS program design.
October 1990 - DES implemented the JOBS program, the JOBS
Automated System, the AFDC Unemployed Parent
program, and additional child care provisions.
October 1992 - Arizona must make the JOBS program available on a
statewide basis.
HANDOUT # 3
DEPARTMENT OF ECONOMIC SECURITY
FAMILY INVESTMENT INITIATIVE
DIRECTOR'S
1 OFFICE 11
/ PROJECT \
MANAGEMENT
EXECUTIVE COUNCIL
OBPPPC
\ /
DIVISION OF
CAMILY SUPPORT
DIVISION OF
SOCIAL SERVICES
OFFICE OF DATA
ADMINISTRATION
DIVISION OF EMPLOYMENT
& REHABILITATION SERVICES
FAMILY ASSISTANCE ADMINISTRATION
I
N
APPLICATION PROCESS
I
ELIGIBILITY DETERMINATION
REFERRAL TO WORK PROGRAM
D E R S
EMPLOYMENT AND TRAINING ADMINISTRATION
INTAKE PROCESS
NEEDS ASSESSMENT
CHILD CARE REFERRAL
PROGRAM PARTICIPATION
Handout # 4
I '
GOVERNOR'S TASK FORCE RECOMMENDATIONS
FOR EMPLOYMENT AND TRAINING
a DES should implement the Family Support Act required JOBS program on a
statewide basis, utilizing the comprehensive service model and case manage-ment
concepts of the WIN Demonstration Project ( Arizona Works!).
* In addition to the mandatory components required by the Family Support Act,
DES should implement the following optional components: On- the- Job Training
( OJT), Community Work Experience ( CWEP), Work Supplementation, and Job
Search.
. DES should exempt mandatory participation in the JOBS program for AFDC
recipients with children under the age of three.
. DES should allow participation, on an individual case by case basis, in employ-ment
andlor vocational activities under the JOBS program for custodial parents
under the age of 20 who fail to make satisfactory progress toward completion of
an adult basic education program or attainment of a GED.
e DES should mandate participation in the JOBS program for both parents in two
parent household, as a condition of receiving benefits.
DES should require that AFDC benefits only be provided to two parent house-holds
after required participation in JOBS with provisions for emergency situ-ations.
a DES should implement a time- limited AFDC Unemployed Parent program for a
maximum of 6 months, in a twelve month period, with exceptions for extraordi-nary
circumstances.
Handout # 5
* - ,-- 7-, I OVERVIEW: AFDC CASELOAD
( Source: DES/ FAA August 1991 Statistical Bulletin)
AFDC-- Basic AFDC-- Unemploved Parent
Total Number of Cases 56,702 1,229
Total Number of Recipients 159,392 5,237
Adults 47,869 ( 30%) 2,207 ( 42%)
Children 1 1 1,523 ( 70%) 3,030 ( 58%)
Average Payment per Case $ 304.90 $ 372.72
Average Payment per Recipient $ 1 08.47 $ 87.47
Average Number of MembersICase 2.8 4.3
AFDC CASE DEMOGRAPHICS
( Source: JOBS Initial State Evaluation, August 1989 active caseload [ AFDC-- Basic only];
consists of all cases in which a head of household was included in the case)
Geoaraphic Distribution
Maricopa County 50%
Pima County 18%
Balance of State 32%
Age of Head of Household Household Size
Most heads of household are over 24 years of The most common household size is 2 compris-age.
The average age of the head of house- ing 38% of the caseload. The average house-hold
is 29 years of age. 8% of the heads of hold size is 3, comprising 30% of the caseload.
household are under 20 years of age. Only 13% of the households have more than 4
members.
Aae of Younaest Child Marital Status
In 40% of the households the youngest child In 46% of the households the head of house-is
less than 3 years old. The average ages of hold has never been married. 41 % are either
the youngest child is 4 years of age. In 45% separated or divorced and 12% are married
of the households the youngest child is 3 to 12 with only 1 % being widowed.
years of age.
Ethnicitv of Head of Household Number of Months on Welfare ( Continuous)
White 38% Less than 7 months 27 7~
Hispanic 33% 7- 12 27 %
American Indian 18% 13 or more* 468
Black 11%
Other < 1% * Length of stay on AFDC not available prior to
August 1988.
, ! I AFDC CLIENT PROFILE
Following is a profile of AFDC recipients ( i. e., only those applying for case review/ recertifica-tion--
31 6 respondents) based on the Maricopa County Survey conducted in December 1 990:
Lenath of Time on AFDC. 81% reported having received AFDC benefits for 3
years or less.
Teens. 19% of cases had children ages 13- 17. 7% of case heads were teen
mothers.
AFDC Benefits. A mother and two children received an average of $ 527 per month
in cash and Food Stamps. The combined benefit met 40% of the Federal Poverty
Level.
Reasons for Usina Welfare. 43% said that meeting the basic needs of the family
was the main reason for being on AFDC ( i. e., major problems paying for food, rent
and needs of children).
Lenath of Residence. 86% had lived in Arizona four or more years.
Housina. 85% of families rented, 12% owed their own homes, and approx~ mately
1 % reported being homeless. 50% reported living in single- family or mobile homes.
Education. More than 70% had not completed high school, but 16% of those had
obtained a GED certificate.
Work Experience. 36% of recipients reported having had a paying job within the
past 12 months, and 12% were employed at the time of the interview. The most
common types of jobs were:
waitress
office work
saies/ cashier
The two most frequently- cited problems were employment- related. The major
reasons cited for current unemployment were ( mutiple responses possible):
Care for family 38%
Pregnancy 19%
Health problems 1 5%
Unable to find job 1 1 %
About 50% indicated they needed job training and help in finding a better job.
Child care. Of those who used child care when working, most relied on relatives
( 43%), followed by non- related adults ( 1 6%), and day care ( 1 5%).
HANDOUT 86
I JOBS Basic
JOBS REFERRAL PROCESS AND CLIENT FLOW
AUTOMATED
REFERRAL OF
INFORMATION
CLIENT I S SENT
AN APPOINTMENT
NOTICE
INFORMATION
IS COMPLETED
THE EMPLOYABILITY
PLAN AND ESA
1.1 CLIENT SUBNITS AN APPLICATION FOR AFDC. THE
F W E L I G I B I L I T Y INTERVIEWER WILL REVIEW
APPLICATION TO DETERNINE ELIGIBILITY FOR
AFDC OR TPEP BENEFITS.
1.2 M E ELIOIBILITY INTERVIEWER DETERMINES
JOBS PARTICIPATION I S REWIRED. REFERRAL
INFORNATION I S SENT TO JOBS.
1.3 JOBS WORKER SCHEDULES AN INDIVIDUAL OR A OROUP
OF CLIENTS FOR ORIENTATION C TESTING. TPEP
CLIENT APPEARS FOR ORIENTATION a TESTING.
1.4 JOBS WORKER CWPLETES AN I N I T I A L ASSESSMENT INTERVIEW.
TnIs INFORNATION IS USED TO DETERNINE WHETHER
INDIVIDUAL WILL BE MOVED TO CASE YANAOENENT.
1.5 THE JOBS CASE MANAGER WILL WORK WITH A JOBS CLIENT TO
SELECT CWPONENT/ ACTIVITIES NEEDED. SUPPORTIVE SERVICES
NECESSARY TO ALLOW JOBS PARTICIPATION ARE IDENTIFIED.
THIS INCLUDES JOBS PAID CHILD CARE.
1 6 CLIENT BEGINS PARTICIPATION I N A CWPONENT/ KTIVITY
AND JOBS CASE MANAGER TRACKS PARTICIPATION.
1.7 CLIENT OBTAINS FULL TIME EMPLOYMENT AND
BECWES POTENTIALLY ELIGIBLE FOR TRANSITIONAL
CHILD CARE AND NECIDAL ASSISTANCE ( AHCCCS) BENEFITS.
1 CASE MANAGER WILL CLOSE CASE I F CLIENT HAS
SUCCESSFULLY CWPLETED 9B DAYS OF EMPLOYNENT OR
WILL CLOSE DUE TO NON- COUPLIANCE/ SANCTION OR
CLOSURE OF AFDC CASE.
Handout # 8
-,- I-+-.
Federally Mandated Components
Education
Education activities below the post secondary level which are appropriate to
the participant's employment goal. These educational activities must include:
High School or GED
Basic and remedial education
English as a second language
Job Skills Training
This includes vocational for a participant in technical job skills, and equivalent
knowledge and abilities in a specific occupational area.
Job Readiness
Activities that help prepare participants for work by assuring that participants
are familiar with general workplace expectations and exhibit work behavior
and attitudes necessary to compete successfully in the labor market.
Job Development and Placement
Activities by the agency, in soliciting a public or private employer's unsub-sidized
job opening or in discovering such job openings, and the marketing of
participants, and securing job interviews for placement.
Job Search
Group or individual activities. Individual job search includes the provision of
counseling, job- seeking skills training, information dissemination and support
on a one- to- one basis. Group job search includes the provision of counseling
and training in a group setting where participants are taught job- seeking skills.
On- The- Job- Trainina ( OJT)
Participant is hired by a private or public employer and while engaged in pro-ductive
work receives training that provides knowledge or skills essential to
the full and adequate performance of that job. Through a contractual agree-ment,
the employer, is reimbursed for providing training and supervision. The
OJT participant is paid by the employer.
Community Work Exoerience ( CWEPI
Unpaid work experience directed at improving the employability of individuals
not otherwise able to obtain employment by providing them work experience
and training to assist them to move promptly into regular public or private em-ployment.
Selected Optional Components
HANDOUT # 9
RESOURCE COORDINATION
COMMUNITY
COLLEGE
STATE AGENCIES :
DOC / DOA / ADOT HEALTH CARE
COST
ADULT BASIC v
JTPA SERVICE COMMUNITY
EDUCATION DELIVERY AREAS BASED
PROVIDERS ORGANIZATIONS
DISTRICTS ! -/ CONTAINMENT
LOCAL
GOVERNMENTS - - J O B - EDUCATION
1
L/ ii \
Handout 910
i
--- C-JOBS
Program Participation Data
( 1 0/ 01/ 90 - 09/ 30/ 91)
JOBS Basic JOBS Two Parent
[ Sinale Parent) Emplovment Proaram [ TPEP)
Total Participants 2,410 2,684
Com~ onents
% Job SearchIJob Readiness 14% 44%
O h Remedial Education 28% 8 O h
O h Training 13% 3%
% Community Work 3% 2 O h
Experience ( CWEP)
% Post- Secondary 18% 4%
Em~ lovmenDt ata
# Entered Employment 180 738
Most Common Clerical ( 93) Service ( 1 66)
Occupational Categories Service ( 42) Construction ( 144)
Professional1 Clerical ( 69)
Technical ( 23) Benchwork ( 62)
Machine Trades ( 60)
Most Common $ 1 01 - $ 200 ( 87) $ 101 - $ 200 ( 425)
Salary Ranges2 $ 201 - $ 300 ( 63) $ 201 - $ 300 ( 1 85)
$ 301 - $ 400 ( 1 2) $ 301 - $ 400 ( 70)
The remaining participants are in orientation, assessment, or are receiving serv-ices
directed at barrier reduction.
includes part- time employment
-
Handout # 7
-- - >-.
JOBS STATUS SUMMARY UPDATE
Actions Completed
Began implementation of JOBS program October 1,1990.
. Implemented JOBS automated system October 1,1990.
. Timely and accurate federal reporting.
e Exceeded the federally mandated participation rate for first year of program
operation.
6 Developed a comprehensive three year evaluation plan and began evaluation
in October 1991.
Actions Planned
. Complete a workload measurement study in November 1991.
D Expand JOBS Basic program to all counties by October 1, 1992.
. Expand use of special projects for target populations ( i. e. teen parents).
. Reevaluate JOBS program design and make modifications as indicated.
- 38 -
1
Welfare Reform/ JOBS
Joint Legislative Committee
On Administration and Reorganization of DES
Response to Request for Additional Information
I. The following is information on persons served at each
location differentiated between JOBS Basic ( AFDC single
parent) and the JOBS Two Parent Employment Program
( TPEP) which serves AFDC two parent families.
Persons served by the JOBS Program
( October 1, 1991 - September 30, 1991)*
Maricopa County Sites
. 1224 S. 7th Ave. . Mesa . Young Families CAN
Special Project in
City of Phoenix . 438 W. Adams . 4635 S. Central . 9801 N. 7th St. . 3406 N. 51st Ave.
Pima Cou! n$ y Sites
. 945 E. Ohio . 316 W. Ft. Lowell . 7750 E. Broadway . I95 W. Irvington
Balance nf State
Flagstaff
\\ linslow
:; how Low
J'rescott
c: ottonwood
Icingman
Lake Havasu
Parker
Yuma
Casa Grande
Coolidge
City
BASIC
Response to Request for Additional Information
Page Two
BASIC TPEP* *
Balance of State ( Continued)
. Globe . P3yson . Bisbee . C3uglas . S3fford . Sierra Vista . Nasgales
Total 2606 Total 2651
* Includes all persons who received some services from
the JOBS program during the period 1 0 / 1 / 9 0 - 9 / 3 0 / 9 1
which was the first year of program operation. These
individuals may or may not have participated in a
comp: nent activity and some of these cases are now
clossd due to employment or other reasons.
** The TPEP caseload is driven by the number of two parent
AFDC families that apply for AFDC since the JOBS
program serves all of these families on a statewide
basis.
11. Teen Parent Data
The total number of teen parents who received services
from the JOBS program from 1 0 / 1 / 9 0 - 9 / 3 0 / 9 1 was 200.
Single Parent Participants = 140
participants from two parent families = 60
Of tnose receiving services, 62 participated in
activities directed toward obtaining a GED, and four
participated in remedial educational activities
Appr:) ximately 88% of the teens in the JOBS program do
not have a high school diploma. Experience with the
Young Families CAN project prior to JOBS indicates that
teens take considerably longer to obtain their GED than
oldc5r participants. This is related to their maturity
faczor and their general instability. They tend to
drop out of the program more frequently and often do
not return for several months which is a hindrance to
the j r progress.
Response to Request for Additional Information
Page Three
Unlike other AFDC clients, teens are not exempt from
participation in JOBS solely because they have a child
under the age of three, but could be exempt for other
reasons. If not exempt for other reasons, they must
participate in an educational activity in JOBS as
condition of AFDC eligibility, if child care is
available, unless they already are in school, have a
GED, or have a high school diploma.
111. A question was also raised regarding how many of the
JOBS participants who were employed are part- time
employed. Of those persons employed between 10/ 1/ 90
and 9/ 30/ 91 about 12% were working less than 30 hours
per treek, which is the definition of part- time
employment for the JOBS program.
WELFARE REFORM - JOB TRAINING AND RELATED PROGRAMS
JOB OPPORTUNITIES & BASIC SKILLS ( JOBS)
APPROPRL4TIONS AND EXPENDITURES
( In thousands)
PROGRAM SUMMARY APPROPRIATION ACTUAL APPROPRIATION
State Federal State Federal State Federal
FTE Positions 45.7 44.8 48.7 48.7 47.2 47.2
Operating Budget $ 1,093.7 $ 1,093.7 $ 1,0924 $ 1,0924 $ 1,3582 $ 1,3582
Contracted Services $ 3,383.5 $ 3,383.5 $ 799.4 $ 799.4 $ 3,3385 $ 3,3385
Subtotal $ 4,477.2 $ 4,477.2 $ 1,891.8 $ 1,891.8 $ 4,696.7 $ 4,696.7
$ 8,954.4 $ 3,783.6 $ 9,393.4
JOBS is located in DES' Division of Employment and Rehabilitative Servicca
* The FY 1991 appropriation and expenditure ptavided funding for 10.5 months for the operating budget
and 9 months for contracted scrvicca Proposals for contracted sewica wm received for Maricop and
Pima Countits, but not for the rest of the state. DES haa utilized contracted servica to fund non-permanent
and rrasonal pceitiom to implement a contingency plan for the geographic area outside of
these two countita
JOBS DAY CARE
APPROPRIATIONS AND EXPENDITURES
( In thousands)
FY 1991 FY 1991 FY 1992
PROGRAM SUMMARY APPROPRIATION AC; TOAL APPROPRIATION
State Federal State Federal State F w
LTE Positions 7.0 7.0 7.0 7.0 7.0 7.0
Operating Budget $ 225.8 $ 225.8 $ 225.8 $ 225.8 $ 225.8 $ 225.8
Assistance Payments $ 856.1 $ 1,385.3 $ 141.8 $ 228.6 $ 571.2 $ 947.5
Subtotal $ 1,081.9 % 1,611.1 $ 367.6 $ 454.4 $ 797.0 $ 1,173.3
$ 2,693.0 $ 8220 $ 1,970.3
JOBS Day Care is located in DES' Division of Social Smricca
* The FY 1991 appropriation and expenditure provided funding for 10.5 months for the operating budget
and 9 months for asshanct paymmta
TRANSITIONAL CHILD CARE FCC)
APPROPRIATIONS AND EXPENDITURES
( In thousands)
FY 1991 FY 1991 FY 1992
PROGRAM SUMMARY APPROPRIATION ACrCTAL APPROPRIATION
State Federal State Federal State Federal
FTE Positions 7.0 7.0 7.0 7.0 7.0 7.0
Operating Budget m1.4 m1.4 m1.4 m1.4 m1.4 m1.4
Assistance Payments $ 9486 $ 1,523.2 $ 531.7 $ 854.2 $ 948.6 $ 1373.6
Subtotal $ 1,160.0 $ 1,754.6 $ 743.1 $ 1,065.6 $ 1,160.0 $ 1,785.0
$ 2894.6 $ 1,8087 $ 2,945.0 1
Transitional Child Care has 4.5 FTE pitiom in DES' Division of S dSe wica and 25 pitione and
$ 82,000 in the Division of Famiiy Suppor~ A sshnct Payments are funded in Social Servicca
JLBC Staff 10/ 8/ 91
DIVISION OF
DEVELOPMENTAL DISABILITIES
DES Division of Developmental isa abilities ( DDD)
The Committee held five hearings and one working session on
the issues of the organizational structure of the Division,
provision of services, personnel, populations served and budgetary
items. Many hours of testimony were received from parents,
advocates and consumers, as well as administrators and case
managers from the Division, focusing on problems relating to these
issues. The Committee also received an overview of the Interagency
Coordinating Council on Infants and Toddlers ( ICC) . Even though
this is not a part of the Division, it coordinates services for
some of the same population. The ICC annual report for 1992 is
inserted at the end of this section.
Part I: Overview of the Division of Developmental Disabilities
This section includes the following:
1. Organizational Chart
2. DES/ DDD Fact Sheet
3. Overview of Program
History of Services in Arizona
Overview of Medicaid Waiver
Access to Services
Services
Service Delivery and Quality Management
Automation and Reporting
Budget
Populations served
4. Charts and Graphs
. Placements ( Institution vs. Home and Community
Based Services
. PIlnsatcietmuetnitosn 19v8s9.- 1991H ome and Community Based
. EPxrpoevniddietru Nreetsw ork Growth and Key
Client and Funding Distribution
PROGRAM ADMINISTRATOR
LONG- TERM CARE
DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF DEVELOPMENTAL DISABILITIES
I ASSISTAW DIRECTOR
DIVISION OF DEVELOPMENTAL
SPECIAL PROJECTS 1 MANAGER 11- 1 t; E: i 1
PROGRAM ADMINISTRATOR
ADMINISTRATIVE SERVICES
FAMILY & CIULDRENS
SERVICES UAISlON
DISTRICT PROGRAM DISTRICT PROGRAM
DISTRICT I DISTRICT II
EXECUTIVE STAFF
ASSISTANT
DISI'RICT PROGRAM
MANAGER
DISrnCT v
PROGRAM ADMINISTRATOR
PROGRAM REVIEW I
DISTRICT PROGRAM
MANAGER
DISTRICT nr
MANAGER I PROGRAM I
I DISTRICT N
DISTRICT PROGRAM
MANAGER
DISTRICT VI I
RIJ1H; b. T DEVP. I. OPMENT COOR1) INATION UNIT 11- 19- 91
PART I
DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF DEVELOPMENTAL DISABILITIES
FACT SHEET
Purpose
The goal of the Department of Economic Security/ Division of
Developmental Disabilities ( DES/ DDD) is to develop, enhance
and support environments which will enable individuals with
developmental disabilities to achieve and maintain physical
well being, personal and professional satisfaction,
participation as family and community members and personal
safety. DES believes that individuals can best be served in
the most integrated home and community based setting;
therefore, the majority of services offered to individuals
are designed to meet personal needs in these settings.
Oraanization and Descri~ tion
Programs and services are coordinated by the Division's
Assistant Director, central office and Management Team.
Central office is comprised of four operational units:
Managed Care, Long Term Care, Administrative Support and
Program Review. Programs are implemented through offices
located in each of six districts throughout the state. Each
district has a District Program Manager ( DPM), Area Program
Managers ( APMs), Case Managers, Intake Workers and direct
care staff.
Po~ ulation Served
DES/ DDD provides or procures services through two major
programs for individuals who have autism, cerebral palsy,
epilepsy or mental retardation who were diagnosed as such
before the age of 18. One program is the state funded system
for persons who meet statutory criteria; the other is the
Arizona Long Term Care System ( ALTCS), the Title XIX Medicaid
program for persons with developmental disabilities who meet
the federal criteria. The ALTCS program was implemented in
Arizona in December of 1988.
The DES/ DDD operates under two budgets: the 100% state funded
budget for persons and services which do not qualify for
Medicaid eligibility; and the ALTCS budget, a combination of
state and federal matching funds for Medicaid eligible
persons and services. The total FY 1992 state appropriated
funding for these two budgets is $ 175,225,400. DES/ DDD has
1,444 authorized FTEs.
- The Arizona Lonq Term Care Svstem ( ALTCS) is a Medicaid
funded program of long term and acute care services for
persons with developmental disabilities who are at risk of
institutionalization. It is a five year research and
demonstration project under the federal Health Care Financing
Administration ( HCFA) intended to show that home and
community based services a managed care approach to
medical care are more cost effective than institution-alization.
A significant factor of this 1115 Research and
Development Waiver Program is the lack of a cap on the number
of individuals who may participate in the home and community
based portion of ALTCS. Long term care and acute care
services are bundled under a single system of case management
to coordinate and enhance service delivery. By the end of FY
91- 92, over 6,300 people will be served in this program.
Services
Services offered under both programs include but are not
limited to:
Assistance to Families
Early Intervention Services
Foster Care
Adult Developmental Homes
Semi- Independent Living
~ ecreation/ Socialization
Vocational Related Services
Acute Care
Non- Emergency Transportation
Current Status
Personal Care
Respite Care
Day Care
Residential Supports
Case Management
Homemaker Services
Home Health Aide
Therapy Services
Disabilities Arizona
o 11,400 persons currently served by the Division of
Developmental Disabilities.
o In ' 91, of 10,800 served, approximately 97% were served in
the community.
o 5375 are Title XIX Arizona Long Term Care System eligible.
o Approximately 96% of those persons who are Title XIX
eligible are served in the community.
o 1,500 persons have been taken off the waiting list since
implementation of ALTCS on December 19, 1988.
o $ 120 Million in federal dollars have been brought into
Arizona through June 30, 1991 to provide services to ALTCS
eligible persons with developmental disabilities.
o There are six institutions in Arizona certified as
Intermediate Care Facilities for the Mentally Retarded
( ICFs/ MR). The Arizona Training Program at Tucson, with 41
eligible persons, has been certified since 1988. The
Arizona Training Program at Coolidge currently has 74
eligible persons. The four Phoenix large group
facilities, with 40 eligible persons, have been certified
since 1988.
- 47 -
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF DEVELOPMENTAL DISABILITIES
I. History of Services in Arizona to Persons with
Developmental Disabilities
o Arizona Children's Colony ( Now called the Arizona
Training Program at Coolidge-- ATPC)
-- Established in 1952
-- Capacity of 350
-- Maximum pmulation of 1,200 in 1969
-- Current population of 184
o Arizona Training Program at Tucson ( ATPT)
-- Established in 1970
-- Capacity of 200
-- Current population of 41
o Arizona Training Program at Phoenix ( ATPP)
-- Established in 1973
-- Capacity of 145
-- Closed August 1988
-- Created 4 community ICFS/ MR
o Joint Legislative Committee established to review
service delivery in 1976
o Lawsuit filed in 1976 against the state and the
ATPC
-- Physical structure
-- Staff ratios
-- Habilitation programs
o Long range plan developed in 1977 for
deinstitutionalization, community development and
development and implementation of monitoring system
for the new comunity programs
o Family Support Program developed in 1977
o The Administration for Children, Youth and Families
transitioned foster care for developmentally
disabled children to the DDD in 1977
-- Provided choices and permanency planning
o Continued deinstitutionalization and community
development 1978- 88
o Assistance to Families Program developed in 1986
-- American Public Welfare Association award 1989
o November 30, 1988 HCFA approved the Research and
Demonstration Waiver
o Arizona Long Term Care System implemented for
developmentally disabled persons December 19, 1988
ARIZONA DEPARTMENT OF ECONOMIC SECURITP
DIVISION OF DEVELOPMENTAL DISABILITIES
11. Overview of the Medicaid Waiver
o Enabling legislation originally passed in 1987 with
major revisions in 1988 that became law September
1988
o DES/ DDD program contractor for management and
delivery of acute and long term care services for
individuals with developmental disabilities
o 5 year research and demonstration waiver
-- GOAL :
To develop and test alternative delivery and
payment systems for long term care services that
facilitate cost containment and improved patient
access and encourage quality care and efficient
treatment patterns
-- OBJECTIVES:
1. To design and test a preadmission screening
( PAS) program to prevent unnecessary nursing
home admissions and to target home and
community based services for persons with
needs that can be met by these services.
To demonstrate and evaluate integration of
payment and case management for the
continuation of services which includes long
term, acute and subacute care. This
objective includes the assessment of
incentives to prevent members from being
inappropriately shifted among different
treatment settings.
3. To monitor the costs for home and community
based care so that expenditures for these
services can be managed.
4. To develop and test alternative financing
schemes for long term care services, that
will include provisions for a full
captitation approach by the end of the
demonstration project, competitive bidding,
selective contracting and placing long term
care contractors and providers at financial
risk both for the number of recipients
referred for services as well as the cost and
volume of services provided.
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF DEVELOPMENTAL DISABILITIES
-- HYPOTHESES:
1. An automated ordinal ranking preadmission
screening instrument will result in Arizona
Title XIX Long Term Care, both institutional
and home and community based ( HCBS) clients
having lower functional levels. This is
shown by the individual and total Activity of
Daily Living ( ADL) scores relative to
national ADL scores for similar age groups
for clients served in institutions or by
HCBS .
2. An automated ordinal ranking preadmission
screening instrument, coupled with an
automated client tracking system and a sound
case management system, relative to other
instruments and information systems, will
more appropriately target home and community
based services and thereby result in:
a. lower rates of nursing home
institutionalization than in other
states;
b. lower per HCBS client costs than
institutionalized clients with
similar ADL scores in Arizona or in
other states;
c. lower per client costs than other
states
d. lower per HCBS client costs than in
comparable states; and
e. no significant distinction between
institutional and HCBS clients in
Arizona in terms of ADL scores.
3. Combining acute and long term care into one
case management system will effectively
coordinate care and improve continuity of
care relative to other Medicaid programs.
4. The availability of HCBS for the
developmentally disabled will divert
recipients at risk of institutionalization
from institutional settings.
5 . Recipients with the same level of ADLs will
be cared for at a lower cost in the community
setting.
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF DEVELOPMENTAL DISABILITIES
6. Arizona will eventually be capitated for the
developmentally disabled population. An
actuarially sound methodology can be
developed to capitate long term care services
as evidenced by contractor and provider
financial soundness and the degree to which
the long term care program is able to attract
providers needed at the rates offered.
7. Competitive bidding and selective contracting
will result in lower per unit/ service cost.
8. The rate of growth in the price of LTC
services will be lower than that experienced
by traditional Medicaid programs.
ARIZONA DEPART!- 1ENT OF ECONOMIC SECURITY
DIVISION OF DEVELOPMENTAL DISABILITIES
SERVICES
" I .: L? fo: I a i i i 1 . i die services QEE ~ c : s t ir j r i , ~ t~ o- Arizona Long Terx Care
S l ~ s t e n( ;, iTCS) and L h o s ~ p r o - ~ i d e da f t e r the i n 3 l e n c n t a t i o n cf ALTCS:
* ? rovi? ec? T itlc% EX o l i g l ; ~ l e i n d i v i d u a l s
** Prqvidcc! tc I C F , / I I ~ o p l v
+ Acute Tare s e r v i c e s
t l d ~ o t i v eA i? s and Devices
4 d u l t Day Care
Advecacy
Assessnent
A u d i o l o g i c a l
SERVICES - AFTE- R XI X
A d a p t i v e A i d s and Devices * +
Adult Cay Care *
; I\ dvocacy
A l t e r n a t i v e Communication Trnq.
Assessment **
A u d i o l o g i c a l ** +
Basic Zducation i3asic Zducation
Communitv Nursing S e r v i c e s
C o n s u l t a t i o n
Counseling
Day Care
Day Treatment and T r a i n i n g
Dental
Develonmental Day T r a i n i n q
Enployrnent R e l a t e d
Family F o s t e r Care
iiome Care
Home Management T r a i n i n g
Home Recruitment
Housekeeping
Case Kanagement *
Cormunity Education & I n f o r m a t i o n
Community Nursing S e r v i c e s *
C o n s u l t a t i o n **
Convalescent Care
Counseling **
Day T r e a t m e n t a n d T r a i n i n g *
Dental +
~ e v e l o ~ m e n t aDla y T r a i n i n g
Emerqency D e n t a l +
Emergency :, ledical * +
Emergency T r a n s p o r t a t i o n +
Enp l o y x e n t Related
Faaily F o s t e r Care *
Family P l a n n i n g *
F o s t e r Care *
IIome Care
iiome Health A i d e *.
Home Management T r a i n i n g *
Home Recruitment
Home Repair
Housekeeping *
ICF *
ICF/ MR
In- home Family Support P r o g r W In- home Family Support Program
Independent L i v i n g S k i l l s
I n p a t i e n t I I o s p i t a l I n p a t i e n t Hospital * +
I n s t i t u t i o n a l S e r v i c e s
I n t e r p r e t e r
SZ; ITIICTS -?? IO- R - TC) :< I:<
Jo'n Dov? ', oonent and Placexent
Job Trainlnq
Laboratory
: ledical Equipment & Sur,,, lies
:. ledical Services
?, ledicaito n
Neurology
3Jurse Practitioner
IJursing
Nutrition Education
Occupational Therapv
O~ hthalmology
Jo2 3eveLo~ 1rlenta nd Placenenz
Job '. loclification
Job Training
LaSoratory * +
Lzgal Assistance
i. leGical Zquip. & Sunplies * +
i? edical Services * +
.'! edical Su~? ort Services * +
!. ledication
Nutrition Education **
Xutritional Supplements +
Occupational Therapy *
Organ Trans~ lants * +
Orientation and Mobility
Orthognathic Surgery * +
Otolaryngology
Outpatient Health +
Parent Aide
Parenting Skills Training
Peer Self Help
Physical Therapy
Preschool Supplement
Psychiatry
Psyci~ ological
Recreation and Socialization
Rehabilitation Instruction
Resident Living'& Development
Sheltered Employment
Speech Therapy
Staff Training
Supported Employment
Transitional Employment
Transnortation
Parent Aide
Parenting Skills Training
Peer Self Help
Personal Care
Personal Living Skills Trng. *
Pharmacy *
Physical Therapy * +
Podiatry * +
Preschool Supplement
Prevocational Training
Prosthetic Devices * +
Psychological ** +
Rec. and Socialization **
Rehabilitation Instruction *
Resident Living & Development
Residential Room and Board
Respite/ Sitter *
Sheltered Ea~ loyment
Skilled Nursing Facility *
Speech Therapy * +
Staff Training
Supported Employment
Transitional Employment
Transportation
V i s i r i n : : J u r s e
V o l u n t e . ? r C o o r d i n a t o r
V i s i o n C a r e * +
' ; i s i t i a g N u r s e * +
: Jclii!? tcer C o o r c l i n a t o r
;; or!; A c t i v i t i c s
' iork ? . d j u s t n e n t
:! or\ Zwcr i e n c e
X- ray * +
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF DJ3WLOPMENTAL DISABILITIES
IV. Access to Services
A. Eligibility for ALTCS
o AHCCCS determines financial eligibility
o AHCCCS determines programmatic eligibility
using the Preadmission Screening ( PAS)
o The Division determines DD eligibility
pursuant to state statute ( ARS 36- 551)
B. Enrollment in ALTCS
o Member is assigned a case manager and back- up
case manager within 48 hours of enrollment
o Member chooses an Prepaid Health Plan ( PHP)
within 72 hours of enrollment ( if available)
o Member must choose a Primary Care Physician
( PCP) within 10 days of enrollment
C. Provision of Services
o Service Plan based on results from the
Preadmission Screening ( PAS) and needs
assessments
o Case Manager prepares Service Plan with input
from the individual and family ( if
appropriate)
o PCP orders medical services
o Includes all needed services
o Service Review Committee ( SRC) pursues all
available community resources to supplement
mandated services
o SRC offers alternative services if needed
o SRC provides choice of service providers
o Develop an Individual Program Plan using an
interdisciplinary team approach
ARIZONA DEPAR! CMENT OF ECONOMIC SECURITY
DIVISION OF DEVELOPMENTAL DISABILITIES
System is in place to insure individual rights
are protected
-- Human Rights Committee volunteers include
consumers, family members and community
members
-- New rule will be effective July 1990 and
staff will receive extensive training on the
changes
o Service plan review by case manager every 180
days for ICF/ MR and every 90 days for HCBS
V. Service Delivery and Quality Management
A. Provider Network
o Acute and long term care services provided
under a bundled approach with a single case
manager
o Contract with Health Maintenance Organizations
o Fee- for- service medical providers as needed
,
o Individual providers are recruited and
contracted with to enhance the scope of the
provider network
o Contract awarded through competitive bidding
by Requests for Proposals ( RFP) process
o Option of multi- year or renewable contracts
o Increased providers from 385 to over 1,500
o Compliance with the Boren Amendment through a
consistent and equitable rate setting
methodology which establishes reimbursement
rates for residential, adult day and child day
services
o Comprehensive review and revision of the rate
setting methodology in 1988- 89 ( yearly
- revisions)
o Providers are certified by the DDD and
registered with AHCCCS
-- 3 references from persons who have personal
or professional experience with the provider
in the area( s) of the proposed service( s)
-- criminal record check
-- complete the Home and Community Based
Services Individual Provider Application
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF DEVELOPMENTAL DISABILITIES
-- Completion of training requirements as
specified in the Training Requirements for
Certification of Home and Community Based
Providers
-- Sign Disclosure Statement to insure no
conflict of interest
o Reviews by HCFA, AHCCCS and the Arizona
Department of Health Services ( ADHS)
o Internal monitoring in ICFs/ MR ( monthly)
-- Reviews a sample of the population to assess
the provision of active treatment and
compliance with the conditions of
participation
-- Report of strengths and needs
-- Plan of correction if appropriate
o Utilization Review and Quality Assurance
-- Verification that physician has indicated
need for ICF/ MR level of care -- Assign a
continued stay date not to exceed 180 days
-- Assessment of IPP goals and objectives
-- Facility and day program observation to
assess active treatment across all settings
-- Review of medical files and procedures
. -- Pre- certification review in preparation for
ADHS survey
-- Report for corrective action if necessary
C. Nursing Facilities ( NFs)
o Review by HCFA and ADHS
o Preadmission Screening and Annual Resident
Review in compliance with the Omnibus Budget
Reconciliation Act of 1987 and 1990( OBRA ' 87
and ' 90
o Utilization Review and Quality Assurance
. -- Verification that physician has indicated
need for NF level of care -- Assign a
continued stay date not to exceed 90 days
-- Assessment of IPP goals and objectives
-- Review of medical files and procedures
-- Report for corrective action if appropriate
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF DEVEZOPMENTAL DISABILITIES
D. Group Homes, Adult Developmental Homes,
Child Developmental Homes
o Association for Retarded Citizen reviews of
Group Homes
-- Approximately 10% of all group homes
reviewed per year
-- Review teams consist of parent volunteers
and consumers
-- Monitor and observe quality of life issues
o Residential licensing
-- Implemented new standards January 1, 1987
which replaced the site review process
-- DES establishes and enforces 300 standards
with 113 that have mandatory compliance; must
comply with 90% of the remaining standards
-- Approximately 375 group homes ( SOGH & VOGH),
375 adult & child developmental homes
E. General Review and Monitoring
o Goals of the Service Plan Review and
Monitoring System
-- Formal review in HCBS every 90 days and
every 180 days in ICFs/ MR -- Reviewed by the
case manager for the necessity and sufficiency
of services
-- Revised as needed
o Quality Review
-- Insure individuals receiving services are DD
eligible
-- Assess whether desired outcomes are being
attained through the measurement of progress
toward individual objectives
-- Assess perceived quality of service delivery
from the point of view of the individual via
an annual consumer satisfaction survey
-- insure program improvement through the
development and monitoring of corrective
action plans
-- Insure cost effectiveness for services
without compromise to quality through prior
authorization, concurrent and retrospective
reviews
o Quality Assurance Reviews for HCBS
-- Individual needs assessments have been
developed and are current
-- Assessments drive service plan
ARIZONA D E P A R m OF ECONOMIC SECURITY
DIVISION OF DEVELOPMENTAL DISABILITIES
-- IPP goals are related to assessments
-- IPP is implemented as approved by the IPP
team, reviewed and modified as necessary
-- Review of medical files and procedures
-- Facility observation to assess
interactions and program implementation
o Quality Control Reporting
-- Encounter Reporting
-- Quarterly Financial Reports
-- Annual Financial Audits
-- Disclosure Statement
-- Provider Registration
-- Third Party Liability
-- Quality Control for HCBS
-- Hospital Utilization Data Reports
-- Quarterly Quality Assurance Reports
-- Quarterly Showing Reports
-- Quarterly Grievance Reports
-- Annual QA/ UR Plan
-- Medical Care Evaluation Study
o Utilization Review
-- Prior authorization of certain medical
services i. e. heart transplants -- Prior
authorization of home and community
based services which exceed the
established service levels
-- Concurrent review ( process of identifying
the medical necessity of hospitalization
and the assignment of a length of stay in
accordance with national averages)
-- Retrospective review of services that have
been provided to ensure cost effectiveness
and medical necessity
-- Periodic review of management information
system data pertaining to utilization
review activities
-- Discharge planning and client transfer
o Training and Technical Assistance
-- Active treatment
-- Individual Program Plan
-- Service Plan
-- Case Manager Desk Manual
-- Overview of ALTCS
-- Provider Requirements
-- Automation Systems
-- Contracting
-- Rate Setting
-- Provider Certification and Registration
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF DEVELOPMENTAL DISABILITIES
o Programmatic Administrative Review ( Grievance
and Appeals)
-- Can request review of decisions relating
to:
-- Eligibility, admission, placement
evaluation and assignment to programs
and services
-- Care and treatment, transfer or
substantial change in service
-- Termination of, or discharge from, a
program or service
o Community Involvement
-- Advocacy groups: Association for Retarded
Citizens, Governor's Council on
Developmental Disabilities, Developmental
Disabilities Advisory Council, Pilot
Parents and Arizona Association of Private
Agencies for Developmental Disabilities
o Yearly conference on Choices
o Public meetings for planning
VI. Automation and ALTCS Reporting
o Arizona Social Services Information and Statistical
Tracking System ( ASSISTS)
-- Maintains ALTCS member and provider records
-- Supports the purchase and delivery of ALTCS
service
-- Composed of integrated modules, each with update
and display screens
-- Provides for HCFA and AHCCCS reporting
requirements -- Existing interfaces are being
refined
-- Over 100 system changes are planned
-- Enhance user friendliness
-- Enhance ability to produce accurate, timely and
complete reports
o Host- to- Host interfaces with ASSISTS
-- Information Network Corporation ( INC)
-- Acute care providers
-- Member enrollment rosters
-- Service plan/ demographics changes
-- Financial reports
-- Encounter data reporting
-- Third party billing
-- Ad Hoc reports
-- Claims
-- Utilization Review and Quality Assurance data
-- DES Financial Management Control System ( FMCS)
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF DEVELOPMENTAL DISABILITIES
-- Processes payments issued from ASSISTS
-- Debits and credits
-- Process through Arizona Financial Information
System ( AFIS) for warrant is produced
-- AHCCCS general computer system
-- Exchange of client service plan data
-- Exchange client demographics
-- Exchange encounter data
-- Exchange of placement and cost effectiveness
data
-- Exchange of general financial and other
consumer related data
VII. Budget Information Fiscal Year 1992
Total budget appropriation $ 175,225,400, of which $ 130
M is LTC
Iinstit utional
a HCBS
Institutional Vs. HCBS Placements
1987 1988 1989 1990 1991
Year
DIVISION OF DEVELOPMENTAL DISABILITIES
WHERE THEY LIVE: TITLE 19 ELIGIBLE
DIVISION OF DEVELOPMENTAL DISABILITIES
WHERE THEY LIVE: TITLE 19 ELIGIBLE
DIVISION OF DEVELOPMENTAL DISABILITIES
WHERE DO THEY LIVE: TITLE 19 ELIGIBLE
DIVISION OF DEVELOPMENTAL DISABILITIES
CERTIFIED PROVIDER NETWORK GROWTH
# PROViDERS
1600.1 I
1400
1200 . . . . . . . . . . .
1000
800
600
400
200
0
HSK HMT OMT PEC PLS RSP TRA GRH OHA DFH DDC HAB
PROVIDER TYPE
JUNE 1989 JUNE 1990 JUNE 1991
Part 11: Summary of Issues, Problems and Recommendations Submitted
to the Committee
Problems*
1. * Case Management System
too many clerical duties and paper work
overworked, underpaid, lack of proper training
high turnover rate; about 72% turnover rate
lack of communication from the administration down
through case managers, clients and providers
clients may go for weeks or months with no case manager
some case managers have bad attitude, i. e., treat
families like welfare clients; Itbe happy with what you
get" attitude
some parents fear repercussion if they complain or speak
out
records sometimes lost or misplaced
parents want a choice in case management system.
2. * Contract Process
. Senator Salmon's request to improve the process not
followed up
delayed payments to providers causes hardships; providers
sometimes have to take out loans to pay bills and meet
. pcaoynrtorlalc. t s Msahyo utladk bee u pl otnoge 1r8 tmhoannt hosn ef yoera rD. E S payments
3. * System is not consumer/ family driven
.. mfoarmei lcioensc ewrann tf ort rou lreest, a rienc oarudtsh, o draittay thoavne rs ecrhviilcde and
participate in decision- making.
4. * communication problems
.. bbeettwweeeenn paadrmeinntiss tarnadt icoans aen mda pnraogveirdse; r psa rents may not know
who to call for help
communication all one way, from top down, with no input
. mfirxoemd fmaemsislaigeess orfr pormo vvairdierosu s levels of management.
5. * Too heavy upper and middle management
. . DsDys theimr eiss mtooroe cpoemopplleex taon d tbruyr etaou ccroartriecc t an inefficient
system and some incapable people. If people cannot do
the job, let them go.
*
Indicates the issue was mentioned more than once.
6. Districts operate by different rules. Also, often
inconsistent and unwritten policies.
Mother required to be home during the time a skilled nurse is
there to care for son. Requests copy of federal law to back
this up.
* Some providers not trained for caring for clients, especially
medical needs.
* Some case managers advising parents to give children up to
become wards of the state to receive services.
Mother can't get respite provider due to child's behavior
problems.
Case managers, administrators and hearing officers sometimes
make judgements on eligibility and care without training or
know the case.
* Budget problems
. too many dollars spent on administration, consultants and
. high salaries for top management rather than services state- funded- only clients getting cut off because Title
19 clients come first
the waiting list is not being funded or served.
* Grievance process should be less intimidating, threatening,
and allow the case worker or provider to attend hearing.
* Accountability problems
. No sense of accountability to either parents or upper
management. Parents made to feel it is none of their
business where the money goes or how or why policies are
made.
* Licensing and monitoring issues
. 315 regulations to learn and follow and I1most are
.. wtghaayrk beacsgl eif. ei nvte mroenatshsse sosrm emnotr ee vteroy g e9t0 dfaiynsg? e rprint results
Court- ordered services sometimes are not implemented.
* Service delivery system
. mpaanrye ntcso msphloauilndt sn ota bhoauvte ntoot barregcaeiinv ionrg tsreardvei fcoers soerr vliocnegs
delays
rural areas lacking in services
- no adult day program or group home in Show Low for
elderly mother's son
- northwest Arizona not receiving preschool and adult
services.
.. Title 19 should include psychological services lack of day care centers who will accept DD children
18. * Providers1 issues
. pay own expenses, i. e., insurance, 15% self- employment
tax, yet are delayed in receiving DES payments
. cDoEmSm tuhnriceaattieonns ptroo bcluetm tsh weiitrh rDaDtDe s
19. * Personnel issues
personnel rules are too complicated, should not tax six
months top hire a new director
... moliovanreccerkr w etooarfrsa kecie pondaoi yrne dgmis panclnaaodtly ieecoseon stn ; aos mi aosttntotgeor n dacicymvt uii cqsnhui paoolnmlisoif ncaieyneyd d a mpngaedon oiaprnglugeel m eet mnoat k ipanyg
overtime .
Recommendations
1. * Investigate establishing a family voucher system.
2. Provide families with pamphlets listing available services,
how to access the system, and contact numbers. Provide a
written explanation of the grievance process and parental
rights.
3 . All Individual Program Plans should be provided in writing to
families and the plan implemented. Changes should involve the
families or guardians.
4. * All other recommendations included taking corrective action
on the problems listed.
Summary of Issues and Recommendations
Submitted by DD Case Managers
The following is a list of issues and recommendations submitted by
DD case managers at the December 9 meeting. The asterisk indicates
the issue was mentioned more than once.
1. Wages should be increased to retain good case managers and
attract more qualified ones.
2. High turnover rate due to low wages and high job demands and
stress. Have to get a promotion to get a pay raise.
3. Title 19 created a dual system; the Title 19 eligible people
get served first since that is an entitlement program, thus
leaving the state- funded clients underfunded and
underserved/ unserved. The state- funded waiting list is
growing daily.
4. No accountability on where money is spent or what the budget
is.
5. Providers sometimes bill for unauthorized services. Provider
contracts may have inflated costs.
1. Inadequate training; the expensive training session in
Prescott is not practical enough to apply to daily job
requirements. Training should be on- going.
2. Case managers must handle foster care cases with no foster
care training.
3. Training should be competency- based.
4. Required legal work, i. e., court documents without training.
* Weaknesses and problems with service delivery system
1. The dual system created by Title 19 is draining all the money
away from the state- funded clients.
2. Lack of qualified providers, especially in rural areas.
3. Lack of transportation services; case managers spend own time
and gas transporting clients.
4. Critical lack of child care for DD clients; child care centers
are not equipped or trained to care for DD children. School-age
children often cannot access after- school care.
5. Shortage in foster care system. Case managers who offer
foster care are not compensated as in ACYF Division.
6. Title 19 does not include payment for diapers.
7. Services may be approved but not available. This causes
confusion and frustration for parents.
8. Dually diagnosed clients are not getting mental health
services.
9. Behavioral health screening team disbanded for lack of funds.
10. Lack of consistent service definitions.
11. Many gaps in the service definitions.
12. Delivery system breaks down on reservations due to inability
or unwillingness of BIA or Indian Health Services to act.
13. Need for bilingual case workers in minority areas and pay them
accordingly for their abilities.
14. Title 19 requirement of a personal assessment of each case
every three months is burdensome.
15. Foster care requires a personal assessment each month, as well
as two court appearances and two foster care review board
appearances per child each year. In addition. case worker
must work with the natural family to fulfill the plan to
return the child home.
16. Case manager in Safford has a case load of 130 clients which
is totally unmanageable.
17. Need to improve public awareness on how to access the system,
available services, description of programs, grievance
procedures, etc.
*~ dministrative problems
1. Frequent and inconsistent changes in policies and procedures,
often inconsistent directions from supervisors,
2. Inconsistent policies among and within the districts.
3. Policies and procedures often dontt follow mission statement.
4. No written definition of Itcase manager." Confusion of roles
of a case manager.
5. Case managers often have too many cases.
6. CPS workers have clerical and parent aidest assistance, not DD
case workers.
7. Too much paper work and required recordkeeping.
8. Poor work sites, i. e., insufficient office space, phones,
areas for confidential visits and phone calls, lack of
security and confidentiality in offices, insufficient officer
equipment and terminals too few and not functioning property
or quickly.
Lack of intergovernmental agreements to avoid gaps in service
with mental, behavioral health, child and adult abuse, public
schools, etc.
Communications break down within the layers of administration.
Upper management does not listen to lower supervisors and case
managers.
Administrators should be aware of all the responsibilities of
case managers.
Program managers are also often overloaded and underpaid.
DD foster care system not at par with CPS foster care system.
Job description of Human Services I does not fit the
responsibilities of DD case managers.
Continually changing requirements of forms and other
paperwork.
Need written prior notice before policies are changed.
Need clear, concise, consistent directives.
No time to do networking of services.
No assessment tools.
Many inappropriate appeals due to lack of communication and
angry parents.
Little or no accountability from upper management. Some local
offices do not yet know their FY 1991- 92 budget.
Need correct, consistent interpretation of Title 19.
Need stronger leadership in upper management, as well as
accountability and improved communications at all levels.
Often conflicting roles as advocate and gatekeeper.
Case managers called upon to be social workers for the entire
family, i. e., assisting in applying for food stamps, health
plans, transporting to clinics, school, etc.
" ASSISTS computer system should be programmed to reduce
paperwork and improve efficiency.
The Division is run by a " management by crisisl1 approach.
There is a lack of specific direction and implementation of
short- and long- term goals.
28. Minimum qualifications for case management positions are
overly restrictive. Years of service in other positions
within DDD are not counted when a person applies for a case
management position.
29. Need assistance from personnel system in filling vacancies in
a timely manner, and revising qualifications specific to DD
case managers.
1. Programs should be consumer driven; families should have
choices.
2. New case managers and other DD workers should have a strong
orientation program.
3. Case managers should be paid for flextime since so many duties
fall outside the normal work day.
4. Compensation should be based on education and experience. All
case managersr salaries should be competitive with the private
sector and other state agencies.
5. Solicit input from parents, consumers, providers and case
managers on program planning.
6. Closer scrutiny and audits of provider contracts.
7. Simplify the management structure and hire more case workers
and clerical and parent aides.
8. Put a cap on caseload sizes.
9. If additional state positions cannot be allocated, use service
dollars to purchase case management and case aides through
contracts.
10. Provide specialized foster care case managers.
11. Develop job coaches in the work place rather than pay them in
sheltered workshops.
12. Provide for a continuum of services for DD persons who
progress out of Title 19 eligibility. Otherwise, they regress
when dropped and repeat the cycle over again.
13. Define specific job responsibilities to get rid of " do
nothingw bureaucrats.
14. Provide incentives; allow for comp time and promotions.
15. Withdraw financial responsibilities such as authorized
representatives, third party liability, billing statements and
trust funds from case managersr work loads.
All other recommendations included taking corrective action on the
problems as listed.
Following are copies of recommendations submitted by agencies.
RESPONSES AND RECOMMENDATIONS FROM DES ADMINISTRATION:
JOINT LEGISLATIVE COMMITTEE ON THE ADMINISTRATION AND
REORGANIZATION OF THE DEPARTMENT OF ECONOMIC SECURITY
Department of Economic Securitv/ Division of Developmental
Disabilities
The goal of the Department of Economic Security/~ ivision of
Developmental Disabilities ( DES/ DDD) is to develop, enhance
and support environments which will enable persons with
developmental disabilities to achieve and maintain physical
well being, personal and professional satisfaction,
participation as family and community members and personal
safety .
Services are provided through two major programs; one is the
state funded system for persons who meet statutory criteria,
and the other is the Arizona Long Term Care System ( ALTCS),
the Title XIX Medicaid program for persons who meet federal
criteria. DES/ DDD operates under two budgets: the 100% state
funded budget for persons and services which do not qualify
for Medicaid; and the ALTCS budget, a combination of state
and federal matching funds for Medicaid eligible persons and
services.
Public Policv Issues for Consideration
Is the state creating a dual system of services for
Arizona citizens with developmental disabilities ?
Title XIX is a federal Medicaid entitlement program.
According to A. R. S. 36- 560, Subsection B, services that
can be provided to individuals who are not eligible for
Title XIX programs are limited to " available funding".
As more state dollars are required to match federal
dollars, the state only funds available for individuals
who are not Title XIX eligible are decreasing. In
addition, the focus of appropriations in recent years has
been on Long Term Care programs rather than increasing
funding in the state only funded budget.
The approximate waiting list for state funded services
for fiscal year 1993 is 267 children and 480 adults.
Recommendation
In order to provide more equitable access to a full range
of services, it is necessary for the State to examine and
determine:
1. what types of 100% state funded services will be
offered for those individuals with developmental
disabilities who are not eligible for Title XIX
services ( ie. similar services to those offered
under Title XIX 3 ) ; and,
2. what level and amount of services is the State
able to provide through appropriation for non-
Title XIX eligible persons?
Should individuals with developmental disabilities who
are voluntary or involuntary disenrollees from the Title
XIX program be placed on a waiting list or should they be
served with 100% state funds?
Currently, individuals can voluntarily withdraw from
Title XIX services or be involuntarily withdrawn through
eligibility redeterminations by AHCCCS.
Increased involuntary disenrollees may be an outcome of
the current AHCCCS revision to the Pre Admission
Screening Test used in eligibility determinations for
Title XIX services.
These disenrollments can be described by the following:
Voluntary - DES/ DDD has had less than 25 individuals
voluntarily disenroll from the Title XIX program in the
last fiscal year. When the Title XIX program was first
implemented, the most frequently cited reason for
disenrollment was dissatisfaction with a primary care
physician. DES/ DDD also found that many of the
individuals who disenrolled during the first nine months
of the program were low utilizers of long term care
services and resided in home environments with the
necessary supports.
Involuntary - Involuntary disenrollees fall into two
categories:
a. those who were receiving state funded services and
then became eligible for Title XIX services when the
program was implemented. The state initially benefitted
when these individuals became eligible because 60% of
state costs were picked up through the federal match;
b. those who were not receiving state funded services and
who may not have come into the program if they were not
eligible for Title XIX services. The state did not
benefit financially because a state match was added when
these individuals entered the program.
Recommendation
For those involuntarv disenrollees who received state
services prior to becoming Title XIX eligible the state
should continue to provide the same level of services
with 100% state funds. The state had an historical
service obligation for these clients and benefitted
financially when the person became Title XIX eligible.
For those involuntarv disenrollees who only came into
service when they became eligible for Title XIX and then
lost those services through re- determination, the state
should maintain services with 100% state funding because
the state has established an obligation and the person is
losing service through no fault of their own.
Each of these considerations will have fiscal
implications for the DES/ DDD state only funded budget.
Individuals who voluntarilv disenroll from the Title XIX
program are currently receiving services with 100% state
only funding. The Department recommends that any future
individuals who voluntarily choose to disenroll be placed
out of service onto a waiting list for state services.
Should the state provide 100% state funded child care
services for individuals with developmental disabilities
beyond the current state day care program? If so, should
the services be provided regardless of family income?
Should there be a sliding scale fee for child care
services? Should there be a capped limit on services
provided ?
The DES/ DDD has in the past provided services such as day
treatment and training ( DTT) to certain families who have
in turn used the services as day care while they worked.
Many of the families are single parent families who may
or may not qualify for limited child care subsidy
dollars.
In addition, many families experience difficulty in
finding traditional day care services at reasonable rates
which will accept a child with developmental
disabilities, particularly one over the age of 12.
However, the use of day treatment and training as day
care is not reimbursable under ALTCS and, if continued,
could place DES/ DDD in the position of being subject to
sanctions from the Health Care Financing Administration
as well as denial of federal financial participation.
The Department has reserved $ 500,000 from the Child Care
and Development Block Grant to establish and operate
child care programs for children with special needs. The
grant requires interested individuals and families to
meet income and programmatic eligibility requirements.
Recommendation
The current state child care subsidy is at 65% of the
1988 state median income and the age limit is up through
age 12. The Department will explore the feasibility and
cost of expanding eligibility from age 13 to 18 for
children with special needs.
4. Should the state establish a pilot program to enable
families to purchase some or all of their own services
within the service delivery criteria established by the
Title XIX program ?
Many families and advocates indicated in testimony that
they feel they have no say in how service dollars are
allocated and that the service system is not consumer
driven.
Recommendation
The Department is proposing legislation for this coming
session called the Family Assistance bill. The intent of
the proposed legislation is to establish a family support
committee charged with the responsibility of designing a
family support system consistent with the principles
outlined in the legislation.
Based on recommendations from the Family Support
Committee, the state should plan to design and implement
a pilot program which would enable families to exercise
greater choice in purchasing services.
5. Should DES ensure that all possible revenue sources are
considered and used for state funded clients?
The DES has implemented a third party liability ( TPL)
system for Title XIX clients as required by the Health
Care Financing Administration ( CFR 433.136) and its
intergovernmental agreement with AHCCCS.
There currently is no specific authority to allow TPL
collections and cost avoidance methods for state funded
clients. Funds collected could potentially be used for
services and programs provided to persons with
developmental disabilities.
A second revenue issue pertains to clients at the Arizona
Training Program at Coolidge and two residents of ICFs/ MR
whose financial resources prohibit their eligibility for
ALTC services. These resources are held in trust funds
or CDs and range from just over $ 2,000 to over $ 60,000.
Currently, the state pays 100% of medical costs not
covered by Medicare for these individuals for an average
annual cost to the state of between $ 150,000 to $ 200,000.
If DES were allowed to require financial contributions
for ancillary services, such as uncovered medical costs,
from client's privately held assets, in many cases it
would allow these individuals to become eligible for
Title XIX programs as well as free up additional state
dollars.
Recommendation
Grant DES the legislative authority to establish a TPL
program for state funded clients through support of
proposed TPL legislation.
Establish statutory authority allowing DES to request
financial contributions for ancillary services received
from assets and resources privately held or held on
behalf of persons in institutions receiving state funded
services.
Pursuant to A. R. S. 36- 562 ( F), DES will promulgate by
rule a sliding fee schedule requiring a financial
contribution from a client, parent, spouse or estate of a
developmentally disabled person for the cost of
nonresidential services funded by state appropriation.
The contribution shall not exceed the actual cost of
services or programs provided and shall not exceed the
amount of the fee prescribed for residential services
pursuant to A. R. S. 36- 562 ( C).
6. A. R. S. 36- 2953 established the Long Term Care System Fund
( LTCSF) for the DES/ DDD pursuant to Laws 1987, Chapter
332. The implementation of this program split the
developmental disability resources into two ( 2) budgets.
The LTCSF finances the care of DES/ DDD clients who
qualify for the federal Title XIX Medicaid assistance.
DES/ DDD clients who do not qualify for federal assistance
are funded through the 100% state funded budget.
As they become Title XIX eligible, clients are
transitioned in from the 100% state funded program to the
Arizona Long Term Care program.
The LTCSF consists of all Arizona Health Care Cost
Containment System ( AHCCCS) monies, state appropriations
and other grants and revenues. The fund is subject to
legislative appropriation and therefore, all transfers
to, from, and within the fund to accomodate client
movement require the approval of the Governor's Office of
Strategic Planning and Budgeting and the Joint
Legislative Budget Committee.
This has resulted in an extremely complex and time
consuming process of budget development and transferring
of funds necessitated by the dynamic process of clients
becoming eligible for Title XIX services. Particularly
at the end of the fiscal year, this can result in
significant delays, cash shortages and problems with
timely payment of bills.
Recommendation
It is recommended that the Legislature eliminate the Long
Term Care System Fund and appropriate funds to DES/ DDD in
a single budget in a manner consistent with other
divisions within DES which receive funding from multiple
sources.
Operational Issues for Consideration
The Department is in the process of procuring a consultant to
do a comprehensive management and operations review of the
Long Term Care systems established when Title XIX was
implemented in order to ensure efficiency, accountability and
compliance with federal regulations.
1. There have been several requests, both from legislators
and advocates, for cost information relating to the
Arizona Training Programs, particularly the Arizona
Training Program at Coolidge.
DES/ DDD is appropriated funding for all personnel related
costs and some state operated facility costs in two
budgets. These funds are allocated to each district
depending on the number of FTEs and caseloads in each
district. In addition, the Administration/ Division of
Business and Finance is appropriated funding for
occupancy costs related to these facilities, as well as
other facilities occupied by DES/ DDD personnel. Current
accounting systems are designed to track costs by
district, not by facility.
The cost information for the Arizona Traininq Proqrams at
Tucson and Coolidae for FY 91 is attached as requested.
2. DES/ DDD is experiencing an on- going problem with
recruiting and retaining qualified case managers. This
problem is particularly acute in rural areas and
exacerbated by situations where DES/ DDD is having to
compete against other agencies such as the BIA, CPS and
BHS which offer higher salaries.
Recommendation
Require the Department of Administration to perform a
Classification Maintenance Review on Human Service
Specialists I, II, III and Supervisors, with consideration
given to differentiating between case managers who deal
with high need individuals and those who don't, and
including the following issues :
a. recruitment c. turnover e. incentives
b. retention d. space f. equipment
3. A great deal of testimony was heard regarding case
managers being overworked, underpaid and poorly trained.
Recommendations
Several options are available to address this issue:
a. Appropriate funds to establish a case management
training unit within DES/ DDD that could provide not
only internal training in developmental disabilities
to entry level case managers, but also focus on the
complex requirements of the Title XIX program.
Currently there are two positions within Central
Office responsible for all training. One of those
positions is specifically for foster care case
management; the other is responsible for all other
training functions statewide;
b. Appropriate a 1: 30 case manager ratio and appropriate
funds for clerical and data entry support for case
management offices in order to allow case managers to
perform their primary roles. If the state were to
fund a 1: 30 ratio, it would increase the state
appropriation in FY 1993 by $ 3,268,700.
4. Families and consumers do not find the grievance and
appeals process to be " user friendly".
Recommendation
Appropriate funding for an ombudsman position within ,
DES/ DDD to assist families with service provision issues
and to act as a source of information and support for
families in grievance and appeals hearings.
5. The Governor's Council on Developmental Disabilities, in
cooperation with DES/ DDD, is currently contracting with
the Human Services Research Institute to study, design
and assist in implementing a comprehensive quality
assurance system for the division. There is some concern
that recommended changes will not be able to be
implemented without additional resources.
Recommendation
The Department, in cooperation with the Governor's
Council on Developmental Disabilities, will develop an
implementation plan for any recommended changes in the
quality assurance system and will submit the plan to the
Legislature if additional resources are needed.
Automation Issues - for Consideration
In testimony, case managers indicated they do not
find the Arizona Social Services Information System
( ASSISTS) to be " user friendly".
The primary function of the ASSISTS program is to
provide accurate encounter data to AHCCCSA in order
for them to determine reimbursement to DES/ DDD. As
such, it is critical that client data is entered
accurately and that updated and current information
is maintained on the service plans.
DES/ DDD has an internal work group to address both
interface and enhancement issues for the ASSISTS
program. The group has prioritized items needing to
be done within available resources and interface
issues with the AHCCCS system remain the top
priority. In order to make the system more " user
friendly" additional resources would be needed to do
some of the enhancement items. Please see attachment
A for a prioritized listing of ASSISTS issues.
Recommendation
Appropriate additional resources to DES/ DDD to
implement enhancement changes to ASSISTS.
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CORREaIVE ACTION PLAIiTING: DEmLBER 1991
C*
Priority . Activity Cescription
Reconcile ASSISTS/ CATS
Resolve Service Plan Transmission Production Issues
Reconcile F? IPVtIS/ ASSISTS Eligibility Dates
Convert ASSISTS to CATS units descriptions
Resolve production data integrity issues
Adjudicate all pended encounters
Resolve pended encoilnter production fix utility issues
Resolve production E( CCR issues
In-~ lenentn ew provider registration model
Ccrcplete htanagernent Information Reports project
C~ mplete all electronic billingg tasks
Complete all TPL requirements
Implement Service Plan turnaround document utility
yes
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Governor's Council
1?; 7 w JEFFEesoN on
SITE CC3E 074Z
DHOENIX ARIZOkA 85007 Developmental Disabilities
FIFE SYMINGTON
Governor
KAREN VAN EPPS
Cha~ rperson
DIANE SKAY
Execut~ ve D~ rector
LEGISLATIVE POSITIONS October 10, 1991
FEDERAL DEFINITION ON DEVELOPMENTAL DISABILITIES
The Governor's Council supports legislation to expand the Arizona
definition of developmental disabilities, to encompass the federal
definition. This would expand the services of the Division to
include categories beyond those listed in ARS 36- 551 of Mental
Retardation, Cerebral Palsy, Epilepsy, and Autism. The Federal
definition states that a disability is " attributable to a mental
or physical impairment or a combination of a mental and physical
impairment. In addition the disability must be manifested before
age 22 and require substantial limitations in 3 or more of the 7
major life functioning areas.
EARLY INTERVENTION FOR CHILDREN'S SERVICES
The Governor's council advocates for an appropriate level of
funding to: 1) assure successful implementation of the Arizona
Early Intervention Program for infants and toddlers age birth
through 2, ( Part H) and 2) assure successful implementation of
programs for children aged 4 and 5.
APPROPRIATIONS
The Governorls Council on Developmental Disabilities supports state
funding for services to meet the needs of individuals with
developmental disabilities through state funding of the Arizona
Department of Education ( ADE) ; the Department of Economic Security,
Division of Developmental Disabilities ( Division), and
Rehabilitation Services Administration ( RSA); and the Department
of Health Services ( DHS). The Council also supports maximizing
local and federal resources.
COMPLIANCE IN ACCESSIBILITY
The Governor's Council supports legislation for Arizona which is
consistent with the Americans with Disabilities Act of 1990, which
prohibits discrimination in areas of accessibility.
DES SUNSET/ ESTABLISHMENT OF A DEPARTMENT OF DEVELOPMENTAL
DISABILITIES
The Governor's Council supports legislation to establish the
Division as a stand alone agency as the Department of Developmental
Disabilities including Long Term Care and the other current
services and programs for individuals who are eligible because of
a developmental disabilities.
HEALTH INSURANCE
The Council supports state legislative initiatives to address the
problem of individuals with pre- existing conditions or labels which
prevent them from purchasing health insurance. Many states have
established insurance pool where consumers are accepted even if
they have pre- existing health conditions.
AVAILABILITY OF SERVICES
The Governor's Council on Developmental Disabilities advocates for
legislation that would mandate needed services for persons with
developmental disabilities, according to the federal definition.
HANDICAPPED PARKING
The Governor's Council on Developmental Disabilities supports
legislation that would make the regulations defining handicapped
parking uniform across the state. ( Ref. P. L. 100- 641)
PREVENTION SERVICES
The Governor's Council on Developmental Disabilities supports the
provision of prenatal services for all women.
DENTAL AND VISION CARE
The Governor's Council on Developmental disabilities advocates for
legislation and appropriations to ensure that all adults who are
eligible for services from both the Division of Developmental
Disabilities and AHCCCS are provided with an adequate level of
dental and vision services including preventive treatment and
restoration.
For further information contact: Margaret white, Planner
Governor's Council, 542- 4049
Association for Retarded Citizens of Arizona, Inc.
561 0 South Central Avenue / Phoenix, Arizona 85040
ARGARET SAXTON- SMITH ( 602) 243- 1 787 1- 800- 252- 9054 PATRICIA J. BROW
Executive Director
HATTIE BABBITT
Honorary State Chairperson
COMMENTS TO THE JOINT LEGISLATIVE COMMITTEE ON ADMINISTRATION AND
REORGANIZATION OF DES
DECEMBER 199 1
ARC members urge that the following steps be taken to address the
consumer concerns that have been raised to the Committee:
1 . ARCmembersbelievethatthemanycriticaIissuesthatwereraised
to the Committee should be given immediate attention. On the issue
of restrt~ cturingD ES and creating a separate agency to replace the
Division of Developmental Disabilities, we urge continued study and
believe that this may be a step that is needed at some time in the
future after implementat ion of recommendations such as those that
follow.
2. Require DES and AHCCCS to promulgate rules regarding assessment
criteria, service definitions, criteria for service decisions, and
qua1 if ications of staff performing assessments and making service
decisions for all consumers served by the Division.
This requirement w i l l provide a mechanism to address many of the
concerns raised by consumers and by case managers. Consumers and
Division staff both testified about confusion, inconsistent and
changing directives, and conflicting messages from various sources.
The frustration caused for consumers was evident. A number of
Division Case Managers also testified about their frustration trying
to do a good job while receiving inconsistent and frequently changing
orders. One case manager testified that there were three different
directives regarding respite care, a1 1 within one week. Another urged
that there be consistent service definitions. Others described how
difficult it is for families to trust case managers who frequently
have to provide different information or correct themselves because a
pol icy has been changed.
- 89 -
WHEN YOU GlVE HELP. . . YOU GlVE HOPE
A State Member Unit of the Association for Retarded Citizens of the United States
Member of the National Health Agencies / Combined Federal Campaign
~ s ~ x l a t rtoxrr ~ etardedC itizens
Regulations must include consistent, written standards for
comprehensive assessments and criteria for service decisions so that
the services included in the Individualized Program Plan ( I. P. P.)
already required by state law can reflect the individual's actual
needs. The written standards w i l l allow consumers and their
families to participate effectively in the I. P. P. process, as state law
intended. By promulgating standards as regulations, the Division w i l l
have the benefit of input from consumers, families, providers, and
other professionals. Consumers w ill have opportunities to comment
on ways the standards can reflect respect for consumers and families
that many have not experienced in the past. ARC urges careful
legislative oversight to ensure that the Division consistently follows
i t s regulations, policies, and instruct ions.
ARC strongly urges legislation to require promulgation of these
regulations with full public participation.
3. Require the Auditor General to conduct a performance audit of the
Division immediately and report to the Legislature and Governor.
( ARC members have learned that a performance review of the Uivisiorl
by the Auditor General w i l l begin in January 1992.)
4. Assure that services to persons with developmental disabilities are
provided consistently statewide. Policies and services must not
differ based on geographic location. AHCCCS should conduct at least
semi- annual quality assurance reviews of ALTCS services to persons
with developmental disabilities and take appropriate actions, to
address any deficiencies that affect the qual i ty of service.
The Division and AHCCCS w i l l need to monitor and enforce the
standards promulgated as regulations. They must be applied
consistently throughout the state. Services should be based on
individual need and not on the individual philosophy of a manager in
the district.
5. Require AHCCCS to review and analyze the intergovernmental
agreements between AHCCCS and DES regarding ALTCS and identify
provisions that have caused difficulties in qual i ty assurance.
Require AHCCCS and DES to amend intergovernmental agreements to
specify responsibilities and define specific standards for operation
- 90 -
of the ALTCS program, following approval of the Developmental
Ofsabltities Advisory Council and the State Medicaid Advisory
Commit tee,
6. Require DES- DDD to provide a1 l consumers with accurate, clear,
understandable, timely, written information about rights
and services. Require individual written not ice to each consumer
prior to any service initiation, change, denial or interruption
including information about rights to ' file a grievance i f not in
agreement with the proposed act ion.
ARC has received many complaints from consumers whq have been
unable to get clear, accurate written information from the Division
about their rights and services. Some families believe that the
Division was " hiding the ball." Others attribute this communication
problem to the frequently changing directives and believe that the
Division was not willing to put anything in writing because this
would create difficulties when interpretations changed later on. For
families, this has meant increasing frustration and distrust. Some
staff have proposed or developed written materials and been unable to
get them approved in a timely manner.
Because of the Division's failure to provide clear information to
consumers, the ARC hi red a staff person to analyze and provide
information and advocacy assistance to long term care ( ALTCS)
consumers. ARC receives no government funds to provide these
services. ARC Board members believe that this help is SG vital for
consumers that the assistance will be continued in 1992 even if funds
must be borrowed to finance the project.
Many consumers have complained that their phone calls to the
Division are not returned and that they seldom hear from the staff
member who is supposed to be managing their case. Many have been
unable to resolve problems in a timely manner even though they
attempted to follow the " chain of command."
7. ReducetheDivision'scomplexbureaucracy. Placeauthorityfor
service decisions with we1 1- qualif ied case managers and primary
care physicians. Eliminate service review committees. Analyze
and reduce administrative costs. Uniform forms must be used
~ spsocatmafw Retrardedt c~ t~ zens
statewide. Provide to1 1- free numbers consumers can use to get
prompt resolution of problems,
Many consumers decried a system in which service decisions are made
by people who have never even met the individual to be served. Others
emphasized that well qualified and well trained case managers should
be given the authority to make service decisions and should not be
second- guessed or overruled by administrators who may be more
concerned about saving money than about serving people and helping
them reach their potential.
8. Require effective case management. Include consumer evaluations
as key elements of any performance review of a case manager.
Require case managers to be know ledgeable about community
resources. Require that the case manager for any medically fragile
consumer be a registered nurse. Require that all new and existing
case managers be appropriately trained and that the Divisio