Report from the Joint Interim Study Committee on Developmental Disabilities Services Delivery System

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REPORT
from the
JOINT INTERIM STUDY COMMITTEE ON DEVELOPMENTAL
DISABILITIES SERVICES DELIVERY SYSTEM
Representative Knaperek
Cochair
December, 1996
Senator Petersen
Cochair
The Joint Interim Study Committee on ~ evelo~ rn~ nDtiasal bilities
Services Delivery System was created in session law during the second regular
session of the 42nd legislature, 1996. The committee completed its duties which
were to:
research the technical means to allow families to purchase services directly
from certified care givers by means of a voucher system;
assess the availability and accessibility of community resources, including
informal care givers;
investigate the potential for the integration of an electronic fund transfer
system within DES, or contracted for by a financial institution to establish
accounts of preapproved service allocations for family consumers.
A list of committee members and copies of minutes are attached. The
committee terminated December 3 1, 1996.
The committee held two meetings in December. Due to lack of a quorum at
the first meeting, all the topics for discussion were repeated at the second meeting
and recommendations were adopted.
RECOMMENDATIONS:
It is recommended that:
1. The joint leadership create a committee to provide ongoing oversight of
the DD services delivery system and examine the feasibility of creating a new
department of developmental disabilities.
2. The DD Division review their rules carefully in the interest of client
safety in their recruiting of new providers.
3. The DD Division and related agencies streamline their paper flow in an
effort to become more user friendly.
4. The Office of Risk Management submit its findings regarding liability
issues in writing to the DD Division as soon as possible.
5. The DD Division develop an aggressive marketing strategy.
6. The legislature draft legislation requiring the DD Division to begin an
electronic transfer pilot program in at least one urban and dne rural county.
7. The legislature and DD Division continue to work with the Congressional
delegation to get clariGcation from the IRS regarding employer/ employee
relationship issues for those who participate in the voucher system.
8. The legislature direct more dollars into the family support line item for
expansion of the voucher system.
JOINT INTERIM STUDY COMMITTEE ON DEVELOPMENTAL DISABILITIES
SERVICES DELIVERY SYSTEM
Requested by Representative Knaperek
Strike- Everything Amendment to HB 2030 made in the House Human
Services Committee on February 15, 1996:
. . a Section 1. Pevelo~ mental disablllt~ es servlces deliverv
svstem studv committee: membership: duties
A. The developmental disabilities services delivery system
study committee is established consisting of the following members:
1. Two members of the senate appointed by the president of
the senate from different political parties. The president shall
designate one member as cochairperson.
2. Two members of the house of representatives appointed by
the speaker of the house of representatives from different
political parties. The speaker shall designate one member as
cochairperson.
3 . Two parents of developmentally disabled children or
adults appointed by the speaker of the house of representatives.
4 . Two parents of developmentally disabled children or
adults appointed by the president of the senate.
5. One representative of the governor's council on
developmental disabilities appointed by the governor.
6. The assistant director of the division of developmental
disabilities in the department of economic security.
7. One representative of an advocacy organization that
serves chronically ill children with developmental disabilities
appointed by the speaker of. the house of representatives.
8. One representative of an advocacy organization that
serves parents of disabled children and adults appointed by the
governor.
9. One representative of a firm that provides services to
disabled children or adults in their homes appointed by the
president of the senate.
10. One representative of a financial institution that
provides statewide electronic fund transfer services appointed by
the governor.
11. The director of the department of administration or his
designee.
B. The committee shall:
1. Research the technical means to allow families to
purchase services directly from certified caregivers by means of a
voucher system.
2. Assess the availability and accessibility of community
resources, including informal care givers.
3. Investigate the potential for the integration of an
electronic fund transfer system within the department of economic
security or contracted for by a financial institution to establish
accounts of preapproved service allocations for family consumers.
4. Conduct its first meeting on or before September 1,
1996.
5. On or before December 15, 1996, submit a report of its
findings to the governor, the president of the senate, the speaker
of the house of representatives, the director of the department of
economic security, the chairman of the house of representatives1
human services committee, the chairman of the senate family
services comm~ ttee, the secretary of state and the director of the
department of library, archives and public records.
C. Legislative staff shall provide the committee with
administrative support and meeting room space.
The Committee shall report to the'speaker and the President on or
before December 15, 1996.
The Committee Terminates: December 31, 1996.
Members :
1. ( R) Knaperek Representative, Cochair
2. ( Dl Hort~ n Representative
3. ( R) Petersen Senator, Cochair
4. LD) Soltero Senator
TWO parents of developmentally disabled children or adults
APPOINTED BY THE SPEAKER:
TWO parents of developmentally disabled children or adults
APPOINTED BY THE SPEAKER:
porothv Sue Alig
4. Diane Hou~ h
Two parents of developmentally disabled children or adults
appointed by the President:
5 . Laura Areya
6 . Judie Walker
7 . Peg Kepner One representative of the Governor' s
Council on Developmental Disabilities,
Appointed by the Governor
8. Rouer Deshaies Assistant Director of the Division of
Developmental Disabilities in DES
9. William J. Timmons Representative of an advocacy organization
that serves chronically ill children with
developmental disabilities APPOINTED BY THE
SPEAKER
Cat Parenti
10. Representative of an advocacy organization
that serves parents of disabled children
and adults appointed by the Governor
11. Jim Musick
Representative of a firm that provides
services to disabled children or adults in
their homes appointed by the President
12. Barbara Sad1 er Representative of a financial institution
that provides statewide electronic fund
transfer services appointed by the Governor
13. Pudv Serino Director of the Department of
Administration, or his designee
STAFF: Chumbley
ARIZONA STATE LEGISLATURE
Forty- second Legislature - Second Regular Session
Joint Interim Study Committee on
Developmental Disabilities Services Delivery System
Minutes of Interim Meeting
Tuesday, December 10, 1996
House Hearing Room 4 - 1 : 00 p. m.
( Tape 1, Side A)
Cochair Knaperek called the meeting to order without a quorum at 1 : 27 p. m. Attendance was noted
by the secretary.
Members Present
Senator Soltero
William J. Timmons
Peg Kepner
Frank Hinds ( for Rudy Serino)
Roger Deshaies
Senator Petersen. Cochair
Representative Knaperek, Cochair
Members Absent
Iiepresentative Horton ( excused)
Dorothy Sue Alig ( excused)
Laura Arena ( excused)
Diane I- Iough
Cat Parenti
Jim Musick
Barbara Sadler
Judie Walker
Speakers Present
I'at Chumbleq~. Research Analyst, I- Iouse of Representatives
Margaret White. Planner, Governor's Council on Developmental Disabilities ( GCDD)
Bev I3ermon. Executive Director, Arizona Consortium for Children with Chronic Illness
Guest List ( none)
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Disabilities Services Delivery system
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Statement of the Mandate of the Committee
Pat Chumbley, Research Analyst, House of Representatives, reviewed the mandate of the
Committee, as follows:
1. Research the technical means to allow families to purchase services directly from
certified caregivers by means of a voucher system.
2. Assess the availability and accessibility of community resources. including
informal caregivers.
3. Investigate the potential for the integration of an electronic fund transfer system
within the Department of Economic Security or contracted for by a financial
institution to establish accounts of preapproved service allocations for family
consumers.
4. Submit a report of findings on or before December 15. 1996.
( For more details. see Attachment 1 .)
1) iseussion of a Voucher Svstern for I*. amilies: I3arriers to Current System
Margaret White, I'lanner. Govcrnor's Council 011 1) evelopmental Disabilities ( GCDD), said the
voucher system is one ofthc most comprclicnsi\~ fa mily support legislative measures in the country.
She noted that the measure contains no restrictions on age and is virtually " wide open."
Ms. Whitc said the three different funding mechanisms are a voucher utilizing title XIX federal
dollars. a vouchcr for individuals that uscs state- only money without additional restrictions, and an
actual cash subsidy. She noted that an c\, aluation picce provides that an IPP team will meet on an
annual basis to review goals. ob, jccti\, es and the service plans.
Mr. I> eshaics rcportcd that e\ en though the \ ouchcr program was expanded to a statewide option
six months carlicr. on11 200 hmilics arc ciirnllcd in thc program. He mentioned DDD's surprise at
the low cnrollmcnt and noted that I > I ) I > mahcs a point of mentioning the voucher option at public
meetings.
Mr. 1) cshaics reviewed several issucs \ sliich are barriers to participation in the voucher program:
1 . From the pcrspectivc of the lntcrnal Kc\ fcnue Service ( IRS), if a family purchases
ser\. ices with a vouchcr. docs the family become an employer responsible for tax-related
\ s'orki?
2. I.' rorii an I I< S perspective. is i l l \, ouchcrs bc considered taxable income?
Joint Interim Study Committee on Developmental
Disabilities Services Delivery system
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3. If an individual hired by a family is injured on the job. who will be responsible
for damages?
4. The federal title XIX program prohibits factoring.
In response to Mr. Timmons, Mr. Deshaies said DDD assumes the risk for families and is attempting
to set up a contract so that DDD will be viewed as the employer.
In answer to Ms. Kepner, Mr. Deshaies explained that case managers and a DDD nlailer made
families aware of the voucher program. In addition. he noted that the program was mentioned at a
series of 28 family meetings held throughout the state during the summer.
Ms. Kepner asked whether families must be under a certain income level to participate in the
voucher program. Mr. Deshaies replied in the negative.
Ms. Kepner asked if an independent developmentally disabled adult living alone would be eligible
for the program. Mr. Deshaies replied affirmatively.
With regard to the independent contractor liability issue, Mr. Hinds said that in order to address the
coverage issuc, Risk Management ~ vouldn eed to know the precise employerlen~ ployecre lationship.
Mr. Deshaies offered to send a copy of the contract to Mr. Hinds.
Cochair Knaperek noted her intention to contact Congressman Salmon's office for suggestions on
the issues before the Committee. She requested recommendations on overcoming the program
barriers.
Mr. 1) eshaies mentioned that the use of electronic benefit transfers may help expand voucher
program enrollment. and result in savings by eliminating some costs associated with contract
conlpliance. I- 1e mentioned that I> I> I) mill be piloting a technical assistance center to help guide
l'amilies in the recruitn~ ento f assistants. ctc.
Still lacking a quorum. Cochair Knapcrck sought input regarding the Con~ mittee's options.
Ms. Kepner noted that the Committee cannot possibly meet the December 15 reporting deadline.
It was decided the Committee would accept public testimony.
' 13~ 1I. Icrn~ onI, ~~ secutivDei rector. Arizona Consortium for Children with Chronic Illness. said that
in days past. there was much morc support at the local community level. As an example, she
recalled that the school districts and cities jointly sponsored summer projects which accommodated
the handicapped. She said the ' l'empe ARC currently has its own thrift shop and usually offers a free
program every night of the week in addition to ~ veckcnd dances and activities designed to normalize
the lives of dcvclopn~ entallyd isabled indi\ iduals. She suggested that Arizona State University is
trcn1endously undcrutilized, considering the number of students who require experience with the
developmentally disabled and could participate in internships.
Joint Interim Study Committee on Developmental
Disabilities Services Delivery system
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Ms. Hernlon stated her belief that the combination of localized case managers and empowered
parents would make it possible to keep developmentally disabled children within their respecti\. e
communities.
Cochair Knaperek requested a report of DES's progress in working with electronic benefit transfers.
Bob Gilligan, Legislative Liaison, Department of Economic Security ( DES), advised the Committee
that electronic benefit transfers ( EBT) have been utilized across the country for years in the form of
pilot projects for the food stamp program. He reported that such programs were not more widely
implemented because technology such as card readers in grocery stores has onl! recently become
common. He said a second deterrent to EBT technology was a regulation which would have held
the state liable for fraud exceeding $ 50 on such a card. He reported that the welfare reform bill
signed by President Clinton eliminated the problem of states being held liable for this type of card
fraud.
Mr. Gilligan noted that if an EBT program proves successful in the state of Washington, the
technology could hopefully be made available to other states by the same vendor which would
reduce start- up costs. He stated DES's hope that the legislature will appropriate a couple hundred
thousand dollars for planning.
Mr. Gilligan expressed hope that EBT technology will address the perceived problem of fraud.
particularly with regard to the buying and selling of food stamps.
Mr. Deshaies said EBT cards would limit the consumer to using certified providers of services which
DDD is authorized to reimburse. I- lc noted that the mechanics of the program have yet to be
dcterniined.
Mr. ' I'immons mentioned that an article he wrote eleven years earlier regarding EBT technology
addressed the food stamp system and day care payments. He said that although the program was
approved and funding was made available, matching funds were unfortunately interrupted as a result
of internal DES politics.
Mr. l'immons commented that a magazine entitled EBT Today is published on a monthly basis.
Ms. Kepncr aslicd if only families currently enrolled in the voucher program would be eligible for
11137' technology. Mr. Dcshaics rcplicd affirnmativclq .
In the wake of the welfare reform bill. Mr. 1- linds inquired as to which entity will be held responsible
for fraudulent use of EBT cards. Mr. ( iilligan shared his belief that the card holder will be held
liable for fraud.
Mr. ' I'ininions remarked that a national research institute on EBT has shown that technology is
capable of providing acceptable safeguards. I4owever, he stated his opinion that abuse of an EBT
system would be most likely to occur at the whitc collar level.
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Disabilities Services Delivery system
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Cochair Knaperek requested that copies of Mr. Timmons' article be distributed to Conlmittee
members.
Cochair Knaperek assigned a variety of homework projects to Committee and staff members.
With regard to the voucher program barriers mentioned by Mr. Deshaies, Ms. White said she has
heard conlplaints that the in~ plementationp rocess is very slow due to the amount of hoops fanlilies
must jump through. She suggested the Committee do an in depth study of the program barriers.
Mr. Ileshaies speculated that the voucher program is not popular simply because of the barriers and
the probability that some families are satisfied with their current situation. Further. he reported his
belief that the program has not expanded options in rural areas.
After some discussion. the Committee decided to schedule the next meeting for December 18 at
10: 00 a. m.
Vlrithout objection, the meeting ( which never had a quorum) ended at 221 p. m.
Teresa Alvarez, Secretary
( Original minutes with attachments and tape on file in the Office of the Chief Clerk. Copy of
minutes \$- it11 attachments on file with Cochair Knaperek and Cochair Petersen. A document present
during the meeting but not specifically referred to is included as Attachment 2.)
taa
12E3/ 96
Joint Interim Study Committee on Developmental
Disabilities Services Delivery System
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ARIZONA STATE LEGISLATURE
Forty- second Legislature - Second Rcgular Session
Joint Interim Study Committee on
Developmental Disabilities Services Delivery System
Minutes of Interim Meeting
Wednesday, December 18, 1996
House Hearing Room 1 - 10: OO a. m.
( Tape 1, Side A)
Cochair Knaperek called the meeting to order at 10: lO a. m. and attendance was noted by the
secretary.
Members Present
Senator Victor Soltero
Representative Herschella I- Iorton
Roger Deshaies
Frank Hinds ( for Rudy Serino)
Jim Musick
William J. Timmons
Judie Walker
Representative Laura Knaperek. Cochair
Senator David Petersen, Cochair
Members Absent
Dorothy Sue Alig
Laura Arena
Ilianc Hough
Peg Kepner
Cat Parenti
Barbara Sadler
Speakcrs I'resent
Bev Hermon. Executive Director. Arizona Consortium for Children With Chronic Illness
Marta Ilrbina. Parent of a 15- year- old daughter with developn~ entald isabilities: StaiT Person, I'ilot
Parent Partnerships
Margaret White. Planner. Governor's Council on Developmental Disabilities ( GCDD)
Guest List ( Attachment 1)
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Disabilities Services Oelivery System
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Introduction of Members
At the request of Cochair Knaperek. Committee members briefly introduced themselves.
Statement of the Mandate of the Committee
Pat Chumbley, Research Analyst, House of Representatives. reviewed the mandate of the
Committee. as follows:
1. Research the technical means to allow families to purchase services directly from
certified caregivers by means of a voucher system.
2. Assess the availability and accessibility of community resources. including
informal caregivers.
3. Investigate the potential for the integration of an electronic fund transfcr system
within the Department oS Economic Security or contracted for by a financial
institution to establish accounts of preapproved service allocations for family
consumers.
4. Submit a report of findings on or before December 15, 1996.
Discussion of a Voucher Svstem for Families: Barriers to Current Svstem
Mr. Deshaies noted that approximately 200 families are currently enrolled in the voucher program
operated by the Division of Developmental Disabilities ( DDD). I Ie added that the vouchcr program
began as a pilot pro- ject and has since been expanded on a statewide basis.
Mr. Deshaies explained that for program recipients not enrolled in the Arizona Long- l'crn~ Care
System ( ALTCS), DDD will offcr families the opportunity to receive cash through contracts. In
cases in which an individual is enrolled in ALTCS, he said a voucher will be provided which
authorizes certain privileges. IIe explained that ALTCS enrollees cannot receive cash payments
because federal requirements pertaining to third- party reimbursements prohibit the giving of actual
cash.
Mr. Dcshaies asserted that the greatest barrier to expansion of the voucher program is burcaucratic
red tapc. For instance. hc explained that because of the Internal Revenue Service ( IRS) definition
ol'an cmployer/ employee relationship. some families and the DDD are concerned that families will
be viewed as an employer for purchasing scrviccs with a voucher and, as such, will be lorced to
Iulfill tax reporting rcquirements. ctc. I Ie pointed out that in the foster care arena. reimbursement
lor serviccs is considered hardship and is not taxable.
Joint Interim Study Committee on Dcvelopmentai
Disabilities Services 1) clivcry System
1 2! 1 8196
As a linal barrier. Mr. Deshaies explained there is some question as to what party will be hcld liable
should a provider injure himself while delivering services in a home. IIe said interprctations arc
varied. and that the inability to issue a clear answer further discourages participation in the voucher
program.
I11 response to Senator Soltero, Mr. Deshaies indicated that the majority of insurance companies will
not provide coverage for an individual who sustains an injury while caring for someone in the home
because such a situation is viewed as an employee/ employer matter. I- Ie added that in two such
instances. DDD and Risk Management provided coverage for an injured person in order to avoid a
court case.
With regard to barriers, Mr. Deshaies admitted that DDD has not done a good job of marketing the
voucher program as an alternative. I- Ie said efforts are being made to identify resourcc people in
each district office who can make tl~ emselves available to families and provide assistance with
screening applicants, writing newspaper ads, ctc.
Mr. Dcshaies reported that in rural areas, the move toward individual funding and family control can
result in management problems lor small agencies. For instance. he said that if some small providers
are not guaranteed a base amount of business. problems will arise with regard to staffing needs.
Mr. Dcshaies said one requirement which does not make sense stipulates that a caregiver must take
seven or eight core training classes ( e. g., CPR. first aid) even if he or she is a trained health care
professional.
In response to Ms. Horton. Mr. Ileshaies said the core training requirements are prescribed in rules.
and that it is within the ability of DDD and the Arizona Health Care Cost Containment System
( AHCCCS) to modify or interpret such rules.
Ms. I- Iorton said that as a registered nurse. she is required to take cardiopulmonary rcsuscitation
( CPR) training each year. She said those who seldom use CPR have need of regular training, and
she suggested it bc carefully considered nhether or not to eliminate training Lxhich may save a life.
In response to Cochair Knaperek. Mr. Dcshaies estimated that any modification to the rules would
take between ten and twelve months for adoption.
' Mr. . l'immons asked iS Health Care Finance Administration ( I- ICFA) approval will bc required to
modify A1 ICCCS- related regulations. Mr. Deshaies answered affirmatively, explaining that an
amendment to the waiver must be submitted to HCFA for approval.
Cochair Knapcrek asked if DDD has approached A1 ICCCS about changing the I ICFA waiver.
Mr. Dcshaics reported that proposed changes to the I- ICFA waivcr were subinitted to A1 ICCCS for
consideration several weeks earlier.
Ms. Cl~ umblcyre ferred to a menlo from ' l'crrec Waslcy ( Attachment 2) of Congressillail Salmon's
officc regarding fcderal employer tax issues for families coping with developmental disabilitics. She
reviewed item # 1. as follows:
Joint interim Study Committee on Developmental
Disabilities Services Delivery System
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1) If families do not use a debit card to purchase services, payment ior services should go
directly to the provider.
Mr. Deshaies remarked that item # 1 addresses factoring or, more specifically. situations in which
the presence of a third party interferes with Medicaid payments.
Cochair Knaperek mentioned that in a telephone conversation which took place prior to the
Committee meeting, Ms. Wasley indicated that HCFA was noncommittal about item ki 1 even though
it liked the idea of a debit card for services.
Ms. Chumbley reviewed items # 2 and # 3 from Ms. Wasley's memo. as follow:
2) Regarding the independent contractor law. the Internal Revenue Service ( IRS) would
review each case separately or the state may request a waiver or a letter from the IRS
stating that they would not prosecute for any violations of the independent contractor
law.
3) Regarding the factoring issue, I- ICFA said it was uncertain whether Arizona has
requested a waiver for this practice.
Cochair Knaperek reported that Ms. Wasley was unable to secure definite answers fro111 I- ICFA or
the IRS. Mr. Deshaies said that in his discussions with the IRS, it was made clear that an individual
who directs the work of another is classified as an employer.
Mr. Hinds, attending on behalf of Rudy Serino, identified himself as a Property and Liability Claims
Manager for Risk Management and said he researched A. R. S. 41- 621 to determine whether Risk
Management could cover on- the- job injuries suffered by providers. I3e reported that Risk
Management has covered two such cases in the past. but pointed out that A. R. S. 41- 621( B) was
modified during the 1996 legislative session to clarify that medical coverage was never intcnded to
become part ofthe Risk Managenlcnt provider program. IHe read an excerpt from A. R. S. 41 - 621( 13)
( Attachment 3). as follows:
.' ... - I ' he insurable programs shall include foster care. programs for the
developmentally disabled. an independent living program pursuant to section 8- 531
and respite- sitter service programs. 7' he department shall obtain insurance or provide
thr state self- insurance pursuant to this subsection to protect the clients participating
in thcsc programs and individual providers of'thcse program se. r. vices 011 bchalfof'thc state and its dcpartmcnts. agencies, boards or con~ mission. s..
Mr. I linds concluded his remarks by stating that as long as providers arc of thc tlpe covered in
statutue, liabilit? coverage will be provided for than with the cxccption of incdical and uorkmen's
compensation.
Cochair Knapcrek asked whether the Department of Administration ( DOA) could scnd a letter to
I> I> D stating that coveragc will be provided. Mr. Hinds indicated no ob. jection.
Joint Interim Study Colnmittee on I) cvelopnicntal
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r) iscussion ot'the Availabilitv and Accessibilitv of'Communitv Resources
Rev I- Iermon. Executive Director. Arizona Consortium for Children With Chronic Illness, reported
that the communities of Tempe. Mesa and Tucson have developed programs for conlmunity
members experiencing certain problems. She recalled that when her developmentally disabled child
was in school, programs were developed jointly between the city and school. Further. shc said that
Boy Scouts, Girl Scouts and churches were once much more involved with handicapped children
and their families.
Ms. IIcm~ onsp eculated that the advent of federal monies resulted in more institutionalization. and
subsequent loss of'community involvement.
Ms. Walker noted that some areas have seen a resurgence of community involvement. She said
children with developmental disabilities are increasingly included in community activities. She
lauded the advances which have allowed developmentally disabled children to remain in their homes
and co~ nmunitiesw hile receiving care.
Cochair Knaperck requested an cxan~ pleo f how the voucher system can improve matters lor fanlilies
ol'thc dcvelopmentally disabled. Ms. Walker said her family is not involved in thc voucher system
because participation would nierely intereferc with fanlily life. She said that providers who enter
the homc deliver very personal services. and that caregivers made available through an agency may
not meet a family's needs or values. As an example, she explained that her teenage son is not a
nlorning person. and can have either a good or bad day based on whether or not his bath goes
smoothly. In addition. she stated her preference that a provider be able to interact positively when
out in the community with her son because children learn from such interaction.
Ms. Walker summarized that it is critical for families to have a say in selecting caregivers bccause
there are bad eggs in every industry.
I) iscussion of I~ nnlcmentationo f an 1: lectronic Fund Transfer System for Families
Mr. ' i'immons referred to a11 articlc cntitled ilrizona 1: B'F Project ( Attachment 4) and recalled that
several years earlier. the Ilepartmcnt of Economic Sccurity ( DES) applied for federal grant monies
to implclncnt an electronic bcnelit translcr ( EB'T) system for programs such as Aid to Families with
Ilependent Children ( AFDC). bod stanips and day carc. I Ic reported that even though the grant was
awarded, program implementation unfortunately never occurred as a result of political infighting.
Mr. ' I'immons sunlmarized that tlic idea behind the I'B'T system was for an applicant to apply for
benefits and. once eligible. liavc a benefit type and dollar amount programmed onto a debit card wit11
a personal identification number ( PIN). I lc said such a debit card could then be swiped through a
card reader at a grocery store.
With regard to day carc. Mr. . l'immons explained that a card- swipe system must work differently
because the da? carc industr!. is time oriented. as opposed to cash oriented. In such a scenario, he
said a point- of- sale device installed in a day carc center would have to have access to information
on all individuals eligible for day carc services. as well as their beneiit type and subsidy amount.
Joint Interim Study Committee on Developmental
1) isabilities Services Dclivcry System
1 21 1 8196
I- Ie said that a parent would swipe the debit card upon dropping off and picking up thc child. and that
a check for services would be mailed to the day care center two days later.
Ms. I3orton mentioned that barriers to similar card- swipe programs have been hotly debated for at
least six ycars. She recalled that in rural areas, small " Mom ' n Pop" groccrs testified against such
programs because only the larger grocery stores would be equipped with card readers. Mr. ' Iimmons
reported that a demonstration project was implemented in Mesa and that thc willingness existed to
install point- of- sale devices in Mom ' n Pop stores. I- Ie expressed doubt. however. that small grocers
could be equipped on a statewide basis.
Cochair Knapcrek diverted attention from food stamps to providers.
Mr. Deshaies explained that in the State of Maine, a program was instituted which allowed
individuals, through a modem. to bill electronically. In rural areas, he said an electronic billing
location was made available to people in return for a small fee. He said that within seven days of
billing. an account was electronically credited for reimbursement.
Mr. I> cshaies conlmentcd that a program is envisioned for thc Lake Havasu CityIKingman area
which would allow contracting with a providcr to furnish point- of- sale technology.
Cochair Knaperek mentioned that Ms. Kepner could not attend the meeting but mailcd in some
suggestions. She recalled that Ms. Kepner's recommendations were to disseminate information
through a newsletter and a mailing to prospective families. Mr. Deshaies remarked that mass
mailings have not been attempted.
Marta IJrbina. I'arent of a 15- vcar- old daughter with developmental disabilities: Staff Pcrson, Pilot
Parent Partnerships, began explaining the mechanics of an individual service program plan ( ISPP).
Senator Soltero requested insight into some of the services available to the developmentally disabled.
Ms. lJrbina said her daughter has cerebral palsy and 111ust use a wheelchair. in addition to having
visual i~ npairnlenta nd an inability to co~ nmunicatev erbally.
Ms. llrbina cxplained that an ISPP is a process b) which a case manager sets dates mith the family.
She stated that her daughter is eligible Ibr Al,. I'CS. and that the AL, TCS eligibility process is vcry
cumbcrsomc and intrusike for a t'anlilq. Shc said thc cligibility process Socuscs on medical nceds.
using " at risk of'institutionalization" as a criteria. and financial status. She mentioned that it is vcry
intrusive f'or an outsider to review your bank statements. bonds. cmployn~ ents tatus. incomc, and
cxpcnditurcs. 1: iirthcr. she indicated that linancial cligibility must be rcdeenled on a ycarly basis.
Ms. llrbina explained that she sustained a back il? iury two ycars earlier while moving hcr daughter.
As a result. shc said thc family I~ asm ade concessions and now has a " Mr. h~ lom"~ vhofu nctions as
a lull- timc carcgivcr. In addition. shc said hcr daugl~ tcrr eceives respite scrviccs and attendant
lolnt lnter~ mS tudy Comni~ ttcco n Dcvclopmental
D~ sabtl~ tS~ ccrsv ~ ccsD clivcry System
13' 1 8196
services Ibr personal care such as bathing. She emphasized that the family must trust and develop
a good relationship with any caregiver who enters the home.
Ms. Urbina said that although a voucher looks marvelous on paper and seems to give the flexibility
to hire or recruit individuals, the program requirements effectively form a barrier.
Ms. lJrbina invited Senator Soltero to visit her home and observe the ISPP process lirsthand.
Cochair Knaperek suggested that Cochair Petersen may be interested in the offer.
Cochair Knaperek inquired how best to enhance programs for the developmentally disabled.
Ms. llrbina shared her belief that efforts are focused in the right direction in terms of providing
flexibility. She reported her biggest obstacle to be the amount of time expended on recruiting
providers. She added that she, like many other families, manage to recruit providers only to lose
them as a result of program delays and bureaucratic red tape.
Ms. Walkcr asserted that electronic reimbursement could play a critical role in eliminating the
paperwork backlog which sometimes forces caregivers to leave the employ of families to seek work
elsewhere.
In response to Cochair Kilaperek. Ms. llrbina said that ISPP case managers advised her family oS
the pilot voucher program. She said she believed the program would give her more control in
recruiting individuals, and the freedom to avoid utilizing agency providers.
Cochair Knaperek asked how families are made aware of the voucher program. Mr. Deshaies said
case managers may advise a family of the program, or a family may place a call to a DDD district
oflice.
Cochair Knaperek and Mr. Deshaies discussed the mechanics of participation in the voucher
program.
Ms. Walker pointed out that. sometin~ es. a very s~ nalel xpense will allow her son to participate in
an existing program. I lowever. she said it is a very undesirable prospect to suffer through a lot of
paperwork in return for enrollment in a six- week program. She asserted that rural areas do a better
job of meeting community needs and added that families should not be forced to relocate to cities
to access services fbr thc developmentally disabled.
Marr- r arct Wliitc, I'lanner, Gocernor's Council on I> cvelonmental Disabilities ( GCDD), shared her
belief that the family support bill which tzlas adopted several years carlier would answer the issues
addressed by the Committee. She expressed sadness that the implementation proccss has been so
slow.
Ms. White expressed her hope to see government place more trust in families because it is the family
that will make the best choice for an individual with developmental disabilities. She recognized
paperwork and a lack of'trust in fanlilies as major program barriers.
Soint Interim Study Co~ nmitteeo n L) cvclopmcntal
Disabilities Services Ocl~ veryS ystem
1 21 1 8/ 96
Ms. Walker stated that some entity must pay for the army of people who fill out and shui~ lep ieces
of paper. She emphasized that if government cannot do the right thing by placing its trust in
families. it should at least do the right thing for the simple reason that it will remove layers of'
administration. She dispelled the idea that families lay awake at night wondering what new services
they can " pack on" because each new service represents a major intrustion into a farnily's life.
Ms. White acknowledged the efforts of individuals and said Mr. Deshaies has been wonderful in his
attempts to fix the system. As an example of program setbacks, Ms. White explained that a group
of people met to discuss an implementation plan and to develop rules. and were discouraged to find
that the final rules basically negated the concept of flexibility by requiring that families meet various
requirements and jump through an assortment of hoops. She suggested that families simply be given
a flat $ 200 per month.
Mr. Deshaies admitted to encountering difficulty in finding a balance between flexibility and
accountability which state agencies need for reporting purposes. He said the situation is further
conlpounded by input from legal experts whose goal is to limit liability to the state.
Cochair baperek stated that rules are not supposed to supersede statute. Mr. Deshaies shared his
opinion that legislative intent is clear and that DDD must do a better job of finding a balance.
Cochair Knaperek suggested the Committee could focus its attention on DDD if that entity were a
stand- alone agency which was not shrouded by DES.
Recommendations
Ms. Ijorton suggested that rules be reviewed carefully so as not to sacrifice safety in an effort to
attract more providers. She also suggested DDD and other agencies streamline their paper flow in
an effort to become more user friendly to consumers. She further recommended that a committee
be created to provide ongoing oversight of thc developmental disabilities services delivery system.
Cochair Knaperek recommended the following:
1) Submit Risk Management's findings, in written form. to the Division 01' Developmental
Disabilities as soon as possible.
2) Dc\, elop an aggressivc marketing stratcg),.
3) Rcduce paperwork and initiate an elcctronic bellelit transfer system.
4) Draft legislation requiring thc Ilivision of' Developmental Ilisabilities to bcgin an
clectronic benefit transfer pilot program in at lcast one urban and one rural county.
5 ) Separate thc Ilivision of Developn~ cntal Ilisabilities from the Department ol'l~ conon~ ic
Security.
Joint Interim Study Co~ nmitteeo n [) evelopmental
Disabilities Services tlelivery Systenl
1 21 1 8196
With regard to item iive. Senator Soltero stated his desire to postpone a decision. Ms. 1 Iorton
pointed out that item iive would expand state government. She said the Conlmittce should instcad
wait to study the findings of an ongoing oversight committee.
Cochair Knaperek countered that DDD currently pays administrative fces to DES. She voiced hcr
belief that if broken out as a separate agency, DDD could continue contracting with 1113 for
administrative services, thereby avoiding the creation of more bureaucracy.
( Tape 2. Side A)
Ms. I Iorton suggested an oversight committee examine the feasibility of crcating a new department.
Mr. Musick said that as a provider, he would like to see DDD aggressively expand thc voucher
systcm into other areas.
Ms. Walker remarked that if thc voucher system is to be expanded. fanlilies nlust be assured in
writing that any conflict with the IRS has been resolved. Ms. Horton rccommeded writtcn
clarification be obtained from the IRS. but also cautioned that IRS clarifications are nonbinding and
can bc reversed at any time. Cochair Knaperek suggested the congressional delegation may be ablc
to get clarification from the IRS.
Cochair Knaperek recommended DDD expand the voucher program and direct more monies into the
family support line item. Ms. Horton mentioned that such action is available to legislators through
the regular appropriations process.
Ms. Horton repeated her idea of working with Cochair Knaperek to develop a joint oversight
committee conlprised of legislators and others.
Without objection. the reco~ nmendationsw ere adopted.
Without objection. the meeting was adjourncd at 12: 13 p. m.
' I'crcsa Alvarez, Committee Sccrctary
( Original minutes with attachments and tapes on file in the Office of the Chief Clcrk. Copy ol'
minutcs with attachments on filc with Cochair Knaperck and Cochair Pcterscn.)
Joint Interim Study Comm~ tteeo n [) cvelopmental
Disabilities Services Dclivcry System
1 21 1 8196

Description

Rating
TITLE	Report from the Joint Interim Study Committee on Developmental Disabilities Services Delivery System
CREATOR	Arizona. Legislature. Joint Interim Study Committee on Developmental Disabilities Services Delivery System.
SUBJECT	Legislative Study Committee. Arizona.; Developmentally disabled--Services for--Arizona; Caregivers;
Browse Topic	Government and politics
DESCRIPTION	19 pages (PDF version). File size: 1091.205 KB.
Language	English
Publisher	Arizona. Legislature. Joint Interim Study Committee on Developmental Disabilities Services
TYPE	Text
Material Collection	State Documents House Received Reports Legislative Study Committee Reports
Acquisition Note	Publication or link to publication sent to reports@lib.az.us
RIGHTS MANAGEMENT	Copyright to this resource is held by the creating agency and is provided here for educational purposes only. It may not be downloaded, reproduced or distributed in any format without written permission of the creating agency. Any attempt to circumvent the access controls placed on this file is a violation of United States and international copyright laws, and is subject to criminal prosecution.
DATE ORIGINAL	1996-12
Time Period	1990s (1990-1999)
ORIGINAL FORMAT	Paper
Source Identifier	LG 1.2:D 83/3
Location	248727060
DIGITAL IDENTIFIER	RMDHOUSE_JISCDDSDS_DEC_1996.pdf
DIGITAL FORMAT	PDF (Portable Document Format)
DIGITIZATION SPECIFICATIONS	Digitized into PDF form through scanning at the Records Management Division, Arizona State Library.
REPOSITORY	Arizona State Library. Archives and Public Records--Law and Research Library.
File Size	1091.205 KB
Full Text	REPORT from the JOINT INTERIM STUDY COMMITTEE ON DEVELOPMENTAL DISABILITIES SERVICES DELIVERY SYSTEM Representative Knaperek Cochair December, 1996 Senator Petersen Cochair The Joint Interim Study Committee on ~ evelo~ rn~ nDtiasal bilities Services Delivery System was created in session law during the second regular session of the 42nd legislature, 1996. The committee completed its duties which were to: research the technical means to allow families to purchase services directly from certified care givers by means of a voucher system; assess the availability and accessibility of community resources, including informal care givers; investigate the potential for the integration of an electronic fund transfer system within DES, or contracted for by a financial institution to establish accounts of preapproved service allocations for family consumers. A list of committee members and copies of minutes are attached. The committee terminated December 3 1, 1996. The committee held two meetings in December. Due to lack of a quorum at the first meeting, all the topics for discussion were repeated at the second meeting and recommendations were adopted. RECOMMENDATIONS: It is recommended that: 1. The joint leadership create a committee to provide ongoing oversight of the DD services delivery system and examine the feasibility of creating a new department of developmental disabilities. 2. The DD Division review their rules carefully in the interest of client safety in their recruiting of new providers. 3. The DD Division and related agencies streamline their paper flow in an effort to become more user friendly. 4. The Office of Risk Management submit its findings regarding liability issues in writing to the DD Division as soon as possible. 5. The DD Division develop an aggressive marketing strategy. 6. The legislature draft legislation requiring the DD Division to begin an electronic transfer pilot program in at least one urban and dne rural county. 7. The legislature and DD Division continue to work with the Congressional delegation to get clariGcation from the IRS regarding employer/ employee relationship issues for those who participate in the voucher system. 8. The legislature direct more dollars into the family support line item for expansion of the voucher system. JOINT INTERIM STUDY COMMITTEE ON DEVELOPMENTAL DISABILITIES SERVICES DELIVERY SYSTEM Requested by Representative Knaperek Strike- Everything Amendment to HB 2030 made in the House Human Services Committee on February 15, 1996: . . a Section 1. Pevelo~ mental disablllt~ es servlces deliverv svstem studv committee: membership: duties A. The developmental disabilities services delivery system study committee is established consisting of the following members: 1. Two members of the senate appointed by the president of the senate from different political parties. The president shall designate one member as cochairperson. 2. Two members of the house of representatives appointed by the speaker of the house of representatives from different political parties. The speaker shall designate one member as cochairperson. 3 . Two parents of developmentally disabled children or adults appointed by the speaker of the house of representatives. 4 . Two parents of developmentally disabled children or adults appointed by the president of the senate. 5. One representative of the governor's council on developmental disabilities appointed by the governor. 6. The assistant director of the division of developmental disabilities in the department of economic security. 7. One representative of an advocacy organization that serves chronically ill children with developmental disabilities appointed by the speaker of. the house of representatives. 8. One representative of an advocacy organization that serves parents of disabled children and adults appointed by the governor. 9. One representative of a firm that provides services to disabled children or adults in their homes appointed by the president of the senate. 10. One representative of a financial institution that provides statewide electronic fund transfer services appointed by the governor. 11. The director of the department of administration or his designee. B. The committee shall: 1. Research the technical means to allow families to purchase services directly from certified caregivers by means of a voucher system. 2. Assess the availability and accessibility of community resources, including informal care givers. 3. Investigate the potential for the integration of an electronic fund transfer system within the department of economic security or contracted for by a financial institution to establish accounts of preapproved service allocations for family consumers. 4. Conduct its first meeting on or before September 1, 1996. 5. On or before December 15, 1996, submit a report of its findings to the governor, the president of the senate, the speaker of the house of representatives, the director of the department of economic security, the chairman of the house of representatives1 human services committee, the chairman of the senate family services comm~ ttee, the secretary of state and the director of the department of library, archives and public records. C. Legislative staff shall provide the committee with administrative support and meeting room space. The Committee shall report to the'speaker and the President on or before December 15, 1996. The Committee Terminates: December 31, 1996. Members : 1. ( R) Knaperek Representative, Cochair 2. ( Dl Hort~ n Representative 3. ( R) Petersen Senator, Cochair 4. LD) Soltero Senator TWO parents of developmentally disabled children or adults APPOINTED BY THE SPEAKER: TWO parents of developmentally disabled children or adults APPOINTED BY THE SPEAKER: porothv Sue Alig 4. Diane Hou~ h Two parents of developmentally disabled children or adults appointed by the President: 5 . Laura Areya 6 . Judie Walker 7 . Peg Kepner One representative of the Governor' s Council on Developmental Disabilities, Appointed by the Governor 8. Rouer Deshaies Assistant Director of the Division of Developmental Disabilities in DES 9. William J. Timmons Representative of an advocacy organization that serves chronically ill children with developmental disabilities APPOINTED BY THE SPEAKER Cat Parenti 10. Representative of an advocacy organization that serves parents of disabled children and adults appointed by the Governor 11. Jim Musick Representative of a firm that provides services to disabled children or adults in their homes appointed by the President 12. Barbara Sad1 er Representative of a financial institution that provides statewide electronic fund transfer services appointed by the Governor 13. Pudv Serino Director of the Department of Administration, or his designee STAFF: Chumbley ARIZONA STATE LEGISLATURE Forty- second Legislature - Second Regular Session Joint Interim Study Committee on Developmental Disabilities Services Delivery System Minutes of Interim Meeting Tuesday, December 10, 1996 House Hearing Room 4 - 1 : 00 p. m. ( Tape 1, Side A) Cochair Knaperek called the meeting to order without a quorum at 1 : 27 p. m. Attendance was noted by the secretary. Members Present Senator Soltero William J. Timmons Peg Kepner Frank Hinds ( for Rudy Serino) Roger Deshaies Senator Petersen. Cochair Representative Knaperek, Cochair Members Absent Iiepresentative Horton ( excused) Dorothy Sue Alig ( excused) Laura Arena ( excused) Diane I- Iough Cat Parenti Jim Musick Barbara Sadler Judie Walker Speakers Present I'at Chumbleq~. Research Analyst, I- Iouse of Representatives Margaret White. Planner, Governor's Council on Developmental Disabilities ( GCDD) Bev I3ermon. Executive Director, Arizona Consortium for Children with Chronic Illness Guest List ( none) Joint Interim Study Committee on Developmental Disabilities Services Delivery system 1211 0196 Statement of the Mandate of the Committee Pat Chumbley, Research Analyst, House of Representatives, reviewed the mandate of the Committee, as follows: 1. Research the technical means to allow families to purchase services directly from certified caregivers by means of a voucher system. 2. Assess the availability and accessibility of community resources. including informal caregivers. 3. Investigate the potential for the integration of an electronic fund transfer system within the Department of Economic Security or contracted for by a financial institution to establish accounts of preapproved service allocations for family consumers. 4. Submit a report of findings on or before December 15. 1996. ( For more details. see Attachment 1 .) 1) iseussion of a Voucher Svstern for I*. amilies: I3arriers to Current System Margaret White, I'lanner. Govcrnor's Council 011 1) evelopmental Disabilities ( GCDD), said the voucher system is one ofthc most comprclicnsi\~ fa mily support legislative measures in the country. She noted that the measure contains no restrictions on age and is virtually " wide open." Ms. Whitc said the three different funding mechanisms are a voucher utilizing title XIX federal dollars. a vouchcr for individuals that uscs state- only money without additional restrictions, and an actual cash subsidy. She noted that an c\, aluation picce provides that an IPP team will meet on an annual basis to review goals. ob, jccti\, es and the service plans. Mr. I> eshaics rcportcd that e\ en though the \ ouchcr program was expanded to a statewide option six months carlicr. on11 200 hmilics arc ciirnllcd in thc program. He mentioned DDD's surprise at the low cnrollmcnt and noted that I > I ) I > mahcs a point of mentioning the voucher option at public meetings. Mr. 1) cshaics reviewed several issucs \ sliich are barriers to participation in the voucher program: 1 . From the pcrspectivc of the lntcrnal Kc\ fcnue Service ( IRS), if a family purchases ser\. ices with a vouchcr. docs the family become an employer responsible for tax-related \ s'orki? 2. I.' rorii an I I< S perspective. is i l l \, ouchcrs bc considered taxable income? Joint Interim Study Committee on Developmental Disabilities Services Delivery system 121 10196 3. If an individual hired by a family is injured on the job. who will be responsible for damages? 4. The federal title XIX program prohibits factoring. In response to Mr. Timmons, Mr. Deshaies said DDD assumes the risk for families and is attempting to set up a contract so that DDD will be viewed as the employer. In answer to Ms. Kepner, Mr. Deshaies explained that case managers and a DDD nlailer made families aware of the voucher program. In addition. he noted that the program was mentioned at a series of 28 family meetings held throughout the state during the summer. Ms. Kepner asked whether families must be under a certain income level to participate in the voucher program. Mr. Deshaies replied in the negative. Ms. Kepner asked if an independent developmentally disabled adult living alone would be eligible for the program. Mr. Deshaies replied affirmatively. With regard to the independent contractor liability issue, Mr. Hinds said that in order to address the coverage issuc, Risk Management ~ vouldn eed to know the precise employerlen~ ployecre lationship. Mr. Deshaies offered to send a copy of the contract to Mr. Hinds. Cochair Knaperek noted her intention to contact Congressman Salmon's office for suggestions on the issues before the Committee. She requested recommendations on overcoming the program barriers. Mr. 1) eshaies mentioned that the use of electronic benefit transfers may help expand voucher program enrollment. and result in savings by eliminating some costs associated with contract conlpliance. I- 1e mentioned that I> I> I) mill be piloting a technical assistance center to help guide l'amilies in the recruitn~ ento f assistants. ctc. Still lacking a quorum. Cochair Knapcrck sought input regarding the Con~ mittee's options. Ms. Kepner noted that the Committee cannot possibly meet the December 15 reporting deadline. It was decided the Committee would accept public testimony. ' 13~ 1I. Icrn~ onI, ~~ secutivDei rector. Arizona Consortium for Children with Chronic Illness. said that in days past. there was much morc support at the local community level. As an example, she recalled that the school districts and cities jointly sponsored summer projects which accommodated the handicapped. She said the ' l'empe ARC currently has its own thrift shop and usually offers a free program every night of the week in addition to ~ veckcnd dances and activities designed to normalize the lives of dcvclopn~ entallyd isabled indi\ iduals. She suggested that Arizona State University is trcn1endously undcrutilized, considering the number of students who require experience with the developmentally disabled and could participate in internships. Joint Interim Study Committee on Developmental Disabilities Services Delivery system 1211 0196 Ms. Hernlon stated her belief that the combination of localized case managers and empowered parents would make it possible to keep developmentally disabled children within their respecti\. e communities. Cochair Knaperek requested a report of DES's progress in working with electronic benefit transfers. Bob Gilligan, Legislative Liaison, Department of Economic Security ( DES), advised the Committee that electronic benefit transfers ( EBT) have been utilized across the country for years in the form of pilot projects for the food stamp program. He reported that such programs were not more widely implemented because technology such as card readers in grocery stores has onl! recently become common. He said a second deterrent to EBT technology was a regulation which would have held the state liable for fraud exceeding $ 50 on such a card. He reported that the welfare reform bill signed by President Clinton eliminated the problem of states being held liable for this type of card fraud. Mr. Gilligan noted that if an EBT program proves successful in the state of Washington, the technology could hopefully be made available to other states by the same vendor which would reduce start- up costs. He stated DES's hope that the legislature will appropriate a couple hundred thousand dollars for planning. Mr. Gilligan expressed hope that EBT technology will address the perceived problem of fraud. particularly with regard to the buying and selling of food stamps. Mr. Deshaies said EBT cards would limit the consumer to using certified providers of services which DDD is authorized to reimburse. I- lc noted that the mechanics of the program have yet to be dcterniined. Mr. ' I'immons mentioned that an article he wrote eleven years earlier regarding EBT technology addressed the food stamp system and day care payments. He said that although the program was approved and funding was made available, matching funds were unfortunately interrupted as a result of internal DES politics. Mr. l'immons commented that a magazine entitled EBT Today is published on a monthly basis. Ms. Kepncr aslicd if only families currently enrolled in the voucher program would be eligible for 11137' technology. Mr. Dcshaics rcplicd affirnmativclq . In the wake of the welfare reform bill. Mr. 1- linds inquired as to which entity will be held responsible for fraudulent use of EBT cards. Mr. ( iilligan shared his belief that the card holder will be held liable for fraud. Mr. ' I'ininions remarked that a national research institute on EBT has shown that technology is capable of providing acceptable safeguards. I4owever, he stated his opinion that abuse of an EBT system would be most likely to occur at the whitc collar level. Joint Interim Study Committee on Developmental Disabilities Services Delivery system 1 21 1 0/ 96 Cochair Knaperek requested that copies of Mr. Timmons' article be distributed to Conlmittee members. Cochair Knaperek assigned a variety of homework projects to Committee and staff members. With regard to the voucher program barriers mentioned by Mr. Deshaies, Ms. White said she has heard conlplaints that the in~ plementationp rocess is very slow due to the amount of hoops fanlilies must jump through. She suggested the Committee do an in depth study of the program barriers. Mr. Ileshaies speculated that the voucher program is not popular simply because of the barriers and the probability that some families are satisfied with their current situation. Further. he reported his belief that the program has not expanded options in rural areas. After some discussion. the Committee decided to schedule the next meeting for December 18 at 10: 00 a. m. Vlrithout objection, the meeting ( which never had a quorum) ended at 221 p. m. Teresa Alvarez, Secretary ( Original minutes with attachments and tape on file in the Office of the Chief Clerk. Copy of minutes \$- it11 attachments on file with Cochair Knaperek and Cochair Petersen. A document present during the meeting but not specifically referred to is included as Attachment 2.) taa 12E3/ 96 Joint Interim Study Committee on Developmental Disabilities Services Delivery System 1 21 1 0196 ARIZONA STATE LEGISLATURE Forty- second Legislature - Second Rcgular Session Joint Interim Study Committee on Developmental Disabilities Services Delivery System Minutes of Interim Meeting Wednesday, December 18, 1996 House Hearing Room 1 - 10: OO a. m. ( Tape 1, Side A) Cochair Knaperek called the meeting to order at 10: lO a. m. and attendance was noted by the secretary. Members Present Senator Victor Soltero Representative Herschella I- Iorton Roger Deshaies Frank Hinds ( for Rudy Serino) Jim Musick William J. Timmons Judie Walker Representative Laura Knaperek. Cochair Senator David Petersen, Cochair Members Absent Dorothy Sue Alig Laura Arena Ilianc Hough Peg Kepner Cat Parenti Barbara Sadler Speakcrs I'resent Bev Hermon. Executive Director. Arizona Consortium for Children With Chronic Illness Marta Ilrbina. Parent of a 15- year- old daughter with developn~ entald isabilities: StaiT Person, I'ilot Parent Partnerships Margaret White. Planner. Governor's Council on Developmental Disabilities ( GCDD) Guest List ( Attachment 1) Joint Interim Study Committee on Developmental Disabilities Services Oelivery System 1 21 1 8196 Introduction of Members At the request of Cochair Knaperek. Committee members briefly introduced themselves. Statement of the Mandate of the Committee Pat Chumbley, Research Analyst, House of Representatives. reviewed the mandate of the Committee. as follows: 1. Research the technical means to allow families to purchase services directly from certified caregivers by means of a voucher system. 2. Assess the availability and accessibility of community resources. including informal caregivers. 3. Investigate the potential for the integration of an electronic fund transfcr system within the Department oS Economic Security or contracted for by a financial institution to establish accounts of preapproved service allocations for family consumers. 4. Submit a report of findings on or before December 15, 1996. Discussion of a Voucher Svstem for Families: Barriers to Current Svstem Mr. Deshaies noted that approximately 200 families are currently enrolled in the voucher program operated by the Division of Developmental Disabilities ( DDD). I Ie added that the vouchcr program began as a pilot pro- ject and has since been expanded on a statewide basis. Mr. Deshaies explained that for program recipients not enrolled in the Arizona Long- l'crn~ Care System ( ALTCS), DDD will offcr families the opportunity to receive cash through contracts. In cases in which an individual is enrolled in ALTCS, he said a voucher will be provided which authorizes certain privileges. IIe explained that ALTCS enrollees cannot receive cash payments because federal requirements pertaining to third- party reimbursements prohibit the giving of actual cash. Mr. Dcshaies asserted that the greatest barrier to expansion of the voucher program is burcaucratic red tapc. For instance. hc explained that because of the Internal Revenue Service ( IRS) definition ol'an cmployer/ employee relationship. some families and the DDD are concerned that families will be viewed as an employer for purchasing scrviccs with a voucher and, as such, will be lorced to Iulfill tax reporting rcquirements. ctc. I Ie pointed out that in the foster care arena. reimbursement lor serviccs is considered hardship and is not taxable. Joint Interim Study Committee on Dcvelopmentai Disabilities Services 1) clivcry System 1 2! 1 8196 As a linal barrier. Mr. Deshaies explained there is some question as to what party will be hcld liable should a provider injure himself while delivering services in a home. IIe said interprctations arc varied. and that the inability to issue a clear answer further discourages participation in the voucher program. I11 response to Senator Soltero, Mr. Deshaies indicated that the majority of insurance companies will not provide coverage for an individual who sustains an injury while caring for someone in the home because such a situation is viewed as an employee/ employer matter. I- Ie added that in two such instances. DDD and Risk Management provided coverage for an injured person in order to avoid a court case. With regard to barriers, Mr. Deshaies admitted that DDD has not done a good job of marketing the voucher program as an alternative. I- Ie said efforts are being made to identify resourcc people in each district office who can make tl~ emselves available to families and provide assistance with screening applicants, writing newspaper ads, ctc. Mr. Dcshaies reported that in rural areas, the move toward individual funding and family control can result in management problems lor small agencies. For instance. he said that if some small providers are not guaranteed a base amount of business. problems will arise with regard to staffing needs. Mr. Dcshaies said one requirement which does not make sense stipulates that a caregiver must take seven or eight core training classes ( e. g., CPR. first aid) even if he or she is a trained health care professional. In response to Ms. Horton. Mr. Ileshaies said the core training requirements are prescribed in rules. and that it is within the ability of DDD and the Arizona Health Care Cost Containment System ( AHCCCS) to modify or interpret such rules. Ms. I- Iorton said that as a registered nurse. she is required to take cardiopulmonary rcsuscitation ( CPR) training each year. She said those who seldom use CPR have need of regular training, and she suggested it bc carefully considered nhether or not to eliminate training Lxhich may save a life. In response to Cochair Knaperek. Mr. Dcshaies estimated that any modification to the rules would take between ten and twelve months for adoption. ' Mr. . l'immons asked iS Health Care Finance Administration ( I- ICFA) approval will bc required to modify A1 ICCCS- related regulations. Mr. Deshaies answered affirmatively, explaining that an amendment to the waiver must be submitted to HCFA for approval. Cochair Knapcrek asked if DDD has approached A1 ICCCS about changing the I ICFA waiver. Mr. Dcshaics reported that proposed changes to the I- ICFA waivcr were subinitted to A1 ICCCS for consideration several weeks earlier. Ms. Cl~ umblcyre ferred to a menlo from ' l'crrec Waslcy ( Attachment 2) of Congressillail Salmon's officc regarding fcderal employer tax issues for families coping with developmental disabilitics. She reviewed item # 1. as follows: Joint interim Study Committee on Developmental Disabilities Services Delivery System 1211 8/ 96 1) If families do not use a debit card to purchase services, payment ior services should go directly to the provider. Mr. Deshaies remarked that item # 1 addresses factoring or, more specifically. situations in which the presence of a third party interferes with Medicaid payments. Cochair Knaperek mentioned that in a telephone conversation which took place prior to the Committee meeting, Ms. Wasley indicated that HCFA was noncommittal about item ki 1 even though it liked the idea of a debit card for services. Ms. Chumbley reviewed items # 2 and # 3 from Ms. Wasley's memo. as follow: 2) Regarding the independent contractor law. the Internal Revenue Service ( IRS) would review each case separately or the state may request a waiver or a letter from the IRS stating that they would not prosecute for any violations of the independent contractor law. 3) Regarding the factoring issue, I- ICFA said it was uncertain whether Arizona has requested a waiver for this practice. Cochair Knaperek reported that Ms. Wasley was unable to secure definite answers fro111 I- ICFA or the IRS. Mr. Deshaies said that in his discussions with the IRS, it was made clear that an individual who directs the work of another is classified as an employer. Mr. Hinds, attending on behalf of Rudy Serino, identified himself as a Property and Liability Claims Manager for Risk Management and said he researched A. R. S. 41- 621 to determine whether Risk Management could cover on- the- job injuries suffered by providers. I3e reported that Risk Management has covered two such cases in the past. but pointed out that A. R. S. 41- 621( B) was modified during the 1996 legislative session to clarify that medical coverage was never intcnded to become part ofthe Risk Managenlcnt provider program. IHe read an excerpt from A. R. S. 41 - 621( 13) ( Attachment 3). as follows: .' ... - I ' he insurable programs shall include foster care. programs for the developmentally disabled. an independent living program pursuant to section 8- 531 and respite- sitter service programs. 7' he department shall obtain insurance or provide thr state self- insurance pursuant to this subsection to protect the clients participating in thcsc programs and individual providers of'thcse program se. r. vices 011 bchalfof'thc state and its dcpartmcnts. agencies, boards or con~ mission. s.. Mr. I linds concluded his remarks by stating that as long as providers arc of thc tlpe covered in statutue, liabilit? coverage will be provided for than with the cxccption of incdical and uorkmen's compensation. Cochair Knapcrek asked whether the Department of Administration ( DOA) could scnd a letter to I> I> D stating that coveragc will be provided. Mr. Hinds indicated no ob. jection. Joint Interim Study Colnmittee on I) cvelopnicntal Disabilities Servlccs Delivery System 1 71 1 8196 r) iscussion ot'the Availabilitv and Accessibilitv of'Communitv Resources Rev I- Iermon. Executive Director. Arizona Consortium for Children With Chronic Illness, reported that the communities of Tempe. Mesa and Tucson have developed programs for conlmunity members experiencing certain problems. She recalled that when her developmentally disabled child was in school, programs were developed jointly between the city and school. Further. shc said that Boy Scouts, Girl Scouts and churches were once much more involved with handicapped children and their families. Ms. IIcm~ onsp eculated that the advent of federal monies resulted in more institutionalization. and subsequent loss of'community involvement. Ms. Walker noted that some areas have seen a resurgence of community involvement. She said children with developmental disabilities are increasingly included in community activities. She lauded the advances which have allowed developmentally disabled children to remain in their homes and co~ nmunitiesw hile receiving care. Cochair Knaperck requested an cxan~ pleo f how the voucher system can improve matters lor fanlilies ol'thc dcvelopmentally disabled. Ms. Walker said her family is not involved in thc voucher system because participation would nierely intereferc with fanlily life. She said that providers who enter the homc deliver very personal services. and that caregivers made available through an agency may not meet a family's needs or values. As an example, she explained that her teenage son is not a nlorning person. and can have either a good or bad day based on whether or not his bath goes smoothly. In addition. she stated her preference that a provider be able to interact positively when out in the community with her son because children learn from such interaction. Ms. Walker summarized that it is critical for families to have a say in selecting caregivers bccause there are bad eggs in every industry. I) iscussion of I~ nnlcmentationo f an 1: lectronic Fund Transfer System for Families Mr. ' i'immons referred to a11 articlc cntitled ilrizona 1: B'F Project ( Attachment 4) and recalled that several years earlier. the Ilepartmcnt of Economic Sccurity ( DES) applied for federal grant monies to implclncnt an electronic bcnelit translcr ( EB'T) system for programs such as Aid to Families with Ilependent Children ( AFDC). bod stanips and day carc. I Ic reported that even though the grant was awarded, program implementation unfortunately never occurred as a result of political infighting. Mr. ' I'immons sunlmarized that tlic idea behind the I'B'T system was for an applicant to apply for benefits and. once eligible. liavc a benefit type and dollar amount programmed onto a debit card wit11 a personal identification number ( PIN). I lc said such a debit card could then be swiped through a card reader at a grocery store. With regard to day carc. Mr. . l'immons explained that a card- swipe system must work differently because the da? carc industr!. is time oriented. as opposed to cash oriented. In such a scenario, he said a point- of- sale device installed in a day carc center would have to have access to information on all individuals eligible for day carc services. as well as their beneiit type and subsidy amount. Joint Interim Study Committee on Developmental 1) isabilities Services Dclivcry System 1 21 1 8196 I- Ie said that a parent would swipe the debit card upon dropping off and picking up thc child. and that a check for services would be mailed to the day care center two days later. Ms. I3orton mentioned that barriers to similar card- swipe programs have been hotly debated for at least six ycars. She recalled that in rural areas, small " Mom ' n Pop" groccrs testified against such programs because only the larger grocery stores would be equipped with card readers. Mr. ' Iimmons reported that a demonstration project was implemented in Mesa and that thc willingness existed to install point- of- sale devices in Mom ' n Pop stores. I- Ie expressed doubt. however. that small grocers could be equipped on a statewide basis. Cochair Knapcrek diverted attention from food stamps to providers. Mr. Deshaies explained that in the State of Maine, a program was instituted which allowed individuals, through a modem. to bill electronically. In rural areas, he said an electronic billing location was made available to people in return for a small fee. He said that within seven days of billing. an account was electronically credited for reimbursement. Mr. I> cshaies conlmentcd that a program is envisioned for thc Lake Havasu CityIKingman area which would allow contracting with a providcr to furnish point- of- sale technology. Cochair Knaperek mentioned that Ms. Kepner could not attend the meeting but mailcd in some suggestions. She recalled that Ms. Kepner's recommendations were to disseminate information through a newsletter and a mailing to prospective families. Mr. Deshaies remarked that mass mailings have not been attempted. Marta IJrbina. I'arent of a 15- vcar- old daughter with developmental disabilities: Staff Pcrson, Pilot Parent Partnerships, began explaining the mechanics of an individual service program plan ( ISPP). Senator Soltero requested insight into some of the services available to the developmentally disabled. Ms. lJrbina said her daughter has cerebral palsy and 111ust use a wheelchair. in addition to having visual i~ npairnlenta nd an inability to co~ nmunicatev erbally. Ms. llrbina cxplained that an ISPP is a process b) which a case manager sets dates mith the family. She stated that her daughter is eligible Ibr Al,. I'CS. and that the AL, TCS eligibility process is vcry cumbcrsomc and intrusike for a t'anlilq. Shc said thc cligibility process Socuscs on medical nceds. using " at risk of'institutionalization" as a criteria. and financial status. She mentioned that it is vcry intrusive f'or an outsider to review your bank statements. bonds. cmployn~ ents tatus. incomc, and cxpcnditurcs. 1: iirthcr. she indicated that linancial cligibility must be rcdeenled on a ycarly basis. Ms. llrbina explained that she sustained a back il? iury two ycars earlier while moving hcr daughter. As a result. shc said thc family I~ asm ade concessions and now has a " Mr. h~ lom"~ vhofu nctions as a lull- timc carcgivcr. In addition. shc said hcr daugl~ tcrr eceives respite scrviccs and attendant lolnt lnter~ mS tudy Comni~ ttcco n Dcvclopmental D~ sabtl~ tS~ ccrsv ~ ccsD clivcry System 13' 1 8196 services Ibr personal care such as bathing. She emphasized that the family must trust and develop a good relationship with any caregiver who enters the home. Ms. Urbina said that although a voucher looks marvelous on paper and seems to give the flexibility to hire or recruit individuals, the program requirements effectively form a barrier. Ms. lJrbina invited Senator Soltero to visit her home and observe the ISPP process lirsthand. Cochair Knaperek suggested that Cochair Petersen may be interested in the offer. Cochair Knaperek inquired how best to enhance programs for the developmentally disabled. Ms. llrbina shared her belief that efforts are focused in the right direction in terms of providing flexibility. She reported her biggest obstacle to be the amount of time expended on recruiting providers. She added that she, like many other families, manage to recruit providers only to lose them as a result of program delays and bureaucratic red tape. Ms. Walkcr asserted that electronic reimbursement could play a critical role in eliminating the paperwork backlog which sometimes forces caregivers to leave the employ of families to seek work elsewhere. In response to Cochair Kilaperek. Ms. llrbina said that ISPP case managers advised her family oS the pilot voucher program. She said she believed the program would give her more control in recruiting individuals, and the freedom to avoid utilizing agency providers. Cochair Knaperek asked how families are made aware of the voucher program. Mr. Deshaies said case managers may advise a family of the program, or a family may place a call to a DDD district oflice. Cochair Knaperek and Mr. Deshaies discussed the mechanics of participation in the voucher program. Ms. Walker pointed out that. sometin~ es. a very s~ nalel xpense will allow her son to participate in an existing program. I lowever. she said it is a very undesirable prospect to suffer through a lot of paperwork in return for enrollment in a six- week program. She asserted that rural areas do a better job of meeting community needs and added that families should not be forced to relocate to cities to access services fbr thc developmentally disabled. Marr- r arct Wliitc, I'lanner, Gocernor's Council on I> cvelonmental Disabilities ( GCDD), shared her belief that the family support bill which tzlas adopted several years carlier would answer the issues addressed by the Committee. She expressed sadness that the implementation proccss has been so slow. Ms. White expressed her hope to see government place more trust in families because it is the family that will make the best choice for an individual with developmental disabilities. She recognized paperwork and a lack of'trust in fanlilies as major program barriers. Soint Interim Study Co~ nmitteeo n L) cvclopmcntal Disabilities Services Ocl~ veryS ystem 1 21 1 8/ 96 Ms. Walker stated that some entity must pay for the army of people who fill out and shui~ lep ieces of paper. She emphasized that if government cannot do the right thing by placing its trust in families. it should at least do the right thing for the simple reason that it will remove layers of' administration. She dispelled the idea that families lay awake at night wondering what new services they can " pack on" because each new service represents a major intrustion into a farnily's life. Ms. White acknowledged the efforts of individuals and said Mr. Deshaies has been wonderful in his attempts to fix the system. As an example of program setbacks, Ms. White explained that a group of people met to discuss an implementation plan and to develop rules. and were discouraged to find that the final rules basically negated the concept of flexibility by requiring that families meet various requirements and jump through an assortment of hoops. She suggested that families simply be given a flat $ 200 per month. Mr. Deshaies admitted to encountering difficulty in finding a balance between flexibility and accountability which state agencies need for reporting purposes. He said the situation is further conlpounded by input from legal experts whose goal is to limit liability to the state. Cochair baperek stated that rules are not supposed to supersede statute. Mr. Deshaies shared his opinion that legislative intent is clear and that DDD must do a better job of finding a balance. Cochair Knaperek suggested the Committee could focus its attention on DDD if that entity were a stand- alone agency which was not shrouded by DES. Recommendations Ms. Ijorton suggested that rules be reviewed carefully so as not to sacrifice safety in an effort to attract more providers. She also suggested DDD and other agencies streamline their paper flow in an effort to become more user friendly to consumers. She further recommended that a committee be created to provide ongoing oversight of thc developmental disabilities services delivery system. Cochair Knaperek recommended the following: 1) Submit Risk Management's findings, in written form. to the Division 01' Developmental Disabilities as soon as possible. 2) Dc\, elop an aggressivc marketing stratcg),. 3) Rcduce paperwork and initiate an elcctronic bellelit transfer system. 4) Draft legislation requiring thc Ilivision of' Developmental Ilisabilities to bcgin an clectronic benefit transfer pilot program in at lcast one urban and one rural county. 5 ) Separate thc Ilivision of Developn~ cntal Ilisabilities from the Department ol'l~ conon~ ic Security. Joint Interim Study Co~ nmitteeo n [) evelopmental Disabilities Services tlelivery Systenl 1 21 1 8196 With regard to item iive. Senator Soltero stated his desire to postpone a decision. Ms. 1 Iorton pointed out that item iive would expand state government. She said the Conlmittce should instcad wait to study the findings of an ongoing oversight committee. Cochair Knaperek countered that DDD currently pays administrative fces to DES. She voiced hcr belief that if broken out as a separate agency, DDD could continue contracting with 1113 for administrative services, thereby avoiding the creation of more bureaucracy. ( Tape 2. Side A) Ms. I Iorton suggested an oversight committee examine the feasibility of crcating a new department. Mr. Musick said that as a provider, he would like to see DDD aggressively expand thc voucher systcm into other areas. Ms. Walker remarked that if thc voucher system is to be expanded. fanlilies nlust be assured in writing that any conflict with the IRS has been resolved. Ms. Horton rccommeded writtcn clarification be obtained from the IRS. but also cautioned that IRS clarifications are nonbinding and can bc reversed at any time. Cochair Knaperek suggested the congressional delegation may be ablc to get clarification from the IRS. Cochair Knaperek recommended DDD expand the voucher program and direct more monies into the family support line item. Ms. Horton mentioned that such action is available to legislators through the regular appropriations process. Ms. Horton repeated her idea of working with Cochair Knaperek to develop a joint oversight committee conlprised of legislators and others. Without objection. the reco~ nmendationsw ere adopted. Without objection. the meeting was adjourncd at 12: 13 p. m. ' I'crcsa Alvarez, Committee Sccrctary ( Original minutes with attachments and tapes on file in the Office of the Chief Clcrk. Copy ol' minutcs with attachments on filc with Cochair Knaperck and Cochair Pcterscn.) Joint Interim Study Comm~ tteeo n [) cvelopmental Disabilities Services Dclivcry System 1 21 1 8196

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Report from the Joint Interim Study Committee on Developmental Disabilities Services Delivery System

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