Agenda Item 20
March 6, 2012
Action
MEMORANDUM
TO:
FROM:
County Council
~
Michael Faden, Senior Legislative Attorney
Action: Bill 40-11, Group Homes - Developmentally Disabled Adults ­
Licensing
SUBJECT:
Health and Human Services Committee recommendation (2-0, Councilmember
Navarro absent): enact as introduced.
Bill 40-11, Group Homes - Developmentally Disabled Adults - Licensing, sponsored by
the Council President at the request of the County Executive and Councilmember Ervin, was
introduced on December 6, 2011. A public hearing was held on January 24 (see testimony, ©9­
18) and a Health and Human Services Committee worksession was held on February 9.
Bill 40-11 would exempt certain group homes for developmentally disabled adults which
are licensed by the state from the County group home licensing law. Reasons given in the hearing
testimony for repealing this requirement include duplication of effort by County and state licensing
agencies and cost savings for group home providers.
Issues/Committee recommendation
1)
Why only "de-license" this category of group homes?
An issue raised by, among others, civic activist Max Bronstein (see letter, ©25) is what is
DHHS' rationale for no longer licensing this category of group homes (developmentally disabled
adults) while both the County and the state continue to license other types of group homes. Neither
DHHS nor the other advocates for this Bill addressed this issue in their hearing testimony.
Before the Committee worksession DHHS staff offered the following explanation:
Group homes for the developmentally disabled are unlike other group homes
licensed by the County in that we have a greater degree of local oversight and involvement
with them than we do with other group homes. Through our contractual arrangements with
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providers of services to those with developmental disabilities, the Department of Health and
Human Services has significant oversight of conditions in DD group homes. Resource
coordinators and contract monitors who work for DHHS visit these homes multiple times
each year to ensure that appropriate services are being provided to the residents. The
County does not have this kind of relationship with other types of group homes licensed by
the County.
In
those instances, only our environmental health inspectors and the Fire
Marshall inspect conditions in these other group homes. For this reason, we were not
comfortable extending exemption to other types of group homes.
2) Does the state effectively perform its licensing function?
A recent state legislative audit of the state group home licensing agency, the Office of
Health Care Quality (OHCQ) in the state Department of Health and Mental Hygiene (DHMH) (see
excerpts, ©19-24), found that, from February 2008 through August 2010, the agency failed to
inspect 76% of the licensed facilities for the developmentally disabled. If one rationale for the
County no longer licensing these facilities is that the state will effectively do so, this data tends to
call that rationale into question.
In
its response to the audit, OHCQ concurred with the auditors'
finding and attributed its failure to inspect to staff shortages - a deficit of 28 inspectors in the DD
unit.
In
Council staffs view, for budget reasons alone, the state's staff situation is unlikely to
improve in the foreseeable future.
Before the Committee worksession DHHS staff offered the following explanation:
We are aware of problems cited in the most recent state audit. The Office of Health Care
Quality has had staffing shortageslissues and consequently has not been maintaining its
inspection schedule. Nonetheless, because of the relationship described in #1, we are
comfortable that we have significant presence in these group homes-far more than would
exist even if state were performing its inspections.
3)
Will
the County continue to perform the same fire code inspections as it currently
does?
Which if any fire code inspections will the County no longer perform?
In
particular, will the
County fire code inspectors continue to inspect each group home before it begins operations? This
is a code where the County is the primary enforcement agency, so concern about gaps in coverage is
especially warranted.
Before the Committee worksession DHHS staff offered the following explanation:
Fire inspections will continue on an annual basis as has always been the case. There will be
no gap in fire inspections performed by Montgomery County Fire Marshall.
After discussing these issues with DHHS staff, the Committee recommended (2-0,
Councilmember Navarro absent) that the Bill be enacted as introduced.
2
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This packet contains:
Bi1l40-11
Legislative Request Report
Memo from County Executive
Fiscal Impact Statement
Hearing testimony
State legislative audit report (excerpts)
Bronstein letter
F:\LAW\BILLS\l 140 Group Homes\Action Memo.Doc
Circle
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4
5
7
9
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25
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Bill No.
40-11
Concerning: Group
Homes
Developmentally Disabled Adults
Revised: 12-1-11
Draft No.
~
Introduced:
December 6, 2011
Expires:
June 6, 2013
Enacted: _ _ _ _ _ _ _ _ __
Executive: _ _ _ _ _ _ _ __
Effective: _ _ _ _ _ _ _ _ __
Sunset Date: -'-"N...,onc.:.::e"--_ _ _ _ __
Ch. _ _, Laws of Mont. Co. _ __
COUNTY COUNCIL
FOR MONTGOMERY COUNTY, MARYLAND
By: Council President at the Request of the County Executive and Councilmember Ervin
AN ACT to:
(1)
(3)
revise the licensing requirements for certain group homes for developmentally
disabled adults; and
generally amend the law regarding regulation of group residential facilities.
By amending
Montgomery County Code
Chapter 23A, Group Homes
Section 23A-3
Boldface
Underlining
[Single boldface brackets]
Double underlining
[[Double boldface brackets]]
* * *
Heading or defined term.
Added to existing law by onginal bill,
Deletedfrom existing law by original bill.
Added by amendment.
Deletedfrom existing law or the bill by amendment.
Existing law unajfocted by bill.
The County Council for Montgomery County, Maryland approves the following Act:
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BILL No. 40-11
1
Sec.
1.
Section 23A-3 is amended as follows:
23A-3.
Applicability of chapter.
This Chapter does not apply to a:
(a)
facility which holds a valid license for institutional care, such as a
nursing home, hospital, child or adult day care facility, or domiciliary
care home for 5 or more residents;
(b) foster or respite care home for children which is approved by the
County Department of Health and Human Services, the State
Department of Juvenile Services, or any licensed child placement
agency, in accordance with standards set by the appropriate State
agencIes;
(c)
foster care or respite care home for adults for 3 or fewer elderly
persons or persons with disabilities, which is approved by the
Department of Health and Human Services;
(d) licensed residential or institutional facility whose total number of
residents at anyone time will exceed 16 or the number of persons
allowed under a license for the facility issued by a state agency,
whichever is less;
(e)
group home which does not routinely provide more than 50 hours of
on-site supervision a week, but a home exempted under this
subsection may apply for a license and be licensed if
it
meets the
requirements of this Chapter; [or]
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
(0
group home for developmentally disabled adults which is licensed
Qy
the state Department of Health and Mental Hygiene; or
(g) group of persons, not related by blood or marriage, living together in a
dwelling unit as a family as defined in Chapter 59. Supportive care
services and treatment for individual residents or the group may be
provided by a person or agency that does not assume responsibility for
24
25
26
27
28
@)
F:\LAW\8ILLS\l140 Group Homes\1140 BiII.Doc
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BILL 1\10.
40-11
29
acquiring those services or treatments or for supervising, directing, or
controlling the residents.
Approved:
30
31
32
33
34
Valerie Ervin, President, County Council
Approved:
Date
35
36
37
38
39
Isiah Leggett, County Executive
This is a correct copy ofCouncil action.
Date
40
41
42
Linda M. Lauer, Clerk ofthe Council
Date
F:\LAW\BILLS\1140 Group Homes\1140 Bill.Doc
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LEGISLATIVE REQUEST REPORT
Bill 40-11
Group Homes
DESCRIPTION:
PROBLEM:
Developmentally Disabled Adults
-
Licensing
Would exempt certain group homes for the developmentally disabled
from county inspection and licensing requirements.
Group homes for developmentally disabled adults are currently .
licensed and extensively regulated both by the State Department of
Health and Mental HygienelDevelopmental Disabilities
Administration. ("DHMHlDDA") and the County.
To eliminate duplication of effort and minimize expense for owners
of group homes serving the developmentally disabled population.
Department of Health and Human Services
See Fiscal and Economic Statement.
See Fiscal and Economic Impact Statement.
To be requested.
Montgomery County is the only jurisdiction in the state that requires
operators of group homes for developmentally disabled adults to
secure both a county and a state license.
Kathy Schoonover, Department of Health and Human Services
(DHHS), Division of Licensing and Regulatory Services;
John J. Kenney, DHHS, Aging and Disability Services;
Michael Donahue, Fire and Rescue Services.
GOALS AND
OBJECTIVES:
COORDINATION:
FISCAL IMPACT:
ECONOMIC
IMPACT:
EVALUATION:
EXPERIENCE
ELSEWHERE:
SOURCE OF
INFORMATION:
APPLICATION
WITHIN
MUNICIPALITIES:
PENALTIES:
NIA
NIA
f:\Iaw\bills\1140 group homes\lrr.doc
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OFFICB OF THE COUNTY EXECUTIVE
ROCKVIU£. MARYLAND 20S5O
Isiab Leggett
County Executive
At'I\
MEMORANDUM
November 2,2011
, --<...s::
~0rq
."
TO:
FROM:
Valerie Ervin, Council President
Isiah
Legget~
County
ExecutiV~-r---
/).a..
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SUBJECf:
Licensure of Group Homes for the Developmentally Disabled-Bill to Exempt
I am attaching for the Council's consideration a bill that would exempt group
homes for the developmentally disabled
from
the general licensure requirements contained in
Chapter 23A ofthe Montgomery C01Ulty Code. Also attached are a Legislative Request Report
and a Fiscal and Economic bnpact Statement for this bill,
Group
homes
for
the developmentally disabled are subject
to
licensure and
inspection requirements by both the state and the county. No other local jurisdiction
in
the state
has similar requirements. This bill would eliminate duplication in the licensure and inspection
process and, as a consequence, reduce costs to the providers who run these group homes.
Iftbis exemption is granted. these group homes will still be subject to the health
and safety standards established by the Office of Health Care Quality (,'OHCQ',) of the State
Department ofHea1th and Mental Hygiene. OHCQ licenses these facilities and
stat~
inspectors
from OHCQ conduct unannounced site visits to review the
safety
ofclients, compliance with
service plans, staffing adequacy, and overall quality of care provided to residents.
In addition, each resident ofa group home receiving
funds
from the
Developmental Disabilities Administration ("DDA'") will
still
be assigned a resource coordinator
working through Aging and Disability Services
in
our Department ofHealth and Human
Services. The coordinator
is
responsible for vislting the client, reviewing the services provided,
and
monitOring the cleanliness of the home.
Fire inspections are an essential element of the safety plan and the Department of
Health and Human Services will require that these facilities continue to be inspected annually by
the County Fire MarshalL
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Valene Ervin, President
November
2.
2011
Page 2
I
have concluded that there
is
sufficient oversight of these homes
by
professional
staff from state and county agencies that the well-being of residents
will
not
be
compromised
by
the removal of the county licensure requirement.
For
questions about this bill, please contact Uma S. Ahluwalia, Director, Department of Health and
Human Services at 240-777-1266.
IL:gh
r
look forward
to
working with the Council
as
it
considers this legislation.
Attachments
(3)
c:
Uma S. Ahluwalia, Director, Department ofHealth and Human Services
Richard Bowers, Chief, Fire and Rescue Services
Kathleen Boucher, Assistant Chief Administrative Officer
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065414
OFFICE OF MANAGEMENT AND BUDGET
Isiah Leggett
~I.:''''::'''',~"""
Jennifer
A.
Hugbes
County Executive
MEMORANDUM
-,
Director
September 21,2011
, .
,
C-,
.~.:;
TO:
FROM:
SUBJECT:
V
alene
Ervin, President, County Council
Jennifer
A. HUghtDirecror
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Bill
to
Amend Chapter 23A,
Group
Residential
Care
FacjJjties, exempting certain
grOup
homes for the developmentally disabled from county inspection and licensure
requirements
-t
-.­
go
The purpose ofthis memorandum is to transmit a fiscal and economic impact statement
to the
Council
on the
subject
Bill.
LEGISLATION SUMMARY
Group homes for developmentally disabled adults are currently licensed and extensively
regulated both by the Maryland State Department of Health and Mental Hygiene, Developmental
Disabilities and Montgomery County. The
goal
ofthis legislation
is
to eliminate the duplication of effort
and
minimize expense
for
owners
of group
bomes serving
the developmentally disabled population.
Bill XX-II
would:
1.
Revise
the
list of facilities to which Chapter 23A does not apply;
2. Add "group homes for developmentally disabled adults which are licensed by the MaryllUld
Department of Health and Mental Hygiene, Developmental Disabilities Administration" as
unregulated residential facilities; and
3.
Generally amend
the
law regarding
certain
unregulated residential facilities.
nSCALANDECONONnCSUMMARY
This
Bill.
if
approved would result in a loss of revenue ofapproximately $39,100 in the
Health Inspections: Living Facilities - Licenses revenue category as these services
win
no longer be
provided. There are 782 Developmentally Disabled Adult (DDA) group home beds. The Department of
Health and Human Services (DHHS)
collects
$50 per
bed
when the facility license
is
renewed annually;
Offiee
of
tbe Director
101 Monroe Street, 14th
Floor •
Rockville, Maryland 20850 • 240-777-2800
www.montgomerycountymd.gov
montgornerycolllltymd.gov/lll
240-773--3556 TTY
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Valerie Ervin. President, County Council
September 21, 2011
Page 2
(782
x
50
=
$39, I00).
This
Bill
will result
in
the loss of
$39,100
in revenue each year over the
next
six
years for
a
total revenue impact of -$234,600 ($39.100 x 6).
DImS
estimates 608 hours are spent
annually
on
DDA
group
home inspections by
six
environmental health specialists who conduct these
inspections
at
100 hours
per
inspector equating to approximately one-third ofa workyear. These hours
will
be redirected to conducting mandated State
food
safety
inspections.
Breakout ofHours:
Number of Group Homes:
Assumptions:
Inspection time (including travel)
Annual inspections:
Ro-inspection
rate
Re-inspection time
Re-inspections:
217
2.S
hours
217 homes
x
2.5
=
543
hours
20%
1.5
hours
217 x 20%
z::
43 homes
x
I.S hours" 65 hours
Total 60S anJluai
inspections
hours (543+65=608)
==
approximately 30% of one work year
Montgomery County Fire and
Rescue
Services (MCFRS)
will
continue mandatory safety
inspections
on
an annual basis with an assessed fee.
The
inspections will be included as
a
contractual
.obligation on the part ofthe provider
as a
condition ofreceiving
county
funding
the
following fiscal year.
Currently. MCFRS charges $154 ($140
+
10% tech fund) for inspection labor and a$55 penuit
fee
for
each group home for a total of
$209
per year. MCFRS
will
waive the permit fee
as
these providers
depend almost entirely on funding through grants and assistance provided
by
the State and County;
the
oew
fee
will
be $154 per year for each group home. Based on the current annual inspection demand of
217
DDAgroup homes. MCFRS will incur a revenue loss
of$11,93S
in each
of
the next six years. The
total revenue impact over the
six
years
is a loss
of
$71 ,61 O.
This Bill has
no
meaningful impact on employment, personal income. investment, or
other
economic
variables to
the
Montgomery County economy as a whole.
The
Bill results in fewer
inspections and fees collected, but on a per-provider basis these changes are insignificant.
The follOwing contributed
to
and
concurred with
this
analysis: Clark
Ben,
Senior
Administrator and
Kathy
Schoonover, Nurse Administrator. Licensure and Regulatory Services, Department
of Health
and Human Services, Michael Donahue,
Assistant
Chief, Montgomery County
Fire
and
Rescue
Services., Mike Coveyou. Department of Finance, and Trudy-Ann Durace, Office of Management and Budget
JAH:tad
c: Kathleen Boucher, Assistant Chief Administrative Officer
Lisa Austin, Offices ofthe County Executive
Uma S. Ahluwalia. Director, Department of Health and Human Services
Beryl
L.
Feinberg. Budget Manager, Office ofManagement and Budget
John Cuff, Office of Management and Budget
Amy
Wilson, Office of Management and Budget
Trudy-Ann Durace, Office of Management and Budget
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\\
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Isiah Leggett
County Executive
Uma S. Ahluwalia
Director
Testimony re Bill 40-11, Group Homes-Developmentally Disabled Adults-Licensing
by
Uma S. Ahluwalia, Director
Montgomery County Department of Health and Human Services
January 24, 2012
• Good Afternoon, Council President Berliner and members of the County
Council. I am
Vma
Ahluwalia, Director of the County's Department of
Health and Human Services. I am here today on behalf of County
Executive Isiah Leggett to testify in support of Bill
40-11
which,
if
approved, will exempt group homes for the developmentally disabled
(DO) from the general licensure requirement contained in Chapter 23A
of the Montgomery County Code.
• We have worked very closely with the numerous stakeholders for
whom the matter of a local licensing requirement- in addition to the
State's licensing requirement-is a serious concern.
Office of the Director
40
I
Hungerford Drive • Rockville. Maryland 20850 • 240-777-1245 • 240-777-1295
TTY •
240-777-1494
FAX
www.montgomerycountymd.gov/hhs
montgomerycountymd.gov/311
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1>'illi!
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....
ti
n·III••,_.,.,.
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240-773-3556 TTY
(j)
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• During the first year of my tenure, I met with the providers of
residential services to individuals with developmental disabilities and
heard their concern that our local licensing requirement of their group
homes was duplicative of the State's licensing activities and imposed a
non-valued burden on their managers and direct care staff. I then
consulted with various stakeholders including other County agencies,
the State Department of Health and Mental Hygiene (DHMH), the
County's Commission on People with Disabilities, and advocates for
persons with developmental disabilities.
• We created a working group comprised of DHHS staff from our
Licensure and Regulation, Aging and Disability Services and the County
Fire Marshal to determine whether there is duplication of inspections by
the Office of Health Care Quality (OHCQ) in the State's DHMH and the
County, and to determine whether there are certain functions conducted
by Montgomery County departments that should be eliminated,
reassigned or maintained.
• Based on the following factors, we concluded that DD group homes
could be exempted from the county licensing requirement without
21Page
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losing safeguards that ensure the safety and well-being of the residents
of these group homes.
o No other jurisdiction in the State requires a local license for DD
group homes in addition to the State license.
o DD group homes must meet State quality of care requirements.
They cannot operate in the County without a state license and are
subject to the health and safety standards established by the State
OHCQ, which will continue to inspect and license these facilities
including unannounced site visits by State inspectors to review the
safety of and overall quality of care provided to residents.
o Through our contractual arrangements with DD providers, DHHS
has significant oversight of conditions
in
DD group homes-far
more than we do with other types of group homes that we license
locally. Resource coordinators and contract monitors who work
for DHHS visit these homes multiple times each year to ensure
that appropriate services are being provided to the residents.
Many of the functions currently conducted by our Public Health
31Page
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Environmental Health Inspectors will be incorporated into the site
visits conducted by our resource coordinators and/ or contract
monitors. Any problems that they identify will be promptly
reported to the appropriate authority.
o
Fire inspections of these facilities will continue to be done on an
annual basis by the County Fire Marshall to ensure they meet all
Code requirements.
• We believe that with these safeguards in place, we can remove the
additional financial and regulatory burden that local licensing imposes
on DD group home providers. For these reasons, we ask that you
support Bill 40-11.
• Thank you for allowing me to testify today.
41Page
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MONTGOMERY COUNTY COMMISSION ON PEOPLE WITH DISABILITIES
0
Testimony on Bi1l40-11, Group Homes - Developmentally Disabled Adults - Licensing
Before the Montgomery County Council
1:30 p.m., January 24,2012
Mark Loberg, Commissioner
Good Afternoon, my name is Mark Loberg and
I
am a commissioner testifYing on
behalf ofthe Commission on People with Disabilities on this bill before you this
afternoon to eliminate the duplication of licensing of group homes for people with
developmental disabilities by both the County and the State. Montgomery County is
the only jurisdiction in the state that requires operators of group homes for adults with
developmental disabilities to secure both a county and a state license.
This licensing duplication was brought to the attention ofthe Commission by a
fonner commissioner who was associated with homes serving adults people with
developmental disabilities, as he reported that this duplication of effort is very time
consuming for staff as well as adds additional cost to group homes serving this
population. The recommendation to eliminate this duplication came from the
Commission to the Department of Health and Human Services a few years back.
At the Commission's January 11, 2012 meeting, a motion was made to support Bill
40-11 to exempt group homes serving people with developmental disabilities from
County licensing requirements.
It
passed unanimously.
It
is our understanding that
the fire marshal will continue to make monitoring visits as well as staff from
Resource Coordination will be making visits to the homes to have meetings with the
residents in the home.
The Commission recommends to the Council to support this bill to revise the
licensing requirements for certain group homes for adults with developmental
disabilities and to amend the law regardiIlg regulation of group residential facilities.
Elimination of duplicative mandates while preserving the safety of those living within
the facilities is a very compelling reason to for the Council to vote
in
favor of this
bill.
We thank the Council for its support over the years of providers serving people with
developmental disabilities. Thank you for the opportunity to comment on behalf of
the Commission.
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Montgomery County InterACCIDD
(Jubilee Assn) 10408 Montgomery Ave. Kensington, Md. 20895
Voice 301-949-8628, Fax 301-949-4628
Co-Chairs; Tim Wiens (twiens@Juhileemd.org)
&
Karen Lee (klee@seeconline.org)
Testimony before the Montgomery County Council
January 24,2012
In support of Bill 40-11, Group Homes - Developmentally Disabled Adults
Montgomery County Inter
ACCIDD
is in support of Bill 40-11 to eliminate County
licensure of group homes that are licensed by the Maryland Developmental Disabilities
Administration (DDA).
Uma Ahluwalia and Jay Kenney from DHHS met with Inter
ACCIDD
members a couple
of years ago in the face of County budget cuts to our agencies and asked for ideas of how
they could help to reduce our costs. Out of that meeting came the suggestion of
eliminating County licensing of group homes that are licensed by DDA.
Following are the reasons we believe County licensing should be eliminated;
1) The Maryland DDA already licenses these homes, and no other County in
Maryland also licensed these homes. In addition to the regular license
inspection the Regional Office of DDA does follow-up inspections when there are
issues of concern from licensing or when there are complaints from family or the
community.
2) Almost all DDA funded clients living in group homes have Resource Coordinators
which are employed or contracted through DHHS. These Resource Coordinators
visit all oftheir clients in their homes at least once a year. We understand that
as part ofthis change that additional questions will be added to their checklist.
3) Contract Monitors as a part of our DD Supplement Contracts visit our homes
every two years and they also have a checklist of items they are reviewing.
4) The Fire Department will continue to inspect these homes annually for fire code
violations.
5) All DDA licensed agencies are required to have an internal"Standing Committee"
which is composed of an equal number of agency employees and non agency
employees. This committee reviews all unusual incidents that are reported to
DDA, makes recommendations for corrections, and sets and monitors quality
assurance goals for the agency.
6) Although County licensing brings some value as one of many parts to the overall
quality assurance system for our services, in tight financial times, we need to ask
ourselves how much value this level of redundancy brings to these services.
Abilities Network, The Arc ofMontgomery County, CALMRA, CHI Centers, Community Support Services,
Inc., Full Citizenship, CSAAC, Head Injury Rehab and Referral, Jewish Foundationfor Group Homes, J.P.
Kennedy Institute, Jubilee Assn., MedSource, R.O.!., Compass Inc, SEEC, TransCen, The Rock Creek
Foundation, Treatment and Learning Centers and other providers and government agencies serving
individuals with developmental disabilities.
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Montgomery County InterACCIDD
(Jubilee Assn) 10408 Montgomery Ave. Kensington, Md. 20895
Voice 301-949-8628, Fax 301-949-4628
Co-Chairs; Tim Wiens (twiens@Jubileemd.org)
&
Karen Lee (klee@seeconline.org)
7) Our agencies will benefit from the lack of licensure fees and from-the time that it
takes our staff to schedule these visits and to respond to licensing issues. It will
result in savings of time and money for all of our agencies. We estimate that it
costs our agencies about
Yz
a day per year of time to process the licensing
application, write the check, schedule the inspection, be at the inspection and
respond to issues raised by the inspector. This is usually done by a first line
supervisor at an estimated cost of $85 for
Yz
day of work plus the licensing fee of
$50 per resident in the home for an average home having 3 residents. So the
average savings per licensed home for our agencies would be about $235.
Jubilee Association is a middle size agency, this would save us about $4,000 a
year.
Submitted by
Tim Wiens, Co-Chair Inter
ACCIDD
and
Executive Director
Jubilee Association of Maryland
Abilities Network, The Arc o/Montgomery County, CALMRA, CHI Centers, Community Support Services,
Inc., Full Citizenship, CSAAC, Head Injury Rehab and Re/erral, Jewish Foundation/or Group Homes, J.P.
Kennedy Institute, Jubilee Assn., lvfedSource, R.o.!., Compass Inc, SEEC, TransCen, The Rock Creek
Foundation, Treatment and Learning Centers and other providers and government agencies serving
individuals with developmental disabilities.
&
t:;;::)
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CALMRA Inc.
serving people with cognitive disabilities
NONPROFfTS
MARYLAND
Testimony before the Montgomery County Council
January 24, 2012
In support of Bill 40-11, Group Homes - Developmentally Disabled Adults
STANDARDS FOR
EXCELLe:NCE
Good Afternoon. My name is Nancy Tolbert and I am the Executive Director of CAlMRA, Inc. CAlMRA is
a non-profit organization serving people with cognitive disabilities in Montgomery and Prince George's
Counties. I am here to testify in strong favor of bill # is 40-11.
I have been a member ofthe Montgomery County InterACC / DD for many years. The issue oflicensing
has been discussed repeatedly for at least the last
15
years. The administrators of agencies like
CALMRA see the County's efforts as duplicative and costly. The costs related to this program are shared
by both, the providers and the county. In this time of extreme fiscal restraint, eliminating these fees
associated with the licensing inspections as well as the staff time devoted to these efforts would help us
considerably. I believe it would also free up the county to utilize their resources in areas that are not
already reviewed and inspected by any other entity such as restaurants, schools, and nursing homes.
Our homes already have a lot of oversight. In addition to having the State of MD review and license our
homes, our properties are visited by Montgomery County resource Coordination. Further oversight is
done by our Quality Assurance Plans that call for monitoring of our programs. These plans are
submitted and approved annually by the State. CAlMRA, like the Council members, is also sensitive to
neighbors' opinions and perspectives. CAlMRA gives all the nearby neighbors our direct phone numbers
should they have a concern with one of our properties.
Montgomery County is the ONLY county in the great State of Maryland to have such a licensing
program. All other counties work with the provider agencies and if needed, State personnel, to address
concerns. Currently Montgomery's duplication of effort is costly and unnecessary to ensure quality
service provision.
Thank you for your serious consideration of this bill and for all your work to help citizens of Montgomery
County who have developmental disabilities.
Respectfully Submitted,
Nancy Tolbert
Executive Director
CAlMRA, Inc.
5020 Sunnyside Ave #206
Beltsville, MD 20705
(301) 982-7177
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5020 Sunnyside Avenue, Suite 206, Beltsville, MD 20705-2307
Phone (301) 982-7177 • Fax: (301) 982-7805 • TOO (301) 982-7804
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Testimony before the Montgomery County Council
January 24, 2012
In support of Bill 40-11, Group Homes - Developmentally Disabled Adults
The Arc Montgomery County is in support of Bill 40-11 to eliminate County licensure of group
homes that are licensed by the Maryland Developmental Disabilities Administration (DDA).
Uma Ahlawalia and Jay Kenney from DHHS met with the Interagency Coordinating Council for
people with Developmental Disabilities a couple of years ago in the face of County budget cuts
to our agencies and asked for ideas of how they could help to reduce our costs. Out of that
meeting came the suggestion of eliminating County licensing of group homes that are licensed
by DDA.
Following are the reasons we believe County licensing should be eliminated;
1) The Maryland DDA already licenses these homes, and no other County in Maryland
duplicates these efforts. In addition to the license inspection, the Regional Office of
DDA completes follow-up inspections when there are issues of concern from licensing or
when there are complaints from family or the community.
2) Almost all DDA funded clients living in group homes have Resource Coordinators which
are employed or contracted through DHHS. These Resource Coordinators visit all of
their clients in their homes at least once a year. We understand that as part of this
change additional questions will be added to their checklist.
3) Contract Monitors as a part of our DD Supplement Contracts visit our homes every two
years (sometimes more often at their discretion) and they also have a checklist of items
they review.
4) The Fire Department wiil continue to inspect these homes annually for fire code
violations.
5) All DDA licensed agencies are required to have an internalliStanding Committee" which
is composed of an equal number of agency employees and non agency employees. This
committee
agency.
5} Although County licensing brings some value as one of many parts to the overall quality
assurance system for our services, in tight financial times, we need to ask ourselves how
much value this level of redundancy brings to these services.
reviews
all
unusual
incidents that
are
reported
to
DDA,
makes
recommendations for corrections, and sets and monitors quality assurance goals for the
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7) Our agencies will benefit from the lack of licensure fees and from the time that it takes
our staff to schedule these visits and to respond to licensing issues. It will result in
savings of time and money for a" of our agencies.
We estimate that it costs our
agencies about
Yz
a day per year of staff time to process (1) licensing application, write
the check, schedule the inspection, be at the inspection and respond to issues raised
by
the inspector. This is usually done by a first line supervisor and monitored by the next
supervisor in line at an estimated cost of $85 for
Yz
day of work plus the licensing fee of
$50 per resident in the home for an average home supporting 3 residents. The average
savings per licensed home for our agencies would be about $235. The Arc operates 43
homes x $235/home
=
$10,105. This is money that is more useful when applied toward
items that directly benefit the residents, i.e. food, supplies, transportation, community
inclusion activities, etc.
Submitted by
Joyce Taylor, Executive Director
The Arc Montgomery County
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Audit Report
Department of Health and Mental Hygiene
Regulatory Services
November 2011
OFFICE
OF
LEGISLATIVE AUDITS
DEPARTMENT OF LEGISLATIVE SERVICES
.MARYLA.ND
GENERAL
ASSE~mL
y
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DEPARTMENT OF LEGISLATIVE SERVICES
OFFICE OF LEGISLATIVE AUDITS
MARYLAND GENERAL ASSEMBLY
November 7,2011
Karl S. Aro
Executive Director
Bruce A. Myers, CPA
Legislative Auditor
Delegate Guy
1.
Guzzone, Co-Chair, Joint Audit Committee
Senator James C. Rosapepe, Co-Chair. Joint Audit Committee
Members of Joint Audit Committee
Annapolis, Maryland
Ladies and Gentlemen:
We have' audited Regulatory Services, a budgetary unit within the Department of
Health and Mental Hygiene (DHMH), for the period beginning February 1, 2008
and ending August 2, 2010. Regulatory Services (hereinafter referred to as the
Unit) consists ofthe following units:
• Health Professional Boards and Commission (comprised of 16 separate
boards and one commission)
• Board of Nursing
• Board of Physicians
• Office of Health Care Quality (OHCQ)
The entities comprising the Unit are responsible for licensing and regUlating
health professionals (such as physicians, nurses, and pharmacists) and health care
facilities in the State. As further explained on page 4 of this report, the Unit was
created based on certain organizational changes made within DHMH.
Our audit disclosed that certain boards had not established adequate control and
accountability over licenses and related cash receipts. For example, as
commented upon in our audit reports dating back to 1987, one of these boards did
not reconcile the value of licenses issued to the related cash receipts. This
condition contributed to the failure ofthe board to detect in a timely manner the
apparent fraudulent sale and distribution of certain certificates.
We also noted that certain health care facilities were not inspected by OHCQ as
required. For example, OHCQ had not performed inspections for 725 of the
1,367 (53 percent) licensed assisted living facilities during fiscal year 2010.
Finally, we identified certain security and control deficiencies pertaining to one
board's information systems.
301 West Preston Street· Room 1202 . Baltimore,
Maryland
21201
410-946-5900/301-970-5900' Fax 410-946-5999/301-970-5999
Other areas jn Maryland 877-486-9964
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DHMH's response to this audit, on behalf of the Unit, is included as an appendix
to this report. We wish to acknowledge the cooperation extended to us during the
course ofthis audit by the Unit.
Respectfully submitted,
Bruce
A.
Myers, CPA
Legislative Auditor
~O-.~
2
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Health Care Facility Inspections
Analysis
OHCQ had not inspected certain heath care facilities as required. OHCQ is
required to conduct inspections of these facilities at least annually to ensure
facility compliance with State and federal regulations regarding patient care and
safety.
7
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According to its records, which we determined to be reliable, for fiscal year 2010,
OHCQ had not performed inspections for 725 of the 1,367 (53 percent) licensed
assisted living facilities nor inspected 154 of the 20 I (76 percent) facilities for the
developmentally disabled. In addition, OHCQ had not inspected any of the 15
related resource coordination agencies (which are primarily county health
departments) responsible for developing appropriate individualized plans for
developmentally disabled individuals. DHMH inspections would include reviews
of the adequacy ofthese plans.
Similar situations were commented upon in our two preceding audit reports of
DHMH Office of the Secretary. DHMH management again indicated that an
increasing workload, combined with reductions in staff, have caused the delays in
performing required inspections and they are continuing efforts to improve
inspection processes to gain efficiencies.
Recommendation 2
We recommend that OHCQ complete inspections of the various health care
facilities, as required
by
law (repeat).
8
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Recommendation 2
We recommend that OHCQ complete inspections
of the
various health care
facilities, as required
by
law (repeat).
OHCQ Response:
OHCQ concurs with the finding and recommendation.
OHCQ's capacity to complete inspections of the various health care facilities as
required by law continues to be challenged by the ongoing surveyor shortage.
According to OHCQ's FY 2010 Staffing Analysis, the surveyor deficit in the
Assisted Living unit was seven positions; the deficit was 28 surveyor positions in
the Developmental Disabilities (DD) unit. In operational terms, the deficit means
that in order to complete the mandated surveys, OHCQ will need an additional 35
surveyors. The number of completed surveys is clearly influenced by the
surveyor staffing deficit. It's important to point out that OHCQ the number of
positions has been 194 to 183, and that the agency staffing deficit for all units is
92. These staff reductions, coupled with furloughs and administrative salary
reduction days, and the lack of administrative support positions, affects the
number of completed surveys.
In an effort to address the oversight concern, OHCQ implemented a number of
initiatives aimed at better utilizing our limited resources; they include:
• DD unit began utilizing provider self-surveys to document mandated
policy and procedure compliance and personnel training requirements,
which resulted in an average savings of two days survey time per agency
surveyed.
• DD unit allocated staff resources to develop a small division with the
primary focus on children's issues, which includes initial and re-licensure
surveys, complaint and incident investigations, and partnerships with
other State and county agencies involved in supporting the needs of
children. The creation of the children's unit should increase OHCQ's
ability to complete mandatory annual visits to each of the 24 agencies.
• DD unit recently began the practice of referring non-health and non-safety
complaints to the four (4) DDA regional offices. Administrative
investigations, rather than those performed on site, are conducted, when
appropriate. Furthermore, the DD unit incorporates incident and
complaint investigations into re-licensure visits whenever possible.
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Page 1 of2
Delgado, Annette
From:
Sent:
To:
Berliner's Office, Councilmember
Wednesday, February 01, 2012 9:44 AM
Montgomery County Council
066492
H.F
M
Subject: FW: Bill 40-11
From: susan or max [mailto:sumax@verizon.net]
Sent:
Tuesday, January
31, 2012 6:47 PM
To: Riemer, Hans; Rice, Craig; Navarro's Office, Councilmember; Berliner's Office, Councilmember; Leventhal's Office,
Councilmember; Eirich's Office, Councilmember; Floreen's Office, Councilmember; Andrews's Office, Councilmember;
Ervin's Office, Councilmember; Ike Leggett
Subject:
Bill 40-11
Dear Councilmembers:
Dear County Executive Leggett:
I have been communicating with Pat Brennan, Legislative Uason at HHS, about this bill. I also spoke
by phone with Mike Faden, of the Council Staff, about the bill. Further, I watched
&
listened to the
speakers at the public hearing on this matter. While I do not oppose the bill, all this attention leaves
me with the following unanswered quesions,
&
concerns about this proposed legislation.
* Why is this bill only applied to group homes for the developmentally disabled?
There are group homes for those with disabilities that are not considered due
to developmental causes, such as physical disabilities; Alzheimer's disease; dementia;
and the like. If the bill's aim is to avoid duplication of State oversight, why the narrow focus?
* What is the political impetus behind the current bill?
Whenever I come across a bill that does not seem to make complete sense, I become concerned that
it has some political basis, and therefore does not have to make complete sense. Do not
misunderstand, I do not oppose the legislati'on, but feel it is incomplete. Also, I emphasize that I do
not suggest that the bill should apply to half-way houses.
I listened closely to the statements by Tim Weems, of Jubilee & the group
home umbrella organization he serves. Mr. Weems mentioned that each of his organization's
homes expend
$235.
which would be saved if the bill passed. Joyce Taylor, of the Arc, used the
exact figure in discussing the ARC's possible saving. The ARC, with
43
homes in Montgomery, is
the giant of this type of organization locally. Interestingly, the ARC's online financial statement for
6/30109
shows them to be a
$24.5
million operation & that
$21.6
million of their revenue is from
government sources. Further, please note that the Arc purchased three homes in one Aspen Hill
neighborhood, paying a total of over
$1.5
million for those homes. Hardly a small operation.
Again, I do not oppose the bill, I feel it should include the additional types of group homes mentioned,
not just those for the developmentally disabled.
Another interesting item came to my attention as I researched BiIl40-11. Until the early 90's, the
County Code had a provision enabling neighborhoods to comment about group homes wishing to
locate in their community. However, the (federal) Fair Housing Act
&
a court decision in
1993
ended
the ability to use that portion of the County Code. Perhaps a proper legal mechanism can be
2/1/2012
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Page 2 of2
formulated so that a public voice can again be heard when group homes overly proliferate too closely
to one another.
Until I hear valid reasons as to why my questions are groundless, my antennae
will
continue to
tingle and twitch indicating that it's just politics, and that a special interest is being served, not the
public interest.
This text has been approved by the Board of the Strathmore Bel-Pre Civic Association.
Max Bronstein
External Affairs Chair
211/2012