Agenda Item 7C
December 12, 2017
Action
MEMORANDUM
December 8, 2017
TO:
FROM:
SUBJECT:
County Council
,
i
~
Josh
Hamlin, Legislative Atoomeyf
4
Action:
Bill 35-17, Finance -Payments to Service Providers
Health and Human Services Committee recommendation (3-0):
enact Bill 35-17 with
amendments
Bill 35-17, Finance - Payments to Service Providers, sponsored by Lead Sponsor then-Council
President Berliner and Co-Sponsors Councilmembers Leventhal, Elrich, Katz, Floreen, Rice, Rucker,
then-Council Vice-President Riemer and Councilmember Navarro, was introduced on October 31,
2017. A public hearing was held on November 28, and a Health and Human Services (HHS)
Committee worksession was held on December 4.
Bill 35-17 would:
• define terms related to the annual supplement to certain providers of services to persons
with developmental disabilities (currently provided through the budget resolution);
• require that a payment be made to eligible providers each year, to the extent that funds are
appropriated;
• require the Director of Finance, in setting the amount of the payment, to consider the State
reimbursement rates to service providers and the additional operating support needed to
allow each service provider to pay direct service workers, on average, 125 percent of the
County minimum wage;
• establish eligibility standards for a provider to receive the payment, including
demonstrating to the Department of Health and Human Services that it pays direct service
workers at a rate specified in the Council's current operating budget resolution; and
• provide for the issuance of method (2) regulations to administer the law.
At its December 4, worksession, the HHS Committee discussed the Bill and recommended
enactment (3-0) with the following amendments:
1.
Require that the payment be calculated by the Director of Health and Human
Services rather than the Director of Finance (3-0).
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2.
Clarify that the calculation of the "amount of payment" is a recommendation,
subject to appropriation, and add consideration of the total cost of providing
services as a consideration (3-0).
Background
For many years, Montgomery County has chosen to pay a supplement to certain providers
of direct services to developmentally disabled individuals ("DDA providers") in recognition that
the State's reimbursement rates do not take into account the higher cost of living in Montgomery
County. For many years, this supplement ("DD Supplement") was distributed based on the
number of clients, the severity of their disability, and services required as determined by the State.
Many years, the total amount of funding was increased by a percent or by an amount that
recognized the increase in the number of people being served (expansion adjustment). Starting in
FY13, the HHS Committee discussed in more detail how these funds were used by organizations.
While most organizations used the additional funding to increase wages, there was no requirement
or reporting on whether the funds were being used for this purpose. The HHS Committee
recommended, and the Council agreed, that starting in FY15, organizations would have to report
to DHHS on the use of funds. There was a phase-in period for the requirement that these funds be
used to ensure worker pay would be above the State minimum.
In FY16, additional funding was added so that the DD Supplement would allow DDA
providers to pay workers at least 25 percent above the minimum wage.
In
FYl 7, the Council
specified that 100 percent of the supplement was to be used to ensure that workers received, on
average, at least 125 percent of the Montgomery County minimum wage.
The FYJ 8 Operating Budget includes the following provision:
This resolution appropriates $14,729,712 to the Department of Health and Human
Services to provide a supplement to organizations providing direct services to
clients of residential, community supported living arrangements, day habilitation,
or supportive employment provided through the Developmental Disabilities
Administration.
In
order to receive this supplement, an organization must
demonstrate to the Department that 100% of the funding is being used to increase
the pay of direct service workers in recognition of the higher cost of living in
Montgomery County compared to other parts of Maryland. Each organization must
document to DHHS that the funds are being used for this purpose. Section G of
this resolution includes entities eligible to receive this non-competitive payment.
For FY18, funds are expected to allow organizations to pay direct service workers,
on average, 124% of Montgomery County minimum wage.
During the Council's recent consideration of Bills to increase the County minimum wage
- first Bill 12-16 and currently Bill 28-17 -these organizations raised concerns about the impact
of the proposed increases on their ability to retain employees. This Bill would codify the above-
described longstanding practice of providing financial assistance to DDA providers. The Bill
would require that determination of the amount of the assistance include consideration of the State
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reimbursement rates to these organizations and the additional support necessary to allow the
organizations to pay direct service workers, on average, 125 percent of the County minimum wage.
Public Hearing
Nine people testified at the November 28 public hearing. All speakers supported the Bill,
and two requested that the Bill be amended to expand the payment beyond DOA providers. Seth
Morgan, Chair of the Commission on People with Disabilities, conveyed the Commis sion's strong
support for the Bill, noting the importance of the services and the higher cost of doing business in
the County (©5). Tim Wiens, Co-Chair of Inter ACC/DD, a coalition of service providers, also
expressed support for the Bill (©6-8).
Mr.
Wiens noted that Inter ACC/D D's estimated a need for
an additional $21,564,666 in FY23 could be significantly reduced if the County is successful in
obtaining a Medicaid match and the State increases its funding based on the recently-released
results of a State Rate Study. Betty Bahadori (©9), Kathy Perlman (©10), and Whitney Ellenby
(©11-12) all spoke in support of the Bill, telling the Council of their experiences as parents of
children with Autism, and of the critical need for service providers. Each mentioned the difficulty
of caregivers' jobs and the importance of consistency in the provision of services to their children.
Afshin Abedi, on behalf of the Maryland Association of Adult Medical Day Services
(MAADS), requested that the Bill be amended to include adult medical day care (AMDC)
providers as recipients of the payment under the Bill (©13-16).
Mr.
Abedi described State and
Federal restrictions on AMDC providers passing on increased costs to consumers or reducing
services or staff, and asserted that the similar need for these services justifies the same payment as
is made to DDA providers.
Larry
Bram of Easter Seals expressed support for the Bill, and
requested a more limited amendment to the Bill, expanding the paymen t to "non-profit Medical
Adult Day Service providers for whom the majority of their participants are supported by
governmental funding" (
©
17-18).
Issues
/
Committee Recommendations
1.
Is it necessary to codify provisions related to the paymen t?
As previously mentioned, payment of the DD Supplement to DDA providers is a
longstanding practice, with the amount of the paymen t calculated each year as part of the County
budget process. The paymen t has been, and could continue to be, made without any requirement
in the County Code. The Bill does not, and could not, bind future Councils to make an
appropriation, but it does codify the historic purposes of the DD Supplement, and sets a benchmark
expectation that providers of direct services to developmentally disabled individuals pay workers,
on average, 125 percent of the County minimu m wage. With the escalation of the County minimum
wage to $15 per hour and beyond under enacted Bill 28-17, recognition of this benchmark and
provision for the payment, albeit ''to the extent that funds are appropriated," represents a higher
level of County commit ment to ensure that these providers of important services can continue to
operate. Thus, while not technically necessary to continue making the payments, the Bill is not
entirely without function.
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2.
What is the fiscal impact of the Bill?
Inter ACC/DD has supplied an estimated cost of continuing the payment using the 125
percent of County minimum wage benchmark (see
©8).
The Inter ACC/DD projections use the
approved FYI 8 approved DD Supplement to establish a baseline, and estimate additional funding
above the approved FY18 amount necessary to maintain wages at 125 percent of the County
minimum wage for fiscal years 2019 through 2023:
Fiscal Year
2019
2020
2021
2022
2023
Additional Funding Required
$2,297,115
$6,768,112
$11,464,280
$16,393,700
$21,564,666
Tim Wiens of Inter ACC/DD did note in his public hearing testimony that these projections
essentially represent a worst-case scenario, and that increases in the State reimbursement rate and
potential Federal Medicaid matching funds could significantly reduce the burden on the County.
3.
Should the Bill be amended to provide for a similar payment to adult medical day
care service providers?
During consideration of Bill 28-17, and again at the public hearing for this Bill,
representatives of AMDC providers indicated that they are in a similar situation as the service
providers that would be eligible for payment under the Bill. At the public hearing, Afshin Abedi
of MAADS requested the Bill be amended to expand the payments to all AMDC providers, and
Larry Bram of Easter Seals requested that non-profit AMDC providers be eligible for the payment.
In his written testimony submitted at the public hearing, Mr. Abedi suggested that the cost to the
County to extend the payment to AMDC providers would be relatively low compared to the cost
to make the payment to DDA providers, and he provided cost estimates FY18 - FY23 (see ©14).
The source or basis of these cost estimates is not provided.
Council staff believes that the payment
provided under the Bill
should not be expanded
without a firm understanding of the potential costs of making such a commitment. As has been
previously noted, the DD Supplement has existed for many years without a legislative mandate,
and the way the Supplement is calculated has evolved over that time. Similarly, a payment can be
made to AMDC providers without a legislative mandate.
If
the Council believes that a payment
similar to the DD Supplement is warranted for AMDC providers, it could consider the appropriate
scope
(i.e.,
all AMDC providers vs. non-profit AMDC providers) and amount of such payment in
the budget process. This would allow the Council to more fully evaluate the need and likely cost
to the County of continuing the payments.
If
through this process the Council determines that a
legislative commitment is necessary, it could then amend the law to so provide.
Council staff recommendation:
Enact the Bill with the existing provision of a payment to DDA
providers, and evaluate the appropriate scope and amount of any payment to AMDC providers
through the budget process. Council staff notes that it took more than one year to fully develop the
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criteria for the current DD Supplement and that DHHS must monitor and ensure that organizations
are properly using these County funds.
4.
Should the Bill be amended to require that the payment be calculated by the
Director ofHealth and Human Services rather than the Director ofFinance?
Executive branch staff suggested that it would be more appropriate to provide that the
Director of Health and Human Services calculate the amount of the payment, rather than the
Director of Finance as the Bill currently provides. Council staff agrees with this suggestion, since
it is the Department of Health and Human Services that is generally responsible for interaction
with the DDA providers, and is charged with verifying that payment recipients are eligible. The
Director of Finance would remain responsible for the actual making of the payment.
Committee recommendation (3-0):
Delete the definition of Director on line 13, and amend lines
19-24 of the Bill as follows:
(hl
Payment.
Each year, to the extent that funds are appropriated, the Director
of Finance must make
~
payment to each eligible service provider in
recognition of the higher cost of living in Montgomery County compared
to other parts of Maryland .
.{£2
Amount
Qf
payment.
In
calculating the payment, the Director of Health
and Human Services must consider:
5.
Should the Bill be amended to clarify that the calculation of the "amount of
payment" is a recommendation, subject to appropriation?
As drafted, the Bill requires the amount of the payment to be calculated using certain
considerations (see lines 23-28). Because the amount of the payment is ultimately subject to
appropriation under the Bill's own terms, Council staff believes that the Bill should be amended
to clearly state that this calculation is, in fact, a recommendation. In addition, Council staff believes
that the total cost of providing services should be considered
in
addition to the existing
considerations, State reimbursement rates and additional operating support needed to allow
providers to pay direct service workers, on average, 125 percent of the County minimum wage.
Requiring that this recommendation be made to the Executive and Council by February 1 of each
year should ensure that the payment receives appropriate consideration in the budget process.
Committee recommendation:
amend lines 23-31 as follows:
[Amount) Recommended amount
Qf
payment.
[[In
calculating the
payment, the)) The Director of Health and Human Services must~
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February 1 of each year, recommend to the Executive and Council the
amount of the payment, [[consider]] considering:
ill
ill
Q)
the State reimbursement rates to service providers; [[
and)l
the total cost of providing services, including wages; and
the additional operating support needed to allow each service
provider to
~
direct service workers, on average, 125[[%]]
percent of the County minimum wage.
6.
Will the provisions for payments in the Bill interfere with the County's proposal for
a Federal match for the DD Supplement?
Montgomery County is proposing the State support a Medicaid match for the DD
Supplement. If approved, Federal dollars could be used for approximately one-half of this
supplement and the County would pay the other half (it is approximate because some clients will
not be covered by the waiver). The County's funds would go to the State, which would distribute
them as part of the Medicaid payment.
There are two issues at the State regarding the approval and implementation of the
County's proposal. First, the State is in the process of creating a new rate structure that is not
expected to take effect until July 2019. Second, the State's current information system is not able
to process the County's Medicaid match billing activity. For these reasons, it is unlikely the
County's proposal will move forward before Fall 2018 at the earliest.
The County contracted with Baldacci Consulting Group (BCG) for analysis and advice on
how best to structure a Medicaid match proposal. BCG has made suggestions such as focusing on
a match for residential services or seeking a rate differential for Montgomery County with the
County contributing the difference between this rate and the rate in other regions
in
the State. BCG
has cautioned against a proposal that specifically says the County is only supplementing a wage,
as Medicaid reimbursement is considered payment in full by the Centers for Medicare and Medical
Services.
Council staff recommendation:
Because a Medicaid match will not be available for fiscal year
2019, Council staff believes the Council can enact this bill without an impact on next year's budget.
The language in the Bill does not specify the payment is a wage supplement, but it requires any
organization receiving the payment to demonstrate that it pays direct service workers at the rate
specified in the Council's budget resolution (which would specify the 125 percent of County
minimum wage or different amount). Council staff recommends removing from the Council's
budget resolution the requirement that 100 percent of the payment be used to increase pay. As the
County moves forward with a proposal for a Medicaid match, the Council may have to amend this
law (if enacted) if it is not in compliance with Medicaid regulations.
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This packet contains:
Bi1135-17
Legislative Request Report
Public Hearing Testimony
Seth Morgan
Tim Wiens
Betty Bahadori
Kathy Perlman
Whitney Ellenby
Afshin Abedi
Larry
Bram
F:\LAW\BILLS\1735 Finance-Payments To Service Providers\HHS Memo.Docx
Circle#
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35-17
Bill No.
Concerning: Finance - Payments to
Service Providers
Draft No. 5
Revised: 12/04/2017
October 31, 2017
Introduced:
May 1, 2019
Expires:
Enacted: _ _ _ _ _ _ _ _ __
Executive: _ _ _ _ _ _ _ __
Effective: _ _ _ _ _ _ _ _ __
Sunset Date: --=--:.N=on..:..::e:...___ _ _ _ __
Ch. _ _, Laws of Mont. Co. _ __
COUNTY COUNCIL
FOR MONTGOMERY COUNTY, MARYLAND
Lead Sponsor: Council President Berliner
Co-Sponsors: Councilmembers Leventhal, Elrich, Katz, Floreen, Rice, Rucker, Council Vice-
President Riemer and Councilmember Navarro
AN ACT
to:
(1) provide for an annual payment to certain providers of direct services to persons
with developmental disabilities;
(2) require the Director of [[Finance]] Health and Human Services to consider certain
factors in [[ setting]] recommending the amount of the payment;
(3) establish eligibility standards for a provider to receive the payment; and
(4) generally amend the law governing payments to service providers.
By adding
Montgomery County Code
Chapter 20, Finance
Article XVI, Payments to Service Providers
Section 20-83
Boldface
Underlining
[Single boldface brackets]
Double underlining
[[Double boldface brackets]]
* * *
Heading or defined term.
Added to existing law by original bill.
Deletedfrom existing law by original bill.
Added by amendment.
Deletedfrom existing law or the bill by amendment.
Existing law unaffected by bill.
The County Council for Montgomery County, Maryland approves the following Act:
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BILL
No. 35-17
1
2
3
4
5
6
7
8
9
10
11
Sec 1. Article XVI (Section 20-83) is added to Chapter 20 as follows:
ARTICLE XVI. Payments to Service Providers.
20-83.
Payment to
providers of direct services to persons with
developmental disabilities.
W
Definitions.
In
this Section:
ill
Developmental disability
means developmental disability as
defined in Section 7-101 of the Health : General Article of the
Maryland Code.
ill
Direct service worker
means an employee of
§:
service provider
that provides direct treatment or services to persons with
developmental disabilities for at least 50[[%]] percent of their
work hours.
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
@
ill
ffi]]
[[Director
means the Director of the Department of Finance.
Service provider
means an organization providing direct
residential,
meaningful
day
(including
employment
and
community development services) or support services to clients
through the Developmental Disabilities Administration of the
Maryland Department of Health.
Payment.
Each year, to the extent that funds are appropriated, the
Director of Finance must make
§:
payment to each eligible service
provider in recognition of the higher cost of living in Montgomery
County compared to other parts of Maryland.
(f)
[Amount] Recommended amount
gf
payment.
[[In
calculating the
payment, the]] The Director of Health and Human Services must¾
~
February 1 of each year. recommend to the Executive and Council the
amount of the payment. [[consider]] considering:
ill
ill
the State reimbursement rates to service providers;
Hand]]
the total cost of providing services. including wages; and
0
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BILL
No. 35-17
29
30
31
32
33
34
Ll)
the additional operating support needed to allow each service
provider to
~
direct service workers, on average, 125[[%]]
percent of the County minimum wage.
@
Eligibility for payment.
To receive
~
payment under this Section, a
service provider must:
ill
demonstrate to the Department of Health and Human Services
that
i!
35
36
37
38
39
40
direct service workers at
~
rate specified in the
Council's current operating budget resolution; and
ill
W
Approved:
meet any other eligibility standards set in regulation.
Regulations.
The Executive may issue regulations under Method
ill
to
implement this Section.
41
Roger Berliner, President, County Council
42
Date
Approved:
43
Isiah Leggett, County Executive
44
Date
This is a correct copy ofCouncil action.
45
Linda M. Lauer, Clerk of the Council
Date
0
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LEGISLATIVE REQUEST REPORT
Bill 35-17
Finance
-
Payments to Service Providers
DESCRIPTION:
Bill 35-17 would:
define terms related to the annual supplement to certain
providers of services to persons with developmental
disabilities;
,
• require that a payment be made to eligible providers each year
to the extent that funds are appropriated;
the
• require the Director of Finance, in setting the amount of
payment, to consider the State reimbursement rates to service
providers and the additional operating support needed to allow
each service provider to pay direct service workers, on average,
125% of the County minimum wage;
the
• establish eligibility standards for a provider to receive
payment, including demonstrating to the Department of Health
and Human Services that it pays direct service workers at a rate
specified in the Council's current operating budget resolution;
and
er
• provide for the issuance of method (2) regulations to administ
the law.
PROBLEM:
ies are
Providers of services to persons with developmental disabilit
their
concerned that proposed increases in the minimum wage will hurt
ability to attract and retain workers.
iders
Provide County commitment to funding for certain service prov
in recognition of the higher cost of living in Montgomery County.
Department of Finance
GO ALS AND
OBJECTIVES:
COORDINATION:
FISCAL IMPACT:
ECONOMIC
IMPACT:
EVALUATION:
EXPERIENCE
ELSEWHERE:
SOURCE OF
INFORMATION:
APPLICATION
WITIIlN
MUNICIPALITIES:
PENAL TIES:
To be requested.
To be requested.
NIA
Josh Hamlin, Legislative Attorney
To be researched.
None
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COJVIMISSION ON PEOPLE WITH DISABILIT IES
Testimony
Montgomery County Council
November 28, 2017
Bill 35-17, Finance-Payments to Service Providers
My name is Seth Morgan, and I currently serve as Chair of the
Commission on People with Disabilities. On behalf of the Commission,
I strongly support Bill 35-17 and commend the Council for its broad
support for this legislation. There are over 4,000 direct service
professionals who work in the County. This bill has language that
Direct Support Professionals will, be paid
125%
above the County 's
minimum wage. This will help agencies to recruit and retain direct
support workers who provide care for persons who have a
developmental disability.
Persons who receive services are mostly persons who qualify for
Medicaid funded Services. Agencies funded by Medicaid are not able to
reduce their services nor can they charge higher fees for services. The
State is not obligated to pay higher rates because of the County's new
minimum wage law. The higher cost of doing business in the County
makes this legislation critical for those most vulnerable members of our
community dependent on the support services provided to them as a
result of this initiative. This truly is a critical life-saving and life-
enhancing program and resonate_s with our recommendations to the
County Council of the last years.
Thank you for your long-standing support and attention to meeting the
needs of people with developmental disabilities and their families.
Department of Health and Human Services
401 Hungerford Drive • Rockville, Maryland 20850 • 240-777-1246 • 240-777-1288 FAX
www.montg omerycount ymd.gov/hh s
.
montgomery countymd.go v/311
.
._.,els-~~-
t
·. ·~311
.
·
, ,
301-251-485 0 TTY
·
~
®
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Montgomery County lnterACC/DD
(Jubilee Assn) 10408 Montgomery Ave. Kensington, Md. 20895
Voice 301-949-8628 x 105
Co-Chair; Tim Wiens (twiens@Jubileemd.org)
Testimony
Montgomery County Council
Novemb er 28,2017
Bill 35-17, Finance - Payments to Service Providers
My name is Tim Wiens, and I currently serve as Co-Chair oflnter ACC/DD, a
coalition of about 30 agencies serving adults who have intellectual and other
developmental disabilities in Montgomery County. We employ over 4,000 direct service
professional (DSP). We support Bill 35-17 which includes specific language that Direct
Support Professionals (DSP's) will, on average, be paid 125% above the county
minimum wage.
We share with you a goal to increase the wages of low income workers. It is an issue of
economic justice for our employees. Our employees should not be considered minimum
wage employees. Our direct service employees are earning an estimated average of
$14.26 an hour in FYI 8 based on the increase in the DD Supplement you provided for
the current fiscal year. This legislation would continue what the County has done for us
under the current County minimum wage law.
As State Medicaid funded agencies we do not have the ability to reduce our services, nor
do we have the ability to charge additional fees for our services. The State is not
compelled to provide additional funding for additional County requirements. Without
your financial support we cannot meet the obligations of the new law.
Under current conditions we estimate that our agencies will need an additional
$21,564,666 in FY23 when the minimum wage is $15 an hour for nonprofit agencies.
Inter ACC/DD agencies have worked with the County Department of Health
&
Human
Services (DHHS) to track our direct service wage numbers to come up with these
estimates. As part of this testimony I have included a chart which shows our projections.
We are also working with DHHS to obtain a Medicaid match on these dollars which
would significantly reduce to the cost to the County. Additionally, earlier this month
DDA released the results of a State Rate Study that calls for an average DSP wage of
$13.03 an hour in FY20.
If
enacted as part of the FY20 State budget this would reduce
the County obligation under this bill by about $5,000,000 a year.
We are aware of the unintended consequences of passing minimum wage laws like this,
in
other jurisdictions, without including the financial resources to fund the requirements
and it is not pretty. Carve outs or extending the implementation of the minimum wage
are of little value to us, since we must compete for employees in this wage market.
Abilities Network!EFCR, The Arc ofMontgomery County, CALMRA, CHI Centers, Community Support
Services, Inc., Compass Inc., Full Citizenship, CSAAC, Head Injury Rehab and Referral, Jewish
Foundation for Group Homes, JP. Kennedy Institute, Jubilee Assn.,
RO.I.,
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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Md
(Jubilee Assn) 10408 Montgomery Ave. Kensington,
Vo ice 301-949-8628 x 105
Co-Chair; Tim Wiens (twiens@Jubileernd.org)
D
Montgomery County lnterACC/D
20895
.
on as sponsors or co-sponsors.
We are delighted that each one of you have signed
the wag es of our Director Support
You hav e all bee n supportive of our efforts to raise
that con tinu ed support.
Professionals in the past and we are very grateful for
CALMRA, CHI Centers, Community Support
Abilities Network/EFCR, The Arc of Montgomery County,
d Injury Rehab and Referra~ Jewish
Services, Inc., Compass Inc., Full Citizenship, CSAAC, Hea
lee Assn.,
RO.I.,
SEEC, TransCen,
The
Rock
Foundation for Group Homes, JP. Kennedy Institute, Jubi
other providers and government agencies serving
Creek Foundation, Treatment and Learning Centers and
individuals with developmental disabilities.
(jJ
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DD Supplement with Five-Year Rollout
Backup for the Projected Impact of a County $15/Ho ur Minimu m Wage on the Value of the
PER FY17 WAGE SURVEY
*
4,890,058
5,030,495
5,181,410
5,336,852
5,496,958
5,661,866
5,831,722
6,006,674
6,186,874
FY15 hours
FY16 hours per ·FY17 wage survey (3% Increase from FY15)
FYl 7 projection (assumes a 3% increase)
FY18 projection (assumes a 3% increase)
FY19 projection (assumes a 3% increase)
FY20 projection (assumes a 3% increase)
FY21 projection (assumes a 3% increase)
FY22 projection (assumes a 3% increase)
FY23 projection (assumes a 3% increase)
Based on FY16 Direct Service Hours Data from the FY17 Wage Survey_
%Above
County
FY18
Difference between Supplement Needed to
Approved DD
Maintain Wages (on
County
125% of
Min Wage and ODA average) at 25% above Supplement
Allocation
Min Wage
Wage Factor
Add'I
$/hr
Funded by
FY18 Base
Supplement
Min Wage
(based on
current
allocation)
Additional Funding Needed to
maintain wages at 125% (on
average)
-
using the FY18
approved amount ($14.7M) as
the base
Year
County Min County Min
Wage*125 %
Wage
ODA Wage
Factor*
FY18
FY19
FY20
FY21
FY22
FY23
7/1/2016
7/1/2017
7/1/2018
7/1/2019
7/1/2020
7/1/2021
7/1/2022
• Assumes a 3.5% increase
10.75
11.50
12
12.75
13.50
14.25
15.00
in FY19 and a
13.44
14.38
15.00
15.94
16.88
17.81
18.75
2% in FY20 -FY23
10.94
11.50
11.90
12.14
12.38
12.63
12.88
2.50
2.88
3.10
3.80
4.49
5.18
5.87
12,940,571
15,343,45 0
17,026,82 7
21,497,824
26,193,992
31,123,412
36,294,378
13,800,221
14,729,712
14,729,712
14,729,71 2
14,729,712
14,729,71 2
14,729,712
2.66
2.76
2.68
2.60
2.53
2.45
2.38
26.5%
24.0%
21.5%
15.6%
10.4%
5.8%
1.8%
FYl 7 Approved
FY18 Approved
2,297,115
6,768,112
11,464,280
16,393,700
21,564,666
Done in collaborati on with DHHS, and edited by Tim Wiens for Inter ACC/DD.
B
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Testimony to County Council November 28, 2017
My name is Betty Bahadori. I am the mother of a 30 year old son, Cyrus, who has severe
Autism. I am speaking to you today on behalf of Autism Society Montgomery County in
a plea to support funding for nonprofit agencies who care for people with Developmental
Disabilities.
For approximately three decades Montgomery County has budgeted money that
supplements the state rates for direct caregivers of people with disabilities. Yet each year
we hear how money is tight, and we reach out to you to remind you why these funds need
to be part of the budget.
My personal story brings a historical spotlight to the subject.
When I was two, my mother was hit by a car crossing the road to get the mail. The
severe brain injury she suffered led to her institutionalization at "The State Home" in
Michigan where we lived. Every Sunday after Mass Dad took us six kids, ages infant to
eight, up the elevator to see Mom. For over 25 years, we saw her in a visiting room, but
we passed the cribs with metal bars on all sides and the top in which adults with
developmental disabilities lay in white cloth diapers. And that was how it was.
In the 80s, we resisted the movement to place her in the community after almost 2
decades at the State Home. We were assured that the funding, the money, would follow.
And she thrived in the group home and day placement. She took less medication. She
started to feed herself and walk. She went to Walmart! She did this only because of the
dedicated staff.
Now our son needs 24 hour care by quality, highly trained, dedicated staff. In order to
attract and retain direct caregivers, agencies caring for these most vulnerable people must
pay them more than minimum wage regardless of what that number is.
Direct caregivers wear many hats as direct support, advocate, educator, nurse and friend.
With a possible crisis around the comer at any time, they must be highly trained and able
to make independent decisions that have huge implications for the health and safety of
the individual being supported. With consistent staff, my son, Cyrus, can lead a busy,
healthy and happy life. With inconsistent staffing, we see increased distress, significant
weight gain, escalated self injury, destruction of property, and limitations to his ability to
function in his home and the community.
It
is so, so heart breaking.
Please continue the county's historical financial support of people with developmental
disabilities.
Thank you.
Betty Bahadori, Board Member of Autism Society Montgomery County
301-802-8343
11820 Pittson Road
Silver Spring, MD 20906
(j)
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Testimony County Council 11/28/17
Bill35-17
Kathy Perlman
My son, Jeremy Perlman, is a 27 year old young man who has DD, blindness and
autism. He has been in the residential program at Community Support Services
(CSS) since 2009. He also participates in vocational and recreational programs at
css.
Jeremy has trouble processing transitions, managing emotions and anticipating and
coping with changes. Consistency in care is of vital importance to helping people like
Jeremy enjoy the same home and community-based activities as the rest of us.
Without that consistency Jeremy's life becomes one anxious moment after another.
When the anxiety becomes too severe, withdrawal, refusal of favored activities and
self-injurious behavior can often be the result. Once that spiral of negative
consequence begins it is extremely difficult to get him back on track.
Jeremy has been fortunate to have some long-term caregivers, several of whom have
been with him since his placement at CSS. He has also, unfortunately, gone through
periods ofrapid turnover of teachers and caregivers. The effect on Jeremy's
behavior when he is with people who are familiar with him is striking. People who
know Jeremy and have seen him function over time are much better able to help him
participate in so many of the small pleasures of life that we all take for granted such
as visits to pools, parks, and bowling alleys.
It is very difficult for agencies to recruit and retain people for employment as
personal caregivers. The job is challenging and demands patience and empathy. It is
also a role that requires the ability to connect with people who present behaviors
that can be difficult to manage safely. These employees are well deserving of a
higher wage but it would be difficult for hiring agencies to provide the mandated
increase in the minimum wage without help from the county. A decrease in wages
would no doubt lead to even greater turnover. Greater turnover leads to greater
turmoil in the lives of Jeremy and people like him and to a significant loss of quality
of life.
I hope that I can count on you to continue the salary supplement for personal care
employees for the DD population in Montgomery County.
Jeremy at his gardening job with the help of
personal care staff.
®
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Testimony in Support of Bill 35-17 - to codify the 125% supplement to providers
Whitney Ellenby, Esq
&
Founder, Autism Ambassadors
Thank you for introducing this bill to recognize that just as the minimum wage must rise
to ensure that workers in our County can afford to live here, so must the living wage rise to
acknowledge the extraordinary work of those who provide direct support for adults with
developmental disabilities who cannot survive without them. I come to this issue from a
threefold perspective - as the mother of a magnificent 16-year-old with Autism, Zack; a fonnerly
practicing attorney; and as someone who runs recreational events for over 700 families impacted
by Autism, and for service providers in Montgomery County.
As a parent, I know that Zack is so significantly impacted by Autism that he will never
live an entirely independent life. His very life and safety will depend entirely on the workers at
issue here. As someone who deals with hundreds of parents through my Autism Ambassadors
events, the refrain is as haunting as it is common, "I cannot get sick. I cannot die. My child
cannot survive without me." That's how terrifying it is to imagine our disabled children
surviving in a world without us to protect them And the frightening part is that it's true, our
developmentally disabled children cannot survive without a surrogate to watch over them. The
painful truth is that at Age 21, our kids age out of the school system, the entitlements end, and
then they live largely on whatever government support is available. Or risk "falling off the cliff'
- meaning no school program, no college, no work, no consistent care.
Quite literally, the only
thing that stands between a safe and productive life versus genuine danger for our kids are
service providers and their ability to pay a competitive wage to their employees.
This is not a minimum wage job.
It
is a job that requires specific training and fierce
dedication.
It's also all-consuming -- when a client collapses into a seizure, the aide holds them
tightly, rides with the ambulance and remains at the hospital. I've seen aides slumped over and
exhausted because when a client is up sick all night, like a dedicated nurse or surrogate parent,
they are also up all night. Direct service providers are how our kids get to work, to recreation, to
doctors. And if we do not pay them what they are worth we risk losing them to jobs that are far
easier to do for the identical pay. And we don't have to wonder what will happen
if
they leave,
the news headlines make it clear - our children will elope into the distance, sprint into traffic,
they might fall out of windows. They might die.
Please remember that direct service providers don't do this because it pays well, it
doesn't pay nearly enough. I know because been on both sides. I was an attorney who made a
high hourly fee, until I was a mother of an autistic child who was paid nothing to spend hours on
my hands and knees scraping feces off walls. And now I know that nothing I ever did as a
highly-paid attorney could compare
with
what service providers so do every single day for a
fraction of what I was paid. And there's nothing just about it. If we're all being honest, ifwe
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faced with the challenges they face, most of us would gladly pay that 125% above the minimum
wage
NOT
to have to do their jobs. It's that hard.
I applaud the recent decision of the Council to be on the side of workers, I believe that
was con-ect.
But if we are really on the side of the workers, we must acknowledge those
extraordinary workers who do the job no one else is qualified to do, and that most of us
cannot handle. When we raise their wage above the minimum it is not charity; it is an
acknowledgment of what they deserve to be paid.
As a County, it's incredibly important that
we let these workers know how much we value them and their daily hard work. And as a parent,
whose son's life will soon depend upon them, I know we can't afford NOT to pay them what
they are worth.
Thank you for introducing this very worthy bill. Montgomery County is uniquely known
for being fully inclusive, and since my son's life depends upon that principle, thank you for
looking out for our most vulnerable citizens. Thank you for raising the issues contained in this
bill, I hope you will all support it.
2
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11/28/17
Honorable Council members,
On behalf of the Maryland Association of Adult Medical Day Services (MAADS), whose
members provide Medical Day Care Services throughout the State and in particular in
Montgomery County, we would like to provide the Council with additional information and
feedback regarding Bill 35-17, Finance - Payments to Service Providers.
It is our request that
potential modifications be made to the language to include Medical Day Providers in the
scope of this bill.
As you are all aware, we have consistently raised our concern about the County's increase in
the
minimum wage rate
over and above the State's minimum wage for two main reasons:
1. Medicaid rules strictly prohibit Adult Medical Day Care Providers (AMDC), like Loving Care,
from passing the associated increase in labor costs to their consumers. This is a sharp
contrast from other businesses that simply can pass the additional costs onto consumers.
2. State licensing regulations prohibit AMDC Providers from reducing staff or limiting services
due to staffing ratio requirements and other requirements. Again, this is in sharp contrast to
other businesses that have the ability to adjust their product lines.
Now that the council has passed legislation to further increase the minimum wage to reach $15
by 2023, AMDC Providers, which are the State's and County's partners in providing much
needed care and support to our disabled and senior populations are in serious need of a
guaranteed supplement to cover these increased costs. For Medical Day Cares, if we were to
simply count on Medicaid alone to increase its reimbursement rate to cover the costs for the
new Montgomery County minimum wage, the amount of funding gap needed to pay for the
increased minimum wage costs by 2023 (which is just 6 years from now) is expected to take
Medicaid more than 20 years to come by (based on Medicaid's previous historical
reimbursement data from the past two decades).
This is cause for serious concern,
and
demonstrates the need for the County to provide assistance to AMDCs to ensure their viability
through this rapid cost increase transition period.
Recognizing the cost associated with legislation like Bill 35-17, we applaud the council's
proactive initiative to set in stone its unwavering support for entities providing services to the
developmentally disabled. The big question that arises here is
Why is the council not
extending the same benefit to AMDCs who also provide care to the county's frail and
vulnerable populations and are subject to similar Medicaid funding shortage and
challenges?
We see absolutely no valid justification for excluding Medical Day Cares from the language of
this bill. These programs are basically branches of the same tree, or arms to the same
body. COMAR defines AMDCs as providing services to
Adults with Medical Disability
and
DDAs as providing services to
individuals with Developmental Disability.
Furthermore,
because developmental disability is a form of medical disability, many people living with
developmental disabilities use and depend on AMDC services for their daily life. All applicable
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Medicaid Waiver programs enable an individual with developmental disability to use services by
an AMDC for their needs.
Therefore we respectfully request that Bill 35-17 be amended to include Adult Medical
Day Care Providers
in the County, such that our labor costs are kept steady as the minimum
wage is phased in.
It does not cost much to cover the AMDCs
Cumulative Budget
Year-by-Year
Shortage
Difference
Min. Wage
FYR
shortage as compared to the DOA
budgetary
. ·····----------------·-··· ·- ..···-------------
programs. The amount projected for the next
11.so
s
2011
few years is shown in this table. This
2018
651,012.46
651,012.46
s
u.oo
$
s
represents as little as 4.2% increase over the
75
$
2019
1,G21,s31.1s
976,s1s.69
$
12..
s
current ODA program funding for the 2018
976,SlB, 69
$
2020
2,604,049.84
mo
S
s
year, yet it ensures viability of the AMDC
14-25
s
2021
3,sso,s,s.s3
976,s1s.69
s
s
programs.
Clearly such a small investment
325,506.23
s
1450
s
2022
3,906,074.76
s
is more than justified considering the
4 ,ss1,0S1.23
651,0 12.46
$
2023
15-00
$
importance of having such services for the
disabled and the elderly whose population is expected to increase significantly over the
next two decades.
It is essential that the County Council deliberate on the policy implications of excluding AMDCs
from the bill.
Exclusion of the AMDCs from the bill signals to the community that our
county does not support those who provide services to the elderly and adults with
medical disability.
Further, not addressing this problem makes it harder and harder for
existing AMDCs to continue providing much-needed services in the County.
Projecting this
into the future will render our county with deficiency in services for elderly and those
with medical disability.
To better demonstrate how AMDCs are such an Integral and inseparable Part of the services
used by DOA and other Adults with Disabilities we are providing a number of cases below. To
maintain the privacy and dignity of individuals their names are not included in the report. Each
case presented represents an individual who is utilizing and depends on AMDC services at the
time of this report.
Note: In the below case studies the participant's identity is not revealed for privacy and security
reasons. They are all active participants in AMDC program in Montgomery County as of the
time of this document.
Case 1:
J.R.
is a 35 yrs old Spanish speaking young man who loves to listen to
music and educational Read Aloud books, and he attends his church
and his adult medical day care religiously. He has Contracture of left
hand, Intellectual Disability/ID, a history of retinoblastoma of the right
eye, and is Legally blind. Although he is blind in his eyes,
J.R.
can see
so much more than most of us. He is an example of an individual who
is in the DOA program and has chosen to attend AMDC every day.
His AMDC program is a place where he feels completely safe and no
longer has to worry about getting hurt by others who don't have full control of their actions or
mean him harm. Since he joined his AMDC, he no longer wets himself, he does not throw up,
and no longer suffers from severe nervousness due to years of anxiety over not knowing who
may attempt to hurt him while in a room or in the bathroom.
J.R.
is safe and happy and brings
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joy to everyone around him. His AMDC program has provided him with not just Life, but a better
Quality of Life.
Case 2:
R.Y. is a 47 year old former auto parts salesperson. Just a short
while ago he used to work and provide for his family of four children
(ranging from teenage on down) and his wife. R.Y. is a victim of
Stroke. One day due to high blood pressure he had a stroke and
then everything in his life changed completely. He is a fighter, and
even though he is against severe odds he is working his way toward
getting better each day. It's not easy for him to stay in his DOA group
home with two other people all day long. So, R.Y. attends AMDC
program to become immersed in the larger community, overcome his severe depression, and
gain the energy and will to fight and get back on his feet again. R.Y. is one of many individuals
for whom the option to attend an AMDC makes the difference between hope and defeat.
Case 3:
P.S. is 52 years young. She loves to dance and listen to music and
bring joy to her friends and loved ones. P.S. has developmental
disability as well as other medical conditions that require a Nursing
Level of Care. She attends AMDC not only because her medical
needs are taken care of but also because she can have a rewarding
experience awaiting her each and every day. She loves to work on
Puzzles, and other cognitive activities of her choosing. The flexibility
of the AMDC program and the loving environment that welcomes
P.S. each and every day is beyond measure to her family. The
AMDC program provides for P.S. a perfect combination of services that she needs, enjoys, and
depends on.
Case 4:
J.C. is as wonderful a person as you could possibly know and meet.
At 72 yrs of age, this honorable veteran has a partial left hand
amputation related to bomb injury during the Vietnam War. Despite
having global aphasia and multiple strokes due to his unstable
hypertension, resulting in weakness of his right side of the body, J.C.
attends his AMDC program every day on the dot. He brings smile to
all his friends and in turn benefits from the blessing of life and love
that spans the atmosphere and provides him with the best defense
against depression, fatigue, and giving up. He is not only a great fighter, but through his AMDC
extended family he also has more to fight for.
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Case 5:
M.T. is a 91 yr young retired teacher with memory loss, diabetes, and
unstable hypertension. She lives with her daughter but due to her
medical and cognitive conditions she cannot be left alone. Her family
desperately sought a solution where M.
T.
could be cared for while
her daughter worked. Before joining the AMDC program, M.T. was
bored, tired, and depressed. After they signed up with her AMDC
something amazing happened in their lives. M.T. now gets up at
4AM every day, puts on her nice dresses, and says
"I'm going to work"!
M.T.'s AMDC has
given her a renewed energy for life, and to her daughter the option not to choose between
family and work.
Case 6:
H.I. is a 99.5 yr old male with impaired memory, stroke,
hypertension, blindness in the right eye, depression, and convulsion.
He lives with his daughter and has unsteady gate. He cannot be left
alone. His condition requires one-on-one assistance with meals,
toileting, and other activities of daily living. The AMDC has been a
blessing in his life as well as his family members, enabling them to
attend to their work during the day while Dad is being cared for at
the Center.
There are thousands of cases such as these where AMDCs provide much needed care and
services to the most vulnerable populations of our great County each and every day.
On behalf of more than 2,000 Montgomery County participants, the 17 providers of AMDC
services and more than 500 employees and their families, we respectfully ask the County
Council to amend the Bill 35-17 to include a guaranteed supplement for Adult Medical Day Care
Providers to ensure their viability as the County minimum wage continues to increase.
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,
.l
'
--···------,
-
- •
I
•;
;.
f
f
s
j
.
J
·.,....._,,-~j
Serving
DCIMDIVA
Testimony
Montgomery County Council
November 28, 2017
Bill 35-17, Finance-Payments to Service Providers
My
name is Larry Bram and I am the Senior Vice President for Innovation at Easter Seals.
We are here to support the bill and to advocate for an amendment to include direct service
staff from
"non-profit Medical Adult Day Service providers for whom the majority of their
participants are supported by governmental.funding"
(including Medicaid, OHS, and the VA).
Medical Adult Day Centers are licensed at the levels of nursing homes, yet keep people out
of nursing homes at a fraction of the cost. Those of us serving the highest acuity individuals
and most in-need communities are already doing it at a loss. We have a $15 gap for every
client, every day-and it is difficult for us to fill that gap. The rising minimum wage is going
to make it even more difficult, but as a non-profit, we are committed to providing access to
those most in need. In many cases our audience is similar to those supported by the DDA
providers, just with a different funding source. At Easter Seals, approximately 1/3 of our
daily census is individuals with intellectual disabilities, many of them coming to us from the
group homes supported by the supplement. The rest of our participants are senior citizens
living with strokes, dementia, and other age-related disabilities. We toilet and feed almost
30 people each day, and serve nearly 70.
I trust that you all agree that these amazing hard working individuals are worthy of pay
well beyond minimum wage. Without this supplement, we are not only competing for
talent with McDonald's but also with the DDA providers.
A
basic principle-equal pay for
equal work. And the work of our direct service staff is most certainly at least equivalent to
those of DDA providers.
I'm sure you are concerned about the cost of adding to the supplement. Unfortunately, ADS
providers don't have the same type of coalition as lnterACC/DD, so I have attempted to
provide some information for estimating the cost.
There are 1,000 ADS waiver slots available in the state, so Montgomery County has
approximately 250 of those
There are 19 ADS programs in the County, but a number of them are private pay
supported
Easter Seals might be the largest Medicaid-based provider in the County
(particularly since we absorbed most of the clients from the Support Center last
year).
We provided your staff with an analysis of the effect on Easters Seals. The cost to the
organization will be about $50,000 per year at the current minimum wage. That gets
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n of raises
everyone up to that 125% level. It does not include the costs to the organizatio
nal
for those at slightly higher wages or deal with equity across our multi-jurisdictio
organization.
ng the low-
Many of the ADS providers in the County would not meet the definition of servi
County to
income/Medicaid population, so I'm prett y confident that the annual cost to the
half of that.
add this provision would be well below $1 million per year. Probably less than
ated, so
But the effect would be profo und on an organization like ours that is highly regul
allow us to
we can't incre ase productivity and don't have the ability to raise prices. It will
life to the
keep great employees, lowe r turnover, and provide a bette r quality of care and
unity, and
many adults and seniors with disabilities that we serve throu ghou t the comm
impo rtant respi te and peace of mind to their family caregivers.
Than k you.
Larry Bram
Senior Vice President, Innovation
&
Program Development
Easte r Seals Serving DCIMDIVA
lbram@eseal.org
301- 920- 9711
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Agenda Item 7C
December 12, 2017
Action
MEMORANDUM
December 8, 2017
TO:
FROM:
SUBJECT:
County Council
,
i
~
Josh
Hamlin, Legislative Atoomeyf
4
Action:
Bill 35-17, Finance -Payments to Service Providers
Health and Human Services Committee recommendation (3-0):
enact Bill 35-17 with
amendments
Bill 35-17, Finance - Payments to Service Providers, sponsored by Lead Sponsor then-Council
President Berliner and Co-Sponsors Councilmembers Leventhal, Elrich, Katz, Floreen, Rice, Rucker,
then-Council Vice-President Riemer and Councilmember Navarro, was introduced on October 31,
2017. A public hearing was held on November 28, and a Health and Human Services (HHS)
Committee worksession was held on December 4.
Bill 35-17 would:
• define terms related to the annual supplement to certain providers of services to persons
with developmental disabilities (currently provided through the budget resolution);
• require that a payment be made to eligible providers each year, to the extent that funds are
appropriated;
• require the Director of Finance, in setting the amount of the payment, to consider the State
reimbursement rates to service providers and the additional operating support needed to
allow each service provider to pay direct service workers, on average, 125 percent of the
County minimum wage;
• establish eligibility standards for a provider to receive the payment, including
demonstrating to the Department of Health and Human Services that it pays direct service
workers at a rate specified in the Council's current operating budget resolution; and
• provide for the issuance of method (2) regulations to administer the law.
At its December 4, worksession, the HHS Committee discussed the Bill and recommended
enactment (3-0) with the following amendments:
1.
Require that the payment be calculated by the Director of Health and Human
Services rather than the Director of Finance (3-0).
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2.
Clarify that the calculation of the "amount of payment" is a recommendation,
subject to appropriation, and add consideration of the total cost of providing
services as a consideration (3-0).
Background
For many years, Montgomery County has chosen to pay a supplement to certain providers
of direct services to developmentally disabled individuals ("DDA providers") in recognition that
the State's reimbursement rates do not take into account the higher cost of living in Montgomery
County. For many years, this supplement ("DD Supplement") was distributed based on the
number of clients, the severity of their disability, and services required as determined by the State.
Many years, the total amount of funding was increased by a percent or by an amount that
recognized the increase in the number of people being served (expansion adjustment). Starting in
FY13, the HHS Committee discussed in more detail how these funds were used by organizations.
While most organizations used the additional funding to increase wages, there was no requirement
or reporting on whether the funds were being used for this purpose. The HHS Committee
recommended, and the Council agreed, that starting in FY15, organizations would have to report
to DHHS on the use of funds. There was a phase-in period for the requirement that these funds be
used to ensure worker pay would be above the State minimum.
In FY16, additional funding was added so that the DD Supplement would allow DDA
providers to pay workers at least 25 percent above the minimum wage.
In
FYl 7, the Council
specified that 100 percent of the supplement was to be used to ensure that workers received, on
average, at least 125 percent of the Montgomery County minimum wage.
The FYJ 8 Operating Budget includes the following provision:
This resolution appropriates $14,729,712 to the Department of Health and Human
Services to provide a supplement to organizations providing direct services to
clients of residential, community supported living arrangements, day habilitation,
or supportive employment provided through the Developmental Disabilities
Administration.
In
order to receive this supplement, an organization must
demonstrate to the Department that 100% of the funding is being used to increase
the pay of direct service workers in recognition of the higher cost of living in
Montgomery County compared to other parts of Maryland. Each organization must
document to DHHS that the funds are being used for this purpose. Section G of
this resolution includes entities eligible to receive this non-competitive payment.
For FY18, funds are expected to allow organizations to pay direct service workers,
on average, 124% of Montgomery County minimum wage.
During the Council's recent consideration of Bills to increase the County minimum wage
- first Bill 12-16 and currently Bill 28-17 -these organizations raised concerns about the impact
of the proposed increases on their ability to retain employees. This Bill would codify the above-
described longstanding practice of providing financial assistance to DDA providers. The Bill
would require that determination of the amount of the assistance include consideration of the State
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reimbursement rates to these organizations and the additional support necessary to allow the
organizations to pay direct service workers, on average, 125 percent of the County minimum wage.
Public Hearing
Nine people testified at the November 28 public hearing. All speakers supported the Bill,
and two requested that the Bill be amended to expand the payment beyond DOA providers. Seth
Morgan, Chair of the Commission on People with Disabilities, conveyed the Commis sion's strong
support for the Bill, noting the importance of the services and the higher cost of doing business in
the County (©5). Tim Wiens, Co-Chair of Inter ACC/DD, a coalition of service providers, also
expressed support for the Bill (©6-8).
Mr.
Wiens noted that Inter ACC/D D's estimated a need for
an additional $21,564,666 in FY23 could be significantly reduced if the County is successful in
obtaining a Medicaid match and the State increases its funding based on the recently-released
results of a State Rate Study. Betty Bahadori (©9), Kathy Perlman (©10), and Whitney Ellenby
(©11-12) all spoke in support of the Bill, telling the Council of their experiences as parents of
children with Autism, and of the critical need for service providers. Each mentioned the difficulty
of caregivers' jobs and the importance of consistency in the provision of services to their children.
Afshin Abedi, on behalf of the Maryland Association of Adult Medical Day Services
(MAADS), requested that the Bill be amended to include adult medical day care (AMDC)
providers as recipients of the payment under the Bill (©13-16).
Mr.
Abedi described State and
Federal restrictions on AMDC providers passing on increased costs to consumers or reducing
services or staff, and asserted that the similar need for these services justifies the same payment as
is made to DDA providers.
Larry
Bram of Easter Seals expressed support for the Bill, and
requested a more limited amendment to the Bill, expanding the paymen t to "non-profit Medical
Adult Day Service providers for whom the majority of their participants are supported by
governmental funding" (
©
17-18).
Issues
/
Committee Recommendations
1.
Is it necessary to codify provisions related to the paymen t?
As previously mentioned, payment of the DD Supplement to DDA providers is a
longstanding practice, with the amount of the paymen t calculated each year as part of the County
budget process. The paymen t has been, and could continue to be, made without any requirement
in the County Code. The Bill does not, and could not, bind future Councils to make an
appropriation, but it does codify the historic purposes of the DD Supplement, and sets a benchmark
expectation that providers of direct services to developmentally disabled individuals pay workers,
on average, 125 percent of the County minimu m wage. With the escalation of the County minimum
wage to $15 per hour and beyond under enacted Bill 28-17, recognition of this benchmark and
provision for the payment, albeit ''to the extent that funds are appropriated," represents a higher
level of County commit ment to ensure that these providers of important services can continue to
operate. Thus, while not technically necessary to continue making the payments, the Bill is not
entirely without function.
3
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2.
What is the fiscal impact of the Bill?
Inter ACC/DD has supplied an estimated cost of continuing the payment using the 125
percent of County minimum wage benchmark (see
©8).
The Inter ACC/DD projections use the
approved FYI 8 approved DD Supplement to establish a baseline, and estimate additional funding
above the approved FY18 amount necessary to maintain wages at 125 percent of the County
minimum wage for fiscal years 2019 through 2023:
Fiscal Year
2019
2020
2021
2022
2023
Additional Funding Required
$2,297,115
$6,768,112
$11,464,280
$16,393,700
$21,564,666
Tim Wiens of Inter ACC/DD did note in his public hearing testimony that these projections
essentially represent a worst-case scenario, and that increases in the State reimbursement rate and
potential Federal Medicaid matching funds could significantly reduce the burden on the County.
3.
Should the Bill be amended to provide for a similar payment to adult medical day
care service providers?
During consideration of Bill 28-17, and again at the public hearing for this Bill,
representatives of AMDC providers indicated that they are in a similar situation as the service
providers that would be eligible for payment under the Bill. At the public hearing, Afshin Abedi
of MAADS requested the Bill be amended to expand the payments to all AMDC providers, and
Larry Bram of Easter Seals requested that non-profit AMDC providers be eligible for the payment.
In his written testimony submitted at the public hearing, Mr. Abedi suggested that the cost to the
County to extend the payment to AMDC providers would be relatively low compared to the cost
to make the payment to DDA providers, and he provided cost estimates FY18 - FY23 (see ©14).
The source or basis of these cost estimates is not provided.
Council staff believes that the payment
provided under the Bill
should not be expanded
without a firm understanding of the potential costs of making such a commitment. As has been
previously noted, the DD Supplement has existed for many years without a legislative mandate,
and the way the Supplement is calculated has evolved over that time. Similarly, a payment can be
made to AMDC providers without a legislative mandate.
If
the Council believes that a payment
similar to the DD Supplement is warranted for AMDC providers, it could consider the appropriate
scope
(i.e.,
all AMDC providers vs. non-profit AMDC providers) and amount of such payment in
the budget process. This would allow the Council to more fully evaluate the need and likely cost
to the County of continuing the payments.
If
through this process the Council determines that a
legislative commitment is necessary, it could then amend the law to so provide.
Council staff recommendation:
Enact the Bill with the existing provision of a payment to DDA
providers, and evaluate the appropriate scope and amount of any payment to AMDC providers
through the budget process. Council staff notes that it took more than one year to fully develop the
4
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criteria for the current DD Supplement and that DHHS must monitor and ensure that organizations
are properly using these County funds.
4.
Should the Bill be amended to require that the payment be calculated by the
Director ofHealth and Human Services rather than the Director ofFinance?
Executive branch staff suggested that it would be more appropriate to provide that the
Director of Health and Human Services calculate the amount of the payment, rather than the
Director of Finance as the Bill currently provides. Council staff agrees with this suggestion, since
it is the Department of Health and Human Services that is generally responsible for interaction
with the DDA providers, and is charged with verifying that payment recipients are eligible. The
Director of Finance would remain responsible for the actual making of the payment.
Committee recommendation (3-0):
Delete the definition of Director on line 13, and amend lines
19-24 of the Bill as follows:
(hl
Payment.
Each year, to the extent that funds are appropriated, the Director
of Finance must make
~
payment to each eligible service provider in
recognition of the higher cost of living in Montgomery County compared
to other parts of Maryland .
.{£2
Amount
Qf
payment.
In
calculating the payment, the Director of Health
and Human Services must consider:
5.
Should the Bill be amended to clarify that the calculation of the "amount of
payment" is a recommendation, subject to appropriation?
As drafted, the Bill requires the amount of the payment to be calculated using certain
considerations (see lines 23-28). Because the amount of the payment is ultimately subject to
appropriation under the Bill's own terms, Council staff believes that the Bill should be amended
to clearly state that this calculation is, in fact, a recommendation. In addition, Council staff believes
that the total cost of providing services should be considered
in
addition to the existing
considerations, State reimbursement rates and additional operating support needed to allow
providers to pay direct service workers, on average, 125 percent of the County minimum wage.
Requiring that this recommendation be made to the Executive and Council by February 1 of each
year should ensure that the payment receives appropriate consideration in the budget process.
Committee recommendation:
amend lines 23-31 as follows:
[Amount) Recommended amount
Qf
payment.
[[In
calculating the
payment, the)) The Director of Health and Human Services must~
5
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February 1 of each year, recommend to the Executive and Council the
amount of the payment, [[consider]] considering:
ill
ill
Q)
the State reimbursement rates to service providers; [[
and)l
the total cost of providing services, including wages; and
the additional operating support needed to allow each service
provider to
~
direct service workers, on average, 125[[%]]
percent of the County minimum wage.
6.
Will the provisions for payments in the Bill interfere with the County's proposal for
a Federal match for the DD Supplement?
Montgomery County is proposing the State support a Medicaid match for the DD
Supplement. If approved, Federal dollars could be used for approximately one-half of this
supplement and the County would pay the other half (it is approximate because some clients will
not be covered by the waiver). The County's funds would go to the State, which would distribute
them as part of the Medicaid payment.
There are two issues at the State regarding the approval and implementation of the
County's proposal. First, the State is in the process of creating a new rate structure that is not
expected to take effect until July 2019. Second, the State's current information system is not able
to process the County's Medicaid match billing activity. For these reasons, it is unlikely the
County's proposal will move forward before Fall 2018 at the earliest.
The County contracted with Baldacci Consulting Group (BCG) for analysis and advice on
how best to structure a Medicaid match proposal. BCG has made suggestions such as focusing on
a match for residential services or seeking a rate differential for Montgomery County with the
County contributing the difference between this rate and the rate in other regions
in
the State. BCG
has cautioned against a proposal that specifically says the County is only supplementing a wage,
as Medicaid reimbursement is considered payment in full by the Centers for Medicare and Medical
Services.
Council staff recommendation:
Because a Medicaid match will not be available for fiscal year
2019, Council staff believes the Council can enact this bill without an impact on next year's budget.
The language in the Bill does not specify the payment is a wage supplement, but it requires any
organization receiving the payment to demonstrate that it pays direct service workers at the rate
specified in the Council's budget resolution (which would specify the 125 percent of County
minimum wage or different amount). Council staff recommends removing from the Council's
budget resolution the requirement that 100 percent of the payment be used to increase pay. As the
County moves forward with a proposal for a Medicaid match, the Council may have to amend this
law (if enacted) if it is not in compliance with Medicaid regulations.
6
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This packet contains:
Bi1135-17
Legislative Request Report
Public Hearing Testimony
Seth Morgan
Tim Wiens
Betty Bahadori
Kathy Perlman
Whitney Ellenby
Afshin Abedi
Larry
Bram
F:\LAW\BILLS\1735 Finance-Payments To Service Providers\HHS Memo.Docx
Circle#
1
4
5
6
9
10
11
13
17
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35-17
Bill No.
Concerning: Finance - Payments to
Service Providers
Draft No. 5
Revised: 12/04/2017
October 31, 2017
Introduced:
May 1, 2019
Expires:
Enacted: _ _ _ _ _ _ _ _ __
Executive: _ _ _ _ _ _ _ __
Effective: _ _ _ _ _ _ _ _ __
Sunset Date: --=--:.N=on..:..::e:...___ _ _ _ __
Ch. _ _, Laws of Mont. Co. _ __
COUNTY COUNCIL
FOR MONTGOMERY COUNTY, MARYLAND
Lead Sponsor: Council President Berliner
Co-Sponsors: Councilmembers Leventhal, Elrich, Katz, Floreen, Rice, Rucker, Council Vice-
President Riemer and Councilmember Navarro
AN ACT
to:
(1) provide for an annual payment to certain providers of direct services to persons
with developmental disabilities;
(2) require the Director of [[Finance]] Health and Human Services to consider certain
factors in [[ setting]] recommending the amount of the payment;
(3) establish eligibility standards for a provider to receive the payment; and
(4) generally amend the law governing payments to service providers.
By adding
Montgomery County Code
Chapter 20, Finance
Article XVI, Payments to Service Providers
Section 20-83
Boldface
Underlining
[Single boldface brackets]
Double underlining
[[Double boldface brackets]]
* * *
Heading or defined term.
Added to existing law by original bill.
Deletedfrom existing law by original bill.
Added by amendment.
Deletedfrom existing law or the bill by amendment.
Existing law unaffected by bill.
The County Council for Montgomery County, Maryland approves the following Act:
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BILL
No. 35-17
1
2
3
4
5
6
7
8
9
10
11
Sec 1. Article XVI (Section 20-83) is added to Chapter 20 as follows:
ARTICLE XVI. Payments to Service Providers.
20-83.
Payment to
providers of direct services to persons with
developmental disabilities.
W
Definitions.
In
this Section:
ill
Developmental disability
means developmental disability as
defined in Section 7-101 of the Health : General Article of the
Maryland Code.
ill
Direct service worker
means an employee of
§:
service provider
that provides direct treatment or services to persons with
developmental disabilities for at least 50[[%]] percent of their
work hours.
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
@
ill
ffi]]
[[Director
means the Director of the Department of Finance.
Service provider
means an organization providing direct
residential,
meaningful
day
(including
employment
and
community development services) or support services to clients
through the Developmental Disabilities Administration of the
Maryland Department of Health.
Payment.
Each year, to the extent that funds are appropriated, the
Director of Finance must make
§:
payment to each eligible service
provider in recognition of the higher cost of living in Montgomery
County compared to other parts of Maryland.
(f)
[Amount] Recommended amount
gf
payment.
[[In
calculating the
payment, the]] The Director of Health and Human Services must¾
~
February 1 of each year. recommend to the Executive and Council the
amount of the payment. [[consider]] considering:
ill
ill
the State reimbursement rates to service providers;
Hand]]
the total cost of providing services. including wages; and
0
f:\law\bills\1735 finance-payments to service providers\bill 5.doc
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BILL
No. 35-17
29
30
31
32
33
34
Ll)
the additional operating support needed to allow each service
provider to
~
direct service workers, on average, 125[[%]]
percent of the County minimum wage.
@
Eligibility for payment.
To receive
~
payment under this Section, a
service provider must:
ill
demonstrate to the Department of Health and Human Services
that
i!
35
36
37
38
39
40
direct service workers at
~
rate specified in the
Council's current operating budget resolution; and
ill
W
Approved:
meet any other eligibility standards set in regulation.
Regulations.
The Executive may issue regulations under Method
ill
to
implement this Section.
41
Roger Berliner, President, County Council
42
Date
Approved:
43
Isiah Leggett, County Executive
44
Date
This is a correct copy ofCouncil action.
45
Linda M. Lauer, Clerk of the Council
Date
0
f:\law\bills\ 1735 finance-payments to service providers\bill 5.doc
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LEGISLATIVE REQUEST REPORT
Bill 35-17
Finance
-
Payments to Service Providers
DESCRIPTION:
Bill 35-17 would:
define terms related to the annual supplement to certain
providers of services to persons with developmental
disabilities;
,
• require that a payment be made to eligible providers each year
to the extent that funds are appropriated;
the
• require the Director of Finance, in setting the amount of
payment, to consider the State reimbursement rates to service
providers and the additional operating support needed to allow
each service provider to pay direct service workers, on average,
125% of the County minimum wage;
the
• establish eligibility standards for a provider to receive
payment, including demonstrating to the Department of Health
and Human Services that it pays direct service workers at a rate
specified in the Council's current operating budget resolution;
and
er
• provide for the issuance of method (2) regulations to administ
the law.
PROBLEM:
ies are
Providers of services to persons with developmental disabilit
their
concerned that proposed increases in the minimum wage will hurt
ability to attract and retain workers.
iders
Provide County commitment to funding for certain service prov
in recognition of the higher cost of living in Montgomery County.
Department of Finance
GO ALS AND
OBJECTIVES:
COORDINATION:
FISCAL IMPACT:
ECONOMIC
IMPACT:
EVALUATION:
EXPERIENCE
ELSEWHERE:
SOURCE OF
INFORMATION:
APPLICATION
WITIIlN
MUNICIPALITIES:
PENAL TIES:
To be requested.
To be requested.
NIA
Josh Hamlin, Legislative Attorney
To be researched.
None
F:\LAW\BILLS\1735 Payments To Service Providers\LRR.Docx
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COJVIMISSION ON PEOPLE WITH DISABILIT IES
Testimony
Montgomery County Council
November 28, 2017
Bill 35-17, Finance-Payments to Service Providers
My name is Seth Morgan, and I currently serve as Chair of the
Commission on People with Disabilities. On behalf of the Commission,
I strongly support Bill 35-17 and commend the Council for its broad
support for this legislation. There are over 4,000 direct service
professionals who work in the County. This bill has language that
Direct Support Professionals will, be paid
125%
above the County 's
minimum wage. This will help agencies to recruit and retain direct
support workers who provide care for persons who have a
developmental disability.
Persons who receive services are mostly persons who qualify for
Medicaid funded Services. Agencies funded by Medicaid are not able to
reduce their services nor can they charge higher fees for services. The
State is not obligated to pay higher rates because of the County's new
minimum wage law. The higher cost of doing business in the County
makes this legislation critical for those most vulnerable members of our
community dependent on the support services provided to them as a
result of this initiative. This truly is a critical life-saving and life-
enhancing program and resonate_s with our recommendations to the
County Council of the last years.
Thank you for your long-standing support and attention to meeting the
needs of people with developmental disabilities and their families.
Department of Health and Human Services
401 Hungerford Drive • Rockville, Maryland 20850 • 240-777-1246 • 240-777-1288 FAX
www.montg omerycount ymd.gov/hh s
.
montgomery countymd.go v/311
.
._.,els-~~-
t
·. ·~311
.
·
, ,
301-251-485 0 TTY
·
~
®
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Montgomery County lnterACC/DD
(Jubilee Assn) 10408 Montgomery Ave. Kensington, Md. 20895
Voice 301-949-8628 x 105
Co-Chair; Tim Wiens (twiens@Jubileemd.org)
Testimony
Montgomery County Council
Novemb er 28,2017
Bill 35-17, Finance - Payments to Service Providers
My name is Tim Wiens, and I currently serve as Co-Chair oflnter ACC/DD, a
coalition of about 30 agencies serving adults who have intellectual and other
developmental disabilities in Montgomery County. We employ over 4,000 direct service
professional (DSP). We support Bill 35-17 which includes specific language that Direct
Support Professionals (DSP's) will, on average, be paid 125% above the county
minimum wage.
We share with you a goal to increase the wages of low income workers. It is an issue of
economic justice for our employees. Our employees should not be considered minimum
wage employees. Our direct service employees are earning an estimated average of
$14.26 an hour in FYI 8 based on the increase in the DD Supplement you provided for
the current fiscal year. This legislation would continue what the County has done for us
under the current County minimum wage law.
As State Medicaid funded agencies we do not have the ability to reduce our services, nor
do we have the ability to charge additional fees for our services. The State is not
compelled to provide additional funding for additional County requirements. Without
your financial support we cannot meet the obligations of the new law.
Under current conditions we estimate that our agencies will need an additional
$21,564,666 in FY23 when the minimum wage is $15 an hour for nonprofit agencies.
Inter ACC/DD agencies have worked with the County Department of Health
&
Human
Services (DHHS) to track our direct service wage numbers to come up with these
estimates. As part of this testimony I have included a chart which shows our projections.
We are also working with DHHS to obtain a Medicaid match on these dollars which
would significantly reduce to the cost to the County. Additionally, earlier this month
DDA released the results of a State Rate Study that calls for an average DSP wage of
$13.03 an hour in FY20.
If
enacted as part of the FY20 State budget this would reduce
the County obligation under this bill by about $5,000,000 a year.
We are aware of the unintended consequences of passing minimum wage laws like this,
in
other jurisdictions, without including the financial resources to fund the requirements
and it is not pretty. Carve outs or extending the implementation of the minimum wage
are of little value to us, since we must compete for employees in this wage market.
Abilities Network!EFCR, The Arc ofMontgomery County, CALMRA, CHI Centers, Community Support
Services, Inc., Compass Inc., Full Citizenship, CSAAC, Head Injury Rehab and Referral, Jewish
Foundation for Group Homes, JP. Kennedy Institute, Jubilee Assn.,
RO.I.,
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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Md
(Jubilee Assn) 10408 Montgomery Ave. Kensington,
Vo ice 301-949-8628 x 105
Co-Chair; Tim Wiens (twiens@Jubileernd.org)
D
Montgomery County lnterACC/D
20895
.
on as sponsors or co-sponsors.
We are delighted that each one of you have signed
the wag es of our Director Support
You hav e all bee n supportive of our efforts to raise
that con tinu ed support.
Professionals in the past and we are very grateful for
CALMRA, CHI Centers, Community Support
Abilities Network/EFCR, The Arc of Montgomery County,
d Injury Rehab and Referra~ Jewish
Services, Inc., Compass Inc., Full Citizenship, CSAAC, Hea
lee Assn.,
RO.I.,
SEEC, TransCen,
The
Rock
Foundation for Group Homes, JP. Kennedy Institute, Jubi
other providers and government agencies serving
Creek Foundation, Treatment and Learning Centers and
individuals with developmental disabilities.
(jJ
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DD Supplement with Five-Year Rollout
Backup for the Projected Impact of a County $15/Ho ur Minimu m Wage on the Value of the
PER FY17 WAGE SURVEY
*
4,890,058
5,030,495
5,181,410
5,336,852
5,496,958
5,661,866
5,831,722
6,006,674
6,186,874
FY15 hours
FY16 hours per ·FY17 wage survey (3% Increase from FY15)
FYl 7 projection (assumes a 3% increase)
FY18 projection (assumes a 3% increase)
FY19 projection (assumes a 3% increase)
FY20 projection (assumes a 3% increase)
FY21 projection (assumes a 3% increase)
FY22 projection (assumes a 3% increase)
FY23 projection (assumes a 3% increase)
Based on FY16 Direct Service Hours Data from the FY17 Wage Survey_
%Above
County
FY18
Difference between Supplement Needed to
Approved DD
Maintain Wages (on
County
125% of
Min Wage and ODA average) at 25% above Supplement
Allocation
Min Wage
Wage Factor
Add'I
$/hr
Funded by
FY18 Base
Supplement
Min Wage
(based on
current
allocation)
Additional Funding Needed to
maintain wages at 125% (on
average)
-
using the FY18
approved amount ($14.7M) as
the base
Year
County Min County Min
Wage*125 %
Wage
ODA Wage
Factor*
FY18
FY19
FY20
FY21
FY22
FY23
7/1/2016
7/1/2017
7/1/2018
7/1/2019
7/1/2020
7/1/2021
7/1/2022
• Assumes a 3.5% increase
10.75
11.50
12
12.75
13.50
14.25
15.00
in FY19 and a
13.44
14.38
15.00
15.94
16.88
17.81
18.75
2% in FY20 -FY23
10.94
11.50
11.90
12.14
12.38
12.63
12.88
2.50
2.88
3.10
3.80
4.49
5.18
5.87
12,940,571
15,343,45 0
17,026,82 7
21,497,824
26,193,992
31,123,412
36,294,378
13,800,221
14,729,712
14,729,712
14,729,71 2
14,729,712
14,729,71 2
14,729,712
2.66
2.76
2.68
2.60
2.53
2.45
2.38
26.5%
24.0%
21.5%
15.6%
10.4%
5.8%
1.8%
FYl 7 Approved
FY18 Approved
2,297,115
6,768,112
11,464,280
16,393,700
21,564,666
Done in collaborati on with DHHS, and edited by Tim Wiens for Inter ACC/DD.
B
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Testimony to County Council November 28, 2017
My name is Betty Bahadori. I am the mother of a 30 year old son, Cyrus, who has severe
Autism. I am speaking to you today on behalf of Autism Society Montgomery County in
a plea to support funding for nonprofit agencies who care for people with Developmental
Disabilities.
For approximately three decades Montgomery County has budgeted money that
supplements the state rates for direct caregivers of people with disabilities. Yet each year
we hear how money is tight, and we reach out to you to remind you why these funds need
to be part of the budget.
My personal story brings a historical spotlight to the subject.
When I was two, my mother was hit by a car crossing the road to get the mail. The
severe brain injury she suffered led to her institutionalization at "The State Home" in
Michigan where we lived. Every Sunday after Mass Dad took us six kids, ages infant to
eight, up the elevator to see Mom. For over 25 years, we saw her in a visiting room, but
we passed the cribs with metal bars on all sides and the top in which adults with
developmental disabilities lay in white cloth diapers. And that was how it was.
In the 80s, we resisted the movement to place her in the community after almost 2
decades at the State Home. We were assured that the funding, the money, would follow.
And she thrived in the group home and day placement. She took less medication. She
started to feed herself and walk. She went to Walmart! She did this only because of the
dedicated staff.
Now our son needs 24 hour care by quality, highly trained, dedicated staff. In order to
attract and retain direct caregivers, agencies caring for these most vulnerable people must
pay them more than minimum wage regardless of what that number is.
Direct caregivers wear many hats as direct support, advocate, educator, nurse and friend.
With a possible crisis around the comer at any time, they must be highly trained and able
to make independent decisions that have huge implications for the health and safety of
the individual being supported. With consistent staff, my son, Cyrus, can lead a busy,
healthy and happy life. With inconsistent staffing, we see increased distress, significant
weight gain, escalated self injury, destruction of property, and limitations to his ability to
function in his home and the community.
It
is so, so heart breaking.
Please continue the county's historical financial support of people with developmental
disabilities.
Thank you.
Betty Bahadori, Board Member of Autism Society Montgomery County
301-802-8343
11820 Pittson Road
Silver Spring, MD 20906
(j)
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Testimony County Council 11/28/17
Bill35-17
Kathy Perlman
My son, Jeremy Perlman, is a 27 year old young man who has DD, blindness and
autism. He has been in the residential program at Community Support Services
(CSS) since 2009. He also participates in vocational and recreational programs at
css.
Jeremy has trouble processing transitions, managing emotions and anticipating and
coping with changes. Consistency in care is of vital importance to helping people like
Jeremy enjoy the same home and community-based activities as the rest of us.
Without that consistency Jeremy's life becomes one anxious moment after another.
When the anxiety becomes too severe, withdrawal, refusal of favored activities and
self-injurious behavior can often be the result. Once that spiral of negative
consequence begins it is extremely difficult to get him back on track.
Jeremy has been fortunate to have some long-term caregivers, several of whom have
been with him since his placement at CSS. He has also, unfortunately, gone through
periods ofrapid turnover of teachers and caregivers. The effect on Jeremy's
behavior when he is with people who are familiar with him is striking. People who
know Jeremy and have seen him function over time are much better able to help him
participate in so many of the small pleasures of life that we all take for granted such
as visits to pools, parks, and bowling alleys.
It is very difficult for agencies to recruit and retain people for employment as
personal caregivers. The job is challenging and demands patience and empathy. It is
also a role that requires the ability to connect with people who present behaviors
that can be difficult to manage safely. These employees are well deserving of a
higher wage but it would be difficult for hiring agencies to provide the mandated
increase in the minimum wage without help from the county. A decrease in wages
would no doubt lead to even greater turnover. Greater turnover leads to greater
turmoil in the lives of Jeremy and people like him and to a significant loss of quality
of life.
I hope that I can count on you to continue the salary supplement for personal care
employees for the DD population in Montgomery County.
Jeremy at his gardening job with the help of
personal care staff.
®
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Testimony in Support of Bill 35-17 - to codify the 125% supplement to providers
Whitney Ellenby, Esq
&
Founder, Autism Ambassadors
Thank you for introducing this bill to recognize that just as the minimum wage must rise
to ensure that workers in our County can afford to live here, so must the living wage rise to
acknowledge the extraordinary work of those who provide direct support for adults with
developmental disabilities who cannot survive without them. I come to this issue from a
threefold perspective - as the mother of a magnificent 16-year-old with Autism, Zack; a fonnerly
practicing attorney; and as someone who runs recreational events for over 700 families impacted
by Autism, and for service providers in Montgomery County.
As a parent, I know that Zack is so significantly impacted by Autism that he will never
live an entirely independent life. His very life and safety will depend entirely on the workers at
issue here. As someone who deals with hundreds of parents through my Autism Ambassadors
events, the refrain is as haunting as it is common, "I cannot get sick. I cannot die. My child
cannot survive without me." That's how terrifying it is to imagine our disabled children
surviving in a world without us to protect them And the frightening part is that it's true, our
developmentally disabled children cannot survive without a surrogate to watch over them. The
painful truth is that at Age 21, our kids age out of the school system, the entitlements end, and
then they live largely on whatever government support is available. Or risk "falling off the cliff'
- meaning no school program, no college, no work, no consistent care.
Quite literally, the only
thing that stands between a safe and productive life versus genuine danger for our kids are
service providers and their ability to pay a competitive wage to their employees.
This is not a minimum wage job.
It
is a job that requires specific training and fierce
dedication.
It's also all-consuming -- when a client collapses into a seizure, the aide holds them
tightly, rides with the ambulance and remains at the hospital. I've seen aides slumped over and
exhausted because when a client is up sick all night, like a dedicated nurse or surrogate parent,
they are also up all night. Direct service providers are how our kids get to work, to recreation, to
doctors. And if we do not pay them what they are worth we risk losing them to jobs that are far
easier to do for the identical pay. And we don't have to wonder what will happen
if
they leave,
the news headlines make it clear - our children will elope into the distance, sprint into traffic,
they might fall out of windows. They might die.
Please remember that direct service providers don't do this because it pays well, it
doesn't pay nearly enough. I know because been on both sides. I was an attorney who made a
high hourly fee, until I was a mother of an autistic child who was paid nothing to spend hours on
my hands and knees scraping feces off walls. And now I know that nothing I ever did as a
highly-paid attorney could compare
with
what service providers so do every single day for a
fraction of what I was paid. And there's nothing just about it. If we're all being honest, ifwe
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faced with the challenges they face, most of us would gladly pay that 125% above the minimum
wage
NOT
to have to do their jobs. It's that hard.
I applaud the recent decision of the Council to be on the side of workers, I believe that
was con-ect.
But if we are really on the side of the workers, we must acknowledge those
extraordinary workers who do the job no one else is qualified to do, and that most of us
cannot handle. When we raise their wage above the minimum it is not charity; it is an
acknowledgment of what they deserve to be paid.
As a County, it's incredibly important that
we let these workers know how much we value them and their daily hard work. And as a parent,
whose son's life will soon depend upon them, I know we can't afford NOT to pay them what
they are worth.
Thank you for introducing this very worthy bill. Montgomery County is uniquely known
for being fully inclusive, and since my son's life depends upon that principle, thank you for
looking out for our most vulnerable citizens. Thank you for raising the issues contained in this
bill, I hope you will all support it.
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11/28/17
Honorable Council members,
On behalf of the Maryland Association of Adult Medical Day Services (MAADS), whose
members provide Medical Day Care Services throughout the State and in particular in
Montgomery County, we would like to provide the Council with additional information and
feedback regarding Bill 35-17, Finance - Payments to Service Providers.
It is our request that
potential modifications be made to the language to include Medical Day Providers in the
scope of this bill.
As you are all aware, we have consistently raised our concern about the County's increase in
the
minimum wage rate
over and above the State's minimum wage for two main reasons:
1. Medicaid rules strictly prohibit Adult Medical Day Care Providers (AMDC), like Loving Care,
from passing the associated increase in labor costs to their consumers. This is a sharp
contrast from other businesses that simply can pass the additional costs onto consumers.
2. State licensing regulations prohibit AMDC Providers from reducing staff or limiting services
due to staffing ratio requirements and other requirements. Again, this is in sharp contrast to
other businesses that have the ability to adjust their product lines.
Now that the council has passed legislation to further increase the minimum wage to reach $15
by 2023, AMDC Providers, which are the State's and County's partners in providing much
needed care and support to our disabled and senior populations are in serious need of a
guaranteed supplement to cover these increased costs. For Medical Day Cares, if we were to
simply count on Medicaid alone to increase its reimbursement rate to cover the costs for the
new Montgomery County minimum wage, the amount of funding gap needed to pay for the
increased minimum wage costs by 2023 (which is just 6 years from now) is expected to take
Medicaid more than 20 years to come by (based on Medicaid's previous historical
reimbursement data from the past two decades).
This is cause for serious concern,
and
demonstrates the need for the County to provide assistance to AMDCs to ensure their viability
through this rapid cost increase transition period.
Recognizing the cost associated with legislation like Bill 35-17, we applaud the council's
proactive initiative to set in stone its unwavering support for entities providing services to the
developmentally disabled. The big question that arises here is
Why is the council not
extending the same benefit to AMDCs who also provide care to the county's frail and
vulnerable populations and are subject to similar Medicaid funding shortage and
challenges?
We see absolutely no valid justification for excluding Medical Day Cares from the language of
this bill. These programs are basically branches of the same tree, or arms to the same
body. COMAR defines AMDCs as providing services to
Adults with Medical Disability
and
DDAs as providing services to
individuals with Developmental Disability.
Furthermore,
because developmental disability is a form of medical disability, many people living with
developmental disabilities use and depend on AMDC services for their daily life. All applicable
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Medicaid Waiver programs enable an individual with developmental disability to use services by
an AMDC for their needs.
Therefore we respectfully request that Bill 35-17 be amended to include Adult Medical
Day Care Providers
in the County, such that our labor costs are kept steady as the minimum
wage is phased in.
It does not cost much to cover the AMDCs
Cumulative Budget
Year-by-Year
Shortage
Difference
Min. Wage
FYR
shortage as compared to the DOA
budgetary
. ·····----------------·-··· ·- ..···-------------
programs. The amount projected for the next
11.so
s
2011
few years is shown in this table. This
2018
651,012.46
651,012.46
s
u.oo
$
s
represents as little as 4.2% increase over the
75
$
2019
1,G21,s31.1s
976,s1s.69
$
12..
s
current ODA program funding for the 2018
976,SlB, 69
$
2020
2,604,049.84
mo
S
s
year, yet it ensures viability of the AMDC
14-25
s
2021
3,sso,s,s.s3
976,s1s.69
s
s
programs.
Clearly such a small investment
325,506.23
s
1450
s
2022
3,906,074.76
s
is more than justified considering the
4 ,ss1,0S1.23
651,0 12.46
$
2023
15-00
$
importance of having such services for the
disabled and the elderly whose population is expected to increase significantly over the
next two decades.
It is essential that the County Council deliberate on the policy implications of excluding AMDCs
from the bill.
Exclusion of the AMDCs from the bill signals to the community that our
county does not support those who provide services to the elderly and adults with
medical disability.
Further, not addressing this problem makes it harder and harder for
existing AMDCs to continue providing much-needed services in the County.
Projecting this
into the future will render our county with deficiency in services for elderly and those
with medical disability.
To better demonstrate how AMDCs are such an Integral and inseparable Part of the services
used by DOA and other Adults with Disabilities we are providing a number of cases below. To
maintain the privacy and dignity of individuals their names are not included in the report. Each
case presented represents an individual who is utilizing and depends on AMDC services at the
time of this report.
Note: In the below case studies the participant's identity is not revealed for privacy and security
reasons. They are all active participants in AMDC program in Montgomery County as of the
time of this document.
Case 1:
J.R.
is a 35 yrs old Spanish speaking young man who loves to listen to
music and educational Read Aloud books, and he attends his church
and his adult medical day care religiously. He has Contracture of left
hand, Intellectual Disability/ID, a history of retinoblastoma of the right
eye, and is Legally blind. Although he is blind in his eyes,
J.R.
can see
so much more than most of us. He is an example of an individual who
is in the DOA program and has chosen to attend AMDC every day.
His AMDC program is a place where he feels completely safe and no
longer has to worry about getting hurt by others who don't have full control of their actions or
mean him harm. Since he joined his AMDC, he no longer wets himself, he does not throw up,
and no longer suffers from severe nervousness due to years of anxiety over not knowing who
may attempt to hurt him while in a room or in the bathroom.
J.R.
is safe and happy and brings
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joy to everyone around him. His AMDC program has provided him with not just Life, but a better
Quality of Life.
Case 2:
R.Y. is a 47 year old former auto parts salesperson. Just a short
while ago he used to work and provide for his family of four children
(ranging from teenage on down) and his wife. R.Y. is a victim of
Stroke. One day due to high blood pressure he had a stroke and
then everything in his life changed completely. He is a fighter, and
even though he is against severe odds he is working his way toward
getting better each day. It's not easy for him to stay in his DOA group
home with two other people all day long. So, R.Y. attends AMDC
program to become immersed in the larger community, overcome his severe depression, and
gain the energy and will to fight and get back on his feet again. R.Y. is one of many individuals
for whom the option to attend an AMDC makes the difference between hope and defeat.
Case 3:
P.S. is 52 years young. She loves to dance and listen to music and
bring joy to her friends and loved ones. P.S. has developmental
disability as well as other medical conditions that require a Nursing
Level of Care. She attends AMDC not only because her medical
needs are taken care of but also because she can have a rewarding
experience awaiting her each and every day. She loves to work on
Puzzles, and other cognitive activities of her choosing. The flexibility
of the AMDC program and the loving environment that welcomes
P.S. each and every day is beyond measure to her family. The
AMDC program provides for P.S. a perfect combination of services that she needs, enjoys, and
depends on.
Case 4:
J.C. is as wonderful a person as you could possibly know and meet.
At 72 yrs of age, this honorable veteran has a partial left hand
amputation related to bomb injury during the Vietnam War. Despite
having global aphasia and multiple strokes due to his unstable
hypertension, resulting in weakness of his right side of the body, J.C.
attends his AMDC program every day on the dot. He brings smile to
all his friends and in turn benefits from the blessing of life and love
that spans the atmosphere and provides him with the best defense
against depression, fatigue, and giving up. He is not only a great fighter, but through his AMDC
extended family he also has more to fight for.
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Case 5:
M.T. is a 91 yr young retired teacher with memory loss, diabetes, and
unstable hypertension. She lives with her daughter but due to her
medical and cognitive conditions she cannot be left alone. Her family
desperately sought a solution where M.
T.
could be cared for while
her daughter worked. Before joining the AMDC program, M.T. was
bored, tired, and depressed. After they signed up with her AMDC
something amazing happened in their lives. M.T. now gets up at
4AM every day, puts on her nice dresses, and says
"I'm going to work"!
M.T.'s AMDC has
given her a renewed energy for life, and to her daughter the option not to choose between
family and work.
Case 6:
H.I. is a 99.5 yr old male with impaired memory, stroke,
hypertension, blindness in the right eye, depression, and convulsion.
He lives with his daughter and has unsteady gate. He cannot be left
alone. His condition requires one-on-one assistance with meals,
toileting, and other activities of daily living. The AMDC has been a
blessing in his life as well as his family members, enabling them to
attend to their work during the day while Dad is being cared for at
the Center.
There are thousands of cases such as these where AMDCs provide much needed care and
services to the most vulnerable populations of our great County each and every day.
On behalf of more than 2,000 Montgomery County participants, the 17 providers of AMDC
services and more than 500 employees and their families, we respectfully ask the County
Council to amend the Bill 35-17 to include a guaranteed supplement for Adult Medical Day Care
Providers to ensure their viability as the County minimum wage continues to increase.
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,
.l
'
--···------,
-
- •
I
•;
;.
f
f
s
j
.
J
·.,....._,,-~j
Serving
DCIMDIVA
Testimony
Montgomery County Council
November 28, 2017
Bill 35-17, Finance-Payments to Service Providers
My
name is Larry Bram and I am the Senior Vice President for Innovation at Easter Seals.
We are here to support the bill and to advocate for an amendment to include direct service
staff from
"non-profit Medical Adult Day Service providers for whom the majority of their
participants are supported by governmental.funding"
(including Medicaid, OHS, and the VA).
Medical Adult Day Centers are licensed at the levels of nursing homes, yet keep people out
of nursing homes at a fraction of the cost. Those of us serving the highest acuity individuals
and most in-need communities are already doing it at a loss. We have a $15 gap for every
client, every day-and it is difficult for us to fill that gap. The rising minimum wage is going
to make it even more difficult, but as a non-profit, we are committed to providing access to
those most in need. In many cases our audience is similar to those supported by the DDA
providers, just with a different funding source. At Easter Seals, approximately 1/3 of our
daily census is individuals with intellectual disabilities, many of them coming to us from the
group homes supported by the supplement. The rest of our participants are senior citizens
living with strokes, dementia, and other age-related disabilities. We toilet and feed almost
30 people each day, and serve nearly 70.
I trust that you all agree that these amazing hard working individuals are worthy of pay
well beyond minimum wage. Without this supplement, we are not only competing for
talent with McDonald's but also with the DDA providers.
A
basic principle-equal pay for
equal work. And the work of our direct service staff is most certainly at least equivalent to
those of DDA providers.
I'm sure you are concerned about the cost of adding to the supplement. Unfortunately, ADS
providers don't have the same type of coalition as lnterACC/DD, so I have attempted to
provide some information for estimating the cost.
There are 1,000 ADS waiver slots available in the state, so Montgomery County has
approximately 250 of those
There are 19 ADS programs in the County, but a number of them are private pay
supported
Easter Seals might be the largest Medicaid-based provider in the County
(particularly since we absorbed most of the clients from the Support Center last
year).
We provided your staff with an analysis of the effect on Easters Seals. The cost to the
organization will be about $50,000 per year at the current minimum wage. That gets
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n of raises
everyone up to that 125% level. It does not include the costs to the organizatio
nal
for those at slightly higher wages or deal with equity across our multi-jurisdictio
organization.
ng the low-
Many of the ADS providers in the County would not meet the definition of servi
County to
income/Medicaid population, so I'm prett y confident that the annual cost to the
half of that.
add this provision would be well below $1 million per year. Probably less than
ated, so
But the effect would be profo und on an organization like ours that is highly regul
allow us to
we can't incre ase productivity and don't have the ability to raise prices. It will
life to the
keep great employees, lowe r turnover, and provide a bette r quality of care and
unity, and
many adults and seniors with disabilities that we serve throu ghou t the comm
impo rtant respi te and peace of mind to their family caregivers.
Than k you.
Larry Bram
Senior Vice President, Innovation
&
Program Development
Easte r Seals Serving DCIMDIVA
lbram@eseal.org
301- 920- 9711
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