CDASS Clients - Have you received an overbudgeting letter?
Dear Fellow CDASS Client:
The Colorado Cross-Disability Coalition has asked Accent to provide this letter to all clients that are in an over-budgeting situation. In a recent discussion with Accent management I became aware that there are quite a few CDASS clients who are going over their allotments on a regular basis. When I asked Accent why they thought this was happening I was disturbed to learn that in most cases clients had asked for an allocation increase and had not received a response from their Single Entry Point agency.
I am writing you to ask that you take action on this. It is important that we do not have over budgeting in the CDASS program as that could be a reason for the state to impose rigid limits OR to take away some or all of the flexibility that this program offers. However, I also do not expect or even want any of you to forgo what you need for your health and safety. Over budgeting will occur for only one of the following reasons:
1) Your allocation is not adequate. This might be because you do not have enough hours and might be because some of your tasks are being considered personal care when they should be considered health maintenance.
2) You are paying too much per hour.
3) You are using too many hours.
As you know, the way the SEP determines your allocation is that they give you certain hours for “unskilled” at $14.52 an hour and certain hours for “skilled” or health maintenance tasks at $27.28 per hour. They use “norms” which is a worksheet to determine how many hours you are supposed to get for each task. However, if the norms are not relevant to you they are required to make adjustments if there is a disability related reason or a reason related to your life circumstances that are beyond your control. Here are some examples that CCDC has seen of inappropriate allocations:
1) Clients that require full assist transfers or use a lift for transfer should have all transfer related tasks considered health maintenance tasks.
2) If you have open sores, infections or regular issues with skin integrity bathing is skilled.
3) If you use any sort of brace dressing should be skilled.
4) Catheter care and bowel programs are skilled if they are actually “inserting” anything.
5) Range of motion prescribed by your doctor or PT is skilled and can be an hour a day if necessary. Most people who are not mobile should get daily range of motion. If it is not prescribed it is simply exercise and is unskilled.
6) If you live in a very rural area you should have extra time allotted for errands.
7) If you have upper respiratory problems you should get double time allotted for dusting and housecleaning.
8) If you are incontinent (no catheter) and have accidents overnight you should get extra time for laundry and linen changes.
9) If you have a service animal or emotional support animal as opposed to pets you should get a small bit of time if you need help with this animal.
10) Some tasks can be done at the same time, for example while someone is in the waiting period of a bowel program the worker should be cleaning so every task will not add up exactly but if they are doing one skilled task during that time the pay rate should be skilled as that is how it works for agency allocations.
In terms of what is a reasonable rate of pay I think we can use the Self Sufficiency standard which is published by the Colorado Center on Law and Policy. Here is a link to that: http://www.cclponline.org/pubfiles/SelfSufficiency08_FinalProof.pdf Now clearly we must set wages to the level of skill involved (our definitions) and consider the time of day they work, how long they have been with us, and other factors. For example I pay more for errands outside of the home because that is done without my direct supervision and I might need to trust the worker with my credit card. That takes more skill and judgment than helping me transfer when clearly I am right there supervising. Those are MY values; you need to use your values. Pay should not be based on how many kids your worker has but on how good they are to you but the self sufficiency standard might be used in a Medicaid administrative law judge hearing if the state says we are paying too much.
Our allocation will never be based on what we pay, it will be based on the Medicaid rate so if we are considering what we pay for unskilled personal care or homemaking and we want to pay a higher rate than allocated we will have to use fewer hours. For example if we have 5 hours of homemaking a week that is $14.52x5 or $72.60. Subtract the 10% for fiscal services and we have $65.34. If we want to pay $10 an hour you figure $11.49 you can get 5.6 hours but if you pay $15 you figure $17.23 and you get only 3.8 hours. This is why it is important that you get adequate hours to begin with—but you cannot argue that you are paying more than $14.52 so you need more hours. The whole point of CDASS was that we could do better than the agencies with the SAME hours. However, often when people go from an agency to CDASS the hours the agency was providing was not what someone needed. Also, especially in the rural areas where there is a lack of skilled care people were receiving only unskilled care hours even if the care was skilled according to the regulations.
CCDC wants to make sure that the state does not have anything to use to hurt the CDASS program so we want to make sure you get the support you need. If you have asked for an allocation increase and have not received an answer OR have not received a written notice with appeal rights you have a right to go to a hearing before an administrative law judge. CCDC will help people with these hearings and even represent you if needed. The Medicaid rules allow you to have a hearing if you have made a request and not received an answer with reasonable promptness. The appeal regulations are at 8.057 in the rules and the link is here:
We have created a form for you to request a hearing and that is attached. If you want our assistance in an appeal we will need you to join CCDC as a member as we are only permitted to help members and fill out the non attorney authorization form also attached.
If you want a CCDC advocate who is also a CDASS client to review your budgeting plan, rate of pay an use of hours we can do that—what you will need to do is ask your case manager for the PAR (prior authorization request) that shows how many hours or units of each area (personal care, homemaker and health maintenance) you have. We will need that and your attendant support management plan. Once we have both of those we can meet with you by phone or in person and discuss your allotment versus your needs or other reasons for the overbudgeting. Accent can provide additional training if you think you need that. If doing the budget is too much for you it is OK to ask for help, either by having a formal authorized representative or informally getting help. However if the issue is that your allocation is not adequate then you need to ask for an increase.
It is important that we keep this program strong as we move into even tougher times financially in the state. Because CDASS serves the most severely disabled (agencies did not want to serve these folks) it looks like CDASS clients cost more than agency clients. We know this is not accurate and can prove if needed that CDASS serves clients with the highest needs. However if we are also having many people go over budget we will have problems justifying this program. If you cannot get an increase or even a formal denial of your request for increase you need to take this to the next level, which is the Office of Administrative Courts.
Thank you for paying attention to this and please let us help so that together we can keep this amazing program. I want to be clear that no one is talking about getting rid of CDASS; we are trying to be proactive.
Sincerely,
Julie Reiskin, CDASS Client
Executive Director CCDC
RESOURCES:
- To access the Self Sufficiency standard which is published by the Colorado Center on Law and Policy
- Download the Appeal Letter Template as a Word document
