By Gina Macris

Rhode Island has two years, five months, two weeks, and four days to correct ongoing violations of the Americans With Disabilities Act and meet a 2024 deadline for complying with a 2014 consent decree in which it agreed to provide appropriate services for adults with developmental disabilities.

But the state hasn’t yet started building the structure for that system, which depends on how much it pays private service providers and the complicated bureaucracy that governs how money is paid and services are delivered.

Indeed, a federal judge has ruled that the state doesn’t adequately fund developmental disability services and can’t comply with the 2014 consent decree unless it conducts a rate review that will map the way forward.

Last fall, as part of an “action plan” to avoid a contempt finding in federal court, the state promised to name a consultant to review existing rates by last Nov. 1. Work was to have begun by Nov. 15, with a completion date in December, 2022, if not earlier.

That timeline, extremely problematic for rolling out a new system and gaining enough experience to warrant the end of federal oversight by mid-2024, has grown even more unlikely.

In the third week of 2022, the consultant has not yet been named.

Randal Edgar, spokesman for the state Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH), said earlier this week that he doesn’t know the reason the rate review contract has not been awarded. But “it’s close” to being announced, he said Jan. 18. He said the same thing last week: “It’s close.”

In 2014, the U. S. Department of Justice found that the state’s fee-for-service reimbursement system for private providers incentivized a segregated system of care, in the form of sheltered workshops and day care centers. Segregated care, in which one person may oversee as many as ten people, is cheaper than than the one-on-one or small group staffing necessary to enable supported employment or other activities in the community.

Sheltered workshops, eliminated in 2018, discriminated against adults with developmental disabilities because they paid sub-minimum wages and denied workers the choice to seek competitive employment in the community. Similarly, day care centers have restricted participants’ access to the daily experiences that most people leading regular lives take for granted.

The fee-for-service system, called Project Sustainability, had been pushed through the Rhode Island House by way of a floor amendment and rubber-stamped by the Senate in the early morning hours of the last day of the General Assembly in 2011.

Project Sustainability lowballed the rates recommended by the rate reviewer of the time, Burns & Associates, which said the minimum wage for direct care workers should be set at $13.97 an hour on July 1, 2011, and raised to $15 an hour a year later.

Those adjustments were never made. It was only last year that the General Assembly, responding to court-ordered negotiations between state officials and providers, raised the hourly rates from $13.18 to $15.75 effective July 1, 2021.

Over the last decade, General Assembly leaders and some BHDDH officials have touted Project Sustainability as a vehicle for the equitable distribution of services.

Asked if that is still the case, spokesmen for House Speaker Joseph Shekarchi and Senate President Dominick J. Ruggerio demurred. They said in a statement Jan. 19: “The Senate and House look forward to reviewing the Administration’s proposals to conform the state to the Consent Decree and subsequent court orders for services for those with developmental disabilities. We anticipate reforms to comply with the Court’s action plan will be included in Governor McKee’s FY2023 budget recommendation.”

The rate review is expected to provide the data and recommendations to develop proposals for reform and calculate the anticipated cost.

Consumers, advocates and providers have protested that Project Sustainability has been just a smokescreen for budget cuts that diminished the quality of life for nearly 4,000 Rhode Islanders and their families.

Project Sustainability resulted in wholesale wage cuts that escalated turnover of front-line workers. Some workers, who had been on career ladders, even lost their homes.

As wages failed to catch up with inflation, the churn in the workforce increased, making it more difficult for private providers to staff existing services, let alone take on new clients and adapt to more labor-intensive, integrated activities required by the consent decree.

And the COVID-19 pandemic only made everything worse, with many adults with developmental disabilities now getting a fraction of the 40-hour service week required by the consent decree, and in many cases affecting family members’ ability to work.

A rate review is intended to address these workforce issues, as well as other features of the bureaucracy of Project Sustainability that holds back the development of integrated, community-based services system-wide.

Indeed, such a review was already overdue in 2018, according to a principal in the consulting firm who helped the state develop Project Sustainability in 2010 and 2011.

Mark Podrazik, co-founder and then-president of Burns & Associates, returned to Rhode Island in November, 2018, to testify before a special legislative commission studying Project Sustainability.

Podrazik said that Burns & Associates recommended rate reviews to its clients every five years.

In 2019 and 2020, BHDDH spent more than $1 million on an outside study of developmental disability services which concluded that the private provider system was on shaky financial ground. But the consultants’ contract with BHDDH did not allow them to make any recommendations, not even for a rate review.

Finally, after the state was called to defend itself against a possible contempt finding in federal court last fall, it unveiled its action plan for compliance, which included a rate review.

The five companies currently under consideration for the rate review include Health Management Associates, based in Lansing, Michigan, the parent company of Burns & Associates, which it acquired in September, 2020. Podrazik is a managing director of Health Management Associates, according to his LinkedIn page.

The other bidders are Guidehouse, Inc., Mercer Health and Benefits LLC, Milliman, and Public Consulting Group. All of them, including Health Management Associates, are national or international firms with a regional presence based in Boston.

The state has not disclosed the budget for the rate review.