Employers Advancing DD Worker Raises While State Updates Reimbursement System

By Gina Macris

Most providers of services for adults with developmental disabilities in Rhode Island have passed along wage increases enacted by the General Assembly for the fiscal year that began July 1, even though the state’s developmental disabilities agency has not yet programmed the higher rates into its reimbursement system.

The raises, negotiated between state officials and representatives of some three dozen private provider agencies under pressure from the U.S. District Court, increase hourly wages for direct care workers by more than $2, from about $13.18 to an estimated $15.75 per hour, depending on variations in payroll taxes and other employer costs related to employment.

The General Assembly approved hikes of well over $3 for supervisory personnel, from $18.41 to $21.99 an hour.

Providers who can afford it are “floating” the pay hikes to staff for a few weeks with the assurance that they will be reimbursed when the increases are fully implemented by the state’s Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), said Tina Spears.

“Providers are desperate for staff,” said Spears, executive director of the Community Provider Network of Rhode Island (CPNRI), a trade association representing about two dozen private agencies. The worker shortage, exacerbated by the pandemic, has increased employers’ overtime costs and forced many supervisors to provide direct care.

The General Assembly set aside $39.7 million in the BHDDH budget for the raises and “associated payroll costs,” which BHDDH says should put the “minimum” pay at $15.75 an hour for direct care workers and $21.99 an hour for supervisors.

But providers say the mathematical formula BHDDH uses to calculate the minimum pay doesn’t allow enough for the added payroll taxes employers must pay every time they hire a new staffer or give someone a raise.

Spears said providers are making every effort to pass on as much of the extra money as possible to their employees. Everyone should be making at least $15 an hour, she said.

In a newsletter last week, BHDDH officials encouraged those “self-directed” individuals or families managing a loved one’s individualized program to advance raises to the workers they hire even though their funding authorizations have not yet been adjusted to reflect higher rates. Self-directed individuals, who do not have overhead, pay more than the provider agencies but don’t offer benefits.

It’s not yet clear whether the pay hikes will be enough to cut into the workforce deficit, one of the reasons holding BHDDH back from implementing requirements of a 2014 consent decree mandating that adults with developmental disabilities be integrated in their communities.

Massachusetts and Connecticut both pay higher hourly rates than Rhode Island for similar jobs, one factor that is said to contribute to the state’s worker shortage.

A consultant has estimated that Rhode Island needs at least 1000 more individuals working with adults with developmental disabilities to implement the consent decree. The worker shortage is one of several reasons the Chief Judge of the U.S. District Court, John J. McConnell, Jr., has scheduled a week-long hearing in mid-October to gather evidence for holding the state in contempt for its failure to overhaul its developmental disabilities system as required by the consent decree.

Vaccinations Accelerate For RI DD Group Homes

By Gina Macris

At least 1,300 residents and staff of group homes for adults with developmental disabilities in Rhode Island have been vaccinated against COVID-19 since Jan. 16, with another 500 vaccinations scheduled for today and plans underway for additional clinics next week, according to a spokeswoman for group home operators, Tina Spears, executive director of the Community Provider Network of Rhode Island.

Spears is coordinating the exchange of logistical information necessary between group home operators and public health officials to carry out the vaccination clinics.

The acceleration of vaccinations for group home residents and staff comes as the rate of COVID-19 infections in congregate care seems to be slowing, after a spike around the Thanksgiving and Christmas holidays. Going forward, health officials on the national and statewide level are racing to step up the pace of vaccinations to prevent the spread of more transmissible variants of the virus arriving from other countries. And they urge the public to remain vigilant about wearing masks and taking other precautions.

A total of 378 group home residents had tested positive for COVID-19 at the end of Tuesday, Jan. 26 – more than double the 182 who had been reported COVID-positive on Nov. 2, according to statistics compiled from RI Department of Health data by the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH). But there were only about 15 new cases between Jan. 20 and 27, or about half the pace of the weekly increase in mid-December. Among all group home residents in privately-run homes, 31 percent have tested positive since the pandemic began 10 months ago.

A total of 612 group home staff had tested positive by the end of the day Jan. 27, or 16 more than the 596 reported the previous week, according to data compiled by BHDDH. During the prior week, the number of cases among staff had jumped by nearly 50.

The cumulative number of hospitalizations among residents and staff and the number of deaths has remained constant since early January. At that time, 84 residents and 19 staffers have been hospitalized since the pandemic began. Only one person is currently in the hospital. A total of 14 persons have died, most of them group home residents.

CPNRI To Host Virtual Forum Tuesday On COVID-19 Impact On RI DD Services

By Gina Macris

Rhode Island’s developmental disabilities community will have a chance to discuss the impact of COVID-19 on services for adults who are intellectually or developmentally challenged during an online forum hosted by the Community Provider Network of Rhode Island (CPNRI) July 21.

The hour-long session, to be facilitated by Tina Spears, executive director of CPNRI, is designed as “an open conversation,” enabling participants to voice concerns and ask questions about what lies ahead for Rhode Islanders with developmental disabilities, according to an emailed invitation.

“We want to ensure everyone understands the current state of the system,” CPNRI organizers said. They also said they want to provide a forum for discussing “actions we can take to ensure the stability of our services moving forward,”

The on-line session, with a closed captioning option, will be Tuesday, July 21 from 5:30 p.m. to 6:30 p.m. Pre-registration is required, as the on-line platform can accommodate no more than 100 participants. If the demand exceeds capacity, CPNRI said, it will host a second forum later in the summer to ensure that all interested participants are accommodated. To pre-register, please click on this link.

RI DD Workers To Get Raise Effective Oct. 1

By Gina Macris

A total of $9.5 million in raises for Rhode Island’s front-line developmental disability workers will go into effect Tuesday, Oct. 1

The state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) has made calculations based on a on a “rate model” that assumes direct care worker earnings will increase by 91 cents an hour, from $12.27 to $13.18, according to a departmental memo to private provider agencies.

Historically, the actual wages of direct care workers have not matched up with the rate model, which providers say does not allow enough for payroll taxes, workers’ compensation and health insurance.

On average, entry-level employees now make about $11.44 an hour, while more experienced direct care workers make an average of about $12.50 an hour, according to a survey of members of the Community Provider Network of Rhode Island (CPNRI), a trade association which represents about two thirds of developmental disability organizations in Rhode Island.

By comparison, the Connecticut legislature enacted a minimum wage of $14.75 for developmental disability and personal care workers in 2018 to avoid a statewide strike at group homes. Massachusetts pays $15 an hour for personal care workers, a category which includes many who support adults with developmental disabilities.

Unlike previous raises for workers in Rhode Island, the impending increase applies only to those providing direct care and not to supervisors or specialists like job developers, according to the budget legislation enacted by the General Assembly. The raises also apply to independent workers who serve individuals and families who direct their own programs.

The assumptions in the rate model are used to calculate dozens of actual rates for specific services, many of them expressed in 15-minute increments according to various staff-to-client ratios.The rate changes required federal approval because they are funded by the federal-state Medicaid program.

In addition to the 91 cent increase for hourly wages in the rate model, the model allows 35 percent, or an increase of nearly 32 cents an hour, for employee-related overhead.

Providers have said that it costs them as much as 64 percent of wages pay for employee-related expenses. As a result, the full amount of previous wage increases calculated by the state in the rate model often has not flowed to workers’ pockets.

In the recent notice about the latest wage boost sent to providers, BHDDH said “it is expected that the rate increases will support Direct Support Professional raises of a minimum of $0.91 per hour and offset related payroll expenses (up to the 35.0 percent assumption utilized in the existing rate model.)”

After the rate change goes into effect, BHDDH will require agencies “to attest to (verify) the use of the additional revenue for the required minimum wage increases and associated payroll expenses through an attestation document or form,” the memo says. It says BHDDH officials will schedule a meeting with providers in coming weeks to develop the process for documenting the use of the $9.5 million.

Additional clarification from BHDDH was not immediately available about what might happen if providers say they cannot pass along the entire 91-cent hourly pay increase to workers.

Tina Spears, executive director of CPNRI, said providers are “thrilled” with the wage increase. Her members “will be using this increase as it was intended by the General Assembly and the Administration,” she said in an email.

In a statement, CPNRI called the impending increase a “welcomed and necessary investment” by the General Assembly and the administration of Governor Gina Raimondo in supporting direct care worker in the work they do.”

Direct care workers, or “Direct Support Professionals (DSP’s) are skilled professionals who deserve compensatory wages that reflect the valuable work they perform,” CPNRI said in the statement, emphasizing that one of its continuing policy goals is to work for a living wage for agency employees.

Over the last four years, the trade association said, private provider agencies have received a $1.63 hourly increase in the reimbursement rate, while the minimum wage has increased by $1.50 over the same period.

At the same time, inflation, health insurance premiums, workers’ compensation premiums, and taxes have risen far beyond the $1.63 rate increase awarded by the state, the statement said.

CPNRI said the gap between state reimbursement and actual costs “continues to be an ongoing challenge that providers are prepared to address during the rate review process” now underway by the New England States Consortium System Organizations (NESCSO) at the behest of BHDDH.

BHDDH has commissioned the outside review of the fee-for-service reimbursement system, which has been criticized by providers, consumers and even federal officials involved in a civil rights consent decree which requires the state to overhaul its adult system of developmental disability services by 2024 to foster the integration of individuals in their communities..

Enacted by the General Assembly in 2011, the design of the reimbursement system incentivized segregated care, which the U.S. Department of Justice said violated the civil rights of adults with developmental disabilities to receive services that integrate them with their communities.

NESCSO’s work is expected to continue through next June. Its representatives have said they expect to make interim recommendations in time to be reflected in the next BHDDH budget.

The consortium does not expect to recommend specific rates, but rather, a roadmap of what it would take to meet the requirements of the 2014 federal consent decree for daytime services, as well as other recommendations affecting the entire system, according to Elena Nicolella, NESCSO’s executive director

Spears, the CPNRI director, said that NESCSO’s rate reviewers have been “very thorough and professional” in reaching out to private providers for their feedback.

CPNRI said providers “welcome and commend our state leaders for their attention to the workforce crisis that has challenged our service delivery system.”

Tim Vogt, Emerging Leader in Building Inclusive Communities, To Speak in Rhode Island Nov. 3

Tim Vogt Photo courtesy of Tim Vogt

Registration information has been corrected.

By Gina Macris

Tim Vogt, a nationally-recognized expert in building inclusive communities, will speak at a free seminar in Rhode Island November 3 that will be sponsored by several organizations that advocate for Rhode Islanders with intellectual and developmental disabilities and their families.

Vogt is executive director of Starfire in Cincinnati, Ohio, where he has developed ways of making connections among individuals that rely on mutual interests and collective strengths while working around disabilities.

“His visionary message is to maximize the positive; minimize the negative,” said Connie Susa, executive director of PLAN RI, one of the sponsoring organizations. Vogt blogs at https://cincibility.wordpress.com/

The November 3 seminar will be at the Dean’s List Academy, 25 Esten Ave., Pawtucket. Check-in will begin at 9 a.m., with the presentation scheduled from 9:30 to 12:30. Anyone planning to attend is asked to register in advance at https://www.eventbrite.com/e/claiming-a-corner-of-community-tickets-51383200536  Additional sponsors are RI FORCE, the Rhode Island Developmental Disabilities Council and the John E. Fogarty Foundation.

The Community Provider Network of Rhode Island, a trade association representing two dozen private organizations that serve adults with developmental disabilities, is a co-sponsor of Vogt’s visit to Rhode Island, Susa said.