Great week at the capitol!  The highlight of the week was the JFAC Public Hearing on Idaho's FY13 budget, the personal testimonies shared on the impact of last year's Medicaid cuts, and the turnout of folks from all over Idaho for Disability Advocacy Day.   This was extremely positive as advocates and providers are continuing to make progress working with legislators to draft legislation to remove some of the Medicaid cuts included in last year's HB260.  Another huge success this week was in the Federal court case, K.W. v. Armstrong, involving twelve adults whose individual budgets were cut. 

Over 500 people from all over the state turned out for Disability Advocacy Day at the Capitol.  Several hundred arrived early in the day to attend the JFAC Public Hearing. Legislators heard over two and a half hours of testimonies from 60 individuals who primarily shared the impact of Medicaid cuts and the need for a suicide prevention hotline in Idaho.  The testimonies were respectful, personal and impactful.  In an interview on Idaho Reports later on Friday, Sen. Cameron and Rep. Bell shared how grateful they were to hear from people and that they are hopeful to "be able to address some of the things."  JFAC will begin setting budgets on February 2th. 

Click here for Idaho Reports interview and other news coverage of the JFAC Public Hearing.

If you were unable to attend or submit your testimony, it is not too late.  Please send a copy to JFACtestimony@lso.idaho.gov.

The Disability Advocacy Day was a collaborative event coordinated by the Consortium for Idahoans with Disabilities and Medicaid Matters in Idaho. Thanks to everyone who attended the event, testified, and met with their legislators.  Special thanks to the fourteen statewide advocacy and provider associations who participated and supported people coming to the capitol.  I would like to especially recognize the Self Advocacy Leadership Network (SALN) that brought members from all over the state and took the time to meet with many legislators to share their personal story.  It was an extremely successful first year event which we hope to continue and expand in years to come.

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Advocacy and Provider representatives met his week with key legislators and the Department of Health and Welfare to discuss recommendations for changes to HB260.  There is hope that some of the most harmful and impactful cuts can be addressed this year through legislation to remove or rewrite the language in statute.  Legislators have heard from constituents, the counties and law enforcement agencies that there have been significant impacts of due to many of these cuts.  As the budget setting process nears, legislators are hoping to have a better idea of how much funding can be added to the Medicaid budget to fund restoring some of these services.  We should know more in the next couple of weeks, including bill numbers and when the bills will be heard in the House and Senate Health and Welfare committees.  Testimonies when these bills are heard will again be vital to their successful passage.

Here are some of the changes that we are working with legislators to include:

1. Striking the language in law that limits Psychosocial Rehabilitation Services (PSR) to 5 hours a week for children and 4 hours a week for adults.
2. Eliminating the language that says that budgets for services for adults with developmental disabilities will be moved into a "tiered approach as currently used for children's developmental therapy."
3. Change the language that says that budget modifications will be allowed only when health and safety issues are identified. 
4. Eliminate the language that requires the Department of Health and Welfare to develop a blended rate to cover both individual and group developmental therapy services.
5. Change the sections in the law that require a person to choose between PSR and developmental therapy even if they need both.
6. Strike the language that does not allow providers to be paid for collateral contact. 

NOTE: Dental - there was a significant amount of testimony on the impact of the dental cuts.  We will be working with legislators to recommend preventative dental be restored this year. 

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HB260 Proposed Rules

The Department of Health and Welfare has proposed rules to implement all the changes that were made as part of HB260 last year.  Most of these rules have been temporary since HB260 was implemented on July 1st, 2011.  These rules now make all these changes and processes permanent.  The rules only have to pass one of the two Health and Welfare committees to be implemented.  Most have been heard and passed the Senate Health and Welfare committee.  This week the House H&W committee will hear the following rule dockets:

1. Changes to Dental Coverage for Individuals on the Enhanced Plan (Docket 16-0310-1103) - HB260 eliminated preventative dental coverage for adults with disabilities.  These rules are being on Mon. Feb 6th at 1:30 p.m. in the House H&W committee.
2. Changes to Reimbursement for Providers (Docket 16-0310-1104) - On Monday, Jan. 30th, the Senate H&W voted to pass these rules with those sections referencing the mandatory cost study to be stricken.  The Department stated that they will work with provider associations to rewrite the rule for next session.  These rules are scheduled to be heard in the House H&W committee on Wed. Feb 8th at 1:30 p.m.
3. Changes to Developmental Disabilities Services and Mental Health Services (Docket 16-0310-1105)  - including:

a.       Elimination of collateral contact and supportive counseling

b.      Requiring individuals with dual diagnosis to choose to access skill training in either mental health services (PSR and Partial Care) or developmental disabilities services (Developmental Therapy, Residential Habilitation, and IBI)

c.       Capping PSR services for adults with mental illness to 4 hours/week

d.      Eliminating service coordination for individuals on the Aged and Disabled waiver

e.       Changing the methodology for developing an individual's budget including limiting the appeal process unless the services are "medically necessary" and are not included in their current needs assessments.

These rules passed the Senate H&W committee two weeks ago.  They will be heard by the House H&W committee on Wed. Feb 8th at 1:30 p.m.  NOTE: Several of the sections of these rules will later need to be changed if HB260 language is changed with passing new legislation.  It will be important to continue to remind legislators of the impact of many of these changes and cuts.  Hopefully we will have legislation introduced that will ultimately result in changes to these rules.

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Court Case - KW v. Armstrong - H&W Individual Budget Cuts Challenged

Background - Adults with developmental disabilities have seen significant cuts in their budgets since July 1, 2011 when the HB260 language went into effect.  The Idaho Department of Health and Welfare was directed by the legislature to save $6.7M total ($2M state dollars) in budgets of services for adults with developmental disabilities.  The budget tool/methodology was modified and has resulted in adults seeing huge changes in their budgets from the previous year.  HB260 includes language that states budget modifications can only be made if there are health and safety issues.  Interpretation of this language and the new rules that limit the appeal process have had huge impacts on the lives and services of adults.  Idaho Legal Aid filed a lawsuit on behalf of twelve adults is KW v Armstrong. 

Here is a quick synopsis of the decision by the court on Friday, Feb. 3rd:

On Friday, February 3rd, the Judge in KW v Armstrong ruled that the notice given to the 12 plaintiffs was legally deficient and that their budgets must be restored to their pre-July 1st levels.  He indicated to the AG that the notices were similarly deficient for everyone else but that their cases are not before him. Still IDHW was admonished to treat them similarly, at least those who have appealed. Therefore it would be good advice to anyone receiving a notice of cuts to their budgets to appeal. The Temporary Restraining Order (TRO) which will be signed today will reflect this. 

The judge is allowing IDHW to come into court next week (possibly Wednesday) to present evidence on their proprietary (trade secret) claim, without giving them any encouragement to think that they can defend the practice. The Judge signaled that he is likely to find that the hearing process (where the Hearing officer is limited to deciding whether H&W followed the rules and prohibited from ruling on the validity of the rules or processes) is similarly inadequate, but this is not a ruling ...yet.  Idaho Legal Aid's attorney, Mr. Eppink, is negotiating with H&W on the wording of an order which would stop the use of the budget formula for everyone and return those who have been cut back to their July 1st budget levels but this has not happened and it may not happen until a class action suit is filed.  (Idaho Legal Aid is prohibited from filing class actions by their federal funding statute). 

We will have more definitive information next week. For now we only have a ruling that the notice in the 12 plaintiffs cases was deficient and that they must restore their budgets. IDHW is restrained from cutting any more budgets until they get a notice procedure (and probably a hearing procedure) which meets with the court's approval. This notice procedure will probably have to include information on how the formula was applied in each case. So far, the court has not ruled on the validity of the formula since there is no evidence of the secret formula before the court.

THIS WEEK 

Mon. Feb. 6th House H&W Committee Meeting at 1:30 p.m. in EW42 to hear rule dockets:

1. Changes to the Dental Coverage Enhanced Plan (Docket 16-0310-1103)
2. Changes to the Dental Coverage Basic Plan (Docket 16-0309-1103)
3. Changes to PT, OT, ST Coverage Basic Plan (Docket 16-0309-1107)

Wed., Feb. 8th House H&W Committee Meeting at 1:30 p.m. in EW42 to hear rule dockets:

1. Changes to Reimbursement for Providers (Docket 16-0310-1104)
2. Docket 16-0310-1105 includes all of the following:

a.      Elimination of collateral contact and supportive counseling

b.      Requiring individuals with dual diagnosis to choose to access skill training in either mental health services (PSR and Partial Care) or developmental disabilities services (Developmental Therapy, Residential Habilitation, and IBI)

c.       Capping PSR services for adults with mental illness to 4 hours/week

d.      Eliminating service coordination for individuals on the Aged and Disabled waiver

e.      Changing the methodology for developing an individual's budget including limiting the appeal process unless the services are "medically necessary" and are not included in their current needs assessments

Reminders on H&W committee meetings:

The Senate committee meets Mon, Tue, Wed and Thu afternoon at 3:00 p.m. in room WW54.   The House H&W Committee meets every even day at 1:30 p.m. in room EW42.  They post their schedules on the legislative website www.legislature.idaho.gov under the "Calendars and Agendas" (click on each of the two H&W committees).  The public can come and testify on any of the rules on the day's agenda.  You will need to sign in as you enter the room, indicate which rule docket you are speaking to and whether you support or oppose the rules.  You should bring a copy of your testimony in writing to be given to the committee secretary (it is also very helpful to provide enough copies for everyone on the committee).

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