HAPPY NEW YEAR- THIS IS I GUESS
THE FIRST- AS HEARING OF THE
SENATE BUDGET FISCAL REVIEW
SUBCOMMITTEE NUMBER THREE IN
HEALTH AND HUMAN SERVICES. FOR
TWENTY TWENTY AND WE'RE
STARTING OFF- TODAY WITH AN
INFORMATIONAL HEARING ON AN
UPDATE ON THE- RATE STUDY IN
REFORM IN THE DEVELOPMENTAL
SERVICES SYSTEM. AND I THINK
IS- OF THE PEOPLE RECALL- LAST
YEAR- THE DEPARTMENT OF- PENCIL
SERVICES- PRESENTED A RATE
STUDY THAT WAS PART OF A-
PREVIOUS LEGISLATION- AND- SAID
THAT THEY WERE GOING TO WORK
ON- I GUESS PLANS TO- TO
ADDRESS SOME OF THE ISSUES IN
THE RATE STUDY AND SO- WE SAID
WE WOULD WANT TO HAVE A-
HEARING HAD TO HEAR FROM THE
DEPARTMENT AND FROM
STAKEHOLDERS. REGARDING WHAT
ACTIONS THE ADMINISTRATION'S
PLANNING TO TAKE AS A RESULT OF
THE RATE STUDY HOW WOULD MAKE
NOTES AND WE CERTAINLY
HOPEFULLY YOU'VE HAD A CHANCE
TO LOOK AT THE BACKGROUND PAPER
WE'RE CERTAINLY GOING TO HEAR
FROM- OPERATE DIFFERENT FOLKS
TODAY- THAT- THE- THIS RATE
STUDY I CAME ABOUT AS A RESULT
OF LEGISLATION- THAT- AND- MANY
WAYS- GIVEN THE CUTS THAT WERE
MADE DURING THE GREAT RECESSION
WHICH- SOME OF WHICH WERE
RESTORED. BUT STILL I THINK
PEOPLE RECOGNIZE THAT. PLAY WE
THE STAFF RAY IN THAT'LL
SERVICES AND- OF OUR ABILITY TO
MEET THE LANTERN AND-
DEVELOPMENTAL DISABILITY
SERVICES ACT- THAT- VARIOUS-
THAT THERE ARE CERTAIN LEVELS
OF COMPLEXITY AND THE
INCONSISTENCIES AND- EVEN THE
LEVEL FUNDING- WAS IT
SUFFICIENT TO MEET THOSE NEEDS
SO- WITH THAT- AGAIN BEGIN-
WITH- SO YOU PATRICK FROM THE
LEGISLATIVE ANALYST'S OFFICE TO
GIVE US. A HISTORY OF THE RATE
STUDY- SO IF YOU CAN COME UP
HERE I WOULD JUST WANNA MAKE
NOTE THAT CERTAINLY WE WILL BE
DELVING INTO THIS LATER IN A
REGULAR BUDGET PROCESS- THAT-
THE GOVERNOR AND HIS- TWENTY
TWENTY ONE- BUDGET- AS SHE HAS
A PROPOSED A- INCREASE. IN NET
INCREASE OF A BILLION DOLLARS-
COMPARED TO THE UPDATED CURRENT
YEAR BUDGET OF WHICH SIX
HUNDRED TWENTY SEVEN MILLION
WERE- GENERAL FUND INCREASE SO
I WANT TO ACKNOWLEDGE THAT THE-
RESTORATION HAS. INCLUDE
INCREASE THE BUDGET- FOR- THE
MONTH SERVICES ARE AND- WITH
SOME SPECIFIC A RATE INCREASES
IN THERE AS WELL AND WHICH A
SKIN WILL MENTION THAT WE WILL
DELVE MORE INTO WE HAVE A
REGULAR BUDGET PROCESS SO- BUT-
TODAY WE'RE GOING TO FOCUS ON-
THE RATE STUDY IN THE RESPONSE
THE RATE STUDY SO. I WANT TO
THANK YOU IN A WELCOME-
HISPANIC AND- LOOK FOR TO YOUR
REMARKS ABOUT THE HIT. THE
FRAME OUR DISCUSSION THE
HISTORY OF THE RATE STUDY THANK
YOU WELCOME. THANK YOU DOCTOR
PAN- AS YOU SAID I'M SO YOU
PICK FROM THE LEGISLATIVE
ANALYST'S OFFICE AND I'M HERE
TO PROVIDE SOME BACKGROUND
INFORMATION IN CONTEXT TO SET
THE STAGE FOR THE DISCUSSION
TODAY ABOUT THE DDS RATE STUDY.
YOU SHOULD HAVE A HAND OUT AND
THE SURGEONS ALSO HAVE EXTRA
COPIES FOR AUDIENCE MEMBERS- IF
YOU COULD TURN TO PAGE ONE I'D
LIKE TO START BY NOTING THAT
EVEN IN ITS ORIGINAL FORM THE
DDS RATE SETTING ARCHITECTURE
IS NOT STRAIGHTFORWARD. AMONG
THE MORE THAN ONE HUNDRED AND
FIFTY SERVICE CATEGORIES THERE
ARE NUMEROUS WAYS THAT RATES
CAN BE SET. INCLUDING BY THE
DEPARTMENT BY STATUTE AND
REGULATION THROUGH NEGOTIATION
BETWEEN REGIONAL CENTERSAND
SERVICE PROVIDERS TO NAME A FEW.
HIT IF YOU TURN TO PAGES TWO
AND THREE YOU'LL NOTE THAT SOME
OF THESE METHODS ARE ONLY
THEORETICAL AT THIS POINT GIVEN
THE NUMEROUS CHANGES AND
ADJUSTMENTS THAT HAVE BEEN
LAYERED ON TOP OF THE BASIC
ARCHITECTURE INCLUDING. RATE
FREEZES IMPLEMENTATION OF
MEDIAN RATES RATE REDUCTIONS
RATE INCREASES RESTORATION OF
FUNDING FROM PREVIOUS CUTS.
PROGRAM CHANGES ADJUSTMENTS TO
COMPLY WITH STATE AND FEDERAL
RULES IF YOU TURN TO PAGE FOR
THE SPAGHETTI LIKE NATURE OF
THE CURRENT RATE SETTING
STRUCTURE LET MEMBERS OF THE
RATES WORK GROUP WHICH IS A
SUBGROUP OF THE DEVELOPMENTAL
SERVICES TASK FORCE. AND IS
COMPRISED OF FAMILY MEMBERS
ADVOCATES SERVICE PROVIDERS
REGIONAL CENTER REPRESENTATIVES
AND OTHERS- TO CALL FOR A RATES
RATES STEADY TO ADDRESS THESE
STRUCTURAL CHALLENGES. THERE
WAS ALSO AN ACKNOWLEDGEMENT
THAT IT WOULD BE DIFFICULT TO
SUSTAIN A RAPIDLY GROWING
SYSTEM. UNDER THE CURRENT
STRUCTURE WHICH IS BECOME
OVERLY COMPLEX INEQUITABLE
ACROSS SERVICE PROVIDERS AND
HARD TO UNDERSTAND. AFTER
GOVERNOR BROWN CALLED FOR A
SPECIAL SESSION IN TWENTY
FIFTEEN TO ADDRESS FUNDING IN
THE DDS SYSTEM. THE LEGISLATURE
AND ADMINISTRATION AGREED IN
TWENTY SIXTEEN TO PROVIDE THE
FIRST SIGNIFICANT RATE INCREASE
IN THE NUMBER OF YEARS TO THE
SYSTEM. AND TO CALL FOR THE
RATE STUDY DDS WAS GIVEN THREE
YEARS AND THREE MILLION DOLLARS
TO CONDUCT THE STUDY. PER THE
LANGUAGE CODIFIED IN STATUTE
WHICH IS SUMMARIZED ON PAGE
FIVE OF THE HANDOUT THE STUDY
WAS TO ADDRESS THE
SUSTAINABILITY QUALITY AND
TRANSPARENCY OF SERVICES. TO
ASSESS THE EFFECTIVENESS OF
DIFFERENT RESETTING METHODS AND
TO EVALUATE THE SERVICE CODE
STRUCTURE. THE STUDY EXAMINED
RATES SET BY DDS THOSE SAID IN
REGULATION AND STATUTE AND
THOSE NEGOTIATED BETWEEN
REGIONAL CENTERS AND PROVIDERS.
THESE RATES ACCOUNT FOR NEARLY
90% OF THE PURCHASE OF SERVICES
SPENDING. THE PRELIMINARY RATE
STUDY RESULTS WERE DELIVERED
LAST MARCH THE FINAL RESULTS
AND RESPONSES TO THE PUBLIC
COMMENT WERE DELIVERED ON
JANUARY TENTH ALONG WITH THE
GOVERNOR'S BUDGET PROPOSAL-
THUS FAR IT WOULD NOTE THAT THE
RATE MODELS DEVELOPED IN THE
RATE STUDY HAVE NOT BEEN
IMPLEMENTED AND THE
ADMINISTRATION AT THIS POINT
DOES NOT- PROPOSED TO IMPLEMENT
THOSE RATE MODELS. WITHOUT I'M
HAPPY TO ANSWER ANY BACKGROUND
QUESTIONS OR TURN IT OVER TO
DIRECTOR PARCHMAN MISTER
PULASKI. THANK YOU VERY MUCH
FOR YOUR PRESENTATION- IS ONE
OF THE QUESTIONS I WANT TO ASK
IT WAS AT. GIVEN THE HISTORY
AND WE'RE GONNA HEAR FROM
DOCTOR LARGE MEN ABOUT WHAT THE
ADMINISTRATION PLANS. YEAH WE
GET TOUCHED ON THE FACT THAT
VARIETY OF BOTH FEDERAL STATE
LEGISLATIVE ACTION ETCETERA- IF
THEY'RE BEEN PREVIOUS EFFORTS
TO MEANS THE MOST RECENT TO
FIGURE OUT HOW TO BETTER
RATIONALIZE OURS IS OUR FIRST.
ATTEMPT IN A VERY LONG TIME NO
THERE HAVE BEEN- PREVIOUS
ATTEMPTS TO REFORM THE SYSTEM I
BELIEVE THE LAST- SIGNIFICANT
EFFORT WAS MADE IN EARLY TWO
THOUSANDS- THERE WAS A CALL TO
DISCUSS REFORMING THE SYSTEM
FOR MANY OF THE SAME REASONS
THAT EXISTS TODAY. AND DUE TO-
RECESSIONARY CHALLENGES AT THAT
TIME THE EFFORT WAS SORT OF.
ECHO OKAY ALL RIGHT AND THAT
WAS IT THAT WAS JUST ONE I
THINK THERE BEEN THINGS EVEN
FURTHER IN THE PAST. OKAY AND
THEN I GUESS THE OTHER QUESTION
I HAVE- JUST BRIEFLY IS THAT-
THE SUN'S RAYS THREE CAME OUT-
IN- LAST YEAR IT ALSO INDICATE
A VERY SIGNIFICANT- I GUESS.
UNDER FUNDING OF THE SYSTEM I
MEAN I THINK. TUNE OF WAS ONE
POINT EIGHT BILLION THAT'S
RIGHT- SO- FROM THE LA AS
PERSPECTIVES- I DON'T KNOW TO
WHAT DEGREE IS DELVED INTO THAT
OR NOT- ANY COMMENTS ON SO WE
HAVE THE RATE METHODOLOGY BUT
ALSO THE- THE LEVEL MOUNT OF
UNDER FINDING THAT- THAT STUDY-
DEDICATED YEAH THAT'S RIGHT.
OUR OFFICE HAS AN INDEPENDENTLY
YOU TRIED TO QUANTIFY THE SORT
OF UNDER FUNDING IN THE SYSTEM
BUT WE- CERTAINLY ARE AWARE OF
THE FACT THAT THERE HAVE BEEN
MANY CHALLENGES INCLUDING-
PROVIDERS JUST STRUGGLING TO
PAY STAFF MINIMUM WAGE
INCLUDING LOCAL MINIMUM WAGES
RIGHT. OKAY AND THEN- ONE OTHER
THING THAT I QUESTION IN TERMS
OF THE RATE STUDY ITSELF AND
WE'RE GONNA HEAR FROM THEM
DIRECTLY SO WE CAN IF YOU WANT
YOU CAN DISABLE LET THEM
EXPLAINED OUT IS THAT BASED ON
A SINGLE POINT TIME DATA OR IS
IT. SO. ARE IS THAT. OUR ALL
LET MISTER PULASKI CAN. THE BUT
I THEY THEY- THEY STARTED STUDY
BASED ON TWENTY SIXTEEN
SEVENTEEN SPENDING AND THEN
WENT FROM THERE AND MADE SOME
ADJUSTMENTS TO ACCOUNT FOR-
SORT OF INFLATION AND THINGS
LIKE THAT SINCE THAT TIME. OKAY
SO IT'STRUE BUT YOU COULD YOU
SHOULD ASK HIM TO CONFIRM THAT
OKAY. ALL RIGHT. SO THANK YOU
VERY MUCH FOR YOUR PRESENTATION
AND A YEAR PRE SHEET YOU AYE
FRAMING THE- ISSUES FOR A FORCE
TODAY THANK YOU DOCTOR AJ THANK
YOU. ALL RIGHT SO OUR NEXT
PANEL- IS ACTUALLY IN OUR VIEW
THE RATE STUDY METHODOLOGY WHEN
I HAVE- CORRECT APARTMENT FROM
DEPARTMENT OF HEALTH SERVICES
AND STEVEN PULASKI FROM BURNS
AND ASSOCIATE THEMSELVES. OF
BEFORE AS YOU COME UP I SAW SO
WHEN EDUCATE FOR THOSE OF YOU
WHO ARE INTERESTED IN MAKING
PUBLIC COMMENT- WHICH WILL BE
AT THE CONCLUSION OF THE
HEARING- PLEASE SIGN IN OVER AT
THE SERGEANTS DESK- TO FOR IF
YOU WISH TO MAKE PUBLIC
COMMENTS- TO HAVE A SIGN UP
SHEET THERE. OKAY SO YES PEOPLE
CAN STILL- JUST FOR THE RECORD-
SO WE KNOW WHO'S GOING TO BE
SPEAKING A PUBLIC COMMENT- AND-
I SHOULD INDICATE I THINK.
LOOKING AT THE AUDIENCE I THINK
WE'LL BE FINE. I DO HAVE A BIT
OF A HARD STOP AROUND NOON SO
BECAUSE OF THAT OTHER THINGS
SO- BUT I THINK WE SHOULD BE
FINE ALL RIGHT- WELCOMED- DRUG
DEPARTMENT- THE- WELCOME.
VI THANK YOU DOCTOR PAN- I
CAN NANCY PARCHMENT DIRECTOR
THE DEPARTMENT OF WILL SERVE AS
AND- HAPPY TO BE HERE AND I
ALSO HAVE WITH ME EVEN PLOWS
SKI WHO IS OUR CONSULTANT WITH
BURNS AND ASSOCIATE- I'M JUST
GOING TO VERY BRIEFLY JUST MAKE
A COUPLE OF COMMENTS BEFORE-
HAVING MISTER PULASKI WALK
THROUGH. AND THE DETAILS THAT
HAVE BEEN ASKED FOR IN THE
AGENDA- I DO WANT TO THANK- A
STAFF FOR THE WORKING TO THE
DETAIL IN THE AGENDA DOES
CERTAINLY SAVE. YOU KNOW SOME
BACKGROUND INFORMATION AND
TIME- THAT WE NEED TO DO TODAY
AND GIVING FRAMEWORK. FOR
DISCUSSION SO THANK YOU I. WE
WERE DURING THE WORK OF THE
THINGS THAT WAS CREDIT AND I
WANT TO THANK OUR TO. FOR THEIR-
INSURANCE OVER THE LAST FEW
YEARS OF THE TIME THAT THEY
WORKED WITH US IN NOT ONLY
WITHIN THE- STRUCTURE OF THE-
SERVICE PROVIDER- SURVEYS AND-
THE THINGS THAT WE NEEDED TO DO
WITH THE COMMUNITY ENGAGEMENT
TO BE ABLE TO. BE INFORMED TO
MOVE FORWARD WITH THE RIGHT
STUDY AND DEVELOPMENT OF THE
RIGHT MODELS. THEY ARE VERY
OPEN THEY WERE PART OF THE
PROCESS. I MEAN WE COULDN'T
HAVE DONE IT WITHOUT THAT
ENGAGEMENT ADDITIONALLY WITH
THE FAMILIES AND CONSUMERS AND
PROVIDING US CONTEXT TO. WHAT
WERE THE THINGS THAT WERE
REALLY IMPORTANT TO THEM WITHIN
THE STRUCTURE. OF A BUILDING
THE RATE MODELS AND THE WORK
WITHIN THE RATE STUDY. SO JUST
VERY QUICKLY I WANT TO JUST
IDENTIFIES SOME OF THE GUIDING-
ELEMENTS THAT WERE PART OF THE
RATE STUDY- WHEN WE'RE LOOKING
AT IT IT WAS VERY MUCH
CONSISTENT WITH- THE ITEMS THAT
WERE OUTLINED IN A B. X. TWO
ONE IN THE FRAMEWORK IN IN
MOVING FORWARD. AND TAKING A
LOOK AT THE EFFICIENCY OF
PAYMENT STRUCTURES- AS MISS
MEDICAID NOTED THAT WE HAVE A
VERY COMPLEX SYSTEM IN OUR
RATES- SPAZ SERVICE CODES
EXETER HAD BEEN COMPLEXITY BEEN
BUILT UPON. OVER THE YEARS AND
SO IT REALLY DID TAKE A LOOK
AT. TAKING A LOOK AT BILLING
CODES IN THE UNITS THE SERVICE.
ALSO TAKING A LOOK AT BUILDING
ON PROVIDERS- SO. CANICE
BILLETED TO MOVE FORWARD AND
STABILIZATION WITHIN THE
PROVIDER DID PARTICULARLY IN
THE AREA. OF TAKING A LOOK AT
THE EQUITY WITHIN THE
DIFFERENT- GEOGRAPHIC AREA AND-
SERVICE- GROUPS. AND SUPPORTING
QUALITY OF SERVICES THE
UNDERLINING COMPONENT OF WHAT
WE REALLY NEED TO DO IS TO MAKE
SURE THAT WE'RE TAKING A LOOK
AT HOW WE'RE DELIVERING
SERVICES TO THE EXPECTATION OF
OUR COMMUNITY. AND SO LOOKING
AT QUALITY SERVICES AND THAT
FRAMEWORK TAKING- THE- FOCUS ON
SERVICE ACCESS AND EQUITY
INSPECTING. REGIONAL
DIFFERENCES TO TRAIN YOUR BIRD
IS PUMP. NEEDS OF THE AND DOES
WERE SERVINGS. CONTENT TO
CHANGE OF ALL OVER. COMPLY WITH
A- YES. ROLE AT ALSO TAKE. OKAY
BE. THANK YOU IN. STATE AND BE.
TO THE WIDE MINIMUM WAGE. AND
THEN FOR. SEEN CERTAIN. SUCH AS
EMPLOYEE. SO WITH THAT I'D LIKE
TO I'M GOING AND HANDED OVER
TO. PLUS. GRAY CONVERTING.
MISTER CHAIRMAN I APPRECIATE
THE OPPORTUNITY TO SPEAK WITH
YOU AND THE COMMITTEE HERE THIS
MORNING- ABSTRACT APARTMENT
SAID MY NAME STEVEN KLASKY IN
THE VICE PRESIDENT OF BROWN'S
ASSOCIATES AND THE PROJECT
MANAGER FOR THIS PARTICULAR
ENGAGEMENT. I'D LIKE TO TALK
BRIEFLY ABOUT THE MAJOR PHASES
OF THE RATES OF THE RATE STUDY
GIVEN ALL AGING AS DRUG
DEPARTMENT THE FARMERS THAT
STAFF TO INPUT INTO THE
MEMORANDUM SO SIMPLY TRY TO RE
CAST HELD AS WE THINK ABOUT
THESE RATES ENGAGEMENTS AN
ADULT CERTAINLY LEAVE TIME FOR
ANY QUESTIONS THAT YOU MAY HAVE.
ONE EIGHT SEVEN PRO LIKE THIS
THERE'S FOUR MAJOR PHASES OF
THE WORK THAT WE DEAL IN THE
FIRST PHASE IT'S MAKING SURE
THAT WE DEVELOP AN
UNDERSTANDING OF THE SYSTEM FOR
WHICH WERE DEVELOPING THE RATES
AS THE OLD SAW GOES AND IT
SYSTEMS WHEN YOU SEE ONE ID
SYSTEM YOU SEE IN ONE IT SYSTEM
SO EVERY SINGLE STATE IS QUITE
UNIQUE IT'S IMPORTANT FOR US TO
UNDERSTAND THE DIFFERENCES THAT
MAKE THE STATE UNIX THAT WERE
ROOF BUILDING REYES REFLECTIVE
OF THAT. INDIVIDUAL STATES
REQUIREMENTS. AND SO AS PART OF
THAT BACKGROUND RESEARCH WE COR
START WITH THE REQUIREMENTS
MAYBE X. TO WANT TO MAKE SURE
WE DESIGNED A RACE SO THAT WAS
COMPLIANCE. WITH THOSE DICTATES.
WE ALSO WILL READ A NUMBER OF
THE USE OF REPORTS THAT HAVE
BEEN ISSUED A PRIOR TO A. B. X.
TWO ONE PASSING SO AS YOU ASKED
STAFF DURING THE OPENING
REMARKS- THE ISSUE OF RACE HAS
BEEN A LONG STANDING CONCERN
FOR MANY WITHIN THE IT
COMMUNITY SO QUITE A BIT. OF
MATERIAL HAS BEEN PUBLISHED
OVER TIME IN THAT PARTICULAR
REGARD. WE ALSO TOOK A LOOK AT
KERN UTILIZATION PATTERNS THAT
WAS AN IMPORTANT PART OF OUR
PROCESS TO MAKE SURE THAT WERE
MAJORING IN THE MAJORS AS WE
SAY THAT WE'RE FOCUSING ON
THOSE SERVICES THAT. GENERATE
THE LARGEST AMOUNT OF SPENDING
AS MISS PATRICK SAID EARNED HER
REMARKS THE SERVICE CODE
INCLUDED IN OUR SCOPE WORK
ACCOUNT FOR ABOUT 90% OF
PURCHASE A SERVICE SPENDING SO
WE WANT TO MAKE SURE WE WERE
COVERING. THOSE MAJOR AREAS.
AND FINALLY WE DID QUITE A BIT
OF WORK TO WORK WITH THE
COMMUNITY TO FIND IS BOTH DIAZ
AS WELL AS PROVIDE ASSOCIATIONS
AND OTHER STAKEHOLDER GROUPS OF
BEFORE WE- REALLY STARTED THE
DATA COLLECTION EFFORT. WE
SPENT A LOT OF TIME WORKING
WITH EDS MAKES THAT WE
UNDERSTAND THE REGULATIONS WHEN
THEY WERE AVAILABLE. WE MADE
PRESENTATIONS TO PROVIDER
GROUPS OTHER STAKEHOLDERS
SOCIAL ASIANS REALLY ANYONE WHO
ASKED FOR OUR TIME WE WANT TO
MAKE A PRESENTATION TO THEM
BOTH FOR US TO SHARE OUR
PROCESS. BUT ALSO TO GET
FEEDBACK FROM ABOUT WHAT IS
IMPORTANT AND WHAT THEY THINK
WE OUGHT TO KEEP IN MIND AS WE
ARE CONDUCTING THE RATE STUDY.
AND THE SECOND PHASE. PROJECT
WE MOVED ON THE DATA COLLECTION
AND ANALYSIS. AND THAT REALLY
INVOLVED INFORMATION BOTH FROM
THE PROVIDER SO WITHIN THE
SYSTEM AS WELL AS INDEPENDENT
DATA SOURCES THAT IS DOWN FROM
OUTSIDE THE SYSTEM. WHEN WE
TALK ABOUT THOSE IN SYSTEM DATA
SOURCES ONE OF OUR PRIMARY
INFORMANTS WAS A PROVIDER SIR
BACK. IS A RATHER COMPREHENSIVE
INSTRUMENTS DESIGNS TO GATHER
INFORMATION RELATED TO
PROVIDERS COSTS. AS WELL AS A
MATTER WHICH THEY'RE DELIVERING
SERVICES TO MIX THAT WERE
UNDERSTANDING THINGS LIKE
STAFFING RATIOS ARE STAFFING
LEVELS THE PRODUCTIVITY OF
STAFF THAT IS TO SAY HOW MUCH
TIME THEY'RE SPENDING ON
BILLABLE ACTIVITIES WERE SADDAM
BILLABLE ACTIVITIES. ULTIMATELY
WE WERE PRETTY PLEASE WITH THE
PARTICIPATION WE HAD NOT
PROVIDER SURVEY WE HAD ABOUT
ELEVEN HUNDRED VENDORS SUBMIT A
COMPLETED SURVEY TO US. IN
ADDITION TO THE VENDOR SURVEY
WE CONDUCTED AN INDIVIDUAL
FAMILY SURVEY ACTUALLY THROUGH
ONE OF OUR SUBCONTRACTORS ON
THIS PARTICULAR ENGAGEMENTS THE
HUMAN SERVICES RESEARCH
INSTITUTE. AND THAT WAS
DESIGNED TO INSURE THAT WE HAVE
AN UNDERSTANDING OF WHAT'S
IMPORTANT TO INDIVIDUALS AND
FAMILY MEMBERS IN THE SYSTEM SO
WASN'T DESIGNED TO CAPTURE
COSTA DATA SO TO SPEAK THAT WAS
GATHERED TO THE PROVIDER
SURVIVE. BUT TO GET AN
UNDERSTANDING ABOUT WHAT THE
VALUE OF THE SYSTEM WHAT THEY
THINK IT'S STRONG POINTS ARE
AND POTENTIAL AREAS FOR
IMPROVEMENT. RECOGNIZING THAT
PROVIDERS COSTS ARE DRIVEN MORE
THAN ANYTHING ELSE BY THE RACE
THEY'RE BEING PAID TODAY WE
ALSO ENDEAVOR TO IDENTIFY WHAT
WE CALL INDEPENDENT SOURCES OF
DATA. SO ONE OF THE THINGS THAT
I KNOW WE SPOKE ABOUT AT SOME
LENGTH DURING THE LAST TIME I
HAD THE OPPORTUNITY TO PRESENT
TO THE SUBCOMMITTEE. WAS
INFORMATION FROM THE BUREAU OF
LABOR STATISTICS WHICH
PUBLISHES. CALIFORNIA SPECIFIC
WAGE DATA FOR A VARIETY OF
OCCUPATIONS. WE LIKE TO USE
THAT AS A INFORMANTS TO OUR
PROCESS BECAUSE IT'S CROSS
INDUSTRY. IT'S NOT RELY TO JUST
ON WHAT DVD PROVIDERS ME DIAZ
FOR BITERS ARE DELIVERING IT
REALLY LOOKS AT. I INDUSTRIES
THAT ARE COMPLYING COMPARABLE
STAFF. BUT IN OTHER SOURCES OF
INFORMATION INCLUDE VARIOUS
FEDERAL PUBLICATIONS ABOUT THE
COST OF HEALTH INSURANCE IN THE
TO THE INDIVIDUAL STATES- WE
USE THE INTERNAL REVENUE
SERVICE'S STANDARD MILEAGE RATE
TO COST OUT TRANSPORTATION
RELATED EXPENSES WE USED
INFORMATION FROM THE- WORKERS
COMPENSATION INSURANCE RATING
BUREAU TO. SET THE WORKERS COMP
RATES AND THE WRESTLING INTO A
VARIETY OF OTHER DATA SOURCES
SIMILAR TO THAT AS WELL THE
IDEA WAS. TO MAKES THAT WE'RE
NOT CREATING A CIRCULAR
ARGUMENTSWERE PROVIDERS COSTS
REFLECTIVE OF THE RACE ARE
BEING PAID TODAY SO. IF WE WERE
JUST CITY SIMPLY BASED. ON
INFORMATION WE WOULD.
EFFECTIVELY END UP IN THE SAME
PLACE WITH THAT WHAT WE
RECOGNIZE THAT THERE WERE SOME.
ISSUES WITH AT LEAST FOR THE
SOURCE CODE. THAT WE THINK
ABOUT THE ADDRESSED. ALSO AS
PART OF THAT GOT A CALL. PHASE
WE DID OF LOT OF WORK TO. READ
DIFFERENCE IN CALL SAYS
EVERYONE IN THIS ROOM CAN. CAL
IS A DIVERSE STATE. AND SO TO
MAKE SENSE FOR US TO SEND A
SINGLE RATE THAT WOULD APPLY TO
EVERY SINGLE. REGION OR AREA OF
THE STATE. INTO THE AREAS WE-
FOCUSED ON A PARTICULAR WERE
WAGE DIFFERENCES. DIFFERENCES
IN TRAVEL REQUIREMENTS OF THE
DISTANCE BETWEEN PROVIDERS AND
THE PEOPLE TO WHOM THEY'RE
DELIVERING SERVICES. AND REAL
ESTATE EXPENSES. WE ACTUALLY
PUBLISHED A SEPARATE COMPANION
PIECE IN MARCH OF TWO THOUSAND
NINETEEN THAT DETAILED EXACTLY
HOW DOES ONE ABOUT THAT SINCE
IT IS SUCH AN IMPORTANT
COMPONENT OF. THE RATE STUDY.
HAVING DONE THAT DATA
COLLECTION ANALYSIS WE MOVED ON
TO THE DEVELOPMENT OF RATE
MODELS. BAND ONE OF THE KEY.
COMPONENTS ARE ONE OF OUR KEY
PRINCIPLES IN THIS WORK WAS TO
MAKE SURE THAT WE WERE
TRANSPARENCY TO THE GREATEST
EXTENT POSSIBLE. SO THAT RESULT
IN ANY RATE PACKET THAT
RECESSED EXCEEDS NOW ABOUT
THREE THOUSAND PAGES BUT WE ARE
NOTHING IF NOT THOROUGH. SO
WE'D OUTLINED OUR SPECIFIC
ASSUMPTIONS OUR DATA SOURCES
AND OUR METHODOLOGY SO THAT
FOLKS CAN RECREATE EFFECTIVELY
OUT AS WE ESTABLISH THE RATES.
AND WE DID THAT BECAUSE IT
REALLY HELPS TO MAKE SURE THAT
THE PUBLIC COMMENT PROCESS WAS
VALUE ADDED IF ALL WE WERE TO
SAY THAT WE THINK RATE OUGHT TO
BE. THIRTY DOLLARS. ON THE WE
WILL GET PROVIDER SAY THAT WE
THINK ARE THE THIRTY FIVE BUT
WITHOUT ANY BASIS FOR-
IDENTIFIED THE DIFFERENCES AND
WHERE WE'VE WAITED WE REALLY
CAN'T HAVE. AND FORM
CONVERSATION ABOUT WHETHER OR
NOT THE THIRTY OR THIRTY FIVE
IS MORE APPROPRIATE. AT SO OUR
PROCESS WE BUILT THREE MODELS
WAS TO BUILD A BASE RATE MODEL.
TO SAY THESE ARE WHAT WE THINK
TO BE. REASONABLE COSTS ARE
DELIVERING SERVICES CONSISTENT
WITH THE STATE'S REQUIREMENTS
AN INDIVIDUAL SERVICE PLANS.
AND THEN FROM THERE WE APPLIED
WE CALLED REGIONAL ADJUSTMENT
FACTORS TO MAKE SURE WE'RE
COUNTING FOR THOSE OUT FOR
MENTION DIFFERENCES IN WAGES
TRAVEL AND REAL ESTATE EXPENSES.
WE DELIVER THOSE RATE MODELS IN
FEBRUARY OF TWO THOUSAND
NINETEEN THAT WAS FOLLOWED
SHORTLY THEREAFTER BY THE
PUBLICATION THE FULL RATE STUDY
MARCH FIFTEENTH OF TWO THOUSAND
NINETEEN. AND THOSE TWO
DELIVERIES KICKED OFF A PUBLIC
COMMENT PROCESS WHICH I KNOW
WILL TALK ABOUT IN MORE DETAIL
LATER ON THIS AGENDA SALAS
PROVIDE A QUICK HIGH LEVEL
OVERVIEW OF. BUT AFTER
PUBLISHING JEFFREY MODELS AND
ALL OF OUR SUPPORTING
DOCUMENTATION WE ENCOURAGED
PROVIDERS AND OTHER
STAKEHOLDERS TO PROVIDE WRITTEN
FEEDBACK TO US ABOUT WHAT IT IS
THEY THOUGHT. WAS WELL DONE WHO
ARE AREAS WHERE THEY THOUGHT WE
SHOULD POTENTIALLY LOOK TAKE A
SECOND LOOK ABOUT THE GIVEN
ASSUMPTIONS. AND AGAIN WILL GO
INTO THE RESPONSE TO THOSE
COMMENTS AND WHAT SOME OF THE
CHANGES WE MADE WERE. IN A FEW
MOMENTS BUT SUFFICE IT TO SAY-
THE COMMENTS TO RESULT IN
LITERALLY DOZENS OF CHANGES TO
OUR RATE MODELS PUBLISHED BACK
IN MARCH. AND RESULTED IN THE
AVERAGE RATE INCREASING BY
ABOUT SEVEN AND A HALF PERCENT-
CERTAINLY SOME RATES INCREASED
BY A GREATER EXPANSE IN
RESPONSE THE PUBLIC COMMENTS
AND SOME. INCREASED BY LESSER
EXTENT OR IN A HANDFUL CASES
ARE ACTUALLY SLIGHT REDUCTIONS
THE RACE BUT OVERALL. WE'RE
LOOKING ABOUT SEVEN AND A HALF
PERCENT INCREASE. IN THE
AVERAGE RATE. AND WITH THAT AS
THE DIRECTOR STAFF MENTIONED-
WE NOW DELIVERED FINAL RATE
MODELS IN RESPONSE THOSE PUBLIC
COMMENTS IN THOSE WERE
PUBLISHED EARLIER THIS MONTH.
WITH THAT I'M HAPPY TO ANSWER
ANY QUESTIONS YOU MIGHT HAVE
ABOUT THE RATE SETTING PROCESS.
OKAY THANK YOU AND- WE WILL BE
COMING BACK TO THE RESPONSE TO
BOTH THE COVER PUBLIC COMES IN
NEXT STEPS IN AND ANOTHER PANEL
I KNOW YOUR BACK YOUR FOR THAT.
THE DOCTOR- SO BUT I DO HAVE
SOME TERMS OF YOUR METHODOLOGY
SO FIRST OF ALL- AT THOSE
QUESTION LA BUT- HE SAID SO HOW
THE DATA THAT'S IN THE- MOST
RECENT. VERSION THAT WAS.
PRESENTED IN JANUARY. IS THAT
IS THE STEP HAS THERE BEEN
UPDATED- GIVEN. FROM THE
ORIGINAL DATA IN TERMS OF- I
UNDERSTAND WAS TWENTY SIXTEEN
DATA THAT YOU WORKED WITH IN
THE BEGINNING SO IT'S ONE KNOW
WHAT. DATA IS BEING USED IN THE
MOST RECENT REPORT. AND NANCY
BARGE MEN- AGAIN MISTER POLICY
CAN GIVE SOME ADDITIONAL DETAIL
BUT AS AS NOTED THAT THE-
PUBLIC COMMENT AND THEN THE
OPPORTUNITY TO PROVIDE SOME OF
THE UPDATED INFORMATION THAT
THAT IS PROVIDED AS THE SOURCE
OF THE UPDATED- GREAT MODELS
AND THE FOR THE FINAL REPORT
THAT WAS POSTED AND SO. IT WAS
BASED ON THAT REGIONALLY ON
SIXTEEN SEVENTEEN AND IT WAS RE
BASED WITH UPDATED INFORMATION
FROM EIGHTEEN NINETEEN I
BELIEVE IS THAT ACCURATE THAT'S
CORRECT AND IT ABOUT
DIFFERENTIATE BETWEEN TWO
POTENTIAL- BLINDS OF
QUESTIONING. THE RATE MODELS
THEMSELVES REFLECT WHAT WE
THINK A REASONABLE COT
ASSUMPTIONS AS OF JANUARY FIRST
OF TWENTY TWENTY. SO WHEN WE
PUBLISHED THREE MODELS IN MARCH
OF TWO THOUSAND NINETEEN OF
COURSE THE IDEA WAS THE SOONEST
THE MOST OPTIMISTIC THE MOST
OPTIMISTICALLY THAT COULD BE
IMPLEMENTED WAS IN. THE FISCAL
YEAR AND NOW FISCAL YEAR
NINETEEN TWENTY AND WE CHOSE
THE MID POINT OF THAT FISCAL
YEAR. AND SO AS PART OF OUR
UPDATING THE RATE MODELS WE DID
LOOK TO SEE IF NEW DATA HAD
BEEN PUBLISHED IN OF COURSE IN
THE SPAN OF ALMOST TWO YEARS
THAT WAS THE CASE SO WE USE NEW
BLS DATA. WE USE NEW
INFORMATION FROM THE W. C. I.
R. B. WE USE THE IRS'S FINAL
PUBLICATION FOR THEIR STANDARD
MILEAGE RATE IN TWENTY TWENTY.
THAT BEING SAID THE RIGHT MODEL
STILL REFLECT WE THINK OF THE
COSTS AS OF JANUARY TWENTY
TWENTY INCLUDING BY STATE WHY
MINIMUM WAGE OF THIRTEEN
DOLLARS AN HOUR. SO IF THE
RIGHT MODELS WERE TO BE
IMPLEMENTED IN THE FUTURE YEAR.
LIKELY WE WOULD NEED TO TAKE A
LOOK AT SOME OF THOSE
ASSUMPTIONS INFLATE THEM
FORWARD TO JANUARY TWENTY
TWENTY ONE OR TWENTY TWENTY TWO
OR AT WHATEVER STAGE. OF THE
STATE WOULD CHOOSE TO IMPLEMENT
THE RATE MODELS SO THAT'S WHAT
THE RATE MODELS REFLECT ON THEM
AS THE DIRECTOR MENTION AN AS
MISS PADDOCK MENTIONED IN TERMS
OF THE FISCAL IMPACT ANALYSIS
THAT WAS BASED UPON ANALYSIS OF
FISCAL YEAR SIXTEEN SEVENTEEN
CLAIMS THE CLAIM TO DRIVE THE
RATE MODELS BUT IT TO DRIVE THE
FISCAL IMPACT ANALYSIS. AND WE
TALK A LITTLE BIT WE'LL TALK A
LITTLE MORE ABOUT THAT I THINK
LATER IN THE PRESENTATION ABOUT
SOME OF THE UPDATES TO HOW WE
FORECAST THE FISCAL IMPACT OF
THAT ON YOUR SPECIFIC QUESTIONS
AT THE END OF THE AGENDA. BUT
IT IS NOW UPDATED TO REFLECT
CLAIMS DATA BECAME AVAILABLE TO
US AFTER THE PUBLICATION MARCH
OF TWO THOUSAND NINETEEN. AND
AN YEAH I KNOW YOU CAN TELL A
LOT MORE PUBLIC BUT I THINK THE
SS DEUCE SIR IF THE STUDY
ITSELF THE OF THE CHARGES FOR
THE STUDY WAS AROUND THE ISSUE
OF. BE SURE YOU HAVE AN
ADEQUATE SUPPLY OF PROVIDERS IN
YOUR METHODOLOGY DEVELOPING THE
STUDY HOW DID YOU TRIED TO DO
YOU DRESS THAT OR DID YOU TO
ADD TO. THE OP THAT ISSUE IN
TERMS OF YOUR DESIRE. BOB YOUR
DESIGN AND OUT NOW THE RESULTS
IS A ARE YOU DID. STEPPING
ADDRESS YOUR YOUR MIND AS THE
PERSON WHO DID IT. SO IN MY
MIND WE CERTAINLY DID TRY TO
TAKE THAT INTO ACCOUNT THE-
RATE STUDY DOES NOT. RECOMMEND
OR SUGGEST A SPECIFIC QUANTITY
OF PROVIDERS WERE A RATIO OF
THE NUMBER OF PROVIDERS TO
INDIVIDUALS RECEIVING SERVICES
THERE ARE NO NATIONAL STANDARDS
IN THOSE REGARDS. IF YOU TAKE A
LOOK AT THE FEDERAL RULES
AROUND ACCESS TO SERVICES IT
TALKS ABOUT THAT FOLKS ON
MEDICAID OUGHT TO HAVE ACCESS
TO SERVICES COMPARABLE TO THOSE
ON PRIVATE INSURANCE. BUT
THAT'S REALLY CHALLENGE AND THE
X. CBS ENVIRONMENT RIGHT THAT
MAKES A LOT OF SENSE WE'RE
TALKING HOSPITAL RATES ARE
POSITION RATES BECAUSE PEOPLE
HAVE PRIVATE INSURANCE FOR
HOSPITALIZATIONS OR POSITIONS.
THERE REALLY IS EFFECTIVELY NO
PRIVATE MARKET FOR HOME AND
COMMUNITY BASED SERVICES WE
DON'T HAVE A STANDARD BY WHICH
WE CAN MEASURE ACCESS TO CARE
QUITE AS EASILY. AS WE DO WHEN
WE DO ACCESS TO CARE STUDIES IN
OTHER STATES FOR- YOUR
TRADITIONAL MEDICAID SERVICES.
THAT BEING SAID WE ENDEAVOR TO
BUILD RATE MODELS THAT WE AS I
MENTIONED DURING MY REMARKS
WERE REFLECT ABOUT THE COST OF
DELIVERING SERVICES. SO WE TO
TAKE IN ACCOUNT THINGS LIKE
REGIONAL DIFFERENCES AND ONE'S
RECOGNIZE THAT THE COST OF
LIVING SERVICES IN THE BAY AREA
IS DIFFERENT THAN THE COST OF
DELIVERING SERVICES. INLAND FOR
EXAMPLE WE THINK THROUGH HAVING
RATES THAT ARE REFLECTIVE OF
THOSE COSTS THAT OUGHT TO BE
SUFFICIENT TO SUPPORT AN
ADEQUATE SUPPLY PROVIDERS I
THINK THAT'S SOMETHING THAT. IS
WORTHWHILE CONTINUE TO MONITOR
OVER TIME AND CERTAINLY YOU
KNOW THE LEGISLATURE THE
EXECUTIVE HAVE BEEN CRITICALLY
INTERESTED IN DISPARITIES IN
ACCESS TO SERVICES. BASED UPON
DIFFERENT LINGUAL- RACIAL
ETHNIC GROUPS AND CERTAINLY I
THINK. IT'S WORTHWHILE TO
CONTINUE TO MONITOR THAT ACCESS
AS WELL AS ACCESS ON A
GEOGRAPHIC PERSPECTIVE. YEAH ME
MADE REFERENCE TO. SAY NO SIR
THINGS ARE. IF THERE. HAD
HEALTH CARE RELATED TO MEDI CAL
RATES AND WE HAVE WON THE
LOWEST MEDICAL RATESIN THE
WHOLE COUNTRY AND I THINK
THERE'S A LOT OF. IN FACT MANY
OF THE PEOPLE WHO ACTUALLY
DELIVER MEDICAL SERVICES. GET
ADDITIONAL SUBSIDIES. FROM THE
FEDERAL GOVERNMENT SO WHERE
DOES MEDI CAL RATES USE FOR
THOSE PARTICULAR SERVICES. ARE
WHERE THEY ADJUSTED FOR ACTUAL.
PAYMENT AND THAT FULL PAYMENT
NOT JUST THE MEDI CAL RATE. SO
WHEN WE PUBLISHED THE REYES
CITY BACK IN MARCH FOR A NUMBER
OF WHAT WE TERM TO PROFESSIONAL
SERVICES THOSE ARE SERVICES
DELIVERED BY- FOLKS THAT
ORDINARILY LICENSED OR
CREDENTIAL THINGS LIKE
THERAPIES- OF A LOT OF THE-
SPECIALIZED THERAPEUTIC
SERVICES AS WELL AS ADAPTIVE
SKILLS TRAINING AND THE NUMBER
OF SERVICE. FALL UNDER THE
UMBRELLA UP INTO DEVELOPMENTS
AS YOU KNOW WE DID PROPOSED TO
TIE THOSE RATES TO THE RATES
PAID ON UNDER THE MEDICARE FEE
SCHEDULE AT LEAST FOR FEE OR
SERVICE- WITH THE OPPORTUNITY
FOR THE REGIONAL CENTERS TO
OFFER ABOUT A 40% ENHANCEMENT
WHICH WAS CONSISTENT WITH
ANOTHER PROGRAM AT THE MUCH
SMALLER PROGRAM. HERE IN
CALIFORNIA. IN RESPONSE TO
PUBLIC COMMENTS THAT
METHODOLOGY WAS WITHDRAWN AND
RATHER THAN TIME RATES TO THE
MEDI CAL FEE FOR SERVICE
SCHEDULE WE DID ACTUALLY
DEVELOP RATE MODELS FOR- THOSE
THAT HAD BEEN ORIGINALLY
PROPOSED TO BE TIED SO THERE
ARE NOW RATE MODELS FOR
SPECIALIZED THERAPEUTIC
SERVICES TO LIVE UNDER SERVICE
CODES ONE FIFTEEN ONE SIXTEEN
ONE SEVENTEEN. ADAPTIVE SKILLS
TRAINING AND INFILL DEVELOPMENT
SERVICES THEIR INDEPENDENCE OF
THE MEDI CAL RATES. OKAY
BECAUSE I MEAN I THINK. TALK
ABOUT CIRCULAR. RIGHT NOW ARMS
ARE MEDICAL RATES ARE NOT BASED
ON MARKET IS THERE IN FACT-
THERE'S ACTION EXPECTATION THAT
PROVIDERS TO PROVIDE MEDICAL
SERVICES ARE SUBSIDIZED- FROM
REIMBURSES THEY'RE GETTING FROM
COMMERCIAL OR THEY ARE CLINICS
THAT CAN GET YOU KNOW AGAIN-
PROTECTED PAYMENT THERE ARE
OTHER TYPES OF ADJUSTMENTS-
THAT THAT ACTUALLY NHANCE
THEIR REIMBURSEMENT SO SOON IS
THE CHAIR SUBCOMMITTEE OVERSEES
MEDI CAL QUITE AWARE. AND ALSO
AS A MEDICAL PROVIDER IS A
PEDIATRICIAN- SO LET THE SO I
THINK IT'S IMPORTANT WE MAKE NO
TO THOSE THINGS- WHEN IT COMES
TO IN TERMS OF YOU SAID YOU
DEVELOP THESE RATE MODELS. HOW
SO WITH IT LIKE A ONE IS ISSUES
THAT- ALSO LOOKING AT WAS THE
STATS- TRYING TO RATIONALIZE
THE PAYMENT SYSTEM AS WE HEARD
FROM OHIO IT'S A IT'S A- SO
WHAT KIND OF WORK DID YOU DO SO
YOU TALKED ABOUT THE VARIOUS
METHODOLOGIES TRY TO COME UP
WITH THE AMOUNTS AND SO FORTH
BUT IN TERMS OF ACTUALLY TRYING
TO BETTER RATIONALIZE THE
PAYMENT SYSTEM IN THESE-
WORKING CAN YOU DESCRIBE ABOUT
THE- HOW HE CAME ABOUT- DOES
SUCH RECOMMENDATIONS. SHORT SO
I THINK THE REALLY TWO PRIMARY
THINGS THAT WE SOUGHT TO DO IN
RESPONSE THAT PARTICULAR
REQUIREMENT A. B. X. TWO ONE.
FUNDAMENTALLY WE DID WANT TO
ESTABLISH RATES THAT ENSURE
THAT PROVIDERS DELIVERING THE
SAME SERVICE WITHIN THE SAME
REGION RECEIVE THE SAME RATE.
AND SO HAVING SPENT A FAIR
AMOUNT OF TIME LOOKING AT
ACTUAL CLAIMS DATA THERE ARE.
SIGNIFICANT DIFFERENCES WITHIN
A REGIONAL CENTER AND THEN
BETWEEN REGIONAL CENTERS EVEN
THOSE THAT ARE A JOINING AND
THE RATES PAID TO PROVIDERS. SO
THERE MIGHT BE A PROVIDER
THAT'S DELIVERING A SERVICE AND
BEING PAID FORTY DOLLARS AN
HOUR AND A PROVIDER IS
LITERALLY DELIVERING THE SAME
SERVICE WITHIN THE SAME REASONS
BEING PAID TWENTY FIVE DOLLARS
PER HOUR. SO THE MOVEMENT TO
STANDARDIZE BE SCHEDULE WOULD
ENSURE THAT A MORE LEVEL
PLAYING FIELD FOR VENDORS
ACROSS THE STATE NOW AGAIN WE
ON THE STATE WIDE RATE BECAUSE
AS I MENTIONED IN AS EVERYONE
ACKNOWLEDGES THE TOSS IN THE
BAY AREA ARE DIFFERENT ON THE
COST. MORE INLAND SO THAT WAS
THAT THE FIRST THING WE WANTED
TO DO WAS TO- INSURE MORE
PARITY AND THERE'S COURT
REASONS WHY THESE THINGS HAVE
TRANSPIRED OVER TIME IN TERMS
OF THE RATE FREEZE IS WHEN
PEOPLE BEGAN DELIVERING
SERVICES SO. THAT'S NOT MEANT
AS A NET CRITICISM NECESSARILY
BUT JUST NOT SURVEYS AND THERE
WAS A LOT OF INEQUITY. IN THE
SYSTEM AND THE DEVELOPMENT OF
THE STANDARDIZED RATES IS
INTENDED TO ADDRESS THAT SOME
OF TO. CREATE A MORE RATIONAL
SYSTEM. BUT THAT THE RATES OF
THE- INCLUDE AND STILL
CONTINUES TO INCLUDE ALTHOUGH
PER. NOT TO. THE SAME DEGREE
WHAT. MORE APPROPRIATE. SOME
SERVE CODES CALIFORNIA HAS FROM
AND IT SYSTEM PERSPECTIVE ONE
THE MORE COMPLEX- SERVICE
DELIVERY SYSTEMS- IN TERMS OF
THE NUMBER OF DIFFERENT
SERVICES THAT ARE IDENTIFIED
AND SOUGHT THAT. OTHER STATES
ARE PROVIDING SIMILAR SUPPORTS
BUT THEY'RE DOING IT UNDER A
PATIENT'S LESTER NUMBER OF SORT
WHAT YOU WOULD CALL SERVICE
CODE SO. WHERE APPROPRIATE WE
DID LOOK TO COLLAPSE SERVICE
CLOSER- SEEKING TO ACCOMPLISH A
SIMILAR TASK INTO A SINGLE
SERVICE CODE SO WE DON'T HAVE.
PAID A SITUATION WHERE. AGAIN
WE HAVE TO PROVIDERS DOING
EFFECTIVELY THE SAME THING I
WANT PROVIDERS DOING IT UNDER
SERVICE CUTBACKS IN ANOTHER
PROVIDERS DOING UNDER SERVICE
CALLED WHY IT MADE SENSE THAT A
FOUR DOOR. BUT IT. THIS CODE.
ACTIVITY IN JEW SO IT'S CONCEPT
OF BASED BUDGETING AND WAS THAT
CAN OUR COURT IN DEVELOPING THE
RIGHT MODELS. BUT FOR THE YEAH
SO REGARDING EXPLORING
ALTERNATIVE MODELS OF PAYMENT-
THOSE ARE CONTINUE
CONVERSATIONS TO THIS IS THE
THAT WAS A ROCK SIDES EYES
ENCLAVE IN TERMS OF FLEX INTO
ALL IN THE CURRENT RATE STUDY
YEAH WAS ALSO TAKING A LOOK
AT YOU KNOW WITHIN- AND AS
MISTER PULASKI HAD IDENTIFIED
THE FEE FOR SERVICE- SO IT
WASN'T ATTACHED TO THEN. OKAY
TO SERVICE OUTCOMES
SPECIFICALLY AND SO THOSE ARE
THAT CONTINUE CONVERSATIONS TO
HAVE OKAY SO IT WILL WILL GET
BACK TO THEM THEY'LL PADS
WONDERING TO WHAT DEGREE WAS
THAT DO DEAL WITH IT'S YOU WERE
DEVELOPING THIS THIS STUDY
THAT'S PRESENT A WEEK YEAH YEAH
THANK YOU WE WHAT WE DID DO IS
THAT WE DID TAKE A LOOK AT
OTHER HELP OTHER STATES ARE HOW
OTHER. SYSTEMS HAVE AN APPROACH
IN DELAY OF PAYMENT MODELS OKAY
AND SO CONSIDERING ALL OF THE
FACTORS IN CONSIDERING KIND OF
THE PRIORITIES WITHIN THE RATE
STUDY THOSE ARE THE THINGS THAT
WERE WERE VIEWED AND BY YOU
WAITED. ON ANYTHING IT JUST. A
SOUND TO DIRECTOR MARGINS FROM.
AS SHE NO WE DON'T HAVE. A SET
OF AT THE FOR BUT OUTCOMES THE
NOT TIE PAYMENTS THOSE OUT. BUT
WE DIDN'T ENDEAVOR TO BUILD
RATES THE REFLECTIVE OF SYSTEM
VALUES SELF FOR EXAMPLE TO DOES
TO GIVE YOU A COUPLE. FOR
TWENTY TODAY STATE PROGRAMS WE
SET A SEPARATE FEES FOR
SERVICES DELIVERED IN A CENTER
AND HIGHER RATES FOR SERVICES
DELIVERED IN THE COMMUNITY
BECAUSE- AS A SYSTEM. I THINK
THERE IS WIDESPREAD AGREEMENT
THAT THE MORE INTEGRATED THE
SERVICE THE BETTER IT IS FOR
THE INDIVIDUAL. AND SO WE HAVE
HIGH RATES FOR THOSE COMMUNITY
BASED SERVICES IT'S NOT
MEASURING- SPECIFIC. COME OTHER
THAN ARE WE SPENDING MORE TIME
IN THE COMMUNITY. ONE OF THE
THINGS THAT WE HAD IN THE RATE
BUDDY IS PROPOSE. DIFFERENT
WORDS THE ROBBERY SAY WILL BE
IMPLEMENTED WHAT. IS THE
ADOPTION OF A TEAR D. S. P.%
SYSTEM WITH THE IDEA BEING
THAT. FOR THOSE DIRECT SUPPORT
PROFESSIONALS WHO ARE RECEIVING
MORE TRAINING AND HAVE HIGHER
SKILLS GO THROUGH SOME SORT OF
CREDENTIALING PROCESS. THE
BEHIND A REIMBURSEMENT. IT. A
IT'S NOT MEDI BRING CIVIC UP
PERCENT. WE'RE TAKING A AN OFF
COLOR FACE. THAT IF WE MORE
QUALIFIED STAFF DELIVERING
SERVICES LIKELY THERE TO LIVE
HIGHER. SERVE IN THEIR FOR
CHEAP. BETTER OUTCOME. FOR
INDIVIDUAL SO THE BEST DRUG
DEPARTMENTS OTHERS ONGOING
CONVERSATIONS ABOUT HOW IT IS
WE CAN CONTINUE TO IMPLEMENT
MORE VALUE BASED OPPORTUNITIES
AND DDS IS ACTUALLY DONE SOME
OF THIS WORK EVEN BEFORE THE
RACE ARE THEY HAVE. VALUE BASED
PAYMENTS FOR EMPLOYMENT
SERVICES FOR EXAMPLE THEY MAKE
BUT I WOULD REFER TO AS KICK
PAYMENTS. ONE VENDORS ARE
SUCCESSFULLY ABLE TO MOVE
SOMEONE INTO A PLAN IS A KIND
OF GET A IN CENTER BONUS
PAYMENTS BECAUSE THAT'S A
EASILY TO FIND OUT CON. U.
LASTLY PART OF THE RACE IDEAS.
WITH KNOWLEDGE AND THAT WE NEED
TO. WALK BEFORE WE CAN RUN SO I
LIKE TO WEAR THAT USED A MOMENT
AGO ABOUT RATIONALIZING THE
SYSTEM IN A LOT OF THAT WE IS
FOUNDATIONAL. IN ORDER TO GET
TO ALTERNATELY A MORE OUTCOME
MORE VALUE BASED SYSTEM. RIGHT
OKAY I KNOW THAT SOMETIMES IT'S
THE LINE BETWEEN WHICH FIVE SO
JUST TRY UNDERSTAND. WHERE WHAT
WENT INTO THE RATE STUDY AND SO
FORTH AND I READ SOME OF IT
STARTS BLEEDING OVER A LITTLE
BIT SO. WELL MAYBE WILL DO THE
POTS HERE- TO BE WILL BRING UP
OR STAKEHOLDERS AND THEN HAVE
YOU COME BACK IN AND WE CAN
START BUILDING MORE INTO WHAT.
FOR DEPARTMENTS PLANE TO GO.
WITH THE STUDY SO THANK YOU
VERY MUCH FOR YOUR
PRESENTATIONS WE- LOOK FOR
THEIR YOU BACK. OKAY SO LET'S
MOVE ON TO THE NEXT PANEL WE
HAVE OUR SERVICE PROVIDERS- DR-
CHILL ROGERS- USING VECTORED
EARLY LEARNING INSTITUTE.
LAURIE ANDERSON PRESIDENT CEO
OF UNITED CEREBRAL PALSY WALKS
INTO LISTEN TURN SANTA BARBARA.
COUNTIES AND KEVIN WRATH EXACT
ACTOR MINNOWS. OKAY WELCOME.
YES WE CAN TAKE IN THAT ORDER
UNLESS YOU WANT TO GO IN A
DIFFERENT ORDER. ALRIGHT OKAY
DOCTOR ROGERS WELCOME. OKAY SO
GOOD MORNING- I AM DOCTOR
MISTER ROGERS AND- SO I CAN TRY
TO STAY WITHIN MY FIVE MINUTES
I'M GOING TO READ TO YOU AND
SO- PROJECTS FOR THAT- FIRST
I'D LIKE TO THANK YOU FOR
ASKING THREE MINUTES CITY CAD
MODELS BUT LACKS QUICK OKAY
WILL HAVE MORE TIME FOR
QUESTIONS SO YOU CAN SEE IS
THAT- I'D LIKE TO THANK YOU FOR
THIS OPPORTUNITY TO SPEAK ABOUT
SUCH AN IMPORTANT TOPIC. THE
RATE STUDY PRESENTS IS ALWAYS
THE OPPORTUNITY TO REALLY
REFLECT ON HOW WE'VE ORGANIZED
A DDS SERVICE DELIVERY SYSTEM
AND HOW WE MEET THE NEEDS BOTH
OF THOSE TO RECEIVE SERVICES IN
THOSE TO PROVIDE THE SERVICE MY
AREA OF EXPERTISE IS
SPECIFICALLY AROUND SERVICES TO
INFANTS AND TODDLERS RECEIVING
EARLY INTERVENTION SERVICES ON
THE FOUNDING PARTNER AND
EXECUTIVE DIRECTOR OF THE EARLY
LEARNING INSTITUTE A VENDOR
AGENCY PROVIDING SERVICES TO
NEARLY FOUR HUNDRED FAMILIES
AND SONOMA COUNTY. I'M ALSO
CALIFORNIA'S AMBASSADOR TO THE
CENTER FOR DISEASE CONTROL'S
LEARN THE SIGNS ACT EARLY
PROGRAM I'M OF. I A NUMBER OF
FIRST COMMISSIONER. AND I HAVE
FOUR GRAND CHILDREN ALL UNDER
THE AGE OF FOUR ONE WHO
CURRENTLY HAS AN I OFFICE BE IN
AS A RECEIVING SERVICES. SO I
AM HEAVILY INVESTED IN THIS. WE
THE SERVICE PROVIDERS OF EARLY
INTERVENTION ACROSS THE STATE
HAVE ALWAYS MADE IT WORK WE
SOMEHOW SOMEWAY FIND MANY FOR
THE BABIES WERE SUPPOSED TO
SERVE AND WHILE I'M VERY
GRATEFUL THAT EARLY
INTERVENTION SERVICES ARE NOW
BEING INCLUDED IN THE TEMPORARY
RATE INCREASES SHOULD THE
GOVERNOR'S PROPOSED BUDGET
PASSED I'M VERY. PROGRAMS ARE
LOSING EXPERIENCED TEACHERS
THEIR SHRINKING OR THEY'RE
CLOSING UP ALL TOGETHER MY OWN
PROGRAM LOS THREE VERY VALUABLE
TEACHERS IN THE PAST YEAR ALL
OF WHOM HAVE MOVED TO ARIZONA
WHERE THE PAY IS HIGHER AND THE
COST OF LIVING IS LOWER I'M NOT
TELLING BUT ALREADY KNOW WE
NEED TO FIND A WAY TO INCREASE
WAGES FOR PEOPLEIN THIS FIELD
SO WE CAN KEEP THE ONES WE HAVE
AN ATTRACT NEW TEACHERS AND WE
NEED TO FIND IT QUICKLY AS OUR
GOVERNOR IS PUTTING MORE MONEY
THIS IS AN EARLY CHILDHOOD.
LAST YEAR THE LEGISLATURE
PASSED AB ELEVEN WHICH REQUIRES
DEVELOPMENTAL AN EARLY
CHILDHOOD SCREENING IN THE
MEDICAL SYSTEM. AND WE'RE ALL
THESE KIDDOS HEADED THEY'RE
HEADED INTO EARLY INTERVENTION.
A SYSTEM WHICH IS ALREADY
FRANTICALLY TRYING TO KEEP
PACE. IT DOESN'T SEEM LIKE A
WELL THOUGHT OUT PLAN TO
INCREASE FUNDING TO FIND
CHILDREN WHO NEED SERVICES
WITHOUT INCREASING FUNDING TO
THE ACTUAL SERVICES. I'VE SPENT
A GREAT DEAL OF TIME LOOKING AT
THE RATE STUDY. BOTH THE FIRST
VERSION AND NOW THE REVISED
VERSION AS IT PERTAINS TO EARLY
INTERVENTION SERVICES. AS YOU
KNOW THE FIRST VERSION
CONTAINED MANY FLAWS AND EARLY
INTERVENTION WAS ACTUALLY LEFT
OUT OF THE RATE TEMPORARY RATE
INCREASES. THE REVISED VERSION
IS BETTER BUT IN MY OPINION
THERE ARE STILL SIGNIFICANT
ISSUES. I'LL TRY TO STAY OUT OF
THE WEEDS WITH YOU. BUT THE E.
EYES BUT BUT THE MOST GLARING
THING FOR ME IS A PRODUCT THE
ADJUSTMENTS THAT INDICATES A
FULL TIME EARLY INTERVENTION
SPECIALIST CAN BILL. LITTLE OF
TWENTY HOURS A WEEK. AND
CLIENTS I'VE EVER. HAVE A CAN
20% CANCEL RATE GIVEN ALL THE
THINGS FAMILIES WITH THE CHILD
IS SPECIAL NEEDS MUST DEAL
WITH. THERAPIES ILLNESSES
DOCTOR APPOINTMENTS
HOSPITALIZATIONS EXCITER. THE
WAY WE SET UP THE PAYMENT
SYSTEM. IS THAT IF WE DON'T SEE
THE CHILD WE CAN'T BILL- ANNA
PRODUCTIVITY FACTOR TWENTY
THREE BILLABLE HOURS GIVEN THE
20% CANCELLATION RATE
TRANSLATES INTO CASE LOADS OF
TWENTY FIVE TO TWENTY NINE
CLIENTS. THIS IS NOT A
REASONABLE EXPECTATION FOR A
FORTY HOUR. WEEK WORKLOAD AND
CERTAINLY NOT DOABLE IN THE ONE
TO ONE HELP ME SETTING THE LAW
REQUIRES. THE RATE STUDY ALLOWS
A LOT TO PROXIMALLY FIVE HOURS
PER WEEK OF DRIVE TIME THREE
HUNDRED MINUTES. THAT'S TEAM
MINUTES PER VISIT IF WE STAY
WITH THEIR TWENTY THREE VISITS
PER WEEK. WHICH IN OUR WORLD
COUNTY IS NOT DOABLE AND IT'S
ALMOST LIKE A BOY. SANDERS STE.
I'M IT. VERSUS VERY VERY
COMPLICATED. BUT COMPLICATED
NOT MEAN BROKEN IT MEANS THAT
WORKING WITH INFANTS AND
TODDLERS IS NEW ONES. AND IT
TAKES MORE TIME IN REALITY THAT
ON PAPER. ANY PARENT WHO'S EVER
TRIED TO GET OUT OF THE DOOR IN
THE MORNING WITH A TODDLER
KNOWS THIS. AND EVERYTHING
TAKES LONGER THAN WE THINK IT
WELL. ANOTHER SIGNIFICANT ISSUE
FOR US IS THE PROPOSED RATES
OCCUR IS A CRISIS SORRY ANOTHER
SICK NEED ISSUES AT THE
PROPOSED RATES. IS IT ACROSS
THE BOARD ADMINISTRATION COSTS
ALLOWANCE OF TWELVE PERCENT. I
RUN A PRETTY TIGHT SHIP AND I
STILL CAN'T GET OUR ADMIN COSTS
DOWN BELOW FIFTEEN PERCENT. AND
MORE TYPICALLY IT'S 18%
LIABILITY AND PROPERTY
INSURANCE WENT UP ALMOST 56%
FOR US FROM NINETY TWO THOUSAND
AND NINETEEN TO TWO THOUSAND
AND TWENTY. DUE PRIMARILY TO
THE CONTINUING NATURAL
DISASTERS IN OUR AREA. WORKERS
COMP WENT UP 40% OVER THE PAST
TWO YEARS RENT GOES UP 3% A
YEAR IF. I COULD GO ON. WHEN I
LOOK AT THIS PERCENTAGE AND I
LOOK AT THE DAILY OPERATION
COST OF TEN DOLLARS PER DAY PER
FULL TIME EARLY INTERVENTION
SPECIALIST I WONDER HOW LONG
AGENCIES LIKE MINE WILL SURVIVE.
ANY FROM SINGLE SINGULAR
INDEPENDENT CONTRACTORS TO THE
REGIONAL CENTER WILL BE THE
ONLY SERVICE PROVIDERS LEFT.
WHO CAN AFFORD TO WORK ON AT
THE PROPOSED RATES. IT MIGHT
SAVE MONEY BUT I BELIEVE IF WE
LET THIS HAPPEN WE WILL BE LEFT
WITH THE SYSTEM OF FRAGMENTED
UNSUPERVISED AN UNSUPPORTED
PROFESSIONALS. A LITTLE QUALITY
CONTROL ONE MORE THING. THE
RATE REFORM COMMITTEE DID A
TREMENDOUS JOB AND THE
CONSULTANTS PROVIDED US ALL
WITH THE BASIC ROAD MAP. BUT
NOW THAN MATT NEEDS WORK AND I
BELIEVE IT NEEDS WORK FROM THE
PROFESSIONALS WHO KNOW THEIR
OWN TERRITORY ONE SUBCOMMITTEE
THIS GOING TO DEAL WITH THE
WHOLE SYSTEM OF CARE I DON'T
BELIEVE CAN COME WITH UP WITH A
QUICK IMPLEMENTATION SYSTEM.
BUT WE HAVE TO DO SOMETHING SO
I'M PROPOSING THAT YOU THINK
ABOUT. IMPLEMENTATION
SUBCOMMITTEES BASED ON THE
SERVICE DELIVERY PROFESSIONALS
IN THAT SYSTEM THE LEARNING
CURVE WOULD BE LESS STEEP. OKAY
THANK YOU AND AGAIN WILL HAVE
AN OPPORTUNITY QUESTIONS I WILL
TELL YOU IS A PEDIATRICIAN TO
SEIZE MEDI CAL PATIENTS OUT GET
PAID FOR THE PATIENTS I SEE AN
ASSET CANCELLATION RATES SO.
HAVE YOU TALKED TO THE EIGHT CS
ABOUT THIS TOO. SO ALL RIGHT
THANK YOU WELCOME. GOOD MORNING
MY NAME IS LAURIE ANDERSON ON
THE PRESIDENT AND CEO OF UNITED
CEREBRAL PALSY OF LOS ANGELES
VENTURE AND SANTA BARBARA
COUNTIES. YOU SEE P. LA IS ONE
OF THE LARGEST PROVIDERS IN
SOUTHERN CALIFORNIA I'M ALSO A
MEMBER OF THE LA COALITION OF
SERVICE PROVIDERS WHICH
CONSISTS OF EIGHTEEN AGENCIES.
WHO COLLECTIVELY SERVED MORE
THAN TWENTY ONE THOUSAND OF
YOUR CONSTITUENTS WITH
DISABILITIES I ALSO SIT ON THE
DS TASK FORCE AND THE FISCAL
REFORM COMMITTEE. I COMMEND DDS
AND DIRECTOR NANCY PARCHMAN FOR
THE WORK ON THE RATE STUDY IN
THE TRANSPARENCY THROUGHOUT THE
PROCESS. THE RATE STUDY IS A
FAIR IS FAIRLY SOLID IN IN
ALIGNMENT WITH HOME AND
COMMUNITY BASED SERVICES. THIS
REPORT DOES DOCUMENTED DEFICIT
IN FUNDING OF COMMUNITY BASED
SERVICES OF ONE POINT EIGHT
BILLION DOLLARS I DO WANT TO
THANK THE ADMINISTRATION AND
LEGISLATOR FOR RECOGNIZING THE
IMPORTANCE. AND MAKING AN
INITIAL INVESTMENT INTO THE
SYSTEM. WELL WE COULD USE THIS
HEARING TO DISCUSS THE DETAILS
OF THE STUDY I BELIEVE. WE MUST
INSIST- WE MUST INSTEAD DISCUSS
THE IMPORTANCE OF MAKING A
COMMITMENT TO BEGIN PROVIDING
THESE NEEDED RESOURCES. WHAT WE
KNOW WAS MORE THAN EIGHTY CENTS
OF EVERY DOLLAR SPENT FOR
COMMUNITY BASED SERVICES GOES
DIRECTLY OUT OF TO THE
WORKFORCE MOSTLY THE DIRECT
SUPPORT PROFESSIONALS. THE RATE
STUDY DOES DOCUMENTED THAT MUCH
OF THE ADDITIONAL FUNDING IS
NECESSARY TO SLOW DOWN THE
MIGRATION OF THE WORK FORCE
FROM SUPPORTING INDIVIDUALS TO
WORKINGOTHER JOBS SUCH AS IN
RESTAURANTS AND THINGS LIKE
THAT. IT IS NOW COMMON
KNOWLEDGE THAT THE TURNOVER
RATE AMONG PROVIDERS IS
APPROXIMATELY 45% EACH YEAR.
FILLING AND RETAINING EMPLOYEES
TO SPEAK TO SUPPORT PEOPLE
SAFELY WHILE MEETING THE
REQUIREMENTS OF HOME AND
COMMUNITY BASED SERVICES IS A
DAILY STRUGGLE FOR PROVIDERS.
MY RECOMMENDATION IS THAT THE
ADMINISTRATION AND LEGISLATOR
EXCEPT AND ACT UPON THE RATE
STUDY CONCLUSION. THAT A MAJOR
INVESTMENT IS NECESSARY AND
THAT WE FOCUS THOSE RESOURCES
ON REBUILDING OUR SYSTEM. IT IS
IMPORTANT THAT WE UNDERSTAND
THIS REFORM WILL NOT HAPPEN ALL
RIGHT. NEEDS TO BE A FULL
PROCESS. FOR EXAMPLE THE
DEPARTMENT OF JUSTICE IN THE
STATE OF OREGON IS IN ITS FIFTH
OUT OF THE SITE YOUR PLATE OF
ENSURING ACCESS COMMUNITY BASED
SERVICES. FOR IT IT WILL THE
BILL. THAT THINK THROUGH.
KNOWING THAT THANK. TO BE TO ON
THE STATE BUDGET IT IS VITAL
THAT WE CONTINUE TO WORK
TOGETHER TO COME UP WITH
SOLUTIONS THAT DELIVER ON
CALIFORNIA'S PROMISE. TO
DELIVER SERVICES FOR
INDIVIDUALS WITH INTELLECTUAL
AND DEVELOPMENTAL DISABILITIES
AND I THANK YOU FOR THIS
OPPORTUNITY TO. THE CHIEF
WELCOME. MORNING MY NAME IS
KEVIN ROTH I'M THE CRIPS.
NAME'S KEVIN RATHNAM EXECUTIVE
DIRECTOR MODELS AT MINUS WE
EMPLOY OVER SIXTEEN HUNDRED
DIRECT SUPPORT PROFESSIONALS
SERVING MORE THAN SIXTEEN
HUNDRED INDIVIDUALS AND THE SAN
FRANCISCO EAST BAY. I'M ALSO ON
THE BOARD OF DIRECTORS FOR THE
CALIFORNIA SUPPORT LIVING
NETWORK AND ON THE PATH FOR
COLLABORATIVE. I'VE WORKED
EXTENSIVELY ON THE STATE. A
RATE STUDY AND BELIEVE IT'S A
CRITICAL STEP TOWARDS NEEDED
REFORM AND I WAS ASKED WHAT IS
MY OPINION ON HOW TO MOVE THE
RATE STUDY FORWARD. WELL THE
REST OF THE CLEARLY SHOWED A
HUGE ONE POINT EIGHT BILLION
DOLLAR DEFICIT IN SERVICES FOR
PEOPLE WITH DEVELOPMENTAL
DISABILITIES BUT IN SOME WAYS
THE RATE STUDY WAS THE EASY
PART OF REFORM. WE ALREADY KNEW
THE SYSTEM WAS EMBARRASSING
THERE'S ONLY UNDERFUNDED BUT
NOW WE MUST DECIDE HOW TO PAY A
NEW PATH FORWARD. AND CREATE A
SYSTEM WITH ACCOUNTABLE AND
MEASURABLE OUTCOMES. WE CAN'T
JUST THROW MONEY AT A PROBLEM
AND EXPECT BETTER RESULTS. WE
NEED AND WE SUPPORT A STRATEGIC
PLAN. A PLAN THAT WILL HELP
ENSURE MONEY GOES TO QUALITY
PROGRAMS THAT PROVIDE QUALITY
SERVICES. AND THAT'S OUR NEXT
STEP DEVELOPING CLEAR AND
CONSISTENT DEFINITIONS FOR
QUALITY DEVELOPMENTAL
DISABILITY SERVICES. IT'S HARD
TO BELIEVE. BUT THOSE
DEFINITIONS DO NOT CURRENTLY
EXIST AT THE STATE OR AT THE
NATIONAL LEVEL. YET THESE
DEFINITIONS OF QUALITY SERVICES
ARE NEEDED TO FORM A SYSTEM
THAT HELPS THE STATE TARGET
RESOURCES TOWARDS QUALITY
PROGRAMS WITH PROVEN OUTCOMES
AND HELP THE STATE UNDERSTAND
WHAT IT IS ACTUALLY PAYING FOR.
THE METHOD FOR DEVELOPING
QUALITY SERVICES HAS JUST BEEN
DELIVERED TO THE SENATE
SUBCOMMITTEE. THE EXECUTIVE
SUMMARIES BEFORE YOU THIS
METHOD WAS DEVELOPED TO THE
CALIFORNIA SUPPORTED LIVING PAY
PROJECT PERSON CENTERED
ADVOCACY VISION AND EDUCATION.
THIS PROJECTS PRIMARY FUNDERS
THIS CALIFORNIA STATE COUNCIL
ON DEVELOPMENTAL DISABILITIES
WE ARE GOING THROUGH A YEAR
LONG PROCESS TO DEVELOP SERVICE
OUTCOMES FOR PERSONAL AND
EMPLOYMENT SERVICES THAT CAN BE
APPLIED TO ALL SERVICES IN THE
SYSTEM. WORKING WITH YOU IN THE
STATE. WE BELIEVE THAT WE CAN
JUMP START THIS PROCESS SO THAT
THE RATE STUDY CAN BE
IMPLEMENTED IN A TIMELY
FASHION. WE CAN DO THAT BY
DEFINING QUALITY SERVICES
DEFINING QUALITY OUTCOMES
MEASURING THE QUALITY BY
COLLECTING AND ANALYZING USAGE
DATA. DESIGNING OUTCOME BASED
TRAINING AND STAFF
CERTIFICATION. FOR DIFFERENT
SERVICES AND TRAINING MORE THAN
ONE HUNDRED THOUSAND DIRECT
SERVICE PROVIDERS. TECH SUPPORT
PROFESSIONALS SUPERVISING STAFF
MANAGEMENT AND MANAGEMENT AND
OUTCOME BASED SERVICE
PROVISION. THESE MEASURES WILL
HELP IMPROVE SERVICES BASED ON
pPRINCIPLES. I THANK YOU FOR
YOUR TIME LOOK FORWARD TO
WORKING WITH YOU. TO HELP
IMPROVE THE QUALITY OF ALL
CALIFORNIANS ESPECIALLY THOSE
WITH DEVELOPMENTAL DISABILITIES
THANK YOU. THANK YOU THANK YOU
ALL I FIND IDEOLOGY- SENATOR
TADAS MEMBERS SUBCOMMITTEE
BEING HERE SHE LAST YEAR SHE
WAS THE ONE WHO CHAMPION
ACTUALLY ADDITIONAL FUNDING
BEYOND WHAT THE GOVERNOR
PROPOSES THAT WE WERE ABLE
SUCCESSFULLY GET INTO THE
BUDGET SO THANK YOU CENTER
TAUGHT OF FOR JOIN US- DID YOU.
BEFORE I GO ON THE QUESTIONS
THAT YOU HAVE QUESTIONS FOR
THIS PANEL. I DON'T REALLY HAVE
ANY QUESTIONS OTHER THAN IF YOU
CAN PROVIDE ME WITH SOME
INFORMATION REGARDING THE WORK
GROUP AND TO WHAT EXTENT. OF I
JUST BEEN HEARING A LOT FROM
THE CENTRAL VALLEY IN AND FOLKS
DOWN THERE. I HAVE SEEN THAT
THE FED. THAT THERE'S- NO REAL
REPRESENTATION ON THE WORK WORK
GROUP SO JUST WANTED TO SEE IF
YOU COULD PROVIDE ME WITH SOME
BACKGROUND ON THAT OR SOME
FURTHER INFORMATION. JUST WANNA
MAKE SURE THAT THEIR SWITCH
WORK GROUP ARE YOU TALKING
ABOUT. ARE THE- WHAT THE WHAT
THE FOCUS IS ON- THE B. B.
RATES WALKED THE RIGHT SIDE THE
RATE STUDY REGARDING- THAT
INCLUDES THE CENTRAL VALLEY THE
FISCAL YES AND- SYSTEM REFORM.
YES SOME TRIED. ON A TASK FORCE
IN I'VE- I DON'T KNOW EVERYBODY
ON THE TASK FORCE BUT- I KNOW
THAT THERE WAS- AT LEAST TWO OR
THREE PEOPLE FROM THE CENTRAL
VALLEY THAT ARE IN. IN THAT-
GROUP BUT I THINK OF DIRECTOR
PARCHMENT COULD SPEAK TO THAT
MORE. OKAY RIGHT AND SHE'LL BE
COMING BACK THE NEXT PANEL.
ACTUALLY THE DOCTOR ROGERS SO I
KNOW THAT- YOU MENTIONED
SEVERAL ITEMS- RELATED TO EARLY
INTERVENTION SERVICES AND
CERTAINLY- AS A FEATURE XIN
I'VE REFERRED MANY PATIENTS TO
EARLY INTERVENTION- SO SOME OF
THE THINGS SO YOU KNOW WE HEARD
FROM THE RATES DOWN FROM THE-
FROM BURNS ASSOCIATES SOB AND
SO MANY OF THE ISSUES THAT YOU
BROUGHT IT WILL- SUCH AS YOU
SAID BRED TO YOU TALKED ABOUT.
WELL PAID FOR THE PAY THE
PEOPLE THAT UP IN THE OF NO
SHOW REYES AND NOW TRAVELS SO
FORTH WHY. WHY DO YOU THINK I
MEAN SEC IT SEEMS LIKE THEY DID
A PRETTY. THE BILL OF THE LARGE
REPORT THEY LOOKED A LOT OF
DIFFERENT THINGS SO WHAT WHAT
WHAT HAPPENED I MEAN TO YOUR
PERSPECTIVE I MEAN THE AND THEN
THERE'S BEEN SOME STAKEHOLDER
FEEDBACK I PRESUME YOU IN SOME
OF YOUR- COLLEAGUES HAVE
PROVIDED THAT. BUT WHY DO YOU
FEEL LIKE THAT THAT'S STILL NOT
ADEQUATELY ADDRESSED SO WHAT
WITH THAT SO YOU DID MENTION
ABOUT HAVING SERVICE PROVIDER
IN TERMS OF THE TATIAN BUT
EVEN. LEADING UP TO THIS ARE
YOU SAYING THAT THE- CURRENT
RATES THAT HE'S STILL NOT
ADDRESSING THE FACTORS THAT
LOOK THAT STORAGE RESTING THE
ISSUES THAT YOU BROUGHT UP.
TODAY I HAVE FROM WHERE I SIT
RUNNING AN AGENCY. I WHAT I
THINK HAPPENED IS THAT ONE THE
RATE THE PROVIDER SURVEY WAS
VERY VERY COMPLICATED. AND MANY
PEOPLE WHO PROVIDE EARLY
INTERVENTION- INDEPENDENT
CONTRACTORS ARE WORD BEFORE YOU
KNOW THE AB SEED WILL CHANGE
THINGS. M. AND AS AN
INDEPENDENT CONTRACTOR IF
YOU'RE A SINGLE PERSON WITH A
SINGLE CASE LOAD YOUR OVERHEAD
IS VERY DIFFERENT THAN AN
AGENCY YOU ALSO HAVE VERY
LITTLE. OVERSIGHT IF YOU WELL
AND IN THE EARLY INTERVENTION
WORLD THERE'S A LOT OF
INDIVIDUAL VENDORS. THEN I'M
PROBABLY LESS SO THAN AGENCIES
THESE DAYS SO I THINK THAT'S
ONE THING IS IF YOU QUERY AN
INDIVIDUAL WHAT THEIR OVERHEAD
IS IT LOOKS VERY DIFFERENT THAN
AN AGENCY. WHO HAS A WHOLE
BUNCH OF. CALIFORNIA LABOR A
LOT OF FOLLOW SO I THINK THAT'S
ONE THING I ALSO THINK PEOPLE
WHO FILLED OUT THE SURVEY
PERHAPS WERE NOT. IN MY CHAIR
OF BEING IN CHURCH PLEASE. I'M
VERY INTIMATE THE- RUNNING IN A-
THEY WERE. PROFESSIONALS WELL
MEANING BUT WHEN YOU TALK ABOUT
HOW MANY KIDS CAN YOU SEE IN A
WEEK WHAT IS THE PRODUCTIVITY
FACTOR NEW LOOK AT WHAT A
CASELOAD IS VERSUS WHAT YOU
ACTUALLY COULD SEE WOULD BE
LIKE ASKING YOU HOW MANY
PATIENTS DID YOU SCHEDULE IN A
WEEK BUT HOW MANY ACTUALLY
SHOWED UP. AND THAT'S A
DIFFERENT NUMBER AND I THINK
THAT THE RATE STUDY WAS
COMPLICATED ENOUGH WHERE VERY
WELL MEANING PEOPLE FILLED IT
OUT AND DIDN'T ACTUALLY
UNDERSTAND ALL THE QUESTIONS
THAT WERE BEING PASSED SO IN
THE ROOM I MEAN BECAUSE THE
FIRST VERSION OF THE RATE
RECOMMENDATIONS IS VERY
DIFFERENT THAN THE SECOND
VERSION WHEN THERE WAS A LOT
MORE INPUT. FROM FOLKS LIKE ME
AND HEAVY DUTY IMPOSED AROUND
WHAT WERE YOU LOOKING AT SO I
THINK THAT'S ONE OF THE
DISCONNECTS BUT I ALSO THINK
THAT- LIKE I HAVE SOME
QUESTIONS EIGHT IN THE FIRST
STUDY THAT AVERAGE
RECOMMENDATION FOR PAYING AN
EARLY INTERVENTION SO THIRTY
SIX DOLLARS AN HOUR THIRTY FIVE
DOLLARS AN HOUR AND IT WENT
DOWN TO TWENTY NINE DOLLARS AN
HOUR. YOU FOR USING LABOR
STATISTICS EXCITER HOW COME IT
WENT DOWN AND IN SOME OF THE
OTHER FACTORS WHEN UP SO
THERE'S JUST SOME QUESTIONS. I
EARLY INTERVENTION IS A VERY
STRANGE SORT OF CAR ABOUT OF
THE REGIONAL CENTER SYSTEM IT'S
GOT A LOT OF RULES A LOT A LOT
AS A LOT OF WAY OF DOING
BUSINESS I AM NOT SAYING THAT
EVERYTHING ELSE IS IN
COMPLICATED BUT WHEN YOU REALLY
LEAVE SUCH A CALM HATED SYSTEM
IN THE RATE STUDY COMMITTEE
THINGS. WHEN WE WERE OUR TO GET.
WE CAN TRY TO SEARCH OF PROVIDE
A WEEK BEING TO YEAH WILL GET
YOU THE BEST GONNA GET YOU GUYS.
THINK I. THE DILIGENCE BE OF
THE- I'D THAT CAN. DE A REALLY
GOOD JOB ESPECIALLY THE SECOND
TIME AROUND BUT I THINK THE
SYSTEM ITSELF HAS. SOME
COMPLICATIONS THAT JUST SIMPLY
CALM WITH BABIES. AND A LOT OF
THOSE FACTORS WERE TAKING AND
I'M GUESSING I'M NOT THE ONLY
EXECUTIVE DIRECTOR HE THINKS A
12% OVERHEAD. IS NOT VERY
REALISTICIN THE CURRENT WORLD
WE LIVE IN. AND WE'RE A SMALL
NONPROFIT WE DO THE VERY BEST
WE CAN. OKAY OBVIOUSLY YOU KNOW
THE POLICY WISE WE LIKE TO KEEP
THE OVERHEADS LOS FACET LAKE
BUT WE ALSO WANT TO BE
REASONABLE. DIAZ I MEAN DE LA
AND OUT OF THIS IS MORE
SPECIFIC TO EARLY INTERVENTION-
BECAUSE YOU ALSO SEEM TO REFER
TO THERE'S A TENSION ARE
DIFFERENCE BETWEEN. THE AGENCY
FOLKS WHICH YOU ARE ONE OF AND
YOU'RE SAYING BASICALLY HE
INDIVIDUAL OYSTER CONTRACTORS
OR RIGHT INDIVIDUAL
PROFESSIONALS DON'T THINK
TENSIONS THE RIGHT WORD I THINK
THAT IT'S A IT'S A DIFFERENT OF
COST. RIGHT IF OKAY I FIGHT
HAVE TO PROVIDE AND WHAT IS A
REASONABLE FORTY HOUR A WEEK
JOB TO AN EMPLOYEE AND HOW WE
BUILD CASELOADS AND WHAT OUR
EXPECTATIONS ARE WHAT OUR
SUPERVISION IS WHAT OUR
TRAINING IS ALL OF THAT STUFF.
AND YOU THE INDIVIDUAL CAN DO
ANYTHING YOU LIKE AND YOU
AVERAGE A CASELOAD OF TWENTY
NINE BECAUSE THAT'S HOW YOU
WANT TO WORK YOU WILL WORK OUT
OF YOUR HOME SO YOU HAVE
VIRTUAL EXPENSES HAVE. YOUR
YOUR WORK LOOKS VERY DIFFERENT
THAN AN AGENCY WORK IF THAT
MAKES SENSE OKAY BUT I GUESS
THAT A YES WILL. DO I GUESS
WHEN WE GET TO THE YEAH THAT HE
WILL SEE ME AT THE TOP OF IT IS
TRYING TO FIGURE OUT. WHAT THE
OVERALL WORK FORCES WERE THEY
ARE. AND WHAT AND THEN HOW DO
YOU MAY. LESS EFFECTIVE YOU
KNOW USE OF. SO OKAY I AGREE
ALL RIGHT AND THEN- I THINK I
JUST GOT IT BUT- DISTRESSED YOU
TALKING ABOUT- IN TERMS OF
REFRAINED QUALITY- SO YOU SAID
THAT THERE'S A- THERE'S AN
ABSENCE OF SERVE QUALITY
STANDARDS. OKAY TO DO CAN YOU
ELABORATE A BIT ON THAT WELL-
WHEN WE WERE PREPARING THE
DOCUMENTS FOR- STARTING.
STARTING OFF THE PAVE PROJECT.
I DID A- RESEARCH I ACTUALLY
FOLLOW THE REYES STUDIES
REFERENCES BECAUSE I THINK
THEY'RE RIGHT THE RATE STUDY
SAYS THERE'S AND- THERE'S NO
CONSENSUS ON QUALITY. AND I
DON'T THINK THAT'S A FALL WITH
THE RATE STUDY BECAUSE THE RACE
THAT HE WASN'T RIGHT CONTRACTED
FOR THAT AND SO I STARTED WITH
THEIR ARTICLES THAT THEY
REFERENCED AND I. AND I DID A
NATIONAL SEARCH AND I CHECKED
IN WITH- STEVE AGAIN WHEN HE
PRESENTED HIS HE HASN'T SEEN
ANYTHING NEW- THERE. WHAT WHAT
I BELIEVE IS THAT. TO SOME
EXTENT- THERE'S BEEN A LOT OF.
THERE'S BEEN A LOT OF FOCUS ON
QUALITY IN THE MEDICAL FIELD
AND- AND THERE'S BEEN LESS.
LESS METHODOLOGY WORKED ON IN
A- IT FOOD DEVELOPMENTAL
DISABILITY SERVICES NOW IN
TERMS OF QUALITY OF LIFE STUDY
WE HAVE THE NATIONAL CORE
INDICATORS. AND THAT'S VERY
SUCCESSFUL BUT THAT'S FOCUSING
ON THE QUALITY OF LIFE WHEN WE
GET TO LOOKING AT WHAT IS A
GOOD SERVICE. THE METHODOLOGY
TENDS TO BREAK DOWN. AND SO
WHAT WE'VE DONE IN ORDER
BECAUSE WE WANT TO CLEAR
STRUCTURE FOR OUR STRUCTURE
CONVERSATIONS IN THE PAVE TASK
FORCE WHAT WE'VE- WHAT WE'VE
DONE IS. RE TOOLED- METHODOLOGY%
FOR LOOKING OUT WHAT IS A
QUALITY. DEVELOPMENTAL
DISABILITY SERVICE AND I THINK
THERE'S A FUNDAMENTAL
DIFFERENCE BETWEEN THE- MEDICAL
MODEL WHICH IS LOOKING AT
ILLNESSES AND DISEASES AND
WHICH IS IMPORTANT OBVIOUSLY
AND THEN. TO SUPPORT SERVICES
THAT DEVELOPMENTAL
DISABILITIES- SERVICES PROVIDE
THERE IS THE METAPHORS MORE
SUPPORT VERSUS CARE. ESPECIALLY
WHEN WE'RE GOING FROM AN
INSTITUTIONAL TYPE OF CARE TO
COMMUNITY. TO COMMUNITY CARE
AND SO WHAT WE DID WAS WE
LOOKED AT WE DIVIDED UP THE
SERVICE- THIS SERVICE DELIVERY
WE DIVIDE UP SERVICE OUTCOMES
INTO SERVICE DELIVERY WHERE THE
SERVICE PROVIDER DELIVERS A
SERVICE. AND WHAT THE- USER OF
THAT SERVICE THE PERSON WITH
THE DEVELOPMENTAL DISABILITY
WHAT THEY DO WITH THAT SERVICE
TO ACHIEVE THE QUALITY OF LIFE
GOALS. THAT THEY'RE INTERESTED
IN SO WE DON'T ACTUALLY TELL
PEOPLE WITH DEVELOPMENTAL
DISABILITIES HOW TO LIVE WHAT
WE DO IS WE MEASURE IF THAT
SERVICE. ACTUALLY HELP THEM DO
THAT AND THAT'S THAT'S WHAT WE
THINK WILL- GET THROUGH THIS
IMPASSE AROUND WHEN QUALITY AND
CAN FORM THE BASIS FOR VALUE
BASED PURCHASING BUT WE CAN. DO
VALUE TO A PERSON PURCHASING IF
WE KNOW. WHAT WOULD PURCHASE.
OKAY AND ACTUALLY. TOWARD END
THAT WAS GOING TO ASK ABOUT
THIS LEADING TO VALUE BASED FOR
SO OUT THAT THREE DIFFICULT DO
THAT BASE FOR. WE HAVE A IN IN
IN IN THE EXECUTIVE SUMMARY WE
DRESS UP A LITTLE BUT WE ALSO
HAVE A FULL DOCUMENT THAT WE
SUBMITTED TO THE COMMITTEE.
THAT YOU COULD- REFERENCE THAT
HAS SEVERAL PAGES ON VALUE
BASED PURCHASING. OKAY ALL
RIGHT. AND THEN- MISS ANDERSON
I THINK GUIDE YOU CHECK. YEAR
IN YOUR REMARKS CHIU FOCUSED ON
THE UNDER FUNDING- BUT YOU ALSO
MADE REFERENCE TO THE- WORK. TO
IT. YOU KNOW YOU'RE- RIGHT I
THINK WAS IT WAS A PUBLIC. IN I
ALSO HAVE ABOUT AND WE'LL PRIDE
GET BACK INTO IT WHEN WE TALK
RESPONSE PUBLIC. SO IN YOUR
MIND I MEAN DO YOU TALK ABOUT
COMPETITION OBVIOUSLY WITH
OTHER TYPES OF JOBS- WHAT SORT
OF APPROACHES DO YOU THINK I
SHOULD BE TAKEN BY THE- ARM IN
TERMS OF TRYING TO ADDRESS
THIS. DON'T THE RED ONE THE
ORIGINAL CHARGES WHICH IS THE
WORK FORCE TO. SO THERE'S BEEN
SOME PEOPLE COMMENTING THAT WE
DIDN'T SUPPORT DIDN'T REALLY
DEAL WITH THE WORKFORCE ISSUES
AS MUCH AS WE'D LIKE IT TO OUR-
DEAL WITH IT- SO. WHAT IN YOUR
MIND WOULD BE SOMETHING YOU'D
THINK THAT THE PART AND ARE THE
ARE A BURNS ISSUE SHOULD DO TO
BETTER ADDRESS THE WORKFORCE
ISSUES ARE ARE YOU SATISFIED-WITH HOW MUCH DATE. DID I'M
GUESSING IT AND SINCE YOU
MENTIONED IT BUT- THE- LA YOU
TALK THREE A FOR YOURSELF. YEAH
NO YOU KNOW I. THE OVERALL
STOCK I IT WAS SOUTH I MEAN.
THERE'S ALWAYS THINGS THAT YOU
KNOW FROM A PROVIDER'S POINT IF
YOU WERE GONNA SAY. WE WOULD
LIKE TO HAVE. IT ON OUR END BUT
I THINK OVERALL IT IS SOLID.
THE WORK FORCE ISSUE IS A
PROBLEM NOT JUST IN CALIFORNIA
BUT IT IS NATIONALLY. AND YOU
KNOW HIGHER WAGES IS ALWAYS
GOING TO. YOU KNOW HELP THE
SITUATION. BUT I THINK WE ALSO
NEED TO LOOK AT THE TYPE OF
WORK AND WHAT OTHER SPORTS WE
CAN PUT IN PLACE. FOR THE T. S.
P.'S ON THE QUALITY OF LIFE FOR
THE T. S. P.'S. RIGHT THAT.
HELLO AT IT. MORE AS A BIGGER
PICTURE THAN YOU KNOW JUST THE
WAGES BUT THE WAGES ARE
EXTREMELY IMPORTANT. OKAY. TO
OPEN THE TWENTY SURE WE TOUCHED
ON THAT. WHAT I MEAN WHAT I
WANT WHEN THE THINGS WITH US TO
TALK ABOUT TERMS OF TRYING TO
STRENGTHEN WORKFORCE IS A LOT
OF PEOPLE TO ORGANIZE AND-
UNION ICE. COSTS MONEY YES WELL
NOW I MEAN WELL THAT'S- THEN
THEY CAN ADVOCATE FOR
THEMSELVES FOR MORE RESOURCES.
THAT'S SOMETHING THAT SAYS.
DISCUSSED YEAH I THINK THE
STUDY DIDOT TOUCH ON THE OF THE
DIFFERENT DSP LEVELS AND THE
COMPETENCIES OF THE T. S. P.'S
AND ALLOWING THEM TO MOVE
FORWARD THAT WAY WITH- YOU KNOW
IMPROVEMENTS- YOU KNOW IT'S AN
UPPER LEVEL SO MOVING FORWARD
WITH- THEIR JOBS IN THE TIERED
LEVELS. RIGHT ANY OTHER ONES.
OUR WELL THANK YOU VERY MUCH
FOR YOU PRESENT AND REALLY
APPRECIATE- YOUR INPUT THANK
YOU. ALL RIGHT THANK YOU THANK
YOU OKAY. SO WE'RE GONNA BRING
BACK- REGULAR BARGE MEN AND-
MISTER PULASKI FOR- AND ALSO
JAKE FOR FROM DEPARTMENT
FINANCE AND BRENT HAUSER FROM
DEPARTMENT OF FINANCE I'M SURE
FINANCES RAY HEARD THE MONEY
QUESTIONS ABOUT BRADY. SO SAYS
THE OVERVIEW TO RESPONSE PUBLIC
COMMENTS AND NEXT STEPS AND I
KNOW THAT. I THINK- I THINK THE
LAST TIME WE LEFT THIS
CONVERSATION WAS IS THAT WE'RE
WORKING ON IT- BECAUSE WE HAD
THE STUDY SO- LOOKING FORWARD
NOW TO THE WHAT HAVE YOU COME
UP WITH- SO WHAT IF PEOPLE SAID
WE COME UP WITH SO THANK YOU
AND- WELCOME BACK. THANK YOU
DOCTOR PAN US SENATOR DADA- SO
THE AS IT THERE'S REALLY BEEN-
REALLY HELPFUL CONVERSATION
TODAY TO LEAD INTO THE-
REPORTING OUT TO YOU AS FAR AS
THE PROCESS OF THE COMMENTS BUT
I THINK. RIGHT NOW LET'S GO
AHEAD AND WE'LL WE'LL HAVE IT
TO HAVING MISTER PULASKI
PROVIDE AN OVERVIEW AS TO WHAT
WERE THE COMMENTS AND THEN
TAKING A LOOK AT THE APPROACH.
IN UPDATING THE RIGHT MODELS
AND THEN ULTIMATELY THEN
ANSWERING A COUPLE THE
QUESTIONS REGARDING KIND OF
THAT THIS CALL PIECE TO IT. BUT
THEN I'M HAPPY TO CIRCLE. AND
HOW PER SE REGARDING THE
ADDITIONAL QUESTIONS THAT YOU
HAVE IN THE AGENDA TO TALK
ABOUT NEXT STEPS TO WORK AT THE
SYSTEM AND FISCAL REFORM. AND
I'D LIKE TO BE ABLE TO MAKE
SURE THAT I- RESPOND TO THE
SENATOR'S QUESTION REGARDING
THE CENTRAL VALLEY- A
REPRESENTATION. SO I'M WITH AT
ALL I'LL GO AHEAD AND HANDED
OVER TO. KLAUS THANK YOU CAN
RESEARCH SIMPLY WITH MISTER. AS
WITH THE OVERVIEW THE RAY SORRY
I THOUGHT I WOULD SPEND A FEW
MINUTES BRIEFLY TALKING ABOUT
THE WORK THAT'S BEEN DONE SINCE
WE LAST GOT TOGETHER AFTER WE
PUBLISHED THE RATE STUDY MARCH
VERSES THE- UPDATE AND FINALIZE
RATE MODELS PUBLISHED EARLIER
THIS MONTH. AND SO THE PUBLIC
COMMENT PROCESS WAS CERTAINLY A
LARGE PART OF THAT BUT THERE'S
ACTUALLY THREE COMPONENTS OF
CHANGES THAT WE MADE TO BOTH
THE RATE MODELS AS WELL AS THE
FISCAL IMPACT ANALYSIS ON. TAKE
BOTH OF THOSE ALL THREE THE-
SAME TURN. SO FIRST WE MADE A
NUMBER OF METHODOLOGICAL
CHANGES IN TERMS OF HOW WE ARE
FORECASTING COSTS AND WILL GO
INTO MORE DETAILS ABOUT THIS-
WHEN WE GET TO SOME OF YOUR
SPECIFIC QUESTIONS AT THE END
OF THE AGENDA WHEN YOU'RE
QUESTIONS WAS ABOUT THE OVERALL
COST IMPACT AND HOW THAT HASN'T
CHANGED SINCE. WHAT WE PUBLISH
BACK IN MARCH BUT- HAS DRUG
DEPARTMENT ALLUDED TO EARLIER
IN HER REMARKS. THAT REALLY IS
A FUNCTION OF US HAVING ACCESS
TO MORE RECENT CLAIMS DATA.
THAT ALLOWED US TO UPDATE OR
FOR CASTING TRANSIT THE
SERVICES THAT. THAT WOULD BE
THAT WOULD RECEIVE LARGE
INCREASES FOR THE RACE A MAN
COMMITTED ARE GROWING AT A
SLOWER PACE THAN THE STUFF. THE
SERVICE CODES. THAT WE GET A
GLASS. OF MORE MODERATE
INCREASE- IF THE RACIALLY WERE
TO BE IMPLEMENTED SO WE SEE A
SHIP FROM- ONE GROUP OF
SERVICES TO ANOTHER GROUP OF
SERVICES. WE ALSO MADE SOME
TECHNICAL CHANGES TO HOW IT IS
WERE FORECASTING ESTIMATED
COSTS MISCELLANEOUS SERVICE
CODES- AND THAT'S A TERM OF ART
THAT'S USED IN DDS FOR A
HANDFUL THE SERVER NUMBER
SERVICE BECAUSE IT DON'T HAVE.
A LOT OF REGULATORY FRAMEWORK.
WHICH POSES OF A CHALLENGE FOR
US BECAUSE WITHOUT A-
STANDARDIZED DEFINITION OR
APPROACH TO REVERSING THOSE
SERVICES ACROSS THE STATE. WE
HAVE TO MAKE A NUMBER OF
ASSUMPTIONS ABOUT WHAT THE
AVERAGE RATE IS AND HOW THAT
WOULD CHANGE BASED UPON. THE
RECOMMENDATIONS INCLUDED IN THE
RATE STUDY. AND WE ALSO MADE
AGAIN SOME CHANGES RELATED TO
HOW DOES WERE FORECASTING THE
PERCENTAGE OF COMMUNITY BASED A
PROGRAMS THAT WOULD QUALIFY FOR
HIGHER RATES FOR HAVING A
MEDICAL OR BEHAVIORAL FOCUS SO.
WE THINK THEY'LL BE LESS OF
THOSE PROGRAMS AND WE
ORIGINALLY ANTICIPATED. SO
THOSE MYTHOLOGICAL CHANGES ALL
RELATED TO HOW WE WERE DOING
THE FISCAL IMPACT ANALYSIS THEY
DIDN'T CHANGE THE RATE MODELS
PER SE. THE SECOND GROUP OF
CHANGES WE MADE TO THE- PACKAGE
WE DELIVERED BACK IN MARCH
WHERE WHAT I REFER TO AS
TACTICAL ADJUSTMENTS. SO ONE OF
THOSE TECHNICAL ADJUSTMENTS WE
TALKED ABOUT IN THE EARLIER
PANEL AND THAT SIMPLY COUNTY
FOR MORE DATA THAT'S BECOME
AVAILABLE SINCE WE PUBLISHED
THE STUDY BACK IN MARCH SO.
THERE'S BEEN NEW DEAL BLS DATA
PUBLISHED. THE IRS PUBLISHED
ITS STANDARD MILEAGE RATE FOR
TWENTY TWENTY THE W. C. I. R.
B. PROVIDED UPDATED FORECAST
FOR THE- PREMIUM RATES FOR
WORKERS COMPENSATION CALENDAR
YEAR TWENTY TWENTY SO WE- AT A
TIME WE HAD ACCESS TO MORE
CURRENT DATA. WE WANTED TO USE
THE MOST COURT CURRENT OUT
AVAILABLE TO US AN UPDATE THREE
MODELS. THERE ALSO AT THE
HANDFUL OF CORRECTIONS WE HAD
TO MAKE TO THE RATE MODELS ON
THAT THREE THOUSAND PAGE
PACKAGE OR WHAT ONE OR TWO
FORMULAE THAT WERE- ABRONIA SO
SOME FOLKS. SOME OF THOSE WERE
POINTED OUT TO US BY COMMENTERS
OTHERS WE- FOUND AS WE CONTINUE
TO. WORK TO FINALIZE THOSE
REMODELS. AND FINALLY OF COURSE
WE MADE A NUMBER OF CHANGES TO
THE RAM MODELS THE RESPONSE OF
PUBLIC COMMENT SO
METHODOLOGICAL CHANGES IMPACT
TO THE FISCAL IMPACT. TACTICAL
ADJUSTMENTS IMPASSABLE TERRAIN
MODELS AS WELL AS THE FISCAL
IMPACT ANALYSIS IN THE WITH
CHANGES RESPONSE PUBLIC
COMMENTS WHICH COULD RESULT. IN
CHANGES TO THE MODELS
THEMSELVES. I WILL GO THROUGH
ALL OF THOSE AS I SAID THERE
WERE LITERALLY DOZENS OF
CHANGES MADE IN RESPONSE TO
PUBLIC COMMENTS. ON BECAUSE
WE'RE BIG ON PUBLISHING LENGTHY
DOCUMENTS WE HAVE ANOTHER
HUNDRED PAGE DOCUMENT THAT
OUTLINES THE- TWO HUNDRED AND
FIFTY OR SO. INDIVIDUAL
INDIVIDUALLY IDENTIFIABLE
PUBLIC COMMENTS THAT WE
RECEIVED. AND THE DEPARTMENT'S
RESPONSE EACH AS WELL AS- AN
EXPLANATION OF THE CHANGE THAT
WE MADE RESPONSE THAT COMMENTS
OR- OUR RATIONALE FOR NOT
MAKING A CHANGE FOR THOSE
COMMENTS THAT DO NOT PRODUCE
ANY UPDATES TO THE RATE MODLS.
BUT I JUST WANT TO TOUCH UPON A
HANDFUL THE CHANGES THAT WE
MADE SOME OF THOSE HIGH LEVEL
ADJUSTMENTS. SO ONE OF THE
THINGS WE TALKED ABOUT IN MARCH
AND OUT CAME UP AGAIN IN THE
PREVIOUS PANEL WAS THE
IMPORTANCE OF THE DIRECT
SUPPORT PROFESSIONALS. FOR A
NUMBER THE SERVICES REACHED
MISSED OUR APPROACH TO
ESTIMATING THE COSTS ASSOCIATED
WITH ME THE AVERAGE WAGE
ASSOCIATE WITH THOSE DSPS AND-
FOR SERVICES LIKE INDEPENDENT
LIVING DAY PROGRAMS WE
INCREASED. THOSE WAGE
ASSUMPTIONS- SIMILARLY WEEK WE
INCREASE THE WEIGHT ASSUMPTION
FOR SUPPORT OF EMPLOYMENT
SERVICES AS WELL. WE ARE OVER
TIME ASSUMPTIONS TO A NUMBER OF
SERVICES THAT TWENTY FOUR HOUR
RESPONSIBILITY FOR INDIVIDUAL
SO SERVICES. LIKE RESIDENTIAL
PROGRAMS IN SUPPORT OF LIVING.
WE MADE A NUMBER OF CHANGES TO
THE RATE MODELS FOR FAMILY
HEALTH AGENCY IN RESPONSE TO
COMMENTS WE RECEIVE THAT
RESULTED IN INCREASING THOSE
RATES TO ENSURE THAT REMAINS A
VIABLE ALTERNATIVE. HOPEFULLY
ACROSS THE STATE SINCE THAT'S
REALLY A PAVE THE MOST HOME
LIKE SETTING FOR INDIVIDUALS
WHO ARE LIVING OUTSIDE OF THEIR
THEIR BIRTH HOMES- BUT GETS
SMOTHERED ADJUSTMENTS WE MADE
TO THE DAY PROGRAM RIGHT MODEL
RE REDUCE THE ASSEMBLY TENDONS
RATES. HANDS WELL AS WE TALKED
ABOUT IN THE- PREVIOUS PANEL
THAT I WAS ON WE ALSO. PULLED
BACK ON SOME OF THE- PROPOSALS
INCLUDED IN THE MARCH RATE
MODEL SO. WE DROPPED THE TIMING
OF PROFESSIONAL SERVICES THE
MEDICARE FEE SCHEDULE. THERE
ARE A NUMBER OF CHANGES THAT WE
PROPOSE RELATED TO EMPLOY A
RECORD SERVICES. HAVE BEEN
PLAYER RECORD RESPITE SERVICES.
AS WELL AS TRANSPORTATION
SERVICES WHEN WE WERE TRYING
TO. AS YOU MENTIONED EARLIER-
CONSOLIDATE SOME SERVICE CODES
THAT BASED UPON THE FEEDBACK
THAT WE RECEIVE WE- THOUGHT
ABOUT THAT A SECOND TIME AND
THEN. DECIDED PERHAPS WAS NOT
THE BEST PATH FOR TO
CONSOLIDATE SOME OF THOSE
SERVICES. FOR A COUPLE OF OTHER
MISCELLANEOUS SERVICE CODE
AGAIN THE SERVICE BECAUSE THEY
DON'T HAVE A REGULATORY- OF A
DETAILED REGULATORY BACKING- WE
DECIDED NOT TO MOVE FOR WITH
SOME OF PROPOSALS THAT WE HAD.
RATHER WE THOUGHT OF MORE AND
TO FOR DEVELOPER. AND THEN
BUILD RATE THE REFLECTS THOSE.
RECOMMENDATIONS SO THAT POLICY
IS DRIVING THE RATES RATHER
THAN THE OPPOSITE SO WE DON'T
WANT TO PROPOSED CHANGES TO.
THE CREATIVE ARTS PROGRAMS
WHICH IS ONE OF THE GROUPS
PROVIDERS YOU HEARD ABOUT HER
FROM BACK IN MARCH CRISIS
SERVICES. AND THE SOCIALIZATION
TRAINING PROGRAMS. LAST MARK I
WANTED A MAY COME JUST
REITERATE THE POINT I MADE IN
THE PREVIOUS PANEL AS WITH ALL
THESE ADJUSTMENTS WE NOW BILL
RATE MODEL SO CONTINUE REFLECT
WE THINK OF THE APPROPRIATE
COSTA SO SHE WAS DELIVERING THE
SERVICES. AS OF JANUARY FIRST
TWENTY TWENTY SO AS OF A COUPLE
OF WEEKS AGO. IF THE STATE WERE
TO MOVE FOR WITH IMPLEMENTATION
YOU WANT TO. TAKE A SECOND LOOK
AT SOME OF THOSE ASSUMPTIONS TO
CONTINUE TO ACCOUNT FOR. I'M
GOING INCREASES IN COSTS SINCE.
THIS THIS MONTH THAT WERE IN
CURRENTLY. THANK YOU. JIM
ANYMORE SO THANK YOU SENATOR
PAN SO TO- MOVE FORWARD AND
TALKING TO SOME OF THE POINTS
IN THE QUESTIONS TO MAKE SURE
THAT WE- ADDRESS THOSE AS FAR
AS THOSE NEXT STEPS FORWARD- TO
THE QUESTION AS FAR AS THE
SYSTEM IN FISCAL REFORM-
REGARDING REPRESENTATION I WANT
TO TOUCH ON THAT- THE WORK THAT
WE DID WITH THE DEVELOPMENTAL
SERVICES TASK FORCE IN THE PAST
IT WAS REALLY ABOUT
TRANSITIONING INDIVIDUALS FROM
THE DEVELOPMENTAL CENTERS AND
CHANGE IN OUR SYSTEM FROM THIS
STATE OPERATED DEVELOPMENTAL
CENTERS. NO SERVICES TO REALLY
BE IN A FULLY COMMUNITY BASED-
SERVICE SYSTEM AND IN ORDER TO
DO THAT WE REALLY NEED TO
RECONSTITUTE THE DEVELOPMENTAL
SERVICES TASK FORCE SO WE DID
THAT WE DID A BY APPLICATION
AND WE HAVE FIVE DIFFERENT WORK
GROUPS ON THE AREAS IN WHICH WE
REALLY SAW THE PRIORITY AND
MAKING SURE THAT WE REPRESENTED
FAMILIES INDIVIDUALS THAT WE
SERVE THE DIVERSITY OF THE
INDIVIDUALS AND MEETING
DIVERSITY THE NEEDS OF THE
CONSUMERS AND THE FAMILIES BUT
ALSO GEOGRAPHICALLY- BUT I'M
GOING TO GO BACK AND TAKE A
LOOK AT. YOU KNOW PARTICULARLY
WITHIN THE SYSTEM AND WE'RE
FROM WORKGROUP I BELIEVE WE DO
HAVE A REPRESENTATION TO THE
NUMBER I'M NOT SURE SO I WILL
FOLLOW BACK UP WITH YOU- AND IF
WE FEEL THAT WE DON'T HAVE
ADEQUATE REPRESENTATION WE CAN
CERTAINLY OPERATORS AT THAT
MAKE SURE THAT THAT WE DO IT.
CALIFORNIA'S A LARGE AND PRINT
PARTS OF THE STATE HAVE
DIFFERENT NEEDS AND WE NEED TO
MAKE SURE THAT WE HAVE THE
VOICE OF THOSE SAID THAT THAT
REALLY A RECEIPT AND SERVICE AS
SO WHAT WILL HAVE CIRCLE WITH.
THANK YOU SO WHEN WE A LOOK THE
RATES AND THE DATED- STUDY AND
MOVING FORWARD YOU KNOW THAT
REALLY FOUND TIONAL RIGHT NOW
TAKE A LOOK AT THE RATES HE WAS
VERY AND INFORMATIVE IN OUR
PROCESS NOT ONLY BE ON WORK
THAT WAS FIRE CONSULTANT BUT
THEN PUT BASED ON THE
ENGAGEMENT WE HAD WITH OUR
COMMUNITY BASED ON THE AND- PER
PROVIDE TO US BUT ALSO WITH
FAMILY. I THE FOR WHAT ARE
THINGS ARE CRITICAL ON MAKING
SURE YOU WERE HAVE A DISK SO
REFORMS. FOUND A AND SO. ATTY
AND THEN WHAT ARE WE PAYING FOR
YOU KNOW ARE WE PYING FOR
THOSE OUTCOMES SO HAVING THAT
THAT CONVERSATION RIGHT NOW IS
REALLY REALLY CRITICAL- WE'VE
BEEN DOING SOME OF THOSE
BUILDING BLOCKS ALL ALONG WITH
THAT WORK WITH THE
DEVELOPMENTAL SERVICE TASK
FORCE STARTING THIS SUMMER WE
ACTUALLY STARTED HAVING SMALLER
WORK GROUP DISCUSSIONS WELL WE
FORMALISE THE WORK GROUP AND WE
HAD OUR FIRST MEETING THIS
THIS. MONTH I THINK WE'RE STILL
IN JANUARY SO WE HAD THAT OUR
FIRST MEETING THAT WASN'T THE
ONLY TIME WE HAD THE
CONVERSATION SO WE MET WITH
FAMILIES WE MET WITH DIFFERENT
ASSOCIATIONS WE HAD SMALLER
WORK GROUPS TO REALLY TALK
ABOUT WHAT ARE THE THINGS THAT
WE NEED TO CONSIDER- REALLY
WHAT INFORMED US IN OUR
PROPOSAL IN THE GOVERNOR'S
BUDGET WHICH AS AS NOTED THAT
WILL HAVE AN OPPORTUNITY TO
TALK A LITTLE BIT MORE ABOUT
THAT MOVING FORWARD. BUT THERE
ARE SOME VERY KEY CRITICAL
THINGS THAT WE HAVE PROPOSED IN
THE GOVERNOR'S BUDGET SO IT
DOES INCLUDE BUILDING ON THE
SUPPLEMENTAL RATE INCREASE
TAKING THE INFORMATION FROM THE
UPDATE OF THE RATE STUDY IN THE
RATE MODELS RECOGNIZING THE
IMPORTANCE OF- CHILDHOOD
SERVICES SO WITH THE EARLY
INTERVENTION SERVICE CODE THE
THERAPEUTIC- SERVICES AND THEN
ALSO TAKING A LOOK AT-
INDEPENDENT LIVING SO
PRIORITIZING KNOWS ADDING THOSE
INTO THE PROPOSAL OF THE
SUPPLEMENTAL RATE INCREASE SO
THAT IS PROPOSED ADDITIONALLY
REALLY GETTING SOME
FOUNDATIONAL WORK ON TAKING A
LOOK AT HOW DO WE TIE OUTCOMES.
AND PAYMENT SO NOT ONLY DO WE
HAVE THE IMPORTANT ROLE OF
TAKING A LOOK AT- SERVICE RIGHT
STORE PROVIDERS WE'VE BEEN
DOING THE WORK WITH THE RIGHT
STUDY WE'VE DONE THE WORK WITH
THIS. I'M RATE JOE WE TO CA TO
.COM. BUT WE ALL NEED TO A LOOK
AT TO DO SIR TO RE CENTER ONE
THE WAY. OTHER STATES HAVE LONG
AT. IS THE AND HOW ARE WE DOING
THAT CASE CORD. AND THAT. THE
LAW COUPLE YEARS FOCUS BECAUSE
IT ON THE IMPORT WORK UP
OVERSTATE ACCOUNTED. AND WITH
REGIONAL CENTERS. I'M TO BUILD
ON THAT SO IN ADDITION TO OUR
REORGANIZATION IN ADDITION TO
SOME OF THE WORK THAT WE'VE
ALREADY BEEN DOING. REALLY
TAKING THIS AS AN OPPORTUNITY.
TO SAY WHAT ARE THOSE THOSE
FOUNDATIONAL OUTCOMES THAT
INDIVIDUALS ARE ASKING TO BE
ABLE TO IMPROVE. IMPROVE AND
HAVE THE BEST QUALITY OF LIFE
AND THEN HOW ARE WE GOING TO
MEASURE WHAT MATTERS. SO RIGHT
NOW THE SYSTEM IN FISCAL-
REFORM WORKGROUP I'VE ASKED HIM
TO REALLY FOCUS ON THIS WITH
US. SO WE CAN REALLY IMPLEMENT
SOMETHING IN A VERY TIMELY WAY.
SO IF WE ARE ABLE TO MOVE
FORWARD WITH THE PROPOSAL OF
THAT PERFORMANCE INCENTIVE. I'M
PROGRAM IT REALLY IS GOING TO
BE FOUNDATIONAL FOR US TO MOVE
THE SYSTEM TO A- ADVANCE THOSE
DISCUSSIONS. IN TIENE SOMETHING
THAT IS A LITTLE DIFFERENT THAN
WHAT WE'VE DONE IN THE PAST. WE
ALREADY HAVE THE PERFORMANCE
CONTRACTS THAT WERE ABLE TO
WORK ON. AND WE'LL TALK SOME
MORE ABOUT THAT YOU KNOW IS A
YEAH WITH THE BUDGET PROCESS.
BUT AGAIN THAT FOUNDATIONAL
WORK WITH THE SYSTEM AND FISCAL
REFORM DISCUSSIONS I THINK WILL
BE REALLY CRITICAL- SO. THEN
MOVING TO MAKING SURE THAT
WE'RE ADDRESSING SOME OF THE
ADDITIONAL QUESTIONS YOU HAVE.
I'M THE GOALS OF THE GROUP
REALLY IT WILL THEN BE HAVING
CON. BOTH ON. KIND OF THOSE
NEXT STEPS FORWARD GIVING US
RECOMMENDATIONS AND SO AS WE
MOVE FORWARD WITH ANY.
ADDITIONAL DISCUSSIONS WITH THE
LEGISLATURE WITH THE
DISCUSSIONS THAT WE HAVE WITHIN
THE ADMINISTRATION AND THEN
ALSO WHETHER- STAKEHOLDERS.
THAT WE HAVE THAT FOUNDATION
FOR THOSE THOSE DISCUSSION
POINTS. HAPPY TO ANSWER ANY
QUESTIONS. OKAY AND I THINK WE
STILL HAVE SOME MORE QUESTIONS
HERE THAT I THINK YOU'LL GET TO.
SO NOW THE RATE STUDY. TO QUIT
THREE YEARS RIGHT AND- AND I
THINK IT. WAS INITIATED BEFORE
I BECAME CHAIRED THE
SUBCOMMITTEE AND JUST REMEMBER
EACH TIME. COME UP THEN WHILE
WE WERE WAITING FOR THE RIGHT
SAY WAIT TODAY'S RATE SAY NOW
WE HAVE THE RATE STUDY. AND I
GUESS WHAT ONE OF THE QESTIONS
IS THAT OKAY SO WHAT I'M
HEARING IS WE HAVE THE RIGHT
STUDY WE'VE UPDATED WE HAVE IN
YOU. KNOW UPDATED RATE STUDY
FOR. JANUARY ITS BENCHMARK FOR
STARTING IN JULY OF TWENTY
TWENTY RIGHT MID YEAR RATE
THAT'S- THE UNITED
RECONSTITUTED THIS. TASK FORCE
WERE HAVING THESE DISCUSSIONS.
AND I APPRECIATE THE
ENGAGEMENT. AND THAT'S REALLY
IMPORTANT. BUT I THINK ALSO
HEARING THAT WELL. JUST BECAUSE
WE'RE TALKING DOESN'T MEAN WE
CAN'T DO SOMETHING MORE AND SO.
A SO I GUESS MY QUESTION TO YOU
IS THAT SO WHAT ARE WE DOING IN
TERMS OF ACTUALLY TRYING TO
IMPLEMENT SOME OF THE PAYMENT
MODELS ALSO MADE MENTION NOW
AND AGAIN I WANT RECOGNIZE THAT
THE THIS BUDGET IS THAT THE IN
DOLLAR OR MORE THIS YEAR THAN.
LAST YEAR SO I MIKE KNOWLEDGE I
SAID THAT IN THE VERY BEGINNING
I THINK SIX HUNDRED SOMETHING
IN THE GENERAL FUND- BUT SOME
OF THAT'S MORE CASELOAD RELATED
SO IT'S NOT NECESSARY AND THEN
OF COURSE WE DO HAVE SOME SOME
TARGETED RATE INCREASES BUT WE
ALSO KNOW FROM THE RATE STUDY
THAT WERE ONE POINT EIGHT
BILLION DOLLARS SHORT NOW. WE
COULD BE RE STILL WE'RE TALKING
ABOUT RESTRUCTURING SOMETHING'S
BUT LETS YOU TELLING ME THAT I
A WRONG I LIVE FEELING THAT
EVEN IN THE RESTRUCTURING AND
WE MOVED TO VALUE BASED
WHATEVER I'M NOT SURE WE'RE
GOING TO BE REDUCING THE
DEMAND. THE NEED BY ONE POINT
EIGHT BILLION SO HE'S SPEAK SO
WE HAVE THE STUDY NOW. LAST
SPRING UPDATED YOUR HAD
PROVIDER IN AT THE YEAH PUBLIC
COMMENT IT CETERA- WHAT IS THE
NEXT STEP- SO I KNOW THERE'S
SOME BUDGETARY STUFF THAT I'VE
SEEN IN THE GOVERNOR'S BUDGET
AND WE MAY BE HEARING MORE IN
OUR BUDGET THANK HEARINGS BUT
WHAT IS THE DEPARTMENT'S PLAN
TO START. AND THINGS SOME OF
THESE THREE ADULTS AND ALSO-
AND WE ARE FINANCE YOUR MAY CON
IS THAT OKAY I MEAN I SEE WHAT
GOVERNOR'S PROPOSING BUT IT'S
SEEMS LIKE THE- STILL. DOES IT.
NOT QUITE CLOSING THE GAP.
RIGHT AND THAT THAT THE GAP
THAT THE DEBATE STUDY AND THAT
OF. AND EVEN IF DO REFER. MY IS
THAT NOT GOING TO CALL. THAT'S
GO TAKE CARE OF THE GAP EITHER
SO CAN SPEAK TO LIKE OKAY NOW
WE HAVE THE STUDY WHAT ARE WE
DOING WITH IT. I THINK IT THAT.
THE RATE STUDY DID A NUMBER OF
THINGS FOR US AND IT IT'S
CERTAINLY OUTLINES- THE ADDRESS
THE AREAS IN WHICH- IT WAS
ASKED TO DO YOU KNOW LOOKING AT
ON THE COMPLEXITY OF OUR SYSTEM
TAKING A LOOK AT REALLY WHAT IT
BUILDING A RATE MODEL THAT
COULD BE TRANSPARENT AND ALL OF
THOSE PIECES. THE OTHER THING
THAT THE RATE STUDY DID FOR US
IN ADDITION TO IDENTIFYING
THOSE THOSE ELEMENTS OF IT IT
ALSO IDENTIFIED THEM IF WE WERE
TO IMPLEMENT THERE WERE CERTAIN
STRUCTURES THAT WE'RE GOING TO
HAVE TO REALLY EVALUATE AND SEE
HOW TO MOVE FORWARD WHETHER
IT'S STATUTE REGULATION LOOKING
AT WAIVER YOU KNOW AMENDMENTS
WAIVER APPLICATIONS THERE'S A
NUMBER OF THINGS BUT THE OTHER
PIECE THAT IT DID IT REALLY HAD
US TAKE A STEP BACK IN ADDITION
TO. KIND OF THE COST OF
IMPLEMENTING BUT THEN WHAT ARE
THOSE TRENDS THAT ARE HAPPENING
IN OUR SYSTEM THAT WE STILL
NEED TO IDENTIFY IT TELLS US
THAT WE HAVE TO TAKE A LOOK
VERY CLOSELY AND TO OUR SYSTEM
AS I SAID EARLIER NOT
MINIMIZING IMPORT OF TAKING A
LOOK AT HOW DO WE MAKE SURE
THAT THERE'S SOME RELIEF
CERTAINLY LAP AT. THAT WOULD
TAKEN THE MINISTER ALLEGE. TO
OF. IT HAVING THE SUPPLEMENTAL
RATED. WE DOES EQUAL TO FOR
HUNDRED MILLION OVER TO. YOU
KNOW OF GENERAL FOR. YOU KNOW
HAVING THAT INVEST IS WAS A
STEP STONE. AT THOSE THREE TO
SERVE CODES YEAR IS ANOTHER
STEPPING STONE IN IN AND
PRIORITIZING THOSE AREAS AS FAR
AS THE- SERVICES TO CHILDREN AS
WELL AS TO AN H. CBS COMPLAINTS
BECAUSE THE INDEPENDENT LIVING
SKILLS BECAUSE GET TO THAT. BUT
THE OTHER PIECES SAYING WAIT WE
NEED TO TAKE A LOOK AT THE
SYSTEM AND FISCAL REFORM SIDE
OF IT. AND THE PAYMENT- THE
PERFORMANCE INCENTIVE PROGRAM
WITH THE REGIONAL CENTERS IT
REALLY IS FOUNDATIONAL TO THAT.
THAT DISCUSSION AND THOSE NEXT
STEPS AS WE'VE TALKED TO OTHER
STATES AS WE REALLY EVALUATED.
AS FAR AS HOW DO YOU IMPLEMENT
SYSTEM CHANGE IT IS AN
ITERATIVE PROCESS THAT DOES
TAKE TIME. AND HAVING AN
OPPORTUNITY TO IMPLEMENT A
VALUE BASED INCENTIVE PROGRAM
RIGHT NOW THAT WE CAN DO WITHIN
THE REGIONAL CENTERS. REALLY
DOES TAKE US A STEP TOWARDS.
OUR NEXT STEPS TO SYSTEM
CHAINS- SO THOSE ARE THE STEPS
IT IS PROPOSED IN THE
GOVERNOR'S BUDGET THOSE ARE THE
STEPS THAT WERE TAKING. BEING
INFORMED BY THE RATE STUDY
BEING INFORMED BY THAT PUBLIC
INPUT THAT WE'VE HAD AND TAKING
THOSE PRIORITIES- WE WILL HAVE
TO GO AHEAD AND APPLY FOR. A
WAIVER AMENDMENT IT WAS NOTED
FOR THOSE THREE DIFFERENT
SERVICE CODE SO IT WOULD BE
IMPLEMENTED- FIRST PART OF
JANUARY TWENTY TWENTY. ONE FOR
THOSE THREE SERVICE. SO I GUESS.
APPRECIATE WHAT YOU'RE SAYING-
MORE THINGS THAT I WOULD LIKE
TO SEE IS THAT- SO YOU COULD BE
DOING THINGS BUT- I MEAN IT THE
PLANET A TIME LINE BECAUSE I
THINK- THAT THAT HELPS KEEP
EVERYONE ACCOUNTABLE AND- TO
SAY LIKE OKAY WELL AND- BE ABLE
PERHAPS- BY TIME BY. YOUR BACK
UP HERE AGAIN DIDN'T READ FOR
US TO BE THAT WOULD PRECEDE
HAVING AT TIELINE SAYING OKAY
WE YEAH WE GOT THREE STAY LAST
SPRING WE GOT PUBLIC AND CUT A
SAID YOU'RE STARTING TO BUT
RELEASE ARE LIKE OKAY WELL. YOU
SAID THERE'S A CERTAIN THE
OTHERS RIGHT DIFFERENT
ACTIVITIES ARE INVOLVED IN THIS.
BUT WHAT POINT DO WE EXPECT.
LIKE OKAY FINE WE'RE GOING TO
TALK ABOUT THIS RELATIONSHIP
WITH ABOUT. WHAT'S THE TIMELINE
FOR FORGETTING OF THEIR MAYBE
YES ADVENTURE WAIVERS AND SO
FORTH. SO WHAT IS THE TIMELINE
FOR US TO GET TO WHERE YOU WANT
TO GET TO- YOU KNOW WITHIN
SPECIFIC SPENT THREE YEARS ON
THIS RATE STUDY RIGHT- AND-
LOOKED A LOT OF DIFFERENT
THINGS AND THAT WE'VE HAD
ANOTHER. SIX MONTHS TO GET
PEOPLE TO GIVE THEIR FEEDBACK
SO FOURTH WE SHOULD SERVICE BE
ABLE TO SKETCH OUT A AND YOU
SAID OKAY WE GOT THESE
DIFFERENT THINGS WERE LOOKING
AT AND I GOT I- IF PROCESS BUT
THERE'S GOT IT IS THE- THERE'S
GOAL OR GETTING TO AND I MEAN I
GUESS. FLAT OUT I MEAN WHO ARE
WE PLANNING TO IMPLEMENT-
REALIZING THAT THERE'S GONNA BE
ADJUSTMENTS AND SO FORTH MADE I
MEAN ARE WE EMBRACING THIS THE
SIZING OUR GOAL IS TO GET TO.
YOU KNOW GET- SOME VERSION OF
THAT YOU KNOW THAT THE PAYMENT
MODELS WITH THAT WHAT THE CODE
SO THAT WE A RATIONALIZED
PAYMENT- WE'RE GOING TO YOU
KNOW GET AIMED AT TRYING TO GET
THE AND WE HAVE ECONOMIC THINGS
AT THE DEAL WITH THAT AIM TO
GET TO SOME LEVEL OF FLEECE
FULL FUNDING AT YOU KNOW IT
CERTAIN SOME POINT TIME OUT IN
THE FUTURE- BASED ON- BASED ON
THE METHODOLOGY I MEAN UNLESS
WE DON'T BELIEVE THE
METHODOLOGIES CORRECT. AT AGE
THAT SERVE TOLD US WHAT WE NEED
TO AND SOME OF THAT WILL OF
COURSE BE AFFECTED BY VARIOUS
YOU KNOW. ADJUSTMENTS YOU MAY
MAKE YOU KNOW IN THE INTERIM
BUT THAT THERE IS THAT THAT IS
SOMETHING WE ARE SETTING AS A
GOAL AND AN DEL EX NUMBER YEARS
THREE YEARS OR WHATEVER I'M
JUST SELL EX NUMBER YEARS WE
PLANT WOULD GO TRY TO GET
THERE- I. SO I THINK THAT. IS
THAT SOMETHING THAT THE
DEPARTMENT CAN CAN CAN CAN DO
AND PERHAPS PERCENT- IN MARCH I
GUESS IS WHEN YOU'LL PROBABLY
BE BACK UP AGAIN I HAVE THE
EXACT DATE I THINK. WHEN HE IS
WORKING ON THAT. SEARCHERS
ASKING A TO DO A PLAN A
TIMELINE. AND WE WILL WILL GO
AND HOW COME. IS TO
CONSTRUCTION OF WHAT ARE. THE
NEXT STEPS ON ON CONVERSATIONS
ABOUT THE SYSTEM IN FISCAL
REFORM YEAH. I MEAN I THINK I
THINK THE THINGS WE HAVE THE
RATE STUDY AND I KNOW IT'S LIKE
I ASSUME THAT. YOU KNOW IF
WE'RE ALL SAYING THAT. THIS IS
GOING ON FORM WE'RE GONNA GO
FOR IT I MEAN I THERE'S
OBVIOUSLY OTHER FEES
INFORMATION AND WE'RE USING
THIS TO. TO RE LOOK AT HOW
WE'RE DOING THINGS AND HOW MUCH
WE SHOULD BE FUNDING AND SO
FORTH THAT WE SHOULD HAVE A
PLANNED FOR SAYING AND
REALIZING THAT YOU'LL DETAILS
MAY NEED TO BE FILLED IN. BUT
WE SHOULD HAVE A TIME LINE OF
THE GOALS FOR WHEN WE HOPE TO
ACCOMPLISH THIS OR IF THE OTHER
RESPONSES THAT. GREAT STUDY WE
SPENT THREE YEARS ON WE CAN'T
TO LATER THAT'S NOT WHAT WE
WANTED THAT WE NEED TO KNOW
THAT TOO SO I THINK IT'S- BUT
WE'RE SAYING THAT THIS IS. THE
BASIS OF YOU KNOW THIS IS. THIS
EFFORT IS GOING TO INFORM HOW
WE'RE GOING TO MOVE IN THE
FUTURE AND THEN. SOME BUT WE
HAVE SET A GOAL FOR SAYING WELL
THIS IS WHEN WE EXPECT. YOU
KNOW WILL WORK WITH PEOPLE TO
TRY TO ACHIEVE. YEAH SOME FIRST
OF THE STRAITS. FUND BILL FIVE
THAT WORD THAT'S WERE GONNA TRY
TO. THAT MAKES SENSE. THE AND I
DO WANT TO MAKE NOTE THAT THE
RATE STUDY HAS INFORMED MANY
DECISIONS. AND SO IT HAS IT IT
REALLY HAS BEEN FOUNDATIONAL
AND KIND OF EIGHT MANY OF THE
DECISIONS HAVE BEEN ANCHORED
INTO INFORMATION THAT IS.
GATHERED THROUGH THE RIGHT
STUDY. SO WHEN YOU LOOK AT THE-
SUPPLEMENTAL RATE ADJUSTMENTS
WHEN YOU LOOK AT THE ADDITIONAL
SERVICES AND THAT AND ALIGNED
WITH- THE PRIORITIES OF MAKING
SURE THAT WE'RE ADDRESSING KIND
OF THOSE REALLY KEY PRIORITIES
WITHIN- THE SYSTEM IN
ADMINISTRATION- AND THEN.
REALLY LOOKING OUT AGAIN THAT
THE PERFORMANCE INCENTIVE
PROGRAM AND TYING THOSE VALUES
AND THOSE PAYMENTS BECAUSE IT
IS TIED TO THE DELIVERY OF
SERVICES AS WELL. YOU KNOW SO
JUST WANTING TO REALLY MAKE
SURE THAT THERE'S- A
RECOGNITION THAT- THAT THE RATE
STUDY IN INFORMATION THROUGH
THAT PROCESS HASN'T BEEN
SHELLED. IT REALLY HAS BEEN- A
PART OF OUR DISCUSSIONS IN
MAKING DECISIONS TO- SOME OF
THE IMPORTANT STEPS THAT WE
HAVE PROPOSED TO THE GOVERNOR'S
BUDGET AS WELL. ALL RIGHT.
ACTUALLY IT MAY QUESTION FOR
FINANCE- SO. WE REALIZED. IS A
YEAR BY YEAR SAYING BUT ALSO
AND WHEN THE GOVERNOR TALKS
DOES BUDGET TALKS ABOUT OUT
YEARS WHEN WE TALK ABOUT THE
BUDGET WE TALK ABUT HOW YEARS.
SO GIVEN THE RIGHT STUDY GIVEN
WHAT WE KNOW FISCAL YOU KNOW
WHAT THE STUDY AT LEAST
INDICATES THAT WHERE WE ARE- IN
TERMS OF. WHAT THAT WHAT'S
NEEDED TO PROPERLY FUN. WHAT IS
THE WHAT SORT OF ASSUMPTIONS.
IS FINANCE USED TO PROTECT THE
OUT YEAR EXPENDITURES FOR-
DEVELOPMENTAL SERVICES. IS THE
ARE YOU TALKING SO WHEN THE
GOVERNOR SAYS OKAY WE HAVE THIS
OUT YOU'RE GOING OUT. WHAT WHAT
WHAT WHAT WE ASSUMING AND
LOOKING AT THE OUT YEARS WHEN
IT COMES TO- THIS PARTICULAR.
SAID DEVELOPMENTAL SERVICES AND
DEPARTMENT ANNOUNCER DEPARTMENT
OF FINANCE I WOULD. NOTE THAT-
IN THE GOVERNOR'S BUDGET YOU
MAY HAVE SEEN THAT THE FOR THE
SUPPLEMENTAL RATE INCREASES
INCLUDING THE TWENTY NINETEEN
BUDGET ACT AS WELL AS WHAT
WE'RE PROPOSING A TWENTY TWENTY
ONE. WE DELAY THE SUSPENSION BY
EIGHTEEN MONTHS SO YOU'LL SEE
THAT- FOR ALL OF THE
SUPPLEMENTAL RATE INCREASES IN
ADDITION TO WHAT'S INCLUDING
THE GOVERNOR'S BUDGET WE PLAN
TO SPEND ON JUNE. THIRTIETH OF
TWENTY TWENTY THREE AND WE'LL
REVISIT THAT IN MAY OF TWENTY
TWENTY TWO DEPENDING ON WHAT
THE REVENUE SITUATIONS LOOKING
LIKE. AT THAT TIME. HI SO
THAT'S THE PLAN FOR THESE
PARTICULAR- FUNDING THAT'S BEEN
PROVIDED THAT SAID BEEN
INFORMED BY THE RATE STUDY.
OKAY SO JUST TO CLARIFY AND
WILL WE WON'T HAVE THE DEBATE
ABOUT THE EXPIRATION RIGHT NOW.
I WILL HAVE THAT LATER. IN THE
FUTURE HEARING- BUT- SO YOU
KNOW AGAIN THE PRE SHOULD IF
THAT THE GOVERNOR'S PUT AN.
INCREASE FOR THIS COMING YEAR.
G. THIS EXPLORATION FURTHER A-
BEFORE THE EXPRESS READ JUST.
THE RE PLANNING ANY FURTHER
INCREASES IN THE OUT YEARS OR
WE'RE JUST. BASICALLY SAYING
WHAT WE HAVE AN INCREASE THIS
COMING YEAR AND THEN FOR THE
USER JUST STAYING THE SAME I
MEAN I GUESS THAT'S THE
QUESTION BEFORE THE EXPIRATION-
JACOB FOR WITH DEPARTMENT OF
FINANCE- THE FORECAST- THAT-
FOR THE MULTI YEAR. DOES NOT
REFLECT- ADDITIONAL INCREASES
BEYOND WHAT'S ALREADY BEEN S.
ENACTED THIS THIS CURRENT YEAR
AND THEN THE ONES THAT WERE
PROPOSING- THERE ARE INCREASES
OBVIOUSLY BECAUSE OF- CONTINUED
INCREASING CASELOAD YOU'D AND
UTILIZATION- AND ALSO THE
MINIMUM WAGE INCREASES. OKAY SO
THERE'S AN ADJUSTMENT FOR
MINIMUM WAGE CASELOAD CHANGES
BUT NO OTHER OKAY. AT EIGHT SO
I GUESS. WE HAVE A STUDY THAT.
WE COMMISSION THE STATE THAT-SAYS WERE ONE POINT EIGHT
BILLION SHORT AT LEAST AS OF
ROUGHLY TWENTY THREE L. TWENTY
TWENTY OR SOMETHING- IS SO IS
THERE BEEN DISCUSSION ON AND
FINANCE- ABOUT TWELVE. WE MIGHT
NEED TO CLOSE THAT UP A LITTLE
BIT. SO I WOULD ONLY KNOW THAT
THE I BELIEVE THEONE POINT
EIGHT BILLION DOESN'T REFLECT
THE ADJUSTMENTS THAT HAVE BEEN
INCLUDED ALREADY SO IT SHOULD
BE ONE POINT EIGHT BILLION THAT
THE DELTA IS THE ONE POINT
EIGHT BILLION MINUS THE FOUR
HUNDRED AND THIRTEEN ANNUALIZED
AMOUNT THAT WAS PROVIDED IN
TWENTY NINETEEN BUDGET ACT. AS
WELL AS THE THIRTY SIX MILLION
THAT'S PROPOSED IN THE TWENTY
TWENTY ONE GOVERNOR'S BUDGET
OKAY SO NOW I GUESS WE'RE DOWN
TO WHAT. ONE POINT SOMETHING
BILLION. LIKE ONE POINT TWO.
ONE POINT TWO OKAY I CAN. OUT
OF THEM YEAH. EXACTLY THAT I
THINK- YOU KNOW AS WE'VE-
DIRECTOR RODRIGUEZ DISCUSSED-
YOU KNOW THE ADMINISTRATION IS
SUPPORTIVE OF- EFFORT. TO KIND
OF LOOK AT. YOU KNOW WHAT CAN
WE DO. IN THE SYSTEM TO MAKE
THE SUSTAINABLE- YOU KNOW THE-
YOU KNOW. WE NOT ONLY HAVE THE
ISSUE OF THE- YOU KNOW THAT
THEIR- RATE STUDY THAT. SHOWS
THIS UNDER FUNDING BUT THERE'S
ALSO THE ISSUE. OF THE
CONTINUED GROWTH IN IN. YOU
KNOW CASE LOADING UTILIZATION.
SO WE REALLY ARE YOU KNOW I
THINK WE'RE VERY SUPPORTIVE OF
FINANCE- OF LOOKING AT. YOU
KNOW HOW DO WE HOW DO WE KIND
OF START WITH THOSE THE
UNDERLYING. YOU KNOW STRUCTURE
AND SCHOOL REFORMS. THAT WE CAN
THEN YOU KNOW BUILD A VERY COST
EFFECTIVE. YOU KNOW- SYSTEM. ON
ON TOP OF SO. UNDERSTANDING
THAT- YOU KNOW THERE'S
SIGNIFICANT- INTEREST IN IN
MOVING FORWARD SOMETHING AND I
THINK THE ADMINISTRATION
LEGISLATURE DID. COME TO AN
AGREEMENT LAST YEAR OR YOU KNOW
FOR THIS YEAR'S BUDGET- AND I'M
SURE THOSE DISCUSSIONS WILL
CONTINUE AS WE MOVE FORWARD.
OKAY WELL I THINK THAT-
INSTANCES AN INFORMATIONAL
HEARING- I GUESS- WE'RE NOT.
JUST TALKING ABOUT THIS COMING
YEARS BUDGET BUT- AS YOU. HEARD
MY CONVERSATION WITH DIRECTOR
MARGIN AND JOB I MEAN I THINK
WE NEED TO THINK ABOUT WHAT
WHERE WERE WE GOING TO WRITE
SO. AGAIN APPRECIATE. THE TO GO
DOUBTS THE GOVERNOR LAST YEAR
DOING THE APPRECIATE THE
GOVERNOR'S. FOR THE YEAR BUT I
THINK IN TERMS OF THINKING
ABOUT WERE WE GOING. FOR THE
YEARS OUT- AND WE CAN EVEN WE
WILL TALK ABOUT THIS YEAR BUT
WE'LL TALK ABOUT FUTURE
HEARING- BUT IT WAS WORTH
THINKING. THINKING ABOUT. HIM
LET'S TRY IF LET'S THINK ABOUT
PLAN FOR WERE WE GOING TO. END
UP RATE- WHAT WHAT'S OUR GOAL
AND MY GUESS IS THAT ISN'T JUST.
THE INCREASE THIS YEAR AND THEN
STAY STILL RIGHT I MEAN WE HAVE
ON GOING WORK TO DO- TO DO THAT
AND- I THINK THE RATE STUDY
WHETHER WE FULLY AGREE WITH ALL
THE THINGS THAT ARE NOT. AND
THEY'RE PO CERTAINLY AND I
APPRECIATE THE PART IS GOING TO
WORK- IN STAKEHOLDERS TO WORK
ON IT WILL TRY TO FIND MORE
COST EFFECTIVE WAYS OF DOING
THINGS- BUT I DON'T SEE US
BEING ABLE TO SQUEEZE OUT
ANOTHER ONE POINT TWO BILLION
THAT WAY. AND SO THERE'S THAT
AND SO I HOPE THAT AS WE'RE
LOOKING GOING OUT- THAT. WE
THINK ABOUT HOW CAN WE- IN A
MORE REALISTIC WAY PLAN FOR
WHAT WE SHOULD BE DOING- GOING
OUT. TO BE SURE WE MEET THE
NEEDS THAT WE HAVE I MEAN
THERE'S NO WE'VE WE'VE
ESTABLISHED CHAIRED THE LANTERN
MAN ACT. RIGHT SO WE HAVE AN
OBLIGATION THAT WE REALLY HAVE
AN LAW. AND SO HOW WE CAN MEET
THAT OBLIGATION ANY KNOW THAT
ALL OF US ARE COMMITTED TO DO
THAT SO- SO. I KNOW WE'RE NOT
GONNA DO IT ALL IN ONE YEAR- IT
BE GREAT IF WE COULD- BUT-
LET'S. YEAH WE HAVE SPENT THE
EFFORT ON THE STUDY LET'S
FIGURE OUT HOW WE TAKE IT AND
THEN HOW WE THE OUTLOOK. IN
LESS WE COME BACK AND SAY OH
YOU KNOW WHAT WE DON'T LIKE IT
WE DON'T AGREE WITH THAT
WHATEVER BUT THAT'S NOT WHY
HEARING THEN. IF THAT'S SO AND
IT'S AND APPRECIATE THAT'S
INFORMING DECISIONS ARE READY.
YOU KNOW HOW HOW DO WE GET TO
WHERE WE WANT TO GO- WITH THIS
OUT AND SEND IT TO AND SET A
TIME LINE. FOR TRYING TO DO
THAT. WE ALL AGREEMENT ON THAT.
I SEE SOME NODS WILL CONTINUE
TO HAVE THE DISCUSSIONS IN TURN
OKAY WELL AT THE I HOPE
CONCEPTUALLY RIGHT WE ALWAYS
ASK ABOUT THE TIME WHEN WILL BE
IT CETERA AND I GET IT YOU KNOW
YOU HAVE TO I HAVE TO PUT ON
THE BUDGET TO YOU KNOW WE'RE ON
IT TOGETHER SO YOU KNOW WE HAD
A AND THERE'S VARIOUS ECONOMIC
VAGARIES AND YEAH I'M VERY
SUPPORTIVE OF- WILL- OF BOTH
THE PREVIOUS GOVERNOR IN THIS
GOVERNOR'S DESIRE TO. BE
FISCALLY PRUDENT AND PREPARE
FOR ECONOMIC DOWNTURNS AND SO
FORTH SO NOT SAYING A WE JUST
SO RIGHT GOT IT BUT LET'S BUT
WE ALSO NEED TO MEET OUR
OBLIGATIONS AND GOT FIGURE OUT
LET'S FIGURE OUT HOW TO DO
THAT. WE CAN AGREE ON THAT. YES
NODS AS WE LOOK I'M LOOKING AT
FINANCE NEARLY THAT YOU IF YOU
THAT I APPRECIATE YOU ANSWERING
SERIOUS MIKE. YEAH I JUST I
WANT TO JUST SAY THAT WE'RE
GOING TO CONTINUE WITH OUR
SYSTEM IN FISCAL REFORM
DISCUSSIONS WITH OUR WORK GROUP
AND THOSE ARE OUR CONVERSATIONS
THAT THAT ARE AND I KNOW. IT
EITHER QUESTIONS ARE ARE
OUTSIDE OF WHAT I AM I AM I AM
SAYING BUT THE WORK THAT OUR
OUR GROUP HAS BEEN DOING IT'S
JUST BEN REALLY REALLY
IMPORTANT AND WE DO NEED TO
START TAKING A LOOK AT THAT
OUTCOMES AND- AND REALLY HOW
WE'RE GOING TO MEASURE WHAT ARE
THOSE THINGS THAT WE'RE GOING
TO MEASURE THAT IS. IS REALLY
CRITICAL TO MEANINGFUL LIFE-
AND IT IT'S AN IMPORTANT
CONVERSATION THAT WE NEED TO
HAVE YEAH. OKAY SO I KNOW I
KNOW IT'S MORE THAN JUST THE
MONEY PART BUT THE MONEY IS
IMPORTANT BUT OUT RESOURCES
PEOPLE CAN'T DO THEIR WORK- SO
I THINK THERE ARE SEVERAL OTHER
QUESTIONS AND I KNOW THAT IT
FEET EARLIER ASKED ONE AND WE
SAID WE'RE HOLD OFF. IN TERMS
OF VALUE BASED AND THEN I.
POLICY INITIATIVES SUCH AS
EMPLOYMENT. SELF DETERMINATION
CONCERN RIGHT MISS OF THE IF
YOU WANT TO DRESS THOSE.
QUESTIONS NOW. THANK YOU- SO
VERY SPECIFICALLY TO THE
QUESTION ON- ITEMS- NUMBER
THREE THAT YOU HAVE. ON PAGE
NINE. SO TALKING ABOUT THE
DIFFERENT POLICY- ITEMS THAT
WERE WERE CONSIDERED AND THE
RATE MODELS IN THE RATE STUDY-
EMPLOYMENT FIRST. SO WHEN
YOU'RE REALLY TALKING ABOUT
KIND OF THE POLICY SO.
INCLUSIVE EMPLOYMENT-
EMPLOYMENT FIRST- COMPLIES WITH
H. CBS FEDERAL RULE. LOOKING AT
THOSE MECHANISMS AND MISTER
CLAUS HE HAD IDENTIFIED A
COUPLE OF THOSE EXAMPLES-
EARLIER- AS FAR AS TAKING A
LOOK AT THAT COMMUNITY. ASPECT
OF THE DAY SERVICES TAKING A
LOOK AT HOW TO- APPROACH SOME
OF THE SERVICES WITHIN. AND THE
RIGHT MODEL SO THOSE THINGS
WERE CERTAINLY CONSIDERED. THE
OTHER IS TAKING A LOOK AT
REGIONAL DIFFERENCES AS FAR AS
MAKING. I'M SURE AS WE CONTINUE
TO KEEP IN THE FOREFRONT OF OUR
DISCUSSIONS AND EVERYTHING AS
FAR AS EQUITY AND ACCESS TO
SERVICES. YOU KNOW SO BI
LINGUAL PAY WAS CONSIDERED SO
THOSE WERE SOME ELEMENTS. WHEN
YOU TAKE A LOOK AT SELF
DETERMINATION. THAT PIECE
THAT'S A SEPARATE SEPARATE
PROGRAM I'M- SO AS FAR AS-
MEANT THAT ARE PART. OF SELF
DETERMINATION. SELF TERMINATION
THAT IS PART OF IT THIS PERSON
CENTERED PLANNING. THOUGH WHILE
STILL DETERMINE. ONE A PART OF
THE- POLICY WITHIN THE SELF.
THAT RIGHT MODELS. PERSON
CENTERED PLANNING AND THAT
FOCUS CERTAINLY WAS. SO ANY
QUESTIONS RE THE- AND THEN I BY
THE THAT WE- HAD ALREADY TALKED
ABOUT THE NEXT STEPS- REGARDING
THESE- SYSTEM AND FISCAL REFORM
WORK GROUP- AND THE
CONSIDERATIONS WITHIN ON THE
ITEMS THAT WERE IDENTIFIED AS
FAR AS THE DIFFERENT POLICIES-
THE CONSIDERATIONS- AS FAR AS
STATUTES AND REGULATIONS THAT
THOSE THINGS WOULD HAVE TO HAVE
FURTHER DISCUSSIONS THAT
IDENTIFIED SHOULD THERE BE-
FURTHER ADVANCEMENT- AND THEN
TAKING A LOOK AT- THE UPDATE ON
THE GOALS AND THE PROGRESS OF
THE SYSTEM AND I'M FISCAL
REFORM WORKGROUP. AS I'D SAID
WHILE THE FORMAL WORKGROUP BUT
THE DS TASK FORCE WAS IN
JANUARY- THERE WERE A NUMBEROF
DIFFERENT MEETINGS AND
DISCUSSIONS THAT IT OCCURRED I
THINK WE HAVE SOMEWHERE BETWEEN
TEN AND FIFTEEN DIFFERENT
MEETINGS THAT WERE VERY FOCUSED
ON ELEMENTS THAT TOUCH SYSTEM
AND FISCAL REFORM- SINCE THE
SUMMER- AND RECONSTITUTING THE
DS TASK FORCE FOR THAT FUTURE
WORKING FOUNDATIONAL WORK WAS
REALLY IMPORTANT AND MORE WE'RE
VERY FORTUNATE THAT WE WERE
ABLE TO DO IT WE HAVE LIKE A
HUNDRED FIFTY SIX DIFFERENT
PARTICIPANTS. BETWEEN THE DS
TASK FORCE IN FIVE DIFFERENT
WORK GROUPS. AND YOU MAY IN
TERMS WRAPS KNEEING STATURE.
CHANGE FOR. EMPLOYMENT SO JUST
AS ANY TIME WE HAVE DIFFERENT
POLICY CHANGES WE ALWAYS HAVE
TO EVALUATE WATER- WHAT WHAT
WHAT CAN WE DO WITH OUR THIRTY.
AND SO THERE'S DIFFERENT TIMES
AND YOU HAVE TO TAKE A LOOK AT
STATUTES. REGULATIONS NO SO
JUST LOOKING AT THE STRUCTURE
OF IT ALSO DO YOU ANTICIPATE.
ANY OF THESE CHANGES BEING
INCORPORATED INTO BUDGET
TRAILER LANGUAGE THIS YEAR OR-
TO THAT SIDE TO DISSIPATE WHAT
WE GOING TO BE ASKED. TO LOOK
AT- SURE SO IT'S A PROBLEM
WE'LL HAVE TO- FOR THE THREE
DIFFERENT- SERVICE CODES SO
THAT WILL REQUIRE A WAIVER
AMENDMENT SO WE WOULD HAVE TO
MOVE FORWARD WITH THOSE THREE
SERVICE CODES. AND ALSO THE
PERFORMANCES- INCENTIVE PLAN
THAT WE WOULD BE I'M HAVING
TRAILER BILL LANGUAGE RELATED
TO THAT BECAUSE WE DO HAVE
CURRENT. AUTHORITY IN THE
STATUTE FOR PERFORMANCE
CONTRACTING- BUT THIS WOULD
FURTHER DEFINING KIND OF THOSE
NEXT STEPS. AND IN TERMS OF.
TIMELINE FOR MY STAFF TO LOOK
AT THESE SOME OF HIS PROPOSED
TRAILER BILL- LANGUAGE DOING TO
SPEAK GETTING THAT AND THE NEXT
I KNOW WE HAVE TIME LINES AND
BEING ABLE TO MOVE THOSE FOR IT
I JUST DON'T HAVE THAT HANDY
WITH ME RIGHT NOW BUT WE'LL
MAKE SURE WE- COMMUNICATE. TO
THE PRESS AT THAT THE PLAN IS
TO GET THOSE. POSTED PUBLICLY
ON THE DEPARTMENT OF FINANCE
WEBSITE- ON FEBRUARY FIRST OKAY
THANK YOU SO WE APPRECIATE
HAVING IT BEFORE WE ACTUALLY
HAVE HER HEARING ON THE- THE-
THE PART OVER. VIEW HERE YEAH
ON THE DEPARTMENT OKAY. AND
THEN I GUESS- NO QUESTION AND
THIS MAY ALSO- FOR- MISTER
PULASKI- SO WE HEARD FROM-
WEBER STAKEHOLDERS TO INVOLVED
AND- EARLY INTERVENTION AND-
SHE RAISED SEVERAL CONCERNS-
ABOUT THE DIFFERENCE BETWEEN
AGENCIES INDIVIDUALS AND SURVEY
MAYBE NOT FOR ACTUALLY
REFLECTING THE OVERHEAD AND
TRAVEL COSTS IT'S ADDRESS SO.
IT CAN YOU PERHAPS ADDRESS.
SOME OF HER REMARKS IN TERMS
OF- HOW HOW UNITED DRESSES OR
HOW YOU. HOW YOU GOING TO OUR
HAVE ADDRESS THOSE ISSUES.
THANK YOU MISTER CHAIRMAN AND.
WE DID TRY TO ADDRESS THOSE
COMMENTS LARGELY THROUGH THE
RECASTING THE RATE MODEL SO AS
I MENTIONED EARLIER IN THE
PREVIOUS PANEL WE DO NOT HAVE
RATE MODELS FROM ANY OF THOSE
SERVICES BACK IN MARCH BECAUSE
OF THE PLANT A TIE THEM TO
MEDICARE RATES AND WE- HEARING
PUBLIC COMMENT DECIDED TO GO.
AND BUILD RATE MODELS AS WE DID
WITH THE- OTHER SERVICES
INCLUDE WITHIN OUR SCOPE OF
WORK. TALKING ABOUT SOME OF THE
SPECIFIC ISSUES THAT WERE
BROUGHT UP- AS WAS MENTIONED
THE ASSUMPTION IS THAT FOLKS
ARE DOING ABOUT TWENTY THREE
BILLABLE HOURS OF SERVICE. ON A
WEEKLY BASIS THAT WAS DRIVEN
MORE THAN ANYTHING ELSE BY
INFORMATION FROM THE PROVIDER
SERVE ACT. NOW I APPRECIATE THE
FACT THAT THE SERVER WAS
COMPLICATED MY CERTAINLY WOULD
NOT DENY THAT- AND- WE DID
HOWEVER TAKE CARE TO BE AS
CLEAR AS WE COULD BE IN THE
INSTRUCTIONS IN TERMS WHAT WE
WERE LOOKING FOR SOMEONE THE
ISSUE THAT WAS BROUGHT UP WAS
DIFFERENCE BETWEEN SCHEDULED
HOURS. VERSUS PROVIDED HOURS WE
WERE PRETTY CLEAR THE
INSTRUCTIONS THAT WERE LOOKING
FOR THE NUMBER OF HOURS OF DRY
CAT WERE PROVIDED. NOT
SCHEDULED WE HAD A SEPARATE
AREA WE'RE ASKING FOR WHAT THE
TYPICAL. A NUMBER OF
UNDELIVEREDHOURS WERE SO WE
HAD A DIFFERENT LINE REPORT
THOSE. THOSE MISSED APPOINTMENT
SO TO SPEAK. AND SO WHAT WE SAW
TO THE PROVIDER SURVEY WAS
PEOPLE REPORTING- I'LL BE ABLE
TO DELIVER BETWEEN TWENTY SEVEN
AND THIRTY HOURS OF DOUBLE
ACTIVELY PER WEEK WE THOUGHT
THAT WAS TOO AGGRESSIVE SO.
CERTAINLY OUR ASSUMPTIONS ARE
LESS THAN IT WAS. TO THE
PROVIDER SERVE AT. I DON'T
THINK I WAS DRIVEN BY THE-
BETWEEN AGENCY. IN IN THE
PROVIDERS BECAUSE WE DID THE
SURVEY ANALYSIS AND WE START IN
THE WEEDS ABOUT HOW DOES WE
APPROACH THAT BUT- WE'LL-
CALCULATE BOTH WEIGHTED
AVERAGES WAITED BY THE SIZE THE
PROVIDER AND MEDIANS. HANDS THE
WEIGHTED AVERAGE IS NOT GONNA
BE IMPACTED VERY MUCH BY
INDIVIDUAL PROVIDERS BECAUSE BY
DEFINITION ARE NOT DELIVERING
AS MUCH SERVICES AS AGENCY
PROVIDERS ARE SO. OUR
ASSUMPTION AS RELATES TO
BILLABLE HOURS IS LESS THAN THE
PROVIDER SURVEY CALCULATED BOTH
AS A WEIGHTED AVERAGE AS WELL
AS A MEDIA. THE ISSUE OF
ADMINISTRATIVE. RATES A
SOMETHING THAT EXTENDS FAR
BEYOND THE INPUT ABOUT THE
PROGRAM AND CERTAINLY NOT
SOMETHING THAT WE DID GET
FEEDBACK ON AS PART OF THE
PUBLIC COMMENT PROCESS IN FACT
I THINK I PROBABLY TALKED ABOUT
THAT. BACK IN MARCH SO THE
APPROACH THAT WE TOOK TO
ADMINISTRATIVE COSTS WAS TO
ATTEMPT TO TARGET. THAT
PARTICULAR COMPONENT THE RIGHT
MODEL TO CURRENT EXPENSES THAT
PROVIDERS ARE INCURRING. SO THE
AGAIN WE GO INTO SOME DETAIL
ABOUT THE RACE CITY REPORT AS
WELL AS THE PUBLIC COMMENTS BUT
THE PROVIDER SURVEY TOLD US
THAT PROVIDERS WERE. OPERATING
AND ADMINISTRATIVE RATES UP
ABOUT SEVENTEEN PERCENT.
HOWEVER WE ARE ALSO PROPOSING
TO INCREASE THE RATES BY ABOUT
40% SO IF YOU TAKE INTO ACCOUNT
THAT 12% IS GOING TO APPLY TO A
MUCH LARGER BASE OF SPENDING.
IT GENERATES THE SAME AMOUNT OF
MONEY. AS THE 17% DOES ON THE
LOWER BASE OF SPENDING SO THE
IDEA WAS WE DON'T WANT TO ADD
ADDITIONAL FUNDING TO
ADMINISTRATIVE COSTS BUT
EFFECTIVELY TO MAINTAIN PARITY.
IN TERMS WERE ADMINISTRATIVE
EXPENSES ARE OUT NOW AS THE
RATE MODELS. BUT I WOULD MAKE
NOTE THAT THAT ASSUMPTION MEANS
THAT WE OF INCREASE THE RATES.
THAT WOULD NOT THAT WE HAVEN'T
DONE YET SO I'VE- WHAT YOU SAY
BUT YEAH. STE CERTAINLY MISTER
CHAIR BACK THE I MEAN THE WHOLE
PREMISE IF THE RATES WERE
IMPLEMENTED AND- RIGHT BEN BEN
AS A PERCENTAGE OF THAT LARGER
BASE THEN YOU'D GET BUT IN THE
ABSENCE OF HIS MERE MINUTES I
WAS OF THE 12% AS A CAP ON WHAT
PROVIDERS CAN DELIVER THEY
DON'T HAVE TO CONTINUE TO
OPERATE AT THE 70% THROUGHOUT
TODAY IF THE RATES. REMAIN
UNCHANGED. WHICH AS MR HOUSE
REPORT ABOUT THE NOT ON CHANGE
RIGHT THERE'S BEEN A FOR THE
MILLION DOLLAR INCREASE- LIVE
WITH THE LAST POINT I WANTED TO
MAKE THOUGH IS AS THE IF THE
RATE MODELS RECOMMENDED IN THE
FUTURE YEAR AND THEY CONTINUE
BE UPDATED AS WE WOULD SUGGEST
ACCOUNT FOR INCREASING RISE IN
THE COST THAT. 12% WILL
CONTINUE TO APPLY TO A LARGER
LARGER BEARS AND GENERATE MORE
ADMINISTRATIVE DOLLARS OVER THE
LONG TERM SO I THINK THOSE ARE
THE TWO PRIMARY CRITICISMS THAT
I HEARD DURING THE EARLY
REMARKS. OKAY AND THEN I GUESS
THE TERM. OF WORK FOR SELF
HEARD NOW. THIS YEAR BUT- PRIOR
HERE. ABOUT THE CHALLENGE OF
THE LARGE RATES OF TURNOVER AND
SO FORTH. IS AT THEIR
DISCUSSIONS ABOUT. NOT JUST IN
TERMS OF BECAUSE YOU KNOW
WE'RE- THE RATE STUDY LOOKING
AT BUT ALSO LOOKING FORWARD AND
MEANS THAT. WE TALK ABOUT
QUALITY MEASURES AND SO FORTH I
MEAN IT'S A SERVER PROCESS
MEASURED TO. AND I KNOW THE
THAT'S ALSO IN CHILD CARE AND
SOME OTHER FIELDS WHERE. THERE
WERE WE'VE MAKING SOME EFFORTS
TO MONITOR. THE RATE OF
TURNOVER BECAUSE- YOUNG WHEN
YOU JUST A DISTRICT A PROVIDER
TURN OVER DEBTS. IN
RELATIONSHIPS THEY'RE HAVING TO
BE RENEWED OR CHANGED AND SO
FORTH AND THERE'S- THERE'S A
COST TO THAT TO BOTH PHYSICALLY
AND ALSO- FOR THE QUALITY S
WELL SO. IS THAT SOMETHING THAT
THE DEPARTMENTS. LOOKING INTO
MONITOR. OF THE THOSE ARE NOW
ARE PAYMENTS ALLOW YOU KNOW
CAUSING HIGH RATES OF. NO TURN
OVER TO WAYS WE CAN REDUCE
TURNOVER. YEAH THANK THE-
HAVING THE GRANULAR DETAIL THIS
THAT TURNER IT AS STATE LAW IS
TO STATE IT'S NOT IT VISIBILITY
THAT WE HAVE HOWEVER YOU KNOW
WE'VE HEARD THE CONCERNS WE FOR
THE CONCERNS FROM THE-
COMMUNITY BOTH THE- PROVIDERS
AND FAMILIES SO WE ARE
EXPLORING THERE'S DIFFERENT
MECHANISMS THAT ARE AVAILABLE
TO BE ABLE TO REALLY DO-
REVEALING ASSESSMENTS ARE WORKS
POINT WHAT THOSE OPTIONS ARE
WHERE THERE'S A NATIONAL CORE
INDICATORS ARE WAYS TO BE ABLE
TO TAKE A LOOK AT STAFF
STABILITY AND- AND WHILE WE
HAVEN'T- ESTABLISHED A
MECHANISM- AS OF NOW WE ARE
AWARE OF THE ISSUE AND
EXPLORING HOW WE CAN. GET IT
JUST ON VISIBILITY INTO INTO IT
OTHER THAN JUST ANECDOTAL
DISCUSSIONS WITH THE COMMUNITY
BY THAT TIME THEY'LL BE THAT
MAYBE THERE COULD BE SOME
MECHANISM TO BE DEVELOPED THAT
IS YOU'RE LOOKING AT HOW DO WE
KNOW MYRA QUALITY AND SERVICE
AND SO FORTH AND IF YOU DO
EVENTUALLY GO TO VALUE BASED-
PROCESS OF. THAT NO QUALITY
DATA COLLECTION THINK CERTAINLY
ONE OF THE ITEMS TO LOOK AT IS-
PERFORCE TURNOVER RATE AND- IT
IS SAID THERE'S A TREMENDOUS
COST TO TURNOVERS SO AND SO
WILL THEIR DATA COSTS SHOULD
THEN BE REINVESTED TO WORK FOR
STABILITY INSTEAD OF SPENDING
IT ON CONSTANTLY. BOWL AND THE
IN IN PLANTS TO NEED TO GET IN
TOUCH ANOTHER PROVIDER WHAT
THEIR SAID IS BECAUSE THAT
PERSON'S CHANGED EIGHT YEN ELF
THE THINKING ABOUT WHAT WITH-
SOME OF THE THINGS WE CAN PUT
INTO PLACE. TO MONITOR THAT.
AND GET THAT KIND OF. IT
ADDITION TO MY BECAUSE WE AS A
ARE FACING SIMILAR CHALLENGES
THAT OTHER SYSTEMS ARE ARE
FACING AS FAR AS WORKFORCE SO
WE YOU KNOW NATIONALLY IT IS IT
A CONCERN AS TO YOU KNOW- IN IT
THE AVAILABILITY OF WORK FORCE
SO WE ALSO ARE WANTING TO
WITHIN THAT DEVELOPMENT SERVICE
THAT'S WORSE IN THE WORK THAT
WE'RE DOING IT AND THEN YOU
KNOW LOOKING AT OUR- OTHER
STATE PARTNERS- IN IN OTHER
STATES AS TO HOW TO ADDRESS
SERVICE DELIVERY AND
DEVELOPMENTAL SERVICES. THAT
ARE YOU KNOW CERTAINLY- WITHIN
OUR EXISTING MODELS BUT ARE
THERE OTHER WAYS TO DELIVER
SERVICES WHETHER IT'S TAKEN AND
INNOVATION AND LOOKING AT
TECHNOLOGY LOOKING AT OTHERS
THAT THAT WAYS TO BE ABLE TO.
DELIVER SERVICE. AGAIN DOING
NOT SILO IN OUR THINKING AND
OUR APPROACH IN LOOKING AT OUR
SYSTEM BUT LOOKING BROADER THAN
THAT AND SAYING OKAY WAIT LET'S
ALSO TAKE A LOOK AT. YOU KNOW
HOW DO WE MAKE SURE THAT WE'RE
DELIVERING THE SERVICES THROUGH
OTHER MECHANISMS THAT MAY. MAY
NOT HAVE BEEN THOUGHT OF OR OR
IMPLEMENTED IN THE PAST AS WELL.
OKAY OF. ALL RIGHT WELL THANK
YOU SO MUCH FOR YOUR
PRESENTATIONS- HOPING THAT AND-
SHE TO CONTINUE DIALOGUE- BUT
BUT- I GUESS I DO HAVE AN
EXPECTATION THAT WHEN I SEE YOU
SOMETIME I THINK SOMETIME IN
MARCH. WE'LL GET THE EXACT
DATE- THAT WILL ALSO IF YOUR
BILL WOULD LIKE TO HAVE AN
UPDATE WITH A- SENSE OF. YOU
KNOW TIMELINE OF FOR YOU KNOW
BASICALLY A REAP ALL IN ON
THIS- YOU KNOW AND WHAT WE
STARTED WITH THIS RATE STUDY
AND WHAT'S THE TIME LINE TO TRY
TO GET. TO A- THE GOAL OF
EMPLOYMENT OF IMPLEMENTING IT
OR WE DECIDED WE DON'T WANT TO
DO THAT THAT WE NEED TO KNOW
THAT TOO SO YOU KNOW IN THE
CONTEXT. SO DESERVE THINKING
OUT BEYOND JUST THE YEAR BUT
ALSO THINKING OUT. DOUBLE THEIR
GOAL TO TRY TO HIT. TO
IMPLEMENT MANY OF THE
RECOMMENDATIONS AND ARE FORGET
PROCESSES TO IMPLEMENT THIS NO
SIR PHYSICALLY SERVICE
IMPLEMENTATION TIMELINE- IT
WOULD BE. YEAH GREATLY
APPRECIATED. OKAY THANK YOU
RIGHT THANK YOU VERY MUCH IF
YOU PRESENT AND FOR THE TOP
CONVERSE I LOOK FORWARD TO
HEARING MORE AS WE GO FORWARD
THANK YOU. ALL RIGHT. OKAY SO-
WE HAVE SO. TWO THREE FOUR SIX
SEVEN EIGHT NINE TEN OR OKAY
ELEVEN PEOPLE WHO SIGNED UP FOR
PUBLIC COMMENT SO WE'LL DO THAT
AT THE MICROPHONE IN THE BACK I
WILL REMIND YOU THAT IF YOU
HAVE MATERIAL YOU CAN SUBMIT IT
TO THE SERGEANTS THEY WERE
PROVIDED TO OUR STAFF AND ASKED
IF YOU CAN TRY TO KEEP YOUR
COMMENTS TO A MINUTE- AND- AND
TO HIT THE HIGHLIGHTS AND AGAIN
IF YOU HAVE MATERIAL ARE BOTH
NOW OR YOU CAN SEND TO US AND
FUTURE AT. PLEASE UP FOR TO THE
SURGEON ARE YOU CAN YOU IT TO
YOU ARE A SET UP WE GOT ONE
MORE HERE ALL RIGHT. OKAY
WELCOME AND- I THINK HE'S A
GOOD PLEASE JUST- INTRODUCE
YOURSELF WITH YOUR NAME AND
ORGANIZATION AND THEN- FISHY TO
HEARING YOUR FEEDBACK THANK YOU
WELCOME THANK YOU DOCTOR PAN
JORDAN IN THE WITH THE ARE
CALIFORNIA UNITED SUPERBOWL THE
CALIFORNIA COLLABORATION. ALSO
CHAIR OF THE LAMB AND
COALITION- FIRST THANK YOU SO
MUCH FOR THIS HEARING THAT'S
REALLY GOING TO BE BENEFICIAL
FOR THE ENTIRE COMMUNITY ALSO
THANKS TO DDS FOR THEIR OUT
REACHING TRANSPARENCY
THROUGHOUT THE RATE CITY
PROCESS- WE- THE LETTERMAN
COALITION FULLY. SUPPORT YOUR
EFFORT TO GET A TIME LINE OF
IMPLEMENTATION AND WE'RE BEHIND
THAT ONE HUNDRED PERCENT- WE
THINK THAT IT'S CRITICAL TO SEE
WHERE THE COMMUNITY IS GOING
AND WHAT WE CAN EXPECT- IT IS
SPECIFICALLY WE ALSO WANT TO
THANK YOU IN THIS COMMITTEE FOR
LAST YEAR'S INITIAL EFFORT IN
THAT AND WHICH WAS EMERGENCY
TRIAGE FUNDING SO THANK YOU AND
THAT YOUR COLLEAGUES EFFORTS IN
THAT. AND WHILE THERE ARE A
COUPLE ISSUES. DURING REMAINING
MOST NOTABLY WITH THEM VERY
MODEST PERHAPS EARLY INVENTION
INFILL DEVELOPMENT SERVICES
THAT CAN BE WORKED OUT. I'M
ALSO MOVING TOWARDS VALUES
BASED PURCHASED WE ALL WANT TO
MOVE IN THAT DIRECTION WHILE WE
WANT TO MOVE IN THAT DIRECTION
AS WELL. DO BELIEVE THE- THAT
UPPER. RATES THAT SAID. OFFICE
FAR WORSE THAN OUR- GOOD RATE
MODEL THAT WE CAN START
IMPLEMENTING TODAY. SO LET'S
BEGIN IMPLEMENTATION THIS YEAR
AND- FULLY SUPPORT THE
LEGISLATURE'S ARE FORGETTING
THAT. DETAILED INFORMATION YOU
NEED TO MAKE THOSE
KNOWLEDGEABLE DECISIONS THANK
YOU. THANK YOU. WELCOME THANK
YOU MARTY MOTOR FAMILY MEMBER
ALSO BUT CITY CAN CALIFORNIA
DISABILITY YOU'RE CLEANING
ACTION NETWORK THANK YOU FOR
DOING THIS HEARING. ALSO THANKS
TO THE APARTMENT. ON THEIR
WORKS AND BRING STAKEHOLDERS
TOGETHER AND- LOOKING AT SYSTEM
REFORM. TWO IMPORTANT THINGS
THAT WE THINK SHOULD BE DONE BY
THE SUBCOMMITTEE OR WORKING
WITH THE STATE. IS TO. MAKE
RETROACTIVE- TO THE THREE
SERVICE BECAUSE THAT WERE LEFT
OUT OF THE SUPPLEMENTAL RATE
INCREASES. THAT WENT INTO
EFFECT THIS YEAR THAT WON'T GO
INTO EFFECT FOR THOSE THREE
UNTIL NEXT YEAR- TWO OF THEM
DEAL WITH THE EARLY START-
WHICH IS A BIG. PARTY FOR THE
STATE- AND IT IN THIS. THIRD
DEALS WITH THE- INDEPENDENT
LIVING THE STATE HAS DONE
RETROACTIVE PAYMENTS BEFORE YOU
MEDI CAL IN OTHER WAYS AND SO.
I THINK THE STATE. SHOULD
CONSIDER THAT THE OTHER. IS
AGAIN- WITH THE WORK GROUPS
UNDER THE DEVELOPMENTAL
SERVICES TASK FORCE DOES
MEETING. AND THE INFORMATION
SHOULD BE MADE PUBLIC AND IT
SHOULD THE MEETING SHOULD BE
POSTED PUBLICLY. I THINK THAT
WAS JUST AN OVERSIGHT BY THE
DEPARTMENT DEPARTMENT HAS
ALWAYS BEEN VERY TRANSPARENT.
BUT AND THEY DON'T NEED TO-
THOSE MEETINGS AT THE PUBLIC
COMMENT BUT EVERY OTHER
DEPARTMENT THAT I WORK. IN A
STAKEHOLDER PROCESS ON MEDI
CAL. MASTER PLAN ON EATING ALL
THOSE WE ARE OPEN TO THE PUBLIC.
SUPPORT ISSUE OF TIME LINE AND
BY THE WAY CAN'T AND- STEPS.
INTO OUT. PARTS OF THE OF THE
RATE STUDY WE THINK THERE'S A
WAY TO DO THAT AND LASTLY- WE
SHOULD LOOK AT THE ISSUE
POLICY. DOES IT ME MAKES SENSE
TO HAVE SERVICE CODES OR EVEN
THE RATE MODELS SO THANK YOU.
THANK YOU. WELCOME THANK YOU
DOCTOR PAIRING CARRUTHERS WITH
THE STATE COUNCIL ON
DEVELOPMENTAL DISABILITIES I
WANT TO THANK YOU FOR YOUR
QUESTIONS TODAY AND THANK THE
DEPARTMENT FOR THAT. TESTIMONY
TODAY BECAUSE IT CENTERED ON
THE TWO MOST IMPORTANT PIECES
IN THIS CONVERSATION ONE IS
STABILIZING THE SYSTEM INTO IS.
IMPROVING THE SYSTEM MOVING A
SYSTEM FOR YOUR QUESTIONS
AROUND VALUES BASED I VERY MUCH
APPRECIATE IT WAS THE COUNCIL'S
RESPONSE WE SAW THE DOLLAR
SIGN. OF ONE POINT EIGHT
MILLION SOUNDS LIKE A BIG
NUMBER HOW DO WE KNOW PEOPLE'S
LIVES WILL BE IMPROVED- WITH
THAT LEGISLATURE'S. INVESTMENT
AND THAT'S WHY THE COUNCIL
CONTRACTED FOR THE STUDY THAT
THE WITNESS MR HAVE TALKED
ABOUT. AND WE'RE LOOKING
FORWARD TO WHAT THOSE OUTCOMES
ARE. ADDITIONALLY WE APPRECIATE
THE COMMENTS FROM THE
DEPARTMENT AND MISTER PULASKI
REGARDING SUPPORTING SERVICE
PROVIDERS THAT RELATIONSHIP IS
ONE OF THE MOST IMPORTANT IN
PEOPLE'S LIVES TO MAKE SURE
SOMEONE THEY KNOW. AND TRUST
AND CAN RELY ON. INVESTING IN
TIERED LEVELS OF TRAINING SO
YOU LEARN MORE YOU GET PAID
MORE AS A WAY TO KEEP A
PROFESSION AS THE WORK FORCE.
ADDITIONALLY WE'RE LOOKING FOR.
SERVICES THAT INCREASE
INVOLVEMENT IN COMMUNITY LIVING
A MISTER PULASKI TALKED ABOUT
HOW THE RATE MODEL INCENTIVIZE
IS SERVICES AND COMMUNITY BASED
SETTINGS WE WOULD LIKE TO SEE
MORE THAT THANK YOU. THANK YOU.
WELCOME MONEY DR GRANT A VERY
JUTTING CAL DISA SERVE A SAYS
I'D LIKE TO ASK MISTER LYNCH
COMMENTS ABOUT OUR GRAY FOR
BOTH THIS HEARING AND ALSO FOR
THE INCREDIBLE EFFORTS OF THIS
SUBCOMMITTEE LAST YEAR AND
REALLY MOVING US FOURTEEN
GETTING US THAT DOWN PAYMENT ON
WHAT WE NEEDED- TO BUILD A FOR
THE RATE STUDY SO YOU YOU
TALKED ABOUT THE- INCREASE IN
PURCHASES SERVICE GROWTH IN THE
SYSTEM THAT'S ASOLUTELY TRUE A
QUARTER OF THAT COMING UP IN
THE COMING YEAR IS THE
SUPPLEMENTAL RATE INCREASES A
THIRD OF IT OR SO IS ABOUT
MINIMUM WAGE. AND THE OTHER
PART OF IT IS ABOUT A PURCHASE
SERVICE SO IT'S NOT REALLY
ABOUT RATE REFORM OTHER THAN
THAT'S THE SUPPLEMENTAL RATE
INCREASES AND SO WE'VE GOT A
SHORTFALL STILL OF ABOUT ONE
POINT FOR A LITTLE BIT LESS
THAN THAT UNDER THE RATE STUDY
AND YOU KNOW THE KNOCK ON
EFFECTS OF THAT ARE PRETTY
PREDICTABLE WE SELL A PROGRAM
CLOSURES WILL LISTS- PEOPLE NOT
GETTING IT SAYS TO THE SERIES
THIS IS WE HAVE ROLLED OVER
THAT IS OVERWORKED UNDER
APPRECIATED WITH INCREDIBLE
TURN OVER AND THEN IT LEAD TO
RECRUIT AND RETAIN THEM SO WE
THINK THAT IT'S IMPORTANT HAVE
THESE CONVERSATIONS ABOUT
SYSTEMS CHANGE MOVING FORWARD
AND ARE HAPPY TO BE PART OF
THAT. BUT AT THE SAME TIME I
CAN'T DO ENOUGH REAL FOCUSING
ON THE TIME LINE AND THESE AND
AN REALLY GET US A WILL WE HAVE
THE BILL BECAUSE I IT'S AN WILL
MATTER OF COURSE AS AS A DOES.
LIZA WE DON'T IT WAS A WORK FOR
WHEN I. LEFT HIM. THANK YOU.
WELCOME MORNING FOR THE ARE ON
DOCTOR DUBS WAYNE WHEN THE
FORMER OF THE SPEECH ON HEARING
IS. I'VE BEEN AND IN OUR FOR
OVER THIRTY FIVE YEARS I HAVE
TO CONCERN WITH REGARD TO RATE
ADJUSTMENTS THE MINIMUM
REQUIREMENT FOR SPEECH LANGUAGE
PATHOLOGISTS AND CALIFORNIA'S A
MASTER'S DEGREE THERE ARE
APPROXIMATELY FIFTEEN THOUSAND
A SPEECH LANGUAGE PATHOLOGIST
IN CALIFORNIA ROUGHLY A THIRD
PART IN SERVICES EARLY
INTERVENTION. WE HAVE A PROBLEM
WITH- WAIT LISTS BECAUSE WE
CAN'T GET IN A SPEECH
PATHOLOGIST BECAUSE WE CAN'T
PAY THEM ENOUGH AS AN EARLY
INTERVENTION PROVIDER. SO WE'RE
TALKING ABOUT EARLY START WE
HAVE A WINDOW OF OPPORTUNITY
FROM TOO MUCH TWO YEARS TO
THREE YEARS AND THE CLICK CLOCK
STARTS TICKING WE NEED TO GET
THEM SEEN. BECAUSE THE SCHOOLS
CAN'T ACCOMMODATE THEM SO I'D
ASK IN THE PROCESS OF EXAMINING
WHAT WE'RE GOING TO DO WITH
REGARD TO RATE IN REIMBURSEMENT
THAT WE CONSIDER THE QUALITY OF
STAFF THAT WE USE THEY'RE
HIGHLY EDUCATED AND EACH YEAR
THEY REQUIRE TWELVE. HOURS OF
CONTINUING AD BUT MOST
IMPORTANTLY IS ACCESS THE
SERVICE BECAUSE ONCE A WEEK
MIGHT WE CLOSE THAT WINDOW THEY
DON'T GET EARLY INTERVENTION
SERVICES. THANK YOU THANK YOU.
WELCOME WE'LL SEVERED ESSIEN
CS- TWO THINGS WERE LIKE REALLY
COMMEND YOU FOR YOUR CALL FOR
ACTION I'M HOPING FOR CONCRETE
ACTION CONVERSATIONS ARE GREAT.
WE CAN HAVE THEM FOR YEARS WE
NEED ACTIONS THAT ARE ACTUALLY
GOING TO INCREASE ACCESS AND
AVAILABILITY OF SERVICES OR
FOLKS. YOUR COMMENTS ON THE
DIRECT SERVICE PROFESSIONALS
RIGHT NOW THE SYSTEM IS BASED
ON BASED ON ALL A SLIGHTLY
BETTER THAN MINIMUM WAGE SYSTEM
THAT'S OUR INCREASES THAT YOU
REFERRED TO IN THE BUDGET ARE.
WE NEED MORE THAN THAT IF YOU
WANT QUALITY SERVICES YOU
REALLY HAVE TO MAKE A PUSH ON
THAT. I WOULD ARGUE THAT PART
OF THE REASON THE DOLLAR AMOUNT
SAY THE SAME IS RIGHT NOW WE
HAVE LESS ACCESS PEOPLE ARE
WAITING. THEREFORE THEY'RE NOT
GETTING THE SERVICES THE
DOLLARS TO INCREASE THE RATE
THE EXPECTED. BECAUSE WE DON'T
HAVE PEOPLE TO FILL THOSE JOBS
IT'S VERY IMPORTANT THAT WE
TAKE A LOOK AT IT FIND A WAY TO
REALLY STABILIZE INCREASE ARE
JUST. REX ARE FOR. THANK YOU.
THANK YOU. WELCOME CHAMBER THE
NIGHT SEVERAL POLICY HERE IN
SACRAMENTO COUPLE POINTS FIRST
THANKS FOR TO DEPARTMENT BIRDS
ASSOCIATES- FOR THE RATE STUDY
WE DO APPRECIATE THAT WORK AND
ALSO THIS COMMITTEE WITHOUT A.
B. TWO X. ONE WE WOULDN'T BE
HERE TODAY TALKING ABOUT THIS
WITH ALL THE DATA THAT WE DO
HAVE SO WE REALLY DO APPRECIATE
IT'S A BIG STEP FORWARD FOUR
YEARS AGO THE CHALLENGE WAS
PROVIDER DATA UNDERSTANDING THE
COST OF THE SERVICE SYSTEM
UNDERSTANDING WHAT OUR EXPENSES
OF PROVIDERS WORK WE DIDN'T
HAVE THAT DATA THAT WAS A
DAUNTING CHALLENGE FOUR YEARS
LATER WE'RE HERE TODAY WE HAVE
THAT DATA WE'RE WITHIN.
EYESIGHT OF A GOAL THAT WE CAN
HIT AS FAR AS IMPLEMENTING
BETTER RATE MODELS TRANSPARENT
RATE MODELS SO THAT'S A HUGE
SUCCESS THE DAUNTING TROUT TASK
NOW SEEMS TO BE SHIFTING
TOWARDS RATE REFORM AND VALUE
BASED PURCHASING AND I WOULD
WANT TO SAY WE WELCOME THAT
CHALLENGE WE'RE SUPPORT OF THAT
WE WANT TO BE A PART OF THAT
CHALLENGE- WE THINK IT'S DOABLE
IT'S NECESSARY BUT WE COUPLE
THINGS ONE WE NEED TO FINISH
WHAT WE STARTED WE ARE REALLY
ON THE CUSP OF BEING ABLE TO
MAKE MEANINGFUL REFORMS IN THE
SYSTEM WITH PROVIDER RATE THAT
WILL DIRECTLY IMPACT OUR
WORKFORCE. BUT WE SHOULD TAKE
THOSE STEPS THAT WE CAN TAKE
NOW INTO THAT INVOLVES A TIME
LINE OF PLAN- OTHER SAID THERE
ARE EASY- WAYS THAT WE CAN
REPORT ON THE MOVE FOR ONCE OUR
CRUISE TO TEXEL OF CODES
TOGETHER. AND BUILD A BIG
MEETING FOR FROM THERE AND THEN
ARE FORCED IS THE BEST THING
ABOUT STAFF AND THAT'S COMING
TO THE RIGHT INCREASES SO THAT
YOU THANK YOU. WELCOME THANK
YOU SAID PAN FOR HAVING HEARING
TODAY IN THANK YOU FOR YOUR IN
QUESTION PRETTY AT YOU'RE THE
OF A HERE TODAY THAT MEANT THE
LAND TO ACT WHICH ANTI CAL WITH
THE TO ACCESS TO SERVICES AND
IF THE SYSTEM ISN'T STABILIZED
THAT ACCESS WON'T BE THERE SO I
A SUPPORT OF PHASED IN A
IMPLEMENTATION OF THE RATE
MODELS AND LOVE TO SEE A
COMMITMENT CONCRETE COMMITMENT
THAT WAS A- A GOOD POINT AND I
THINK OUR TURNOVERS 40% I
REPRESENT AND ORGANIZATIONS
MATTEO IN SANTA CLARA COUNTY
AROUND THE CORNER IN AND OUT IS
NINETEEN DOLLARS AN HOUR. FOR
ONE MINUTE DENTAL. IN WE CANNOT
CA WITH THAT. AND AGAIN THE
SYSTEM WILL NOT CONTINUE TO
PROVIDE QUALITY SERVICES
WITHOUT. SOME FINANCIAL REFORM
IN RELIEF. I ALSO SUPPORT THE
RETROACTIVE IMPLEMENTATION OF
THE THREE SERVICE CODES EARLY
START INDEPENDENT LIVING I'D
LIKE TO SEE THAT JANUARY FIRST
TWENTY TWENTY THANK YOU THANK
YOU. WELCOME THANK YOU GOOD
MORNING- I JUST WANNA ALSO
REITERATE MY THANKS TO YOU FOR
HEADING THE FUNDING THAT
STABILIZED OUR OUR SERVICE
DELIVERY SYSTEM THIS YEAR WE
WOULDN'T BE HERE TALKING TO YOU
WITHOUT THAT STEP. AND I AM
VERY HEARTENED TO HEAR YOU
CONTINUE TO EMPHASIZE THE NEED
FOR A PHASED IN PLAN FOR THE
RATE SURVEY- IF I DIDN'T HAVE
PLANS IN MY ORGANIZATION I
WOULDN'T HAVE A JOB I HEARD YOU
ASKING FOR THIS LAST YEAR I
WANT YOU TO CONTINUE TO
EMPHASIZE THAT THIS YEAR. AND
I'M- TO WORK FORCE ISSUES I
JUST WANT TO REITERATE WHAT
EVERYONE ELSE IS AND MY NAME'S
BURGER FARM AND I'M WITH YOU
SEE P. AT NORTH BAY WE HAVE A
MINIMUM WAGE IN PETALUMA A
FIFTEEN DOLLARS AN HOUR WE ARE
ALREADY. FOR BEHIND THE EIGHT
BILLION IN IN. THAT
REIMBURSEMENT SO THANK YOU.
THANK YOU. WELCOME LOW. HI I
MELANIE MERRY FROM VALUE AND
DEVELOPMENTAL SERVICES AND WE
ARE FROM THE CENTRAL VALLEY AND
WORK COMPREHENSIVE AN INFANT
DEVELOPMENT PROGRAM AND A
SERVING ABOUT THREE HUNDRED
FIFTY INFANTS AND TODDLERS AND
THEIR FAMILIES WE HAVE ABOUT
FIFTY EMPLOYEES AND- WHEN YOU
TALK ABOUT AGENCY VERSES
INDEPENDENT CONTRACTOR I'VE
BEEN BOTH- AND THERE'S A HUGE
DIFFERENCE BETWEEN AN AGENCY
COSTS VERSUS AN INDEPENDENT
CONTRACTOR COST. THERE'S YOU
THE OVERHEAD COST OF HAVING
OFFICE FOR STAFF PEOPLE TO COME
TO YOU KNOW WHEN YOU'RE NOT
HELLO WHEN YOU'RE NOT OF- ABLE
TO HAVE STAFF AS SUBCONTRACTORS
THEY HAVE TO HAVE A PLACE TO BE
ABLE TO COME TO AND THEN DDS IS
REQUIRED TO EMPLOY PEOPLE. HAVE
THE MESS UP TRACTORS. YOU HAVE
A DIFFERENCE IN MILEAGE RATES
AND- YOU WERE GIVEN FIFTY
CENTS- PER MILE AND YOU HAVE TO
BE FIFTY EIGHT PER STATE. AND
THERE'S ALL KINDS OF
ADMINISTRATIVE COSTS WHICH ARE
PROBABLY THE 17% AND OURS RANGE
ANYWHERE FROM FIFTEEN TO
EIGHTEEN PERCENT. RETAIN STAFF
IS VERY HARD I'M- HERE KEEPING
QUALIFIED STAFF. AT BECAUSE OF
THE RATES YOU CAN'T KEEP
QUALIFIED STAFF. AND THERE'S NO
OTHER SOURCES TO GET THE COST.
BACK YOU LIKE IN OTHER PROGRAMS
CCS PROGRAMS LIKE THAT YOU CAN
GET SOME OF THE COSTS BACK. IN
A SUPPORT THE TOPPLING-
RETROACTIVE. TIME AM. AN I'M- I
WOULD JUST WANT TO SAY YOU KNOW
WHEN THEY HAVE THE- DEAD. THEY
WANT COMP TIME YOU KNOW FOR
THINGS TO BE SENT IN AND STUFF
TO- BE GIVEN WORD MORE NOT
ALWAYS PART OF THAT. OKAY THANK
YOU AND PLEASE FEEL FREE TO
ALSO SOME ADDITIONAL
INFORMATION TO START THANK YOU
DOCTOR PAN AND- DISTINGUISH
STAFF- RICK ROLLINS
REPRESENTING THE ASSOCIATION
REGIONAL CENTER AGENCIES AND ON
BEHALF THE REGIONALLY CENTERS
I'D LIKE TO THANK YOU FOR
HOLDING THIS HEARING AND ALSO
FOR THE GREAT WORK LAST YEAR IN
TEEN UP. THE AND UP. BEEN SO
PROCESS ON MAKING SURE THAT ARE
SO DID RECEIVE A- INFLUX OF NEW
FUNDING I WOULD LIKE TO
ASSOCIATE OURSELVES MANY OF THE
COMMENTS WERE MADE TODAY AND
ALSO STRONGLY SUPPORT THE
LETTERMAN COALITIONS PROPOSAL
FOR A PHASE IN A TO FUND THE
RATE STUDY MOVING FORWARD WE
WILL BE PROVIDING A COPY OF THE
LETTER IN TESTIMONY AT YOUR
HEARING IN MARCH ON THE BUDGET
ISSUES. THANK YOU THANK YOU.
WELCOME I MARK LANSON AG SECTOR
DIRECTOR OF THE CALIFORNIA
SUPPORTED LIVING NETWORK I'M
JUST WANNA SABER- EXCITED TO BE
EMBARKING ON THE PROJECT IN
PARTNERSHIP WITH STATE
COUNSELING DEVELOPMENTAL
DISABILITIES ON TO IN A DEEP
DIVE WITH- OUR COMMUNITY ON
OUTCOMES- OF KEY LEVEL SERVICES
THAT ARE MEASURABLE- SO WE'RE
EXCITED TO BE GETTING THAT WORK
STARTED- WORKFORCE TRAINING
TURN CSL INTO A COMPETITIVE
WAGE STUDY LAST YEAR THAT
OPPOSITE GALLAGHER AND
NATIONALLY RENOWNED- COMPANY
SO- WE DO WE DO- LOOK FORWARD
TO WORKING WITH CBS ON BROWN
WHAT THAT TERM RATE SOMEWHAT
THAT MIGHT LOOK LIKE- I'LL-
WORKED THAT WAY MEAN FOR.
LIVING THIS IS ON THE STILL
WORKS NEEDS TO BE ON THAT RATE
MODEL AND NO PROVIDERS RECEIVE-
A REDUCTION IN THE RATES THAT
THE RECEIVING. FOR THE SERVICES
THAT THEY'RE PROVIDING. SHE
SUPPLEMENT RATE INCREASE AND
THE EXTENSION OF THE SUNSET BUT
WE'RE HEARING FROM. THAT
MINIMUM WAGES KILLING AND NOT.
THE HEALTH AND SAFETY WEAVER
PROCESS IS A REALLY COMPLEX-
LENGTHY PROCESS SO- WE
APPRECIATE THAT THE HEARINGS IN
THE OPPORTUNITY TO. SPEAK SO
THANK YOU THANK YOU. WELCOME HI
DONNA FUNGAL THE DOCTOR
LEARNING CENTER I JUST WANT TO
REITERATE WHAT MANY HAVE SAID
CENTER DEPEND ON THAT- I REALLY
APPRECIATE THE FACT THAT YOU
REALLY EMBRACED OUR ISSUES YOU
TRULY UNDERSTAND WHAT WE ON THE
STREETS ARE DEALING WITH AND-
WE THANK YOU FOR YOUR SUPPORT-
I DON'T FEEL THE SENSE OF
URGENCY FROM THE DEPARTMENT AND
FROM THE FINANCE ON SOME OF THE
ISSUES I THINK STERN REFORM IS
IMPORTANT BUT WE HAVE- WE HAVE
STAFF WHO ARE LIVING IN POVERTY
THIS IS SERIOUSLY A SOCIAL
JUSTICE ISSUE THAT WE CONTINUE
TO COMPETE HERE WHAT ARE STAFF
TO RESPONSIBLE FOR THE LIVES OF
OUR MOST VULNERABLE CITIZENS.
TWO PEOPLE WHO FLIPPING
HAMBURGERS AND ONCE AGAIN ON
ALL WORKERS VALUABLE BUT YOU
KNOW I DON'T THINK WE CAN
COMPARE THE SAME WE HAVE A
SERIOUS- VALUE ISSUE HERE IN
TERMS OF HOW WE SUPPORT OUR
STAFF AND I'M CONCERNED IT IT'S
GONNA BE YEARS UNTIL THERE'S A
SOLUTION FROM THE SYSTEM REFORM
WE HAVE CONTINUE TO BUILD ON
THE WITH THE BOMB US UP. IN. AS
WE THIS YEAR. NEXT THANK YOU.
THANK YOU. WELCOME THANK YOU
TONIGHT I'M THE CAN SERVE TO
MORE INVENT. AND ALSO A PARENT
AND I DO WANT TO THANK FOR THE
THAT IS ON OUR SIDE. IN MY DUAL
ROLES THAT'S ESPECIALLY CLEAR
TO ME AB I THINK A STOP GAP
MEASURE IS A WONDERFUL THING
AND WHAT WE'VE GOT SO FAR IS A
WONDERFUL THING AS SUCH BUT IT
NEEDS TO BE RECOGNIZED FOR WHAT
IT IS BY DEFINITION IT'S A
TEMPORARY STOPGAP FIX. AND IN
THE MEANTIME WHAT I'M SEEING IS
YET THE GAP IS CONTINUING TO
WIDEN WE'VE GOT THESE GREAT
IDEAS H. CBS PERSON CENTERED
THINKING INCREASED MEANING FULL
COMMUNITY ENGAGEMENT BUT WELL
WE'VE GOT THE IDEAS GOING EVERY
DAY WHAT I SEE IN REALITY IS
THE PEOPLE WE SERVE. A NUMBER
GET LEFT BEHIND EVERY DAY
BECAUSE WE CANNOT RETAIN THE
STAFF TO SAFELY TAKE THEM OUT
IN THE COMMUNITY THANK YOU
THANK YOU. WELCOME TO. GOOD
MORNING MY NAME IS ERIC
HARRISON WITH DISABILITY RIGHTS
CALIFORNIA AND THERE ARE THREE
MAIN POINTS THAT DEAR SEE
SUPPORTS REGARDING RATES FIRST
WE SUPPORT THE SUPPLEMENTAL
RATE INCREASE FOR EARLY START
SPECIALIZATION THERAPEUTIC
SERVICES INFANT DEVELOPMENT AND
INDEPENDENT LIVING SERVICES
CONSISTENT WITH THE
SUPPLEMENTAL RATES INCREASE
INCLUDED IN THE TWO THOUSAND
NINETEEN BUDGET OUR SECOND WE
SUPPORT THE PERFORMANCE
INCENTIVE PROGRAM BASED ON THE
REGIONAL CENTER PERFORMANCE
CONTRACT AND FRANKLY WITH THE
INDIVIDUAL AND GROUP RATE
REVISED MODEL INCLUDING NON.
ENGLISH RATES. YOUR WORK OVER
THE PAST YEAR AND THANK YOU FOR
YOUR- THANK YOU FOR YOUR
CONTINUED WORK ON THIS TOPIC.
THANK YOU. AS. SENATOR PAN MY
NAME'S ERIC STERN I HAVE BEEN
WORKING AS A SERVICE
COORDINATOR TO REGIONAL CENTER
OF THESE PAY FOR THE LAST
NINETEEN YEARS IT'S VERY COMMON
FOR VENDORS TO TELL ME THEY
WILL PROVIDE SERVICES WHEN THEY
CAN STAFF UP IN OUR AREA I
BELIEVE IT'S CLOSE 250% IN THE
EAST BAY OF- ANNUAL TURNOVER OF
DRUG SUPPORT STAFF. THE TRICK
SUPPORTS HAVE CRUCIALLY NEED TO
BE HONORED AND RESPECTED FOR
THE CRUCIAL WORK THEY TO. AS
CHAIR OF THE ACLU CALIFORNIA DD
COUNCIL REPRESENTING THOUSANDS
OF A DIRECT SUPPORT OF REGIONAL
CENTER WORKERS WERE FULLY INTO
LINE WITH THE LETTERMAN
COALITIONS. THREE YEAR
REINVESTMENT PROPOSAL NOT JUST
A STOP GAP MEASURE BUT TO FULLY
FUND THE ONE POINT EIGHT
BILLION DEFICIT- AND INCLUDING.
AB THIS FUNDING FOR I ALLOWS
AND- EARLY START. THANK YOU SO
MUCH FOR PUTTING ON THIS
HEARING. THANK YOU BOB. WELCOME
HI GOOD MORNING THANK YOU
DOCTOR PAN- MY NAME'S TOM HINES
SOME EXECUTIVE DIRECTOR OF
NONPROFIT CALLED THE SPAN OF A
SINCE WE PROVIDE SUPPORTED
LIVING INDEPENDENT LIVING IN
EMPLOYMENT SERVICES IN ALAMEDA
COUNTY- WE APPRECIATE YOUR
SUPPORT LAST YEAR FOR THE
SUPPLEMENTAL RATE INCREASES
REALLY APPRECIATE THE INCLUSION
OF THE OTHER SERVICE CODES IN
THIS YEAR'S- GOVERNORS BUT- MY
AGENCY- IS IN. A HIGH COST AREA
WE HAD 49% TURNOVER IN STAFF IN
LAST YEAR WE CARRY ABOUT
FIFTEEN TO TWENTY VACANCIES AT
ANY GIVEN TIME. THE MINIMUM
WAGE ISSUE IS A HUGE ISSUE FOR
US. FOR SUPPORTED LEVINE THE
LAW ALSO THE RATE- METHODOLOGY
I'M CONCERNED ABOUT CONSUMERS
WHO HAVE HIGH NUMBERS OF AYE
HSS HOURS. AND LOW NUMBERS HAVE
SUPPORTED LIVING HOURS FUNDED
BY THE REGIONAL CENTER AND
THOSE HOURS WON'T COVER COSTS
WE HELP PEOPLE MANAGE THEIR I
TO PASS A CORD BOB COM SITE. TO
BE LOOKED AT THANK. THANK YOU.
WELCOME THANK YOU SO MUCH OR
HOLDING THIS HEARING DOCTOR PAN
REALLY APPRECIATE YOUR SUPPORT-
I AM WENDY FERGUSON I'M THE CEO
OF COMMUNITY CATALYST OF
CALIFORNIA WE SERVE- ABOUT
SEVEN HUNDRED INDIVIDUALS
ANNUALLY WE HAVE OVER THREE
HUNDRED EMPLOYEES THROUGHOUT
THE STATE- AND I WANT TO FIRST
AND FOREMOST SAY THAT I
COMPLETELY SUPORT THE LINEMEN
COALITION PROPOSAL I HAVE
FUNDING FINDING THE RIGHT MODEL
AND THE DEFICIT OF ONE POINT
EIGHT MILLION I ALSO AGREE HAVE
SIGNIFICANTLY WITH THE MINIMUM
WAGE ISSUE HEALTH AND SAFETY
WHICH IS NOT EFFECTIVE- I DO
THINK THERE NEEDS TO BE
SOMETHING IN PLACE TO INCREASE
MINIMUM WAGE ACROSS THE BOARD-
WITHOUT MANY HAVING TO EXPEND A
LOT OF ADMIN. OF TIME TO TRY TO
GET A COUPLE PENNIES TWENTY
THIS COUPLE PENNIES ON OUR RATE
FOR A FEW EMPLOYEES THE OTHER
PART THAT I WANTED TO SPEAK TO
TODAY IS THE- PERFORMANCE
INCENTIVE THAT'S IN THE BUDGET.
I AM CONCERNED THAT THAT'S CAN
BE PUT ON THE BACKS OF
PROVIDERS WHO ARE CURRENTLY
UNDER FUNDED. BECAUSE IF THE
REGIONAL CENTERS ARE GOING TO
HAVE TO MEET PERFORMANCE
CRITERIA TO SHOW THAT WE'RE
PROVIDING QUALITY SERVICES IN
ORDER FOR THE- DDS TO GIVE THEM
MONEY. THAT MEANS SOMEBODY'S
PAYING FOR THAT AND ENSURING
THE SERVICES ARE OCCURRING IN
ORDER TO GET IT. SO I JUST
WANNA STATE THAT AS A CONCERN
THANK YOU THANK YOU. WELCOME
THANK YOU THANK YOU DOCTOR PAN
OUT THAT PASSED OVER WITH
IMAGINE SUPPORTED LIVING APTOS
CALIFORNIA AND- IF WE'RE GOING
TO CONTINUE TO HAVE A PURELY
BECAUSE BASED FUNDING MODEL I
APPRECIATE THE DYNAMIC
TRANSPARENT- ONE THAT'S BEEN
CREATED BUT I DO THINK THAT-
QUALITY AS AND I APPRECIATE
YOUR BRINGING THIS UP AND ALSO
ADDRESSING DISPARITIES IN OUR
UNDERSERVED COMMUNITIES ARE
JUST AS OUR CHEN MY HOPE THOSE
WILL STAY TOP OF MIND ALSO WAS
WE DECIDE. WHAT TO DO GOING
FORWARD THANK YOU THANK YOU.
WELL I THANK EVERYONE FOR.
BEING HERE FOR THIS HEARING AND
APPRECIATE THE PUBLIC COMMENTS
AS WELL I'VE TYPICALLY DO ONE I
THINK- DIRECTOR- PARCHMAN SO
MUCH- AND- DEPARTMENT OF
DEVELOPMENTAL SERVICES I KNOW
THAT- YOU A LOT OF YOUR PLATE
AND YOU'RE WORKING VERY HARD-
BUT THAT DOESN'T MEAN THAT I
WON'T ASK MORE OF YOU- SO- AND
I ALSO THANK YOU SO MUCH OF HIS
PHILOSOPHY FOR BEING HERE AS
WELL AND- THE WORK THAT. BURNS
ASSOCIATES DOES AND DOING ON
THIS DONE ON THE RATE STUDY AND
HOPEFULLY THE FURTHER WORK- SO
APPRECIATE- FINANCE BEING
ANOTHER STILL HERE- THEY ICE
THE THEM. DUDE THE ALSO. IT L.
A. L. US A FRAMER ISSUES THAT
AN HOUR FOR A- SO AND I THINK
WE'RE TRYING TO GET SOMETHING
ON THE BALLOT SO WE CAN GET YOU
SOME MORE RESOURCES TO DO MORE
WORK FOR US SO. ANYWAY I THINK
WE SET THE STAGE FOR. FURTHER
DISCUSSION WE'RE GOING TO HAVE
IN THE ACTUAL BUDGET HEARING
AND THAT- YOUR COMMITMENT TO-
HELP US KEEP THE BALL MOVING IN
WE HAVE YOU COME BACK AGAIN AND
AS WE TRY TO GET THIS YEAR'S
BUDGET. TOGETHER SO THANKS VERY
MUCH AGAIN AND- WITH THAT- THIS
HEARING OF THE SENATE BUDGET
FISCAL REVIEW SUBCOMMITTEE
NUMBER THREE ON HEALTH AND
HUMAN SERVICES NOW ADJOURNED
THANK YOU.