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Yakima Valley RHC

Yakima Valley RHC. March 4, 2009. Action DD’s Presentation to the Washington State Legislature 2009. The Olmstead Decision The Law. The U.S. Supreme Court in the Olmstead decision stated –

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Yakima Valley RHC

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  1. Yakima Valley RHC March 4, 2009 Action DD’s Presentation to the Washington State Legislature 2009

  2. The Olmstead Decision The Law • The U.S. Supreme Court in the Olmstead decision stated – • “We emphasize that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings • ----Nor is there any federal requirement that community-based treatment be imposed on patients who do not desire it. • Nothing in this part shall be construed to require an individual with a disability to accept an accommodation…which such individual chooses not to accept…Persons with disabilities must be provided the option of declining to accept a particular accommodation.

  3. FEDERAL LAW AND Medicaid Waivers Federal requirements for states using waivers under Section 1 915c of the Social Security Act are codified in 42 Code of Federal Regulations, Chapter IV, Sub-part G – Home and Community Based Services. 42 CFT Chapter IV: Paragraph 441.302. State Assurances  HCFA will not grant a waiver under this subpart and may terminate a waiver unless the Medicaid agency provides the following satisfactory assurances to HCFA:  (d) Alternatives – Assurance that when a recipient is determined to be likely to require the level of care provided in an SNF, ICF, or ICF/MR, the recipient or his or her legal representative will be – (1) Informed of any feasible alternatives available under the waiver; and (2) Given the choice of either institutional or home and community-based services.

  4. The Centers for Medicare and Medical Services Washington Medicaid Assessment Report Community Alternatives Program Waiver Control Number 0050.90R2 …We also found the State had adopted laws and policies inappropriately limiting access to Medicaid State Plan services provided by intermediate care facilities for the mentally retarded. This placed the state in noncompliance with federal law and Washington’s Medicaid State Plan. Non-compliance of this nature could jeopardize future federal funding of the State’s Medicaid program. Doctors complain of the inadequate care in the community and inability to get patients admitted into RHCs. Nurses are in short supply all over our state – resulting in community homes with inadequate care, unskilled, non-medical personnel that act as custodians. “The Federal Investigator”

  5. CAP WAIVER CAP stands for the Community Alternatives Program, a Medicaid program for people with developmental disabilities. The CAP waiver is available for both institutional and community settings. “To be or not to be…outside the RHC? What are the cost comparisons of the different choices of living arrangements? A difficult question as the cost comparisons are not computed. All costs are computed for the RHCs but in computing the costs in the community programs, the following costs are not included: Medical or Dental DSHS allocated overhead costs DDD allocated overhead costs Depreciation of DSHS & DDD headquarters Bond Interest Fixed Asset Depreciation

  6. While Residential Habilitation Center costs are all inclusive, (including a considerable amount of DSHS overhead, depreciation, transportation, medical, and the like), the stated Residential Contract Rates for the community do not include all the costs.

  7. Guiding Principles for this Analysis of Yakima Valley School • Protect most vulnerable populations • Maximize federal dollars • Form better partnerships with local governments-align goals san set parameters • Capture and critique returns on investment • Invest early-on to prevent chronic health issues such as mental health, substance abuse, and obesity • Use existing research to evaluate programs • Invest in Health Care system • Find opportunities for consolidation and transformation • Ensure delivery systems are effective and efficient • Avoid cuts that will have negative long-term impact • Rep. Eric Pettigrew • Dec. 11, 2008

  8. The state invests $178 per day for care of each of the 103 vulnerable citizens at the Yakima Valley School The Feds and the residents invest an additional $263 per day to care for the 103 residents.

  9. Cost of living at Yakima Valley School Fiscal year 2007 Total Operating Costs fy 2007: $16,613,438 Total Reimbursable Costs: 17,784,060 Contribution to General Fund…………………………………$ 470,054 Federal Investment: $8,613,302 Medicare D 408,275 Other 272,750 Resident Rent 618,436 Total Other (Non-State) Investment ………………… $9,912,763 State Investment: $6,700,675 Number of residents 103 Cost per year for state $65,055 Cost per day for state $178 This state investment leverages an investment of $9,912,763 148% Return on the State’s Investment. :

  10. ECONOMIC IMPACT OF State Investment in Yakima Valley School On Selah and the Yakima Valley

  11. THE ECONOMICS OF INVESTING IN YAKIMA VALLEY SCHOOL The state invests $6,700,675 in the Yakima Valley School… The Other Investors: $9,912,763 Total revenue contributed to the Yakima Valley Community: $16,613,438 148% ROI

  12. ECONOMIC CHURN With a rate of churn of 2.5, this state/federal /citizen partership’s investment nets the Selah economy 275 living wage jobs with an economic Impact of $41,533,595 which in turn creates additional jobs. The Yakima Valley Development Association has over the past three years been able to create 1200 jobs, about 400 per year given their very best efforts. We do not need to reduce that amount by putting the Yakima Valley School out of business.

  13. 11% UNEMPLOYMENT IN YAKIMA VALLEY The Yakima Valley economy has one of the highest unemployment rates in the state and would be reeling from another $41 million decline in economic activity and loss of jobs.

  14. 11.1

  15. It is the third largest employer in the City of Selah. 275 people work at the Yakima Valley School. These 275 workers support about 1100 family members. Unemployment in Yakima is running in the double digits. The unemployment lines wind around the Work Source Office in Yakima for unemployment checks. Workers then go to other offices to sign up for food stamps, public assistance, medicaid and other essential social services.

  16. The state has invested in the specialized training of the staff who operate the Yakima Valley School. This investment must be perserved! We are all in this economic crisis together and we will all come through it together and show the world an example of the kindness, the respect and the dignity of the citizens of the State of Washington. We truly believe that the golden rule is the principle upon which we found our economic recovery.

  17. Cost of Living at Fircrest ICF/MR Fiscal Year 2007 Total Operating Costs fy 2007 $22,513,281 Total Reimbursable Costs: 25,387,426 Net Contribution to General Fund $667,078 Federal Investment: 12,309,989 Resident Investment: 694,326 Medicare D: 538,128 Other Investments : 313,598 Total Other Investment: $13,856,041 State Investment: 8,657,240 Number of Residents: 107 Cost per year for state: $80,902 Cost per day for state: $222 State Investment of $8,657,240 leverages $13,856,041 RETURN ON INVESTMENT: 160%

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