◊ JOB MATCH

Service Coordination
ARE WE GETTING OUR MONEY'S WORTH?

Let's take a look at service coordination under the MR/DD waiver program.  This is the service that agencies, as providers, covet because it is considered a "money maker."

The Medicaid reimbursement for service coordination is $9.50 per unit (15 minutes).  That's $38 per hour.  Each MR/DD waiver participant may receive up to 70 units (17.5 hours) per month of service coordination.  There are 3,844 participants on the MR/DD waiver program.

Let's assume* for the sake of argument that agencies are billing only HALF of what each participant may receive (i.e., 35 units per month).  That would mean Medicaid is paying nearly $1.3 MILLION each month for service coordination alone.

For that kind of money, every waiver service identified on every program plan should be in place and operating smoothly.  Is it?  Of course not.

Now, BMS claims, in the latest draft of the MR/DD waiver renewal application that its proposed "level of support/service" methodology:

... encourages an independent identification of needs or supports that are known to the consumer, service coordinator, provider, and other members of the interdisciplinary team. This process establishes a “fire-wall” between the consumer and service provider agency, thereby, allowing the service coordinator to independently advocate on behalf of the consumer.

Say what?  Identifying the necessary services and having them documented on the program plans has NEVER been the problem.  Getting those services DELIVERED, on the other hand, is and always has been the problem.  (Trust BMS to redefine the problem to meet its proposed solution.)  Absolutely nothing about the proposed "level of support/service" methodology alleviates the true problem, for as long as the same agency is providing both service coordination and other services, the conflict of interest will exist.  As long as direct care staff are earning poverty-level wages, turnover will be high and quality will be low -- both of which increase the demand for service coordination.  It's a vicious cycle that can only be broken by removing the conflict of interest.

MRU WV recommends that any agency providing service coordination be prohibited from providing direct care services to the same individual.  Further, that for each hour of service coordination billed, an agency must provide 24 hours of direct care services to a different individual.  This will force agencies to step up to the plate and deliver the direct care that comprises the largest gap in service delivery on the MR/DD waiver program.  It will also force agencies to manage their resources in such a way as to effectively recruit and retain staff, and it will let service coordinators fulfill their roles effectively so that the money is not just squandered with nothing to show for it.  Lastly, it will improve the consistency and continuity of services that are essential if waiver participants are to benefit from their habilitation programs.

~*~  Contributions are NOT (yet) tax deductible.  ~*~

++  PRIVACY STATEMENT  ++

MRU WV will never share its members' personally-identifiable information (name, address, phone, or e-mail address) with any outside person or organization without express consent.

This page last updated Friday 17 June 2005