Faced with stifling reimbursement cuts and the unforeseen changes that will come with the transition to a managed care-based service delivery system, The Resource Center is reaching out to its state representatives for assistance.
The Resource Center held a legislative meeting recently to discuss a variety of issues with elected officials pertaining to major current concerns, but also some potential solutions. State Sen. Catharine Young and Assemblyman Andrew Goodell braved snowy weather to attend the session so that they could learn more about the challenges TRC faces.
Present at the session were Dr. Todd Jacobson, the president of TRC's board of directors; board member William Haenggi and his wife, Donna; and TRC members Don and Joan Yost (all of whom are parents of people with disabilities), as well as Paul Cesana, executive director; Denise Jones, associate executive director; and Nancy Ingram, assistant executive director.
Paul Cesana makes a point, as state Sen. Cathy Young listens. Assemblyman Andy Goodell is seen in the background.
Jacobson told the lawmakers that frozen reimbursement rates, the elimination of the rate appeal process and the lack of inflationary trend increases "are really putting us in a precarious position for the coming years." He also said The Resource Center's struggles in retaining employees to provide support to the people with disabilities who the agency serves.
The Haenggis, whose son has received supports from The Resource Center for many years, expressed concern about the effect the funding cuts will have regarding the types of services TRC will be able to provide. They noted that their son functions fairly independently but that people with severe disabilities need more intensive supports.
"So many people require one-on-one care. So many people deserve more than they're getting," Mrs. Haenggi said.
"I'd hate to see these services cut back," added her husband, who has witnessed the development of more individualized supports since becoming involved with TRC in the 1980s. "It took us so long to get where we are."
Utilizing a prepared PowerPoint presentation, Cesana followed the themes laid out by Jacobson, explaining that there has been a major shift in the way New York State (through the Office for People With Developmental Disabilities and other state offices) funds the services provided by voluntary organizations such as The Resource Center.
"We really are going through some very challenging times right now," he said.
Cesana explained that, until a few years ago, TRC's intermediate care facilities received cost-based funding, while the agency's individualized residential alternatives and day habilitation programs received site-based funding, all of which was aligned with changes in people's needs as well as new or revised regulatory mandates. In 2011, reimbursement was capped at an agency's historical level of reimbursement, regardless of the actual costs incurred in providing services. In 2012, TRC experienced a $3 million shortfall in the operation of those three programs due to New York State's insufficient and arbitrary reimbursement methodology. In the past, TRC could file appeals to the state to cover, retrospectively, deficits incurred based on documented justification. But as of June 2011, the state eliminated the appeal process.
"The Resource Center had traditionally incurred financial operating losses and assumed operating liability because of this imperfect, but reasonable, reimbursement methodology," Cesana said. "This methodology was based on a stated, and often cited, partnership between the state of New York and voluntary organizations such as TRC that could meet the needs of the most vulnerable population in our state in a most cost-effective way.
"This partnership and covenant between the state of New York and voluntary organizations such as The Resource Center have been shattered."
While cutting funding to agencies like The Resource Center, New York state continues to expand regulatory mandates in order to deal with circumstances that occurred in state-operated environments or in response to concerns emanating from the U.S. Centers for Medicare and Medicaid Services. The effect has been to force TRC to cut some services, and additional cuts will occur if this trend is allowed to continue.
Young and Goodell said the families TRC supports need to be more vocal in speaking out against New York state's actions, and they said the most effective way to speak out is ideally by traveling to Albany to tell their stories in person, in addition to writing letters, sending e-mails or making phone calls.
Another critical issue is the area of health services, as The Resource Center is the only safety-net provider of primary care and dental services in Chautauqua County and is also a key provider of mental health services. In 2012, TRC experienced $2.2 million in operating losses in its health and mental health services due to what Cesana called an inadequate, over-regulated and fragmented system.
On a positive note, Cesana illustrated that The Resource Center is uniquely positioned to provide constructive demonstrations that are consistent with the current goal of the ongoing health system transformation directed at the "Triple Aim" of improving health outcomes for individuals, improving the effectiveness and efficiencies of the current health system, and reducing the worrisome escalations of costs associated with the provision of health services.
With its System Transformation with Accountability, Results and Satisfaction Model aimed at addressing all key aspects of a person's life - basic needs; employment; wellness; mental health; family stability - The Resource Center could be an example in the achievement of the Triple Aim in communities such as Chautauqua County that are characterized by largely rural areas with relatively small urban centers, Cesana said.
Young, who serves as the chair of the state legislature's bipartisan Commission on Rural Resources, said she would help The Resource Center try to move this initiative forward.
TRC officials were grateful that Young and Goodell took time to hear their points and that the two lawmakers are committed to assisting the agency as it navigates through the challenging times ahead.