Wednesday, March 22, 2006

This year's cost containments

Demonstrating either my clairvoyance or my willingness to talk about matters I know nothing of, a few comments on the cost containments to be proposed by DDS this Spring. It's my workup for the California Disability Community Action Network teleconference so those of you with good fortune to read this before the teleconference will know what I'll say, and those of you listen to the teleconference first can quit reading now.

The cost containment mentioned in the Governor's Budget may include new contract language for regional centers requiring certain Purchase of Service decisions to be made in a certain way. For example, the low-cost provider able to meet the needs of the consumer shall be used and, where appropriate group services should be used rather than one-on-one services. On a common sense basis in which the words appropriate and need have their usual meanings and include a respect for important preferences, this should already be the case and isn't. In that regard, I'm tempted to agree with this proposal.

On the other hand, the first requirement of citizenship is to disagree with the administration and I do. Confidently. Two perspectives seem very difficult for the Department, which make disagreement not only possible but easy.

On the one hand, regulations and statutes and contract language have very little to do with service coordination except in cases where they amount to no and that seems like the better answer to the regional center decision-maker. Many of us here the once-proposed requirement to prefer group settings where appropriate and imagine that it will be quoted and followed faithfully always and only where inappropriate. The low-cost provider who meets the client's needs will be the provider at whatever cost who meets the service coordinator's needs or no-one's. I'll wager that no end-user of this system or vendor will find my claims here controversial or exaggerated.

The second, and more essential perspective missing from this proposal is the understanding that regulations are most often sources of inefficiency and poor outcome. When our system works best it provides a continuum of support to clients that reduces the need for supervision, future assistance and expensive support by assisting the individual to make choices. This is the most cost-effective behavior in our system where the client lives fully and the taxpayers save money. Any regulation, including contract language, of that process inhibits creativity, innovation and motion along this path. Proposals like the one I expect are as likely to freeze a client in an unchosen environment at needless cost as they are to save money.

3 comments:

MobiusMan said...

But the prison Guards and their "clients" may get an increase of $2 billion to their existing $6 billion base?
Maybe I need to ask for a prison guard, rather than a case manager to develop and fund my son's IPP.
This really isn't, sadly, a flippant comment.....does Lanterman Act say we can't?
Can prison guards enforce law and interpret Purchase of Service standards better?
Bet THEY know victims of violation of law vs. victimless crimes.
Do the crime....pay the fine or do the time.
Hmmm
And just what can an interim acting director do that permanancy cannot/does not?
$2,999,999,997; $2,999,999,998;
$2,999,999,999; $3,000,000,000.....
yep, still a whole lot of money for potential direct service delivery model.

PARCA said...

We all know thaat the State is trying to contain costs, and with good reason. In California, we are in deep trouble. Unfortunately, the biggest cost in providing services to the developmentally disabled is not the consumer, it is the administration and bureaucracy called the regional center system. And, since this system is totally flawed, maybe it is time we start looking at how we can cut costs in this area. Oh, I forgot, those big directors with their big salaries wouldn't be happy about that.

Parca

Anonymous said...

The only reason "cost containment" is an issue is to allow the Gov and his minions steal billions in Medicaid waiver money brought into the system by our children. God forfend we spend the money on them! MadMom