Committee Reduces Rate Increases Promised to Health Care Providers

By JoAnne Young
For the Lincoln Journal Star
Lincoln, NE
November 12, 2009

They said decisions about budget cuts would be hard.

The difficult discussions began in earnest Thursday morning in the Legislature's Appropriations Committee, starting with a decision to reduce increases private providers of health care services for the state would get next year.

The committee will recommend those increases be reduced to 0.5 percent for behavioral health, public assistance and Medicaid providers. For providers of services for developmentally disabled and aging clients, the increase would be 1 percent. The smaller increases discussed a week into a special budget-cutting session would save $7 million in an effort to meet the $334 million deficit.

The action Thursday also would send back to the general fund $500,000 that was not used this year to move developmentally disabled clients off of the waiting list for services.

The provider rate increases were established in the 2009 legislative session with long, intense discussions. There was to be a 1.5 percent increase in 2010-11 for behavioral health, public assistance and Medicaid providers, and a 2.5 percent increase for providers of services for developmentally disabled. Those providing care to aging clients were to get 3 percent.

Those increases would have amounted to $20.9 million next year.

Some Appropriations Committee members argued Thursday that private providers have not kept up with salaries and benefits of state workers. The providers had made some gains recently, and the state had seen some positive benefits, said Lincoln Sen. Danielle Conrad.

"These are actual direct services to our most vulnerable citizens," she said. "This is a morale issue far more than a budgetary issue."

Appropriations Committee Chairman Lavon Heidemann said that if the committee reversed the proposal in Gov. Dave Heineman's budget to take away that $20.9 million, the amount would have to be made up elsewhere.

"That makes me nervous about where you're going to hit someplace else," Heidemann said.

Lincoln Sen. Tony Fulton said his concern was that provider rate increases were for the private sector, which has to react to the marketplace in competing for employees and running businesses.

The committee had looked at a proposal to restore half of the increase amounts, but even that would have been $11 million.

"Restoring half is probably larger than we can afford to do," said Sen. John Wightman of Lexington.

Sen. John Harms of Scottsbluff said the vote was "very painful for me." It was hard for him to accept reductions in provider raises, but at the same time, he said, he didn't know where else in the budget senators would find $21 million.

Several committee members talked about how tight the budget could be in the 2011-13 cycle unless the economy turns around drastically.

"If we don't focus on (those future years), we will really be in trouble," Harms said.

Including the cuts the committee restored on Wednesday, said Wightman, "I don't think we're going to come out of this special session with a balanced budget."

That is, unless the Legislature dips into the cash reserve or goes deeper with other cuts, he said.

The possibility of raising taxes is not included by the governor in other remedies the Legislature could use.

Reach JoAnne Young at 473-7228 or jyoung@journalstar.com.

© Copyright 2009, JournalStar.com, 926 P Street Lincoln, NE

The Rosalynn Carter Institute Will Host a Session on Caregiving

The Rosalynn Carter Institute Will Host a Session on Caregiving at the 2010 Aging in America Conference, March 19, 2010

The Rosalynn Carter Institute for Caregiving (RCI) will host a session at the 2010 Aging in America Conference called "Expanding Access to Evidence-Based Programs for Caregivers".

For more information: www.RosalynnCarter.org

The session will be held Friday, March 19, 2010 from 9:30 a.m. - 4:00 p.m. This session will present the RCI’s model for support and will address important factors that determine effective implementation of evidence-based programs for caregivers: reaching family caregivers; tailoring programs to meet needs; securing organizational buy-in and leveraging partnerships. The session will end with the presentation of a position paper that builds the case for better caregiver support systems.

This session is held in conjunction with the 2010 Annual Conference of the American Society on Aging and the National Council on Aging, being held March 15-19 in Chicago, Illinois. Pre-registration is required, the $35 fee includes lunch. Attendees must be registered for the Aging in America Conference. Session is limited to 300, so secure your space early! For more information visit: www.RosalynnCarter.org.

For more details about the Aging in America Conference, visit: http://www.agingconference.org/AiA10/index.cfm Rosalynn Carter Institute for Caregiving, 800 Georgia Southwestern State University Dr., Americus, GA 31709.

Nebraska Care Providers Claim State Hypocrisy

Dispute Over Care For Mentally Disabled Nebraskans Emerges During Budget-cutting Talks

November 11, 2009

(AP) LINCOLN, Neb. (AP) - Pay at some state-funded programs where people with mental disabilities are cared for in Nebraska is so low that McDonald's workers make a higher hourly wage.

"Why would you work here?" said Linda Redfern, director of the Scottsbluff-based Region I Office of Human Development. Overseen by elected county officials, the office provides day and round-the-clock residential services to 190 people in 11 Panhandle counties.

Redfern and others across the state who help people with developmental disabilities likely won't have a better answer to that question again next year if Gov. Dave Heineman's budget-cutting plan is approved by lawmakers. Those who care for the developmentally disabled say his plan to ax previously approved, state-funded pay hikes next year for people who care for people with mental disabilities could keep them from expanding at the same time state officials say they want to move more people out of institutions and into the programs.

The plan is part of his wide-ranging proposal to shave $334 million from the two-year state budget over the next couple weeks during a special legislative session called to respond to drooping state revenues.

"It's such an ironic set of circumstances. If we weren't in the middle of it all, it would be unbelievable," said Alan Zavodny, CEO of Northstar Services, which provides services to about 300 developmentally disabled people in 22 northeastern Nebraska counties.

"At the same time community-based programs are falling behind, we're talking about increasing the number of people in the community." Northstar now serves about 300 people and he said it's likely fewer will be served next year.

Zavodny, president of a state association of organizations that serve the mentally disabled, predicted some would go out of business if Heineman's plan is approved.

State officials strongly disagree and say they expect capacity at the programs will actually increase even if providers like Zavodny don't get an increase in state funds next year to boost employee pay. State-funded pay hikes that went into effect this year and that Heineman's proposal won't change allowed Redfern, for example, to increase starting wages to $9 an hour from $8.30 an hour.

"I'm not buying that at all," Jodi Fenner, director of the state's developmental disabilities division, said of claims that nixing the previously planned pay increases for next year would shutter some organizations. "I agree it's a financial hardship, but am I afraid we'll lose capacity? I don't think so."

Fenner said that the stream of money that follows mentally disabled people into community-based programs where they get job training and more interaction with the general public is not being disrupted under Heineman's plan. Flat funding for employee pay, she said, may narrow the profit margins of businesses such as Zavodny's, but shouldn't limit their ability to expand.

Also, Heineman's plan doesn't attempt to take any of the $10 million lawmakers set aside early this year to help reduce a waiting list of mentally disabled people wanting services.

Lawmakers set aside the money after attempts to improve the Beatrice State Developmental Center, where hundreds of cases of alleged abuse and neglect of mentally disabled residents were reported in 2006 and 2007, drew attention to the waiting list of about 2,000 people.

As of Nov. 6, 1,717 people were on the waiting list. State officials say some people on the list are already receiving services but have requested additional services.

http://www.cbsnews.com/stories/2009/11/11/ap/business/main5614192.shtml?tag=contentMain;contentBody

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