DD SUBCOMMITTEE 1/31/23
DD Coordinating Subcommittee Meeting Summary
January 31, 2023
Rate Study Update
ADMH is still in discussion with HMA regarding public comments received and what/if changes will be made to recommended rate methodologies. Andy Slate reported that 100% of providers have submitted Recruitment and Retention reports. 61 providers have not submitted the Attestation Statements. ADMH must receive both of these documents in order for the organization to receive enhanced rates starting this month. ADIDIS is still being updated with the new rates.
HCBS Compliance Site Visits
74 more onsite reviews to be complete; should be completed by next week. All P&P reviews have been completed.
Appendix K Update
Public Health Emergency ends May 11, 2023. Appendix K will run 6 months past the ending of the PHE, through November. After that the flexibilities will go away, unless the state submits a waiver amendment to adopt adopt. ADMH has reviewed and submitted a list of flexibilities in Appendix K they are going to continue and will including in the waiver amendment. We requested a list of these, and DeAnna will forward when received.
PCP Discussion
Discussed concerns from Support Coordination agencies that providers were not attending person-centered planning meetings and refusing to sign draft PCP document. Associate Commissioner Sawyer will send out a memo regarding person centered planning requirements outlining who needs to attend, what assessments should have been completed prior to the meeting and by whom, who signs what, and when an electronic signature is acceptable.
ARPA Funding Request
A workgroup was convened, and the following recommendations were made to the Associate Commissioner:
ARPA Fund Priorities
Workforce Stabilization, Development and Training
Assistive Technology
Affordable Housing
Workforce Stabilization, Development & Training
Message: Investing in building provider and workforce capacity statewide; developing and expanding the direct support workforce; and strengthening provider capacity which will increase access to and quality of services for all Alabamians served.
We are supportive of the Alabama Council for Behavioral Healthcare who submitted an ARPA funding request similar to the COVID Relief Grants for Rural Hospitals administered by The Alabama Department of Finance and the Coronavirus Recovery Funds Office. This proposal included $100 million grant program that would be available for any provider certified with ADMH, contracts with the ADMH to deliver services, and is a non-profit. Providers will apply through the State of Alabama CRF website just as was done with Rural Hospitals.
Funds should be allocated to providers based on the number of individuals they served with Mental Health, Substance Abuse and Intellectual Disabilities as enumerated in the ADMH 2020 Annual Report. The Treasury Guidance clearly supports and enumerates the use of ARPA funds to support behavioral health services. Therefore, the grants would be used in supporting “prevention, outpatient treatment, inpatient treatment, crisis care, diversion programs, outreach to individuals not yet engaged in treatment, harm reduction & long-term recovery support” which is a clearly enumerated use in the Treasury’s Final Guidance. This investment could also assist with the significant workforce challenges the public mental health system is currently facing. COST: $100,000,000
In addition, we are recommending that ARPA funding be used to establish and develop a statewide training curriculum for all direct support providers and direct support workforce. The Alabama Department of Mental Health would own the curriculum and maintain it on their website for certified community providers to download and utilize for training their direct support staff. This would ensure quality, consistent training among direct support care workers throughout the state. COST: $250,000
Assistive Technology
Message: Investing in building provider and workforce capacity statewide; promoting accessibility and independence in the home and community settings.
Remote Supports are already a billable service on the DD Waivers, but are not widely utilized due to lack of information and knowledge on how to access and best practices.
These one-time funds could be used for consultants and/or technical assistance to support all DD providers in accessing Assistive Technology/Remote Supports as a billable service. COST: $250,000 for 2 years contract
Affordable Housing ***This is the most challenging category due to the ARPA restrictions around eligible uses of these funds.***
Secure ARPA funds to contract for a consultant to provide technical assistance in the following areas:
Establish an Affordable Housing Task Force with high-level policy makers and leaders to address housing needs of individuals served by each ADMH division
Leveraging resources to create housing and services that promote community living
Needs assessments and strategic planning to increase supportive housing
Research and adaptation of best practices to specific populations and communities
Partnership and consensus-building to support effective community integration
Develop policy documents and financing proposals, including Medicaid waivers and state plan amendments
COST: $450,000 for 3 years contract
Create a new funding stream for affordable housing that provides gap financing for projects that reserve homes for people with disabilities: This source should be coordinated with existing investment vehicles for affordable housing such as tax credits, Community Reinvestment Act investments, and the Community Development Financial Institutions Fund and most likely dispersed by the Alabama Housing Finance Authority. Alternatively, the funding can come through metropolitan land trusts and in partnership with transit-oriented development to ensure that housing is situated close to resources such as grocery stores, hospitals, and employment. These funds can be used to set up a one-time special Notice of Funding Availability (NOFA) to provide low interest, residual receipts loan to the project that is administered in partnership with the Department of Mental Health. COST: $10,000,000
Create a pilot program through the Department of Mental Health to fund affordable housing with a specific mandate for community integration: In California the similar fund would be the Community Placement Fund that is administered by the Department of Developmental Services. They pledge up to $1M to new multi-family projects that includes set-asides for people with developmental disabilities. The Department of Mental Health can request $7M to fund 5 projects (and fund $.5M in administration costs). The funds would be issued similar to the funding stream mentioned above but with special reporting requirements for pilot projects to see if they supported the state transition plan to HCBS compliant settings. COST: $10,000,000
DD Coordinating Subcommittee approved the recommendations, and they will be submitted to Commissioner Boswell for review and consideration.