Thursday, January 17, 2019

Revisiting the DDS Contribution to Costs Policy and Procedures

I made a mistake when I wrote that there was no room for further debate or discussion with respect to the current version of the DDS policy and procedures on contribution to costs of care (“Housing Changes That Could Change Your Life, Part One,” December 28, 2018).  On further review, it’s clear that not everything in the policy and procedures was already fully spelled out in the law and regulations.  Even though the Contribution to Costs regulations were already published in the DC register ( and new versions of the policy and procedures were distributed last weekend at the Project Action! Meeting ( and - safe links to my Google Drive account), there are lingering issues that DDS still needs to acknowledge, discuss further with public advocacy groups, and address before finalizing the policy and procedures.  These issues (with references to key sections of the policy, but necessitating changes to other parts of the policy and procedures) include:

-             The need to air more fully and consider the implications of 3.B. of the policy (made even more explicit in the January 12 revision) which makes the residential provider (along with guardian if applicable) fully responsible for ensuring a person has applied for applicable public benefits, with no apparent DDS responsibility.

-             In 3.C. of the policy, the need to include, in addition to the statement that “DDS will not require a person to contribute more than the actual cost of their DDA residential supports,” a more specific statement that the person will not be expected to contribute to the costs of their staffing or other Medicaid-reimbursed supports.

-             The need to state clearly in 3.C. and 4.O. of the policy that, if a person is receiving residential supports and already contributing to his or her own cost of occupancy, e.g. by paying utility or cable bills, that that amount should be deducted from the total amount the person is expected to pay to the residential provider.

-             The need to recognize, in 3.D. of the policy, that if a person’s SSI is decreased due to third-party housing assistance, the amount of that assistance will not be available to the person in order to compensate the difference up to the maximum SSI amount, and that they should therefore still continue to receive their full $100 allowance.

-             The need to acknowledge, with respect to section 3.G. of the policy, that merely documenting the contribution to costs of residential supports in the Individual Financial Plan is inadequate.  People have legal rights to formal written notice individualized to the person's specific financial circumstances and stating what the person is to be charged, how that was calculated, what the relevant laws and policies are, what the consequences are of not paying, and how to appeal the determination (see below).

-             The need to ensure, with respect to 4.P. and 4.Q. of the policy, that people will not be unduly punished by the threat of discharge from residential services because a representative payee or guardian has failed to ensure payment of their contribution to the cost of residential supports.  DDS and providers should instead turn to other less punitive remedies, such as seeking (after discussion and via a transparent and fair due-process approach) to have the delinquent representative payee or guardian replaced.

-             With respect to section 4.J. of the policy, DDS should wait until the DDA Complaint System is operational before putting this policy and procedures into effect.  Otherwise there is no formal recourse in the earliest months of implementation, when many of the most significant unforeseen consequences will become evident.

-             Finally, what is addressed nowhere is the need for troubleshooting staff which I referenced in my December 28 blog post on this issue.  Having such staff will avoid the need for regular recourse to the Complaint System once it is in place, by ensuring that service coordinators, who will not be in a position to address or adjudicate many of the issues in the policy and procedures, will have easy recourse to in-house expertise.

I hope that DDS will slow the train down and take the time to fully consider the above, as well as other issues raised in the Project Action! meeting on January 12, before putting the Contribution to Costs policy and procedure into final form.

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