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INARF Doing Nothing

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Joined: 24 Apr 2006
Posts: 28

PostPosted: Thu Apr 27, 2006 10:34 am    Post subject: INARF Doing Nothing Reply with quote

Below is a discussion occurring between Jim Hammond, President, INARF and a provider member concerning the 11/1/05 Annual Plan Project, the Case Management RFP and the lack of support provided by INARF to stop the devastation. Please read from the bottom up and give your thoughts:

Jim ~

I would like to add a few points to the discussion occurring:

1. Go on www.waiverwatch.com. I suggest you go on this website to see exactly the same predictions that David Ellison made concerning the consolidation of Case Management and what this will lead to for other providers.

2. INARF has allowed the state to implement Federally, "unapproved" revisions to Indiana's Medicaid Waiver program since 11/1/05. In my communications with Leslie Campbell, Regional Director, CMS, Chicago, CMS is still reviewing the original 11/1/05 Annual Plan project and have indicated "many concerns to the state of Indiana." This is exactly the same process INARF has allowed the state to implement with the Case Management RFP. Below is the original email I received from CMS per this RFP:

We have been alerted to the case management issue. The State is only able to limit choice in for the DD population as long as its not a waiver service (which it is in the DD and Support Services waiver - not the Autism). They would have to amend their waiver to take out these services in order to limit case management providers. Case management can be limited if it is offered as a regular Medicaid State Plan Service. Our waiver specialist is following up with the State on this issue.


Leslie N. Campbell
Medicaid State Representative for Indiana
Health Insurance Specialist
Centers for Medicare & Medicaid Services
233 N. Michigan, 6th Floor
Chicago, Illinois 60601
(312) 353-1557 (Phone)
(312) 353-3866 (Fax)

Therefore, how can INARF who is the "protector" of support providers within the state of Indiana continue to sit back and allow the state to cut funding, cut services and devastate the Medicaid Waiver program when the knowledge is there that nothing has been federally approved?

3. What information is INARF sending to the provider community concerning the $6 million grant monies that the state must spend toward the HCBS Waiver program or face loss of this money? This is a well know fact from IFSSA that there is more money in the till that must be spent but yet, the state is holding this funding and risking the loss of $6 millon.

4. Back to the Case Management RFP.....information has arisen that a "high ranking Republican" is the holder of IPMG. How does INARF explain this scenario and not admit that the protector of the provider community is more interested in political gain and secret deals with the state than ensuring the future of its constituents?

5. Mitch Roob, Office of the Secretary, IFSSA during his "visits" to consumers and providers, openly admits he does not feel that developmentally disabled persons should be in the community and too, cannot understand why they will not be "healed." How does INARF as the protector of the provider community, not stand strong against such naivity?

6. On July 1, 2003, Case Management provider took their first rate cut hit (from $382/month to $229/month). Residential providers scoffed at this cut even though as a Case Management provider, we warned all providers this was just the beginning. Two years.....11/1/05 came with massive cuts to consumers' rates and supports, no emergent support availability, denials of rate appeals and inability for case managers to modify CCBs to reflect consumer needs. Now consolidation of the provider community is the key ideal of the state to "save" money.........the trend will spread to other provider groups.

I look forward to your response of the particulars of how INARF has negotiated for the betterment of the provider community.

Christina J. Helser, CEO
Ascend, Inc.

Christina J. Helser, CEO
Ascend, Inc.

----- Original Message -----
From: David Ellison
To: Jim Hammond
Cc: Bill Neczypor ; Stephani Baatz ; Erin Kreigh ; Dawn Ritchie ; Bevaun Graves ; Christina Helser
Sent: Thursday, April 27, 2006 8:39 AM
Subject: Re: On the Record Prior to 2007 & 2008


Thanks for the response! However, you did not predict what the outcomes of your actions will be for the industry in 2007 & 2008. I had the guts to go on the record with my predictions. I would think that the Executive Director and the INARF Board of Directors would be willing to do the same. Then your members can judge the results at the end of 2008.

The reasons we did not join INARF were as follows -

1) The INARF leadership - Executive Director and the Board - did not understand that the attack on Case Management over the last 3 years was the State's attempt to eventually control and reduce the funds and services to the families and service providers. While the ARC and INARF applauded and stood by with two different Case Management rate cuts, the clients, the families/guardians, and the INARF service providers are now vulnerable to cuts in rates and services.

2) INARF has become a collection of human services persons pursuing legal and lobbying issues. The original reason for a trade association in the field of MR/DD was to pool money for the best lobbyists and attorneys. Now, the INARF member fees are used for a bloated human services bureaucracy.

I look forward to your 2007 & 2008 predictions. Again, I am copying my staff so they can forward this email to our INARF clients, as well as the families and guardians.


----- Original Message -----
From: Jim Hammond
To: David Ellison
Sent: Wednesday, April 26, 2006 11:23 PM
Subject: RE: On the Record Prior to 2007 & 2008


Thank you for your response to my Executive Memorandum dated April 14, 2006. Although I disagree with your conclusions on each and every point, I respect your right to offer an opinion to me as well as to others. Had you been a member of INARF, you could have participated in the discussions and helped to shape our public policy on this issue. Regrettably, you are not a member, and thus I will only politely respond that you are somewhat na´ve about the business environment that exists in Indiana in this field today and in the near future. If you wish to discuss membership with INARF and/or our positions regarding specific aspects of the developmental disabilities service system in Indiana, please contact me for an appointment.

Best Regards,

Jim Hammond


From: David Ellison [mailto:ellisonmt@columbus.rr.com]
Sent: Friday, April 21, 2006 10:42 AM
To: Jim Hammond
Cc: Stephani Baatz; Dawn Ritchie; Erin Kreigh; Bevaun Graves; Christina Helser; Leslie Campbell
Subject: On the Record Prior to 2007 & 2008

Hello Jim:

I read your letter of 4/14/06 summarizing the Indiana Administrative and General Assembly moves in 2006. I would like to dispute your statement in the letter - "From INARFs perspective, we did fine in terms that no harm was done." This email will put me on record as predicting the impact of the 2006 moves prior to their outcomes in 2007 and 2008.

As a Case Management provider, the 2006 move by the State of Indiana to consolidate Waiver Case Management services to ONE COMPANY by 1/1/07 is a problem for my company and the other 170+ Case Management Companies. After 7 years of providing excellent case management services to INARF Members, our company will be out of business. This is very distressing since the ARC did not protect the clients, families, and guardians from this move, and INARF did not protect its members from this move. Either the ARC and INARF do not see the coming impact in 2007 and 2008, or they were gutless in not fighting the impact.

The following will be the impact of the consolidation of Case Management to one company in 2007 & 2008 -

1) In 2007 & 2008, Case Management will now work for the State and not for the clients & families. Currently, the client and/or family/guardian representatives employ the Case Manager to fight for funding and to follow-up on services. As ONE COMPANY, the Case Management company will now be on contract with the State and will not be able to be hired and fired by the client and/or family/guardian.

2) In 2007 & 2008, the Case Management agency will become the financial agent for the State. To keep the $15M a year sole provider of service contract, the Case Management company will squeeze the funds to the clients and providers to assure the ongoing contract renewal. If the State is currently spending $500M, all they have to do is tell the Case Management entity to not authorize more than $490M in contracts in the coming year. The State saves $10M and the Case Management company gets another contract renewal with most likely a healthy raise. Currently, each Case Manager of our company is fighting for the most appropriate services and the highest payment for the service provider allowed under the Waiver rules. This will now change dramatically!

3) In 2007 & 2008, The ONE COMPANY approach allows the Case Management company to be the FUNDER, QUALITY ASSURANCE, AND FOLLOW-UP TO SERVICES. This is a severe conflict of interest. ALSO, this sets the providers of service up to fail. In a crisis, I seriously doubt that the Case Management company in a QA review will find themselves guilty of not authorizing enough services. As for the families, there only option to appeal is to the State. Will the State find their own sole contractor guilty?

Clearly, the partnership of INARF and the ARC to allow the Case Management component to be compromised will be a tragedy for the waiver services in Indiana. In 2006, the impact will hit the 170+ Case Management companies that will close their doors. But in 2007 and 2008, the impact will be on the clients, families/guardians, and the service providers. AND NOW, I am on record predicting these clear results PRIOR to implementation!!

I am copying my Case Managers on this email so they can forward this email to all families, guardians, and service providers. Again, I want to be on record prior to the collapse of the services and funding in 2007 and 2008.


David Ellison
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PostPosted: Thu Apr 27, 2006 11:28 am    Post subject: INARF and ARC Reply with quote

I applaud everyone's effort in fighting against the case management RFP.....it seems that everyone in every corner of the state has had enough of this crap!

INARF and ARC have always had issues with case managers, this has been discussed for the last several years and I've heard many comments from a variety of INARF members that I found offensive.

These organizations are entirely too involved in the decisions that are being made by the State.

Perhaps INARF is going to be the residential provider's sole entity, just like IPMG will be the case management entity??
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PostPosted: Thu Apr 27, 2006 8:37 pm    Post subject: Be Healed Reply with quote

We can all hope and pray that Mitch Roob will be "healed" soon from his massive ignorance and heartlessness; however, people with disabilities do not need "healing"--instead if more of us would be like them--loving, courageous, hard-working, talented, great memories, and compassionate (just to name a few)--this world might be a better place. Governor Daniels, Bisbecos, Roob, IN-ARF, ARC, and other FSSA employees--please be "healed"!!!!
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