A new federal rule in the works is spurring discussion about what it means to integrate Kansans with disabilities with their communities and how service providers can do it.
The rule being developed by the Centers for Medicare and Medicaid Services seeks to ensure that providers of home and community-based services are providing enough opportunities for their clients with disabilities to interact with the community at large.
State officials, who will be responsible for administering the rule starting in March 2019, have spent the week soliciting public input from service providers and disability advocates in Hays, Topeka, Overland Park and Wichita.
Susan Fout, director of the Home and Community Based Services division of the Kansas Department for Aging and Disability Services, moderated a meeting Wednesday in Topeka.
She stressed that the rule was intended to improve quality of life for people with disabilities, a goal that providers, their clients and the state share.
“I think we all have to work together,” Fout said. “We’re all in this together.”
Providers, though, expressed concerns about how the rule will be implemented.
Staff of sheltered workshops were particularly concerned after Fout said their type of services, as well as those provided by assisted living facilities connected to nursing facilities, would face renewed scrutiny under the rule to ensure they are providing an “individual experience” and “community integration” for their clients.
“The ones of concern are those that have the appearance of isolation or an institution,” Fout said.
She said KDADS will be posting a “tool” on its website next week with tips for providers on how to identify and avoid practices that isolate clients.
Cottonwood Inc. is a nonprofit in Lawrence that provides residential services to Kansans with disabilities, including a sheltered workshop.
Janet Fouche-Schack, the organization’s director of support services, said she hoped few changes would be necessary to comply with the new rule once it’s finalized.
“I want to make sure they understand that, in my opinion, we are community-based,” Fouche-Schack said. “We make every effort to provide opportunities for people to be in the community.”
Fouche-Schack said about half of Cottonwood’s clients have some employment in the community, though it may not be full-time.
Sheltered workshops have become controversial, with some providers arguing they provide a path to more competitive employment and some disability advocates saying they represent a low-paying dead end.
Jill Baker, Cottonwood’s administrator of services, said the facility uses its work center “as a staging area” where clients with disabilities can gather before heading to places in the community. But she said rather than feeling isolated, some clients like the company and camaraderie of being with other people with disabilities at the facility.
The new rule should allow for that sort of individualized approach, she said.
“We’re hoping they don’t get too prescriptive,” Baker said.
But Ian Kuenzi, a Topeka disability advocate who has cerebral palsy, said facilities that gather Kansans with disabilities are, by definition, isolating them from the community at large, and the new rule should crack down on that.
“First of all, we need to define what a facility is,” Kuenzi said. “Secondly, how could a facility ever be community-based?”
Kuenzi questioned whether KDADS should give providers notice before inspections to evaluate their compliance with the coming rule.
Fout said the advance notice would only be given in the lead-up to the finalized rule, as the agency works with providers to try to ease the transition.
Rather than see providers close or send clients elsewhere, the agency would like to help them better integrate clients, she said.
“Our goal is that our providers will want to make any needed modifications to those settings,” Fout said.
She also said the week’s meetings had given her a better sense of the possible costs involved for providers to make their services more individualized.
Sean Gatewood is a former Democratic state representative who now works as an advocate for people in KanCare, the state’s privatized Medicaid program. He asked Fout if the state would reapply for $15 million in federal vocational rehabilitation money that it turned down last year.
Fout said she wasn’t aware of that possible funding source and she would ask Michael Donnelly, director of rehabilitation services for the Kansas Department for Children and Families, about it.