By Timothy Cox
County Mental Retardation and Developmental Disabilities (MR/DD) boards across the state are awaiting a decision by the legislative Joint Committee on Agency Rule Review to decide whether a proposed fee scale for various services is justified.
If the fee schedule is adopted, it would raise costs substantially and threaten the financial solvency of MR/DD programs statewide, Mercer County MR/DD Superintendent Mike Overman told Mercer County Commissioners on Tuesday.
The fee schedule is being looked at as part of implementing Medicaid reform that was part of House Hill 94, the last two-year state budget bill. The changes made more federal money available to the local program to help developmentally disabled people, but the new fee schedule comes as an unintended consequence of the legislation, Overman said.
County boards used to perform services or contract privately for them based on competitive rates. If state officials disagreed with the charges, costs were settled after the fact through adjusting Medicaid payments. To streamline the system, a firm fee schedule was proposed.
The Medicaid reform was widely hailed by industry professionals, who now are starting to change their minds, Overman told commissioners. "In some instances, the fees are outrageously high," Overman said.
For example, Overman cited a service provided by Delaware County officials to support autistic children. The service costs about $45,000 annually, but under the new proposed fee structure, the exact same service would run $325,000 per year. In another case, general full-time nursing services would cost more than $1 million per year, he said.
"That's how out-of-reality some of these rates are," Overman said. "It opens the door to bankrupting county boards."
With such exorbitant rates in place, Overman noted that fewer than a dozen Medicaid-eligible clients could gobble up the entire MR/DD budget.
The Joint Committee on Agency Rule Review recently tabled a decision on the issue, Overman said. Commissioner Jim Zehringer wondered if lobbying the legislators who serve on the committee might be worthwhile. Commissioner Tom Gagel said the County Commissioners Association of Ohio is aware of the issue and supports the county MR/DD programs in their fight against the fee schedule.
The Ohio Association of Boards of MR/DD also supports the counties' fight against the proposed rules.
"Unfortunately, the law has not taken effect smoothly," said Charlie Arndt, CEO of the state association for an April 19 story in The Daily Standard on the same issue. "Over the past three years, HB 94's implementation has seen a number of changes that both deviate from the law's original intent and now actually threaten to bankrupt the 88 county boards."