SmartTranscript of House Appropriations - 2025-02-05 - 2:20PM

[Chair Robin Scheu ]: We are live. Good afternoon. This is the House Appropriations Committee. It is Wednesday, February fifth, twenty twenty five. It's almost two thirty. We're running a little behind, but we appreciate your patience as we have the folks from jail [Assistant Erin Pedley ]: who are with us. And we're just trying to remember, have we introduced ourselves to you this session yet? [Dr. Jill Bowen ]: We did, like, over the Frank, on before. Okay. We have a lot of familiar to me. And even in the same seats. [Chair Robin Scheu ]: Yeah. I think we're good. So we're good here. I just just don't wanna be rude and give you to not introduce ourselves if we have. Thank you. So what you introduce yourselves for the record and tell us about your budget. [Dr. Jill Bowen ]: Hi. I'm doctor Bowen Dilbone, commissioner for Dale Department of Disabilities, Aging, and Independent Living. And we have a number of people here in the room and also on screen. [Bill Kelly ]: Bill Bill Kelly, finance director. [Dr. Jill Bowen ]: We will be testifying, but in the room also. Do you wanna introduce yourself? [Assistant Erin Pedley ]: Sure. Angela Smith, Jane. [Dr. Jill Bowen ]: And online, we have, Jen, do you wanna introduce yourself, please? [Jennifer Garabedian ]: Yeah. Thank you. I'm Jennifer Garabedian. I'm Dale's, developmental disability services division director. [Dr. Jill Bowen ]: And Stuart. [Bill Kelly ]: Hi, everybody. I'm Stuart Sher, general counsel for Dale. [Chair Robin Scheu ]: Thank you. Okay. So we have lots of information from you, and we're certainly interested in hearing of what's working well, what your successes are, what your challenges are, if you're gonna change some programs or expand them and and, before we get into the ups and downs, just kind of that that review of how you're doing. [Dr. Jill Bowen ]: So, we are prepared to walk you through the testimony and and to give you that exact view into the department. Thank you. So just to begin, the Department of Disabilities Aging and Independent Living is responsible for managing services for all of the Vermonters and Vermonters of all ages with disabilities. This is codified in thirty three BSA chapter five of Vermont's Human Services statute. It's the mission to make Vermont the best state in which to grow old or live with a disability with dignity, respect, and independence. This guides the delivery of all of our services. Our vision is to enable older Vermonters and Vermonters with disabilities to receive supports and services in their homes, in their chosen communities, living independently and fully included as participating and contributing member of those communities. This is pretty critical. It's part of a system of care. It includes community services and choice. And the commitment is underlined by state and veteran mandates. It includes the Stage Strong Vermont Plan, and Year one Implementation Report is now out, and you will be getting some information on that shortly. The Older Vermont Act, the Older Americans Act, the Americans with Disabilities Act, the Workforce Innovation Opportunity Act, Vermont Healthcare Administrative Rules, the Global Commitment to Health, eleven fifteen waiver, federal health and community based rules, and the Olmstead decision. So Vermont remains a leader in supporting self determination, choice, expansion of community based options, the development of robust supported employment, mature worker options, and lifesaving protective services. Our work does align with the Governor's priorities to grow the economy, build the safest and healthiest communities. We embrace continuous performance improvement approaches, ensuring the to ensure the highest quality services to the monitors. And throughout this document, we will identify different ways in which we do that. For more information, you we do have Dale performance budget scorecard and Dale's division scorecards, and the testimony provides a link to those as well as a summary of our performance measures by division and program at the end of testimony. [Assistant Erin Pedley ]: And you do not need to [Chair Robin Scheu ]: go through and read your entire piece and just, you know, sort of giving us the highlights will be Okay. [Dr. Jill Bowen ]: So we will then jump to the highlights. Thank you. [Chair Robin Scheu ]: You can read this at our pleasure. Thank you. [Dr. Jill Bowen ]: Yes. It's if it was the summer, I'd say it's good beach reading. So, [Chair Robin Scheu ]: the beach about now, I'm thinking. Yeah. [Dr. Jill Bowen ]: Okay. So I will jump now to department highlights. I will go through these, but then the big section where it kinda deep dives into many, many, many pages, There will be a very brief summary for that. That. So don't lose heart. Okay. So I wanna jump to those accomplishments, which is on the bottom of page four. So it's age strong Vermont plan. We are pleased to report the continuing momentum of this extraordinary plan, multi sector, multiyear plan, which was launched January twenty twenty four. So that's why we are at year one of implementation. And that report was just released. And it there's an interactive community services finder map. There's goal trackers and a whole lot of information in there that gives you, a view into our progress over year one on the objectives and goals of the the age strong Vermont plant. The developmental disability services supported housing, we were really excited that in October of twenty twenty four, Riverflow Inc opened their doors. It is an intentional supported housing community in Moncton, Vermont, and it came out of the Act one eighty six pilot grants that were awarded through Dale. The Developmental Disability Services Division quality assurance, DDSD, implemented an interim quality assurance process to ensure for an on-site quality review for each designated and specialized service agency, as well as the state supportive intermediate intermediary service organization. There's five new DDSD quality positions, which, made the enhanced process possible that was provided by the legislature. Thank you. The new process includes the monthly review of individuals engaged in services, affording DDSD quality staff, the opportunity to perform standard quality assurance processes, interview individuals and guardians as appropriate, and connect with staff. [Bill Kelly ]: I had a question. I think, Rep Stevens had a question. Maybe I maybe too. Yes. It it's fine. Just going back to that to the, housing that's opened, how many units is that? And then that's part of we we just included two point eight million dollars for the projects in Burlington. This is the first piece of those three units. Can you just spend a couple of minutes just describing the difference between the first this one and the two that are that are part of the pilot program? [Dr. Jill Bowen ]: So there's there's three, recipients of the pilot grants, four programs that are coming out of that. Riverflow was the first one to open, its doors. There's four, individuals with complex developmental disabilities that reside at this house. It's a very nice space. I've been there and had an opportunity to meet with the staff, to meet with the individuals who are being served there. So they live there, and so do two staff live there. So there are six rooms. And then you walk into what feels very much like a house in a really community. So that model, community connectedness model, the the inclusion model, the staff being there is what was stood up at Riverflow. Do you wanna say how that compares to some of the other Jen, when I go for you. Jen, do you wanna say how that compares to the other models that were part of the pilot program? [Jennifer Garabedian ]: Yeah. Sure. Thank you, doctor Bowen. So Upper Valley Services has a project in Waterbury in partnership with the Downstreet Housing. And so that is apartment set aside, which will have service supported housing. So apartments for individuals with intellectual or developmental disabilities and then services that support individuals to live there with the with any level of disability. So it could be modest or moderate level of need or more complex level of need as doctor Bowen has described for individuals who are living in the river flow. But so that that model can support a variety of levels of need. And then they have also Upper Valley Services is working in Randolph for converting a a historic building to have a I think it's a it's a two unit, and then some accessory dwellings, so up to four units ultimately. And that will have some service supported housing and then more of a kind of the model that the Riverflow has. So individuals living with service, like, service providers in the home as well. So kind of that community based integration as well. And then the Champlain Housing Trust model, which I think is what you were referring to, representative, they also have a service supported housing model. That apartment building is intended in in its entirety to support individuals with intellectual and developmental disabilities, which is what sets itself apart from the upper valley services model. [Chair Robin Scheu ]: Great. Thank you. Thank you. And, Rachael, you got a question. Oh, [Rep. Wayne Laroche ]: thank you. I'm very excited to see these come, you know, to life, and these are pilot programs. I'm just wondering what the plan is for rolling out more, of this housing. We had testimony, at one point during the BAA, attesting to a very significant [Dr. Jill Bowen ]: community statewide need. That's So there is, statewide need for housing across the board and, for Vermonters and those with developmental disabilities are no exception. Right? They also what we're looking for here is the new models. The pilot program is designing models that we need to see what's most effective and also creating choice in the in the community. The developmental disabilities, residential kind of program, it's not really residential, it's a community based, is mostly shared living providers right now. And there's fewer and fewer shared living providers. So the models are incredibly important. There are other DS units planned. We are very much aware of the numbers of units that ultimately need to stand up, and are working towards that. There are somewhere, like, I think it's forty some odd programs at various, levels or stages that have, I think it's twenty six to thirty two potential new units that may be able to come on. In addition to that, what has happened through this pilot, which was really a seeding pilot, right, with seeding funding to help them get get up is that partnerships have been created, and it's really they're really extensive partnerships with, you know, housing trusts. Anything from, you know, more public to very person you know, private donors and just a a range of varied stakeholder. And they are helping to create the ability for for the programs to expand. So Riverflow, for example, has already been working to get funding for the next one that nice. I'm showing it like this because they have a lot of them laid on. And the next one's gonna be over here, and the next one's gonna be over here. So they're already working through their model to duplicate the model and then duplicate the model or duplicate the model. And that's what we are hoping will happen with all of the pilot programs is that the strategies that they employ to get the additional monies to operationalize their their model can be replicated. Does that answer that question? [Rep. Wayne Laroche ]: Sure. I I think what I what I'm hearing you say is there is not, additional money built into the budget to help continue to see some of these things, that that is is not is really the responsibility of the folks developing housing, supported housing. [Dr. Jill Bowen ]: So it's a sustainable model. There there is resources that, like, we have a housing coordinator that we that is funded through through us and some other ways in which we are helping to try and make those connections to so that there is, support for funding. But housing in general is in the governor's budget. So exactly how that will end up playing out is not, you know, is not clear. But there is there's need for housing across the board. So what we're also looking for is, we pay close attention to people who have developmental disabilities that are that maybe are experiencing housing insecurity or crisis, etcetera. So we will need to see how housing as a whole and where people with developmental disabilities can fit into that. But if you're saying is there a specific plan or something in this for another round or another that's not in this particular budget. Jen, did you wanna add to that? [Jennifer Garabedian ]: I would just also mention that the agency of human services was awarded a housing accelerator grant. And while the term grant suggests funding associated with it, which it doesn't come with funding per se, but it does afford the state access to a subject matter expert, which will help pull together, like, a core contingency of local experts as well as, again, access to a subject matter expert at an national level. So to bring together available resources within our state and ensure that we are all working towards the same end goal and bring together sort of the voice of the department and our our populations to the table to make sure that we are leveraging all of the available public and private partnerships to move these kinds of projects and the replicability of these projects to the forefront. [Dr. Jill Bowen ]: I have to say Riverflow has been very, very successful and looks like some of these other programs too in terms of their their public private partnerships. The accelerated grant the accelerated grant is no small thing. It's competitive. We we were very excited to get it. It was a collaborative effort to different parts of AHS. Dale is the lead on this. And many who who do get an accelerator grant and then get all of this support and technical system that that tends to result in funding. So we are looking towards that and building those connections to be able to, you know, turn that into potential fundability. [Chair Robin Scheu ]: So I rep Barush has a question on the screen. Go ahead, Wayne. [Member Christopher Yacovone ]: I was just curious. What's the total number of people, you know, in the programs or for whether it's housing or whatever. What what's what's your population that you're dealing with on an annual basis? [Dr. Jill Bowen ]: Anne, you wanna take that? [Jennifer Garabedian ]: Alright. So in developmental disability services, across all of the different programs that we have, we support about forty five hundred individuals. [Chair Robin Scheu ]: And that's just in the developmental disabilities area of your yeah. [Dr. Jill Bowen ]: That's what the pilots were, dedicated to and the units that we're talking about that are in various levels of development and that we're hoping for expansion through these, partnerships, are focused on. [Chair Robin Scheu ]: Yeah. Great. So we have a lot of highlights in here. And what are the highlights of the highlights? Because I know you'll be going to how student services, and they'll be going into more detail of all of your experience. [Dr. Jill Bowen ]: P2P is a is a program we're also very, pleased that our, Department of Blind and Division of the Blind and Visually Impaired is the lead for the state, multi partner also focused on transitioning youth with, various, disabilities. So coming out of high school and and connecting to to work. Next page, we'll I'll just mention Mission Care. We can discuss it further. It is a the first complex care nursing home, that has opened in Vermont. And it's, has been successful so far in moving, fifteen people who many of whom were in, situations where they were in beds for hundreds of days, like, four hundred days. The ones that came from psychiatric hospitals was six hundred days. So if you heard about beds that were blocked in the hospital system, this is helping to move them. Rutland said they can now open their ICU again. So the flow is happening. They are specialty because of the complex nature of these both. They may have mental health issues in addition to meeting nursing home eligibility. They're all choices for care. They may have criminal justice challenges, but the kinds of skills that were needed that were that made it difficult for others to take them in. So they are it is moving. That's a highlight of the highlights. Sure. I'll I'll keep moving to the ones that I think particularly. The adult day start up grant on the following page was granted to Central Vermont Council on Aging as a fiscal sponsor for Generations Vermont, an organization that's designing a new multigenerational adult day center and child care center in Central Vermont. Very happy about that. The multigenerational approaches are really healthy. It's a win win. So I just wanted to highlight that for you. The home delivered meals with the global commitment investment. Again, this is about extending deals on wheels and home delivery through Medicaid services. [Chair Robin Scheu ]: And it's Remember, we asked last year to have to see if that could be done that way and [Dr. Jill Bowen ]: we could extend it. So I'm so glad this worked out. It it made a difference in many people's lives. Yeah. I'm gonna keep going. Payment reform after six years. This is now getting ready to roll. It's an implementation phase. It is, really very much of a transformation in terms of how payment methodology works. And it is in the DS system, and it is goes hand in hand to some degree with the conflict for a case manager who we will talk about. Yeah. When we get to the right. But it is something that will enable us to monitor and track and really have information about what services are provided, to whom and when. So nursing facility rates, recruitment, and retention grants. This is this is efforts to stabilize the nursing, how much, costs are very, very high. The emergency fund relief, this this is part of statutory requirements. And in addition to the rebates that will be happening this year, there is there were grants that were provided, through legislature to help recruit, LNAs and medical directors. [Chair Robin Scheu ]: We're using a lot of traveling nurses. [Dr. Jill Bowen ]: Oh, my goodness. Contract and traveling nurses extremely expensive. LNAs are the backbone of the nursing, while RNs maybe in hospitals have stabilized a little bit. Not the case for LNAs. K. Okay. I'm done with those highlights at super speed. [Chair Robin Scheu ]: Thank you. We appreciate it. Super speed as I [Dr. Jill Bowen ]: could do it. And I'm at our I'm at the page where I can just specifically speak about the one proposal that is in the fiscal year twenty six for Dale, which is the mandatory federal conflict free case management. It's been a multiyear project, and it is necessary to comply with mandatory federal regulations requiring conflict pre case management and home and community based services. This has been well documented. This is not something that is is new to folks. It's been work working towards this. We do have a deadline for implementation in order to be in compliance with our approved plan of implementation with CMS. So the RFP for developing the, case management. Again, if people are not maybe it's not on top of your head like it's on some of them. But it's a separate direct service and case management ultimately because there's an inherent conflict in that, and it's required by it's required by CDC. [Chair Robin Scheu ]: I see that rep Larish has a question. Yeah. Chris, go ahead, Wayne. [Member Christopher Yacovone ]: Yeah. I would sort of like to fall back for a second to the the meals, meals on wheels for looks like not very much money. Is that the entire program for, you know, taking food to elderly or disabled people? Is that is that the total cost? [Dr. Jill Bowen ]: Most of the money for, Meals on Wheels comes through the Older Americans Act. So it's a separate federal, grant, and there's approximately ten million dollars that comes through that way. The majority of it is for nutritional services like Meals on Wheels. And then there's six approximately six million dollars from the state that's also in there. So this was an extension to be able to stretch further. [Member Christopher Yacovone ]: So so roughly sixteen million. So I'm just I'm just wrapping my head around how much money we spend on, you know, meals for for kids and and, you know, wrapping around this. So I I see there's more money than what I thought was there. Thanks. [Dr. Jill Bowen ]: Yeah. It was one point three additional on top of the one million. The legislature has been paying attention to that and really really appreciated it. Yes. So the the mandatory conflict free case management is for DS, also for Choices for Care. The area agencies in aging have been picking up the case management. There's an r RFP that has is is finalized for the case management provider for DS. The total budget request that was in the Governor's budget is eight point six million dollars global commitment to cover the courts. Diane? Yes, go ahead. So that eight point six million dollars will cover this plan issue? Yes. [Member Eileen Dickinson ]: Okay. So if I'm your service coordinator and I've helped line up a home provider for you and I'm visiting you once a month and I'm helping you address different issues that come up, How do we how do we make sure that and then there's case manager separate from this who I guess is a second set of eyes? [Dr. Jill Bowen ]: Different function. [Member Eileen Dickinson ]: It is it can you explain how it's a different function? [Dr. Jill Bowen ]: Yeah. Jen, do you wanna do that? Duplication? Yeah. It's not duplication. It's it is quite different. She'll just be better at explaining it than I've Mhmm. Go ahead. [Jennifer Garabedian ]: A lot of faith in me. Yeah. That's a great question. Thanks, Ravi, Echo Bonnie. So the case management functions are are very specific roles and responsibilities related to person centered planning, assuring that assessments are performed, performed, helping the individual develop their individual service agreement, working with an individual, their guardian, their family to determine the services that they're looking for and to advise Mhmm. Where they can get services, so options counseling. A direct service provider, so the designated agency and the specialized services agencies, they have the responsibility of program management. So in the future state after October first, a service coordinator, those case management functions will move to the independent case management entity. And what will remain are service coordination. And so the things like overseeing a shared living provider, making sure that direct services occur and are overseen and managed appropriately. All of those functions will remain. It was, you know, sort of determined to be a pretty significant amount of work still, you know, obviously. And so those functions remain. They'll no longer be called service coordination. They'll no longer be billed or encountered through the agency in the same way, but are pretty separate and distinct roles and responsibilities. So are not considered duplicative through, the Centers for Medicare and Medicaid, and we'll work with the agencies to make sure that those things are not overlapping, but would still remain the you know, the service coordinator can evolve to a program coordinator. The same individual that was supporting someone can remain at the agency. And so, [Member Eileen Dickinson ]: you know you anticipate the case load ratio to be? If I'm a case manager, how many clients would I be responsible for? [Jennifer Garabedian ]: Yeah. So we put that into our request for proposals. So based on the, level of need, we we laid out some pretty specific expectations knowing that there would be a blend and that, likely, a case manager's caseload would be made up of a variety of individuals and a a person like, a variety of needs. We, expect that case managers will have caseloads on average of thirty two individuals. While that is significantly higher than what we see in service coordination now, it is still pretty significantly lower than the national average of case managers. What we've heard is that across the country, case managers often have caseloads, upwards to a hundred. And so having a caseload that is at set around thirty two is is significantly lower and should, allow for pretty high quality case management. [Dr. Jill Bowen ]: Thank you. [Chair Robin Scheu ]: Mhmm. [Dr. Jill Bowen ]: So that is our proposal for for Dale for a safe fiscal year, May six. And I am just going to do that very quick overview and skip all the rest of those pages until we get to the numbers. So Which page we should be looking on? Well, this is this is the this I'm going to give you just a summary, but it's for pages ten through whatever that last one is, like, forty. Ten through forty is basically a breakdown. It's a drill down of each division. Okay. It [Chair Robin Scheu ]: gives you a lot [Dr. Jill Bowen ]: of detail about what's happening in those divisions. Mhmm. What I did when I read through what seemed like a lot that was actually some of our our five lives. There's a lot of activity going on. For kids. Yes. [Chair Robin Scheu ]: You do a lot of work. We appreciate that. [Dr. Jill Bowen ]: And, of course, is you know, it's it's wider range of things, I think, than than people may think, but I'm gonna just say. So the adult services division responsible for managing a full array of long term services and supports, which we call, you know, long term services and supports l LTSS for older Vermonters and adults with physical disabilities. Vermont Medicaid, the Federal Older Americans Act, and state general funds are the primary sources of funds for these services. And, ASD or the adult services division, primary partners include the area agencies on aging, the designated and specialized service agencies, the home health agencies, the adult day centers, SASH, and long term care facilities. So it's a whole system of care. We think of it in terms of, like, a triangle. You might have a public health triangle. So together, our community partners, ASD served thousands of Vermonters since state fiscal year twenty four. Some highlights include more than forty eight thousand five hundred people who received a variety of Older Americans Act services, including Meals on Wheels. Just under eighty seven hundred people received home delivered meals, as I was saying. Six thousand six hundred and sixty three reserved received choices for care services across all settings. Four thousand seven hundred and fifty five received SASH services and three hundred and seventy four participated in adult state programs. So that's the adult services division with some of the, reach numbers. Mhmm. The developmental disability services division supports people to live, work, and participate as integrated citizen in their local communities, pursuing their own choices, goals, aspirations, and preferences. The division plans, coordinates, administers, monitors, and evaluates state and federally funded services for people with developmental disabilities and their families within Vermont. Services are individualized to address the goals, capacity, needs, and values of each person. DDSD provides funding for services, systems planning, technical assistance, training, quality assurance, program monitoring, and standards compliance. Also provide provides court ordered public guardianship to adults with developmental disabilities and older Vermonters age sixty and over on behalf of the commissioner. So they this this is the office of public guardians. Okay. Okay. By the numbers, three thousand three hundred ninety four people were served in home and community based services. Over a thousand served by flexible family funding. Nearly six hundred and fifty served by family managed respite. Four hundred and sixty served in bridge program. Seven hundred and fifty received, Office of Public Guardian guardianship services, and three hundred and twenty eight received, Office of Public Guardian representative payee services. The next division is the Division for the Blind and Visually Impaired, who assist individuals who are blind or visually impaired to meet their employment and independence goals by obtaining livable wage jobs and income. They provide training to improve employment skills, higher education that leads to degrees or certificates. They help transition high school students from school to the work world, and helps individuals of all ages to build adaptive skills related to their visual impairment through assistive technology, low vision orientation and mobility, and independent living skills. By the numbers, over a thousand one thousand one hundred and sixty three, are served total or served total training hours is two thousand three hundred and forty four. Next is this vision of licensing and protection. The vision of licensing protection is a division under Dale. There are two branches that work to protect vulnerable adults and individuals receiving care. That's survey and certification, which is the licensing and certif certificate for the health care organizations so that they meet ensuring that they meet minimum state and federal regulatory compliance. In addition to survey and certification, the adult protective services is the other arm of, the division of licensing and protection, and that's APS, so the adult protective services. APS investigates allegations of abuse, neglect, and exploitation of bold vulnerable adults and implements protective services as as necessary to limit future maltreatment. Survey and certification conducted two hundred sixty six on-site investigations at nearly five hundred combined complaints four nearly five hundred combined complaints and self reports across all state and federal provider groups. They've all APS Adult Protective Services received nearly four thousand reports alleging abuse, neglect, or exploitation of vulnerable adults. And APS included, four zero two investigations and four twenty four assessments, just to give you an idea of the breadth of the work. HireAbility, which is the division of vocational rehabilitation, and the mission there is to help Vermonters with disabilities prepare for, obtain, and maintain meaningful careers, and to help employers recruit, train, and retain employees with disabilities. HireAbility serves people who face barriers to employment, help participate participants figure out the type of career pathways, and provide employers with a workforce that has the skills that are needed. By the numbers, six thousand seven hundred and thirty four individuals served in state fiscal year twenty four, which is an increase year over year. More than six thousand people were served in the core hireAbility program, and nearly six thousand served, which is, again, an increase from the previous year. And nearly sixteen hundred high school students served through the preemployment transition services program, which is also an increase over the previous year. The difference in the lives of the high school students is I mean, they give testimonials about quite something. Recent successes, I think we went through in our highlights. They're pretty much our success. I pulled out as highlights what were our successes. Mhmm. And then we have important ongoing work, which we are which were also in the highlights. So that brings us to the the numbers. Do you have any questions? I know I went too fast, but It's great. [Chair Robin Scheu ]: I actually met somebody who was going through your higher ability program and is working in a community organization in Millbury and is thriving. I mean, it's very exciting to to see somebody who was so successful going through the program. So You [Dr. Jill Bowen ]: know, I went through it very, very fast, but I'll just say that HireAbility actually was awarded opioid settlement dollars to continue the work that they're doing with folks who are in recovery from opioid use disorder to connect connect them to jobs. And it's it's quite effective. They've had a lot of success. That's great. [Chair Robin Scheu ]: Rebecca, go on. [Member Eileen Dickinson ]: Just briefly, adult day services. I'm hearing from our adult day programs that because of the high rate of, absenteeism, folks who are, not well, they can't come in that day, and the weather can be intimidating, etcetera, that they can't bill. So, consequently, it's destabilizing them financially. And the conversation moved to a wonder if by looking at the numbers, you must budget so much a year and they're coming in at x a lower amount. If that's so, could the rate be adjusted so it maximize Medicaid, but it make up for some of that lost time to keep the capacity in place? Have you had any of those kinds of conversations? [Dr. Jill Bowen ]: We've had some of those conversations and that the absenteeism or the no shows create a challenge. I don't know if you have any further information on that right now, Angela. [Assistant Erin Pedley ]: I would just add that what a lot of adult days try to do to to ensure that they're all can be at higher capacity is they have, you know, upwards of, you know, you know, if they have a hundred people enrolled in the program, they'll they'll have about thirty people come on any given day so that if someone doesn't show up, then another person could potentially pick that spot. Often, you know, it's a weather related event. You can't get someone else to come back quickly. But if it's an illness where you know someone's gonna be out for a week, you may be able to call another or just even on their list to have have them come. So there are ways that agencies try to address that. In addition, the rate increase that was given following the rate study was above what was really recommended in the rate study and was partly partly why it was above was, to try to provide some of that stabilization given the absenteeism. Thank you. [Dr. Jill Bowen ]: So now I'm on page, forty one. So I'll walk through the numbers. The state fiscal year twenty twenty six total, Dale proposed budget is seven hundred and eighty three million five hundred and twenty one thousand eight hundred and twenty one. That rep that is divided four point six percent of that comes from the general fund. Eighty eight point eight percent comes from global commitment, Medicaid waiver. Six point two percent is federal fund other than global commitment. And, one percent is special and interdepartmental funds, less than one percent. So I will go into this by division. So the developmental disability services division, the proposed budget totals three hundred and fifty three thousand three hundred and fifty three million four hundred and seven thousand two hundred and thirty six. That's forty five percent of the total budget. You can see the general fund and global commitment split. It's a heavily global commitment at ninety seven percent. And then the federal other at one percent. The adult services division, three hundred and seventy eight million five hundred and ninety thousand seven hundred and forty one. That is forty eight percent of the total budget. Again, heavily global commitment at ninety three percent, with three percent general fund, four percent federal other. Vocational rehabilitation, which is hireAbility, thirty one million seven hundred and sixty one thousand six hundred and seventy eight, which is four percent of the total budget. Here, you'll see a general fund of twenty three percent. There's no global commitment, and the federal dollars that flow through come through other grants, and that's seven percent of hireAbility's funds. Blinds and visually impaired, five million seven hundred and fifty five thousand one hundred and seventy seven dollars which is one percent of the total budget. Eighteen percent is general fund. This is five percent of global commitment. And then seventy seven percent of the federal or other. Much of that is the P2P or the Pathways Partnership that I mentioned earlier. Licensing and protection, seven million eighty six thousand two hundred and sixty three, also approximately one percent of the total budget, fifty one percent of which is general fund. None is a global commitment, and forty nine percent are other funds that support APS and and survey and certification. Commissioner's office is six million nine hundred and twenty thousand seven hundred and twenty six, which is one percent, seventy eight percent of which is general fund, two percent from global commitment, and twenty eight percent from other federal dollars, which brings us back to the total of seven hundred and eighty three million five hundred and twenty one thousand eight hundred and twenty one. If there are no questions, the following page is, a summary of changes from last year's base budget to this year's proposed budget. [Chair Robin Scheu ]: And we we don't need to talk about salary and bridge and collective bargaining. They're just kind of are what they are everywhere. So if you have any particular new initiatives that you want to highlight, we don't need to go through the salary piece. [Dr. Jill Bowen ]: Okay. So we will so number two on there is conflict free case management. So you're gonna see that in a couple of different places, which will ultimately add up to the eight point six. Yeah. Okay? So this piece of it is the five new positions, three ASD quality, and program participant specialist, and two, DS data analyst, which will do the eligibility determination. And the costs of that is one point two one million two hundred eighty nine thousand. The next is we go down to adult services division. We don't have anything other than, you know What's the salary? Collected. Right. Right. Okay. Blind visually impaired. You just see here that Pathways to Partnership grant, one million five hundred thousand. K? Vocational rehabilitation with with the entire ability, there's just a budget neutral fund transfer to to move administrative into general fund. It's just a switch. It's and where it sits. Okay. Developmental services grants appropriation. Okay. So here, you're seeing a a a big chunk of that eight point six. It's the five million eight hundred and forty two thousand three hundred and fifteen dollars for conflict free case management as for the for the Developmental Services Division. We also have a DS caseload increase. So it's five million three hundred and ninety thousand and forty five for that. We have an increase in our Public Safety Act two forty eight caseload. And Act two forty eight are the folks who are committed to the custody of the Commissioner after being found not good to proceed in a criminal matter that was had some some seriousness associated. Okay. You're familiar with that? Okay. The budget to actuals alignment actually is a an offset, and that had to do with people being budgeted for who actually didn't come on full year. So there's a yeah. Like a vacancy savings. Yeah. Okay. Commercial policy workers' comp premium decrease is just I think what what was that? The sixty six thousand for the policy workers' comp? [Bill Kelly ]: Yeah. It's like an internal service fund. We're just given the cost, and it actually went down. Okay. [Dr. Jill Bowen ]: Okay. Wow. Okay. The the concept? I'm I'm it's just like you [Chair Robin Scheu ]: know, we'll [Bill Kelly ]: take it. [Jennifer Garabedian ]: And I know that that [Dr. Jill Bowen ]: was explained to me before, but I'm like, oh, okay. Brain injury program, traumatic brain injury, TBI, utilization increase of three hundred and fifty thousand, and conflict free case management applies to that program as well. So that's where the one eight one hundred eighty three thousand four hundred and sixty six. We'll skip over that next one. And then for Choices for Care, you have the statutory nursing home inflationary increase. A lot. Yes. So it is a lot. It's a statutory This is the rebasing. Yep. Okay. That happens every two years, and this is statutorily. [Chair Robin Scheu ]: Do you think this will help where you know, because we're giving twenty one million in EFR funds. Should that be reduced in the future as a result of this, you think? [Dr. Jill Bowen ]: We do believe that this will stabilize because the the extraordinary funding request, the last time there was the statutory rebasing, it's there's always a a lag. So the last time it was done, it was based on, fiscal year twenty one realities, which at that point were right in the middle of the pandemic, and they the cost were lower because Right. There was so many fewer. So there was just more of a gap between what their actual costs were [Bill Kelly ]: Mhmm. [Chair Robin Scheu ]: And [Dr. Jill Bowen ]: what the rebates were for them. This year, since it's based on, county fiscal year twenty three's reality, that's on this side of the pandemic, and it'll be closer to the reality of their current costs. Will it eliminate extraordinary funding requests? I can't say that. Hope it will reduce. But it should reduce it. It should help to stabilize the, the nursing home. And then you can just see that there's a also a big bed day utilization, as there's increased need for nursing home beds. [Chair Robin Scheu ]: And we put twenty four million in a budget adjustment as well for almost seventy eight thousand more bed days. Right. So is this, like, another seventy eight thousand bed days on top of those seventy eight thousand? [Bill Kelly ]: No. This is annualizing the the [Dr. Jill Bowen ]: Annualizing the other one. Okay. Exactly. Yes. And then again, you'll see the conflict free case management come up here in choices of care for one million three hundred and twenty nine thousand one hundred and one. And then there's the the the regular veterans home projected quest on the settlement at three million nine hundred and fourteen four hundred and eighty one. [Chair Robin Scheu ]: And that, hopefully, is the veterans home where there's no way coming budget adjustment, and now we're gonna see [Dr. Jill Bowen ]: it here. That's the that's the That's [Chair Robin Scheu ]: the plan. I know. Yes. [Dr. Jill Bowen ]: Great. So that's our recommendations for the the changes from last year. Great. Alright. And then you've got drill down. I just wanna bring, you know, details if you will, for your, again, reading pleasure. From page forty six on is a really nice way to see more about what we do and how what the costs are associated with it. And, also, I think, importantly, the performance measures are right there. So and I know there was request for that. Yeah. So if you have it, Mac goes for several pages because, you know, we have a lot [Chair Robin Scheu ]: of programs. [Dr. Jill Bowen ]: Our our folks are amazing. They work really hard as long as we've got that. I wanna say that. [Chair Robin Scheu ]: Yeah. Thanks. [Dr. Jill Bowen ]: And then that goes to page sixty four. And then the only thing we really love is the organizational chart. And that's us. [Chair Robin Scheu ]: Quite an impressive array of activities that you all do. It's it's something else. [Bill Kelly ]: This is not my question. [Chair Robin Scheu ]: We are very glad that representative Giacalone has this budget. He's familiar with it. [Bill Kelly ]: It is [Member Eileen Dickinson ]: very nice to meet [Bill Kelly ]: you now. [Member Eileen Dickinson ]: Nicely ties in together. [Chair Robin Scheu ]: Yeah. And so he's he's our expert. [Dr. Jill Bowen ]: We're delighted to have him be our liaison. [Chair Robin Scheu ]: Yes. You know, we're all happy then. Yes. It's great. So we we will final committee our questions through through Dave, and we really appreciate you all coming in here and on the screen and and telling us about all the great things you do. It's so So much. A lot of territory and serve a lot of people with a lot of different kinds of needs. So Perfect. K. Thank you so much. Okay. You all have a good day. Okay. [Bill Kelly ]: Thank you. [Chair Robin Scheu ]: Maybe our website's down, but, you know, some of those things get up. But, I think that we're done for the day. [Dr. Jill Bowen ]: Oh, this table and [Bill Kelly ]: this. And [Chair Robin Scheu ]: and so Aaron has been trying to she's been doing heroic work to try to get somebody to come tomorrow, and I actually texted the commissioner of Simon and said, we are probably finding people coming in. And at this point What were you? Yeah. He did, and then they said they weren't. So you don't have vacations. You have to work on your budget. Read the rest of the language, work on your budget areas. I know some of of you have been having meetings. We are on the floor with budget adjustment tomorrow after minute three. We'll be the only probably the only bill that's on the floor. So be prepared, Gabby, to yield to you if there are questions that folks have. I I have no idea. I mean, we've all talked about it in our conversation. We've talked about it with people in various places. So we probably have a good idea what the questions are, but you just never know what's happened before. So for you. As in Let's see. I'm gonna go my report. We could Thank you. We can [Bill Kelly ]: make up tomorrow morning so I have a full schedule. [Chair Robin Scheu ]: If check the check the agenda. We won't start before nine if we've got something, but maybe we should just check-in with each other at nine tomorrow morning. You just pop in, and we'll see where we are. [Bill Kelly ]: Are you are you getting any questions from your budget, buddy? No. Right. Have you reached out to everybody? [Chair Robin Scheu ]: Okay. [Bill Kelly ]: Send a note right now. [Chair Robin Scheu ]: Saw. I sent something to the entire party. Just a second. [Bill Kelly ]: We did. And I forwarded that to my group. Great. Again, we couldn't have all the links Yeah. Or attach Attachments. Yep. And just said that you're stuck with me. So And [Chair Robin Scheu ]: they haven't responded. [Bill Kelly ]: No. That's right. I can't hear you. [Chair Robin Scheu ]: Great. Alright. Well, so we'll just check-in tomorrow morning at nine and see if we need to go live and if we have anything otherwise.

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