A stronger disabilities agency for Maryland

Health secretary details reform efforts in the Developmental Disabilities Administration

September 30, 2013|By Joshua Sharfstein

Marylanders with developmental disabilities deserve the opportunity to reach for their potential to live independently, work, and contribute to their communities. As Secretary of Maryland's Department of Health and Mental Hygiene, I am responsible for the Developmental Disabilities Administration, the agency that finances a broad range of services to advance this goal.

A federal audit this month detailing faults with the state's billing of the federal government brought attention to the DDA, but our efforts to improve support for Marylanders with developmental disabilities — and to reform the agency itself — began long before that report and far exceed its scope.

Since 2006, under the O'Malley administration, Maryland has increased the budget for services for individuals with developmental disabilities by more than one-third. Each month, about 8,000 Marylanders with developmental disabilities live in community supported living arrangements or are served by community residential providers; 4,700 receive assistance with employment; and 7,200 receive daily services. The numbers of individuals and families supported has never been greater.

The alcohol tax increase that the General Assembly approved in 2011 provided $15 million each year for individuals with disabilities, helping hundreds more Marylanders with the most intense needs to move off of the waiting list for services. In 2012, we invested $6 million to improve the infrastructure of more than 100 service providers and over $10 million to help more than 1,500 families care for loved ones at home. In 2013, we provided additional support to many individuals already within our system whose needs are evolving as they age.

Our commitment to Marylanders with disabilities includes rooting out and addressing challenges within the DDA. Over the last several years, we have uncovered significant administrative and financial weaknesses in the agency. For example, we found that many transactions were still handled on paper and depend on systems that do not connect, following practices in place for many years. Under state law, service providers receive advance payments based on estimated expenditures, and reconciling them with actual expenditures can take months or even years. These antiquated systems have failed to provide timely data to guide budget development and program oversight.

In 2011, we identified a pattern of significant under-spending in the budget for developmental disabilities (and then reinvested additional funds in the budget moving forward). Auditors have noted additional issues, including errors in archaic computer systems that have at times undercharged the federal government for matching funds due Maryland, and at other overcharged the federal government, leading to payback requirements. We found that these challenges have been complicated by a lack of clear policies in certain areas.

In response, we are making fundamental changes.

In June, I appointed a new acting director for the DDA, and we executed a contract for expert support from a national firm with experience turning around agencies that serve individuals with developmental disabilities. This new team is capable of identifying and understanding the many challenges facing our system and taking action to address them.

The agency is adding additional financial controls and improving the fairness and transparency of key policies. Key projects include strengthening internal leadership within the agency, promoting consistency across regional offices, creating a more efficient and effective path for families to tailor services to each individual's needs, and developing a standard approach to audits of providers.

Our consultants are developing a plan for a modernized IT system that would facilitate far greater accountability and compliance. They are planning a long-overdue review of provider rates. And they are revising key policies related to eligibility to make them more effective, as well as more understandable and helpful to families.

Each step is being taken in consultation with individuals with disabilities, their families, providers and other advocates. The senior staff meets regularly with members of the Developmental Disabilities Coalition to explain potential changes and receive feedback.

Within several weeks, the new leadership at the agency intends to provide a report detailing key actions to take place over the next 12 months, including a process for stakeholder input. These actions will help strengthen service providers, enhance financial integrity, predictability and accountability and set a high standard for quality and oversight.

Strengthening the Developmental Disabilities Administration will complement our efforts to further expand access to services. At different levels of need, thousands of Marylanders with disabilities remain on the waiting list. A stronger agency will be able to strengthen and expand support for far more of our family members, friends and neighbors.

At this time of transition, one thing is not changing — our commitment to the independence and dignity of Marylanders with developmental disabilities and their families. This commitment will guide our actions and ultimately assure our success.

Dr. Joshua Sharfstein is secretary of Maryland's Department of Health and Mental Hygiene. His email is joshua.sharfstein@maryland.gov.

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