THE “FEE FOR SERVICE”

Fee for Service is kicking in.  There is much confusion about the process.  Some States, I have been informed, have pulled out of it due to the complex nature of the program.  Many Agencies are overwhelmed with the mechanics of how to incorporate this new system into what they have mastered for years with the old system based on Contracts.

This new system is much more tedious with allotting 15 minute chunks of time for accounting purposes.  It is a totally complicated system when dealing with so many developmentally disabled individuals with specific needs.  This makes for intricate accountability of each program for each individual and for each staff member.  A lot of time has to go into this. 

There is speculation that things may get better with more services available.  Yet, so many services have been removed before this came into play that it becomes a process of filling in the gap.  An example is the personal training was terminated along with Gym memberships.  Instead other therapies will now be allowed like Speech, OT, and PT.  I believe the trick behind this is that you will need a doctor to attest to the need for such services, whereas, going to a Gym is not considered a medical goal. 

Everyone previously had the State paying for housing after they billed what they could of the clients and their families.  Now a variation of Section 8 Housing is coming into play through various agencies.  So, every aspect of the disabled person’s life is being affected by this change.

There is concern if the Agencies which run programs for the disabled will survive this change; or, if Doctors would continue taking these types of patients with the new system in place.  This is because this population is so vulnerable to not being able to make it to appointments for therapies, education, habilitation, and doctor visits that the concern is the payments will not take place and there will be a large loss of income for these providers.

Also, the same holds true with people who work with these individuals who are not very well paid at all to begin with.  There may be a large loss of their income with inconsistent pay that will result in a bigger loss of workers in the field.

As in the past with the Dept. of Human Service and the Division of Developmental Disabilities, there have been so many programs implemented and revoked throughout the years that it is stunning that by now nothing solid has been in place.  And, with this program, which has many parents concerned with all the pressure on them, their children, and the agencies they are involved with, who knows how long even this will last or how it will evolve.  And with each change of the political environment, new ways of thinking come into play.  So it is a matter of time before we are able to see the fate of Fee for Service.