Latest news with #FSSA
Yahoo
30-05-2025
- Business
- Yahoo
FSSA secretary: Braun administration ‘inherited a mess'
FSSA Secretary Mitch Roob addresses a crowd at the Indiana Fiscal Policy Institute's 2025 Policy Summit on May 30, 2025 to discuss the agency and Medicaid policy. (Whitney Downard/Indiana Capital Chronicle) When it comes to the Family and Social Services Administration — which oversees Medicaid alongside other state programs like child care subsidies — Gov. Mike Braun 'inherited a mess,' FSSA Secretary Mitch Roob said Friday. Roob is taking his second turn leading the agency, which has the single largest budget due to its federal funding. Previously, he led FSSA under former Gov. Mitch Daniels. Donning his now-standard 'Make Medicaid Boring Again' hat, Roob said the state had 'no other choice' than to make the program more sustainable and fiscally sound. He spoke at the Indiana Fiscal Policy Institute's 2025 Policy Summit in Indianapolis. 'Very few people wear — other than (President) Donald Trump — wear their job description on their hat, but I do,' said Roob. 'That is our task for the next four years.' House GOP overwhelmingly votes to impose Medicaid work requirements Under Daniels, Roob launched the earliest version of the Healthy Indiana Plan, which covers moderate-to-low-income Hoosiers but has grown since its first iteration. HIP 3.0, on the other hand, would return to its roots and 'inject personal responsibility for able-bodied adults again,' Roob said, putting it into alignment with federal discussions on work requirements for the Medicaid program. Also in his first term, Roob said the agency conducted monthly finance reporting and other fiscal checks to tamp down on spending. He said departing from that norm in subsequent administrations is when the program went awry, pointing specifically to cost growth for applied behavior analysis therapy and attendant care. The former is a treatment sought by some parents with autistic children while the latter is a program that previously allowed parents to be paid as caregivers for their children with complex medical needs. '… that lack of accountability, that lack of paying attention to the dollars is why we had ABA therapy growing at a pace that we did. It's why we had attendant care growing at the pace that it did,' said Roob. 'It's very difficult to put that genie back in the bottle here because, in both of those cases, we had created, inadvertently, a dependency.' He never specifically named former Gov. Eric Holcomb in his criticism. In 2019, Indiana's Medicaid program spent $120 million on ABA therapy, but the program ballooned to $639 million by 2023. In response, Braun established a panel to consider cost controls earlier this month. 'If you think this is sustainable, you're budgeting at the federal level,' quipped Roob. 'Because this will bankrupt Indiana.' Similarly, attendant care costs for parents of disabled children grew rapidly during that time span. Roob said the agency spent $11 million monthly in July 2020 but the number soared to $84 million each month by May 2024, when the agency diverted parents to a structured family caregiving program that paid at a lower rate. Combined, Roob said those numbers contributed to a December 2023 state forecast determining Indiana was $1 billion short in its Medicaid budget. Providers, seniors continue to experience challenges under PathWays program 'Many folks look at the Medicaid program and they go, 'How did you get in debt a billion dollars?' Well, it's because you have so many more people receiving care and help. Because we are paying so much more for very discrete parts of the agency,' Roob said. Another program that transitioned care for elderly Hoosiers from state oversight to a contract with insurers — known as managed care entities — would 'never' be something he would pursue, said Roob. 'I have been quite clear this program … I never would implement (it),' said Roob. 'Because it's very difficult for managed care companies to manage the care of individuals who are in nursing homes. What is the value?' Early pitches said the PathWays to Aging program would deliver savings because the state would pay a flat fee for Hoosiers and private companies would manage their care, rather than Indiana paying piecemeal for every cost. However, the transition to get there 'is very difficult,' Roob said. 'We have not, today, seen the results that we are hoping for,' said Roob, adding that the state will pay $300 million extra to the companies in cost overruns this year. '… it's been painful for everybody involved so far and that pain shows signs of easing — but only signs.' Roob didn't limit his criticisms of previous administrations solely to health care programs, also saying there was 'a lack of planning' when it came to the state's child care options. Roughly 75,000 children currently receive some form of child care through the agency, an increase initially funded by federal pandemic dollars, Roob said. 'Their plan was in April of this year simply to take children off of the child care program with no particular warning,' asserted Roob. 'Gov. Braun and the legislature felt that was probably not the best answer, so they have allowed us to create a slope to slowly dr0p people from the child care program. 'That doesn't minimize the fact that we're losing over 20,000 daycare slots for the children of men and women who make below 127% of the poverty level,' continued Roob. CONTACT US Additionally, the 'lack of planning and forethought by our predecessors' meant that there would be even fewer options for parents seeking child care for infants or one year olds. Part of the problem with Indiana's Medicaid spending can be attributed to the state's high health care costs, an explicit priority for Braun. Since his tenure under Daniels, Roob said the disparity between what Hoosiers pay and what they receive has worsened. 'When Gov. Daniels was in office, I used to tell people that Indiana residents were buying a Cadillac and getting a Chevrolet,' Roob said. 'Unfortunately, today, we're no longer driving Chevrolet. We are driving a used Kia.' SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
09-05-2025
- Health
- Yahoo
Indiana panel to consider ABA therapy cost controls
A psychologist takes notes on a clipboard in a therapy session for children. (iStock/Getty Images Plus) Twenty-one agency leaders, health industry professionals, disability advocates and others will look to contain Medicaid spending on Applied Behavior Analysis (ABA) therapy — while ensuring continued care for thousands of young, autistic Hoosiers — the Indiana Family and Social Services Administration (FSSA) announced Friday. Gov. Mike Braun directed the agency to create the working group in a February executive order. A report featuring three cost-containment recommendations is due by December. ABA therapy is commonly used to improve social, communication and learning skills in children and young adults with autism or other developmental disorders. Some critics, however, object to the teaching tool and say it encourages compliance over independence. Additionally, some practitioners coupled it with electroshock therapy as late as 2022. Indiana Medicaid spending on ABA therapy has risen over time: 2019: $120 million 2020: $102 million 2021: $276 million 2022: $420 million 2023: $639 million Source: Indiana Capital Chronicle reporting Nevertheless, it's increasingly popular. Families, however, often struggle to access the therapy because of the price, limited insurance coverage and other health care industry stumbling blocks. State coffers are also taking a hit. Indiana Medicaid expenditures for ABA therapy rose from about $14 million in 2017 to $120 million in 2019, according to FSSA, then dipped to $102 million in 2020 — still the second-highest in the nation, per U.S. Health and Human Services' Office of Inspector General. The cost surge prompted the federal office to audit Indiana's 2019 and 2020 ABA payments. The 2024 report found at least $56 million in improper payments — citing problems with documentation, diagnostic evaluations, staff credentials, referrals and more. It recommended that Indiana refund more than $39 million to the federal government. Soaring totals since then have prompted greater scrutiny from Hoosier leaders worried Medicaid costs are growing too much, too fast. The financial pressure has only worsened. A grim April revenue forecast forced lawmakers to cut $2 billion in spending out of the state's next two-year, now-$44 billion budget. Braun's order charged the working group with evaluating cost-containment strategies that 'minimize the negative impact felt by enrollees and their families.' He directed the group to evaluate the 'best' clinical care models to provide the right therapy in the right setting at the right ages. The order sought recommendations for 'a better coordinated experience' for children, 'but in a financially sustainable manner.' Under the order, group members must also consider potentially implementing quality metrics for ABA services, caps on the number of therapy hours per week, caps on the number of months children can receive the therapy, an appeals process for 'extenuating circumstances' along with new provider enrollment and billing requirements. The 'comprehensive review' of ABA therapy in Indiana should 'identify key drivers of Medicaid expenditures,' Friday's news release read. An evaluation must be completed by September 30. A written report has to include three recommendations for 'meaningful' cost-containment, plus the advantages and disadvantages for each recommendation. That's due to Braun by November 30. The working group's members include: FSSA staff, some of whom lead disability and Medicaid utilization efforts Health care industry representatives, including a pediatrician, psychiatrist and a health insurance company lobbyist Autism, other disability and special education organization advocates State lawmakers Other parents Controversy over ABA cuts ensnarled Braun's predecessor, former Gov. Eric Holcomb. Families rallied repeatedly, urging Holcomb and his FSSA to reconsider. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Indianapolis Star
08-05-2025
- Business
- Indianapolis Star
The Indianapolis Star Subscription Offers, Specials, and Discounts
As Indiana officials try to rein in spending in the face of a predicted revenue shortfall, advocates fear a behind-the-scenes move to privatize the state's Adult Protective Services program could prevent elderly and at-risk Hoosiers from receiving the help they need. Indiana Family and Social Services Administration confirmed to IndyStar that it has awarded PCG-Indiana Inc. a 3-year contract, estimated at more than $19 million, for the firm to staff and operate Adult Protective Services starting July 1. An award letter released April 30 greenlighted contract negotiations with the company. The contract could contain an option for the state to add three one-year extensions, potentially lengthening the deal to six years. Indiana's Adult Protective Services is responsible for investigating reports of neglect, abuse and exploitation of vulnerable adults and coordinating a response to protect them. Traditionally, FSSA has contracted with the Indiana Prosecuting Attorneys Council 's hub prosecutor offices to operate the program, but those contracts expire on June 30. The new contract takes Adult Protective Services out of the hands of local prosecutors, who for years have complained that Indiana underfunded the program, and puts the program under a subsidiary of Boston-based Public Consulting Group. The parent company, with offices in nearly a dozen states, works with public-sector health, human services and education agencies. PCG-Indiana, the subsidiary, has contracted with Indiana since 2010, providing consulting services related to education, children and social services, and workforce development, according to public records. "Over the next two months, the Division of Aging, will work with PCG-Indiana and the current APS units to establish an APS model for Indiana that is in line with new federal requirements and best practice recommendations," FSSA said in an emailed statement. Public Consulting Group did not respond to a request for comment. Meanwhile, prosecutors and advocates say FSSA hasn't been transparent about the procurement process and what the APS model would look like under a private contractor with a motive to make a profit. "It's been a very opaque discussion that's been going on the state level with regard to what's going on with APS," said H. Kennard Bennett, executive director and senior counsel for the Center for At-Risk Elders, Inc., a lawyer-led nonprofit that provides guardianship and advocacy for endangered adults in Marion County. "They've not sought any input from any stakeholders." Adult Protective Services fields 20,000 calls a year A report is made to Adult Protective Services whenever an individual 18 years or older is suspected of being deprived of food and water, improperly clothed, neglected medically, exploited financially, or in other ways. In 2023, Adult Protective Services received more than 20,000 calls for service, according to the FSSA Division of Aging Adult Protective Services 2024 Annual Report. Of those, 11,653 cases resulted from the calls. Vulnerable adults can include individuals unable to care for themselves due to age, mental or developmental disabilities, incapacitating injuries, mental illness, or those suffering from isolation or neglect. The program, which resides in FSSA's Division of Aging, is funded through state appropriations. Indiana operates Adult Protective Services within the county-based criminal justice system and contracts with 17 prosecutors to administer it through a hub model. Most hubs service multiple counties. Prosecutors say the program repeatedly had funding issues. "For multiple budget cycles, the State and the Family and Social Services Administration (FSSA) declined to provide sufficient financial resources to the Adult Protective Services (APS) program, leaving prosecutors concerned that the standard of care to Indiana's increasing elder population and vulnerable adults could not be maintained," Whitney Riggs, spokeswoman for the Indiana Prosecuting Attorneys Council, said via email. A 2016 IndyStar investigation revealed that Indiana Adult Protective Services was too understaffed, underfunded and ill-equipped to handle the deluge of calls requesting assistance for at-risk adults. At the time, Indiana had budgeted roughly $3.5 million for the program — significantly less than other states. The lack of support left adults who could not protect themselves exposed to abuse and neglect, and well-intentioned investigators overwhelmed by caseloads. Shortly after the investigation was published, Indiana lawmakers pledged an additional $1.1 million to hire more full-time investigators for adult protective services. But, advocates say funding shortfalls did not cease. The situation is becoming more dire as the state's population ages. "The hope was that there would be an approach taken to reorganizing the APS model into a better, more efficient agency and to fund it appropriately," Bennett said. "There was some more funds dedicated following that series of articles.... but, I don't think it has been sufficient by any means." Riggs said there have been times when county governments subsidized budgetary shortfalls, leaving residents of some counties to finance services for residents of other counties. "This was unsustainable long term," she said. According to the Adult Protective Services 2024 annual report, the APS Unit Contract was $5.6 million in 2023. The majority of the funding — $4.4 million — was from a state appropriation. The remaining $1.2 million was from federal Medicaid dollars. Acting on continued funding concerns, Indiana Prosecuting Attorneys Committee notified FSSA in late 2023 that the majority of hub prosecutors did not intend to renew their contractual relationship again. FSSA, in turn, issued in September 2024 a request for proposals soliciting vendors interested in administering the program. Prosecutors bid to keep providing services Riggs said the Adult Protective Services Hub Prosecutors Committee submitted a bid for the new contract. It was "at an amount of money that nearly forty years of experience doing this work told us would be the minimal amount of state money that should be allocated for a successful program, and in the same amount previously requested," she said. For months, the council heard nothing. It's unclear how the model for Adult Protective Services could change under PCG-Indiana. Neither the state nor the company responded to IndyStar questions about the for-profit company's plans for the program or what the transition would entail. IndyStar has requested copies of the state's initial request for proposal and the responses to it. According to the award letter recommending PCG-Indiana for the contract, the Massachusetts company will subcontract with three partners. Marion Edward Associates Inc., a Boston-based staffing firm, will get 9% of the contract value. Local consulting company Briljent LLC will get approximately 12% of the contract value while Axon Advisors LLC, a market research firm also based in Indianapolis, will receive about 4%. PCG-Indiana beat out IPAC's Adult Protective Service Hub Prosecutor Committee and Community Care Hub of Indiana for the contract. The proposals were evaluated by FSSA and the Indiana Department of Administration, which oversaw the procurement process. According to the letter, the agencies were made aware of updates that were part of the state's budget process and limited the maximum amount of funding available. Respondents were invited to withdraw or revise their proposals to align with the changes and new budget cap. "Only one of the three respondents updated their technical and cost proposals to align with a reduced scope of services within the new budget maximum. This Respondent was PCG," the letter reads. Said Riggs: "Prosecutors were hopeful they could persuade the state to provide adequate resources for this important mission." 2-month transition window causes concern Prosecutors, investigators and advocates who reached out to IndyStar have expressed concern about the lack of communication regarding the procurement process from FSSA and state officials. "We're very concerned about what will happen and I know the courts are very concerned about what will happen with APS," said Bennett, who wasn't familiar with PCG Indiana or Public Consulting Group. "I'm hoping that whomever takes on the contract provides good services to be able to respond to complaints that APS might receive, but I think I may have to take a wait and see attitude on that. He said FSSA has not sought input from stakeholders. Prosecutors will focus on a smooth transition and handover of the program, Riggs said, though advocates wonder if there's enough time to transition the program. The state awarded PCG-Indiana the Adult Protective Services contract just two months before the expiration of the current contracts on June 30, leaving some investigators to wind down active cases without a resolution and advocates wondering where they should turn to report suspected cases of abuse and neglect.
Yahoo
17-03-2025
- Health
- Yahoo
Measure updating Adult Protective Services glides through committee
Sen. Mike Crider, R-Greenfield, talks about his Family and Social Services Administration agency bill in committee on Monday, March 17, 2025. (Leslie Bonilla Muñiz/Indiana Capital Chronicle) Improvements are on the way for Indiana's Adult Protective Services — the initiative protecting abused, exploited and neglected adults — after a 12-0 committee vote Monday morning. Sen. Mike Crider, R-Greenfield, told committee members that the 'clean-up' bill removes 'antiquated' language and offers the Family and Social Services Administration more flexibility in drawing up contracts for Adult Protective Services. Senate Bill 182 would specify that the entire chunk of Indiana Code dedicated to Adult Protective Services would apply to reports of suspected abuse, neglect and exploitation that are made by phone or online. To report suspected abuse, neglect or exploitation of an endangered adult, call Indiana's toll-free hotline at 800-992-6978 or fill out an online form. It would remove 'habitual drunkenness' and 'excessive drug use' from the list of conditions that might render adults incapable of taking care of themselves or their belongings — and at risk of harm. Left in the definition of an 'endangered' adult would be dementia, intellectual disability, mental illness and other incapacities. 'It's not something that requires an investigation of law enforcement as far as, are they being exploited financially or being harmed in some way by another individual? It's more considered self-harm,' Crider told the Capital Chronicle. He said his bill's information-sharing provisions would make sure Hoosiers with substance abuse disorders are 'appropriately referred over to the Division of Mental Health and Addiction,' instead of the Division of Aging. FSSA houses both. Others provisions would introduce a record-keeping minimum, let the Adult Protective Services unit restrict records releases 'to the extent that information … is needed to coordinate or implement services,' and require only an alleged victim's consent for release. Crider said the proposal arose from previous, successful legislation letting FSSA contract out to other entities when county prosecutors didn't want to renew their contracts. 'A few issues came up as FSSA began to try to develop the contract language,' he said. The bill removes language requiring the Indiana Prosecuting Attorneys Council to concur on standards of practice and exceptions that currently allow for an Adult Protective Services unit or staffer to be appointed as the representative or guardian for an endangered adult. It also tweaks how cases are reported to law enforcement and others. Crider said less than 2% of cases are referred for prosecution, and even fewer are prosecuted. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
19-02-2025
- Health
- Yahoo
Gov. Mike Braun orders cross-agency group to tackle soaring costs of autism therapy
In response to soaring costs in a Medicaid-covered therapy service for kids with autism ― a program that was recently the subject of a federal audit ― Gov. Mike Braun is ordering a cross-agency working group to figure out how to get the program under control. His executive order comes just days after his administration abandoned a cost-cutting measure drafted at the tail end of the last administration that would have kicked a number of kids off Medicaid-reimbursed Applied Behavior Analysis, known as ABA, come April 1. "I'm committed to protecting this program for the families that need it," Braun said Wednesday. "But in the future, we got to run it efficiently and make sure that we marshal the resources to keep it sustainable." More: Federal audit finds $56 million in 'improper' Indiana Medicaid payments for autism services The working group established by this executive order would consist of experts from the Family and Social Services Administration, the Department of Education and the Department of Child Services, as well as lawmakers and families. The group will come up with recommendations for ideal clinical care models, better care coordination, transitioning kids from ABA therapy settings to other settings, caps on hours or the number of months a child can receive the service, appeals processes and new billing requirements to address the issues found in the federal audit. The experts will give a report to the governor by Nov. 30. FSSA has been making changes to the program since 2023 in an attempt to rein in costs. The state Medicaid office started covering ABA therapy in 2016 by reimbursing providers based on a percentage of whatever each individual provider billed. The first full year, the program cost the state $14 million. In 2019, it grew to $120 million; then $420 million 2022, and an anticipated $645 million in 2026. That's partly because the number of kids receiving therapy has increased, but so has the cost per child. In the fall of 2023, the agency implemented a standardized, flat reimbursement rate for these services, rather than the widely varied hourly rates that providers would charge. Providers largely agreed that the rate needed to be standardized to prevent abuses in the system, but feared the rate the state chose would force some of them to lay off staff or close. More: 'Rippling effect': Autism therapy providers fear drastically lower proposed Medicaid rates More than 40 state lawmakers signed a letter asking then Gov. Eric Holcomb to intervene after the first low rate FSSA proposed. The agency then landed on a compromise, and the new rate took effect at the start of 2024. Then in December, at the tail end of Holcomb's tenure, FSSA proposed an amendment to the state Medicaid plan that would have capped Medicaid coverage of ABA therapy at 30 hours per week for a maximum of three years per child. This would have applied retroactively to children already undergoing therapy, meaning kids who happened to have started therapy three years ago would have been booted off on April 1. Within days of proposing that amendment, the Health & Human Services Office of the Inspector General published an audit of Indiana's ABA claims in 2019 and 2020, finding at least $56 million in "improper" payments. That's more than a third of the audited payments in those two years. An FSSA spokesperson at the time said this audit "underscored" the need for their state plan amendment. But after meeting with stakeholders and legislators, the Braun administration changed the proposed amendment. Pending federal approval, FSSA will implement a tiered system, where the limit on hours depends on the severity of the child's autism diagnosis and lends some deference to the provider's judgment. And crucially to advocates, the rule will no longer be applied retroactively. Republican Rep. Robb Greene, who has a child who underwent ABA therapy, credited Braun and his FSSA secretary Mitch Roob with making this change based on his feedback. 'This goes beyond policy and politics for me, and I want the Governor to know that I'm grateful to him as a dad," Greene said in a statement. "This is a great first step, and I am excited to continue the work we are doing.' Speaking to reporters Wednesday, Roob said discovering the true implications of the April 1 cutoff for certain kids was "not on my bingo card." "And there was no plan to deal with these children," he said. "There was no connection to the school. There was no connection anywhere else. And I think that's why you saw the understandable outrage on the part of the parents. And so as soon as we found that out, we knew we had to change that." The Arc of Indiana CEO Kim Dodson called the changes a "major victory," though the organization still wants to see the three-year limit removed. "We thank the families and advocates who took the time and effort to educate their legislators and the governor on the importance of ABA therapy," she said. "Their efforts truly made a difference." Roob said the administration plans to work on another state plan amendment, and may consider adjusting the three-year cap. He said the administration doesn't have a particular enrollment number in mind. "We want to make sure that we are providing care in a holistic manner, hopefully preventative care, to those who are eligible for it and not to those who are not eligible," he said. Contact IndyStar state government and politics reporter Kayla Dwyer at kdwyer@ or follow her on X: @kayla_dwyer17. This article originally appeared on Indianapolis Star: Gov. Braun orders agencies to get autism therapy costs under control
