FY 2016 Appropriation

The Division of Services for People with Disabilities (DSPD) is responsible for providing residential, day services, family support services, and attendant care for people with severe intellectual disabilities and other related conditions, including brain injury and physical disabilities. To receive services, people must have substantial functional limitations in three or more of the following life activities: self care, receptive and expressive language, learning, mobility, self direction, capacity for independent living, or economic self-sufficiency. The services provided range from limited family support to a full array of 24-hour services both in the community and at the Utah State Developmental Center. Services are also available in private Intermediate Care Facilities for people with an Intellectual Disability (ICFs/ID) with funding through the Department of Health.

Additional information regarding the Division of Services for People with Disabilities can be found on its official website found at: Utah Division of Services for People with Disabilities

The Division of Services for People with Disabilities' most recent annual report can be found at: DSPD Annual Report - FY2014

Funding History

Funding Issues

Direct Care Staff Salary Increase

This request would raise the wage of direct care workers providing services for the Division of Services for People with Disabiities (DSPD). The increase would apply to any 'waiver code' where there is a direct care worker. During FY 2014 DSPD had difficulty placing individuals already funded by the Legislature because community providers were unable to staff these placements due to lack of appropriate staff. This difficult is evidenced by DSPD nonlapsing $6.7 million in state funds (meant for services) at the end of FY 2014. The issue meant that families anticipating receiving services already approved had to wait for as long as six months to receive that service. The issue also involves access with regard to the Medicaid waiver and quality of care when appropiate staff cannot be hired.

Disabilities Mandated Additional Needs

There is a Medicaid requirement that the health and safety service needs of individuals receiving waiver services be met. Of the 4,800 covered individuals, 660 or 13.8 % identified last year as having increased health and safety needs. This is an increase from the base of 1.9%. How Measure Success? "Percent of people who are satisfied with their staff, support coordinator, and fiscal agent."

Disabilities Waiting List

The Disability Waiting List was funded in the 2014 General Session with one-time money. Advocates are looking to make this funding ongoing plus any additional funding request in the 2015 General Session. If the Legislature funds approximately 150 individuals currently on the waiting list for services it would cost about $1,000,000 in General Fund and $3,500,000 in total funds. This is an increase from the base of 1.86%. How Measure Success? "Percent of people who are satisfied with their staff, support coordinator, and fiscal agent."

Federal Medical Assistance Percentage Change (FMAP)

This increased cost reflects a lower federal medical assistance match rate for FY 2016. The Federal Medical Assistance Percentage (FMAP) represents the federal share of the programmatic costs for Medicaid, Foster Care, and Adoption Assistance. When the federal government's participation rate goes up, the state of Utah's participation goes down in a commensurate manner. The federal government utilizes a formula to determine its annual percent of FMAP based on a rolling three year average of per capita income levels compared to the national average. By law the FMAP rate cannot be lower than 50 percent or higher than 83 percent.

Youth Aging Out of DCFS Custody

This request maintains youth with intellectual disabilities on the Medicaid waiver who are aging out of the Division of Child and Family Services (DCFS) custody. DCFS is currently providing the funding until a person reaches age 18 (sometimes up to age 22). This item was funded $455,200 one-time General Fund in 2014 General Session. The underlying dynamics of the program would require an ongoing funding to replace the one-time funding plus any estimate in growth (or decline) of the need. How Measure Success? "Percent of people who are satisfied with their staff, support coordinator, and fiscal agent."
Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $277,937,500 from all sources for Services for People w/ Disabilities. This is a 9.4 percent increase from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $81,861,000 from the General/Education Funds, an increase of 20.7 percent from revised Fiscal Year 2015 estimates.

Appropriation Adjustments

In addition to statewide compensation and internal service fund cost increases, the following appropriation adjustments were made during the 2015 General Session:

DescriptionOngoingOne-Time Background Checks/HB 145 Vulnerable Adult Workers$231,400$0
OngoingOne-TimeFinancing Source
$88,700$0General Fund
$142,700$0Transfers - Medicaid
Human Services - Background Checks & HB 145 - Vulnerable Adult Worker Amendments - "to enable background checks of employees working with vulnerable adults."
Direct Care Staff Salary Increase$14,260,400$4,211,600
OngoingOne-TimeFinancing Source
$4,232,500$0General Fund
$0$1,250,000General Fund, One-time
$10,027,900$2,961,600Transfers - Medicaid
This request would raise the wage of direct care workers providing services for the Division of Services for People with Disabiities (DSPD). The increase would apply to any 'waiver code' where there is a direct care worker. During FY 2014 DSPD had difficulty placing individuals already funded by the Legislature because community providers were unable to staff these placements due to lack of appropriate staff. This difficult is evidenced by DSPD nonlapsing $6.7 million in state funds (meant for services) at the end of FY 2014. The issue meant that families anticipating receiving services already approved had to wait for as long as six months to receive that service. The issue also involves access with regard to the Medicaid waiver and quality of care when appropiate staff cannot be hired.
Direct Care Staff Salary Increase - Internal Funding$3,917,500$0
OngoingOne-TimeFinancing Source
$1,162,700$0General Fund
$2,754,800$0Transfers - Medicaid
This request would raise the wage of direct care workers providing services for the Division of Services for People with Disabiities (DSPD). The increase would apply to any 'waiver code' where there is a direct care worker. During FY 2014 DSPD had difficulty placing individuals already funded by the Legislature because community providers were unable to staff these placements due to lack of appropriate staff. This difficult is evidenced by DSPD nonlapsing $6.7 million in state funds (meant for services) at the end of FY 2014. The issue meant that families anticipating receiving services already approved had to wait for as long as six months to receive that service. The issue also involves the issue of access with regard to the Medicaid waiver and quality of care when appropiate staff cannot be hired.
Disabilities - Capital Development Assistance$0$500,000
OngoingOne-TimeFinancing Source
$0$500,000General Fund, One-time
The funding could either be for FY 2015 or FY 2016. The funding will be used to assist individuals with disabilities living in community settings where the services are throughout much of the state.
Disabilities - Inclusive Schools, Communities, Workplaces$0$50,000
OngoingOne-TimeFinancing Source
$0$50,000General Fund, One-time
The funding is to provide assistance for creating inclusive schools, communities, and workplaces for individuals with disabilities.
Disabilities Dental Program$0$200,000
OngoingOne-TimeFinancing Source
$0$200,000General Fund, One-time
Funding is meant to help provide specialized dental services statewide to individuals with disabilities.
Disabilities Mandated Additional Needs$5,157,000 ($3,697,100)
OngoingOne-TimeFinancing Source
$1,530,600$0General Fund
$0 ($1,097,300)General Fund, One-time
$3,626,400 ($2,599,800)Transfers - Medicaid
There is a Medicaid requirement that the health and safety service needs of individuals receiving waiver services be met. Of the 4,800 covered individuals, 660 or 13.8 % identified last year as having increased health and safety needs. This is an increase from the base of 1.9%. How Measure Success? "Percent of people who are satisfied with their staff, support coordinator, and fiscal agent."
Disabilities Transportation$0$508,600
OngoingOne-TimeFinancing Source
$0$150,000General Fund, One-time
$0$358,600Transfers - Medicaid
Increases the rate for transportation services for people with disabilities to get from their homes to day programs, jobs, and other activities. This item was funded with one-time money during the 2014 General Session. Intent language was included to study the issue and provide a report to the LFA (which was done). The report included a number of recommendations almost all of which consisted of increasing the rates in various ways.
Disabilities Waiting List$0$4,211,600
OngoingOne-TimeFinancing Source
$0$1,250,000General Fund, One-time
$0$2,961,600Transfers - Medicaid
The Disability Waiting List was funded in the 2014 General Session with one-time money. Advocates are looking to make this funding ongoing plus any additional funding request in the 2015 General Session. If the Legislature funds approximately 150 individuals currently on the waiting list for services it would cost about $1,000,000 in General Fund and $3,500,000 in total funds. This is an increase from the base of 1.86%. How Measure Success? "Percent of people who are satisfied with their staff, support coordinator, and fiscal agent."
DSPD Nonlapsing Carryforward$0 ($6,676,200)
OngoingOne-TimeFinancing Source
$0 ($6,676,200)General Fund, One-time
DHS - DSPD Nonlapsing carryforward - the Division of Services for People with Disabilities (DSPD) has a large amount of unspent General Fund it has carried from FY 2014 into FY 2015. DSPD suggests this funding is due to difficulties in placing individuals into services in a timely manner. This funding is one-time. Utah Code (UCA 62A-5-102(7) dictates how nonlapsing funds may be used. DSPD would like to use the one-time funding to provide $5,000 in Respite Services per person to 850 people currently on the DSPD Waiting List ($4,250,000) and to cover: 1) the costs of Mandated Additional Needs for individuals currently receiving Medicaid Waiver Services who experience a loss of natural supports or a deterioration in health or behavior requiring additional supports to ensure their health and safety ($1,530,600); 2) the additional General Fund costs of children aging out of DCFS and DJJS custody who are receiving Medicaid Waiver Services through DSPD ($537,900); and 3) continue, and add to, the one-time transportation rate increase appropriated for FY 2015 ($357,700). The subcommittee may choose to agree with these uses or to use the funding in an alternate manner.
Nonlapsing Balance Transfer$0$475,000
OngoingOne-TimeFinancing Source
$0$475,000Beginning Nonlapsing
No Description
Portability - Transfer IN - DOH to DHS$1,146,900$0
OngoingOne-TimeFinancing Source
$340,400$0General Fund
$806,500$0Transfers - Medicaid
Transfer ongoing General Fund of $1,466,000 for portability and transition programs beginning in FY 2015 from the Department of Health's Medicaid Optional Services to the Department of Human Services' Division of Services for People with Disabilities. The clients associated with the funding have already transferred from Health to Human Services. This adjustment facilitates the funding following the person. Both the Department of Health and the Department of Human Services agree with this transfer.
Youth Aging Out of DCFS Custody$537,900$0
OngoingOne-TimeFinancing Source
$537,900$0General Fund
This request maintains youth with intellectual disabilities on the Medicaid waiver who are aging out of the Division of Child and Family Services (DCFS) custody. DCFS is currently providing the funding until a person reaches age 18 (sometimes up to age 22). This item was funded $455,200 one-time General Fund in 2014 General Session. The underlying dynamics of the program would require an ongoing funding to replace the one-time funding plus any estimate in growth (or decline) of the need. How Measure Success? "Percent of people who are satisfied with their staff, support coordinator, and fiscal agent."
Staff Analysis

Separate tables are shown under the tab labeled "Financials" in each COBI section. These tables provide information regarding: 1) funding sources (where the money comes from), 2) standardized state expenditure categories (where the money goes), and 3) agency sub-programs (when viewed at the line item level). For the most recent completed fiscal year, the following information represents the purposes for which the money was used:

Services for People with Disabilities Administration Detailed Purposes

DSPD Service Delivery Detailed Purposes

Utah State Developmental Center Detailed Purposes

DSPD Community Supports Waiver Detailed Purposes

Community Supports Waiver Expenditures by Category

DSPD Acquired Brain Injury Waiver Detailed Purposes

Acquired Brain Injury Waiver Expenditures by Category

DSPD Physical Disabilities Waiver Detailed Purposes

Physical Disabilities Waiver Expenditures by Category

DSPD Non-waiver Services Detailed Purposes

Non-waiver Services Expenditures by Category

In FY 2014 there were 176 community providers delivering services on behalf of the Division of Services for People with Disabilities. Of the 176, 40 providers delivered 89 percent of the total amount expended on these services as the following table shows.

DSPD Top 40 Community Providers

Issue Brief - 2014 Interim - Disabilities Waiting List and Needs Assessment Study

Issue Brief - 2014 Interim - Disabilities Transporation Service Study

DSPD Provider Rates Analysis

OLAG - A Performance Audit of the Division of Services for People with Disabilities

Performance measures can be found at the individual program level.

Statute

Utah Code Title 62A, chapters 5, 5a, 5b, and 6 describe the state's program of services for people with disabilities.

Chapter 5:

  • Part 1: Creation and duties of the division
  • Part 2: Utah State Developmental Center
  • Part 3: Admission to a facility for individuals with an intellectual disability
  • Part 4: Support to families for home-based services

Chapter 5a: Creates the Coordinating Council for Persons with Disabilities.

Chapter 5b: Sets out rights and privileges of a person with a disability.

Chapter 6: Deals with sterilization of a person with a disability.

In addition to state law, many functions provided by DSPD have provisions detailed in federal law. Those federal law references, where available, follow:

  • 42 USC 1396a-n: State Plans for Medical Assistance
  • 42 USC 1396r-3: Correction and Reduction plans for intermediate care facilities
  • 42 CFR 440.150: Intermediate Care Facility for the Mentally Retarded Services
  • 42 CFR 441.300 et. seq.: Home and Community Based Services - Waiver Reqs.
  • 42 CFR 442.15 et. Seq.: Provider Agreements
  • 42 CFR 483.440: Condition of Participation: Active Treatment Services

Intermediate Care Facilities for People with an Intellectual Disability (ICFs/ID)

The other system of providing Medicaid-supported services for individuals with disabilities is the mix of privately and publicly owned and operated ICFs/ID. Private institutions range in size from 12 beds to more than 80 beds. The ICF/ID system is funded through the Division of Medical and Healthcare Financing in the state Department of Health (Medicaid). The Utah State Developmental Center in American Fork, with a current population of 203 residents, is a state operated ICF/ID and is funded through DSPD. The ICF/ID system is approximately 70 percent financed with federal Medicaid funds. If qualified, patients have a right to be admitted to an ICF/ID. There cannot be a waiting list for ICF/ID services.

Home and Community-based Services (HCBS)

The state has also chosen to provide an alternative to the ICF/ID system, which is the Home and Community-based Services (HCBS) system. The HCBS system includes a range of services and supports for individuals in homes and apartments, including full residential placement arrangements located in community settings throughout the state. This system is also 70 percent funded by Medicaid as a result of being a Medicaid waiver program. Unlike ICFs/ID, this service is not an entitlement to eligible individuals, but can only be used to the extent that resources permit. Therefore, most states have waiting lists for services in their HCBS programs. The HCBS system is funded through the Division of Medical and Healthcare Financing of the state Department of Health which contracts with DSPD to operate certain of its HCBS waiver programs. This includes determining eligibility for services and serves as the gatekeeper for the HCBS systems. It is a Medicaid requirement that the health and safety service needs of individuals receiving services under the HCBS waiver be met. The Medicaid waiver requires a review of an individual's needs take place at least annually. Approximately 10 percent of individuals on the waiver are identified each year as having increased health and safety needs due to worsened conditions.

Waiting List for Home and Community Based Services

There are more eligible people desiring home and community-based services under the Medicaid waiver than there are resources available. This has caused a waiting list. This list has grown from 498 in 1990 to 1,930 in 2014. The number of people served since 1990 has grown from 1,989 to 4,964, which is a 149 percent increase.

Emergency Services

Each year, there are emergencies requiring immediate assistance from the division. A crisis may arise when persons with disabilities grow older and develop behavior problems or when natural caretakers become ill or die. A crisis may also arise in cases where individuals are committed to division services by the courts. Children aging out of state custody in the divisions of Child and Family Services (DCFS) and Juvenile Justice Services are also required to be served by DSPD. In FY 2014 the total number was 29. When these youth become adults they age out of DCFS custody and lose the funding previously provided for them as the funding stays with DCFS to pay for new children and youth with intellectual disabilities placed in state custody. As a condition of the federal waiver approval, Utah agrees not to drop current waiver recipients from service (State Medicaid Directors Letter -- Olmstead Update No. 4).

Portability between ICFs/ID and Home and Community-based Services

In 1998, legislation set in motion a process where individuals with developmental disabilities and/or intellectual disabilities who are receiving state services could move from institutional care (ICFs/ID) to Home and Community-based Services (HCBS), or the reverse. Since FY 2005, approximately 72 people have moved from the ICFs/ID system to services in the community. It was originally agreed that to facilitate these moves, state funds would also be transferred from the Department of Health, which funds ICFs/ID clients, to DSPD, which funds the community services program.

After several years of experience, it was observed that as individuals transferred out of ICFs/ID, new clients soon entered the system and filled the vacated beds. This added cost prevented the Department of Health from shifting any additional funds to DSPD for clients transferred to the community waiver services. Therefore, a moratorium was placed on further portability transfers in FY 2003. In FY 2005, the Legislature appropriated new funding for portability to the Department of Health which allowed for some individuals to transfer to community service. Since that time, additional appropriations to allow portability have been inconsistent.

The ICF/ID industry occupancy is consistently at 99 percent. UCA 26-18-503, Authorization to Renew, Transfer or increase Medicaid Certified Programs, authorizes the Medicaid director to consider how to add additional capacity to the long-term care delivery system to best meet the needs of Medicaid recipients. Over the years, Medicaid has managed service capacity for this population through a balanced approach of adding capacity to both facility based and community based services. For facility based services, a limited number of additional ICF/ID beds has been authorized. For community based services, a factor has been added to Medicaid's Case Load and Utilization line item to allow a limited number of individuals to transfer from ICFs/ID into the Community Supports Waiver.

Intent Language

SB0002: Item 83

The Legislature intends the Division of Services for People with Disabilities (DSPD) in the Department of Human Services provide to the Office of the Legislative Fiscal Analyst no later than September 1, 2015 a report that includes a(n): 1) response to each specific audit recommendation found in A Performance Audit of the Division of Services for People with Disabilities (October 2014 - Audit No. 2014 - 10), 2) identification of specific efficiencies gained by DSPD through implementing the audit's recommendations, 3) estimate of savings, if any, achieved through implementation of each recommendation, and 4) measures that demonstrate effective implementation of each recommendation. The Legislature further intends the Office of the Legislative Fiscal Analyst provide the report to the Office of the Legislative Auditor General (OLAG) and that OLAG review the report in order to assess: 1) if the measures accurately demonstrate effective implementation of the recommendations and 2) the accuracy of the savings estimates, if any. The Legislature further intends OLAG report its review of the DSPD report to the Social Services Appropriations Subcommittee.

SB0002: Item 83

The Legislature intends that for the building block titled "DSPD - Direct Care Staff Salary Increase," the Division of Services for People with Disabilities (DSPD) shall: 1) Direct funds to increase the salaries of direct care workers; 2) Increase only those rates which include a direct care service component, including respite; 3) Monitor providers to ensure that all funds appropriated are applied to direct care worker wages and that none of the funding goes to administrative functions or provider profits; 4) In conjunction with DSPD community providers, report to the Office of the Legislature Fiscal Analyst no later than September 1, 2015 regarding: 1) the implementation and status of increasing salaries for direct care workers, 2) a detailed explanation with supporting documentation of how DSPD providers are reimbursed, including all accounting codes used and the previous and current rates for each accounting code, and 3) a conceptual explanation of how DSPD community providers realize profit within the closed market of providing DSPD community services.

SB0003: Item 134

The Legislature intends that the $400,000 in Beginning Nonlapsing provided to respite care for individuals with disabilities in the Division of Services for People with Disabilities is dependent upon up to $400,000 funds not otherwise designated as nonlapsing to the Department of Human Services - Division of Substance Abuse and Mental Health line item being retained as nonlapsing in FY 2015.

SB0003: Item 134

The Legislature intends that the $75,000 in Beginning Nonlapsing provided to respite care for individuals with disabilities in the Division of Services for People with Disabilities is dependent upon up to $75,000 funds not otherwise designated as nonlapsing to the Department of Human Services - Executive Director Operations line item being retained as nonlapsing in FY 2015.

SB0007S01: Item 28

The Legislature intends that the Division of Services for People with Disabilities (DSPD) use Fiscal Year 2016 beginning non-lapsing funds to provide services for individuals needing emergency services, individuals needing additional waiver services, individuals who turn 18 years old and leave state custody from the Divisions of Child and Family services and Juvenile Justice Services, individuals court ordered into DSPD services and to provide increases to providers for direct care staff salaries. The legislature further intends DSPD report to the Office of Legislative Fiscal Analyst on the use of these non-lapsing funds.

SB0007S01: Item 28

The Legislature intends that the Department of Human Services report on the following performance measures for the Services for People with Disabilities line item: (1) Community Supports, Brain Injury, Physical Disability Waivers, Non-waiver Services - % providers meeting fiscal requirements of contract (Target = 100%), (2) Community Supports, Brain Injury, Physical Disability Waivers, Non-waiver Services - % providers meeting non-fiscal requirements of contracts (Target = 100%), and (3) People receive supports in employment settings rather than day programs (National ranking) (Target = #1 nationally) by January 1, 2016 to the Social Services Appropriations Subcommittee.

Medical and Health Care Financing - Medicaid

Utah's Medicaid agency is the Division of Medical and Healthcare Financing (DMHF) in the Department of Health. This agency coordinates with DSPD to establish rates and eligibility, prepare revisions and renewals of Utah's Home and Community-based Services (HCBS) waivers, process reimbursements for Medicaid funds, and train and monitor for compliance. DSPD administers three HCBS waivers: 1) Community Supports, 2) Acquired Brain Injury, and 3) Physical Disabilities. DMHF also contracts with and provides administrative oversight for private Intermediate Care Facilities for people with an Intellectual Disability (ICFs/ID).

Non-Lapsing Authority and Attrition

DSPD has nonlapsing authority to carry any unused funds from one fiscal year into the subsequent fiscal year. These funds can only be used for one-time expenditures unless otherwise authorized by the Legislature (UCA 62A-5-102(7)). Nonlapsing balances are often created because DSPD generates savings through attrition when individuals receiving services exit the program. Attrition can occur when an individual moves out of state or relocates into institutional care, the individual dies, or the individual no longer meets the eligibility requirements. The 2004 Legislature approved a plan to allow the use of nonlapsing funds to cover ongoing costs associated with emergency services and individuals who age out of foster care with the understanding that internal savings will generate the ongoing base funds needed to continue their services in future years. This authority has been annually reviewed and then renewed through adoption of intent language.

Utah State Developmental Center Land Fund -- Restricted Special Revenue Fund

In 1995, the Legislature created the Account for People with Disabilities (UCA 63A-5-220) and renamed the account the Utah State Developmental Center Land Fund in 2013. The fund consists of proceeds from the sale or lease of lands and facilities at the Utah State Developmental Center (USDC) located in American Fork. By statute, the department may only use interest earned on the fund itself. After approval by the division director in consultation with the department executive director, these funds may be used for the benefit of the Utah State Developmental Center and programs described in Title 62A, Chapter 5, which is the DSPD section of the code.

For analysis of current budget requests and discussion of issues related to this budget click here.

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COBI contains unaudited data as presented to the Legislature by state agencies at the time of publication. For audited financial data see the State of Utah's Comprehensive Annual Financial Reports.