Advocates say Iowa unwilling to bolster nursing services

DES MOINES - The leader of an advocacy group seeking to bolster services for nursing facility residents with mental illness and intellectual disabilities said her agency filed a complaint with federal officials after other attempts to get better results from Iowa officials proved fruitless.

'I think there was just a basic unwillingness to deal with this issue,” said Jane Hudson, executive director of Disability Rights Iowa (DRI), a federally funded organization that advocates for Iowans with disabilities or mental illness. 'We felt like we were kind of at the end of our attempts to try to resolve things.”

Hudson said her nonprofit group's two-year probe of nursing facilities found evidence the state was violating three federal laws in failing to adequately evaluate, deliver and oversee needed services to about 550 Iowans with mental illness and intellectual disabilities in some of Iowa's 430 nursing facilities.

On Wednesday, DRI officials filed an administrative complaint with the federal Centers for Medicaid and Medicare Services, alleging the state has illegally shifted to nursing facilities its federal obligation to arrange or provide specialized services for seniors with mental illness, intellectual disabilities or related conditions.

The DRI complaint also contends the state has been 'fundamentally indifferent” to creating an effective oversight system to ensure that nursing facility residents with these conditions are receiving the critical services they need to improve and maintain their functioning, reduce their dependence on anti-psychotic medications and transition into community settings where appropriate.

The complaint brought against Gov. Terry Branstad, Charles Palmer, director of the Iowa Department of Human Services, and Julie Lovelady, DHS acting administrator of the Iowa Medicaid Enterprise, requests federal assistance and intervention in ordering the state to take corrective action to remedy the alleged violations in administering federally funded programs.

In response to the DRI complaint, Branstad spokesman Jimmy Centers issued a statement saying 'Gov. Branstad is committed to ensuring Iowans in nursing facilities receive the care they are entitled to and need. Gov. Branstad will ensure that DHS follows the law and works in the best interests of Iowans.”

DHS spokeswoman Amy Lorentzen McCoy said her agency shares the same goal with DRI to ensure nursing facility residents get the mental health and disabilities services they need in the least-restrictive setting possible, but may have differences on who delivers them and how they're delivered.

In fiscal 2013, Ascend - a DHS contractor and nationally recognized leader in Preadmission Screening and Resident Review (PASRR) program compliance - performed over 35,000 initial screenings of nursing facility residents, McCoy said, with less than 5 percent resulting in further evaluation. About 600 evaluations that were completed led to recommendations for specialized services.

The PASRR Technical Assistance Center rated Iowa at 100 percent comprehensive in 2012 and 2013, McCoy noted. Also, the department has a new quality assurance process which went into effect Wednesday whereby nursing facilities will submit 100 percent of plans of care for specialized services for compliance review and the state will continue its annual on-site quality reviews of all Medicaid-certified facilities, she added.

'We feel like we're making great efforts to put the PASSR requirements in place,” McCoy said.

Hudson said the DRI complaint includes examples of how four unidentified Iowans who gave DRI officials consent to review their records have been harmed by the state's failure to comply with federal guidelines to screen patients' needs and to provide specialized services directly or arrange for their provision. The four 'exemplars” represent 'only the tip of the iceberg,” according to the complaint.

'The state has dumped its responsibilities on nursing facilities to provide services to these folks and they're often provided by unqualified professionals,” Hudson said in an interview.

During discussions with state officials, Hudson said DRI advocates were 'shocked” when told the state's position was it has no legal obligation to provide effective services 'even though the state's pulling down millions of dollars in Medicaid and Medicare funds.” She also said efforts last legislative session to get $50,000 in state funding to conduct a pilot study at five facilities to identify problems and begin to develop an oversight system received no DHS support.

McCoy said her agency supported the governor's proposed budget and that item was not included in it.