Oh, Nina Bernstein!
When the welfare reform bill became law in 1997, Carlton Palms was nearly ten years old. It had opened under the premise it would serve 20 to 30 students, as reported at the time by the Lake Sentinel. By 1990, Carlton Palms was serving 48 clients from 28 states. In 1997, the company, rechristened Advoserv, cared for 120 children and adults in Delaware, New Jersey, and Florida. At its height in 2015, Advoserv would house more than 700 severely disabled children and adults.
In the late 1990's Au Clair rechristened itself Advoserv. The "new" company began to carefully tread waters in Florida, a full five years ahead of their efforts to stymie reform in Delaware.
During the following decade, a series of bills were passed in the U.S. Congress following the welfare reform bill that had opened the floodgates of funding for state and federal funding for-profit facilities.
- In 2000, Congress funded the new Developmental Disabilities Act and Bill of Rights Act, creating 1) State Councils on Developmental Disabilities 2) Codified Protection and Advocacy systems 3) Developed University Centers for Excellence in Developmental Disabilities in each state and territory, funding a total of 67 UCEDDs, and 4) Projects of National Significance(PNS).
- In 2004, U.S. Congress began affirming new and re-affirming older legislation designed to protect citizens with disabilities. The Individuals with Disabilities Education Act and the Assistive Technology Act were addressed.
- However, 2006 was a banner year for those with disabilities. By years end, the U.S. Congress had re-authorized the Individuals with Disabilities Education Act, the Family Opportunity Act, Improving Long-term Care under Medicaid, Money Follows the Person Rebalancing Demonstration, Lifespan Respite Care Act, Combating Autism Act, and the National Institutes of Health Reform Act.
An unusual event occurred in 2003, perhaps this could have been the first crack in the foundation for Carlton Palms. The State of Florida temporarily cut-off a lucrative voucher funding stream to 21 private schools. Each had failed to submit proper paperwork for various Education Department tuition-voucher programs. Carlton Palms found itself on this list. The affected schools were given to December 15, 2003 to make corrections and resubmit applications. Facilities that failed to comply would not receive their Feb. 2004 voucher payment. -
However, Carlton Palms rebounded tenfold.
Florida began adjusting policies to comply with the new federal mandates and allowances. In 2006, the "legislature statutorily created the Comprehensive Transitional Education Program (CTEP) to serve individuals primarily, though not limited to those with developmental disabilities, who have severe or moderate maladaptive behaviors." - http://disabilityrightsflorida.org/documents/Carlton_Palms_Report_3-5-18.pdf
The intention of the bill was to provide services that were required to be temporary and delivered with the primary goal of achieving principles of self-determination and person-centered planning. The plan was to transition clients to the most appropriate, least restrictive community living program of their choice. That final program of choice could not be operated as a comprehensive transitional education program. CTEP was banned from being the long-term solution. -https://www.flsenate.gov/Laws/Statutes/2018/393.18
Yet, many who entered CTEP appear to have never left. The only facility in Florida to benefit was Advoserv and its reputation was less than steller. Lobbyists went back to the Florida legislature repeatedly over the next ten years to revise the legislation - winning more beds, more tiers, and more people living together than had been typically allowed nor considered best practices. With the revisions also came higher Medicaid payments for residents compared to other programs in the state. Money funneled into Advoserv's vast campus', but it's unclear who if anyone funneled out. HIPPA.
No. That's not true. There are six known victims of Advoserv, aka Bellwether Behavioral Health. We know they left because they trickled out by ambulance. This may or may not be an exhaustive list. Given the way records were kept fifty years ago, there may or may not be other victims like John Doe 1998. A resident of Delaware's Au Clair/Advoserv/Bellwether, John Doe died in 1998 after reportedly having seizures. Aside from Delaware's News Journal citing an ambo call and a later correction, efforts to identify John Doe have yet to yield a result. To date, Echo has identified six Bellwether-related deaths, Bellwether legacies:
- Paige Lunsford (Florida),
- William James Lamson (Florida),
- Jon Hensley (Florida),
- John Doe 1998 (Delaware),
- Janaia Barnhart (Delaware),
- Susan Osborne (New Jersey)…
How did Bellwether manage to have a monopoly in CTEP beds? Heather Vogell of ProPublica unearthed a small caveat imbedded in Florida law. From 2006 to 2015, Bellwether's special status was protected by carefully worded legislation that required the state to contract only with facilities that had obtained their license(s) prior to 1989. Carlton Palms fit that bill with flourish where few other facilities had roots as deep as 1989.
Instead of needing to prove it offered the highest quality care in the most cost-effective way, Carlton Palms continued to get the state's business automatically. The only way the state could have stopped doing business with Carlton Palms would have been for public officials to prove the facility had broken state laws or regulations. - Heather Vogell, ProPublica via Tampa Bay Times.
Bellwether began to feel the winds blowing in a new direction. By 2010, an alarming letter penned by Carlton Palms Director Thomas P. Shea found its way to the parents of his residents. Shea opined:
“Both the Florida House and Senate in their efforts to reduce next year’s budget have proposed to reduce the budget by placing a cap for reimbursement for Tier One intensive behavior services for the coming year. The proposed cap is so far below what one could reasonably expect to provide professional, safe, humane, clinical and educational services that we will not be able to serve you and [your child] as of the end of June.” “… We are now at the point of no return for our program’s survival.”
Despite years of lucrative Medicaid payments, the possibility of caps unnerved Shea. He implored families to sign a petition, attend legislative hearings, and seek out their elected officials to plead on Bellwether's behalf. Legislators received a flurry of "Dear Fellow Floridians" like this one:
It's not surprisingly that Echo has been unable to locate a public follow-up presser from Carlton Palms regarding the final word on Tier I funding. Yet, it seems the strategy prevailed. The Quarterly Report on Agency Services to Floridians with Developmental Disabilities and Their Costs , First Quarter Fiscal Year 2011/12 (July, August, September) submitted November 2011 shows Tier 1 as having no cap whereas Tiers 2-4 were capped at varying amounts.
Again, Carlton Palms escaped unscathed.
Next: Cartlon Palms, The Final Decade
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