To say that a lot has changed in the IDD industry over the last two years would be massive understatement. There were pandemic-related shutdowns and reopenings, COVID-related rate changes, vaccine rollouts, and nationwide launch of EVV — to name a few.
So, what can we expect for the industry in the coming year? While no one has a crystal ball, we are constantly reading the latest research, attending conferences, and talking to our clients to find out what’s happening in the field. These are the trends that stand out:
One positive thing to come out of the pandemic is the shift to remote services. These remote services not only give individuals and their families more ways to access support, but also allow providers to reach a wider service area.
Even as the return to in-person continues, many providers will keep offering at least some services remotely in 2022. However, the extent to which they are able to offer these services will depend largely on the rates in their state or county. Some states, such as California, will allow providers to continue alternative services at their current rates. Others may decide to allow remote services to continue — but at a lower rate and higher ratio.
Meanwhile, states that scrap remote services altogether will likely be met with pushback from individuals, families, and providers who felt that these types of services were working well for them.
If other industries are any indication, DSP staffing shortages aren’t going to improve in 2022. From nursing homes to fast food restaurants, employers nationwide are struggling with a labor market where there are 20% more jobs than unemployed workers.
In the IDD industry specifically, our recent DSP staffing crisis survey shows that 80% of agencies expect the staffing crisis to stay the same or get worse in the coming year. Knowing this, employee retention should be a top priority for agencies in 2022. Ensuring that your current DSPs are happy, that they’ve been given sufficient training, and that your organization is a great place to work, all contribute to the strength of your culture and the loyalty of your employees.
The COVID-19 vaccine rollout has happened faster than expected, with all American adults now eligible for a shot. In turn, some states and facilities are requiring employees to get vaccinated before returning to work. However, some disability service providers worry that vaccine mandates will further exacerbate turnover in an industry already suffering from staffing shortages.
In other settings that have already adopted vaccine mandates, such as hospitals, resignations and staffing shortages haven’t been as bad as anticipated. In North Carolina, for example, just 16 state healthcare workers — less than 0.2% — were fired for their refusal to comply with the state’s vaccine directive.
Likewise, only 34 New York City police officers out of about 35,000 were placed on unpaid leave when the city’s vaccine deadline passed — far less than the 10,000 resignations predicted by police unions. We’re hopeful that the same will hold true for the disability services industry.
After numerous delays, the EVV requirement for personal care services went into effect in most states in 2021. Providers have spent the past year trying to figure out how to clock in and out, correct timesheet errors, and submit data to their EVV aggregator. And as states and providers continue to work out the bugs, we expect it’s still going to be chaos nationwide in 2022.
Some states will continue their EVV rollouts in the coming year. For example, South Carolina recently extended EVV to personal care services provided through the Community Support (CS), Head and Spinal Cord Injury (HASCI) and Intellectual Disability and Related Disabilities (ID/RD) waivers as of November 2021.
Other states will launch new EVV systems or change the way they collect and report EVV data. Alabama, for instance, will switch from a state-mandated external vendor to an open vendor model in January 2022.
Another bright spot in 2022 is the potential for rate increases. For example, we know that Illinois, Kansas, Maryland, Minnesota, New Jersey, Ohio, Oregon and Virginia are all increasing reimbursement rates for certain services or keeping COVID-related rate increases in place in FY2022.
It’s not clear whether this shift is happening in response to DSP workforce issues, leftover CARE funds from the pandemic, or something else. In any case, raising service rates would help support higher wages for DSPs and bring desperately needed relief to agencies hit hard by the pandemic.
Of course, we know that these types of increases won’t be across the board, and in fact some states may see decreases — but we’ll keep our fingers crossed that this is a step in the right direction.
We could also see an uptick in mergers and acquisitions (M&A) in the coming year, with larger IDD organizations absorbing smaller organizations or smaller organizations combining to be a larger entity.
Of course, M&A isn’t exactly a new trend. M&A advisory firm VERTESS notes that “IDD is a large industry ($30 billion of annual spend) that has been going through significant consolidation over the past 10 years.”
Several factors will drive M&A activity in 2022. For one, remote services and EVV are accelerating deals as many organizations see the need for more modern electronic recordkeeping systems. Likewise, the shift to managed care could drive consolidation as agencies feel the need to be larger so they can demonstrate outcomes to the MCO and handle the changes that come with that.
This isn’t necessarily a bad thing, though. By combining their resources, smaller agencies will be able to reach more people with IDD in the community.
One solution that will help providers rise to the challenge in 2022 is the use of digital tools. Specifically, we expect to see more providers adopting IDD software platforms that enable them to streamline service delivery, reduce errors, and improve reporting — freeing up more time and resources to serve more people.
Some providers had already begun this process before the pandemic hit. Organizations that were already paperless were in a better position when COVID-19 closed offices. On the flip side, organizations without paper files and outdated legacy systems struggled with the transition.
Now, having seen this disparity first-hand, many software projects that got pushed to the back burner during the pandemic will be back on. EVV mandates and the shift to MCOs will also drive digitization as providers grapple with how best to collect service data and report on outcomes.
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