04/18/2025
To Whom Concern,
I am writing on behalf of a billing company that has been actively processing DDD-related claims since 2018. Over the years, we have observed significant issues in the administration and management of funding, provider recruitment, and claims support that are adversely affecting not only the service quality for members but also the fiscal sustainability of the programs.
Budgetary Constraints and Enrollment Policies
It has come to our attention that DDD funds are rapidly approaching depletion due to extended budgets that are being strained by several factors. One critical issue is the acceptance of all members, including those relocating from other states. While inclusiveness is essential, this policy inadvertently overburdens the current fiscal framework. Typically, other states implement a waitlist system designed to protect funding allocations. Introducing a similar waitlist for the fiscal year would help align the available budget with the needs of the enrolled members, ensuring more sustainable operations.
Provider Training and Operational Standards
Another area of concern is the standard of care provided by parent providers. Currently, these providers are not universally required to undergo rigorous training or pass home inspections. Furthermore, there is an expectation among parents that these companies provide additional benefits such as vacation time and worker’s compensation. In instances where service complexity necessitates additional oversight, it is advisable for members to be placed in group homes staffed by professionals specially trained to deliver appropriate care. This approach not only enhances the quality of care but also mitigates operational inconsistencies that currently contribute to financial inefficiencies.
Insurance Rate Assignments and Staffing Matrix
There is an observable discrepancy in the rate assignment for members by insurance companies. The existing matrix often assigns higher rates to members with lower needs while under-compensating those requiring more intensive support. I have mock schedules that illustrate these discrepancies. Improving the pairing of members with the appropriate level of service and integrating a modifier system for rate assignments would ensure that funds are allocated in a manner that more accurately reflects the care needs of everyone. Additionally, while increasing the number of staff in homes might seem like a solution, it can overwhelm both the members and the operational workflow. Enhanced training programs aimed at preventing fraud, waste, and abuse should be prioritized.
Claims Support and Post-COVID Staffing Shortages
Significant delays in the claims process have been reported and are impacting on both service providers and members. Despite the critical nature of this support infrastructure, additional staff have not been hired since the onset of the COVID-19 pandemic. Moreover, the absence of enhanced support from systems such as Wellsky further compounds the challenges faced by providers. Smaller providers are under significant stress, to the extent that many are being forced out of the market, despite the demand for services being more than sufficient to support a diverse range of organizations.
Conclusion and Call to Action
As a billing company with extensive experience in processing DDD claims, we are deeply invested in ensuring the long-term viability and effectiveness of these programs. We respectfully urge DDD leadership, the Governor’s office, and policymakers to consider the following actions:
Implement a waitlist system to better align fiscal resources with service demand.
Establish mandatory training and inspection protocols for all provider types.
Reevaluate the staffing and rate-assignment matrix to ensure accurate cost recovery based on member needs.
Reinforce and expand the claims support infrastructure to address post-pandemic staffing shortages and operational delays.
We are prepared to provide additional data, including mock schedules and detailed analyses, to support these recommendations. A collaborative effort in addressing these challenges will help ensure that the DDD programs continue to serve Arizona’s residents effectively, without compromise to service quality or fiscal responsibility.
Thank you for your time and attention to these pressing matters. I look forward to your prompt response and to the opportunity to work together toward sustainable solutions for all stakeholders.
Sincerely,
Enclosures:
Data Analysis Summary
Mock Scheduling Documentation (available upon request)
