Senate Appropriations hears DD budget briefing; department urges time if accreditation requirement removed

Tina Bay, director of the Developmental Disability section at the North Dakota Department of Health and Human Services, summarized budget changes and program priorities for the DD (developmental disability) system, told the Senate Appropriations — Human Resources Division during its hearing that accreditation is a core part of the state’s quality framework and asked for time to develop an alternative if the Legislature removes that requirement.

Bay said the DD system “costs over $810,000,000” and described accreditation as providing “an external unbiased third party review of policies, practices, and the experiences of those receiving services.” She asked the committee that, if Section 28 of Engrossed House Bill 1012 removes the accreditation requirement, the department be given time to develop another oversight approach.

The request matters because the department presented data showing a gap between provider self-assessments and accreditation findings: for one rights-protection measure providers rated themselves at 100% on evidence of practice while the accreditation reviewer, CQL, found 75% and the national benchmark was 54.3%; for policy-and-procedure compliance CQL reviewed 58.3% against a 43.8% national benchmark. Bay used those figures to argue that a third-party review adds objectivity to provider oversight.

Bay also described a case example to illustrate service pathways: a child identified as “Eve” who qualified for early intervention and DD waiver services but later regressed, prompting a regional team review of eligibility and options. That anecdote prefaced discussion of the department’s cross-disability work, which Bay said aims to expand access to home- and community-based services for children ages 3–21 with mild-to-moderate support needs.

On the cross-disability waiver, Bay said the state is seeking to design and test a new level of care and a service array tailored to children, including aligning eligibility for 3–5 year olds with Part B eligibility under the Individuals with Disabilities Education Act. The department listed an anticipated start date for service delivery under the new system of July 2028. Bay said, “We currently don't have this waiver. This is something we wanna move forward.”

Bay described planned changes to the DD level-of-care definition to include social functioning and to align with modern standards such as AIDD guidance, DSM‑5 and ICD‑11. She told senators that North Dakota’s current assessment focuses more on learning, self‑care and mobility and that the department wants a tool that better captures social functioning when determining eligibility.

Committee members questioned whether North Dakota Century Code changes were needed to broaden eligibility. Bay replied the issue is less the statute and more the assessment tool the state uses, noting that any new assessment would require CMS approval. She also warned of potential unintended consequences: the department plans to test any new tool to avoid creating eligibility losses.

The department addressed policy and budget items included in the executive and House versions of the bill. Bay said the DD admin and related programs show a general fund total of $403,484,000 (an increase of about $7,500,000 from the prior biennium, per the presentation). She also noted a $1,700,000 compensation package in the executive recommendation to cover ongoing employee compensation needs and health insurance cost increases. Bay reported that 95.2% of the DD section budget is passed through to private providers; 3.2% covers direct DD program manager services; 1.5% is administration; and 0.3% is IT.

On intermediate care facilities (ICFs), Bay explained a House proposal placing a moratorium on new ICF beds is intended to contain costs; she said the state currently has about 450 licensed ICF beds with utilization around 380–400 beds and that a moratorium would not reduce existing capacity but would limit growth. Bay said that if a moratorium remains, the department would inventory unused beds to ensure capacity where needed.

Donna Auckland, chief financial officer for DHHS, told the committee that Section 25 of the bill lists 12 carryover requests (many large, multiyear IT projects) and offered to supply itemized detail and follow up by email or in a subsequent hearing.

Bay also noted two DD-related bills the department listed as having budget impact: Senate Bill 2305, the family-paid caregiver pilot (listed at $7,300,000 general fund), and Senate Bill 2029, establishing an Office of Guardianship Council and transferring guardianship funds and certain corporate guardianship responsibilities to the Supreme Court (listed at $6,100,000 general fund). She said the House had left guardianship funding in the HHS budget pending final action.

To close, Bay summarized other work the DD section expects to pursue in the coming biennium: host homes, level-of-care redesign, cross-disability waiver design, system process redesign, and youth-oriented employment and day services developed with ARPA funding. She offered to return with more detail if the committee requests it.

Votes or formal committee actions were not recorded during the excerpted hearing; senators directed questions and requested follow-up information from staff.