Commissioners Reject Easterseals Adult Day 'Pay-for-Spot' Fee Change

Rockingham County commissioners voted on June 12 against a proposal to change Easterseals' adult day program from fee-for-service to a fee-for-spot billing model that would require payment for scheduled days regardless of attendance.

The proposal, presented during the board meeting by a representative identified as Sue from Easterseals, would have taken effect May 12 and required payment for reserved spots even if a participant did not attend. “We changed our rate structure from fee for service to fee for spot,” Sue told the board, adding that the provider had a 16–20% absentee rate and that staff and facility costs do not disappear when participants are absent.

The change was described by Sue as intended to stabilize staffing and program delivery. “If you don't show up for a medical appointment or you don't cancel within a certain amount of time, then you are charged for that fee,” she said, noting other programs and medical providers use similar policies and that Easterseals would exempt medical hospitalizations or rehab.

Some commissioners pushed back on the proposal. Commissioner Tom (surname unclear in the record) said he did not support the change and cited county funding already provided to the program. “I don't support it. If they don't come, that's not our problem,” he said. He reviewed county payments to similar providers and questioned the need to shift the billing policy for a program that he described as already well supported by the county.

Commissioner Gardeau (name rendered variously in the transcript) asked about the timing of cancellations and whether the program allows flexibility when families provide advance notice. Sue said families can notify the program, and staff will try to accommodate alternate days; she also said meal preorders and other program costs remain even with short notice.

A motion to approve the fee-structure change — described in the meeting record as “to approve a change in the fee structure for Easterseals adult day program effective 05/12/2025 from fee for service to fee for spot requiring payment for the days individuals are scheduled to be in the program regardless of attendance” — was made and voted. The roll-call in the transcript records at least three 'no' votes and the chair recording a 'no.' The motion did not carry.

Why it matters: The county provides financial support and placements for adult day services; a change that requires payment for reserved spots could shift more cost onto families and private-pay clients and affect program operations and staffing stability. Commissioners emphasized the county's role in balancing support for services with stewardship of public funds.

The record shows the board did not adopt any alternate directions or follow-up assignment on the item during the meeting. No additional written policy or contract change was recorded as approved.