power point conversion providermeeting 8.1.13
TRANSCRIPT
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Division of Disabilities and Rehabilitative ServicesAugust 1, 2013
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Discussion Items: FSSA/DDRS Priorities
Supervised Group Living Conversions- Where do we go
from here?
Health Care Coordination/Health Homes
Rate Methodology for BDDS Waiver Services
Assistance with Setting DDRS Goals
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FSSA/DDRS Priorities
Mission:
To develop, finance and compassionately administerprograms to provide healthcare and other social services to
Hoosiers in need in order to enable them to achieve
healthy, self-sufficient and productive lives.
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FSSA/DDRS PrioritiesVision:
To become a high performance, integrated andinterdependent agency, leveraging its resources across the
continuum of services we provide in order to reliably
and consistently serve our customers while acting as
astute stewards of the state and federal money provided tous.
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FSSA/DDRS Priorities
Core Values:
Integrity, trust, honesty and leadership
Dignity and respect shown to all people
Commitment to enabling people to achieve their fullest
potential
Quality care and measurable results
Responsible stewardship of tax dollars
Active promotion of partnerships with providers and the
community
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Supervised Group Living Conversions-
Where do we go from here?
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SGL in Indiana
Currently there are 522Intermediate Care Facilitiesfor persons with Intellectual Disabilities (ICF/ID, aka
Supervised Group Living (SGLs) in Indiana that serve
3,740 consumers
There are currently 14,826 consumers being served on
Home or Community Based Services (HCBS)
waivers.
There are currently 6,535 consumers served via the FamilySupports Waiver (FSW) and 8,291consumers served via the
Community Integration & Habilitation Waiver (CIH)
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Indiana SGL Cost and HCBS Waiver Cost Indiana Average SGL = $76,856 (ranks 48th)1
Indiana Average HCBS Waiver = $52,309 (ranks 23rd)2
1Residential Services for Persons with Developmental Disabilities Status and
Trends Through 2010, CEHD report
2 The State of the States in Developmental Disabilities 2013, Braddock report
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Balancing Incentives Program (BIP)Goal of Program:
To leverage the Balancing Incentives Program (BIP) to
expand the systems of home and community-based care
provided to Hoosiers with behavioral health needs,physical and/or intellectual disabilities.
The intent of the Indiana project is to realize the long-
term goal of increasing the percentage of expendituresfor long-term supports and services (LTSS) provided in
home and community-based settings.
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Supervised Group Living
Conversion AnalysisMilliman Report
This independent analysis provides an estimated fiscal
impact of converting the 459 SGL homes to HCBS
waiver homes:
1 Shelteredhome;
113 Intensive Training homes;
126 Developmental Training homes; and,
219 Basic Developmental homes.
The report compares the current facility cost to the
current cost for comparable waiver recipients.
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Milliman Report
Projected Annual Expenditures in statedollars for 3317 residents in 459 SGLs:
SGL Facility: $68,377,321
Projected Waiver Funded Homes: $83,116,738
The Milliman analysis indicates it will cost an
additional $14,739,417 in state funds annually, ifthe 459 SGLs facilities are converted to HCBSWaiver Funded Homes.
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Milliman Report
The $14,739,417 additional state funds is due to increasedservice cost:
Waiver services;
Medicaid state plan services;
Food stamps; and, The impact of the 6% loss of the provider tax that is
allowable on the SGL services, but not on the HCBS
waiver services.
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DDRS AnalysisConversion Cost as of July 1, 2013 SGL Cost vs. HCBS Cost
(Federal and State cost)
SGL Cost: The total annual Medicaid SGL reimbursement
rate for the 93 residents that resided in the 16 homes that
have converted was: $6,564,367
HCBS Cost: The total annual HCBS Medicaid Waiver
allocation for the same 93 individuals is: $7,155,277
Difference: $590,910 total annual increase$6,354 per person annual increase
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DDRS Analysis
Estimated increased cost if all SGLs licensed as Sheltered,
Intensive, Developmental Training and Basic Developmentalhomes convert to waiver Providers.
3,317 (APPROXIMATE NUMBER OF RESIDENTS)x $6,354 (AVERAGE ANNUAL INCREASED CONVERSION COST TO DATE)
$21,076,218 (TOTAL ESTIMATED ANNUAL CONVERSION COST: STATE & FEDERAL)
-$14,068,376 (LESS FEDERAL SHARE 0.6675)
$5,444,465 (ADDITIONAL COST IN STATE FUNDS)
Note: The increased cost does not include the cost associated with the lossof the 6% ICF/ID facility tax, additional Medicaid state plan services orthe conversion risk mitigation grants.
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Original Communication re: Conversions
The State is investing in small (ICF/ID, or otherwise
known as SGL) providers via grants to assist in theconversion of their group homes into Medicaid waiver
homes.
It has been communicated with providers that thisconversion is mandatory for all group homes (licensed
as Sheltered, Intensive Training , Developmental
Training, and Basic Developmental Training homes),
as the Rule that establishes ICF/IDs is scheduled tosunset (expire) in 2015. This would affect 3,317
consumers residing in 459 SGLs.
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Due to a number of concerns including:Appropriate placementsCurrently a structured group
home environment may be considered an appropriate
placement based on an individuals unique needs;
System CapacityIncluding but not limited to direct careand case management
CostThe projected cost increase will limit ability to
address the waiting list;
Alternative approaches were explored.
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Alternative Approaches
Alternative 1: Convert only Sheltered and Intensive SGLs;
Alternative 2: Convert only individuals with Algo levels
of 0 thru 3;
Alternative 3: Make conversions strictly voluntary;
Alternative 4: Change focus to Large Private ICF/IDs;
Alternative 5: Combination of Alternatives 3 and 4:
Voluntary SGL conversions;
Emphasis on individuals residing in SGLs beginning with those
who have lived there for over 5 years; and,
Emphasis on persons residing in Large Private ICF/ID.
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What Approach was Chosen?
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Alternative 5 and Next Steps
Discontinue the current mandatory conversion process;
Institute voluntarily conversions based on individual needs.
DDRS will work with providers using newly developed
guidelines;
Amend current CIH Waiver to add:
Slots for those that have already converted or intend to
convert; and,
Move forward with working with large private ICF/IDs
(North Willow/150, Arcadia/58 and Hickory Creek/64) to
determine which individuals would like to move;
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Next Steps
Utilize the same approach of interviewing consumers in
SGLs beginning with those who have lived there for over
5 years
Readopt ICF/ID licensure rule that is scheduled to sunsetin 2015
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Proposed Utilization of the BIP Funds
Utilize funds for any provider that wants to voluntarily convert
their SGL into a waiver setting.
Utilize funds to support increased budgets necessary for
consumers coming out of the large ICF/IDs during thetransition period.
Utilize funds to assist in increased staffing to complete the
interviewing of consumers in the large ICF/IDs and SGLs.
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This Step Cannot be Done in
Isolation..
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Health Care Coordination/Health Homes
How do we provide for the medical needs of our
consumers receiving wavier services?
Health Homes vs. Health Care Coordination
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Health Care CoordinationPrevious Definition:
Coordination of services to manage the health care and
medical needs of an individual regardless of the complexity
of the health need, including but not limited to:
1. Medical consults
2. Medications
3. Development and oversight of risk plans, if indicated
4. Utilization of needed supports
5. Maintenance of health records
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Moving Forward DDRS will be working with INARF, the health care
committee from the ARC of Indiana, and representatives
on behalf of families and consumers to gather input
regarding the reinstatement of Health Care Coordination
as a waiver service.
Anticipated application to CMS and implementation is
January 1, 2014.
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Rate Methodology for BDDS
Waiver ServicesDDRS will take an aggressive assessment of the current waiver
systems rate structure;Input will be obtained from the rate methodology group that INARF
has convenedInformation and research will be obtained through NASDDS as well as
other national organizations as to other States and their methodologies
A new Rate Structure wil l be proposed to CMS within 12months
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Current Rates: Waiver services that were reduced in 2010 will be increased by
1% with an anticipated date of January 1st. These rates werefor:
RHS 1 RHS 2
Respite Services
Facility Habilitation (Individual)
Community Habilitation (Individual)
FSSA recognizes the financial difficulties that all Providers haveencountered during this time and appreciate the partnership thathas been displayed.
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Assistance with Setting DDRS Goals
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Assistance with Setting DDRS Goals
DDRS is requesting feedback regarding the identification of
three main goals to be accomplished over the next 24 months
Items such as the following may be identified:
Vocational Rehabilitation Employment Rate Structure
Crisis Intervention
Case Management Improvement
Level of Care and Algo Methodology
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Assistance with Setting DDRS GoalsOnce Priorities are identified the following will be
completed:
Publically post the priorities with defined timelines fordevelopment andimplementation;
Develop a small workgroup and ask for assistance from INARF, and the Arc of
Indiana and other stakeholder groups with receiving feedback regarding progress on
goals and strategies for implementation;
Publically report progress so that accountability can be adhered to in meeting thedefined outcomes.
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Coming together is a beginning. Keeping together isprogress. Working together is successHenry Ford