Division of Disabilities and Rehabilitative Services
August 1, 2013
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
FSSA/DDRS Priorities
Mission:
To develop, finance and compassionately administer programs to provide healthcare and other social services to Hoosiers in need in order to enable them to achieve healthy, self-sufficient and productive lives.
FSSA/DDRS Priorities
Vision:
To become a high performance, integrated and interdependent 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 to us.
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
Supervised Group Living ConversionsWhere do we go from here?
SGL in Indiana
Currently there are 522 Intermediate Care Facilities
for 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 Family
Supports Waiver (FSW) and 8,291consumers served via the Community Integration & Habilitation Waiver (CIH)
Indiana SGL Cost and HCBS Waiver Cost
Indiana Average SGL = $76,856 (ranks 48th)
1
Indiana Average HCBS Waiver = $52,309 (ranks 23rd)
Residential Services for Persons with Developmental Disabilities Status and Trends Through 2010, CEHD report
1 2
The State of the States in Developmental Disabilities 2013, Braddock report
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 longterm goal of increasing the percentage of expenditures for long-term supports and services (LTSS) provided in home and community-based settings.
Supervised Group Living Conversion Analysis Milliman Report
This independent analysis provides an estimated fiscal impact of converting the 459 SGL homes to HCBS waiver homes:
1 Sheltered home; 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.
Milliman Report
Projected Annual Expenditures in state dollars 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, if the 459 SGLs facilities are converted to HCBS Waiver Funded Homes.
Milliman Report
The $14,739,417 additional state funds is due to increased service 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.
DDRS Analysis
Conversion 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
DDRS Analysis
Estimated increased cost if all SGLs licensed as Sheltered, Intensive, Developmental Training and Basic Developmental homes convert to waiver Providers.
3,317 x $6,354 $21,076,218 -$14,068,376 $5,444,465 (ADDITIONAL COST IN STATE FUNDS)
(LESS FEDERAL SHARE 0.6675)
(APPROXIMATE NUMBER OF RESIDENTS) (AVERAGE ANNUAL INCREASED CONVERSION COST TO DATE)
(TOTAL ESTIMATED ANNUAL CONVERSION COST: STATE & FEDERAL)
Note: The increased cost does not include the cost associated with the loss of the 6% ICF/ID facility tax, additional Medicaid state plan services or the conversion risk mitigation grants.
Original Communication re: Conversions
The State is investing in small (ICF/ID, or otherwise known as SGL) providers via grants to assist in the conversion of their group homes into Medicaid waiver homes.
It has been communicated with providers that this conversion 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 to sunset (expire) in 2015. This would affect 3,317 consumers residing in 459 SGLs.
Due to a number of concerns including: Appropriate placements Currently a structured group home environment may be considered an appropriate placement based on an individuals unique needs; System Capacity Including but not limited to direct care and case management Cost The projected cost increase will limit ability to address the waiting list; Alternative approaches were explored.
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.
What Approach was Chosen?
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;
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 sunset
in 2015
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 the transition period.
Utilize funds to assist in increased staffing to complete the
interviewing of consumers in the large ICF/IDs and SGLs.
This Step Cannot be Done in Isolation..
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
Health Care Coordination
Previous 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. 2. 3. 4. 5.
Medical consults Medications Development and oversight of risk plans, if indicated Utilization of needed supports Maintenance of health records
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.
Rate Methodology for BDDS Waiver Services
DDRS will take an aggressive assessment of the current waiver
systems rate structure;
Input
will be obtained from the rate methodology group that INARF has convened Information and research will be obtained through NASDDS as well as other national organizations as to other States and their methodologies
A new Rate Structure will be proposed to CMS within 12
months
Current Rates:
Waiver services that were reduced in 2010 will be increased by
1% with an anticipated date of January 1st. These rates were for:
RHS 1 RHS 2 Respite Services Facility Habilitation (Individual) Community Habilitation (Individual)
FSSA recognizes the financial difficulties that all Providers have encountered during this time and appreciate the partnership that has been displayed.
Assistance with Setting DDRS Goals
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
Assistance with Setting DDRS Goals
Once Priorities are identified the following will be
completed:
Publically post the priorities with defined timelines for development and
implementation; 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 the defined outcomes.
Coming together is a beginning. Keeping together is progress. Working together is success
Henry Ford
