Post on 13-Jan-2016
Residential Rate Proposals
Department of Medical Assistance Services
and
Department of Behavioral Health and Developmental Services
Interagency Workgroup
July 25, 2011
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Short-term Goals
Support smaller group homes Provide additional funding for individuals
with very high needs who are more challenging to serve in the community
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Rate Initiatives
Congregate Residential
– Increase rate for group homes with 4 beds or less
– Maintain rate for group homes with 5 beds or more
– Possibly lower rate for Sponsored Residential
New “exceptional” rate differential for Congregate and In-Home Residential
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Increase Rate for Group Homes of 4 Beds or Less
Group homes of 4-beds or less are more desirable, but may not be economically feasible
In 2007, DBHDS recommended 25% increase Assumption that group homes of 5 and 6 beds are
economically feasible at current rate 25% rate increase results in the same revenue as a fully
occupied 5-bed group home or 17% less revenue than a fully occupied 6-bed group home
Higher rate will incentivize smaller group homes– Only 42% of current group homes are licensed for 4-beds
or less– However, many more may be de-facto 4-bed group homes
because occupancy rate is only 66%
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Group Home Statistics
Bed Range Number of Group Homes
Licensed Beds
1-4 430 1,530
5-6 414 2,293
7 and more 185 1,596
Total 1,029 5,419
3,583 waiver individuals in group homes
66% occupancy rate
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Rate for Group Homes of 4 Beds or Less
Increase current Congregate Residential rate 10% to 25% for group homes of 4 beds or less– Assume all 5-bed group homes convert to 4-bed
group homes– Assume 50% of group homes with 6 beds or
more convert to 4-bed group homes– Assume all new group homes are 4 beds or less
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Sponsored Residential
820 waiver individuals in Sponsored Residential
Currently pay same rate as group home even though this model is not the same as the group home model
– DBHDS has evidence that this model is less expensive to operate
– Other states pay less for this model
Reduce Congregate Residential rate 10% to 25% for sponsored residential
– Do not want to disincentivize this model
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Exceptional Rate Differential
Assume that the number of authorized hours reflects to some extent the needs of a waiver individual
But a small percentage may need additional service– 3% - 5% of current waiver members and those on
waiting list– 15% - 20% of training center residents
Possibly two levels (assume very small number qualify for level two)
Available for Congregate Residential (4-beds or less), Sponsored Residential and In-Home Residential (ID and DD waiver)
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Number of Authorized Hours Varies by Need
Distribution of
Authorized Hours per Week
Percentile Sponsored Residential
Group Home In-Home
Residential
0-20 62 63 11
21-40 82 79 25
41-60 94 88 37
61-80 107 101 49
81-100 126 129 84
Average 94 92 41
Top Four Percent 140 151 119
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Percent Who Qualify for Exceptional Rate May Vary by Service
Residential Service Percent of Members with SIS Level 6
Sponsored Residential 12%
Group Home 9%
In-Home3%
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Fiscal Impact
Proposals are contingent on funding authorized in a budget amendment
Significant fiscal impact for existing waiver
Will add to the cost of new waiver slots Proposals could be phased in
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Fiscal Impact – Congregate Residential
Estimated cost increase for existing waiver population is $16.2 to $40.4 million ($8.1 million to $20.2 million in state funds)
Will increase the cost of new slots
– Waiting list population
– Training center population
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Fiscal Impact – Exceptional Rate Differential
Base rates to be determined
Criteria to qualify for the exceptional rate to be determined
Required services for the exceptional rate to be determined