Power Point Conversion ProviderMeeting 8.1.13

7/27/2019 Power Point Conversion ProviderMeeting 8.1.13

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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


14/31

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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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

Power Point Conversion ProviderMeeting 8.1.13

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