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