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Table of Contents. 1.Executive Summary2.Overview of Current Waiver Day Services in MinnesotaFigure 2.1. Service Types and DefinitionsFigure 2.2. Populations ServedFigure 2.3. Types of Providers and Staffing Ratio OptionsFigure 2.4. Key Employees and Average Wages3.Licensed Provider CapacityFigure 3.1. Adult Day Care Capacity in Minnesota by CountyFigure 3.2. DT
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1. State of Minnesota Department of Human Services Disability Services Division Inventory of
Day Services and Supports
FINAL
June, 2008
2. Table of Contents 1. Executive Summary
2. Overview of Current Waiver Day Services in Minnesota
Figure 2.1. Service Types and Definitions
Figure 2.2. Populations Served
Figure 2.3. Types of Providers and Staffing Ratio Options
Figure 2.4. Key Employees and Average Wages
3. Licensed Provider Capacity
Figure 3.1. Adult Day Care Capacity in Minnesota by County
Figure 3.2. DT&H Capacity in Minnesota by County
Figure 3.3. Supported Employment Capacity in Minnesota by County
4. Day Service Utilization
Figure 4.1. Total Day Service Utilization in Minnesota SFY 2005
Figure 4.2. DD Waiver Utilization in Minnesota by County
Figure 4.3. CAC, CADI, TBI Waiver Utilization in Minnesota by County
Figure 4.4. DD Waiver Utilization in Minnesota, Data
Figure 4.5. CAC, CADI, TBI Waiver Utilization in Minnesota, Data
5. Budgeting and Rates
Figure 5.1 Total Day Services Expenditures in Minnesota SFY 2005
Figure 5.2. 2008 DD Aggregate Budget by County
Figure 5.3. 2008 CAC, CADI, TBI Aggregate Budget by County
Figure 5.4. Average DD Waiver Budget Amount per Participant by County
Figure 5.5. Average CAC, CADI, TBI Waiver Budget Amount per Participant by County
Figure 5.6. DD Waiver Aggregate Budget Amount and Budget per Participant
Figure 5.7. CAC, CADI, TBI Waiver Aggregate Budget Amount and Budget per Participant
Figure 5.8: 2008 Rates by Service Type
6. Sources Cited
3. 1. Executive Summary As a component of our project to assist the State of Minnesota’s
Disability Services Division (DSD) with the development of a new
payment structure for day services provided to people with
disabilities, Navigant Consulting conducted analysis and
prepared an inventory of existing services. The purpose of this
Inventory compilation is to:
Establish a baseline understanding of currently available day services under the State’s existing disability waivers, Medicaid State Plan, and ICF/MR Pass Through, and to understand which services will be impacted by the new day services payment structure.
Identify factors that may affect the development of the new payment structure, such as geographic variation in wage rates paid to employees that provide day services to waiver participants.
Understand the differences in day supports and services that are currently available in different regions and counties in the State, and identify regions/counties that have potential gaps in service offerings.
Understand the variation in the funding levels for individuals served in different regions and counties.
Provide information that will help the project team understand what additional types of services are needed in different parts of Minnesota.
4. 1. Executive Summary (cont’d) Below is an overview of some of the key findings detailed in this
Inventory compilation:
There are five (5) primary day service types in Minnesota: Adult Day Care, Day Training and Habilitation (DT&H), Pre-Vocational Habilitation, Structured Day Program, and Supported Employment.
Many Counties do not have any Adult Day Care capacity.
The vast majority of counties have DT&H capacity.
With regard to utilization by county, there are several county outliers (highest and lowest utilization as compared to the statewide average), which indicates an area for further study.
The many differences in the existing rates, ratesetting methodologies, and rate units across day service types, which indicate a need for increased uniformity and standardization.
There is significant variation in the average waiver funding amount per participant by county and by region, with the highest levels of funding per participant occurring outside of the more metropolitan areas of Minnesota, which have the highest total aggregated amount of waiver funding.
5. 2. Overview of Current Waiver Day Services in Minnesota This section of the Inventory provides a high-level summary of
day services currently available to DD, CAC, CADI and TBI
waiver participants, recipients of Medicaid State Plan and recipients
of ICF/MR Pass Through services.
Figure 2.1 defines Minnesota’s current day service offerings.
Figure 2.2 identifies populations served by Minnesota’s day services.
When reviewing Figures 2.1 and 2.2, it is important to note that the definitions for day services are not necessarily synonymous across all of Minnesota’s HCBS waiver programs, and that the Division is currently in the process of developing a Common Service Menu to make the service definitions consistent.
Figure 2.3 defines the service providers and staffing ratios currently used within each type of day service. Figure 2.3 shows that provider types and staffing ratios can vary significantly within each service type. It is our experience that variation among both provider type and staffing ratios can create significant variation in the costs to providers associated with service provision. This will be an important consideration as the new payment structure is developed.
Figure 2.4 shows the 2007 average hourly wage for direct care staff and case coordinators, which are among the most significant contributors to the costs associated with waiver day services. Figure 2.4 shows significant variation in hourly wage rates among Minnesota’s regions and counties, which may directly influence costs incurred by providers. This will be another important consideration in developing a new payment structure.
6. Figure 2.1: Service Types and Definitions
7. Figure 2.2: Populations Served
8. Figure 2.3: Types of Providers and Staffing Ratio Options
9. Figure 2.4: Key Employees and Average Wages
10. 3. Licensed Provider Capacity In this section of the Inventory, we present three color-coded maps of Minnesota that show, by county, the licensed capacity of Adult Day Care, DT&H and Supported Employment providers.
There was insufficient data to generate similar maps for the providers of the other two day service types, Pre-Vocational Services and Structured Day Program.
By preparing and reviewing these maps, we found:
Many Counties do not have any Adult Day Care service capacity, with most of the State’s Adult Day Care capacity concentrated in Region 11.
Only 4 Counties in the State do not have DT&H capacity.
Regions 1 and 2 are especially lacking in Supported Employment provider capacity.
11. Figure 3.1: Adult Day Care Provider Capacity in Minnesota by County
13. Figure 3.3: Supported Employment Provider Capacity in Minnesota by County
14. 4. Day Service Utilization In this section of the Inventory, we present utilization data for Minnesota’s State Plan services, waiver program services, and ICF/MR Pass Through services.
Figure 4.1 shows overall utilization in State Fiscal Year (SFY) 2005 for all day services in Minnesota. We then present waiver utilization data in two color-coded maps of Minnesota, Figures 4.2 and 4.3, which show DD waiver utilization in 2007 and CAC, CADI, and TBI waiver utilization in 2007, both by region and by county.
We also present two tables, Figures 4.4 and 4.5, that show the number of waiver participants served per 1,000 population, the total number of waiver participants, and the total population by county.
As a result of these analyses, we found:
All Counties have at least 8 DD waiver participants.
All Counties have at least 7 participants enrolled in the CAC, CADI and TBI waivers.
With regard to utilization by county, there are several county outliers (highest and lowest utilization as compared to the statewide average), which indicates an area for further consideration in the development of the new payment structure.
15. Figure 4.1: Total Day Service Utilization in SFY 2005
16. Figure 4.2: DD Waiver Utilization in Minnesota by County
18. Figure 4.4: DD Waiver Utilization in Minnesota by County, Data
19. Figure 4.4: DD Waiver Utilization in Minnesota by County, Data (cont’d)
20. Figure 4.4: DD Waiver Utilization in Minnesota by County, Data (cont’d)
21. Figure 4.4: DD Waiver Utilization in Minnesota by County, Data (cont’d)
22. Figure 4.5: CAC/CADI/TBI Waiver Utilization in Minnesota by County, Data
23. Figure 4.5: CAC/CADI/TBI Waiver Utilization in Minnesota by County, Data (cont’d)
24. Figure 4.5: CAC/CADI/TBI Waiver Utilization in Minnesota by County, Data (cont’d)
25. Figure 4.5: CAC/CADI/TBI Waiver Utilization in Minnesota by County, Data (cont’d)
26. 5. Budgeting and Rates This section of the Inventory provides detail on the allocated funds used to pay for day services in Minnesota.
Figure 6.1 shows a table of expenditures in SFY 2005 to pay for all day services in Minnesota, based on best available data. A series of color-coded maps, Figures 6.2 - 6.5, show the aggregate waiver budget and average budget amount per participant, by region and by county. Figures 6.6 and 6.7 show the data used to generate these maps in a table format. Finally, Figure 6.8 shows the 2008 rates for waiver day services.
The analyses in this section of the Inventory show that:
County Aggregate Budgets for the DD, CAC, CADI and TBI waivers are not proportional to the County’s respective waiver utilization rate, and the average budget per participant varies significantly by region and by county.
County average budgets per participant for the CAC, CADI and TBI waivers are significantly higher than the average budget per participant for the DD waiver.
The many differences in the existing rates, ratesetting methodologies, and rate units across day service types indicates a potential need for increased uniformity and standardization.
27. Figure 5.1: Total Day Services Expenditures in Minnesota SFY 2005
28. Figure 5.2: 2008 DD Aggregate Budget by County
29. Figure 5.3: 2008 CAC, CADI and TBI Aggregate Budget by County
30. Figure 5.4: Average DD Waiver Budget Amount per Participant by County
31. Figure 5.5: Average CAC, CADI and TBI Waiver Budget Amount per Participant by County
32. Figure 5.6: DD Waiver Aggregate Budget Amount and Budget per Participant
33. Figure 5.6: DD Waiver Aggregate Budget Amount and Budget per Participant (cont’d)
34. Figure 5.6: DD Waiver Aggregate Budget Amount and Budget per Participant (cont’d)
35. Figure 5.6: DD Waiver Aggregate Budget Amount and Budget per Participant (cont’d)
36. Figure 5.7: CAC, CADI and TBI Waiver Aggregate Budget Amount and Budget per Participant
37. Figure 5.7: CAC, CADI and TBI Waiver Aggregate Budget Amount and Budget per Participant (cont’d)
38. Figure 5.7: CAC, CADI and TBI Waiver Aggregate Budget Amount and Budget per Participant (cont’d)
39. Figure 5.7: CAC, CADI, and TBI Waiver Aggregate Budget Amount and Budget per Participant (cont’d)
40. Figure 5.8: 2008 Rates by Service Type
41. 6. Sources Cited “2007 DTH COLA Rates.” Courtesy of the Minnesota Disability Services Division.
"2008 Waiver Allowable Budgets." Courtesy of the Minnesota Disability Services Division.
“Annual Report on Home and Community-Based Services Waivers, CMS-372” for the CAC, CADI, TBI and DD Waivers. September 29, 2005. Courtesy of the Minnesota Disability Services Division.
“Continuing Care Matrix of Services to People with Disabilities.” FY 2005 Service Costs. www.dhs.state.mn.us/main/groups/disabilities/documents/pub/dhs_id_049281.pdf. Accessed May 2008.
“Licensing Lookup.” State of Minnesota, Department of Human Services, Licensing Division. http://www.dhs.state.mn.us/main/ idcplg?IdcService=GET_ DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_054422. Accessed March 2008.
42. 6. Sources Cited (Continued) “Minnesota Disability Services Program Manual.” State of Minnesota, Department of Human Services. www.dhs.state.mn. us/main/idcplg?IdcService=GET_ DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_000402 Accessed March 2008.
“Minnesota Statutes and Rules.” State of Minnesota, Office of the Revisor of Statutes. www.dhs.state.mn.us/main/idcplg? IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_000402. Accessed March 2008.
"Waiver Program HCPC Service Rate Limits Effective October 1, 2007.“ Courtesy of the Minnesota Disability Services Division.
Annual Report on the Use and Availability of Home and Community-Based Waivers for Persons with Disabilities. A Report to the Minnesota Legislature. February 2008. (Source data from MMIS-II Recipient file, Screenings and Paid Claims).
Murphy, Kathleen A., CCP. Murphy Management Consultants. “MHC and MNDACA 2007 Salary Survey.” May, 2007.
