THE DDPA APPROACH TO PAYMENT REFORM

1. THE DDPA APPROACH TO PAYMENT REFORM Better Care, Equity in Services, Fairness for Providers David Ivers DDPA Annual Spring Conference May 22, 2012

2. DDPA’s ROLE“How it all works” • Data • Research • Meetings and more meetings • Committees and Subcommittees • Negotiations • All under auspices of DDPA Board & Exec Committee

3. DDPA PRIORITIES ▪ Prospective payment instead of retrospective reconciliation ▪ Get rid of 15-minute units and go to daily or monthly rate ▪ No risk sharing across providers ▪ No subcontracting requirement ▪ Preserve licensed nonprofit community providers per 20-48-101 et seq. ▪ Allow for DD Health Homes to coordinate care instead of medical home ▪ Create a broader, more flexible DDTCS service package ▪ Retain entitlement status for enhanced DDTCS ▪ Integrate all DD care plans and licensure requirements ▪ Minimize administrative burdens (focus on outcomes not process) ▪ Use assessment to ensure resource allocations are based on actual need

4. DDPA PRIORITIES (continued) ▪ Use assessment that is tailored to DD ▪ Do not require full assessment every year ▪ Pilot first & phase-in implementation ▪ Revise income eligibility requirements ▪ Obtain meaningful data ▪ Behavioral health services ▪ Adequate Rates ▪ Consider “Community First Choice” option under ACA ▪ Big Picture: Reduce inequality in amount of services and reduce waiting list

5. Payment for episode • Prospectively Bundled Payment Vs. • Retrospective Reconciliation with risk

6. Accountable for Episode“Single Point of Accountability” • DD Lead Provider vs. • Principle Accountable Provider (PAP)

7. Basic Data • Total Medicaid Budget (2012): $4.7 Billion • DD Services (2012): ~ $600 Million

8. Basic Data -- Waiver Slots • Waiver Slots (2012): 4,100 • Waiver Waiting List (2012): 2,127

10. DD BreakoutSFY 2010

11. DD BreakoutSFY 2010

12. Recap: This initiative aims to address three opportunities DD service episode Expenditures impacted by health home Initial phase: Adult DD clients1 7,020 • Includes DD clients ages 18+ receiving HDC, ICF, Waiver and/or DDTCS services. Excludes 180 clients ages 18-20 receiving outpatient therapy only and excludes 13 clients receiving DDTCS transportation but not receiving DDTCS services • Includes medical and behavioral spend, personal care, in-patient, out-patient, pharmacy, dental, hospice and non-emergency transportation. Does not include third party liability or state hospital expenditures SOURCE: Medicaid claims data for claims incurred in SFY 2010

13. DD Health Homes • Separate payment from episode • In form of PMPM (Per Member Per Month) • Likely require use of co-ops or some other sharing of resources • Separate quality measures • Full benefit dependent upon HIT

14. Community First Choice Option (ACA § 2401 – Adds § 1915(k) to SSA) Under consideration by DHS “Home-and-community-based attendant services and supports” Increased Federal match of 6%. No expiration. Statewide, no cap or waiting list. Cannot discriminate based on age or type of disability or form of services/supports required. Must meet institutional LOC

15. For more information visit: DDPA web site at http://www.arkansasddpa.org/ medicaidreform.htm “Arkansas Healthcare Improvement Initiative” at http://humanservices.arkansas.gov/ director/Pages/APII.aspx