Disability Waiver Rate System

1. Disability Waiver Rate System 2013 Odyssey Presentation

2. Learning Objectives • Understand the Disability Waiver Rate System in a comprehensive manner: • Goals • Methodologies and values, noting changes made in the 2013 Legislative session • Implementation plan • Research and refinement plan

3. Overview DWRS is designed to: • Create statewide rate methodologies to ensure state’s ongoing participation in federal programs • Provide a rational architecture for the calculation of service rates • Establish rates that: • Are equitable, consistent, and transparent • Allow choice and portability for consumers • Reflect individualized nature of service • Promote quality

4. Overview DWRS calculates rates using: • Rates Management System • Service-specific algorithms • Fixed component values • Information about recipient needs

5. Rates Management System • Web-based software application securely accessed by lead agencies • Gathers data points specific to the provision of service for an individual • Data provided by service providers, approved and entered by lead agencies • Plugs information into algorithms populated with component values and produces a unit rate to be used in authorizing services in MMIS

6. Universal Component Values • Direct staff: wages, span of control, vacation/sick/training, customization • Employee-related: taxes & workers comp, other benefits • Client Program & Support • Program Plan Support • Program-related expenses tab: standard G&A, program-related support, utilization and absence factors

7. Service-Specific Component Values • Annual transportation amount for residential frameworks • Facility use factor for day services • Meal, snacks, and bath for Adult Day Care • One-way transportation for DT&H • Room and board for overnight respite in a facility

8. Recap: 2012 Legislation • Defined service areas: • Residential • Day Program • Unit with Program • Unit without Program

9. Service Areas

10. Residential Methodologies • Framework choices: Residential Support Services • corporate or family • Fields for entry: • Shared staff hours per week • Awake or asleep • Shared or individual • Direct or remote • Individual direct nursing hours per week • RN or LPN • Customization option • Product: price of daily unit

11. Residential Methodologies • Enhanced Customized Living Tool • 24 Hour Customized Living • Customized Living • Residential Care Services • Product: price of daily unit

12. Day Methodologies • Framework choices and products: • Price of 15 minute unit: • Day Training & Habilitation • Adult Day Care • Structured Day Program • Day Transportation (one way trip) • Price of 1 hour: Prevocational Services • DT&H, ADC, and SDP can be billed at a daily unit at 6 hours or more

13. Day Methodologies • Fields for entry: • Staffing ratio • Individual direct nursing hours per week • RN or LPN • Customization option • One way transportation shared and individual: does the vehicle have a life, is a lift required, number of one-way miles • For Adult Day Care: number of meals and snacks provided

14. Unit With Program Methodologies • Framework choices: • Behavior Support Services: Specialist, Analyst, Professional • Housing Access Coordination • In Home Family Support • Independent Living Skills Training • Supported Employment • Supported Living Service • Fields for entry: customization option • Product: price of 15 minute unit

15. Unit Methodologies: Shared Services • Independent Living Skills Training • 1:1 is the preferred ratio • 1:2 will be allowed when all of the following are true: • The service recipients are roommates or family members. • The goals and learning styles of the service recipients are congruent. • The service recipients choose the shared provision of ILS.

16. Unit Methodologies: Shared Services • Supported Employment • 1:1 is the preferred ratio • 1:2 or 1:3 will be allowed when all of the following are true: • The goals and learning styles of all service recipients are congruent. • The service recipients choose the shared provision of Supported Employment. • Supported Employment provided at a ratio greater than 1:3 should be considered Prevocational Services or DT&H

17. Unit Methodologies: Shared Services • Services may not be shared if a service recipient has health and safety needs that impact the delivery of the service to other individuals, nor if a service recipient’s conduct presents a risk of physical harm to self or others. • Full units will be authorized and billed at a rate divided among the service recipients, indicated with a HCPCS modifier specifying ratio.

18. Unit Without Program Methodologies • Framework choices: • Night Supervision • Personal Support • Adult Companion Care • Respite • Fields for entry: • Customization option • Respite room and board • Product: price of 15 minute unit

19. Recap: 2012 Legislation • Required projected spending for each service area equivalent to projected spending under current law

20. 2013 Legislation: Budget Neutrality • The final step of each framework is: • Multiply total by the Budget Neutrality Factor (BNF) • Residential: 1.003 • Day: 1.000 • Unit with Program: 0.941 • Unit without Program: 0.796

21. Pricing Non-framework Services

22. Recap: 2012 Legislation • Set implementation for January 1, 2014, with limited rate changes during a phase-in period

23. 2013 Legislation: Banding

24. 2013 Legislation: Banding Refines duration and value of banding: • 0.5% change for 2014 • An additional 0.5% change for 2015 • An additional 1.0% change for 2016 • An additional 1.0% change for 2017 • An additional 1.0% change for 2017 • Unbanded RMS rates by 2018

25. 2013 Legislation: Implementation • Rolling implementation • On January 1, 2014, all new service authorizations must use the DWRS • Beginning January 1, 2014, all renewing service authorizations must use the DWRS as reassessment and reauthorization occurs • By December 31, 2014, all disability waiver rates must be set by the DWRS

26. 2013 Legislation: Exceptions • Criteria: • Service needs of an individual can’t be met through increasing a quantity of the service • The DWRS rate results in a provider discharging an individual • Process: • Lead agencies submit request to DHS • If the denial of an exception request results in a proposed demission, the commissioner shall issue a stay until the lead agency provides informed choice of appropriate alternative services to the individual

27. 2013 Legislation: Research • Analysis of impact of DWRS at the individual, provider, lead agency, and state levels • Evaluation of the values associated with a list of 15 topics, including: • Transportation • Facility use rate • Employee-related expenses • Evaluate component adjustments to replace the BNF

28. 2013 Legislation: Reporting and Refinement • Reports to legislature in 2015, 2016, 2017, 2019, 2023, and every four years after • If estimated spending using DWRS rates differs by 0.3% or more from estimated spending under the rates in effect on July 1, 2013, the commissioner, with MMB, will adjust the BNF to ensure budget neutrality

29. DWRS Questions ???

30. Resources • DWRS website • Article 13 of 2013 legislation • DSD Stakeholder E-list