OASIS : District 4 forums

1. Indiana Department of Family and Social Services Administration OASIS:District 4 forums Davis Deshaies LLC

2. What’s the PROBLEM? PEOPLE WITH SIMILAR NEEDS HAVE VARIED ACCESS TO SERVICES BECAUSE THE AMOUNT OF SERVICE YOU GET DEPENDS ON: • WHEN you requested service • HOW MUCH money was available • WHATservices were available

3. What’s the SOLUTION? FAIRNESS & EQUITY • Refine Individual Resource Allocation process • Connect to Provider Reimbursement & Outcomes PRINCIPLES & VALUES • Person - Centered Planning • Self - Directed Choice PREDICTABLE AND STABLE FUNDING • Balance quality, utilization, cost, and access

4. APPROACH Design an INDIVIDUAL RESOURCE ALLOCATION system Determine FAIR PROVIDER REIMBURSEMENT RATES Connect both to PERSONAL & SYSTEM OUTCOMES Assure QUALITY

5. Overview of Approach FIVE STEPS: • Collect Information • Build data & policy BASELINE (3 months) • Figure out HowMuch people need • Define BEST PRACTICES(3 months) • See if the BEST PRACTICESMake Sense • SHADOWin District 4 (6 months) • See ifOASIS WORKS • PILOT rates and individual allocations (6 months) • IMPLEMENT(18 months)

6. Implementation Schedule for OASIS Implementation Complete Determine Best Practice & Cost Drivers Determine Standard Price for Service TASKS Connect Best Practice to Cost Drivers Shadow Test In District 4 Pilot OASIS in District 4 Implement OASIS Statewide 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd3rd 4th 2007 Quarters 2008 Quarters 2009 Quarters

7. OASIS - BIG PICTURE

8. Step 1 Determine Individual Cost Guidelines Step 3 Test for Fairness $ All of the Parts Step 4 Apply Standard Rates Step 5 Utilization Review if Needed Step 2 Plan, Cost Out & Budget Step 6 Select Provider & Implement Plan Appropriate services and supports at a fair rate Step 7 Measure personal outcomes

9. Building the OASIS Allocation Individual Needs Assessment Standard Rate Market Analysis Cost Per Unit of Service Number of Units of Service Cost Drivers (age, life events) OASIS Allocation X X =

10. OASIS: The Pieces

11. Assumptions • People use similar amounts of services in very different ways • Determining how much paid staff support is needed is more importantthan why it is needed. • People and families are the best predictors of the amount of service needed. • Historical costs don’t always predict need.

12. WHAT DOES OASIS GIVE YOU?(Objective Assessment System for Individual Supports) • SINGLE ANNUAL AMOUNT:Total for Year • RANGE: Gives a view of typical costs and services for people with similar needs • GUIDELINES for planning rather than ultimatums • Connected toBEST PRACTICES

13. What INDIANA Cost Drivers will be CONSIDERED? Other States found: • Primary Cost Drivers: • Age • Family Living Situation • Work Situation • Life Events • Geography & Transportation • Secondary Cost Factors: • Functional Abilities • Behavior & Health Supports • Needs Assessments do not predict cost for OUTLIER consumers Indiana Work Group potential factors: • Other Factors (natural supports, employment, forensic and behavioral health issues)

14. What’s the BOTTOM Line? • How OLD are you? • Where do you LIVE? • With WHOM do you LIVE? • Any Significant Life Events? • How’s your HEALTH & BEHAVIOR?

15. What are the PREDICTIVE LIMITS of OASIS? UPPER LIMIT • People who need full-time 1:1 direct care support or more on a 24 hour / 7 day per week basis • People who have court-ordered care LOWER LIMIT • People who require less than $(?) per year of supports • People who require only support coordination

16. SHADOW & PILOT TEST

17. How Should We TEST our IDEAS? Statistical Validation • Face • Content • Construct • Convergent / Criteria Focus Groups • Frequent consumer / family discussions • Frequent provider / case manager discussions Best Practice Groups • Consumer Outcomes • Provider Outcomes • Case Management Outcomes Test & Refine • Simulate with People, Families, Providers, Case Managers

18. What are BEST PRACTICES? • Health & Wellness • Safety & Freedom from Harm • Stable Home • Sufficient Personal Income • Satisfaction & Inclusion

19. Key Tasks – Pilot Phases • SHADOW(July ’07 to December ’07) • Compare current rates and allocations to proposed • “What would happen IF” • TEST(January ’08 to June ‘08) • Best Practices consumer group • Sample of Providers • Phased IMPLEMENTATION(July ’08 to Dec ’09) • By District • Constant modification and adjustment • Evaluate & MODIFY(On-going)

20. People in the Pilot • Receive Individual Resource Allocations • Using Person-Centered Planning, build an Individual Budget Plan and Key Personal Outcomes • Receive technical assistance as needed from Pilot Team • Select provider and Case Manager initiates individual’s budget. • Participate in Outcome Study

21. Providers in the Pilot • Receive Business Development Assistance • Market Analysis • Cash Flow Management • Human Resource Management • Strategic Planning • Receive Technical Assistance on Implementing Self-Directed Supports • Choice & Empowerment

22. PROVIDER RATE SETTING

23. What DO People BUY? • People purchase staff time • Personal Support • Training & Guidance • Therapies & Nursing • People purchase transportation • People purchase housing • People purchase equipment

24. Why does Indiana need NEW RATES? CMS Requires “Transparency” • Must be able to measure by “unit of service” • Must differentiate between services • Must reflect Individual Consumer need • Reward success CMS Requires “Standardization” • Consumer Portability • Public Transparency Historically negotiated Rates • Dependent upon timing & funds available • Advocacy Driven Public financing is not able to keep up with Provider Costs

25. What should rates ACCOMPLISH? Pay a FAIR PRICE for FAIR WORK • Create stable provider network • Attract and retain qualified staff • Encourage research & development • Reward success Connect to OASIS Allocations • Consumer Portability • Public Transparency Guarantee Quality Services • Consumer Outcomes • Provider Outcomes • Case Management Outcomes Other Reasons

26. How much VARIATION in the RATE FACTORS? Geographical factorscan vary up to 30% between communities in Indiana • Wages & Unemployment • Housing & Cost of Living • Available Skilled Labor Force • Competing Employers Transportation costsare influenced by diverse factors: • Urban density • Rural remote access

27. What are STANDARD RATES? • Rates are the AMOUNT OF MONEY PER UNIT OF SERVICE which is paid to a PROVIDER • The RATE AMOUNT is based upon STANDARDIZED COSTS for • Wages and Salaries • Employee-related Expenses such as BENEFITS & Paid Time Off • Program Indirect Costs such as supervision, materials, utilities • General & Administrative Costs • A PROVIDER may SPEND FUNDS DIFFERENTLY than the RATE ASSUMPTIONS.

28. Rate Building APPROACH • Examine Direct Care Staff Salaries • Compute Employee - Related Expenses / Benefit Costs • Survey Program - Related / Clinical Supervision Costs • Establish General & Administrative Costs

29. Rate Building APPROACH (continued) • Wage Parity across all services and employer type. • Employee-Related Expenses are reflecting actual Workers’ Compensation, FICA experience, and geographical differences. • Program-Related Costs have the highest variability. • General and Administrative Costs will be established by policy.