SJI and DUII Utilization Review

1. SJI and DUII Utilization Review December 1, 2009

2. How are we doing in SFY ’10? • The Client Limits implemented in July of 2009 have successfully managed short-term residential and detoxification lengths of stay • Nonetheless, residential service expenditures (short-term and detox) have continued to rise • Increased number of clients receiving residential services • Increased average cost per client

3. SJI FY 2009 DATA REVIEW 61% of SFY 09 Expenditures were for residential Treatment

4. SJI FY 2010 DATA REVIEW 78% of First Quarter SFY 2010 SJI Expenditures were for residential Treatment

5. Comparison SJIFY 09 and FY 10 Quarter 1 Outpatient

6. Comparison SJIFY 09 and FY 10 Quarter 1 Residential

7. Comparison SJIAdolescent and Adult Expenditures FY 09

8. Sustainability of the SJI in SFY 2010 • If residential service utilization (client volume and cost per client) continues at the current rate, SJI funds will be fully expended before the end of the fiscal year • Action is required now to continue access throughout the year • Expended 1.1 million in first quarter of SFY ’10 • Obligated 593,000 for first two months of the second quarter • Current rate of expenditure is $400,000 per month. • By December there will only be enough funds to spend $140,000 per month

9. DUII FY 2009 DATA REVIEW 64.6% of SFY 09 DUII Expenditures were for residential Treatment

10. DUII FY 2010 DATA REVIEW 70% of First Quarter SFY 2010 DUII Expenditures were for residential Treatment

11. Comparison DUIIFY 09 and FY 10 Quarter 1 Outpatient

12. Comparison DUIIFY 09 and FY 10 Quarter 1 Residential

13. DUII Initiative Spending • The average monthly expenditure required to remain within budget is $593,000 • Currently DUII spending at a monthly rate of $501,000 • Action not required immediately. If rate of spending increases action will be needed to continue access throughout the year • Residential expenditures continue to be an increasingly larger portion of funding

14. GOAL for moving forward • Our goal is to implement clinically sound and fiscally responsible utilization management guidelines that will ensure continued client access to resources throughout the year

15. Utilization Management Options • Limit Length of stay • Cap # of clients by month • Cap $ expended monthly • Cap providers expenditures • Cap services by treatment modality • Require all clients to be assessed by outpatient provider before being referred to residential services • Set aside for adolescents

16. Options South Jersey County Directors discussed for SJI • Limit length of stay • Cap Funding Monthly • Require all clients to be assessed by outpatient provider before residential • Set aside funds for adolescent

17. Utilization Options discussed at Stakeholder Meeting 12/1/09 • Cap residential services • Suboxone ambulatory detox integrated with residential tx to avoid residential detox costs • SJI fund MD visit for the Suboxone detox • Narrowing network of the SJI to southern providers only • Dual or Flexible Licensure at Provider agencies to allow for more fluid movement between levels of care • Track and make decisions based upon client dx • Change the age of eligibility for SJI thereby decreasing the number of clients eligible • Develop a set aside for Adolescent treatment

18. Options from 12/1/09 cont. • Assess clients at outpatient provider before any residential stay (exclude emergency detox) • Ensure that DYFS funds are used before SJI funds • Further limit length of stay guidelines • Approval of extensions to LOS in smaller increments • Use mechanisms that are more specific in the short term to keep spending within the yearly budget(s) • Cap by month • No new clients • Provider caps • Caps by level of care • Start charging co-pays (DAS to explore the fees in FFS) • Change fiscal income eligibility for clients

19. Input on Next Steps • Short Term – December 2009-June 2010 • Long Term