Level Building Models for DD Waiver-SIS Assessment Based Reimbursement

1. Level Building Models for DD Waiver-SIS Assessment Based Reimbursement May 2008

2. Why do states pick the Supports Intensity Scale? • National norms – buying the bell shaped curve • Great for writing waiver service plans with individual, families, and providers • Captures support needs hence some of the natural supports that save state dollars • Considers both behavioral and medical challenges • Has potential for helping shape waiver individual budgets and/or reimbursement levels

3. HSRI is designing the financial architecture for entire state DD/ID comprehensive waiver service systems

4. HCBS waiver reimbursement is not rocket science. It is a lot harder. Gary Smith

5. HSRI Level and Rate Models Offer • HSRI’s history of exploration of assessment, quality enhancement, National Core Indicators, & individual budgets • Work led by Gary Smith, John Agosta, Mady Kimmich, Val Bradley, Sarah Taub, Giuseppina Chiri, & Drew Smith • Open architecture in reimbursement modeling • Ability to help states in Medicaid (CMS) distress • Stakeholder and advocate involvement

6. HSRI Level and Rate Models Offer • Design built on the assessed support needs of people served informed by provider cost and waiver expenditure • Ability to partner with established waiver rate setters • Potential to handle needs for long term maintenance, repair, enhancement, & simulation • Ability to help when historical expended dollars and support needs of a state’s waiver system do not line up

7. HSRI Level and Rate Methodology

8. Strategic Planning Process Developing Individual Budgets In Relation to Service Payment Rates Review Findings in Relation to Policy Goals Collect Information on Individuals Assign Individuals to Assessment Levels Collect Data  Consider Potential Implementation Issues Set Policy Goals Compile the Collected Information System Set Individual Budget Allocations in Relation to Rates Engage Stakeholders Plan for Implementation Implement New Practices Choose Assessment Measure Set Levels & IBAs   Prepare  Implement

9. HSRI Customers Include:

10. State SIS Comprehensive Adult Waiver Results

11. State SIS Support Adult Support Waiver* Results http://aspe.hhs.gov/daltcp/reports/2007/gaugingfr.htm

13. Georgia is working with SIS assessment based reimbursement for 2 new waivers • Virginiahas a prototype waiver level called the Virginia System • Nebraskacompares ICAP and SIS results collected by a highly trained cadre of state case managers • Oregon uses a federally funded five year assessment, budget, and rate transformation grant (ReBAR) to change the comprehensive waiver rate system • Louisiana has one of the best SIS training programs and has collected 1,000 SIS results and will collect 3,000 more individual results for their NOW waiver • Colorado is using SIS results for reimbursement level and rate building for their comprehensive waiver and has started with their support waiver

14. Individual Budgets, Levels/Tiers & Rate Building: Opportunities Application & roll out challenges Maintenance Collected datasets Enhancements and fixes Recession and downturns

15. Development of State Models • Colorado Level Model • Virginia System Prototype • Oregon ReBAR Level Model • Georgia Individual Budgets Human Service Research Institute’s SIS reimbursement configurations work in a variety of states and support each other Fits Individual SIS results from Louisiana Fits Individual SIS results from Oregon

16. May lead to possible system changing partners and future data exchanges: Individual State Waiver Quality Assurance Contracts http://www.hsri.org/nci/ http://www.hsri.org/index.asp?id=gary

17. Ad eundum quo nemo ante iit