300 likes | 449 Views
Disability Waiver Rate System. 2013 Odyssey Presentation. 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.
E N D
Disability Waiver Rate System 2013 Odyssey Presentation
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
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
Overview DWRS calculates rates using: • Rates Management System • Service-specific algorithms • Fixed component values • Information about recipient needs
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
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
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
Recap: 2012 Legislation • Defined service areas: • Residential • Day Program • Unit with Program • Unit without Program
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
Residential Methodologies • Enhanced Customized Living Tool • 24 Hour Customized Living • Customized Living • Residential Care Services • Product: price of daily unit
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
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
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
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.
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
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.
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
Recap: 2012 Legislation • Required projected spending for each service area equivalent to projected spending under current law
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
Recap: 2012 Legislation • Set implementation for January 1, 2014, with limited rate changes during a phase-in period
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
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
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
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
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
DWRS Questions ???
Resources • DWRS website • Article 13 of 2013 legislation • DSD Stakeholder E-list