Level Building Models for DD Waiver-SIS Assessment Based Reimbursement

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

2. Early models have simple rules but revolutionary concepts

3. Rittenhouse Orrery’s mechanical model of the solar system built in 1771

4. Solar system for the classroom London teaching aide from 1850’s

5. 2008 Model of the Solar System Now 8 planets, 166 moons, and 3 dwarf planets

6. Such models lead to the possibility of a bigger picture

7. Developed model of our invested culture - stealth fighter 3 years of continuous supercomputer time in the 1970’s producing the “flawed diamond design”

8. Leads to new models Mach 6 S1-91 Aurora reconnaissance plane

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

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

11. HSRI Level and Rate Methodology

12. 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

13. 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

14. 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

15. HSRI Customers Include:

16. State SIS Comprehensive Adult Waiver Results

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

18. 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

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

21. 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 Fits Individual SIS results from Louisiana Fits Individual SIS results from Oregon

22. 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

23. Ad eundum quo nemo ante iit