Transcript Disability Waiver Rate System

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
Service Areas
Adult Day Care-Day
Behavior Support
RSS-Corporate Basic
Adult Day Care-15 min
Companion Services
RSS-Corporate Intensive/SLS
DT&H-Day
Housing Access Coordination RSS-Family Basic
DT&H-15 min
In Home Family Support
Prevocational services-Day
ILS Training
Prevocational services-Hour
Night Supervision
Structured Day-Day
Personal Support
Structured Day-15 min
Respite
One Way Trip
Supported Employment
SLS (not corp, adult, 15 min)
RSS-Family Intensive/SLS
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
Pricing Non-framework Services
Market Price
Predetermined Rate
24 Hour Emergency
Assistance and Personal
Emergency Response
System
Specialist Services
Adult Day Bath
Assistive Technology
Specialized Supplies
and Equipment
Chore
Family/Caregiver
Counseling and
Education
Transitional Supports
Homemaker
Live-in Caregiver
Expenses
Community
Transportation
Home Delivered Meals
Modifications and
Adaptations
Crisis Respite and
Respite in a Hospital or
Nursing Facility
Recap: 2012 Legislation
• Set implementation for January 1,
2014, with limited rate changes
during a phase-in period
2013 Legislation: Banding
BANDING
residential
day
day pilot
unit
existing recipient with no individual reimbursement rate for individual reimbursement rate
changes
a recipient in effect on 12/1/2013 for a recipient in effect on
12/1/2013
individual
individual reimbursement
reimbursement rate for rate for a recipient in effect
a recipient in effect on on 12/1/2013
12/1/2013
new service recipient and Rate Management System
existing provider
weighted average authorized
rate for each provider # in the
county of service effective
12/1/2013
authorized rate for the
provider in the county of
service effective
12/1/2013
weighted average
authorized rate for each
provider # in the county of
service effective
12/1/2013
existing recipient
changing to an existing
provider
weighted average authorized
rate for each provider # in the
county of service effective
12/1/2013
authorized rate for the
provider in the county of
service effective
12/1/2013
weighted average
authorized rate for each
provider # in the county of
service effective
12/1/2013
Rate Management System
Rate Management
System
Rate Management System
set by lead agency using their
respective methodology for
residential services
new or existing recipient Rate Management System
and new provider
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