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Transcript of 1 Division of Disability & Rehabilitative Services Andrew Ranck, Director of Initiatives OASIS...
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Division of Disability & Rehabilitative Services
Andrew Ranck, Director of Initiatives
OASISStatewide TourSpring 2008
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Agenda
• OASIS Forum list• OASIS –why it is happening• Activities to date – Rate Setting, Service
Planner reconciliation in District 4• What is coming – Day Program Rates• Best practices – what is this is• Resource Allocation Tool• Future – April, July benchmark dates• Q & A
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Date City Time Room Location
ThursdayMarch 20, 2008
Greencastle2:00pm – 4:00pmand 6:00-8:00pm
Pulliam Center for Contemporary Media
Watson Forum
DePauw University313 South Locust StreetGreencastle, IN 46135
TuesdayMarch 25, 2008
Merrillville2:00pm – 4:00pmand 6:00-8:00pm
Check in at Front DeskIndiana Wesleyan University
8415 Georgia St.Merrillville, IN 46410
WednesdayMarch 26, 2008
Fort Wayne2:00pm – 4:00pmand 6:00-8:00pm
Main Meeting RoomLower Level
League for the Blind & Disabled5821 S. Anthony Blvd.Fort Wayne, IN 46816
FridayMarch 28, 2008
South Bend2:00pm – 4:00pmand 6:00-8:00pm
Check in at Front DeskIvy Tech Community College
220 Dean Johnson Blvd.South Bend, IN 46601
WednesdayApril 2, 2008
New Albany2:00pm – 4:00pmand 6:00-8:00pm
Strassweg AuditoriumNew Albany Public Library
180 West Spring St.New Albany, IN 47150
ThursdayApril 3, 2008
Indianapolis2:00pm – 4:00pmand 6:00-8:00pm
Irvington BranchIrvington Public Library
5625 E. Washington St.Indianapolis, IN 46219
TuesdayApril 8, 2008
Evansville2:00pm – 4:00pmand 6:00-8:00pm
Red Bank Branch
Evansville Public LibraryRed Bank Branch
120 S Bank St.Evansville, IN 47712
ThursdayApril 10, 2008
Indianapolis2:00pm – 4:00pmand 6:00-8:00pm
Wayne BranchWayne Library Branch198 S. Girls School Rd.Indianapolis, IN 46224
* FridayApril 11, 2008
Richmond2:00pm – 4:00pmand 6:00-8:00pm
Check in at Front DeskIVY Tech College
2357 Chester BoulevardRichmond, IN 47374
OASIS Forums
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Objective
Assessment
System for
Individual
Supports
O-A-S-I-S:
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THE SITUATION Today
PEOPLE WITH SIMILAR NEEDS HAVE VARIED ACCESS TO SERVICES BECAUSE THE AMOUNT OF SERVICE YOU GET DEPENDS ON:
1. WHEN you requested service
2. HOW MUCH money was available
3. WHAT services were available
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The Future - OASIS
PRINCIPLES & VALUESPRINCIPLES & VALUES• Person - Centered Planning• Self - Directed Choice
FAIRNESS & EQUITYFAIRNESS & EQUITY• Refine Individual Resource Allocation process• Connect to Personal Outcomes• Connect to Provider Reimbursement
PREDICTABLE AND STABLE FUNDINGPREDICTABLE AND STABLE FUNDING• Balance quality, utilization, cost, and access
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Goal of OASIS
Create a uniform funding model to
determine fair and equitable levels of
State support based on an Objective
Assessment and driven by Person
Centered Planning (PCP) and
Individualized Support Plan (ISP)
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OASIS GoalsThe Funding Model:
Establish a standard model for allocation of the State’s resources whereby individuals with similar needs will be able to receive similar services/supports
Create a model that results in a specific annualized funding amount that is availableto the individual and their team for service planning purposes
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OASIS GoalsFunding Model (Continued):
Incorporate a funding mechanism for those individuals who are identified as “outliers”
Provide a consistent system that will support a network of provider agencies that is financially viable and able offer an array of relevant services
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OVERVIEW OF APPROACH
FIVE STEPSFIVE STEPS:
1. Collect Information- completedInformation- completed Build data & policy BASELINEBASELINE (3 months)
2. Figure out How MuchHow Much people need Build TOOLSTOOLS (3 months)
3. See if the TOOLS Make SenseMake Sense – in-progress – in-progress SHADOWSHADOW the Tools (6 months)
4. See if the TOOLS WORK – in-progress TOOLS WORK – in-progress PILOTPILOT rates and individual allocations (6 months)
5.5. IMPLEMENTIMPLEMENT (18 months) – July 1, 2008
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Pilot Rate ScheduleBDDS District 4
PPIILLOOTT
The following rates will be applied to agencies providing Home and Community-Based Services (HCBS) in the Bureau of Developmental Disabilities Services District 4.
The Rates will be effective on the following dates:
January 1, 2008:1. Residential Habilitation Support Services (RHSS)2. Adult Foster Care (all levels)3. Respite Care4. Behavior Management (single rate upon promulgation of administrative rule)
April 1, 2008:1. Day Habilitation2. Supported Employment (all tiers)3. All Other Therapies
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Rates Piloted in Jan. 2008
Service Type Unit Total Rate
Residential Habilitation Support Services (RHSS) Hour $23.74
Adult Foster Care (moderate supervision) I Day ($48.47) $51.87
Adult Foster Care (high supervision) II Day $75.67
Adult Foster Care (intensive supervision) III Day $102.87
Behavior Management Services (single rate after rule review) B-man II
15 Minute $20.32
Behavior Management Services (single rate prior to rule review) B-man II
15 Minute $18.20
Behavior Management Services (single rate prior to rule review) B-man I
15 Minute $18.20
Respite Care (all services) Hour $19.45
All Other Therapies No change No change
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RHSO Pilot Activity
January 2008 $3.3 million invoiced ( this is high due to
duplicate invoices being created)
$3.1 million paid in claims (80% of approved
CCB’s)
$3.8 million in approved CCB’s
Jan. 2007 paid approximately $3.3 million in
BDDS District 4
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Decisions to Date
Use of the Invoicing tool is mandatory
SSW participants will receive an ICAP, will not experience the OASIS model
DD & Autism Waiver participants will transition to OASIS at the time of their annual review beginning July 2008 (789)
All billing will be based on direct care staff hours
Nursing Respite will be available
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DDRS has determined that the Resource Determination Tool will generate an annual allocation amount and recommendations of service mix. The team will determine whether to follow the
recommendation
Waiver specialist will look for identification of day services in the plan
Service authorization for billing for RHSS & Day Services will be forwarded to EDS on a 3 month basis for pilot only. Other services (for example therapies, Respite) will receive longer authorization limits
Decisions to Date(Continued)
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Decisions to Date(Continued)
“Sleep Time” is not an approved waiver habilitation service. It cannot be billed as an RHS service
A recommendation has been made that an audit template is not required. DDRS will provide documentation requirements from CMS
Providers will have payroll records available for audit to support services billed
The Waiver program will not reimburse for sheltered work
Day Program PROVIDER RATES
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Day Habilitation Rate Day Habilitation Rate Assumptions Assumptions
Full Program Year: 260 daysConsumer Absence: 11 days / 4% factor Non-Allowable Expenses: building-related
expenses, workshop expenses, consumer wages, depreciation, fund raising expenses, production expenses
Direct Care Wages & Benefits: parity with RHSS
Supported Employment: 3 tiers (5 hours / 10 hours / 15 hours per month) & hourly rate after 15 hours per month
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What is in a Rate?
Cost Factor Day HabilitationResidential Habilitation
DCS WAGE $10.27 $10.27
Days-Upper Limit 260 365
Vacancy Factor 96% 96%
Billable Days Adjusted for Consumer Leave
249 350
ERE 38.8% 38.8%
PR 26.6% 27.7%
G&A 10% 10.0%
TOTAL RATE$23.26 facility
$23.74 community$23.74
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Rates to be piloted April 1 2008
Service Type Unit Total Rate
Day Service Program – Community (1:4 ratio for group) Hour $23.74
Day Service Program – Facility (1:8 ratio for group) Hour $23.26
Pre-voc 1:12 ratio Hour $23.26
Individual Supported Employment (individual full time) TIER 1 (1-5 hrs per month)
Month $175.95
Individual Supported Employment (individual full time)TIER #2 (6-10 hrs per month)
Month $351.90
Individual Supported Employment (individual full time)TIER #3 (11-15 hrs per month)
Month $527.85
Individual Supported Employment(Exception over 15 hrs per month)
Hour $35.19
Respite Nursing Care – will be available Quarter hour $7.79
Best Practices Group
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Key Points
PurposePurpose:: Establish a benchmark group to calibrate Establish a benchmark group to calibrate OASIS factorsOASIS factors
Process / Actions To DayProcess / Actions To Day:: 1. Collect pre / mid / post outcome data and verify2. Track amount of services planned and delivered
during pilot3. Develop benchmark service standards and
connect cost factors4. Apply service standards to District 4 consumer
plans5. Project impact
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Key Points
Future ActionsFuture Actions: : 1. Collect mid project outcome data with focus
groups and data collection tools – April 20082. Provide OASIS amounts and test validity /
variation – April 20083. Fine-tune benchmark service standards – June
20084. Finalize OASIS – July 20085. Continuing review and revisions – December
2009
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What are the Best Practice conditions?
Personal Health
Safety & Freedom from Harm
Stable Home
Sufficient Personal Finances
Satisfaction & Inclusion
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Comparative Data Comparative Data
1. The demographic characteristics of Best Practice consumers are similar to general District 4 consumers.
2. Best Practice and general District 4 consumers have similar ICAP scores
3. Best Practice consumers use less behavioral management services
4. Best Practice consumers use more RHSS and CHIO, and less Sheltered Workshop services
5. Slightly more Best Practice consumers live with their families (31% versus 27%)
6. Best Practice RHSS utilization has increased the OASIS benchmarks.
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Comparative DataComparative DataDistribution by WaiverDistribution by Waiver
Type of WaiverBest Practice Group
District 4 Consume
rs
Percent Sample
BPG distributi
on
District 4 distributi
on
DD Waiver Consumers
68 557 12.2% 70.8% 61.8%
SSW Consumers
26 302 8.6% 27.1% 33.5%
Autism Waiver Consumers
2 42 4.8% 2.1% 4.7%
TOTAL IPMG Plans
96 901 10.7% 100.0% 100.0%
Resource Allocation Tool
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COST DRIVER ASSUMPTIONS
• People use similar amounts of services in very different ways
• Determining how much paid staff support is needed is more important than why it is needed.
• People and families are the best predictors of the amount of service needed.
• Historical costs don’t always predict need.
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ICAP Assessment Information
Arbitre was hired as an independent party
to perform the assessments
Agreement to complete 4000 in first year
(2007) and 6000 in second year (2008)
4601 completed to date
All of BDDS District 4 completed prior to
start of pilot
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What will OASIS give the Consumer
1. Gives a view of typical costs and services for people
with similar needs
2. GUIDELINES for planning rather than ultimatums
3. Connected to BEST PRACTICES
4. Flexibility and choice within allocation
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OASIS Factors
• The primary predictors of cost for a consumer are: age, living situation (whether with family, alone or roommates), and Behavior intensity and frequency, employment.
• The additional predictors of cost for a consumer are: the ICAP scores, additional need for family support, visual impairment, and Health intensity and frequency
• The OASIS tool can predict 80% of our population.
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OASIS AllocationAssumptions
Any person approved for a waiver will receive at a minimum $13,500 up to a maximum of $173,300 for an annual allocation
Any person needing additional funds will be handled on a case by case basis.
The team will work to establish the plan and determine how to best utilize the allocation amount.
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Interactive Budget Tool
Web Based Interactive Budget Tool
Provides a private secure, place for resource planning
Available for all stakeholders
All team members can use for planning pre/post annual date
Available for consumer and advocate testing April 17th & 18th 2008
Working with the ARC of Indiana to establish “BETA” Groups (up to 40 participants)
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Future Activities
Day Service Rates- Rollout on 3/24/08 & POC/CCB pilot 4/1/08
Multiple providers will be allowed on the POC/CCB
Direct linkage of the Invoicing tool to EDS
DDRS is exploring pay for performance for providers
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OASIS-ICAP
Help Lines:
317-234-5222
1-888-527-0008
OASIS Website:
http://davisdeshaies.com/page10.html
Resources: