State Rates Advisory Committee: Children’s & Transportation Rate Update April 2006 State of...
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Transcript of State Rates Advisory Committee: Children’s & Transportation Rate Update April 2006 State of...
State Rates Advisory Committee:
Children’s & Transportation Rate Update
April 2006
State of MontanaHelena, Montana
Davis Deshaies, LLC
3
CURRENT CHILDREN’S SYSTEM
1. Single Blended Rate
2. Family Cost Plan
3. Managed Care: provider assumed risk
4
NATIONAL TRENDS
1. Transparent / unbundled rates
2. Increased family control & choice of providers and services
3. Limited Provider ROI
4. Focus on integration with other federal funding sources (e.g. CWS, DVR, schools, Headstart, No Child Left Behind, TANF, Medicaid State Plan services)
5. Increased emphasis on children with select diagnoses (e.g. autism, dual diagnoses)
6. Seamless transition from school to adulthood
5
CURRENT MENU OF CHILDREN SERVICES
ServiceService Percent of Children Percent of Children receiving Servicereceiving Service
Percent of DDP Funds Percent of DDP Funds spent on Servicespent on Service
Family Support Specialist
100% 42%
Residential Habilitation (Non-facility based)
80.1% 24.9%
Respite 90.9% 22.4%Day Habilitation 14.8% 0.1% (except: 7.2%)
Therapies / Homemaker
9.7% 0.1% (except: 8.0%)
Transportation 32.5% 0.1%Environmental Mods. / Equipment
30.2% 4.7%
6
Family Support Specialist StudyFamily Support Specialist Study
Davis Deshaies, LLC
TASK Sample 1 Sample 2 Difference
Assessment/ Information 10.44% 12.65% 2.21%
Travel 11.50% 12.66% 1.16%
Education/ Training 15.80% 17.73% 1.93%
IFSP Development 25.04% 21.55% -3.49%
Habilitation 3.71% 3.96% 0.25%
Personnel Recruitment/ Supervision
5.08% 3.81% -1.27%
Support Coordination 11.61% 12.17% 0.56%
Administrative Functions (includes leave time)
16.83% 15.47% -1.36%
Number of FSS Responders 95 81
7
Children’s Rate Assumptions
1. Family Support Specialists caseload may up to 1 FSS to 16
Families
2. Family Education & Training is a separate hourly rate
3. Residential Habilitation is divided into two types of service:• Direct care service reimbursed on an hourly basis• Individual training materials (up to $1,000 per year)
4. Respite Care is divided into two types of service:• Direct care service reimbursed on an hourly basis• Individual care materials (up to $1,000 per year)
5. Day Habilitation is reimbursed on an hourly basis
6. Therapies are reimbursed on an hourly basis
8
Children’s Rates – Family Support Specialist
Cost CenterCost Center Cost FactorCost Factor
Direct Care Salary $15.14$15.14
Employee-Related Expenses 40.13%40.13%
Program Related Expenses 32.0%32.0%
General & Administrative 11%11%
TOTAL HOURLY RATE $35.06 hour$35.06 hour
MONTHLY RATE $368 / month$368 / month
9
Children’s Rates: Published Rate Schedule
ServiceService RateRate
Family Support Specialist $368 per month$368 per monthFamily Education & Training $35.06 per hour$35.06 per hourResidential Habilitation (non-facility direct care)
$17.19 per hour$17.19 per hour
Residential Habilitation (individual training materials)
$1,000 per year$1,000 per year
Respite Care (direct care) $12.96 hour$12.96 hourRespite Care (individual care items) $1,000 per year$1,000 per yearDay Habilitation $17.84 per hour$17.84 per hourTherapies State Plan hourly rateState Plan hourly rate
10
Children’s MONA Assumptions
1. Children who are14 years or older will have MONAs
2. Children under 14 years will be screened using:
• Presenting behavioral or autism diagnoses
• Presenting medical care needs
• Intensity of Family support needs
3. Individual Cost Plans (ICP) will account for ALL
funds to include administrative costs
11
Next Steps: Children’s Services
Task Responsibility Timeline
1. Step #1: Shadow Published Rates and determine fiscal and operations impact
All Children’s providers
May - September 2006
2. Step #2: Complete MONAs and Child Assessments for Regions I & II
Regions I & II September 2006
3. Step #3:Pilot Published Rates in Regions I & II; extend other provider contracts
Region I & II October 2006
4. Step #4: Complete MONAs and Child Assessments for ALL Regions
All Regions January 2007
5. Step #5: Implement statewide for ALL providers
All Regions July 2007
12
Recommendations
1. Establish Family & Legislative Oversight work group
2. Independent Quality Assurance & Evaluation
3. Attend to HCBS Waiver definitions and service options
4. Independent resource allocation process
15
Transportation Rates Assumptions & Findings
Travel Zones: Each person is assigned into one of 3 zones based upon the amount of NON-DAY PROGRAM travel per YEAR
• Zone 1 = 8,580 miles (50% of population) • Zone 2 = 11,700 miles (30% of population)• Zone 3 = 13,520 miles (20 % of population)• Special Need = (10% of population);
assumes three Zone distribution (50%,
30%, or 20%)
16
Transportation Rates Findings
Travel Zones: REGION II Survey
ASSUMPTIONASSUMPTION SURVEY FINDINGSURVEY FINDING
ZONE 1ZONE 1 50% 89%
ZONE 2ZONE 2 20% 0%
ZONE 3ZONE 3 20% 5%
SPECIAL NEEDSSPECIAL NEEDS 10% 6%
17
Mileage Rate Assumptions
Mileage Rate: mileage is priced at $0.35 per mile
Special Need: people needing wheelchair vans are priced at $0.45 per mile
18
Next Steps: Transportation
Task Responsibility Timeline
1. Step #1: Identify medically-related travel which is Medicaid State Plan reimbursable
Region II / Case Managers / Providers
May 5, 2006
2. Step #2: Adjust mileage zone assignments without medically-related travel
Region II Providers
May 5, 2006
3. Step #3: Recalculate mileage factors (increase from $0.35/mile)
Davis Deshaies May 12, 2006
4. Step #4: Assign mileage zones to Individual Cost Plans
DDP Central Office; Davis Deshaies
June 1, 2006