THE DDPA APPROACH TO PAYMENT REFORM

Better Care, Equity in Services,Fairness for Providers

David IversDDPA Annual Spring Conference May 22, 2012

Data Research Meetings and more meetings Committees and Subcommittees Negotiations All under auspices of DDPA Board

& Exec Committee

▪ Prospective payment instead of retrospective reconciliation

▪ Get rid of 15-minute units and go to daily or monthly rate

▪ No risk sharing across providers

▪ No subcontracting requirement

▪ Preserve licensed nonprofit community providers per 20-48-101 et seq.

▪ Allow for DD Health Homes to coordinate care instead of medical home

▪ Create a broader, more flexible DDTCS service package

▪ Retain entitlement status for enhanced DDTCS

▪ Integrate all DD care plans and licensure requirements

▪ Minimize administrative burdens (focus on outcomes not process)

▪ Use assessment to ensure resource allocations are based on actual need

▪ Use assessment that is tailored to DD

▪ Do not require full assessment every year

▪ Pilot first & phase-in implementation

▪ Revise income eligibility requirements

▪ Obtain meaningful data

▪ Behavioral health services

▪ Adequate Rates

▪ Consider “Community First Choice” option under ACA

▪ Big Picture: Reduce inequality in amount of services and reduce waiting list

Prospectively Bundled Payment Vs. Retrospective Reconciliation with risk

DD Lead Providervs.

Principle Accountable Provider (PAP)

Total Medicaid Budget (2012): $4.7 Billion

DD Services (2012): ~ $600 Million

Waiver Slots (2012): 4,100 Waiver Waiting List (2012): 2,127

Service # of Adults DD Expenditures

Number % to TotalDollars (in millions) % to Total

Avg Cost Per Ben.

HDC 1064 15.16% 104 35.25% 97,744

ICF 426 6.07% 25 8.47% 58,685

Waiver Only 1229 17.51% 55 18.64% 44,752

Waiver & DDTCS 2038 29.03% 88 29.83% 43,180

DDTCS Only 2263 32.24% 23 7.80% 10,163

Total 7020 100% 295 100% 42,023

Service Halo Expenditures Total Expenditures

Dollars (in millions) % to Total

Avg Cost Per Ben.

Dollars (in millions) % to Total

Avg Cost Per Ben.

HDC 3 8.57% 2,820 107 32.42% 100,564

ICF 2 5.71% 4,695 27 8.18% 63,380

Waiver Only 10 28.57% 8,137 65 19.70% 52,889

Waiver & DDTCS 11 31.43% 5,397 99 30.00% 48,577

DDTCS Only 9 25.71% 3,977 32 9.70% 14,141

Total 35 100% 4,986 330 100% 47,009

DD service episode Expenditures impactedby health home

Initial phase:Adult DDclients1

7,020

1Includes DD clients ages 18+ receiving HDC, ICF, Waiver and/or DDTCS services. Excludes 180 clients ages 18-20 receiving outpatient therapy only and excludes 13 clients receiving DDTCS transportation but not receiving DDTCS services2Includes medical and behavioral spend, personal care, in-patient, out-patient, pharmacy, dental, hospice and non-emergency transportation. Does not include third party liability or state hospital expendituresSOURCE: Medicaid claims data for claims incurred in SFY 2010

Separate payment from episode In form of PMPM (Per Member Per Month) Likely require use of co-ops or some other

sharing of resources Separate quality measures Full benefit dependent upon HIT

(ACA § 2401 – Adds § 1915(k) to SSA)

Under consideration by DHS

“Home-and-community-based attendant services and supports”

Increased Federal match of 6%. No expiration.

Statewide, no cap or waiting list.

Cannot discriminate based on age or type of disability or form of services/supports required.

Must meet institutional LOC

DDPA web site at http://www.arkansasddpa.org/

medicaidreform.htm

“Arkansas Healthcare Improvement Initiative” at http://humanservices.arkansas.gov/

director/Pages/APII.aspx