1 Division of Disability & Rehabilitative Services Andrew Ranck, Director of Initiatives OASIS Statewide Tour Spring 2008.

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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:

[email protected]

317-234-5222

1-888-527-0008

OASIS Website:

http://davisdeshaies.com/page10.html

Resources: