FINAL RATE MODELS
DBHDD released proposed rate models on July 8, 2015. Providers and other interested stakeholders were invited to submit comments in response to the proposals. Approximately 60 individuals and organizations emailed comments.
The Department reviewed all submittals and made several changes in response to the comments. Specifically:
• The proposed establishment of monthly billing limits on Community Living Supports has been withdrawn. There will continue to be an annual limit for CLS, but members will have flexibility in regards to how they use their budgets over the course of their plan years.
• The proposed elimination of the personal assistance retainer for Community Living Supports has been withdrawn. The CLS rate model was revised to exclude a productivity adjustment for missed appointments.
• The minimum share of the Host Home rate that agencies must pass-through to the home providers has been reduced from 65 percent to 60 percent.
• The workers’ compensation cost assumed in the rate models has been increased from 3.0 percent of wages to 3.2 percent.
• Overhead funding has been added to the Additional Residential Staffing rate model at one-half of the amounts included in other rate models (producing an overhead rate of about 10 percent).
DBHDD thanks everyone who took the time to review the materials, to participate in one of the webinars that were conducted to explain the proposals and answer questions, and/or to submit comments.
• DBHDD’s responses to each of the responses can be found here.
• Responses that were sent to families who emailed the dedicated account established for families’ questions can be found here.
• The final rate models, which incorporate the changes noted above, can be found here.
• An updated analysis of the fiscal impact of the final rates can be found here.
These rates will be incorporated in the application to reauthorize the Comprehensive Waiver. DBHDD intends to submit the Waiver application to the Department of Community Health (DCH) in September 2015. Once DCH approves the application, it will be submitted to the federal Centers for Medicare and Medicaid Services (CMS) for its approval.
PROPOSED RATE MODELS
The following materials were made available for review:
• An overview of the rate study can be found here. This presentation should be reviewed first. It summarizes the work that has been completed as part of the cost study, the proposed rate models and changes to service definitions, and next steps.
• A recording of a June 13th webinar facilitated by B&A to explain the cost study and proposed rate models can be found here.
• The proposed rate models, which detail the specific assumptions used to develop each rate can be found here. The appendices included in this packet further detail the methodology associated with constructing wage, benefit, and productivity assumptions for direct support professionals, as well as group home staffing assumptions.
• The analysis of the estimated fiscal impact of the proposed rate models if they are fully implemented can be found here. The notes that accompany the analysis specify the assumptions used when developing the estimates.
• An information brief on how the Supports Intensity Scale (SIS) and Health Risk Screening Tool (HRST) will be used to assign members to rate categories for certain services can be found here.
• A summary of the results from the provider survey conducted earlier this year can be found here.
• A DBHDD website with a series of questions and answers for individuals and families to highlight how the cost study will impact them can be found here.
The survey and instructions can be downloaded here and here. The original documents have been revised to reflect clarifications made in response to questions asked during the webinars. Revisions in the instructions are marked in red. Revisions to the survey are not marked, but primarily involve corrected formatting. The changes are non-substantial so if providers have begun completing the original form, they do NOT need to use the revised version.
A provider survey is a significant component of the rate study. The survey was emailed to all providers on March 20. B&A has conducted two technical assistance webinars to explain the survey and respond to questions.
A recording of the second webinar can be found here.
A summary of the questions and answers that have been asked to date can be accessed here.