Email received outlines a DRAFT plan of PROPOSED Waiver reductions for people with developmental disabilities.  Because the format of this informational sheet is not compatible with the Weblog and my formatting abilities are extremely limited on the blog, I am reformatting it so that it will fit properly.  There is no website that you can be linked to that contains this information.

1.  Companion ration/limit adjustment–expected savings $18,605,801 

  •  Detailed Description–Allow up to 3 people to be served/Set rate at average of the 1:2 level
  • Action Needed–Handbook change, rate rule change
  • To be completed as of August 1, 2011

2.  Allow IHSS in all tiers in the family home as a less costly option for PCS at lower IHSS rate–expected savings $1,765,277

  • Detailed Description–PCA at 15 per hour versus IHSS at 12 per hour–optional to help reduce cost of services and must always be considered for an increase of services
  • Action Needed–Case Review
  • Started July 1, 2011 with case by case review

3.  Transportation Review and service limitations–expected savings $1,375,000

  • Detailed Description–Ensure transit is funded by waiver only as a last resort and limited number of round trips
  • Action Needed–This requires a county-by county review to ensure cost effectiveness.
  • Reviews to be completed in September 2011 with service limitations effective November 1, 2011. Areas are working with Transportation Disadvantaged Providers to achieve most cost-effective delivery of service.

4.  Pool Respite services for families to draw from and reduce allocation–expected savings $975,042

  • Detailed Description–This initiative primarily reduces unused service authorizations in current cost plans. The actual savings are based on 3% reduction in actual billings with 10 months implementation
  • Action Needed–Currently being implemented and will be completed by October 1, 2011

5.  Move SMH Therapy to MSP (adults)–expected savings $1,395,703

  • Detailed Description–JT to DCF move expenditure from waiver through amendment for the long term because service is provided by DCF/ACHA
  • Action Needed–Handbook change, Rate Rule change, Waiver Amendment
  • While waiting for waiver amendment, case by case transition of services to MSP. Waiver will be amended this FY

6.  Move skilled nursing to MSP (adults)–expected savings $1,615,650

  • Detailed Description–JT from AHCA and remove expenditure from waiver and do waiver amendment for the long term because skilled nursing is provided by MSP
  • Action Needed–Handbook change, Rate Rule change, Waiver Amendment
  • While waiting for waiver amendment, case by case transition of services to MSP. Waiver will be amended this FY

7.  Rate adjustment for all ADT recipients and reduce burdensome regulations–expected savings TBD

  • Detailed Description–Rate adjustment to targeted savings
  • Action Needed–Handbook change, Rate Rule change with reduced paperwork and regulation
  • Prior proposed to consolidate into one ADT rate not well received. Seeking provider input for alternative savings in this category

8.  Eliminate Behavior assistant services with ResHab and ADT–expected savings ?$5,000,000

  • Detailed Description–Elimination of duplicative services occurring in the same settings
  • Action Needed–Handbook change for policy clarification
  • Behavior Assistance services are duplicative of the services and training provided in residential habilitation and adult day training

9.  Agency Rate premium set to a maximum of 20% above solo rates for all services with agency rate–expected savings $3,712,169

  • Detailed Description–Currently there is a range of 5% to 45% over solo rates as an agency premium 
  • Action Needed–Rate Rule change 
  • Current rate premiums vary from 5% to 42% depending on the service category

10.  Behavior Analyst collapse rate from level 1 to level 2–expected saving $2,580,874

  • Detailed Description–Rate for level 2 is $50 per hour for solo and agency is 20% above – based on average
  • Action Needed–Handbook change, Rate Rule change
  • Current behavior analyst rates for level 1 are not directly associated with the client level of need or service outcomes and are based solely on years of experience

11.  Rates reduced to MSP (nursing and therapies and assessments)–expected savings $1,530,476

  • Detailed Description–Use current waiver rate X units – MSP rate X units
  • Action Needed–Rate Rule change
  • Currently in process of including this change in the DD Rate Rule

12.  Res Hab reduce rate levels from 9 to 4–expected savings $21,113087

  • Detailed Description–redefine level of support descriptions and associated rates and revise associated staffing levels in the handbook
  • Action Needed–Handbook change, Rate Rule change
  • Seeking provider input for alternative savings in this category

13.  IHSS collapse quarter-hour above live-in rate–expected savings $2,914,937

  • Detailed Description–Delete use of quarter-hour above the day rate
  • Action Needed–Using QSI 1,2,3 and eliminate IHSS 1/4 hr above day rate
  • Individuals with level of need 1,2,and 3 do not require additional supports beyond a daily rate for in-home supports

14.  Utilization management of behavioral services–expected saving  ?$3,000,000

  • Detailed Description–6 month increment with reapplication and approval required after each increment:  declining hours based on matrix scores
  • Action Needed–none
  • Implementing on-site reviews for continued stay in intensive behavioral programs. Additional utilization reviews ongoing to match services to level of need of client

15.  Publish Standardized 1B rates for future with lower rates retained–expected savings $1,549,764

  • Detailed Description–Standardizing rates based on individual needs rather than negotiated contract
  • Action Needed–Rate Rule promulgation required
  • Rate Matrix in development.  Savings dependent on effective date

16.  Res Hab quarter-hour eliminate since other options are available for in-home supports–expected savings $917,290

  • Detailed Description–Eliminates the quarter-hour unit for this service. Typically used for individuals in their own home and the services is more appropriately provided as in-home support
  • Action Needed–Rate Rule change
  • This would increase IHSS use and reduce service array

17.  Fee collection by residential providers–expected savings *FARF estimate $8,401,147

  • Detailed Description–Create form to calculate recipient responsibility to be deducted from waiver service bills, monthly surplus frozen or swept by service
  • Action Needed–Develop method and procedures to monitor
  • Inplementation strategy and monitoring procedures need to be developed and vetted, late year implementation

18.  12.5% reqd match as state share–expected savings TBD

  • Detailed Description–Would leverage current spending to decrease GR effort
  • Action Needed–Lond term research with AHCA and CMMS
  • Unknown if loca effort is applicable to matching in this context. Variables include in-kind share, local funds, and other sources

19.  Core service models–expected savings TBD

  • Detailed Description–Limit waiver services to only those services considered core to prevent institutionalization
  • Action Needed–Waiver amendment required

20.  Services limits–expected savings TBD

  • Detailed Description–Reduce services limits for each waiver service
  • Services limited to only essential elements within budget

21.  Limit individual cost plan to not greater than average ICF/DD–expected savings $3,300,000

  • Detailed Description–FL ARC estimates 3.3 m based on “limiting most cost plans to $150,000.”
  • Action needed–Waiver amendment required prior to implementation
  • CMMS will require alternative supports for adversely impacted clients.  Data suggest that 17 m in savings could be realized if waivers were limited to individual’s cost of ICF/DD service
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