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Division of Disability & Rehabilitative Services Andrew Ranck, Director of Initiatives

Division of Disability & Rehabilitative Services Andrew Ranck, Director of Initiatives. OASIS Statewide Tour Spring 2008. Agenda. OASIS Forum list OASIS –why it is happening Activities to date – Rate Setting, Service Planner reconciliation in District 4

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Division of Disability & Rehabilitative Services Andrew Ranck, Director of Initiatives

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

  2. 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

  3. OASIS Forums

  4. O-A-S-I-S: Objective Assessment System for Individual Supports

  5. THE SITUATION Today PEOPLE WITH SIMILAR NEEDS HAVE VARIED ACCESS TO SERVICES BECAUSE THE AMOUNT OF SERVICE YOU GET DEPENDS ON: • WHEN you requested service • HOW MUCH money was available • WHAT services were available

  6. The Future - OASIS PRINCIPLES & VALUES • Person - Centered Planning • Self - Directed Choice FAIRNESS & EQUITY • Refine Individual Resource Allocation process • Connect to Personal Outcomes • Connect to Provider Reimbursement PREDICTABLE AND STABLE FUNDING • Balance quality, utilization, cost, and access

  7. 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)

  8. OASIS Goals The 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

  9. OASIS Goals Funding 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

  10. OVERVIEW OF APPROACH FIVE STEPS: • Collect Information- completed • Build data & policy BASELINE (3 months) • Figure out How Much people need • Build TOOLS(3 months) • See if the TOOLSMake Sense – in-progress • SHADOWthe Tools (6 months) • See if the TOOLS WORK – in-progress • PILOT rates and individual allocations (6 months) • IMPLEMENT(18 months) – July 1, 2008

  11. Pilot Rate ScheduleBDDS District 4 PILOT • The following rates will be applied to agencies providing Home and Community-Based Services (HCBS) in the Bureau of Developmental Disabilities Services District 4. • TheRates will be effective on the following dates: • January 1, 2008: • Residential Habilitation Support Services (RHSS) • Adult Foster Care (all levels) • Respite Care • Behavior Management (single rate upon promulgation of administrative rule) • April 1, 2008: • Day Habilitation • Supported Employment (all tiers) • All Other Therapies

  12. Rates Piloted in Jan. 2008

  13. 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

  14. 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

  15. Decisions to Date(Continued) • 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

  16. 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

  17. Day Program PROVIDER RATES

  18. Day Habilitation Rate Assumptions • Full Program Year: 260 days • Consumer 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

  19. What is in a Rate?

  20. Rates to be piloted April 1 2008

  21. Best Practices Group

  22. Key Points Purpose:Establish a benchmark group to calibrate OASIS factors Process / Actions To Day: • Collect pre / mid / post outcome data and verify • Track amount of services planned and delivered during pilot • Develop benchmark service standards and connect cost factors • Apply service standards to District 4 consumer plans • Project impact

  23. Key Points Future Actions: • Collect mid project outcome data with focus groups and data collection tools – April 2008 • Provide OASIS amounts and test validity / variation – April 2008 • Fine-tune benchmark service standards – June 2008 • Finalize OASIS – July 2008 • Continuing review and revisions – December 2009

  24. What are the Best Practice conditions? • Personal Health • Safety & Freedom from Harm • Stable Home • Sufficient Personal Finances • Satisfaction & Inclusion

  25. Comparative Data • The demographic characteristics of Best Practice consumers are similar to general District 4 consumers. • Best Practice and general District 4 consumers have similar ICAP scores • Best Practice consumers use less behavioral management services • Best Practice consumers use more RHSS and CHIO, and less Sheltered Workshop services • Slightly more Best Practice consumers live with their families (31% versus 27%) • Best Practice RHSS utilization has increased the OASIS benchmarks.

  26. Comparative DataDistribution by Waiver

  27. Resource Allocation Tool

  28. 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.

  29. 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

  30. What will OASIS give the Consumer • Gives a view of typical costs and services for people with similar needs • GUIDELINES for planning rather than ultimatums • Connected to BEST PRACTICES • Flexibility and choice within allocation

  31. 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.

  32. 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.

  33. 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)

  34. 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

  35. Resources: OASIS-ICAPHelp Lines: OASIS-ICAPhelp@fssa.in.gov 317-234-5222 1-888-527-0008 OASIS Website: http://davisdeshaies.com/page10.html

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