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Division of Intellectual Disabilities Services

Division of Intellectual Disabilities Services

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Division of Intellectual Disabilities Services

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  1. Division of Intellectual Disabilities Services FY2010-2011 - Reimbursement Changes Home and Community Based Services

  2. why? Reductions to D.I.D.S. Programs… • State revenues continue to fall short. • D.I.D.S., like most other state agencies, was asked to submit reductions totaling 9% of its state dollars ($26 million) in the FY2010-2011 budget. State dollars are used to match federal Medicaid dollars at a rate of $1 state dollar for every $2 federal dollars.

  3. When submitting the FY2010-2011 reductions, D.I.D.S. used the following methodology: Reduce costs and gain efficiencies by closing or downsizing the state’s developmental centers. These centers are expensive to operate and in need of costly repairs. Reduce as many 100% state funded programs as possible so that we can maximize the amount of federal funds the state receives. For the most part, every state dollar we remove from a Medicaid program results in the loss of $2 federal dollars. Our community based waiver programs represent 65% of our total budget. There was no way we could implement the required reductions without affecting the waiver programs. The following slides address the FY2010-2011 changes to the home and community based programs. why? Reductions to D.I.D.S. Programs…

  4. State Funded Services Total dollars available for state funded services for fiscal year 2010-2011 is $7.4 million. This represents a $12.3 million reduction from the amount available in the 2009-2010 fiscal year. For the past two years, the Division has been preparing for these reductions and has been implementing policies and procedures to efficiently manage these funds. Limited supplemental state dollar funding is available to waiver individuals as indicated on the following two slides. Other state dollar funding is limited to class members who are not waiver eligible.

  5. State Funded Services continued Policies, memorandums and protocols are available on the D.I.D.S. website.

  6. State Funded Services continued Policies, memorandums and protocols are available on the D.I.D.S. website.

  7. The $16.2 million reduction to the levels of need 1, 2, 3 and 4 residential rates has been restored with one-time funding. However, the $7.9 million reduction associated with RN oversight was not restored. Except for the removal of RN oversight in level of need 4, there will be no changes to these rates in FY2010-2011. Reductions will be needed for FY2011-2012 if revenues do not improve. Rate Changes – Levels of Need 1, 2, 3 & 4 Residential Rates

  8. RN oversight funding will be eliminated effective July 1, 2010 from all levels of need 4 and 6 residential rates. The requirement for this function will also be removed effective July 1, 2010. Level of need 6 two-person residential rates will be decreased effective July 1, 2010 for the removal of RN oversight and increased for staffing adjustments. Rate Changes – RN Oversight and Levels of Need 4 & 6 Residential Rates

  9. continued Rate Changes – RN Oversight and Levels of Need 4 & 6 Residential Rates Rates after the elimination of RN oversight (Res Hab & SL) effective July 1, 2010.

  10. continued Rate Changes – RN Oversight and Level of Need 6 Residential Rates Level of need 6 two-person residential rates (Res Hab & SL) after elimination of RN oversight and rate increase.

  11. Level of need 5 (Medical) two, three, and four-person home rates will be increased effective July 1, 2010 to reflect a $2 an hour increase for LPN services. Medical residential single-person home rates remain unchanged. Rate Changes – Level of Need 5, Medical Residential Rates

  12. continued Rate Changes – Level of Need 5, Medical Residential Rates Level of need 5 medical rates (Res Hab and SL) after LPN rate increase effective July 1, 2010.

  13. Personal assistance and hospital attendant will be reduced to a maximum rate of $3.69 per quarter hour effective July 1, 2010. Enhanced and 2 staff rates will be eliminated effective July 1, 2010. No changes to individual transportation are anticipated. Rate Changes – Personal Assistance& Hospital Attendant

  14. continued Rate Changes – Personal Assistance& Hospital Attendant All personal assistance and hospital attendant rates will be a maximum of $3.69 per quarter hour effective July 1, 2010.

  15. Waiver Changes - pending an approved waiver amendment Dental services will be limited to a maximum of $7,500 every three years with no more than $5,000 reimbursed in any waiver year. Nutrition services will be limited to a maximum of 6 visits per year. Nursing services will be limited to a maximum of 12 hours per day (48 quarter hour units per day). Personal assistance services will be limited to a maximum of 50 hours per week (200 quarter hour units per week). Environmental and vehicle accessibility services will be eliminated.

  16. Policy/Provider Manual Proposed Changes Reportable staff misconduct investigation reports no longer required to be submitted to D.I.D.S. for approval. Personal funds policy revised to allow $10 or less expenditures without a receipt. Electronic Signature and Electronic Records policy development in final stage. TennCare is supportive of this initiative. Release of electronic signature policy is likely for implementation by September 1, 2010. D.I.D.S. policy committee process implemented to expedite policy and provider manual changes. 16

  17. Policy/Provider Manual Proposed Changes Task force on regulatory relief established by Legislative Act (Senate Bill 3514). Division Reorganization. Removal of minimum staffing requirements is under discussion. Eliminate plan of correction for unsubstantiated investigations. Provider Incident Management Committees (I.M.C.) meet bi-weekly rather than weekly. Adopt Support Intensity Scale as assessment to replace ICAP. continued 17

  18. Frequently Asked Questions What is the status of individuals receiving only state funded services? Over the past year, the Division has converted as many people as possible from 100% state funding to waiver funding. Success achieved for six individuals seriously impacted by this decision. Other resources will cover these six individuals so their services will continue. Is the hospital attendant service being eliminated?Hospital attendant services will continue to be approved, as long as funding is available, in accordance with the protocol for this service.

  19. Can a person that receives less than 12 hours nursing per day also be in a medical residential service? Yes. The provider manual indicates this service as one where all residents must require direct skilled nursing services (excluding nursing assessment and nursing oversight) on a daily basis and at a level which cannot for practical purposes be provided through two or fewer daily skilled nursing visits. Protocols apply for any approval of this service. Is there a proposed across-the-board nursing hours reduction? A limit of 12 hours per day will be implemented pending an approved waiver amendment. Frequently Asked Questions

  20. What about the commitment that D.I.D.S. gave to the Division of Rehabilitation Services (DRS) that they would provide follow-along to DRS funded service recipients? DRS and D.I.D.S. do not have a Memorandum of Understanding pertaining to follow-along services. DRS has its own policies and requirements regarding follow- along. Please contact DRS if you have questions about DRS policies/requirements. While appreciated – the increase in Med Res does not even make up for the lost day service rate taken away a few years ago. The introduction of 24 hour Medical Residential rates in July 2006 increased rates to include a factor for day services. The July 1, 2010 change was not intended to enhance day services but rather increase the allowance for LPN hourly wages. Frequently Asked Questions

  21. What actual obligations will be removed from providers with the removal of RN oversight? A Deputy Commissioner memo dated August 18, 2005 outlines the expectations of RN oversight. The RN oversight in residential levels of need 4 and 6 does not include the provision of direct skilled nursing services. But it does include an on-going systematic monitoring and review process by an RN to assure the service recipient’s health care needs are being addressed. This would include such things as oversight of the Medication Administration Record and medication errors and follow-up of recommended services. After the removal of RN oversight, there remains an expectation for each provider to have a process for health care oversight by program staff to assure that the service recipient’s health care needs, regardless of funding level, are being addressed. There have been no changes to the medical residential requirements for RN oversight. Additional information on the expectations of this service may be found in the Provider Manual chapter 9 section 4.d. Frequently Asked Questions

  22. Will providers be subject to recoupments for failure to provide RN oversight? No, not for services rendered on or after July 1, 2010. Will there be any cost to providers for continuing the College of Direct Supports in FY2010-2011? No, D.I.D.S. will cover the cost for this last year of the current contract. Frequently Asked Questions