State of Indiana Family Social Services Administration April

State of Indiana Family & Social Services Administration April 2007 OASIS Initiative: How Stuff Works

THE CURRENT SITUATION 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 2

THE FUTURE DIRECTION PRINCIPLES & VALUES n Person - Centered Planning n Self - Directed Choice FAIRNESS & EQUITY n Refine Individual Resource Determination process n Connect to Personal Outcomes n Connect to Provider Reimbursement PREDICTABLE & STABLE FUNDING n Balance quality, utilization, cost and access 3

OVERVIEW OF APPROACH FIVE STEPS: STEPS 1. Collect Information n Build data & policy BASELINE (3 months) 2. Figure out How Much people need n Define BEST PRACTICES (3 months) 3. See if the BEST PRACTICES Make Sense n SHADOW in District 4 (6 months) 4. See if OASIS WORKS n PILOT rates and individual allocations (6 months) 5. IMPLEMENT (18 months) 4

IMPLEMENTATION SCHEDULE FOR OASIS Determine Best Practice & Cost Drivers Implementation Complete TASKS Connect Best Practice to Cost Drivers Determine Uniform Rates for each Service Shadow Test In District 4 1 st 2 nd 3 rd 2007 Quarters 4 th Implement Uniform rates Statewide Pilot Test in District 4 1 st 2 nd Implement OASIS Statewide 3 rd 4 th 2008 Quarters 1 st 2 nd 3 rd 2009 Quarters 4 th 5

How is the OASIS individual allocation determined and what does it mean? 6

COST DRIVER ASSUMPTIONS n n 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. Best Practices better define costs. 7

WHAT ARE BEST PRACTICES? µ Personal Health µ Safety & Freedom from Harm µ Stable Home µ Sufficient Personal Finances µ Satisfaction & Inclusion 8

WHAT DOES OASIS GIVE YOU? (Objective Assessment System for Individual Supports) 1. 2. 3. 4. SINGLE ANNUAL AMOUNT: Total for Year RANGE: Gives a view of typical costs and services for people with similar needs GUIDELINES for planning rather than ultimatums Connected to BEST PRACTICES 9

What INDIANA Cost Drivers will be CONSIDERED? Other States found: n n n Primary Cost Drivers: – Age – Family Living Situation – Work Situation – Life Events – Geography & Transportation Secondary Cost Factors: – Functional Abilities – Behavior & Health Supports Needs Assessments do not predict cost for OUTLIER consumers Indiana Work Group potential factors: n Other Factors (natural supports, employment, forensic and behavioral health issues) 10

HOW SHOULD WE TEST OUR IDEAS? Statistical Validation – – – Straight Face Test Content, Construction & Design Predictive ability Focus Groups – – Frequent consumer / family discussions Frequent provider / case manager discussions Best Practice Groups – – – Consumer Outcomes Provider Outcomes Case Management Outcomes OASIS MONOPOLY – Simulate with People, Families, Providers, Case Managers 11

Building the OASIS Allocation Individual Needs Assessment Number of Units of Service Standard Rate Market Analysis Cost Per Cost Unit of Drivers X X Service (age, life events, etc. ) OASIS = Allocation 12

How will Standard RATES for each Service be set? 13

WHAT ARE STANDARD RATES? n n Rates are the AMOUNT OF MONEY PER UNIT OF SERVICE which is paid to a PROVIDER The RATE AMOUNT is based upon STANDARDIZED COSTS for – Wages and Salaries – Employee-related Expenses such as BENEFITS & Paid Time Off – Program Indirect Costs such as supervision, materials, utilities – General & Administrative Costs n A PROVIDER may SPEND FUNDS DIFFERENTLY than the RATE ASSUMPTIONS. 14

What DO People BUY? n People purchase staff time – Personal Support – Training & Guidance – Therapies & Nursing n People purchase transportation n People purchase housing n People purchase equipment 15

RATE BUILDING APPROACH n n Examine Direct Care Staff Salaries Compute Employee - Related Expenses / Benefit Costs Survey Program - Related / Clinical Supervision Costs Establish General & Administrative Costs 16

RATE BUILDING APPROACH (continued) n n Wage Parity across all services and employer type. Employee-Related Expenses are reflecting actual Workers’ Compensation, FICA experience and geographical differences. Program-Related Costs have the highest variability. General and Administrative Costs will be established by policy. 17