State of Montana Helena Montana April 2006 State

State of Montana Helena, Montana April 2006 State Rates Advisory Committee: Children’s & Transportation Rate Update Davis Deshaies, LLC

CHILDRENS RATES DISCUSSION: 2

CURRENT CHILDREN’S SYSTEM 1. 2. 3. Single Blended Rate Family Cost Plan Managed Care: provider assumed risk 3

NATIONAL TRENDS 1. 2. 3. 4. 5. 6. Transparent / unbundled rates Increased family control & choice of providers and services Limited Provider ROI Focus on integration with other federal funding sources (e. g. CWS, DVR, schools, Headstart, No Child Left Behind, TANF, Medicaid State Plan services) Increased emphasis on children with select diagnoses (e. g. autism, dual diagnoses) Seamless transition from school to adulthood 4

CURRENT MENU OF CHILDREN SERVICES Service Percent of Children receiving Service Percent of DDP Funds spent on Service Family Support Specialist 100% 42% Residential Habilitation (Non-facility based) 80. 1% 24. 9% Respite 90. 9% 22. 4% Day Habilitation 14. 8% 0. 1% (except: 7. 2%) 9. 7% 0. 1% (except: 8. 0%) Transportation 32. 5% 0. 1% Environmental Mods. / Equipment 30. 2% 4. 7% Therapies / Homemaker 5

Family Support Specialist Study TASK Sample 1 Sample 2 Difference Assessment/ Information 10. 44% 12. 65% 2. 21% Travel 11. 50% 12. 66% 1. 16% Education/ Training 15. 80% 17. 73% 1. 93% IFSP Development 25. 04% 21. 55% -3. 49% Habilitation 3. 71% 3. 96% 0. 25% Personnel Recruitment/ Supervision 5. 08% 3. 81% -1. 27% Support Coordination 11. 61% 12. 17% 0. 56% Administrative Functions (includes leave time) 16. 83% 15. 47% -1. 36% Number of FSS Responders Davis Deshaies, LLC 95 81 6

Children’s Rate Assumptions 1. Family Support Specialists caseload may up to 1 FSS to 16 Families 2. Family Education & Training is a separate hourly rate 3. Residential Habilitation is divided into two types of service: • Direct care service reimbursed on an hourly basis • Individual training materials (up to $1, 000 per year) 4. Respite Care is divided into two types of service: • Direct care service reimbursed on an hourly basis • Individual care materials (up to $1, 000 per year) 5. Day Habilitation is reimbursed on an hourly basis 6. Therapies are reimbursed on an hourly basis 7

Children’s Rates – Family Support Specialist Cost Center Cost Factor Direct Care Salary $15. 14 Employee-Related Expenses 40. 13% Program Related Expenses General & Administrative TOTAL HOURLY RATE MONTHLY RATE 32. 0% 11% $35. 06 hour $368 / month 8

Children’s Rates: Published Rate Schedule Service Family Support Specialist Family Education & Training Rate $368 per month $35. 06 per hour Residential Habilitation (non-facility direct care) $17. 19 per hour Residential Habilitation (individual training materials) $1, 000 per year Respite Care (direct care) $12. 96 hour $1, 000 per year Respite Care (individual care items) Day Habilitation Therapies $17. 84 per hour State Plan hourly rate 9

Children’s MONA Assumptions 1. Children who are 14 years or older will have MONAs 2. Children under 14 years will be screened using: • Presenting behavioral or autism diagnoses • Presenting medical care needs • Intensity of Family support needs 3. Individual Cost Plans (ICP) will account for ALL funds to include administrative costs 10

Next Steps: Children’s Services Task Responsibility Timeline 1. Step #1: Shadow Published Rates All Children’s and determine fiscal and operations providers impact May September 2006 2. Step #2: Complete MONAs and Child Assessments for Regions I & II September 2006 3. Step #3: Pilot Published Rates in Regions I & II; extend other provider contracts Region I & II October 2006 4. Step #4: Complete MONAs and Child Assessments for ALL Regions All Regions January 2007 5. Step #5: Implement statewide for ALL providers All Regions July 2007 11

Recommendations 1. 2. 3. 4. Establish Family & Legislative Oversight work group Independent Quality Assurance & Evaluation Attend to HCBS Waiver definitions and service options Independent resource allocation process 12

TRANSPORTATION RATES Status Update: 13

Transportation Rate Assumptions 1. Travel Zones 2. Shared Expenses 3. Mileage Rates 14

Transportation Rates Assumptions & Findings Travel Zones: Each person is assigned into one of 3 zones based upon the amount of NON-DAY PROGRAM travel per YEAR • • Zone 1 = 8, 580 miles (50% of population) Zone 2 = 11, 700 miles (30% of population) Zone 3 = 13, 520 miles (20 % of population) Special Need = (10% of population); assumes three Zone distribution (50%, 30%, or 20%) 15

Transportation Rates Findings Travel Zones: REGION II Survey ASSUMPTION SURVEY FINDING ZONE 1 50% 89% ZONE 2 20% 0% ZONE 3 20% 5% SPECIAL NEEDS 10% 6% 16

Mileage Rate Assumptions n n Mileage Rate: mileage is priced at $0. 35 per mile Special Need: people needing wheelchair vans are priced at $0. 45 per mile 17

Next Steps: Transportation Task Responsibility Timeline 1. Step #1: Identify medically-related travel which is Medicaid State Plan reimbursable Region II / Case Managers / Providers May 5, 2006 2. Step #2: Adjust mileage zone assignments without medicallyrelated travel Region II Providers May 5, 2006 3. Step #3: Recalculate mileage factors (increase from $0. 35/mile) Davis Deshaies May 12, 2006 4. Step #4: Assign mileage zones to Individual Cost Plans DDP Central Office; Davis Deshaies June 1, 2006 18