Waiver Implementation Council Improving Home and Community-Based Services for Adults with Intellectual and Developmental Disabilities March 22, 2018 Facilitator: Kimberley Smith 1
Welcome • Introductions • Housekeeping ➢ Please feel free to step out if you need to ▪ The restroom is in the hallway to the right ➢ Please keep your cell phone on silent or vibrate ➢ Please sign in and add your current contact information to the sign in sheet 2
Agenda 11:00 am Overview of Today’s Meeting WIC Role and Charge 11:15 am Review June WIC Meeting Summary 11:20 am Waiver Redesign Refresher and Update 11:35 am Budget Considerations Review Submitted Questions 12:20 pm Group Breakout: WIC Planning 12:50 pm Public Comment 1:00 pm Adjourn 3
Materials • June 28 th Meeting Summary • Waiver Submission Timeline • R-19 Budget Request • WIC Proposed Calendar for Discussion • Statute, Rules, and Waivers Crosswalk 4
Meeting Scope Today’s Meeting Future Discussions Update • Service and Coverage • Standards Content Budget Request and • Process Rates Setting Process • Timeline • Provider Qualifications • WIC Planning • Unit Limitations • Submitted Questions • Self-Direction •
Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 6
Office of Community Living Vision ACCESS COORDINATE RECEIVE Streamline Access Improve Service Increase Service to Services Coordination Options and Quality 7
Council Role & Charge 8
Implementation Council Purpose Provide ongoing guidance and advice on the development and implementation of a redesigned waiver to support adults with intellectual and developmental disabilities. 9
Implementation Council Role • Consultation and advice ➢ Examine redesign concepts ➢ Suggest improvements through new ideas and perspectives ➢ Provide solution-oriented feedback • Stakeholder ambassadors ➢ Identify other stakeholder groups/experts ➢ Create partnerships ➢ Disseminate and collect information ➢ Communicate with a broader audience 10
Working Agreements • Treat each other with respect and honor one another as whole individuals • Value diversity in experiences and perspectives ➢ Robust examination and discourse improves our work • Engage with each other as partners ➢ Direct communication ➢ Solution-oriented collaboration • Feedback Options ➢ Index cards ➢ Group break out ➢ Parking lot 11
Review Meeting Summaries June 28, 2017 Waiver Implementation Council Meeting Summary For Our Stakeholders Committees, Boards, and Collaboration Waiver Implementation Council Past Meeting Materials June 28 th 2017 12
Refresher 13
Waiver Redesign: Why? • Current Waivers ➢ Inflexible and outdated ➢ Individuals and families want greater control and authority ➢ Encourage a caretaker role ➢ No alternative service delivery options ➢ History of waiting lists 14
Our Charge • Design services to ensure: ➢ People get the right service, in the right amount, in the right place at the right time, per their individual preferences, goals, aspirations & needs ➢ The redesigned waiver is sustainable long into the future & people get equitable access to the waiver 15
Our Work in 2017-2018 • Online Forum • Service Coverage Standards Progress • OCL Reorganization- we now have a full team • Contracted Work ➢ Rates Cost Factors Survey ➢ Residential Habilitation Microservices Survey and Analysis ➢ Utilization Claims Review ➢ Facilitator/Stakeholder Engagement ➢ Provider Qualifications and Quality Recommendations • R-19 Budget Request 16
Update 17
July 2017-March 2018 Incorporated WIC feedback and contractor work into service coverage standards 18
Residential Habilitation Service Analysis Learned about complexity of the delivery model Understood that billing Redesigned 15 minute units would Residential be arduous and non- Habilitation representative Service Identified additional actuarial work (R19) needed to analyze utilization of the combined population 19
R-19 Budget Request • The Department submitted a budget request on November 1, 2017 • Funding from FY 2018-19 Priority R-19, IDD Waiver Consolidation Administrative needed for… ➢ Data and actuarial analysis. ➢ Transition plan development and ad hoc analysis. ➢ Stakeholder engagement. 20
HCBS Final Rule Amend the NEW existing WAIVER HCBS DD waiver Not in compliance Faster but more complex with the Final Rule with a challenging (CFCM 2022) timeline HCBS Final Rule - 79 Fed. Reg. 2948 (2014) 21
Waiver Implementation Timeline Q4 Q1 Q3-Q4 Q4 Q1 Q1 Q3 FY 17-18 FY 18-19 FY 18-19 FY 18-19 FY 19-20 FY 19-20 FY 19-20 Service Contractor CMS Public Waiver Provider Waiver Response Coverage work Comment Submission Training Approved and Standards begins to CMS and and Incorporate Drafts Public Enrollment Transition Finalized Comment Begins Quarter Key Fiscal Year Key • FY 17-18 – July 1 st 2017-June 30 th 2018 • Q1 – July – September • FY 18-19 – July 1 st 2018-June 30 th 2019 • Q2 – October – December • FY 19-20 – July 1 st 2019-June 30 th 2020 • Q3 – January – March • FY 20-21 – July 1 st 2020-June 30 th 2021 • Q4 – April - June 22
Budget Considerations 23
Estimating the Cost of IDD Waiver Consolidation Presented by: Jill Schnathorst March 22, 2018 24
Challenges in Estimating Waiver Consolidation • Variation in Need • Residential Habilitation • HCBS-DD Waiting List • Funding 25
Challenge 1: Variation in Need HCBS-DD Percent of Population at Each HCBS-SLS Percent of Population at Each SIS/Support Level SIS/Support Level 37.43% 21.41% 20.97% 32.09% 16.00% 15.50% 14.50% 11.62% 10.01% 7.34% 7.32% 5.80% 1 2 3 4 5 6 1 2 3 4 5 6 26
Challenge 1: Variation in Need • How to limit services ➢ Service Plan Authorization Limits? ➢ Unit Limits? • FY 2018-19 R- 19 “IDD Waiver Consolidation and Administrative Funding” Budget Request ➢ Stakeholder Engagement ➢ Data and Actuarial Analysis ➢ CMS Waiver Application Support 27
Challenge 2: Residential Habilitation • Approximately 93% of HCBS-DD clients in FY 2016- 17 used Residential Habilitation services • $225 Million paid in FY 2016-17 for HCBS-DD Residential Habilitation services 28
Challenge 2: Residential Habilitation Residential Habilitation SIS/Support Level Cost per Utilizer Level 1 $24,804 Level 2 $36,938 Level 3 $44,122 Level 4 $53,169 Level 5 $59,483 Level 6 $73,015 29
Challenge 3: HCBS-DD Waiting List • FY 2017-18 R-I- 1 “Elimination of the IDD Waiting List” budget request ➢ $190 million annually once fully eliminated • Major Assumptions ➢ All clients would be enrolled by July 1, 2020 ➢ 2,310 on the waitlist September 2016 ➢ Offsets to costs 30
Challenge 3: HCBS-DD Waiting List • 70% receive services in HCBS-SLS • 19% receive no Medicaid services • 6% receive services in HCBS-EBD • 5% receive only State Plan services • As of February 2018 approximately 2,800 people are waiting for HCBS-DD services with ASAP status 31
Challenge 4: Funding • There was no funding appropriated for services in HB 15- 1318 “Consolidate Intellectual and Developmental Disabilities Waivers” • No reserve funding from under utilization 32
Challenge 4: Funding • State Budget Process Internal Approval April/May Submit to Governor’s Office August Submit to Joint Budget November Committee Briefing and Hearing December Figure Setting March Funding Available July 1 33
Questions or Concerns? 34
Submitted Questions 35
Question: Can we get clarification on the timelines for implementation of the: 1) Combined Waiver 2) New Assessment Tool 3) Settings Final Rule in Colorado 4) No Wrong Door Program 5) Conflict-Free Case Management? 36
STREAMLINE IMPROVE SERVICE INCREASE SERVICE ACCESS TO SERVICES COORDINATION OPTIONS AND QUALITY Person-Centered Support No Wrong Door (NWD) Self-Direction Tools Planning Process Person-Centered Budgets New Functional Assessment Tool Colorado Choice Transitions (CCT) Cross System Crisis Response Financial Eligibility Reform Regional Center Task Force Case Management Redesign Medicaid Buy-In Expansion Community First Choice Waiting List(s) Elimination (State Plan Option) Intensive Case Management for Regional Center Transitions Housing & Transportation CHRP – Cut Child Welfare Requirement CHRP CCB Case Management CDASS & IHSS Expansion OPERATIONAL EXCELLENCE INTIATIVES Employment First + WIOA • Background Checks • Electronic Visit Verification Waiver Redesign • Conflict-Free Case Management • Mandatory Reporting • Rate Setting • CHRP Transfer GJRC Relocation • COMMIT/Revalidation • eLTSS Record + Personal Health Record • CCB Transparency • OCL Re-org HCBS Settings Rule Compliance 37
Recommend
More recommend
