IDD CFO Consortia

1

• IDD CFO Consortia
• June 24, 2009
• By
• Mel Hughes Cindy Lucas

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SB 1 Rider 48

• Community Service Expansion
• HCS
• HCS-Promoting Independence
• HCS-Emergency /Prevent Institutionalization
• CLASS
• Deaf/Blind Multiple Disabilities

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SB 1 Rider 48

• Transfer of HCS Case Management to MRAs
• DADS MRA training and hiring case managers to
  provide HCS case management
• HCS Hold Harmless Rate Increase
• Safety Net Increase
• Community Based Regulatory

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SB 1 Rider 48

• TxHmL Rate Increase
• ICF/MR Rate Increase
• ECI stimulus funds

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Community IDD Funding
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Community IDD Funding
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Community IDD Funding
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Safety Net Funding

• More than half-distributed on equity formula
  (centers below mean per capita)
• May exclude ICF and HCS local resources use a
  pure per capita formula
• Remaining portion distributed across the state as
  a rate increase

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Equalization of TxHLW Rates to HCS Rates
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Transferring case management function to local
Mental Retardation Authorities

• Tentatively scheduled to begin June 1, 2010.
  (not 2009 error in handout).
• How many consumers from private providers will
  MRAs be picking up?
• How many providers will MRAs be working with?
• (See handouts)

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Transferring case management function to local
Mental Retardation Authorities

• Based on 135 case load.
• MRAs will be responsible for PDP on an ongoing
  basis.
• The purchaser for the person Service Planning
  Team instead of IDT (includes MRA Case
  Manager).
• More Thursday afternoon at 3pm Mary Skillman
  session.

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Schedule for Adoption of Rule Changes

• June 11 Present to MCAC
• June 24 Present to A D Services Council
• July 3 Publish Proposed Rules in Tx
  Register
• August 28 Publish adopted Rules in Tx Register
• September Rule Effective

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Hearings on Proposed Rate Changes-mid to late
July 2009

• HCS requisition fees
• HCS TXHLW nursing rates
• Equalization of TXHLW rates to HCS rates
• Equalization of non-nursing professional services
  rates for CBA, CWP, DBMD to HCS TxHLW
• Redistribution of HCS Admin Op Fees
• ICF Rate increase -1.5
• HCS rate adjusted to transfer of CM to MRA

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HHSC Proposal-ICF, HCS TxHLW Reimbursement Rule
Changes

• Professional services definitions are identical,
  rates are not. (Nursing, OT, PT, ST, dietary,
  behavioral support)
• Revised HCS TxHLW billing guidelines for
  nursing rates will be lower, but guidelines will
  allow for significantly more billable UOS
• In future-separate rates for LVN vs RN services.
  A new service-specialized nursing will be added
  (see current rates in other 1915c waivers)

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Waiver Rates
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HCS Admin Op Fee Re-distribution Proposals
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HCS Admin Op Fee Re-distribution Proposals
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HB 2303 - Scope of Services

• Community MHMR centers may provide health and
  human services and supports through contracts
  with local, state and federal agencies in
  addition to operating for the purposes and to
  perform the functions defined in the centers
  operational plan.
• Community Centers may continue to provide
  services to persons with developmental
  disabilities.

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HB 2309Bond Homes

• Provides for the transfer from DADS of 42
  separate properties specifically designated for
  providing community-based facilities for
  difficult-to-place persons with developmental
  disabilities to 10 community mental health and
  mental retardation (MHMR) centers in Texas for
  the purpose of providing services for persons
  with developmental disabilities.

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Rider 9Limitation on Transfer Authority

• Specifies conditions under which DADS may
  transfer funds appropriated
• Includes waiver programs and ICF/MR services in
  state school and community
• Must be approved by the Legislative Budget Board
  and Governor

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Rider 17MR Residential Placement Options

• MR Residential Services Funded by GR
• Requires DAD to refinance with Medicaid funding

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Rider 22MR Residential Placement Options

• Requires an individual or LAR seeking residential
  services to receive a clear explanation of
  services
• Requires DADS to keep a central listing of
  openings available in each type of service

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Rider 31Cost Comparison Report

• DADS must develop a report to legislature
  analyzing services in HCS, TxHmL, and ICF/MR
  comparing
• Monthly average cost per person by level of need
  and facility size
• Severity across settings
• Number of persons transitioned from state ICFs/MR
  to HCS residential services for the previous
  biennium and
• Average monthly cost of HCS
• Requires report of all costs, including indirect
  costs, maintenance and construction,
  administrative and medical and overhead costs
• Due August 31, 2010

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Rider 32Services Under a 1915 (c) Waiver

• Directs DADS to allow persons 21 and under to
  leave a nursing home and enter a waiver other
  than a nursing home waiver if person is eligible
  and needs such services

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Rider 33Services Under HCS Waiver Program

• Directs DADS to allow persons 21 and under,
  seeking to leave an ICF/MR, and who are
  ineligible for HCS to be served in another waiver
  program if eligible

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Rider 34Promoting Community Services for Children

• Intent
• Out of funds appropriated, children under age 22
  residing in community ICFs/MR should be provided
  opportunities to transition to families when
  requested by parent/guardian
• Funding for up to 50 children will be transferred
  from community ICFs/MR to cover the cost of
  shifts of service
• Rules may be developed to allow decertification
  of the ICF/MR beds upon such transfers to prevent
  additional costs being incurred

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Rider 36Waiver Cost Limits

• Specifies range of CMS cost-effectiveness
  requirements and individual cost limits for each
  waiver program
• HCS services may be funded up to 200 of the
  reimbursement rate that would have been paid for
  the same person to be served in an ICF/MR or 200
  of the estimated annualized per capita cost for
  ICF/MR services, which ever is greater

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Rider 40Limits for Waivers and Other Programs

• Governs expenditures across DADS programs

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Rider 41Contingency for Transferring Savings
Related to State School Downsizing

• Authorizes savings from DADS strategies for
  downsizing state schools and transitioning more
  state school residents to community-based care to
  be transferred to specified community programs
• Prior to transfer of funds DADS must obtain
  certification from HHSC of the amount of savings
  related to the downsizing of state schools

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Rider 42Contingency for Eliminated Consolidated
Waiver Program

• Contingent on passage of SB 705 or similar
  legislation
• Specifies programs to which funding of
  Consolidated Waiver Program must be allocated in
  order to continues services to persons served in
  the CWP

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Rider 48Waiting List Reduction

• DADS rider, different from HHSC Section 48,
  reported elsewhere as SB 1 Rider 48
• Directs DADS to consider factors such as length
  of time on the interest/waiting list, size of
  waiting list, demographics, average cost, and
  crisis stabilization in providing services to
  persons on waiting list on a program specific
  basis

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Rider 9Funding for ECI Services

• Directs DADS to certify by February 1 or each
  year to the Executive Commissioner of HHSC
  whether funding needed to serve all eligible
  children will exceed revenue available to DARS
• If transfer is necessary, HHSC shall submit a
  written request to the LBB and Governor providing
  substantial information
• All transfers require written approval of LBB and
  Governor

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Rider 12Limitation Transfer Authority for ECI
Strategies

• Directs DARS regarding transfer provisions among
  ECI strategies which may be made with
  notification to rather than approval from LBB and
  Governor

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Section 19IDEA, Part C, Special Education Grants
for infants and Families Stimulus Funds

• Authorizes DARS to utilize stimulus funding to
  provide temporary provider rate increases to ECI
  providers in the 2010-11 biennium, contingent
  upon
• Retaining current eligibility criteria
• Retaining no less than current service levels per
  child
• Agency attesting that a temporary provider rate
  increase will not create a need for supplemental
  funding or a transfer from another agency,
  including Rider 9
• Agency attesting it can reasonably and
  proportionately reduce or eliminate the temporary
  rate increase after stimulus funding is reduced
  or eliminated
• Use of funds is allowed by ARRA

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Rider 63Dual Diagnosis Pilot

• From funds appropriated authorizes HHSC to fund
  up to 75,000 per year to provide a grant to a
  non-profit organization to maintain a pilot
  project directed at enhancing the well being and
  care of citizens who are dually diagnosed with
  mental retardation and mental illness (San Angelo
  St. School project).

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Rider 67Fiscal Accountability for Programs for
Persons with Intellectual or Developmental
Disabilities

• Contingent on implementation of a rate
  enhancement system or other appropriate financial
  performance standards to ensure prudent use of
  funding HHSC is authorized to discontinue fiscal
  accountability spending requirements

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Section 18Mental Health and Mental Retardation
Collections for Patient Support and Maintenance

• Provides extensive instructions regarding
  definition of reimbursements covered, depositing
  and reporting revenues, authority and accounting
  for expenditure of collections, responsibility
  for share of indirect costs and benefits

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Section 19General Revenue Funds for Medicaid
Mental Health and Mental Retardation Services

• Directs appropriate use, classification and
  expenditure of GR

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Section 39Efficiencies at Local Mental Health
and Mental Retardation Authorities

• Funds appropriated shall be maximized by
  minimizing overhead and administrative costs and
  achieving purchasing efficiencies. Strategies for
  consideration include
• Consolidations among local authorities and
  partnering among local authorities on
  administrative, purchasing, or service delivery
  functions
• States intent DADS GR funds for community
  services are not to supplement rate-based
  payments to fund costs of providing waivers or
  ICF/MR services

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Section 48Contingency Appropriation for the
Reshaping of the System for Providing Services to
Individuals with Developmental Disabilities

• Sets forth conditions for funding outlined in IDD
  appropriations Table. Contingencies include
• Expansion of community services for individuals
  moving out of ICFs/MR, children aging out of
  foster care, children at risk of
  institutionalization in ICFs/MR and adults at
  risk of institutionalization due to crisis
• DADS reducing the number of state school
  residents through census management, without
  removing a resident against residents will or
  will of residents LAAE, and DADS identifying
  state school residents through the Community
  Living Options Information Process who could move
  into community programs and

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Section 48Contingency Appropriation for the
Reshaping of the System for Providing Services to
Individuals with Developmental Disabilities

• Transferring the case management function from
  HCS providers to local Mental Retardation
  Authorities (MRAs). Also requires HHSC and DADS
  to jointly design a plan to implement a capitated
  or non-capitated managed care pilot to serve
  individuals with IDD.

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Section 52Expansion of Community-based Services

• Summarizes appropriations made elsewhere in SB 1
  to expand community-based services

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Medicaid Billing Audits

• What are the recent findings and trends?
• What do we know?
• What do we not know?
• Discussion
• (Mel Hughes)

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In Home Family Support (1154 Funds)

• Strategies to assure all funds are distributed.
• Unique ideas from Centers.
• General Discussion
• (Mel Hughes)

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Conclusion

• Other issues/concerns we have not discussed.
• Information / clarification we need to obtain on
  legislative issues or other issues. Who will
  gather the info? By what timeline? And how will
  it be distributed to everyone?
• clucas_at_lubbockmhmr.org
• Melvin.Hughes_at_mhmrtc.org