SJI and DUII Utilization Review

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SJI and DUII Utilization Review

• December 1, 2009

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How are we doing in SFY 10?

• The Client Limits implemented in July of 2009
  have successfully managed short-term residential
  and detoxification lengths of stay
• Nonetheless, residential service expenditures
  (short-term and detox) have continued to rise
• Increased number of clients receiving residential
  services
• Increased average cost per client

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SJI FY 2009 DATA REVIEW
61 of SFY 09 Expenditures were for residential
Treatment
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SJI FY 2010 DATA REVIEW
78 of First Quarter SFY 2010 SJI Expenditures
were for residential Treatment
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Comparison SJIFY 09 and FY 10 Quarter 1
Outpatient
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Comparison SJIFY 09 and FY 10 Quarter 1
Residential
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Comparison SJIAdolescent and Adult Expenditures
FY 09
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Sustainability of the SJI in SFY 2010

• If residential service utilization (client volume
  and cost per client) continues at the current
  rate, SJI funds will be fully expended before the
  end of the fiscal year
• Action is required now to continue access
  throughout the year
• Expended 1.1 million in first quarter of SFY 10
• Obligated 593,000 for first two months of the
  second quarter
• Current rate of expenditure is 400,000 per
  month.
• By December there will only be enough funds to
  spend 140,000 per month

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DUII FY 2009 DATA REVIEW
64.6 of SFY 09 DUII Expenditures were for
residential Treatment
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DUII FY 2010 DATA REVIEW
70 of First Quarter SFY 2010 DUII Expenditures
were for residential Treatment
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Comparison DUIIFY 09 and FY 10 Quarter 1
Outpatient
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Comparison DUIIFY 09 and FY 10 Quarter 1
Residential
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DUII Initiative Spending

• The average monthly expenditure required to
  remain within budget is 593,000
• Currently DUII spending at a monthly rate of
  501,000
• Action not required immediately. If rate of
  spending increases action will be needed to
  continue access throughout the year
• Residential expenditures continue to be an
  increasingly larger portion of funding

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GOAL for moving forward

• Our goal is to implement clinically sound and
  fiscally responsible utilization management
  guidelines that will ensure continued client
  access to resources throughout the year

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Utilization Management Options

• Limit Length of stay
• Cap of clients by month
• Cap expended monthly
• Cap providers expenditures
• Cap services by treatment modality
• Require all clients to be assessed by outpatient
  provider before being referred to residential
  services
• Set aside for adolescents

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Options South Jersey County Directors discussed
for SJI

• Limit length of stay
• Cap Funding Monthly
• Require all clients to be assessed by outpatient
  provider before residential
• Set aside funds for adolescent

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Utilization Options discussed at Stakeholder
Meeting 12/1/09

• Cap residential services
• Suboxone ambulatory detox integrated with
  residential tx to avoid residential detox costs
• SJI fund MD visit for the Suboxone detox
• Narrowing network of the SJI to southern
  providers only
• Dual or Flexible Licensure at Provider agencies
  to allow for more fluid movement between levels
  of care
• Track and make decisions based upon client dx
• Change the age of eligibility for SJI thereby
  decreasing the number of clients eligible
• Develop a set aside for Adolescent treatment

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Options from 12/1/09 cont.

• Assess clients at outpatient provider before any
  residential stay (exclude emergency detox)
• Ensure that DYFS funds are used before SJI funds
• Further limit length of stay guidelines
• Approval of extensions to LOS in smaller
  increments
• Use mechanisms that are more specific in the
  short term to keep spending within the yearly
  budget(s)
• Cap by month
• No new clients
• Provider caps
• Caps by level of care
• Start charging co-pays (DAS to explore the fees
  in FFS)
• Change fiscal income eligibility for clients

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Input on Next Steps

• Short Term December 2009-June 2010
• Long Term