Presentation on theme: "New Jersey Department of Human Services"— Presentation transcript:
1 New Jersey Department of Human Services Division of Developmental DisabilitiesJohnston, Villegas-Grubbs and Associates LLC (JVGA)Rate Construction for New Jersey Developmental Disability Services July 18, 2014
2 Agenda 10:00 am - 12:00 pm 12:00 pm – 1:30 pm 1:30 pm – 3:00 pm Welcome and AcknowledgementsElizabeth M. Shea, Assistant Commissioner, NJ Division of Developmental DisabilitiesRate Setting PresentationJVGA TeamThomas Papa, Chief of Staff, NJ Division of Developmental DisabilitiesSubmission of Questions12:00 pm – 1:30 pmLunch Break1:30 pm – 3:00 pmReview of Questions
3 The Conversion to Fee for Service: Key Questions Why are we converting to Fee for Service (FFS)?Why do we need a standard rate schedule?How will FFS work?How does FFS fit in with the other reforms?When will the conversion to FFS take place?What else needs to happen to implement FFS?
4 Principals of Rate Architecture Fairness and EquityPortabilityAffordabilityReformSimplicity and Practicality
5 The Rate Setting Project: Background Role of Advisory CommitteesRole of Other StakeholdersData Collection and Analysis: GLs and CallsThe Committee MeetingsBudget Work
6 Basis of the Rate: Four Components of “THE BRICK”™ Direct Care Staff WageStaff time to deliver service (based on BLS assumption inflated to January 2015)The BLS category chosen varies by service and provides the basis of each rate as closely as possible
7 Basis of the Rate: Components of “THE BRICK”™ Employment-Related ExpendituresCombination of discretionary (health benefits, retirement, etc.) and non-discretionary costs (unemployment, social security, workers compensation, etc.)Each General Ledger provided to JVGA was analyzed to arrive at a 39% factor
8 Basis of the Rate: Components of “THE BRICK”™ Program SupportExpenditures needed to support consumers that are not assignable to a single consumer (supplies, supervision, equipment, training)These percentages vary by serviceAcuity differentiated rates may have higher Program Support percentages due to the increased need for staff supervisionTraining & staff recruitment costs were included in this component based on Committee recommendations (as opposed to G/A)
9 Basis of the Rate: Components of “THE BRICK”™ General and Administrative (G/A)Costs of doing business that are common across all industries (Legal and Accounting, Administrative salaries, etc.)G/A is calculated as a percentage of the cumulative total of Direct Care Staff Wage, Employment Related Expenditures and Program SupportAn analysis of the current DDD provider inventory indicates that, on average, G/A is being applied at 10.5%In most federal programs, G/A is typically applied in the 10% rangeBased on input from the Advisory Committees and other stakeholders, JVGA recommends a 12% G/A factor in the rate structure.
10 Developmental Disability Services: Rates Scope of work included all DDD waiver services – both Community Care Waiver and Supports ProgramThe only exception is the CCR modelServices fall into four categoriesExisting and Re-engineered servicesNew ServicesServices still under constructionServices where there is no standard rate to be set
11 Existing and Re-engineered Services Developmental Disability Services: Service Categories for Rate ConstructionExisting and Re-engineered ServicesDay Habilitation, Respite, Individual Supports, Supported Employment, Support CoordinationNew ServicesBehavioral Supports, Career Planning, Cognitive rehabilitation Therapy, Community Based Supports, Community Inclusion, Interpreter Services, Physical Therapy, Prevocational Training, Speech Therapy
12 Services that are still under construction Developmental Disability Services: Service Categories for Rate ConstructionServices that are still under constructionTransportation, Supports BrokerageServices where there is no standard rate to be setAssistive Technology, Case Management, Community Transition Services, Environmental Modifications, Fiscal Intermediary, Goods and Services, Natural Supports Training, PERS, Vehicle Modifications
13 Remember… The Rate Sheet Walk Through There are different rate structures The billable unit also needs to be consideredRemember…
14 Other Key Assumptions Related to the Rate Setting Project Demographic DifferentialStudied the need for differentials based on geographic characteristics, size of provider, and offsets.JVGA concluded that one standard rate can be used statewide and ensured that these issues were factored into the sample
15 Other Key Assumptions Related to the Rate Setting Project Acuity DifferentialStudied the need for an acuity differential to account for the higher costs associated with serving individuals with significant medical and/or psychiatric needsThis differential is only applied in cases where specialized staff, usually with higher credentials, is necessary based on assessmentApplication of the differential is used to address the need for a higher level of a particular service, not more staffing hours
16 Other Key Assumptions Related to the Rate Setting Project HousingCurrent contract funding (~$75M) was set asideApproach will be two-fold:Existing residential placements - combination of (1) Service Funding (FFS, rate model), (2) Contribution to Care (SS, through rep payee), and possibly (3) DHS housing subsidy (used to help bridge gaps)New placements - long-term goal is to collaborate with the community to build a housing model that is sustainable and can be supported via Service Funding and Contribution to CareWith rates now available for modeling, this will be an area of immediate discussion with the community and the new DHS Housing Unit (to determine both process and criteria around any potential use of subsidy)
17 Other Key Assumptions Related to the Rate Setting Project TransportationFor licensed settings (GH, SA), the value of transportation has been added as a factor to the Individual Supports rateTransportation needs will be met by residential provider, except where transportation is factored into the rate for another serviceFor all others, transportation will be billed primarily on a mileage reimbursement modelParking and tolls includedFurther discussion is needed
18 Other Key Assumptions Related to the Rate Setting Project RespiteThere are significant variations in this service within our current systemService definitions and provider qualifications between waiver programs will be alignedFurther collaboration with families and providers will be needed to line up current programs and services with the upcoming FFS modelReminder: CCRs not included in this rate projectImportant takeaway: There is no habilitation component in respite
19 Other Key Assumptions Related to the Rate Setting Project Self HiresNeed to finalize list of services for which self hires will be an optionRates are equal but components of rate will need to be utilized to compensate the FIRFP for DHS FI issued 6/23/14; bidding closes 8/12/14
20 Key Recommendations with Stakeholder Input Individual Supports (Blocking)Self HiresTransition Period / Banding the LossG/ATraining & Recruitment costsInflation adjustment of BLS wage assumptions (2015)Parking and tolls included in transportation rate5% Absence FactorAcuity Levels*
21 Future Rate Influences Data collection/utilizationAs data improves, the system improvesAdvocacyTransparency = opportunitiesAffordable Care Act (ACA)There are some things that we know can happen but we cannot measure their effect
22 Final Decisions Blocking Assumptions Transition Period / Banding the LossComponents of the BrickBLS Assumptions (including inflation adjustment)EREProgram Support %General and Administrative %
23 Upcoming Discussions Housing policies and licensing regulations NJCAT Crosswalk: Service Access & Acuity FactorOut of Program DaysTransportationRespiteSupports Brokerage
24 Using Rates in a Fee for Service System What does it meanFor ProvidersFor FamiliesFor Consumers
25 Wrap-Up and Next Steps Timeline / FFS Implementation Schedule Upcoming Policy meetingsWebinars / Stakeholder conference callsA FFS dedicated web page and Helpdesk will be in place beginning in August 2014.
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