1 Division of Disability & Rehabilitative Services Andrew Ranck, Director of Initiatives OASIS Statewide Tour Spring 2008

2 Agenda OASIS Forum list OASIS –why it is happening Activities to date – Rate Setting, Service Planner reconciliation in District 4 What is coming – Day Program Rates Best practices – what is this is Resource Allocation Tool Future – April, July benchmark dates Q & A

3 DateCityTimeRoomLocation Thursday March 20, 2008 Greencastle 2:00pm – 4:00pm and 6:00-8:00pm Pulliam Center for Contemporary Media Watson Forum DePauw University 313 South Locust Street Greencastle, IN Tuesday March 25, 2008 Merrillville 2:00pm – 4:00pm and 6:00-8:00pm Check in at Front Desk Indiana Wesleyan University 8415 Georgia St. Merrillville, IN Wednesday March 26, 2008 Fort Wayne 2:00pm – 4:00pm and 6:00-8:00pm Main Meeting Room Lower Level League for the Blind & Disabled 5821 S. Anthony Blvd. Fort Wayne, IN Friday March 28, 2008 South Bend 2:00pm – 4:00pm and 6:00-8:00pm Check in at Front Desk Ivy Tech Community College 220 Dean Johnson Blvd. South Bend, IN Wednesday April 2, 2008 New Albany 2:00pm – 4:00pm and 6:00-8:00pm Strassweg Auditorium New Albany Public Library 180 West Spring St. New Albany, IN Thursday April 3, 2008 Indianapolis 2:00pm – 4:00pm and 6:00-8:00pm Irvington Branch Irvington Public Library 5625 E. Washington St. Indianapolis, IN Tuesday April 8, 2008 Evansville 2:00pm – 4:00pm and 6:00-8:00pm Red Bank Branch Evansville Public Library Red Bank Branch 120 S Bank St. Evansville, IN Thursday April 10, 2008 Indianapolis 2:00pm – 4:00pm and 6:00-8:00pm Wayne Branch Wayne Library Branch 198 S. Girls School Rd. Indianapolis, IN * Friday April 11, 2008 Richmond 2:00pm – 4:00pm and 6:00-8:00pm Check in at Front Desk IVY Tech College 2357 Chester Boulevard Richmond, IN OASIS Forums

4 O bjective A ssessment S ystem for I ndividual S upports O-A-S-I-S:

5 THE SITUATION Today PEOPLE WITH SIMILAR NEEDS HAVE VARIED ACCESS TO SERVICES BECAUSE THE AMOUNT OF SERVICE YOU GET DEPENDS ON: 1.WHEN you requested service 2.HOW MUCH money was available 3.WHAT services were available

6 The Future - OASIS PRINCIPLES & VALUES Person - Centered Planning Self - Directed Choice FAIRNESS & EQUITY Refine Individual Resource Allocation process Connect to Personal Outcomes Connect to Provider Reimbursement PREDICTABLE AND STABLE FUNDING Balance quality, utilization, cost, and access

7 Goal of OASIS Create a uniform funding model to determine fair and equitable levels of State support based on an Objective Assessment and driven by Person Centered Planning (PCP) and Individualized Support Plan (ISP)

8 OASIS Goals The Funding Model: Establish a standard model for allocation of the States resources whereby individuals with similar needs will be able to receive similar services/supports Create a model that results in a specific annualized funding amount that is available to the individual and their team for service planning purposes

9 OASIS Goals Funding Model (Continued): Incorporate a funding mechanism for thoseindividuals who are identified as outliers Provide a consistent system that will support a network of provider agencies that is financially viable and able offer an array of relevant services

10 OVERVIEW OF APPROACH FIVE STEPS FIVE STEPS: Information- completed 1.Collect Information- completed BASELINE Build data & policy BASELINE (3 months) How Much 2.Figure out How Much people need TOOLS Build TOOLS (3 months) Make Sense – in-progress 3.See if the TOOLS Make Sense – in-progress SHADOW SHADOW the Tools (6 months) TOOLS WORK – in-progress 4.See if the TOOLS WORK – in-progress PILOT PILOT rates and individual allocations (6 months) 5.IMPLEMENT 5.IMPLEMENT (18 months) – July 1, 2008

11 Pilot Rate Schedule BDDS District 4 P I L O T The following rates will be applied to agencies providing Home and Community-Based Services (HCBS) in the Bureau of Developmental Disabilities Services District 4. The Rates will be effective on the following dates: January 1, 2008: 1. Residential Habilitation Support Services (RHSS) 2. Adult Foster Care (all levels) 3. Respite Care 4. Behavior Management (single rate upon promulgation of administrative rule) April 1, 2008: 1. Day Habilitation 2. Supported Employment (all tiers) 3. All Other Therapies

12 Rates Piloted in Jan Service TypeUnit Total Rate Residential Habilitation Support Services (RHSS)Hour$23.74 Adult Foster Care (moderate supervision) IDay($48.47) $51.87 Adult Foster Care (high supervision) IIDay$75.67 Adult Foster Care (intensive supervision) IIIDay$ Behavior Management Services (single rate after rule review) B- man II 15 Minute$20.32 Behavior Management Services (single rate prior to rule review) B-man II 15 Minute$18.20 Behavior Management Services (single rate prior to rule review) B-man I 15 Minute$18.20 Respite Care (all services)Hour$19.45 All Other TherapiesNo change

13 RHSO Pilot Activity January 2008 $3.3 million invoiced ( this is high due to duplicate invoices being created) $3.1 million paid in claims (80% of approved CCBs) $3.8 million in approved CCBs Jan paid approximately $3.3 million in BDDS District 4

14 Decisions to Date Use of the Invoicing tool is mandatory SSW participants will receive an ICAP, will not experience the OASIS model DD & Autism Waiver participants will transition to OASIS at the time of their annual review beginning July 2008 (789) All billing will be based on direct care staff hours Nursing Respite will be available

15 DDRS has determined that the Resource Determination Tool will generate an annual allocation amount and recommendations of service mix. The team will determine whether to follow the recommendation Waiver specialist will look for identification of day services in the plan Service authorization for billing for RHSS & Day Services will be forwarded to EDS on a 3 month basis for pilot only. Other services (for example therapies, Respite) will receive longer authorization limits Decisions to Date (Continued)

16 Decisions to Date (Continued) Sleep Time is not an approved waiver habilitation service. It cannot be billed as an RHS service A recommendation has been made that an audit template is not required. DDRS will provide documentation requirements from CMS Providers will have payroll records available for audit to support services billed The Waiver program will not reimburse for sheltered work

Day Program PROVIDER RATES

18 Day Habilitation Rate Assumptions Full Program Year: 260 days Consumer Absence: 11 days / 4% factor Non-Allowable Expenses: building-related expenses, workshop expenses, consumer wages, depreciation, fund raising expenses, production expenses Direct Care Wages & Benefits: parity with RHSS Supported Employment: 3 tiers (5 hours / 10 hours / 15 hours per month) & hourly rate after 15 hours per month

19 What is in a Rate? Cost FactorDay Habilitation Residential Habilitation DCS WAGE$10.27 Days-Upper Limit Vacancy Factor96% Billable Days Adjusted for Consumer Leave ERE38.8% PR26.6%27.7% G&A10%10.0% TOTAL RATE $23.26 facility $23.74 community $23.74

20 Rates to be piloted April Service TypeUnit Total Rate Day Service Program – Community (1:4 ratio for group) Hour$23.74 Day Service Program – Facility (1:8 ratio for group) Hour$23.26 Pre-voc 1:12 ratioHour$23.26 Individual Supported Employment (individual full time) TIER 1 (1-5 hrs per month) Month$ Individual Supported Employment (individual full time) TIER #2 (6-10 hrs per month) Month$ Individual Supported Employment (individual full time) TIER #3 (11-15 hrs per month) Month$ Individual Supported Employment (Exception over 15 hrs per month) Hour$35.19 Respite Nursing Care – will be available Quarter hour$7.79

Best Practices Group

22 Key Points Purpose: Establish a benchmark group to calibrate OASIS factors Process / Actions To Day: 1. Collect pre / mid / post outcome data and verify 2. Track amount of services planned and delivered during pilot 3. Develop benchmark service standards and connect cost factors 4. Apply service standards to District 4 consumer plans 5. Project impact

23 Key Points Future Actions: 1. Collect mid project outcome data with focus groups and data collection tools – April Provide OASIS amounts and test validity / variation – April Fine-tune benchmark service standards – June Finalize OASIS – July Continuing review and revisions – December 2009

24 What are the Best Practice conditions? Personal Health Safety & Freedom from Harm Stable Home Sufficient Personal Finances Satisfaction & Inclusion

25 Comparative Data 1.The demographic characteristics of Best Practice consumers are similar to general District 4 consumers. 2.Best Practice and general District 4 consumers have similar ICAP scores 3.Best Practice consumers use less behavioral management services 4.Best Practice consumers use more RHSS and CHIO, and less Sheltered Workshop services 5.Slightly more Best Practice consumers live with their families (31% versus 27%) 6.Best Practice RHSS utilization has increased the OASIS benchmarks.

26 Comparative Data Distribution by Waiver Type of Waiver Best Practice Group District 4 Consume rs Percent Sample BPG distributi on District 4 distributi on DD Waiver Consumers %70.8%61.8% SSW Consumers %27.1%33.5% Autism Waiver Consumers %2.1%4.7% TOTAL IPMG Plans %100.0%

Resource Allocation Tool

28 COST DRIVER ASSUMPTIONS People use similar amounts of services in very different ways Determining how much paid staff support is needed is more important than why it is needed. People and families are the best predictors of the amount of service needed. Historical costs dont always predict need.

29 ICAP Assessment Information Arbitre was hired as an independent party to perform the assessments Agreement to complete 4000 in first year (2007) and 6000 in second year (2008) 4601 completed to date All of BDDS District 4 completed prior to start of pilot

30 What will OASIS give the Consumer 1.Gives a view of typical costs and services for people with similar needs 2.GUIDELINES for planning rather than ultimatums 3.Connected to BEST PRACTICES 4.Flexibility and choice within allocation

31 OASIS Factors The primary predictors of cost for a consumer are: age, living situation (whether with family, alone or roommates), and Behavior intensity and frequency, employment. The additional predictors of cost for a consumer are: the ICAP scores, additional need for family support, visual impairment, and Health intensity and frequency The OASIS tool can predict 80% of our population.

32 OASIS Allocation Assumptions Any person approved for a waiver will receive at a minimum $13,500 up to a maximum of $173,300 for an annual allocation Any person needing additional funds will be handled on a case by case basis. The team will work to establish the plan and determine how to best utilize the allocation amount.

33 Interactive Budget Tool Web Based Interactive Budget Tool Provides a private secure, place for resource planning Available for all stakeholders All team members can use for planning pre/post annual date Available for consumer and advocate testing April 17 th & 18 th 2008 Working with the ARC of Indiana to establish BETA Groups (up to 40 participants)

34 Future Activities Day Service Rates- Rollout on 3/24/08 & POC/CCB pilot 4/1/08 Multiple providers will be allowed on the POC/CCB Direct linkage of the Invoicing tool to EDS DDRS is exploring pay for performance for providers

35 OASIS-ICAP Help Lines: OASIS Website: Resources: