The Department of Intellectual and Developmental Disabilities Recommended Budget, Fiscal Year

DIDD FY Budget Hearing Program Updates Budget by Program Funding Source Estimates Budget Reductions Cost Increases Capital Budget Supplemental Request 2

Program Updates Home & Community Based Waivers  Statewide Waiver Census 6,240  FY2012 Average Cost Per Person Per Day $  Self Determination Waiver Census 1,132  FY2012 Average Cost Per Person Per Day $50.91  Centers for Medicare & Medicaid Services (CMS) recognized the waiver as a model of best practices.  CMS has just approved the renewal of this waiver.  Arlington Waiver Census 313  FY2012 Average Cost Per Person Per Day $  Waiting list for intellectual disabilities waiver services is 7,264 3

DIDD Waiver Census History 4 Census is as of June 30 th of each year.

Program Updates Developmental Centers  2% of the population served by DIDD is in developmental centers.  Clover Bottom’s census is 41 with planned closure in  Greene Valley’s census is 136; however, 12 residents will transition to state- operated community homes once constructed.  Harold Jordan Center’s census is 4. The department is making programmatic changes to enable greater use of the facility while also allowing the state to receive federal Medicaid funds. Presently, this center is 100% state funded. 5

Program Updates State Operated Intermediate Care Facility Homes  West Region  All 12 homes are operational.  Current census is 48.  FY2012 actual cost per person per day was $1,  East Region  Total of 16 homes are planned.  13 are constructed with a current census of 51.  Construction will begin soon for the last 3 homes.  FY2012 actual cost per person per day was $  Middle Region  Total of 9 homes are planned.  Lots have been purchased for 9 homes.  Construction has begun on 4 of these homes. 6

Program Updates Resource Centers Current Status: There are three resource centers operating in the three regions and providing the following services: assistive technology, occupational and physical therapy, speech and language pathology, dental, behavior analysis, and physical nutritional management. Proposed Changes: In the FY2014 budget, 35 positions are moved from the resource centers to the developmental centers where they provide services. Another 35 positions will be abolished. Middle & east resource centers are restructured leaving only assistive technology and dental services. The west resource center will continue to operate with a full array of services. 7

Home and Community Based Waiver Services (TennCare’s budget) $ 653,468,600 Developmental Centers 70,908,900 Administration, QA, Regional Offices 75,152,400 Community Homes 35,837,300 Resource Centers 6,256,500 Family Support 7,383,600 Council on Dev Disabilities 2,092,200 $ 851,099,500 8 Budget by Program (includes waiver funding within TennCare)

Recommended Budget by Funding Source DIDD State$28,727,300 Federal Revenue1,781,600 Current Services Revenue4,712,600 TennCare Revenue*146,858,900 Other Interdepartmental Revenue15,550,500 Total Recommended DIDD Budget (Volume 1, page B-199) $197,630,900 Waiver funding in TennCare* (not in DIDD’s Budget)$653,468,600 Total Funding for Programs Administered by DIDD$851,099,500 *TennCare revenue includes $279,555,000 in state matching funds. Direct services receive almost a $2 federal match for every $1 in state funds. Administrative expenses are matched at $1 for $1. 9

10 DIDD Funding By Source

Base Budget Reductions DescriptionPos.Total Reduction Base Budget Reductions (Volume 2, pages ) Centralization of Human Resources and Fiscal Services-9-274,700 Harold Jordan Center Programmatic Changes – Obtain intermediate care facility (ICF) certification for 12 beds (Total state reduction of $1,945,500) -43,400 Printing - Utilize copiers instead of printers (Total state reduction $42,300)-64,200 Greene Valley Developmental Center – Staffing and professional services contracts (Total state reduction $274,800) ,800 Central Office - Staffing, contract services and other operating expenses (Total state reduction $497,100) -6-1,112,500 Regional Office – Staffing, contracts & leased space (Total State reduction $1,541,600)-35-2,739,500 Community Services Contract – Pre-Admission Screening and Resident Review contract (Total state Reduction $46,100) -184,400 Resource Centers –Restructure leaving only assistive technology & dental services in middle and east (Total state reduction $424,700) -35-7,215,300 Community Homes – Staffing, leased space, contracts & supplies (State reduction $171,700) ,700 Total Base Reductions ,954,500 11

DIDD & Total State Position History 12

Core Services Continuation and Cost Increases DescriptionPos.Total Increase Core Services Continuation (Volume 1, page A-50) Family Support Program – Provides non-recurring funds to assist families with a developmentally disabled family member. These funds are in addition to the $4,702,100 in recurring funds within the base budget bringing the total funding for Family Support to $7,383,600. -$2,681,500 Total Core Services Continuation-$2,681,500 Cost Increases (Volume 1, page B-162) Clover Bottom – Non-recurring funds for the temporary continuation of operations at Clover Bottom until community homes are built. Funded as interdepartmental revenue from TennCare and is comprised of $1,309,200 in state appropriation and $2,306,600 in federal revenue. -$3,615,800 Middle TN Homes Certification – Non-recurring funds for the first 30 days of operation during which time the department cannot bill TennCare. Increase in state appropriation of $241,200 and decrease in interdepartmental revenue of $241, Arlington Lawsuit Exit Plans – Provides funds that will allow the state to exit the Arlington lawsuit by December 31, Includes 11 positions for an intermediate care facility (ICF) survey team, 4 positions for an enrollment team and 1 position for lawsuit compliance. Also includes $866,300 in recurring state funded services for the at-risk expansion. 16$1,584,300 Total Cost Increases16$5,200,100 13

Waiver Cost Increases (TennCare’s Budget) DescriptionPos.Total Increase Cost Increases in TennCare’s Budget for DIDD Waivers (Volume 1, page B-159) HCBS Waiver Programs – Provides recurring funds for growth in enrollment and costs in the home and community based services waiver programs. Allows for 550 enrollments and 454 dis-enrollments for a net growth of 96 people from July 1, 2012 to June 30, ($4,448,200 state and $8,445,100 federal) -$12,893,300 Arlington Lawsuit Exit Plan – Provides recurring funds for home and community based wavier services for an additional 182 people who are part of the at-risk expansion and 9 people who will transition from nursing homes to community services. ($10,823,300 state and $20,548,500 federal) -$31,371,800 Total Home and Community Based Services Cost Increases-$44,265,100 If these cost increases are approved, total funding for the home and community based waivers will be $653,468,600 and will include funding for a 287 person program expansion. All waiver funding resides in TennCare’s budget. 14

DIDD History of Expenditures Millions 15

DIDD History of People Served 16

17 Capital Budget DescriptionProject Cost Capital Maintenance (Volume 1, page A-171) Greene Valley - Upgrade power to two cottages; replace air handling units in the central services building and four cottages; replace the chiller in the resource center building; and replace the roofs on eleven cottages and the gymnasium $3,620,000 Arlington Campus - Replace the HVAC systems and demolish the existing cooling tower; replace the current energy management system controls; and convert the air handler system to a variable volume system 2,800,000 Total Capital Maintenance$6,420,000 Capital Projects (Volume 1, page A-165) Harold Jordan Center Renovations$2,850,000 Arlington Developmental Center – Cottages Demolition (Exit plan requirement)2,350,000 Ruilman Center Renovations720,000 Total Capital Projects$5,920,000 Total Capital Outlay$12,340,000

Supplemental Appropriations (Volume 1, page A-32) Arlington Lawsuit Exit Plan $569,400 Total Funding $300,000 State in TennCare’s budget for DIDD 16 positions 11 for an intermediate care facility survey team 4 for an enrollment team 1 for lawsuit compliance FY2013 Supplemental Request 18

 Allows for enrollment growth of 287 people in home and community based services.  191 people as part of the Arlington lawsuit exit plan  96 people associated with normal growth in the waivers  Continues funding for the Family Support Program at the FY2013 level of $7.4 million.  Provides funding for the temporary continuation of operations at the Clover Bottom Developmental Center.  Reduces 120 authorized positions (54 are estimated to be vacant).  Facilitates programmatic changes at the Harold Jordan Center which allows for the collection of Medicaid funding.  Provides for capital project maintenance and improvements. FY2014 Budget Highlights 19