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 Budget Highlights Accomplishments 2

Program Updates Home and Community Based Services Waivers Statewide Waiver Census - 6,336 Average Cost Per Person Per Day - $ Self Determination Waiver Census – 1,132 Average Cost Per Person Per Day - $53.80 Arlington Waiver Census Average Cost Per Person Per Day - $ Waiting list for intellectual disabilities waiver -7,130 3

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

Program Updates Developmental Centers Clover Bottom’s census is 38 with planned closure in May Greene Valley’s census is 119; however, 12 people will move to state- operated community homes in fiscal year Harold Jordan’s census is 6 of which 4 people are in the state-funded forensic program and 2 people are in the new ICF/IID funded program. This new 12 bed program for persons with significant behavioral and psychiatric challenges obtained ICF/IID certification in October This means DIDD will now be able to receive federal funding for these beds. The department will soon be admitting more people to this program. 5

6 Developmental Center Transition Cost Comparison Total Arlington Transition Cost FY2006 to FY $254.7 Million Total Clover Bottom Transition Cost FY2010 to FY $172.7 Million

Program Updates State Operated Intermediate Care Facility Homes West Region All 12 homes are operational. Current census is 46. East Region Total of 16 homes are planned. Thirteen are constructed with a current census of 51. Last 3 homes will open in fiscal year Middle Region Total of 9 homes are planned. Four homes are constructed and transitions from Clover Bottom are occurring. Current census is 2. One home is scheduled to be fully occupied by March 28 th. 7

Budget by Program (includes waiver funding within TennCare) 8 Home and Community Based Waiver Services (TennCare’s budget) $ 663,350,600 Developmental Centers 59,619,200 Administration & Regional Offices (including QA)58,067,100 Community Homes48,772,000 Community Services17,508,700 Resource Centers 6,307,100 Protection From Harm5,112,200 Council on Dev. Disabilities (CDD) 1,923,300 $860,660,200

Recommended Budget by Funding Source 9 DIDD State$25,651,100 Federal Revenue1,642,700 Current Services Revenue5,229,400 TennCare Revenue*145,639,500 Other Interdepartmental Revenue19,146,900 Total Recommended DIDD Budget (Volume 1, page B-169)$197,309,600 Waiver funding in TennCare* (not in DIDD’s Budget)$663,350,600 Total Funding for Programs Administered by DIDD$860,660,200 *TennCare funding includes $289,454,000 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.

10 DIDD Funding By Source

Base Budget Reductions DIDD Reductions - (Volume 2 pages 59 – 61)Pos.Total Reduction Council on Developmental Disabilities – Reduce cost of operation (Total State $24,100)--24,100 Centralization of Fiscal and Human Resources (Total State $74,200)-3-216,900 Intermediate Care Facilities & Developmental Centers – Match staffing with reduced census at Greene Valley and continue cost efficiency efforts at the state operated homes. This reduction in cost includes the reclassification of nursing positions at the West TN Homes. (Total State $1,747,800) -40-4,360,200 Miscellaneous Positions and Operating Expenses – Reduce positions and other operational expenditures in the central office (Total State $485,000) -5-1,418,500 Resource Centers – Reduce positions and other operational expenditures at the three resource centers located in East, Middle and West Tennessee (Total State $592,100) ,100 Community Services Contracts – Reduce budgeted contracts ensuring contractors supplement state staff efficiency (Total State $136,800) --278,600 Regional Office Staffing and Operational Expenditures – Reduce administrative positions and operational costs in the three regional offices in East, Middle and West including the elimination of the Arlington Court Monitor (Total State $1,306,800) -7-2,245,800 Total Base Reduction (Total State $4,366,800)-62-9,468,200 11

Base Budget Reductions Waiver Reduction in TennCare - (Volume 2, Page 39)Pos.Total Reduction New Waiver Cap – Institute an individual expense cap on all people enrolling into services beginning January 1, 2015 (Total State $79,800) --231,200 Total Waiver Reduction In TennCare (Total State $79,800)--231,200 Reductions Offsetting Cost Increases (Volume 2, Page 11)Pos.Total Reduction Community Services – State Funded Services (Total State $1,957,700)--1,957,700 West TN Regional Office – One long-term vacant position (Total State $16,700)-32,800 West & Middle Resource Centers – Assistive Technology Revenue (Total State Savings $726,500) -- Total Reductions Offsetting Cost Increases (Total State $2,700,900)-1,990,500 12

13 DIDD & Total State Position History

Cost Increases – Non-Waiver Programs Description - (Volume 1 Pages B-141 & B-142)Pos.Total Increase Middle TN Homes Transition – Non-recurring funds for the phased opening of four-person homes located in the community while phasing out operations at the Clover Bottom Developmental Center to be completed by May 2015 (Total State $1,713,500) 164,904,800 Community Homes Certification – Non-recurring funds for the first 30 days of operation prior to home certification (Total State $158,600) -- Developmental Disabilities Planning – Recurring funds for two state positions to assess the needs and to begin planning future programs for people with a developmental disability (Total State $183,900) 2183,900 Utilities – Recurring funds for utility expense at the Middle TN Regional Office after the Clover Bottom Developmental Center is closed (Total State $573,100) -1,042,100 Total (Total State $2,629,100)18$6,130,800 14

Waiver Cost Increases (TennCare’s Budget) Description - (Volume 1 Pages B-138 & B-139)Pos.Total Increase Waiver Programs – Net increase in the number of people receiving residential, day services, case management and therapies by 100 people projected to be enrolled due to their crisis status (Total state $2,456,700) -7,032,300 Waiver Rate Increase – Large Homes – 10% rate increase for five or more person group home residential services enabling providers to meet their costs so current residents may continue to choose to live in these homes (Total State $351,200) -1,005,400 Waiver Rate Increase – Targeted Services – Rate increase equivalent to 1% of the DIDD administered HCBS program targeted to services where providers struggle to meet their costs (Total State $2,215,300) -6,341,200 Total Waiver Cost Increases (Total State $5,023,200)-$14,378,900 15

FY Budget Highlights Increases the number of individuals receiving home and community based services by 100 Includes funding for 2 positions for developmental disabilities planning. Continues recurring funding for the Family Support Program at $7.4 million Allows for targeted rate increases in areas where providers struggle to meet their costs Reduces 100 authorized positions 37 positions at the Middle TN Homes for the conversion from state employees to contract employees 62 positions as part of the Department’s reduction plan 1 position as a reduction to offset cost increases 16

Accomplishments Completed the transfer of the licensing function from Mental Health to DIDD. Obtained ICF/IID certification in October 2013 to allow federal funding for 12 people at the Harold Jordan Center. Exited from the 21 year old Arlington Lawsuit. Completed the exit plan two months ahead of schedule. Completed centralization of several administrative functions. Completed construction of 4 homes in Middle TN. Transitions from Clover Bottom to these homes are now occurring. Staff completed training and began surveying private ICF/IID’s effective March 1 st. This function was previously performed by the Department of Health. Conducted extensive review and re-write of the DIDD Provider Manual. Continued efforts in the development of a new information system, Project Titan. Continued efforts to become the first accredited intellectual disabilities state system. 17