State Rates Advisory Committee: Children’s & Transportation Rate Update April 2006 State of Montana Helena, Montana Davis Deshaies, LLC

2 CHILDRENS RATES DISCUSSION:

3 CURRENT CHILDREN’S SYSTEM 1. Single Blended Rate 2. Family Cost Plan 3. Managed Care: provider assumed risk

4 NATIONAL TRENDS 1. Transparent / unbundled rates 2. Increased family control & choice of providers and services 3. Limited Provider ROI 4. Focus on integration with other federal funding sources (e.g. CWS, DVR, schools, Headstart, No Child Left Behind, TANF, Medicaid State Plan services) 5. Increased emphasis on children with select diagnoses (e.g. autism, dual diagnoses) 6. Seamless transition from school to adulthood

5 CURRENT MENU OF CHILDREN SERVICES Service Percent of Children receiving Service Percent of DDP Funds spent on Service Family Support Specialist 100%42% Residential Habilitation (Non-facility based) 80.1%24.9% Respite 90.9%22.4% Day Habilitation 14.8%0.1% (except: 7.2%) Therapies / Homemaker 9.7%0.1% (except: 8.0%) Transportation 32.5%0.1% Environmental Mods. / Equipment 30.2%4.7%

6 Family Support Specialist Study Davis Deshaies, LLC TASKSample 1Sample 2Difference Assessment/ Information10.44%12.65%2.21% Travel11.50%12.66%1.16% Education/ Training15.80%17.73%1.93% IFSP Development25.04%21.55%-3.49% Habilitation3.71%3.96%0.25% Personnel Recruitment/ Supervision 5.08%3.81%-1.27% Support Coordination11.61%12.17%0.56% Administrative Functions (includes leave time) 16.83%15.47%-1.36% Number of FSS Responders95 81

7 Children’s Rate Assumptions 1.Family Support Specialists caseload may up to 1 FSS to 16 Families 2.Family Education & Training is a separate hourly rate 3.Residential Habilitation is divided into two types of service: Direct care service reimbursed on an hourly basis Individual training materials (up to $1,000 per year) 4.Respite Care is divided into two types of service: Direct care service reimbursed on an hourly basis Individual care materials (up to $1,000 per year) 5.Day Habilitation is reimbursed on an hourly basis 6.Therapies are reimbursed on an hourly basis

8 Children’s Rates – Family Support Specialist Cost Center Cost Factor Direct Care Salary$15.14 Employee-Related Expenses40.13% Program Related Expenses32.0% General & Administrative11% TOTAL HOURLY RATE $35.06 hour MONTHLY RATE $368 / month

9 Children’s Rates: Published Rate Schedule ServiceRate Family Support Specialist $368 per month Family Education & Training $35.06 per hour Residential Habilitation (non-facility direct care) $17.19 per hour Residential Habilitation (individual training materials) $1,000 per year Respite Care (direct care) $12.96 hour Respite Care (individual care items) $1,000 per year Day Habilitation $17.84 per hour Therapies State Plan hourly rate

10 Children’s MONA Assumptions 1.Children who are14 years or older will have MONAs 2.Children under 14 years will be screened using: Presenting behavioral or autism diagnoses Presenting medical care needs Intensity of Family support needs 3.Individual Cost Plans (ICP) will account for ALL funds to include administrative costs

11 Next Steps: Children’s Services TaskResponsibilityTimeline 1. Step #1: Shadow Published Rates and determine fiscal and operations impact All Children’s providers May - September Step #2: Complete MONAs and Child Assessments for Regions I & II Regions I & IISeptember Step #3:Pilot Published Rates in Regions I & II; extend other provider contracts Region I & IIOctober Step #4: Complete MONAs and Child Assessments for ALL Regions All RegionsJanuary Step #5: Implement statewide for ALL providers All RegionsJuly 2007

12 Recommendations 1. Establish Family & Legislative Oversight work group 2. Independent Quality Assurance & Evaluation 3. Attend to HCBS Waiver definitions and service options 4. Independent resource allocation process

13 TRANSPORTATION RATES Status Update:

14 Transportation Rate Assumptions 1. Travel Zones 2. Shared Expenses 3. Mileage Rates

15 Transportation Rates Assumptions & Findings Travel Zones: Each person is assigned into one of 3 zones based upon the amount of NON-DAY PROGRAM travel per YEAR Zone 1 = 8,580 miles (50% of population) Zone 2 = 11,700 miles (30% of population) Zone 3 = 13,520 miles (20 % of population) Special Need = (10% of population); assumes three Zone distribution (50%, 30%, or 20%)

16 Transportation Rates Findings Travel Zones: REGION II Survey ASSUMPTION SURVEY FINDING ZONE 1 50%89% ZONE 2 20%0% ZONE 3 20%5% SPECIAL NEEDS 10%6%

17 Mileage Rate Assumptions Mileage Rate: mileage is priced at $0.35 per mile Special Need: people needing wheelchair vans are priced at $0.45 per mile

18 Next Steps: Transportation TaskResponsibilityTimeline 1. Step #1: Identify medically-related travel which is Medicaid State Plan reimbursable Region II / Case Managers / Providers May 5, Step #2: Adjust mileage zone assignments without medically- related travel Region II Providers May 5, Step #3: Recalculate mileage factors (increase from $0.35/mile) Davis DeshaiesMay 12, Step #4: Assign mileage zones to Individual Cost Plans DDP Central Office; Davis Deshaies June 1, 2006