Residential Rate Proposals Department of Medical Assistance Services and Department of Behavioral Health and Developmental Services Interagency Workgroup July 25, 2011

2 Short-term Goals n Support smaller group homes n Provide additional funding for individuals with very high needs who are more challenging to serve in the community

3 Rate Initiatives n Congregate Residential –Increase rate for group homes with 4 beds or less –Maintain rate for group homes with 5 beds or more –Possibly lower rate for Sponsored Residential n New “exceptional” rate differential for Congregate and In-Home Residential

4 Increase Rate for Group Homes of 4 Beds or Less n Group homes of 4-beds or less are more desirable, but may not be economically feasible n In 2007, DBHDS recommended 25% increase n Assumption that group homes of 5 and 6 beds are economically feasible at current rate n 25% rate increase results in the same revenue as a fully occupied 5-bed group home or 17% less revenue than a fully occupied 6-bed group home n Higher rate will incentivize smaller group homes –Only 42% of current group homes are licensed for 4-beds or less –However, many more may be de-facto 4-bed group homes because occupancy rate is only 66%

5 Group Home Statistics Bed RangeNumber of Group Homes Licensed Beds , ,293 7 and more1851,596 Total1,0295,419 n 3,583 waiver individuals in group homes n 66% occupancy rate

6 Rate for Group Homes of 4 Beds or Less n Increase current Congregate Residential rate 10% to 25% for group homes of 4 beds or less –Assume all 5-bed group homes convert to 4-bed group homes –Assume 50% of group homes with 6 beds or more convert to 4-bed group homes –Assume all new group homes are 4 beds or less

7 Sponsored Residential n 820 waiver individuals in Sponsored Residential n Currently pay same rate as group home even though this model is not the same as the group home model –DBHDS has evidence that this model is less expensive to operate –Other states pay less for this model n Reduce Congregate Residential rate 10% to 25% for sponsored residential –Do not want to disincentivize this model

8 Exceptional Rate Differential n Assume that the number of authorized hours reflects to some extent the needs of a waiver individual n But a small percentage may need additional service –3% - 5% of current waiver members and those on waiting list –15% - 20% of training center residents n Possibly two levels (assume very small number qualify for level two) n Available for Congregate Residential (4-beds or less), Sponsored Residential and In-Home Residential (ID and DD waiver)

9 Number of Authorized Hours Varies by Need Distribution of Authorized Hours per Week PercentileSponsored Residential Group HomeIn-Home Residential Average Top Four Percent

10 Percent Who Qualify for Exceptional Rate May Vary by Service Residential ServicePercent of Members with SIS Level 6 Sponsored Residential12% Group Home9% In-Home 3%

11 Fiscal Impact n Proposals are contingent on funding authorized in a budget amendment n Significant fiscal impact for existing waiver n Will add to the cost of new waiver slots n Proposals could be phased in

12 Fiscal Impact – Congregate Residential n Estimated cost increase for existing waiver population is $16.2 to $40.4 million ($8.1 million to $20.2 million in state funds) n Will increase the cost of new slots –Waiting list population –Training center population

13 Fiscal Impact – Exceptional Rate Differential n Base rates to be determined n Criteria to qualify for the exceptional rate to be determined n Required services for the exceptional rate to be determined