1. Conversion of Contract Reimbursement to Medicaid Fee for Service Model: National and New Jersey Experiences
Dan Keating, PhD, Executive Director ABCD
October 16, 2017
Community Access Unlimited
Alliance for the Betterment of Citizens with Disabilities

2. Chronology 2013 Rate Setting Process Initiated Consultant engaged
Advisory Work Groups formed/convened
Assessment tool (DDRT) identified
Draft Service Definitions Published
Provider Workshops
CCW Renewal Submitted to CMS
Alliance for the Betterment of Citizens with Disabilities

3. Chronology 2014: Results of Consultant General ledger Study
Demographic/Geographical Differentials
Acuity
Band the Loss
Final Report/Rate Unveil
Fee for Service Rate Utilization
CCW Renewal Extensions
Alliance for the Betterment of Citizens with Disabilities

4. Chronology
2015
Comprehensive Waiver (1115) Amendments submitted to CMS
Tiering Introduced/Rate Schedule Published
NJCAT Tool Developed/Assessments commence
Support Program Commences/Draft P&P for SP
Support Coordination
Provider Applications
Alliance for the Betterment of Citizens with Disabilities

5. Chronology
2016
Implementation of enrollment, service delivery and service reimbursement for initial cohorts in SP
Awaiting CMS approval of CCW (1915 waiver)
Provider Applications
Housing policy development
Alliance for the Betterment of Citizens with Disabilities

6. Chronology 2016: Accessing DDD Services NJCAT
Tier, Individual Budget and Waiver Assignment
SCA Selection and Waiver Enrollment
Plan Development
Service and Provider Selection
Prior Authorization
Plan amendments
Service Delivery
Provider Claims and Reimbursement
Alliance for the Betterment of Citizens with Disabilities

7. Chronology 2017: Support Program enrollment continued
New Fiscal intermediary contracted
CCW Renewal approved by CMS
Implementation of shift to FFS for CCW individuals
ALL providers expected to be capable of billing for services through Medicaid
CCW pilot (April-June)
Tier Reports available
Alliance for the Betterment of Citizens with Disabilities

8. Chronology 2017 (continued) CCW P&P Draft developed and published
Expectation to complete full enrollment of all eligible participants onto Supports Program completed by June 30, 2018
Expectation is that all in-state CCW participants(excluding CCR residents) will be converted to FFS by June 30, 2018
Contract renewal process moves toward elimination of contracts
Housing vouchers become available for residents in contracted residential homes
CCW (1915) folded into the Comprehensive waiver (1115)(effective 11/1/2017)
Alliance for the Betterment of Citizens with Disabilities

9. Current Snapshot Supports Program Current enrollment is 4,000 +
Projected timeline:
December ,500
March ,000
June Full Enrollment
Alliance for the Betterment of Citizens with Disabilities

10. Current Snapshot CCW Conversion/ Individual Supports
1,000+ Support Coordination Selection Forms sent to CCW participants
Nearly 700 CCW participants assigned to SC
Approximately 6,000 individuals have been identified for conversion to FFS through the pilot, cohort 1 and cohort 2 combined
Alliance for the Betterment of Citizens with Disabilities

11. Current Snapshot Support Coordination Implementation
99 Medicaid/DDD approved Support Coordination Agencies
Individuals assigned to SCA = 8664
Expansion of SCA Monitoring and mentoring
4 QAS (Quality Assurance Specialists being added
Assistant Directors are being appointed to oversee Mentoring and Monitoring
Quarterly Progress reports for SCAs not yet released to approve ISPs
Alliance for the Betterment of Citizens with Disabilities

12. Legislation
Alliance for the Betterment of Citizens with Disabilities