Waiver Implementation Council Improving Home and Community-Based - - PowerPoint PPT Presentation

Waiver Implementation Council

Improving Home and Community-Based Services for Adults with Intellectual and Developmental Disabilities

1

March 22, 2018 Facilitator: Kimberley Smith

Welcome

• Introductions
• Housekeeping

➢Please feel free to step out if you need to

▪ The restroom is in the hallway to the right

➢Please keep your cell phone on silent or

vibrate

➢Please sign in and add your current contact

information to the sign in sheet

2

3

Agenda

11:00 am

Overview of Today’s Meeting

11:15 am

WIC Role and Charge Review June WIC Meeting Summary

11:20 am

Waiver Redesign Refresher and Update

11:35 am

Budget Considerations

12:20 pm

Review Submitted Questions Group Breakout: WIC Planning

12:50 pm

Public Comment

1:00 pm

Adjourn

• June 28th Meeting Summary
• Waiver Submission Timeline
• R-19 Budget Request
• WIC Proposed Calendar for Discussion
• Statute, Rules, and Waivers Crosswalk

4

Materials

Future Discussions

• Service and Coverage

Standards Content

• Rates Setting Process
• Provider Qualifications
• Unit Limitations
• Self-Direction

Today’s Meeting

• Update
• Budget Request and

Process

• Timeline
• WIC Planning
• Submitted Questions

Meeting Scope

Our Mission

Improving health care access and

• utcomes for the people we serve

while demonstrating sound stewardship of financial resources

6

Office of Community Living Vision

7

ACCESS RECEIVE COORDINATE

Streamline Access to Services Improve Service Coordination Increase Service Options and Quality

Council Role & Charge

8

Provide ongoing guidance and advice

• n the development and

implementation of a redesigned waiver to support adults with intellectual and developmental disabilities.

9

Implementation Council Purpose

Implementation Council Role

• Consultation and advice

➢ Examine redesign concepts ➢ Suggest improvements through new ideas and

perspectives

➢ Provide solution-oriented feedback

• Stakeholder ambassadors

➢ Identify other stakeholder groups/experts ➢ Create partnerships ➢ Disseminate and collect information ➢ Communicate with a broader audience

10

• Treat each other with respect and honor one

another as whole individuals

• Value diversity in experiences and perspectives

➢ Robust examination and discourse improves our work

• Engage with each other as partners

➢ Direct communication ➢ Solution-oriented collaboration

• Feedback Options

➢ Index cards ➢ Group break out ➢ Parking lot

11

Working Agreements

June 28, 2017 Waiver Implementation Council Meeting Summary For Our Stakeholders  Committees, Boards, and Collaboration  Waiver Implementation Council  Past Meeting Materials  June 28th 2017

12

Review Meeting Summaries

Refresher

13

• Current Waivers

➢ Inflexible and outdated ➢ Individuals and families want greater control and

authority

➢ Encourage a caretaker role ➢ No alternative service delivery options ➢ History of waiting lists

14

Waiver Redesign: Why?

• Design services to ensure:

➢ People get the right service, in the right amount, in the right

place at the right time, per their individual preferences, goals, aspirations & needs

➢ The redesigned waiver is sustainable long into the future &

people get equitable access to the waiver

15

Our Charge

• Online Forum
• Service Coverage Standards Progress
• OCL Reorganization- we now have a full team
• Contracted Work

➢ Rates Cost Factors Survey ➢ Residential Habilitation Microservices Survey and Analysis ➢ Utilization Claims Review ➢ Facilitator/Stakeholder Engagement ➢ Provider Qualifications and Quality Recommendations

• R-19 Budget Request

16

Our Work in 2017-2018

Update

17

18

Incorporated WIC feedback and contractor work into service coverage standards

July 2017-March 2018

19

Learned about complexity of the delivery model Understood that billing 15 minute units would be arduous and non- representative Identified additional actuarial work (R19) needed to analyze utilization of the combined population

Redesigned Residential Habilitation Service

Residential Habilitation Service Analysis

• The Department submitted a budget request on

November 1, 2017

• Funding from FY 2018-19 Priority R-19, IDD Waiver

Consolidation Administrative needed for…

➢ Data and actuarial analysis. ➢ Transition plan development and ad hoc analysis. ➢ Stakeholder engagement.

20

R-19 Budget Request

21

NEW WAIVER

Amend the existing HCBS DD waiver

Not in compliance with the Final Rule (CFCM 2022) Faster but more complex with a challenging timeline

HCBS Final Rule

HCBS Final Rule - 79 Fed. Reg. 2948 (2014)

22

Waiver Implementation Timeline

Q4 FY 17-18 Service Coverage Standards Drafts Finalized Q1 FY 18-19 Contractor work begins Q3-Q4 FY 18-19 CMS Public Comment Q4 FY 18-19 Response and Incorporate Public Comment Q1 FY 19-20 Waiver Submission to CMS Q1 FY 19-20 Provider Training and Enrollment Q3 FY 19-20 Waiver Approved and Transition Begins

Fiscal Year Key

• FY 17-18 – July 1st 2017-June 30th 2018
• FY 18-19 – July 1st 2018-June 30th 2019
• FY 19-20 – July 1st 2019-June 30th 2020
• FY 20-21 – July 1st 2020-June 30th 2021

Quarter Key

• Q1 – July – September
• Q2 – October – December
• Q3 – January – March
• Q4 – April - June

Budget Considerations

23

Estimating the Cost of IDD Waiver Consolidation

Presented by: Jill Schnathorst

24

March 22, 2018

Challenges in Estimating Waiver Consolidation

• Variation in Need
• Residential Habilitation
• HCBS-DD Waiting List
• Funding

25

Challenge 1: Variation in Need

26

11.62% 20.97% 15.50% 16.00% 21.41% 14.50%

HCBS-DD Percent of Population at Each SIS/Support Level

37.43% 32.09% 10.01% 7.34% 7.32% 5.80%

HCBS-SLS Percent of Population at Each SIS/Support Level

Challenge 1: Variation in Need

• How to limit services

➢ Service Plan Authorization Limits? ➢ Unit Limits?

• FY 2018-19 R-19 “IDD Waiver Consolidation and

Administrative Funding” Budget Request

➢ Stakeholder Engagement ➢ Data and Actuarial Analysis ➢ CMS Waiver Application Support

27

Challenge 2: Residential Habilitation

• Approximately 93% of HCBS-DD clients in FY 2016-

17 used Residential Habilitation services

• $225 Million paid in FY 2016-17 for HCBS-DD

Residential Habilitation services

28

Challenge 2: Residential Habilitation

SIS/Support Level

Residential Habilitation Cost per Utilizer

Level 1 $24,804 Level 2 $36,938 Level 3 $44,122 Level 4 $53,169 Level 5 $59,483 Level 6 $73,015

29

Challenge 3: HCBS-DD Waiting List

• FY 2017-18 R-I-1 “Elimination of the IDD Waiting

List” budget request

➢ $190 million annually once fully eliminated

• Major Assumptions

➢ All clients would be enrolled by July 1, 2020 ➢ 2,310 on the waitlist September 2016 ➢ Offsets to costs

30

Challenge 3: HCBS-DD Waiting List

• 70% receive services in HCBS-SLS
• 19% receive no Medicaid services
• 6% receive services in HCBS-EBD
• 5% receive only State Plan services
• As of February 2018 approximately 2,800 people

are waiting for HCBS-DD services with ASAP status

31

Challenge 4: Funding

• There was no funding appropriated for services in

HB 15-1318 “Consolidate Intellectual and Developmental Disabilities Waivers”

• No reserve funding from under utilization

32

Challenge 4: Funding

• State Budget Process

33

Internal Approval April/May Submit to Governor’s Office August Submit to Joint Budget Committee November Briefing and Hearing December Figure Setting March Funding Available July 1

Questions or Concerns?

34

Submitted Questions

35

Question:

Can we get clarification on the timelines for implementation of the: 1) Combined Waiver 2) New Assessment Tool 3) Settings Final Rule in Colorado 4) No Wrong Door Program 5) Conflict-Free Case Management?

36

Financial Eligibility Reform Medicaid Buy-In Expansion Waiting List(s) Elimination No Wrong Door (NWD)

STREAMLINE ACCESS TO SERVICES INCREASE SERVICE OPTIONS AND QUALITY IMPROVE SERVICE COORDINATION

CHRP – Cut Child Welfare Requirement CDASS & IHSS Expansion Housing & Transportation Person-Centered Support Planning Process Self-Direction Tools Person-Centered Budgets Waiver Redesign Intensive Case Management for Regional Center Transitions Employment First + WIOA HCBS Settings Rule Compliance GJRC Relocation Cross System Crisis Response Regional Center Task Force Community First Choice (State Plan Option) Colorado Choice Transitions (CCT) Case Management Redesign New Functional Assessment Tool CHRP CCB Case Management

• Background Checks
• Conflict-Free Case Management
• Rate Setting
• COMMIT/Revalidation
• CCB Transparency

OPERATIONAL EXCELLENCE INTIATIVES

• Electronic Visit Verification
• Mandatory Reporting
• CHRP Transfer
• eLTSS Record + Personal Health Record
• OCL Re-org

37

38

General Timelines for Initiatives

Conflict-Free Case Management Deadline HCBS Settings Final Rule Compliance No Wrong Door (NWD) New Assessment Tool Combined Waiver

Submit to CMS July 2019 Piloting through Fall 2019 March 2020 Piloting through FY 2018-19 June 30, 2022

FY 2018-19 FY 2019-20 FY 2020-21 FY 2021-22

Question: How is the Department going to encourage participation on the Online Forum?

39

Group Breakouts: WIC Planning

40

41

How to give feedback in the most efficient and timely way for Service Coverage Standards (Mar-May 2018)? What will the charge be for the next iteration of the WIC (July 2018)? (Think about WIC meeting topics June 2018-June 2019.) How should we get people engaged on the online forum to make it fully functional? How do we increase WIC membership to represent people waiting for services and direct service providers?

Questions to Guide Discussion

Group Report Out on Solutions and Suggestions

Discussion Period

42

Next Steps

43

Public Comment Period

44

Wrap Up

45