State Rates Advisory Committee:

Children’s & Transportation Rate Update

April 2006

State of MontanaHelena, Montana

Davis Deshaies, LLC

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CHILDRENS RATES DISCUSSION:

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CURRENT CHILDREN’S SYSTEM

1. Single Blended Rate

2. Family Cost Plan

3. Managed Care: provider assumed risk

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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

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CURRENT MENU OF CHILDREN SERVICES

ServiceService Percent of Children Percent of Children receiving Servicereceiving Service

Percent of DDP Funds Percent of DDP Funds spent on Servicespent 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%

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Family Support Specialist StudyFamily Support Specialist Study

Davis Deshaies, LLC

TASK Sample 1 Sample 2 Difference

Assessment/ Information 10.44% 12.65% 2.21%

Travel 11.50% 12.66% 1.16%

Education/ Training 15.80% 17.73% 1.93%

IFSP Development 25.04% 21.55% -3.49%

Habilitation 3.71% 3.96% 0.25%

Personnel Recruitment/ Supervision

5.08% 3.81% -1.27%

Support Coordination 11.61% 12.17% 0.56%

Administrative Functions (includes leave time)

16.83% 15.47% -1.36%

Number of FSS Responders 95 81

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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

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Children’s Rates – Family Support Specialist

Cost CenterCost Center Cost FactorCost Factor

Direct Care Salary $15.14$15.14

Employee-Related Expenses 40.13%40.13%

Program Related Expenses 32.0%32.0%

General & Administrative 11%11%

TOTAL HOURLY RATE $35.06 hour$35.06 hour

MONTHLY RATE $368 / month$368 / month

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Children’s Rates: Published Rate Schedule

ServiceService RateRate

Family Support Specialist $368 per month$368 per monthFamily Education & Training $35.06 per hour$35.06 per hourResidential Habilitation (non-facility direct care)

$17.19 per hour$17.19 per hour

Residential Habilitation (individual training materials)

$1,000 per year$1,000 per year

Respite Care (direct care) $12.96 hour$12.96 hourRespite Care (individual care items) $1,000 per year$1,000 per yearDay Habilitation $17.84 per hour$17.84 per hourTherapies State Plan hourly rateState Plan hourly rate

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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

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Next Steps: Children’s Services

Task Responsibility Timeline

1. Step #1: Shadow Published Rates and determine fiscal and operations impact

All Children’s providers

May - September 2006

2. Step #2: Complete MONAs and Child Assessments for Regions I & II

Regions I & II September 2006

3. Step #3:Pilot Published Rates in Regions I & II; extend other provider contracts

Region I & II October 2006

4. Step #4: Complete MONAs and Child Assessments for ALL Regions

All Regions January 2007

5. Step #5: Implement statewide for ALL providers

All Regions July 2007

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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

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TRANSPORTATION RATES Status Update:

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Transportation Rate Assumptions

1. Travel Zones

2. Shared Expenses

3. Mileage Rates

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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%)

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Transportation Rates Findings

Travel Zones: REGION II Survey

ASSUMPTIONASSUMPTION SURVEY FINDINGSURVEY FINDING

ZONE 1ZONE 1 50% 89%

ZONE 2ZONE 2 20% 0%

ZONE 3ZONE 3 20% 5%

SPECIAL NEEDSSPECIAL NEEDS 10% 6%

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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

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Next Steps: Transportation

Task Responsibility Timeline

1. Step #1: Identify medically-related travel which is Medicaid State Plan reimbursable

Region II / Case Managers / Providers

May 5, 2006

2. Step #2: Adjust mileage zone assignments without medically-related travel

Region II Providers

May 5, 2006

3. Step #3: Recalculate mileage factors (increase from $0.35/mile)

Davis Deshaies May 12, 2006

4. Step #4: Assign mileage zones to Individual Cost Plans

DDP Central Office; Davis Deshaies

June 1, 2006