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SJI and DUII Utilization Review

SJI and DUII Utilization Review. December 1, 2009. How are we doing in SFY ’10?. The Client Limits implemented in July of 2009 have successfully managed short-term residential and detoxification lengths of stay

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SJI and DUII Utilization Review

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  1. SJI and DUII Utilization Review December 1, 2009

  2. How are we doing in SFY ’10? • The Client Limits implemented in July of 2009 have successfully managed short-term residential and detoxification lengths of stay • Nonetheless, residential service expenditures (short-term and detox) have continued to rise • Increased number of clients receiving residential services • Increased average cost per client

  3. SJI FY 2009 DATA REVIEW 61% of SFY 09 Expenditures were for residential Treatment

  4. SJI FY 2010 DATA REVIEW 78% of First Quarter SFY 2010 SJI Expenditures were for residential Treatment

  5. Comparison SJIFY 09 and FY 10 Quarter 1 Outpatient

  6. Comparison SJIFY 09 and FY 10 Quarter 1 Residential

  7. Comparison SJIAdolescent and Adult Expenditures FY 09

  8. Sustainability of the SJI in SFY 2010 • If residential service utilization (client volume and cost per client) continues at the current rate, SJI funds will be fully expended before the end of the fiscal year • Action is required now to continue access throughout the year • Expended 1.1 million in first quarter of SFY ’10 • Obligated 593,000 for first two months of the second quarter • Current rate of expenditure is $400,000 per month. • By December there will only be enough funds to spend $140,000 per month

  9. DUII FY 2009 DATA REVIEW 64.6% of SFY 09 DUII Expenditures were for residential Treatment

  10. DUII FY 2010 DATA REVIEW 70% of First Quarter SFY 2010 DUII Expenditures were for residential Treatment

  11. Comparison DUIIFY 09 and FY 10 Quarter 1 Outpatient

  12. Comparison DUIIFY 09 and FY 10 Quarter 1 Residential

  13. DUII Initiative Spending • The average monthly expenditure required to remain within budget is $593,000 • Currently DUII spending at a monthly rate of $501,000 • Action not required immediately. If rate of spending increases action will be needed to continue access throughout the year • Residential expenditures continue to be an increasingly larger portion of funding

  14. GOAL for moving forward • Our goal is to implement clinically sound and fiscally responsible utilization management guidelines that will ensure continued client access to resources throughout the year

  15. Utilization Management Options • Limit Length of stay • Cap # of clients by month • Cap $ expended monthly • Cap providers expenditures • Cap services by treatment modality • Require all clients to be assessed by outpatient provider before being referred to residential services • Set aside for adolescents

  16. Options South Jersey County Directors discussed for SJI • Limit length of stay • Cap Funding Monthly • Require all clients to be assessed by outpatient provider before residential • Set aside funds for adolescent

  17. Utilization Options discussed at Stakeholder Meeting 12/1/09 • Cap residential services • Suboxone ambulatory detox integrated with residential tx to avoid residential detox costs • SJI fund MD visit for the Suboxone detox • Narrowing network of the SJI to southern providers only • Dual or Flexible Licensure at Provider agencies to allow for more fluid movement between levels of care • Track and make decisions based upon client dx • Change the age of eligibility for SJI thereby decreasing the number of clients eligible • Develop a set aside for Adolescent treatment

  18. Options from 12/1/09 cont. • Assess clients at outpatient provider before any residential stay (exclude emergency detox) • Ensure that DYFS funds are used before SJI funds • Further limit length of stay guidelines • Approval of extensions to LOS in smaller increments • Use mechanisms that are more specific in the short term to keep spending within the yearly budget(s) • Cap by month • No new clients • Provider caps • Caps by level of care • Start charging co-pays (DAS to explore the fees in FFS) • Change fiscal income eligibility for clients

  19. Input on Next Steps • Short Term – December 2009-June 2010 • Long Term

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