Aging and Adult Services, MN Department of Human Services

1. Establishing Component Rates & Individual Service Plans forEW Customized Living ServicesBackground Information Aging and Adult Services, MN Department of Human Services March, 2009

2. This information is being provided for background only. These slides are not part of today’s presentation.

3. Information contained here: • Very little bit of history • Program integrity goals • Brief on implementation strategies for rate-setting and services planning “tool kit” • Review of Component Input & Negotiated Rates Worksheets • Policy resource information

4. Customized Living • Is an important part of the service array for older people • Is part of a very large market: • more HwS than NF capacity in Minnesota • Portion of EW total spending spent on CL/24 CL services continues to increase

5. EW CL Trends • The number of EW persons served in HwS settings continues to grow • The aging of “Boomers” over the next 10-20 years will greatly increase demand for long term care services • These facts result in an increasing demand to demonstrate accountability

6. 2007 Customized Living Legislation • Changed the name from AL/AL+ to CL, 24-Hour CL • Established parameters for authorizing and purchasing CL and 24 hr CL under the EW program. • Rate and service parameters are detailed in MN Statute 256B.0915 governing EW under subd. 3e and 3h • Reflects federal waiver requirements as well as specific MN statutory language

7. By implementing 2007 legislation…. • Achieve program integrity goals, assure federal compliance • Provide individuals with maximum choice of services to meet their needs • Maintain/improve provider capacity

8. Federal Quality Assurance Requirements • For all participants of all waiver programs, and for all services purchased under ANY waiver program: • Consumer must have a documented need for the service • Rates are paid within parameters established by the state • Identified needs are being met within the overall community support (care) plan • Evidence-based quality management systems (i.e. we need to “prove” it)

9. CMS Requirements for EW Renewal • EW plan is negotiated between DHS and CMS for 5 year increments • New EW plan, effective July 1,2008 was approved in September • CMS was concerned about rate disparity • DHS agreed to require that all counties and tribes use DHS-issued CL tools as a condition of EW renewal

10. Under Managed Care • If MCOs use the county or tribal provider network, they will use the tribal or county-negotiated component rates and apply the tool to individual services planning and authorization • While CMS recognizes that MCOs are allowed to establish rates and contracts with providers differently, DHS will also encourage MCOs not contracting through counties to use the new tool.

11. Under Managed Care • MCOs requested the State to develop the new tool and have been part of the development and testing process.

12. The Right Service for the Right Person at the Right Price • DHS has responsibility to ensure that the “right rate is paid for the right service, for the right person”. • This has also been a working definition of “quality” for many years.

13. “Right” Service • There is assessed need for the service • Is the person’s choice/preference in how to meet the need • Will be delivered by the provider • Is within the provider’s competency • Meets service definition as approved in the waiver plan • Is delivered in compliance with other MA requirements

14. Statutory Language Related to the “Right” Service • Customized living services must not include rent or raw food costs. • The lead agency shall ensure that there is a documented need for all services authorized.

15. Statutory Language Related to the “Right” Service • The lead agency shall ensure that the frequency and mode of supervision of the recipient and the qualifications of staff providing supervision are described and meet the needs of the recipient. • Shall not authorize 24-hour customized living services unless there is a documented need, based on criteria in 256B.0915, Subd. 3h, for 24-hour supervision

16. Statutory Language Related to the “Right” Rate • The authorized payment rate must be based on services to be provided. • The payment agreement must specify the services and the amount of each service to be provided. • Negotiated rates must not exceed payment rates for comparable EW or MA services. • Rates must reflect economies of scale

17. Implementation Strategies: Rate Setting and Individual Services Planning: 2007 -2008 • Training and bulletins related to change to CL/24hr CL • Established criteria for 24 hr CL • MMIS changes to support this • Creation of the Contract Planning Worksheet • Statewide meetings regarding that Worksheet

18. Implementation Strategies: 2008 to Present • Work group established to design a rate setting and services planning tool that meets the requirements in state and federal law. • Xcel workbook that reflects these requirements • Workbook contains tools for providers, contract managers, and case managers and care coordinators

19. Review of the Contract Management Tools • February video conference • Reviewed the Component Input and Negotiated Rates worksheets

20. Step 1: Contract Planning Worksheet • Clarifies component services the provider will make available, as well as any limitations or special features of services made available • Is based on component services that are allowable under the EW service definition • Reflects the Uniform Consumer Guide (required of all Assisted Living) to the extent possible • Is a fillable Word document • For communication between provider and lead agencies

21. EW Customized Living Workbook Step 2: Contract Management • Component Rates Input Worksheet: • is used to establish rates for component services. Main focus for today. • Negotiated Rates Output Worksheet for component services: • automatically populated by the Component Rates Input Worksheet

22. Person Responsible to Complete • The provider who is enrolled in Minnesota Health Care Programs (MHCP) as the licensed provider of EW CL/24CL service must complete the Worksheet. • If an enrolled Class A or Class F provider delivers CL/24CL in more than one registered Housing with Services establishment, the Class A or Class F provider must complete a worksheet for each Housing with Services establishment in which they deliver services to EW consumers.

23. Contract Managers • Lead agency staff responsible for negotiating contracts with waiver providers will review the provider’s proposed component rates. • The lead agency may, at its discretion, request verification from the provider of staffing reported, and the average numbers of residents reported as served. • The lead agency may be a county, a managed care organization, or a tribe under contract with DHS to manage and administer the EW program.

24. EW Customized Living Workbook: Reference Worksheets • These worksheets reflect state limits on comparable services, case mix budgets, CL/24 hr CL rate limits • These worksheets provide data needed to “automate” the workbook • There is no input work to be done, the reference worksheets are populated by AAS as part of the toolkit

25. The Purpose of the Component Input Worksheet • The Component Input Worksheet: • Provides information to establish the hourly service rate for each component service • Accounts for individual as well as shared services • Captures staff resources available to deliver services. This information is needed to determined shared service rates. • Calculates shared supervision rates • Establishes per-meal charges, means for summoning assistance

26. Component Input Worksheet • Limits the component rate to the closest equivalent EW or MA service as required in statute. • The service level and associated rate used within the toolkit is for the required staff competency level and the rate associated with that staff competency. • Requires the provider to evaluate staff schedules, and staff assignments, including the number of residents served by the staff resource described.

27. Sections on the Input Worksheet • Provider Information • Services Sections • Hourly Rate Limits • Report Average Staff Time: Staff Schedules • Report “Average Number of Residents” Briefly reviewed each section at February video conference

28. Negotiated Component Rates • After completion of the Input Worksheet, the information provided will populate the Negotiated Component Rates Form. • This form provides the dollar amounts for component rates that are used when completing an individual’s CL/24CL service delivery plan in order to help calculate the amount to be authorized for those services.

29. Hourly Rate Limits • The hourly rate limits listed in the Worksheet are those established by DHS in consideration of 2007 legislative requirements. • Negotiated rates for component services cannot exceed these limits. See Handout. • These limits will only change if the Legislature grants increases or requires decreases in the comparable rates used and described below. If this occurs, DHS will update the tool to reflect these changes. • These rate limits represent the rate for an hour of service. An individual customized living or 24 hour customized living service delivery plan can and typically will include units of any given component service of less than an hour. In this case, the time and price will be calculated as such on the individual plan.

30. Resources:Elderly Waiver Bulletin 07-25-01C • Replaced all previous bulletins related to AL and AL+ ** • Policy regarding the need to attach dollars to services and individualize service plans is not new • Provider standards are not new • Changes in license name but not requirements • http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_137006 **NOTE: All DHS bulletins expire two years from date of issue.

31. “Instructionsfor Component Rates” • Document attached to Bulletin 09-25-01 • Provides more detail about each cell within the worksheet