Waiver Implementation Council · Q3- Q4 FY 18-19 CMS Public Comment -19 Response and Incorporate...
Transcript of Waiver Implementation Council · Q3- Q4 FY 18-19 CMS Public Comment -19 Response and Incorporate...
Waiver Implementation Council
Improving Home and Community-Based Services for
Adults with Intellectual and Developmental Disabilities
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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
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Agenda
11:00 am Overview of Today’s Meeting
11:15 am WIC Role and ChargeReview 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
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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
outcomes for the people we serve
while demonstrating sound
stewardship of financial resources
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Office of Community Living Vision
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ACCESS RECEIVECOORDINATE
Streamline Access
to Services
Improve Service
Coordination
Increase Service
Options and Quality
Council Role & Charge
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Provide ongoing guidance and advice
on the development and
implementation of a redesigned waiver
to support adults with intellectual and
developmental disabilities.
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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
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• 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
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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
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Review Meeting Summaries
Refresher
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• 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
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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
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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
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Our Work in 2017-2018
Update
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Incorporated WIC feedback and contractor work into
service coverage standards
July 2017-March 2018
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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.
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R-19 Budget Request
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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)
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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
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Estimating the Cost of IDD
Waiver Consolidation
Presented by: Jill Schnathorst
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March 22, 2018
Challenges in Estimating Waiver
Consolidation
• Variation in Need
• Residential Habilitation
• HCBS-DD Waiting List
• Funding
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Challenge 1: Variation in Need
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11.62%
20.97%
15.50%16.00%
21.41%
14.50%
1 2 3 4 5 6
HCBS-DD Percent of Population at Each SIS/Support Level
37.43%
32.09%
10.01%
7.34% 7.32%
5.80%
1 2 3 4 5 6
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
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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
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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
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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
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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
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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
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Challenge 4: Funding
• State Budget Process
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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?
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Submitted Questions
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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?
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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
RequirementCDASS & IHSS Expansion
Housing & Transportation
Person-Centered Support
Planning ProcessSelf-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
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General Timelines for Initiatives
Conflict-Free Case ManagementDeadline
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?
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Group Breakouts: WIC Planning
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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
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Next Steps
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Public Comment Period
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Wrap Up
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