Waiver Updates 2016 OPRA Spring Conference

Litigation US DOJ Olmstead DRO Claims seem focused on ICF’s of 8 beds and larger ADS impact Private duty nursing HCBS community rule

Waiver Expansion 3,000 new waiver slots 2,000 IO 1,000 Level One Conversion of ICF’s to waiver Downsizing developmental centers Closure of 2 developmental centers Approximately 40,000 new customers

Waiver Administration Merging TDD waiver into IO waiver Increased training and quality oversight of waiver services Provide support for people with complex needs HCBS waiver administration rule (poss. 10/1/16) 56 hour limit for direct care weekly New money management service (poss. 10/1/16) SELF waiver, elimination of sub-caps

Nursing Services Add nursing services to IO waiver effective 7/1/16 Skilled nursing services provided directly by RN/LPN Needs can’t be met by med admin/delegation/state plan DODD determines medical necessity Classification 1 - Examples: Tracheostomy suctioning, mechanical ventilation support, tracheostomy care including tube changes, wound care, IV administration, venipunctures, peritoneal dialysis Classification 2 – Examples of extenuating circumstances: unstable medical condition or no available provider

Shared Living Merging AFL and AFC AFL Utilization Data 257 providers use daily rate 79 providers use 15 minute unit Total of 336 AFL providers Average annual cost for AFL daily rate $23,830 Average annual cost for AFL 15 minute rate $21,935

Family/Individual Self- Direction Survey IO and Level One Employer authority Hire and fire workers Decide worker’s training Decide hours of work Sign timesheets Manage and supervise workers Determine pay of workers (within a range) Financial management services Budget authority Pay workers less to buy more services Decide where to buy stuff so get best price What are they unable to buy on the waiver

Family/Individual Self- Direction Survey Employer Authority Same as IO and Level One, with additional questions Co-employer or common law impressions What do they need help with regarding being an employer of their direct care staff Assessment of FMS’s help with being an employer Budget Authority What budget decisions do they make What services What to pay for those services Do they use someone to help them to make best decisions about budget What does the person helping them with budget do for them Any suggestions for help with gaining a better understanding of employer and budget authority

HCBS Rule Implementation Implementation of transition plan to comply with CMS HCBS regulations on definition of community and person-centered planning “Community” standards Conflict-free case management Target populations Ohio’s state transition plan under CMS consideration No extension of compliance deadline past March 17, 2019 Settings compliance guidelines released by DODD

Independent Providers Possible self-direction in every HCBS waiver Not public employees – state vs. federal issue Paying overtime

DSP Wage Increase Individual Options waiver 6% waiver rate increase effective January 1, 2016 DRA span needs broken at 12/31/15 to avoid rate dilution Targeted to direct support staff for H/PC, shared living and OSOC Targeted toward achieving a more stable DSP workforce Inflation from 2005 – 2014 up 21.3% Critical that DSP’s realize a 6% increase in wages, for near- term advocacy for additional funding

Example of Distribution Average DSP Wage Overtim e ER E Average Total Cost DSP Wage and ERE New Average DSP Wage Rate Distributi on for DSP Wage Remaining Distribution Based on Average Rate $ %30% (66%).41 (34%)

Example of Distribution Average DSP Wage Overtim e ER E Average Total Cost DSP Wage and ERE New Average DSP Wage Rate Distributio n for DSP Wage Remainin g Distributio n Based on Average Rate $20.00 $ %30%$13.85$10.60$.83 (69%)$.37 (31%)

Example of Distribution Average DSP Wage Overtim e EREAverage Total Cost DSP Wage and ERE New Average DSP Wage Rate Distributi on for DSP Wage Remaining Distributio n Based on Average Rate $20.00 $ %30%$16.62$12.72$.99 (83%)$.21 (17%)

Waiver Pilot/Residential Habilitation Develop a daily or weekly rate modeled after waiver pilot, possibly residential habilitation Shared savings Reinvest efficiency dividends in waiting list, workforce and budgets Draft rule being reviewed by stakeholders

Employment and Day Services Replace workshops and facility-based day services with new service models that promote community employment and integrated day services Implement an outcome-based reimbursement system for employment services DODD and OOD partnership

Building Waiver Provider Capacity 40,000 new customers and lower ratios Workforce 3 pronged strategy Adult day services transition for county boards and private providers COGS Infrastructure Timeframe

Thank You! Mark Davis Mark Davis 1152 Goodale Blvd. Columbus, Ohio