Conversion of Contract Reimbursement to Medicaid Fee for Service Model: National and New Jersey Experiences Dan Keating, PhD, Executive Director ABCD October 16, 2017 Community Access Unlimited Alliance for the Betterment of Citizens with Disabilities

Chronology 2013 Rate Setting Process Initiated Consultant engaged Advisory Work Groups formed/convened Assessment tool (DDRT) identified Draft Service Definitions Published Provider Workshops CCW Renewal Submitted to CMS Alliance for the Betterment of Citizens with Disabilities

Chronology 2014: Results of Consultant General ledger Study Demographic/Geographical Differentials Acuity Band the Loss Final Report/Rate Unveil Fee for Service Rate Utilization CCW Renewal Extensions Alliance for the Betterment of Citizens with Disabilities

Chronology 2015 Comprehensive Waiver (1115) Amendments submitted to CMS Tiering Introduced/Rate Schedule Published NJCAT Tool Developed/Assessments commence Support Program Commences/Draft P&P for SP Support Coordination Provider Applications Alliance for the Betterment of Citizens with Disabilities

Chronology 2016 Implementation of enrollment, service delivery and service reimbursement for initial cohorts in SP Awaiting CMS approval of CCW (1915 waiver) Provider Applications Housing policy development Alliance for the Betterment of Citizens with Disabilities

Chronology 2016: Accessing DDD Services NJCAT Tier, Individual Budget and Waiver Assignment SCA Selection and Waiver Enrollment Plan Development Service and Provider Selection Prior Authorization Plan amendments Service Delivery Provider Claims and Reimbursement Alliance for the Betterment of Citizens with Disabilities

Chronology 2017: Support Program enrollment continued New Fiscal intermediary contracted CCW Renewal approved by CMS Implementation of shift to FFS for CCW individuals ALL providers expected to be capable of billing for services through Medicaid CCW pilot (April-June) Tier Reports available Alliance for the Betterment of Citizens with Disabilities

Chronology 2017 (continued) CCW P&P Draft developed and published Expectation to complete full enrollment of all eligible participants onto Supports Program completed by June 30, 2018 Expectation is that all in-state CCW participants(excluding CCR residents) will be converted to FFS by June 30, 2018 Contract renewal process moves toward elimination of contracts Housing vouchers become available for residents in contracted residential homes CCW (1915) folded into the Comprehensive waiver (1115)(effective 11/1/2017) Alliance for the Betterment of Citizens with Disabilities

Current Snapshot Supports Program Current enrollment is 4,000 + Projected timeline: December 2017 5,500 March 2018 7,000 June 2018 Full Enrollment Alliance for the Betterment of Citizens with Disabilities

Current Snapshot CCW Conversion/ Individual Supports 1,000+ Support Coordination Selection Forms sent to CCW participants Nearly 700 CCW participants assigned to SC Approximately 6,000 individuals have been identified for conversion to FFS through the pilot, cohort 1 and cohort 2 combined Alliance for the Betterment of Citizens with Disabilities

Current Snapshot Support Coordination Implementation 99 Medicaid/DDD approved Support Coordination Agencies Individuals assigned to SCA = 8664 Expansion of SCA Monitoring and mentoring 4 QAS (Quality Assurance Specialists being added Assistant Directors are being appointed to oversee Mentoring and Monitoring Quarterly Progress reports for SCAs not yet released to approve ISPs Alliance for the Betterment of Citizens with Disabilities

Legislation Alliance for the Betterment of Citizens with Disabilities