ID Partnership Advisory Committee Update on Rate Transition October 2016

History of DDS Rates and Rate Transition Current rates are disparate based on a variety of factors Year individual entered service system and funding provided Year provider began providing services as older providers typically have lower rates Unionized vs. non-unionized agencies Prior methodology of DDS individually negotiating amounts for Community Living Arrangements (CLAs) services Why DDS was moving towards ‘leveling the playing field’? Primary factor was CMS guidance to require individuals to be able to move throughout service system without barriers created by available funding Disparity of wages and costs by provider without differences in quality Provider community stability

History of DDS Rates and Rate Transition continued Plan for rate transition coincided with CT fiscal difficulties No COLA Reductions to grant accounts First year of anticipated 7 year rate transition occurred for below-the-rate providers Responsibility for rate methodology/claiming moved to DSS – DDS rate transition was put on hold pending finalization of new methodology Updating and standardization of CLA rates

Accomplishments to Date Developed Intellectual Disability Partnership (IDP) structure Identified appropriate state agency staff to join IDP committees Established IDP Advisory Committee Developed a Memorandum of Agreement (MOA) to ensure coordination between state agencies and timely payments to providers Developed draft reimbursement model for CLAs

Draft Reimbursement Model: Tenets of the Approach Informed by federal Centers for Medicare and Medicaid Services (CMS) guidance, including HCBS Final Settings Rule Maintains individual freedom to choose providers (portability of funds) Takes into consideration individual acuity (Level of Need)

Draft Reimbursement Model: Key Features Agency-specific base rate adjusted for the individual’s Level of Need (LON) and staffing enhancements will be used to calculate individual-specific per diem reimbursement amounts Takes into consideration: Individual acuity levels (Level of Need assessment) Number of beds in a residence Maintains current total contract amount for each provider Current agency legacy rates built into agency-specific rates Current need-based staff enhancement amounts pulled out (will be converted into a fee schedule) One-time funding dollars pulled out (Medicaid eligible services will be converted into a fee schedule) Transportation pulled out

Next Steps Fiscal Transition Subcommittee determines rate setting and transition policy decisions and presents them to Secretary of OPM and DDS, DSS Commissioners Committees begin to meet as needed Waiver Transition Subcommittee begins work on waiver language changes Provider Transition Subcommittee begins work on transition needs of providers Long-Term Strategies Subcommittee begins work on future strategies