Division of Intellectual Disabilities Services Recommended Fiscal Year Budget

Slide 2 2 Change FY 2010 to FY 2011 Pos.StateFederalOtherTotal FY $69,791,300$2,058,600$763,769,800$835,619,700 FY ,905,9001,861,100695,309,100728,076,100 Reduction622$38,885,400$197,500$68,460,700$107,543,600 Other represents revenue from TennCare. This includes both the federal Medicaid reimbursements and the required state match. 2

Slide 3 3 % of Budget By Type of Program Fiscal Year 2010Fiscal Year %16% 8% 7% 4% 72%11% 10% 3% 4%

Slide 4 4 $107.5m Reduction by Type of Program Program Funding Change % of Reduction % Reduction to Program Budget Developmental Centers$51.1m reduction47.5%38.5% State Funded Programs$35.5m reduction33.0%60.5% Home & Community Based Waivers $18.0m reduction16.7%3.3% State Community Homes$3.1m reduction2.8%9.4% Other$0.2m increase 4

Slide 5 5 Developmental Ctrs - $51.1m Reduction Arlington Closure $1.7m funded in FY10 with non-recurring funds $1.0m for transfer of utilities, court monitor expense, etc to West Regional Office $8.3 for final closure on June 30, Positions Abolished Clover Bottom Downsizing $9.2m funded in FY10 with non-recurring funds for transitions to private ICF/MR (129 Positions) Respites (25 positions previously intended for GVDC) $13.9m associated with downsizing to 32 beds (23 vacant positions abolished. 282 positions & $13.9 million restored with non-recurring funds for 6 months transition) 5

Slide 6 6 Developmental Ctrs - $51.1m Reduction Greene Valley – Reduce Census & Daily Cost $3.2m reduction for transitions to private ICF/MR $2.2m reduction for transitions to state-operated community homes $11.4m reduction of operational cost 210 Reduction in Force Major Maintenance - Reduction of $.2m 6

Slide 7 7 State Funded Programs $35.5m Reduction ProgramFunding CSN of West Tennessee (targeted to end 6/10) $18.3 million Wrap-around Services - Hospital Attendants, Household Establishment, Housing Subsidies, Some Dental Services, Class Transportation (effective date of 07/01/10) $9.5 million Consumer Directed Supports – (ended 12/31/09 ) $5.0 million State Funded Non-class Members$2.7 million 7

Slide 8 8 Home and Community Based Waiver Program $18.0m Reduction Exceeded waiver budget by $41m in FY09 $62.7m increase based on current enrollment and current level of expenditures $36.5m decrease from non-recurring FY10 funding $13.2m increase for growth of 108 people per year $57.4m decrease for targeted reductions 8 65% of Division’s FY10 Budget is waiver funding 72% of Division’s FY11 Budget is waiver funding

Slide 9 9 Targeted Waiver Reductions Reduction Waiver Amendment Estimated People Served Savings Dental - cap at $2500 per year Yes640$1.2m Nutrition - limit to 6 visits per year Yes871$0.4m Nursing - limit to 12 hours per day Yes130$14.3m Personal Assistance - limit to 50 hrs per week Yes1760$15.1m Environmental & Vehicle Accessibility Modifications - eliminate service Yes174$1.1m Individual Transportation - eliminate service ( 67% of people who receive PA receive this service) Yes1315$1.2m Remove RN oversight - adjust level 6 rates No1478$7.9m Revise Residential Rates No3344$16.2m 9

Slide Proposed Waiver Rates Residential Rates range from Level 1thru 6. The higher the level, the more supervision is required. Addressed here are proposed changed to levels 2 thru 4. ServiceCurrent RateProposed RateDifference LON 4 Single Person Placement$484.20$364.65($119.55) SL 4- Two Person Home$294.35$277.75($16.60) SL 4-Three Person Home$247.35$232.60($14.75) Res Hab 4- Four Person Home$189.10$178.25($10.85) SL 3-Two Person Home$241.55$233.90($7.65) SL 3-Three Person Home$169.10$170.60$1.50 Res 3-Four Person Home$95.40$96.90$1.50 LON 2 Single Person Placement$206.95$138.75($68.20) SL 2- Two Person Home$148.75$138.75($10.00) 10

Slide Proposed Waiver Rates Continued ServiceCurrent Rate Proposed RateDifference LON 1 Companion$176.55$102.55($74.00) LON 1 Single Person Home, Shift Staff$191.00$102.55($88.45) SL 1-Two person home$115.50$102.55($12.95) SL 1-Three person home$80.75$81.25$0.50 Res 1-Four person home$62.25$62.75$0.50 LON 6 Single Person Home$775.25$747.75($27.50) SL 6-Two Person Home$387.65$475.65$88.00 Medical Residential, Two Person Home$546.61$589.60$42.99 Medical Residential Three person$415.13$443.95$ Note: Independent Support Coordination - Revising rate for people in ICF/MR’s from $232 to $175, a 25% reduction in rate for this category

Slide Targeted Waiver Reductions *$ Average Daily Rate FY 09/10 2.8% Over expenditure 7.2% State Revenue Decline *$ Average Daily Rate FY10/11 *Average for all three waivers 12

Slide State Operated Homes $3.1 Million Reduction East TN Homes $1.8m increase  Operational Funding for 4 additional homes  59 positions from GVDC  Non-recurring start-up funding West TN Homes $4.9m reduction  Abolish 77 positions 13

Slide DIDS Contact Information James Finch, Ed. D., Deputy Commissioner Fred Hix, Assistant Commissioner, Administrative Services Debra Payne, Assistant Commissioner, Community Services Missy Marshall, Director of Public Affairs