OASIS: District 4 forums Davis Deshaies LLC Indiana Department of Family and Social Services Administration

What’s PROBLEM? What’s the PROBLEM? PEOPLE WITH SIMILAR NEEDS HAVE VARIED ACCESS TO SERVICES BECAUSE THE AMOUNT OF SERVICE YOU GET DEPENDS ON: 1. WHEN 1. WHEN you requested service 2. HOW MUCH 2. HOW MUCH money was available 3. WHAT 3. WHAT services were available

What’s the SOLUTION? FAIRNESS & EQUITY Refine Individual Resource Allocation process Connect to Provider Reimbursement & Outcomes PRINCIPLES & VALUES Person - Centered Planning Self - Directed Choice PREDICTABLE AND STABLE FUNDING Balance quality, utilization, cost, and access

Design an INDIVIDUAL RESOURCE ALLOCATION system Determine FAIR PROVIDER REIMBURSEMENT RATES Connect both to PERSONAL & SYSTEM OUTCOMES Assure QUALITY APPROACH

Overview of Approach FIVE STEPS FIVE STEPS: Information 1. Collect Information BASELINE Build data & policy BASELINE (3 months) How Much 2. Figure out How Much people need BEST PRACTICES Define BEST PRACTICES (3 months) Make Sense 3. See if the BEST PRACTICES Make Sense SHADOW SHADOW in District 4 (6 months) OASIS WORKS 4. See if OASIS WORKS PILOT PILOT rates and individual allocations (6 months) 5. IMPLEMENT 5. IMPLEMENT (18 months)

Implementation Schedule for OASIS TASKS 1 st 2 nd 3 rd 4 th 1 st 2 nd 3 rd 4 th 1 st 2 nd 3 rd 4 th Connect Best Practice to Cost Drivers Implement OASIS Statewide Shadow Test In District 4 Determine Best Practice & Cost Drivers Pilot OASIS in District 4 Implementation Complete 2007 Quarters 2008 Quarters 2009 Quarters Determine Standard Price for Service

OASIS - BIG PICTURE

All of the Parts Step 1 Determine Individual Cost Guidelines Step 2 Plan, Cost Out & Budget Step 3 Test for Fairness Step 4 Apply Standard Rates Step 5 Utilization Review if Needed Step 6 Select Provider & Implement Plan Step 7 Measure personal outcomes $ Appropriate services and supports at a fair rate

Number of Units of Service Building the OASIS Allocation Cost Per Unit of Service X = OASIS Allocation Cost Drivers (age, life events) X Individual Needs Assessment Standard Rate Market Analysis

OASIS: The Pieces

Assumptions similar amounts different ways People use similar amounts of services in very different ways how much more importantthan why Determining how much paid staff support is needed is more important than why it is needed. best predictors People and families are the best predictors of the amount of service needed. Historicalpredict Historical costs don’t always predict need.

WHAT DOES OASIS GIVE YOU? (Objective Assessment System for Individual Supports) 1. SINGLE ANNUAL AMOUNT: Total for Year 2. RANGE 2. RANGE: Gives a view of typical costs and services for people with similar needs 3. GUIDELINES 3. GUIDELINES for planning rather than ultimatums BEST PRACTICES 4. Connected to BEST PRACTICES

What INDIANA Cost Drivers will be CONSIDERED? Other States found: Primary Cost Drivers: Primary Cost Drivers: – Age – Family Living Situation – Work Situation – Life Events – Geography & Transportation Secondary Cost Factors: Secondary Cost Factors: – Functional Abilities – Behavior & Health Supports Needs Assessments do not predict cost for OUTLIER consumers Needs Assessments do not predict cost for OUTLIER consumers Indiana Work Group potential factors: Other Factors (natural supports, employment, forensic and behavioral health issues) Other Factors (natural supports, employment, forensic and behavioral health issues)

What’s the BOTTOM Line?  How OLD are you?  Where do you LIVE?  With WHOM do you LIVE?  Any Significant Life Events?  How’s your HEALTH & BEHAVIOR?

UPPER LIMIT 1. People who need full-time 1:1 direct care support or more on a 24 hour / 7 day per week basis 2. People who have court-ordered care LOWER LIMIT 1. People who require less than $(?) per year of supports 2. People who require only support coordination What are the PREDICTIVE LIMITS of OASIS?

SHADOW & PILOT TEST

How Should We TEST our IDEAS? Statistical Validation – Face – Content – Construct – Convergent / Criteria Focus Groups – Frequent consumer / family discussions – Frequent provider / case manager discussions Best Practice Groups – Consumer Outcomes – Provider Outcomes – Case Management Outcomes Test & Refine – Simulate with People, Families, Providers, Case Managers

What are BEST PRACTICES?  Health & Wellness  Safety & Freedom from Harm  Stable Home  Sufficient Personal Income  Satisfaction & Inclusion

Key Tasks – Pilot Phases SHADOW (July ’07 to December ’07) Compare current rates and allocations to proposed “What would happen IF” TEST TEST (January ’08 to June ‘08) Best Practices consumer group Sample of Providers IMPLEMENTATION Phased IMPLEMENTATION (July ’08 to Dec ’09) By District Constant modification and adjustment MODIFY Evaluate & MODIFY (On-going)

Receive Individual Resource Allocations Receive Individual Resource Allocations Using Person-Centered Planning, build an Individual Budget Plan and Key Personal Outcomes Using Person-Centered Planning, build an Individual Budget Plan and Key Personal Outcomes Receive technical assistance as needed from Pilot Team Receive technical assistance as needed from Pilot Team Select provider and Case Manager initiates individual’s budget. Select provider and Case Manager initiates individual’s budget. Participate in Outcome Study Participate in Outcome Study People in the Pilot

Receive Business Development Assistance Receive Business Development Assistance – Market Analysis – Cash Flow Management – Human Resource Management – Strategic Planning Receive Technical Assistance on Implementing Self-Directed Supports Receive Technical Assistance on Implementing Self-Directed Supports – Choice & Empowerment Providers in the Pilot

PROVIDER RATE SETTING

What DO People BUY? staff time People purchase staff time – Personal Support – Training & Guidance – Therapies & Nursing transportation People purchase transportation housing People purchase housing equipment People purchase equipment

Why does Indiana need NEW RATES? CMS Requires “Transparency” – Must be able to measure by “unit of service” – Must differentiate between services – Must reflect Individual Consumer need – Reward success CMS Requires “Standardization” – Consumer Portability – Public Transparency Historically negotiated Rates – Dependent upon timing & funds available – Advocacy Driven Public financing is not able to keep up with Provider Costs

What should rates ACCOMPLISH? Pay a FAIR PRICE for FAIR WORK – Create stable provider network – Attract and retain qualified staff – Encourage research & development – Reward success Connect to OASIS Allocations – Consumer Portability – Public Transparency Guarantee Quality Services – Consumer Outcomes – Provider Outcomes – Case Management Outcomes Other Reasons

How much VARIATION in the RATE FACTORS? Geographical factors Geographical factors can vary up to 30% between communities in Indiana – Wages & Unemployment – Housing & Cost of Living – Available Skilled Labor Force – Competing Employers Transportation costs Transportation costs are influenced by diverse factors: – Urban density – Rural remote access

What are STANDARD RATES? AMOUNT OF MONEY PER UNIT OF SERVICE Rates are the AMOUNT OF MONEY PER UNIT OF SERVICE which is paid to a PROVIDER STANDARDIZED COSTS The RATE AMOUNT is based upon STANDARDIZED COSTS for – Wages and Salaries – Employee-related Expenses such as BENEFITS & Paid Time Off – Program Indirect Costs such as supervision, materials, utilities – General & Administrative Costs SPEND FUNDS DIFFERENTLY A PROVIDER may SPEND FUNDS DIFFERENTLY than the RATE ASSUMPTIONS.

Rate Building APPROACH Examine Direct Care Staff Salaries Examine Direct Care Staff Salaries Compute Employee - Related Expenses / Benefit Costs Compute Employee - Related Expenses / Benefit Costs Survey Program - Related / Clinical Supervision Costs Survey Program - Related / Clinical Supervision Costs Establish General & Administrative Costs Establish General & Administrative Costs

Rate Building APPROACH (continued) Wage Parity Wage Parity across all services and employer type. Employee-Related Expenses Employee-Related Expenses are reflecting actual Workers’ Compensation, FICA experience, and geographical differences. Program-Related Costs Program-Related Costs have the highest variability. General and Administrative Costs General and Administrative Costs will be established by policy.