1. A Practical Discussion: 6% Increase for Certain Waiver DSP’s

2. Provider Rate Increase Targeted toward Direct Support Professionals (DSP’s) who provide certain HCBS waiver services H/PC On Site/On Call Shared Living 65 – 80% of cost Quality factor #1 issue for providers

3. Provider Rate Increase 6% increase on 100% of the rate Effective on January 1, 2016 Services included: H/PC, OS/OC and Shared Living Targeted toward achieving a more stable DSP workforce – downpayment Inflation from 2005 – 2014 up 21.3%

4. Assurance of DSP Wage Impact Governor and Staff Legislature Other Stakeholders NCI Staff Stability Survey Baseline data for CY2015 Surveyed in 1 st quarter of 2016 Comparison data for CY2016 Surveyed in 1 st quarter of 2017

5. Rate Methodology Rate Components Direct care Direct care ERE Supervisor Supervisor ERE Productivity assumption Administration

6. Example of Distribution Average DSP Wage OvertimeEREAverage Total Cost DSP Wage and ERE New Average DSP Wage Rate Distribution for DSP Wage Remaining Distribution Based on Average Rate $20.00 9.5415%30%13.2110.11.79 (66%).41 (34%)

7. Distribution Scenarios Across the board wage increases Differentials for Shift worked Acuity of individuals supported Geographic Longevity of individual staff Merit Not in employee related expenses (ERE) January – December 2016 will be impact period Delayed increases, if average for year is 6% or greater Bonuses Importance of communicating to all staff, how and to whom increases are distributed

8. System Issues with Implementation DRA spans need to be broken at 12/31/2015 Not intended to offset any cost in other areas, such as room and board How to communicate with staff that are not in HCBS waivers, that they may not be getting a commensurate increase How to operationalize the increase in a unionized environment How DODD will assure the wage increase for DSP’s with the survey What will happen to providers who don’t give their DSP’s an average 6% increase

9. Future for Rates and DSP’s Down payment on system reform and staff stability Additional rate increases System reform initiatives Waiver pilot Health care coordination LTSS and health care integration C3P(O) Pilot Improve the work environment Our integrity matters

10. Questions and Discussion What issues do you see with achieving at least a 6% increase to your average DSP wage? How can you move our work forward, to achieve a stable DSP workforce that delivers quality outcomes? Other questions?

11. Resources Provider wage increase survey questions may be directed to: Tina Evans at tina.evans@dodd.ohio.govtina.evans@dodd.ohio.gov Provider rate distribution questions may be directed to: Mark Davis at mdavis@opra.orgmdavis@opra.org Questions from county boards may be directed to: Lori Stanfa at lstanfa@oacbdd.orglstanfa@oacbdd.org

12. Thanks!