1. ID Partnership Advisory Committee
Update on Rate Transition
October 2016

2. 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

3. 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

4. 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

5. 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)

6. 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

7. 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