1. 1915(i) Community Recovery Services January 11, 2011 1

2.  Introduction to CRS  Recent Changes in Federal Law  Initial Financial Data and Projections  Questions and Discussion 2 Presentation Overview

3.  Home and Community-Based Services (HCBS) 1915(i) state plan amendments allow states to expand Medicaid eligibility for consumers with a history of psychiatric illness, risk factors indicating a need for continuing supports, and a need for one or more of the covered services as identified in a comprehensive service plan developed by an interdisciplinary team.  Wisconsin’s Community Recovery Services benefit reimburses three core services for consumers:  Community Living Supportive Services – allows for consumers to live with maximum independence in community integrated housing;  Supported Employment – assists consumers with acquiring and maintaining competitive employment; and  Peer Supports – Provides reimbursement for certified Peer Specialists to use their recovery based experiences to assist others to move toward recovery. 3 Introduction

4.  Eligible for State Plan Medicaid or BadgerCare Plus,  HMOs – Not Part of Capitation Rate – Refer to County or Tribe  Countable Income at or Below 150% of FPL,  Reside in the Home or Community (Not an Institution),  Meet Functional Eligibility Criteria,  State Approved Individual Service Plan. 4 Eligibility Requirements for CRS

5.  Tribal and County case managers utilize the Adult Mental Health/AODA Functional Screen –OR- the Children’s Long Term Care Functional Screen to verify functional eligibility.  Effective 10/1/2010, CRS utilizes the Community Options Program (COP) functional need criteria but the eligibility criteria is more strict then COP as mental health diagnoses are more limited.  Consumer must also have at least one of the following diagnoses:  Mood Disorder,  Schizophrenia,  Other Psychotic Disorder. 5 Functional Eligibility

6. 6 Recent Changes in Federal Law Affordable Care Act of 2010 – Effective 10/1/2010 Must be Offered Statewide: DHS is inviting all Wisconsin counties and tribes to begin the application process to become CRS providers. Eliminates Wait Lists:The ACA eliminated Wisconsin’s ability to manage the growth of the program through the use of waitlists.

7. CRS Initial Financial Data and Estimates For the Period January 15, 2010 through January 3, 2011 7 CountyConsumersBilled*Paid Washington7$117,112$61,184 Wood13$409,375$175,078 Barron1$12,200$4,578 Richland4$231,500$69,491 Jefferson12$57,740$19,964 Totals37$827,927$330,295 *Includes Non-Federal Share.

8.  CLSS Per Diem$125.00/day  CLSS Periodic$ 20.00/hour  Supported Employment$ 46.04/hour  Peer Supports$ 39.12/hour  Travel reimbursement is available for CLSS Periodic, Supported Employment, and Peer Supports – Up to 1 Hour TO the service site, and 1 Hour BACK from the service site.

11. Service CategoryFee ScheduleAvg. Co. Cost CLSS – Per Diem$125/Day$105.67/Day CLSS - Periodic$20.00/Hour$40.63/Hour Supported Employment$46.04/Hour$45.53/Hour Peer Supports$39.12/Hour$56.08/Hour Comparison of Medicaid Fee Schedule and Average County Costs Keep in mind that CRS is a cost- based benefit. Counties file a cost report each year, and settlement is made accordingly.

12. CLSS – Per Diem20102011 Projected Consumers¹366914 Realistic Enrollment²36180 Weighted Avg. Billable Days³6,05941,724 Assumed Avg. Cost $105.67/Day Gross Revenues $640,255$4,408,975 Less: County Match $255,875$1,982,743 Net Revenues $384,380$2,426,232 Milwaukee County Revenue Discussion ¹ Per Milwaukee County’s Response to Info Memo 2009-10 ² A more realistic enrollment number for the sake of discussion. ³ Weighted average billable days assuming consumers approved evenly throughout the year.

13. Quarter & YearFMAPState Admin. %² 2010 Q470.63%15% 2011 Q167.63%15% 2011 Q265.63%15% 2011 Q3 Forward¹60.16%5% Behind the Numbers: FMAP and the State’s Statutory Administrative Cut Example: County Cost of Service$100.00 FMAP Q4 2010 @ 70.63%$ 70.63 Less: State Admin. @ 15%$ 10.59 County Nets………………………….$ 60.04 ¹ ARRA Enhanced FMAP ends on June 30, 2011. ² State’s admin. stated as $600,000 thru SFY11, and a Flat 5% thereafter.

14. Please visit the CRS Webpages at: http://www.dhs.wisconsin.gov/MH_BCMH/crs/index.htm Or Contact: Michael Jones, CRS Coordinator (608) 267-9864 michaelb.jones@wisconsin.gov 14