1. Age & Disabilities Odyssey Conference Tuesday, June 21, 2011

2. Topic areas Background / Impetus for Rate Setting Project Objectives of the Project Activities and Products of the Project Next Steps

3. Background/Impetus for Rate Setting Project To meet CMS requirements, DHS must adopt uniform rate determination methods / standards that apply to each waiver service to ensure: Equitable payments across all areas of the state Rate differences based on concrete indicators Rate variations capture the individualized nature of services

4. Background / Impetus for Rate Setting Project DHS sets rates for home care services, day training and habilitation services and personal care assistant services. DHS also sets maximum rates for case management services. For all other waiver services, DHS sets a rate file limit. Counties negotiate service rates with providers based on the enrollee’s need and may negotiate rates that exceed the rate file limits based on the enrollee’s needs.

5. Objectives of the Rate Setting Project DSD has worked with stakeholder groups to establish rate-setting methodologies that: Abide by the principles of transparency and equitability across the state Involve a uniform process of structuring rates for each service Meet federal requirements for the administration of waiver programs Promote quality and participant choice

6. Data, Data, Data To inform the payment methodology design process, and ultimately, the rate setting process, the following data sources have been utilized: Primary data is inclusive of all information, statistics, facts, figures and numbers obtained from national sources; as an example, the Bureau of Labor Statistics, Employee Benefit Research Institute. Secondary data is inclusive of all responses accrued through a scheduled Cost and Wage Survey that was completed by a random sample of Minnesota’s DSD service providers. Provider data request: day and residential providers

7. Provider Data Request Shared staffing Nursing Awake night staff Asleep night staff Individual staffing Information that is not contained in DHS Data Sets

8. What’s next: the next 18 months: June 2011 Initial budget impact analysis July 2011 Continue to develop web based technology Fall 2011 Rollout of training in various formats such as: Webinars ITV On line

9. The next 18 months continued January 2012 Implement shadow rates January – December 2012 On-going technical support and evaluation during the year of shadow rates January 2013 and on… New rates fully implemented On-going technical support and evaluation

10. Alignment: Provider Enrollment Provider Standards County based contracting will end and DHS will assume the contract function per CMS requirements. Negotiation of rates at the county and provider level will no longer be necessary – focus on the needs of the person and the services to meet them. Recipients will have a broader choice of providers. Providers will be able to provide services statewide. Implementation is aligned with Rate Setting – January 2013.

11. Why does rate setting matter to a recipient? Standardized pricing helps recipients make informed decisions about how to get the most for their money from all available resources

12. CHOICE Community membership Health, wellness and safety Own place to live Important long-term relationships Control over supports Employment earnings and stable income

13. Why does rate setting matter to providers? Standardized rates enable providers to spend more time focused on delivering quality services Providers know exactly what services they are expected to deliver to the individual

14. Why does rate setting matter to counties? State-provided tool makes it easier for lead agencies to calculate service rates and to monitor the delivery of purchased services Consistent rates help lead agencies accommodate individuals who move to other counties to obtain services Meets CMS requirements for the administration of disability waiver services

15. Core elements of the rate architecture Staffing and related expenses Wages and benefits Program and recipient support expenses Program supervision Program supplies Community access General and administrative expenses Administrative salaries and benefits Office expenses, advertising, etc.

16. What about individual needs? Glad you asked !! Takes into consideration the assessed needs of recipients, such as: Complex medical Behavioral intensity Deaf and hard of hearing

17. What does rate setting have to do with care planning? Again…glad you asked !!! Spend less time on rate administration and more time focused on serving the individual Lead agencies can provide individuals with clear information about the prices of services they need State-provided tool makes it easier for lead agencies to calculate service rates and to monitor the delivery of purchased services Consistent rates help lead agencies accommodate individuals who move to other counties to obtain services Planning the services to meet the needs of the individual

18. Building a Sustainable Service System Establishes a consistent, equitable process for standardizing rates Leverages technologies across DHS systems & initiatives Streamlines administrative processes to keep focus on quality & outcomes

19. Stakeholder input Where we’ve been, and where we’re going Intensive and Expanded Work Groups completed their work in December, 2010 DSD has convened an Advisory Committee with a broad base of stakeholders Committee will consult with staff on a regular basis Committee will have regular input and gather feedback in the implementation phase of the project

20. Information and input Project web site http://www.dhs.state.mn.us/dhs16_144651 You will find: Policy statements Rate frameworks Meeting minutes Much more Project E-mail box DSD.Rates@state.mn.us