1. OASIS Initiative: How Stuff Works April 2007 State of Indiana Family & Social Services Administration

2. 2 THE CURRENT SITUATION 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

3. 3 THE FUTURE DIRECTION PRINCIPLES & VALUES Person - Centered Planning Self - Directed Choice FAIRNESS & EQUITY Refine Individual Resource Determination process Connect to Personal Outcomes Connect to Provider Reimbursement PREDICTABLE & STABLE FUNDING Balance quality, utilization, cost and access

4. 4 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)

5. 5 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 Test in District 4 Implementation Complete 2007 Quarters 2008 Quarters 2009 Quarters Determine Uniform Rates for each Service Implement Uniform rates Statewide

6. 6 How is the OASIS individual allocation determined and what does it mean?

7. 7 COST DRIVER 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 Best Practices Historical costs don’t always predict need. Best Practices better define costs.

8. 8 WHAT ARE BEST PRACTICES?  Personal Health  Safety & Freedom from Harm  Stable Home  Sufficient Personal Finances  Satisfaction & Inclusion

9. 9 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

10. 10 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)

11. 11 HOW SHOULD WE TEST OUR IDEAS? Statistical Validation – Straight Face Test – Content, Construction & Design – Predictive ability Focus Groups – Frequent consumer / family discussions – Frequent provider / case manager discussions Best Practice Groups – Consumer Outcomes – Provider Outcomes – Case Management Outcomes OASIS MONOPOLY – Simulate with People, Families, Providers, Case Managers

12. 12 Number of Units of Service Building the OASIS Allocation Cost Per Unit of Service X = OASISAllocation CostDrivers (age, life events, etc.) X Individual Needs Assessment Standard Rate Market Analysis

13. 13 How will Standard RATES for each Service be set?

14. 14 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.

15. 15 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

16. 16 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

17. 17 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.