Establishing Component Rates & Establishing Component Rates & Individual Service Plans forIndividual Service Plans for

EW Customized Living ServicesEW Customized Living Services

Background InformationBackground Information

Aging and Adult Services, Aging and Adult Services, MN Department of MN Department of

Human ServicesHuman ServicesMarch, 2009

This information is being This information is being provided for background provided for background

only.only.

These slides are not part of These slides are not part of today’s presentation.today’s presentation.

Information contained Information contained here:here:

Very little bit of historyVery little bit of history

Program integrity goalsProgram integrity goals

Brief on implementation strategies Brief on implementation strategies for rate-setting and services planning for rate-setting and services planning “tool kit”“tool kit”

Review of Component Input & Review of Component Input & Negotiated Rates WorksheetsNegotiated Rates Worksheets

Policy resource information Policy resource information

Customized LivingCustomized Living

Is an important part of the Is an important part of the service array for older peopleservice array for older people

Is part of a very large market: Is part of a very large market: more HwS than NF capacity in more HwS than NF capacity in

MinnesotaMinnesota

Portion of EW total spending Portion of EW total spending spent on CL/24 CL services spent on CL/24 CL services continues to increasecontinues to increase

EW CL TrendsEW CL Trends

The number of EW persons served in The number of EW persons served in HwS settings continues to growHwS settings continues to grow

The aging of “Boomers” over the The aging of “Boomers” over the next 10-20 years will greatly increase next 10-20 years will greatly increase demand for long term care servicesdemand for long term care services

These facts result in an increasing These facts result in an increasing demand to demonstrate demand to demonstrate accountabilityaccountability

2007 Customized Living 2007 Customized Living LegislationLegislation

Changed the name from AL/AL+ to CL, 24-Hour Changed the name from AL/AL+ to CL, 24-Hour CLCL

Established parameters for authorizing and Established parameters for authorizing and purchasing CL and 24 hr CL under the EW purchasing CL and 24 hr CL under the EW program. program.

Rate and service parameters are detailed in Rate and service parameters are detailed in MN Statute 256B.0915 governing EW under MN Statute 256B.0915 governing EW under subd. 3e and 3hsubd. 3e and 3h

Reflects federal waiver requirements as well Reflects federal waiver requirements as well as specific MN statutory languageas specific MN statutory language

By implementing 2007 By implementing 2007 legislation….legislation….

Achieve program integrity goals, Achieve program integrity goals, assure federal complianceassure federal compliance

Provide individuals with maximum Provide individuals with maximum choice of services to meet their choice of services to meet their needsneeds

Maintain/improve provider capacityMaintain/improve provider capacity

Federal Quality AssuranceFederal Quality Assurance RequirementsRequirements

For For allall participants of participants of allall waiver waiver programs, and for programs, and for allall services services purchased under purchased under ANY ANY waiver program:waiver program: Consumer must have a documented need

for the service Rates are paid within parameters

established by the state Identified needs are being met within the

overall community support (care) plan Evidence-based quality management Evidence-based quality management

systems (i.e. we need to “prove” it)systems (i.e. we need to “prove” it)

CMS Requirements for CMS Requirements for EW RenewalEW Renewal

EW plan is negotiated between DHS EW plan is negotiated between DHS and CMS for 5 year incrementsand CMS for 5 year increments

New EW plan, effective July 1,2008 New EW plan, effective July 1,2008 was approved in Septemberwas approved in September

CMS was concerned about rate CMS was concerned about rate disparitydisparity

DHS agreed to require that all DHS agreed to require that all counties and tribes use DHS-issued counties and tribes use DHS-issued CL tools as a condition of EW renewalCL tools as a condition of EW renewal

Under Managed CareUnder Managed Care If MCOs use the county or tribal provider If MCOs use the county or tribal provider

network, they will use the tribal or county-network, they will use the tribal or county-negotiated component rates and apply the negotiated component rates and apply the tool to individual services planning and tool to individual services planning and authorizationauthorization

While CMS recognizes that MCOs are While CMS recognizes that MCOs are allowed to establish rates and contracts allowed to establish rates and contracts with providers differently, DHS will also with providers differently, DHS will also encourage MCOs not contracting through encourage MCOs not contracting through counties to use the new tool.counties to use the new tool.

Under Managed CareUnder Managed Care

MCOs requested the State to develop MCOs requested the State to develop the new tool and have been part of the new tool and have been part of the development and testing the development and testing process.process.

The Right Service for the Right The Right Service for the Right Person at the Right PricePerson at the Right Price

DHS has responsibility to ensure that DHS has responsibility to ensure that the “right rate is paid for the right the “right rate is paid for the right service, for the right person”. service, for the right person”.

This has also been a working This has also been a working definition of “quality” for many definition of “quality” for many years.years.

““Right” ServiceRight” Service There is assessed need for the serviceThere is assessed need for the service Is the person’s choice/preference in Is the person’s choice/preference in

how to meet the needhow to meet the need Will be delivered by the providerWill be delivered by the provider Is within the provider’s competencyIs within the provider’s competency Meets service definition as approved Meets service definition as approved

in the waiver planin the waiver plan Is delivered in compliance with other Is delivered in compliance with other

MA requirementsMA requirements

Statutory Language Related to Statutory Language Related to the “Right” Servicethe “Right” Service

Customized living services must not Customized living services must not include rent or raw food costs. include rent or raw food costs.

The lead agency shall ensure that The lead agency shall ensure that there is a documented need for all there is a documented need for all services authorized.services authorized.

Statutory Language Related to Statutory Language Related to the “Right” Servicethe “Right” Service

The lead agency shall ensure that the The lead agency shall ensure that the frequency and mode of supervision of the frequency and mode of supervision of the recipient and the qualifications of staff recipient and the qualifications of staff providing supervision are described and meet providing supervision are described and meet the needs of the recipient.the needs of the recipient.

Shall not authorize 24-hour customized living Shall not authorize 24-hour customized living services unless there is a documented need, services unless there is a documented need, based on criteria in 256B.0915, Subd. 3h, for based on criteria in 256B.0915, Subd. 3h, for 24-hour supervision24-hour supervision

Statutory Language Related to Statutory Language Related to the “Right” Ratethe “Right” Rate

The authorized payment rate must be based on The authorized payment rate must be based on services to be provided.services to be provided.

The payment agreement must specify the The payment agreement must specify the services and the amount of each service to be services and the amount of each service to be provided.provided.

Negotiated rates must not exceed payment rates Negotiated rates must not exceed payment rates for comparable EW or MA services.for comparable EW or MA services.

Rates must reflect economies of scaleRates must reflect economies of scale

Implementation Strategies: Implementation Strategies: Rate Setting and Individual Rate Setting and Individual

Services Planning: 2007 -2008Services Planning: 2007 -2008 Training and bulletins related to change to Training and bulletins related to change to

CL/24hr CLCL/24hr CL

Established criteria for 24 hr CLEstablished criteria for 24 hr CL

MMIS changes to support thisMMIS changes to support this

Creation of the Contract Planning Creation of the Contract Planning WorksheetWorksheet

Statewide meetings regarding that Statewide meetings regarding that WorksheetWorksheet

Implementation Strategies: Implementation Strategies: 2008 to Present 2008 to Present

Work group established to design a rate Work group established to design a rate setting and services planning tool that setting and services planning tool that meets the requirements in state and meets the requirements in state and federal law.federal law.

Xcel workbook that reflects these Xcel workbook that reflects these requirementsrequirements

Workbook contains tools for providers, Workbook contains tools for providers, contract managers, and case managers contract managers, and case managers and care coordinatorsand care coordinators

Review of the Contract Review of the Contract Management ToolsManagement Tools

February video conferenceFebruary video conference Reviewed the Component Input and Reviewed the Component Input and

Negotiated Rates worksheetsNegotiated Rates worksheets

Step 1: Step 1: Contract Planning WorksheetContract Planning Worksheet

Clarifies component services the provider will make Clarifies component services the provider will make available, as well as any limitations or special available, as well as any limitations or special features of services made availablefeatures of services made available

Is based on component services that are allowable Is based on component services that are allowable under the EW service definitionunder the EW service definition

Reflects the Uniform Consumer Guide (required of Reflects the Uniform Consumer Guide (required of all Assisted Living) to the extent possibleall Assisted Living) to the extent possible

Is a fillable Word documentIs a fillable Word document

For communication between provider and lead For communication between provider and lead agenciesagencies

EW Customized Living Workbook EW Customized Living Workbook Step 2: Contract ManagementStep 2: Contract Management

Component Rates Component Rates Input Input Worksheet:Worksheet: is used to establish rates for component is used to establish rates for component

services. Main focus for today.services. Main focus for today.

Negotiated Rates Negotiated Rates Output Output WorksheetWorksheet for for component services: component services: automatically populated by the Component automatically populated by the Component

Rates Input WorksheetRates Input Worksheet

Person Responsible to Person Responsible to CompleteComplete

The provider who is enrolled in Minnesota Health Care Programs (MHCP) as the licensed provider of EW CL/24CL service must complete the Worksheet.

If an enrolled Class A or Class F provider delivers CL/24CL in more than one registered Housing with Services establishment, the Class A or Class F provider must complete a worksheet for each Housing with Services establishment in which they deliver services to EW consumers.

Contract ManagersContract Managers

Lead agency staff responsible for negotiating contracts with waiver providers will review the provider’s proposed component rates.

The lead agency may, at its discretion, request verification from the provider of staffing reported, and the average numbers of residents reported as served.

The lead agency may be a county, a managed care organization, or a tribe under contract with DHS to manage and administer the EW program.

EW Customized Living EW Customized Living Workbook: Reference Workbook: Reference

WorksheetsWorksheets These worksheets reflect state limits These worksheets reflect state limits

on comparable services, case mix on comparable services, case mix budgets, CL/24 hr CL rate limitsbudgets, CL/24 hr CL rate limits

These worksheets provide data These worksheets provide data needed to “automate” the workbookneeded to “automate” the workbook

There is no input work to be done, the There is no input work to be done, the reference worksheets are populated reference worksheets are populated by AAS as part of the toolkitby AAS as part of the toolkit

The Purpose of the The Purpose of the Component Input WorksheetComponent Input Worksheet

The Component Input Worksheet:The Component Input Worksheet: Provides information to establish the Provides information to establish the

hourly service rate for each component hourly service rate for each component serviceservice

Accounts for individual as well as shared Accounts for individual as well as shared services services

Captures staff resources available to Captures staff resources available to deliver services. This information is deliver services. This information is needed to determined shared service needed to determined shared service rates.rates.

Calculates shared supervision ratesCalculates shared supervision rates Establishes per-meal charges, means for Establishes per-meal charges, means for

summoning assistancesummoning assistance

Component Input Component Input WorksheetWorksheet

Limits the component rate to the closest equivalent EW or MA service as required in statute. The The service levelservice level and and associated rateassociated rate used within used within

the toolkit is for the the toolkit is for the requiredrequired staff competency level staff competency level and the rate associated with that staff competency.and the rate associated with that staff competency.

Requires the provider to evaluate staff schedules, and staff assignments, including the number of residents served by the staff resource described.

Sections on the Input Sections on the Input WorksheetWorksheet

Provider InformationProvider Information Services SectionsServices Sections Hourly Rate LimitsHourly Rate Limits Report Average Staff Time: Staff Report Average Staff Time: Staff

SchedulesSchedules Report “Average Number of Residents”Report “Average Number of Residents”

Briefly reviewed each section at February video conference

Negotiated Component Negotiated Component RatesRates

After completion of the Input Worksheet, the information provided will populate the Negotiated Component Rates Form.

This form provides the dollar amounts for component rates that are used when completing an individual’s CL/24CL service delivery plan in order to help calculate the amount to be authorized for those services.

Hourly Rate LimitsHourly Rate Limits The hourly rate limits listed in the Worksheet are

those established by DHS in consideration of 2007 legislative requirements.

Negotiated rates for component services cannot exceed these limits. See Handout.

These limits will only change if the Legislature grants increases or requires decreases in the comparable rates used and described below. If this occurs, DHS will update the tool to reflect these changes.

These rate limits represent the rate for an hour of service. An individual customized living or 24 hour customized living service delivery plan can and typically will include units of any given component service of less than an hour. In this case, the time and price will be calculated as such on the individual plan.

Resources:Resources:Elderly Waiver Bulletin 07-25-01CElderly Waiver Bulletin 07-25-01C

Replaced all previous bulletins related to AL Replaced all previous bulletins related to AL and AL+ **and AL+ **

Policy regarding the need to attach dollars to Policy regarding the need to attach dollars to services and individualize service plans is not services and individualize service plans is not newnew

Provider standards are not newProvider standards are not new Changes in license name but not Changes in license name but not

requirementsrequirements http://http://www.dhs.state.mn.us/main/idcplg?IdcServicewww.dhs.state.mn.us/main/idcplg?IdcService==

GET_DYNAMIC_CONVERSION&RevisionSelectionMethodGET_DYNAMIC_CONVERSION&RevisionSelectionMethod==LatestReleased&dDocNameLatestReleased&dDocName=dhs16_137006=dhs16_137006

**NOTE: All DHS bulletins expire two years from date of issue.**NOTE: All DHS bulletins expire two years from date of issue.

““InstructionsInstructionsfor Component Rates”for Component Rates”

Document attached to Bulletin 09-Document attached to Bulletin 09-25-0125-01

Provides more detail about each cell Provides more detail about each cell within the worksheetwithin the worksheet