OPWDD

Rate Methodology Review

  • Document also available in Portable Document Format (PDF)
February 14, 2018

Agenda

  • Introductions
  • 7/1/17 Rate Review
  • Moving Forward – "Things on the Plate"
  • Open Discussion

7/1/17 Rate Review

7/1/17 Rate Review

  • Rebased Rates
    • CFR Periods Utilized 2014–15 (FY filers) and 2015 (CY filers)
    • Final Transition 25/75 Percent (base/target) to 100 Percent Target Rate
  • Survey D
  • Acuity Factor (Supervised and Supportive IRA)
  • Budget Neutrality
  • Occupancy Factor
  • Capacity/Units
  • Property

Acuity Adjustment Factors

  • Concept – Create a Factor to Address Resource Utilization (Similar to Risk Adjustment in Traditional Rate Setting
  • Goal – Examine if a correlation exists among resource utilization and current assessment tool (DDP)
    • Historical DDP Information
    • Historical Utilization – DC Staff Hours
    • Template Status
    • Willowbrook Status
    • Average Bed Size

Steps Taken in Developing an Acuity Adjustment

  • Step 1 – Utilize cost report data and agency DDP assessment tool to build dataset
  • Step 2 – Perform regression analysis to determine how variables (bed size, behavioral, adaptive scores, Willowbrook & Template status) influence direct care hours
  • Step 3 – Use regression results to determine appropriate direct care hours per individual per month
  • Step 4 – Adjust results to account for variation not explained by regression ("credibility" adjustment")
  • Step 5 – Use results to determine agency–specific case intensity relative to Statewide average (2015 Statewide Avg Hours: Supervised IRA – 3,518; Supportive IRA – 1,143; 2017 Statewide Avg hours: Supervised IRA – 3,541; Supportive IRA – 1,051)

Acuity Results

  • What is driving the change in Acuity?
    • CFR hours per capacity – Actual agency experience makes up at least 75% of the factor, and many agencies have changes of 5–10% or more hours per capacity
    • DDP2 scores – Some agencies see significant changes in DDP2 scores, especially agencies with lower capacities
    • Other components of factor – Average bed size, percentage of Willowbrook class, incorporating template, minimum staffing needs

Budget Neutrality

  • Corridor Approach
    • Resources generated from rebasing will be reinvested into High Priority Programs and Waiver Services (Supervised IRA Supportive IRA, Day Habilitation, Prevocational Services)
    • Corridor approach allows for a transition period for providers negatively impacted by the rebasing

Budget Neutrality Corridors

Waiver Services

From To Budget Neutrality Factor
−7% −8+% 1.03000
−3% −7% 1.02000
0% −3% 1.01000
1% 0% 1.00000
5% 1% 0.99000
5+% 5% 0.98000

ICF/IID

From To Budget Neutrality Factor
0% −% 1.00000
1% 0% 1.00000
3% 1% 0.99000
3+% 3% 0.98000

Note: No additional resources generated from
the rebasing are included in the ICF/IDD rates.

Occupancy Adjustment

  • Supervised IRA and ICF/IID
  • Based on Previous Year’s Experience (7/1/16–6/30/17)
  • Non–Billable Days Survey
    • Days not billed through Medicaid or OPWDD Voucher Processing

"2018 Things on the Plate"

Moving Forward – "2018 Things on the Plate"

  • 1/1/18 Minimum Wage Increase and Reconciliation
    • Provider Attested Survey
    • 2015 CFR Data (for providers who did not submit a survey)
    • Supplemental Cost Report to Verify Use of Resources
  • 1/1/18 Direct Support Professional Compensation Increases
    • "Be Fair to Direct Care" Compensation Increase (3.25%)
      Position Title Codes: 100–199 Support Staff and 200–299 Direct Care Staff
  • 4/1/18 Compensation Increases
    • "Be Fair to Direct Care" Compensation Increase (6.5%)
    • Clinical Compensation Increase (3.25%) Position Title Codes: 300–399

Moving Forward – "2018 Things on the Plate"

  • CFR Corrections
    • Use of revised CFR data is limited to the calculation of 7/1/18 rates
    • Timeline for CFR Corrections:
      • January 29, 2018 – Letter to providers detailing resubmission and revision specifications February 9, 2018 Deadline for CFR Requests for Resubmission and CEO Attestation Statement February 16, 2018 Issuance of DOH Determination of Request
      • March 2, 2018 – Deadline for revised CFRs to be uploaded electronically, via the internet CEO Certification Statement (CFR–i) sent to OPWDD
      • March 30, 2018 – Independent Accountant’s Report (CFR–ii or CFR–iiA) for revised CFR to OPWDD June 1, 2018 Assessment of budget neutrality calculations and use of corridors
      • July 1, 2018 – Rates issued based on revised CFR information.

Open Discussion

Contact Information

Bureau of Mental Hygiene Services Rate Setting:

mhrs@health.ny.gov

DOH Webpage:

http://www.health.ny.gov/health_care/medicaid/rates/mental_hygiene/index.htm