OPWDD

Rate Methodology – Acuity Review

  • Overview also available in Portable Document Format (PDF)
March 19, 2018

Agenda

  • Rate Methodology Overview
  • Acuity Review

Methodology Overview

Methodology Recap – DC Component

Direct Care Hourly Rate (WEF–Adjusted)

(Agency–specific $27.50 × .75) + (Avg Regional $26.90 × .25) = $27.35		 × Direct Care Average Annual Hours
(Statewide average annual hours)*
3,469		 × Direct Care Acuity Factor

1.50		 × Rate Capacity

10		 = Annual Direct Care Revenue

$1,423,157

Methodology Recap – Clinical Component

Salaried Clinical Annual Hours
(Agency–specific hours)

1,000		 × Clinical Hourly Wage (WEF – Adjusted)

(Agency–specific $35.00 × .75) + (Avg Regional $31.63 × .25) = $34.16		 = Annual Salaried Clinical Revenue

$34,160
Contracted Clinical Annual Hours
(Agency–specific hours)

100		 × Contracted Clinical Wage
(Regional Average)

$57.98		 = Annual Contracted Clinical Revenue

$5,798

Methodology Recap – PS Component

Annual Direct Care Revenue

$1,423,157		 + Annual Salaried Clinical Revenue

$34,160		 + Annual Contracted Clinical Revenue

$5,798		 × Budget Neutrality Factor

1.0		 ÷ 2017 Rate
Units

3,650		 = Total Operating Rate

$400.85

Acuity Review

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
    • Minimum Staffing Requirements
    • 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, Minimum Staff Requirements & 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

  • Current R–squared for Supervised IRA: .3987 (2015:.3632)
  • Current R–squared for Supportive IRA: .3310 (2015:.3473)
  • Relationship between the thresholds and DDP scores improved slightly compared to prior year
  • Provider Outlier Corridor Protection
    • 57 providers benefited from the protection
    • 61 providers were brought closer to their reported hours
  • 117 Providers are over threshold and 123 providers are below threshold
  • 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