Disability Waiver Rate System

Provider TrainingMOHR Professional Development

ConferenceJune 2015

Disability Waiver Rate System

Ensures state’s ongoing participation in federal programs

Provides a rational architecture for the calculation of service rates that:

Are equitable, consistent, and transparent

Allow choice and portability for consumers

Reflect individualized nature of servicePromote quality

Disability Waiver Rate SystemThe DWRS calculates a payment rate based on information about: The amount of direct staffing (staff hours or ratio)

purchased for an individual The amount of nursing assessment and treatment

(RN or LPN) purchased for an individual Transportation purchased for an individual Deaf/Hard of Hearing Customization purchased

for an individual

Disability Waiver Rate System: Website

http://mn.gov/dhs/partners-and-providers/continuing-care/reform-initiatives/rate-setting/disability-waiver-rates.jsp

Google Minnesota Disability Waiver Rate Setting---it’s easier!

Bookmark the site for your convenience

Disability Waiver Rate System

Disability Waiver Rate System: RMS

• Web-based software application securely accessed by lead agencies through SSIS

• Gathers data points specific to the provision of service for an individual

• Data provided by service providers, approved and entered by lead agencies

• Plugs information into algorithms populated with component values and produces a unit rate to be used in authorizing services in MMIS

Disability Waiver Rate System: RMS

Disability Waiver Rate System: Worksheet 6790E

Disability Waiver Rate System: Worksheet 6790A

Disability Waiver Rate System: Worksheet 6790F

Disability Waiver Rate System: Worksheet 6790I

Disability Waiver Rate System: Worksheets

Disability Waiver Rate System: Definitions Staffing ratio means the number of

recipients a service provider employee supports during a unit of service based on a uniform assessment tool, provider observation, case history, and the recipient's services of choice, and not based on the staffing ratios under section 245D.31

Individual Direct RN or LPN refers only to skilled assessment and treatment that cannot be delegated

Disability Waiver Rate System: Day Transportation For Daily DTH:

Time the individual is in transport can be included in the six hours of service required to bill a daily unit of DTH (Note: this is not the case for any other day service)

For individuals with renewing service plans for Daily DTH, obtain the amount previously authorized for DTH Transportation (T2002) and enter this in the RMS in the field for “Total Daily To/From DTH Transportation” on the Daily DTH page

For individuals with new service plans for Daily DTH, use the lead agency’s historic rate-setting methods to price what would have previously been T2002 and enter this in the RMS in the field for “Total Daily To/From DTH Transportation” on the Daily DTH page

Do not separately authorize DTH Transportation (T2002) for transportation regualrly rendered for Daily DTH

For 15 Minute and Partial Day DTH: Separately authorize DTH Transportation (T2002) using the amount previously

authorized for T2002 or using the lead agency’s historic rate-setting methods to price T2002.

For Hourly or Daily Prevocational Services, 15 Minute or Daily Structured Day Program, 15 Minute or Daily Adult Day Care, and Supported Employment:

Separately authorize Extended Transportation (S0215 UC or T2003 UC) using the lead agency’s historic rate-setting methods to price Extended Transportation

Disability Waiver Rate System: Supported Employment Unit-based service (not in the day bucket) Individual service provision on DD waiver Ratio of 1:1, 1:2, or 1:3 possible on CCB waivers

(1:1 preferred) Separately authorize to/from transportation as

Extended Transportation (S0215 UC or T2003 UC) using the lead agency’s historic rate-setting methods to price Extended Transportation

Disability Waiver Rate System: BandingBanding limits changes from historic unit rates for all existing authorizations and some new authorizations of framework services. A 0.5% band applying to the unit rate is in effect from rolling

implementation through the end of 2014.This means that in 2014, payment rates for services which existed in 2013 will not increase or decrease by more than 0.5%.

In 2015, there is an additional 0.5% band, and in each of the following three years there is an additional 1% band.

2015 legislation adds an additional year of banding and changes the third year to 0.5%. PENDING CMS APPROVAL.

Disability Waiver Rate System: Banding Banding is applied in the following

circumstances: when you renew a waiver span for an existing

recipient, or when you authorize a new day or unit-based

service with a provider who was authorized to provide that service (identified by procedure code and modifier) in that county (recipient’s county of residence) in December 2013, or

when you change the unit rate from an existing service agreement for residential or day services

Disability Waiver Rate System: Banding

Individuals as of Dec 1 Individuals after Jan 1

Banded to Individual Historic Rate Banded to Weighted Average Historic Rate

Day and Unit-based services

Disability Waiver Rate System: Definitions

Disability Waiver Rate System: DefinitionsTerms Used in the Rate Management System Historic Rate: The Historic Rate is the rate to which the

band is applied. In 2014, the Final Rate will not be more than 0.5% different from the Historic Rate (if there is a Historic Rate).

RMS Rate: The RMS Rate is the rate produced by the framework. This is the pure rate produced by the algorithms and component values, independent of any banding.

Final Rate: The Final Rate is the unit rate to be authorized in MMIS. Usually this will be the Historic Rate +/- 0.5% toward the RMS Rate, but it may be manually banded rate or an exception rate.

Disability Waiver Rate System: DefinitionsBanding is based on historic rates which were authorized in MMIS in December 2013. There are two types of Historic Rates, individual and weighted average. Individual Rates are based on a match of:

Recipient: PMI number, Service: procedure code including modifiers, Provider: NPI or UMPI, and County: County of Residence for recipient

Weighted Average Rates are based on a match of: Service: procedure code including modifiers, Provider: NPI or UMPI, and County: County of Residence for recipient

Disability Waiver Rate System: DefinitionsDefinitions: Deaf / Hard of Hearing Screening Document Criteria: DD Screening Document:

Hearing: Field 28: score 5 or 6; ANDExpressive Communication: Field 32: score 6, 7, 8, or 99; ANDReceptive Communication: Field 33: score 4, 5, or 99

LTC Screening Document:Hearing: Field 56: score of 02 or 03 ANDCommunication: Field 57: score of 02

Service Criteria: The service must be provided by staffs that are fluent signers of ASL,

and the staffs must employ this skill in the provision of service to an individual who meets the screening document criteria.

Disability Waiver Rate System: Exceptions Exceptions are for exceptional needs that

cannot be met by a DWRS framework rate through additional units of service.

Exceptions are available to: New recipients, or Existing recipients who have a change (of provider

or intensity) in service plan—and then the exception is only for the difference

Disability Waiver Rate System: ExceptionsAn individual can apply for an exception when their needs cannot be met with the rate produced by the framework due to other cost drivers. Common examples of other cost drivers include the following: Wage differential Training costs Supervision intensity Absence costs

Disability Waiver Rate System: ExceptionsApplications must include a thorough account and documentation of: Summary of recipient need Extraordinary program/service response (to meet

need) that is not acknowledged by the framework Cost of extraordinary program/service response ISP/CSSP Cost documentation

Disability Waiver Rate System: Exceptions

ExceptionsDHS has hired a consulting firm, The Improve Group to analyze: What number of waiver recipients will likely need an exception

when banding is not available? What are their general profiles? Are there particular services that have higher proportions of

exceptions?

They will use the data analysis to predict spending and determine impact on rate setting methodologies. Could result in increased customizations. Complete prior to next session.

Disability Waiver Rate System: Intensity ChangeJohn Peterson has lived in a

corporate SLS since January, 2012. On October 1, 2014, he was in a car accident and as a result, his needs have increased significantly. Now what?

Disability Waiver Rate System: Intensity Change

Disability Waiver Rate System: Intensity Change

Disability Waiver Rate System: Intensity Change***STEP THREE: Calculate the price of the change in intensity***RMS Rate for new level of service - RMS Rate for previous level of service = Price of Change =

$231.62-$110.13 = $121.49

***STEP FOUR: Add the Price of The Change to the Historic MMIS Rate***MMIS Rate + Price of Change = $100.32+121.49 = $221.81

Disability Waiver Rate System: Intensity Change

Regional Variation Factor Implementation

Implementation required by DWRS legislation passed in 2014. Accounts for differences in the cost of doing business in varying

regions of the State Based on MSA’s which are areas that have a “high degree of

social and economic integration” 12 MSA’s will be used. Implementation beginning October 1, 2015 on a rolling basis Factor will be implemented as a percentage (+ or -) used as the

final rate calculation. Banding applies currently. Data analysis completed by Truven Analytics The Plan for implementation will be posted in July/August for

public input.

2015 Legislation Incorporates 3rd year of banding at .5% and a sixth year of

banding (must have CMS approval, waiver amendment to be sent to CMS in August, much broader than just this issue)

Follows a study/analysis to be completed through a contractor DHS has hired related to Exceptions. Plan to create structural changes to the RMS to account for high needs, rather than exceptions

Creates increased accountability for counties to spend their Waiver allocations

Continues research topics related to day services, such as transportation, weightings of the ratios, resulting in a structured work plan for the coming year. Day Services and Transportation are the first priorities.

Requires additional training for lead agencies, providers DID NOT INCLUDE AN ANNUAL BUDGET NEUTRALITY

ADJUSTMENT for spending that will potentially leave the system

More to Come!

Data will be needed---thanks for responding to the MOHR survey. We need this data for modeling possible future changes. Lynn Noren Lnoren@rise.org Rick Hammergren

RHammergren@opportunities.org