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The Department of Intellectualand Developmental Disabilities
Recommended Budget, Fiscal Year 2013-14
2
DIDD FY2013-14 Budget Hearing
• Program Updates• Budget by Program• Funding Source Estimates• Budget Reductions• Cost Increases• Capital Budget• Supplemental Request
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Program Updates
Home & Community Based Waivers Statewide Waiver Census 6,240
FY2012 Average Cost Per Person Per Day $235.33
Self Determination Waiver Census 1,132 FY2012 Average Cost Per Person Per Day $50.91 Centers for Medicare & Medicaid Services (CMS) recognized the
waiver as a model of best practices. CMS has just approved the renewal of this waiver.
Arlington Waiver Census 313 FY2012 Average Cost Per Person Per Day $396.94
Waiting list for intellectual disabilities waiver services is 7,264
4
2008 2009 2010 2011 2012 2013 (est.) 2014 (rec.)0
1000
2000
3000
4000
5000
6000
7000
8000
6062 6062 6080 6126 6213 6285 6548
1116 1223 1175 1166 1143 1123 1119289 315 325 332 321 309 297
Statewide Self Determination Arlington
DIDD Waiver Census History
Census is as of June 30th of each year.
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Program Updates
Developmental Centers
2% of the population served by DIDD is in developmental centers.
Clover Bottom’s census is 41 with planned closure in 2014.
Greene Valley’s census is 136; however, 12 residents will transition to state-operated community homes once constructed.
Harold Jordan Center’s census is 4. The department is making programmatic changes to enable greater use of the facility while also allowing the state to receive federal Medicaid funds. Presently, this center is 100% state funded.
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Program Updates
State Operated Intermediate Care Facility Homes
West Region All 12 homes are operational. Current census is 48. FY2012 actual cost per person per day was $1,092.53
East Region Total of 16 homes are planned. 13 are constructed with a current census of 51. Construction will begin soon for the last 3 homes. FY2012 actual cost per person per day was $872.32.
Middle Region Total of 9 homes are planned. Lots have been purchased for 9 homes. Construction has begun on 4 of these homes.
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Program Updates
Resource Centers
Current Status:• There are three resource centers operating in the three regions and providing the
following services: assistive technology, occupational and physical therapy, speech and language pathology, dental, behavior analysis, and physical nutritional management.
Proposed Changes:
• In the FY2014 budget, 35 positions are moved from the resource centers to the developmental centers where they provide services.
• Another 35 positions will be abolished.
• Middle & east resource centers are restructured leaving only assistive technology and dental services.
• The west resource center will continue to operate with a full array of services.
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Home and Community Based Waiver Services (TennCare’s budget) $ 653,468,600
Developmental Centers 70,908,900
Administration, QA, Regional Offices 75,152,400
Community Homes 35,837,300
Resource Centers 6,256,500
Family Support 7,383,600
Council on Dev Disabilities 2,092,200
$ 851,099,500
Budget by Program (includes waiver funding within TennCare)
HCBS Waiver
Ser-vices76.8%
Dev Ctrs.8.3%
Admin, QA
8.8%
Community Homes4.2%
Resource Centers0.7% Family Support
0.9%Council on Dev Disabilities
0.3%
Chart Title
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Recommended Budget by Funding Source
DIDD State $28,727,300
Federal Revenue 1,781,600
Current Services Revenue 4,712,600
TennCare Revenue* 146,858,900
Other Interdepartmental Revenue 15,550,500
Total Recommended DIDD Budget (Volume 1, page B-199) $197,630,900
Waiver funding in TennCare* (not in DIDD’s Budget) $653,468,600
Total Funding for Programs Administered by DIDD $851,099,500
*TennCare revenue includes $279,555,000 in state matching funds. Direct services receive almost a $2 federal match for every $1 in state funds. Administrative expenses are matched at $1 for $1.
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DIDD Funding By Source
DIDD State3%
Federal0%
Current Services1%
Interdepartmental2%
TennCare State279555000
33%TennCare Federal520772500
61%
DIDD State Federal Current Services Interdepartmental TennCare State TennCare Federal
Base Budget Reductions
Description Pos. Total Reduction
Base Budget Reductions (Volume 2, pages 46 - 48)
Centralization of Human Resources and Fiscal Services -9 -274,700
Harold Jordan Center Programmatic Changes – Obtain intermediate care facility (ICF) certification for 12 beds (Total state reduction of $1,945,500)
-43,400
Printing - Utilize copiers instead of printers (Total state reduction $42,300) -64,200
Greene Valley Developmental Center – Staffing and professional services contracts (Total state reduction $274,800)
-15 -812,800
Central Office - Staffing, contract services and other operating expenses (Total state reduction $497,100)
-6 -1,112,500
Regional Office – Staffing, contracts & leased space (Total State reduction $1,541,600)
-35 -2,739,500
Community Services Contract – Pre-Admission Screening and Resident Review contract (Total state Reduction $46,100)
-184,400
Resource Centers –Restructure leaving only assistive technology & dental services in middle and east (Total state reduction $424,700)
-35 -7,215,300
Community Homes – Staffing, leased space, contracts & supplies (State reduction $171,700)
-4 -507,700
Total Base Reductions -104 -12,954,50011
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2006 2007 2008 2009 2010 2011 2012 2013 20140
10,000
20,000
30,000
40,000
50,000
60,000
48,435 48,767 49,835 48,097 47,583 46,196 45,150 44,185 43,886
4,028 3,904 3,682 3,451 3,177 2,860 2,252 2,248 2,131
FY2006 To Recommended FY2014
Total State General Fund Positions DIDD Positions
DIDD & Total State Position History
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Core Services Continuation and Cost Increases
Description Pos. Total Increase
Core Services Continuation (Volume 1, page A-50)
Family Support Program – Provides non-recurring funds to assist families with a developmentally disabled family member. These funds are in addition to the $4,702,100 in recurring funds within the base budget bringing the total funding for Family Support to $7,383,600.
- $2,681,500
Total Core Services Continuation - $2,681,500
Cost Increases (Volume 1, page B-162)
Clover Bottom – Non-recurring funds for the temporary continuation of operations at Clover Bottom until community homes are built. Funded as interdepartmental revenue from TennCare and is comprised of $1,309,200 in state appropriation and $2,306,600 in federal revenue.
- $3,615,800
Middle TN Homes Certification – Non-recurring funds for the first 30 days of operation during which time the department cannot bill TennCare. Increase in state appropriation of $241,200 and decrease in interdepartmental revenue of $241,200.
- -
Arlington Lawsuit Exit Plans – Provides funds that will allow the state to exit the Arlington lawsuit by December 31, 2013. Includes 11 positions for an intermediate care facility (ICF) survey team, 4 positions for an enrollment team and 1 position for lawsuit compliance. Also includes $866,300 in recurring state funded services for the at-risk expansion.
16 $1,584,300
Total Cost Increases 16 $5,200,100
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Waiver Cost Increases (TennCare’s Budget)
Description Pos. Total Increase
Cost Increases in TennCare’s Budget for DIDD Waivers (Volume 1, page B-159)
HCBS Waiver Programs – Provides recurring funds for growth in enrollment and costs in the home and community based services waiver programs. Allows for 550 enrollments and 454 dis-enrollments for a net growth of 96 people from July 1, 2012 to June 30, 2014. ($4,448,200 state and $8,445,100 federal)
- $12,893,300
Arlington Lawsuit Exit Plan – Provides recurring funds for home and community based wavier services for an additional 182 people who are part of the at-risk expansion and 9 people who will transition from nursing homes to community services. ($10,823,300 state and $20,548,500 federal)
- $31,371,800
Total Home and Community Based Services Cost Increases - $44,265,100
If these cost increases are approved, total funding for the home and community based waivers will be $653,468,600 and will include funding for a 287 person program expansion. All waiver funding resides in TennCare’s budget.
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2008 2009 2010 2011 2012 2013 Est 2014 Rec 770 780 790 800 810 820 830 840 850 860 870 $865
$838
$857
$805 $803
$835
$851
Actual Expenditures FY2008 to Recommended FY2014
DIDD History of Expenditures
Millions
16
2008 2009 2010 2011 2012 2013 20140
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
State Funded Dev Ctrs Waivers Community Homes
8,399
8,399 8,447 8,352 8,106 8,107 8,133 8,400
DIDD History of People Served
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Capital Budget
Description Project Cost
Capital Maintenance (Volume 1, page A-171)
Greene Valley - Upgrade power to two cottages; replace air handling units in the central services building and four cottages; replace the chiller in the resource center building; and replace the roofs on eleven cottages and the gymnasium
$3,620,000
Arlington Campus - Replace the HVAC systems and demolish the existing cooling tower; replace the current energy management system controls; and convert the air handler system to a variable volume system
2,800,000
Total Capital Maintenance $6,420,000
Capital Projects (Volume 1, page A-165)
Harold Jordan Center Renovations $2,850,000
Arlington Developmental Center – Cottages Demolition (Exit plan requirement) 2,350,000
Ruilman Center Renovations 720,000
Total Capital Projects $5,920,000
Total Capital Outlay $12,340,000
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Supplemental Appropriations (Volume 1, page A-32)Arlington Lawsuit Exit Plan • $569,400 Total Funding
• $300,000 State in TennCare’s budget for DIDD
• 16 positions• 11 for an intermediate care facility survey team• 4 for an enrollment team• 1 for lawsuit compliance
FY2013 Supplemental Request
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Allows for enrollment growth of 287 people in home and community based services. 191 people as part of the Arlington lawsuit exit plan 96 people associated with normal growth in the waivers
Continues funding for the Family Support Program at the FY2013 level of $7.4 million.
Provides funding for the temporary continuation of operations at the Clover Bottom Developmental Center.
Reduces 120 authorized positions (54 are estimated to be vacant).
Facilitates programmatic changes at the Harold Jordan Center which allows for the collection of Medicaid funding.
Provides for capital project maintenance and improvements.
FY2014 Budget Highlights