The Department of Intellectualand Developmental Disabilities

Recommended Budget, Fiscal Year 2013-14

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

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DIDD Waiver Census History

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Census is as of June 30th of each year.

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.7

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

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Budget by Program (includes waiver funding within TennCare)

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

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 -12,954,500 11

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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DIDD History of Expenditures

Millions

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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

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

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