better care, equity in services, fairness for providers david ivers ddpa annual spring conference...
TRANSCRIPT
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Better Care, Equity in Services,Fairness for Providers
David IversDDPA Annual Spring Conference May 22, 2012
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Data Research Meetings and more meetings Committees and Subcommittees Negotiations All under auspices of DDPA Board
& Exec Committee
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▪ Prospective payment instead of retrospective reconciliation
▪ Get rid of 15-minute units and go to daily or monthly rate
▪ No risk sharing across providers
▪ No subcontracting requirement
▪ Preserve licensed nonprofit community providers per 20-48-101 et seq.
▪ Allow for DD Health Homes to coordinate care instead of medical home
▪ Create a broader, more flexible DDTCS service package
▪ Retain entitlement status for enhanced DDTCS
▪ Integrate all DD care plans and licensure requirements
▪ Minimize administrative burdens (focus on outcomes not process)
▪ Use assessment to ensure resource allocations are based on actual need
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▪ Use assessment that is tailored to DD
▪ Do not require full assessment every year
▪ Pilot first & phase-in implementation
▪ Revise income eligibility requirements
▪ Obtain meaningful data
▪ Behavioral health services
▪ Adequate Rates
▪ Consider “Community First Choice” option under ACA
▪ Big Picture: Reduce inequality in amount of services and reduce waiting list
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Prospectively Bundled Payment Vs. Retrospective Reconciliation with risk
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DD Lead Providervs.
Principle Accountable Provider (PAP)
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Total Medicaid Budget (2012): $4.7 Billion
DD Services (2012): ~ $600 Million
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Waiver Slots (2012): 4,100 Waiver Waiting List (2012): 2,127
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Service # of Adults DD Expenditures
Number % to TotalDollars (in millions) % to Total
Avg Cost Per Ben.
HDC 1064 15.16% 104 35.25% 97,744
ICF 426 6.07% 25 8.47% 58,685
Waiver Only 1229 17.51% 55 18.64% 44,752
Waiver & DDTCS 2038 29.03% 88 29.83% 43,180
DDTCS Only 2263 32.24% 23 7.80% 10,163
Total 7020 100% 295 100% 42,023
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Service Halo Expenditures Total Expenditures
Dollars (in millions) % to Total
Avg Cost Per Ben.
Dollars (in millions) % to Total
Avg Cost Per Ben.
HDC 3 8.57% 2,820 107 32.42% 100,564
ICF 2 5.71% 4,695 27 8.18% 63,380
Waiver Only 10 28.57% 8,137 65 19.70% 52,889
Waiver & DDTCS 11 31.43% 5,397 99 30.00% 48,577
DDTCS Only 9 25.71% 3,977 32 9.70% 14,141
Total 35 100% 4,986 330 100% 47,009
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DD service episode Expenditures impactedby health home
Initial phase:Adult DDclients1
7,020
1Includes DD clients ages 18+ receiving HDC, ICF, Waiver and/or DDTCS services. Excludes 180 clients ages 18-20 receiving outpatient therapy only and excludes 13 clients receiving DDTCS transportation but not receiving DDTCS services2Includes medical and behavioral spend, personal care, in-patient, out-patient, pharmacy, dental, hospice and non-emergency transportation. Does not include third party liability or state hospital expendituresSOURCE: Medicaid claims data for claims incurred in SFY 2010
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Separate payment from episode In form of PMPM (Per Member Per Month) Likely require use of co-ops or some other
sharing of resources Separate quality measures Full benefit dependent upon HIT
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(ACA § 2401 – Adds § 1915(k) to SSA)
Under consideration by DHS
“Home-and-community-based attendant services and supports”
Increased Federal match of 6%. No expiration.
Statewide, no cap or waiting list.
Cannot discriminate based on age or type of disability or form of services/supports required.
Must meet institutional LOC
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DDPA web site at http://www.arkansasddpa.org/
medicaidreform.htm
“Arkansas Healthcare Improvement Initiative” at http://humanservices.arkansas.gov/
director/Pages/APII.aspx