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Better Care, Equity in Services,Fairness for Providers
David IversDDPA Annual Spring Conference May 22, 2012
Data Research Meetings and more meetings Committees and Subcommittees Negotiations All under auspices of DDPA Board
& Exec Committee
▪ 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
▪ 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
Prospectively Bundled Payment Vs. Retrospective Reconciliation with risk
DD Lead Providervs.
Principle Accountable Provider (PAP)
Total Medicaid Budget (2012): $4.7 Billion
DD Services (2012): ~ $600 Million
Waiver Slots (2012): 4,100 Waiver Waiting List (2012): 2,127
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
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
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
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
(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
DDPA web site at http://www.arkansasddpa.org/
medicaidreform.htm
“Arkansas Healthcare Improvement Initiative” at http://humanservices.arkansas.gov/
director/Pages/APII.aspx