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Proprietary and Confidential
Arkansas Health Care Reform
Task Force – ID/DD Wait List
Exploring Options for Addressing t...
2
Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
Executive Summary
• TSG reports what a new wai...
3
Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
Agenda
• Review historical spending for Waiver...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
Waiver Background
• Improve the quality of ser...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
Services
• Supportive Living – enable benefici...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
Services (cont.)
• Specialized Medical Supplie...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
SFY2015 Services by Claim Amount
Supportive
Li...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
Spending by Service Type
Service Type
Total Wa...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
Supportive Living Averages $49,000
82%
99%
0%
...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
Cost of Services Other Than
Supportive Living...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
Services other than Supportive Living
Rarely ...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
A Program Capped at as Little as $6,000 would...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
Agenda
• Review current spending for Waiver p...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
Survey Method
• Survey invitation sent by US ...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
Responses Covered the State
Note: 81% of resp...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
How the Services were Ranked
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50
100
150
200...
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ArkansasBureauofLegislativeResearchMarch2016
Services by Rank
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150
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ArkansasBureauofLegislativeResearchMarch2016
Summary Findings from Survey
• Supportive Liv...
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ArkansasBureauofLegislativeResearchMarch2016
Agenda
• Review current spending for Waiver p...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
What if…
• TSG has modeled a waiver like thos...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
TSG Developed the Model Based On
• Assumption...
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ArkansasBureauofLegislativeResearchMarch2016
0
3,000
6,000
9,000
12,000
15,000
18,000
21,0...
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ArkansasBureauofLegislativeResearchMarch2016
Agenda
• Review current spending for Waiver p...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchMarch2016
Full Cost of Capped Waiver for 2,640
on the I...
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Arkansas Health Care Reform Task Force – ID/DD Wait List

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Exploring Options for Addressing the Wait List for the DDS Alternative Community Services (ACS) Waiver Program for the Intellectually Disabled and Developmentally Delayed

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Arkansas Health Care Reform Task Force – ID/DD Wait List

  1. 1. 1 Proprietary and Confidential Arkansas Health Care Reform Task Force – ID/DD Wait List Exploring Options for Addressing the Wait List for the DDS Alternative Community Services (ACS) Waiver Program for the Intellectually Disabled and Developmentally Delayed March 2016
  2. 2. 2 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Executive Summary • TSG reports what a new waiver benefit would look like for the 2,640 people on the ID/DD wait list • Top-5 benefits except Supportive Living
  3. 3. 3 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Agenda • Review historical spending for Waiver program • Report results of a survey of households on the wait list • Model the effect of alternative capped a range of alternative waiver programs • Recommend path forward
  4. 4. 4 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Waiver Background • Improve the quality of services through Home and Community Based Waiver Services provided under a 1915 waiver for a limited number of individuals as an alternative to ICF/ID placement • Serving targeted populations: mental illness, and intellectual, developmental or physical disabilities with an age of onset before age 22 • Participation capped at 3,9881, with turnover, served 4,127 different individuals in SFY2015 • Wait list of 2,640 1 - http://humanservices.arkansas.gov/ddds/waiverDocs/ACSWaiverGuidebook.pdf
  5. 5. 5 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Services • Supportive Living – enable beneficiaries to live in their own homes, with their family, or in an alternative residence • Respite Services – short-term benefits for beneficiaries unable to care for themselves due to absence of non-paid caregivers • Supportive Employment – enable beneficiaries who need intensive ongoing support to perform in a competitive work setting • Adaptive Equipment – equipment to increase, maintain or improve functional capabilities to perform daily life tasks • Vehicle Modifications – adaptations to an automobile or van to accommodate the special needs of the beneficiary • Environmental Modifications – modifications made to or at the beneficiary’s home
  6. 6. 6 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Services (cont.) • Specialized Medical Supplies – items necessary for life support not otherwise available under Medicaid • Supplemental Support Service – enable community living, in response to crisis, emergency or life threatening situations • Case Management Services – assistance in gaining access to needed services, in or out of the Waiver • Consultation Services – clinical and therapeutic services • Crisis Intervention Services – in the beneficiary’s home or other local community site by a mobile intervention team • Community Transition Services – set-up expenses for beneficiaries who are transitioning from an institution
  7. 7. 7 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 SFY2015 Services by Claim Amount Supportive Living 0 25 50 75 100 125 150 175 200 225 Millions Waiver Spending by Service Transition Respite Care Consultative Specialized Medical Supplies Adaptive Equipment Supported Employment Case Management Supportive Living Claims data from SFY2015 federal Expenditures Report 81% Cummulative 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 100 200 300 400 500 600 700 0-10,000 10,000-20,000 20,000-30,000 30,000-40,000 40,000-50,000 50,000-60,000 60,000-70,000 70,000-80,000 80,000-90,000 90,000-100,000 10,0000-110,000 110,000-120,000 120,000-130,000 130,000-140,000 140,000-150,000 150,000-160,000 160,000-170,000 170,000-180,000 180,000-190,000 190,000-200,000 >200,000 NumberofBeneficiaries Annual Claims Amount by Beneficiary Spending Levels by Beneficiary 96% of Waiver Spending is for Supportive Living 20% of beneficiaries spend less than $20,000 – 80% less than $70,000
  8. 8. 8 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Spending by Service Type Service Type Total Waiver Claims Amount Unique Beneficiary Count Average for Those Claiming Benefit Percent Supportive Living 196,404,211 4,013 48,979 95.9% Case Management Services 5,550,856 4,094 1,357 2.7% Supportive Employment 668,300 103 6,617 0.3% Specialized Medical Supplies 642,407 925 696 0.3% Consultation Services 453,751 733 621 0.2% Adaptive Equipment -ACS 392,835 155 2,568 0.2% Respite Services 380,605 153 2,521 0.2% Environmental Modifications 238,010 52 4,760 0.1% Supplemental Support Service 16,462 17 1,097 0.0% Adaptive Equipment - PERS Monthly Fee 13,733 31 474 0.0% Adaptive Equipment - PERS Installation 479 6 120 0.0% Total 204,761,648 4,124 49,675 100.0% Claims data from SFY2015
  9. 9. 9 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Supportive Living Averages $49,000 82% 99% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 100 200 300 400 500 600 CumulativePercentofBeneficiaries NumberofBeneficiaries Total Waiver Claim Amount per Person -- SFY 2015 Supportive Living Frequency Cummulative Claims data from SFY2015
  10. 10. 10 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Cost of Services Other Than Supportive Living 1,357 6,617 696 621 2,568 2,521 4,760 1,097 474 120 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 0.0 1.0 2.0 3.0 4.0 5.0 6.0 CaseManagement Services SupportiveEmployment SpecializedMedical Supplies ConsultationServices AdaptiveEquipment- ACS RespiteServices Environmental Modifications SupplementalSupport Service AdaptiveEquipment- PERSMonthlyFee AdaptiveEquipment- PERSInstallation Average Annual($Millions) Historic Total and Average Costs of Services Other Than Living Total Waiver Claims Amount Average for Those Claiming Benefit Claims data from SFY2015
  11. 11. 11 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Services other than Supportive Living Rarely Total More than $6,000 77% 90% 96% 99% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 500 1,000 1,500 2,000 2,500 3,000 3,500 CumulativePercentofBeneficiaries NumberofBeneficiaries Total Waiver Claim Amount per Person -- SFY 2015 All Claims other than Supportive Living A program capped at $6,000 would meet 96% of needs other than Living Support Claims data from SFY2015
  12. 12. 12 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 A Program Capped at as Little as $6,000 would Cover Most Historic Claims -- Except Supportive Living 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 20,000 22,000 AnnualClaimsAmount Individual Beneficiaries Spending by Current Waiver Beneficiary (Other than Supportive Living) 100% Claims data from SFY2015
  13. 13. 13 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Agenda • Review current spending for Waiver program • Report results of a survey of households on the wait list • Model the effect of alternative capped a range of alternative waiver programs • Recommend path forward
  14. 14. 14 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Survey Method • Survey invitation sent by US mail to 2,640 individuals on the wait list • Asked to rank the top 5 most important benefits from the list • Respondents responded by using a web survey • Asked for comments at the end of the survey • Offered the opportunity to respond anonymously or provide detailed contact information • Respondents spent an average of 8 minutes responding (long for a web-based survey). This suggests they took it seriously
  15. 15. 15 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Responses Covered the State Note: 81% of responses provided name and address, only these are graphed • 440 responses in 10 days—17% response rate • 81% provided addresses • All but one provided a comment • Responses represented the entire state
  16. 16. 16 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 How the Services were Ranked 0 50 100 150 200 250 300 350 400 450 NumberofResponses Services Ranking in the Survey n=440 Rank 5 Rank 4 Rank 3 Rank 2 Rank 1
  17. 17. 17 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Services by Rank 0 50 100 150 200 250 300 350 400 450 Rank 1 Rank 2 Rank 3 Rank 4 Rank 5 NumberofResponses Services Ranking in the Survey n=440 Crisis Intervention Services Vehicle Modifications Specialized Medical Supplies Community Transition Services Supplemental Support Service Adaptive Equipment Consultation Services Environmental Modifications Supportive Employment Case Management Services Respite Services Supportive Living
  18. 18. 18 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Summary Findings from Survey • Supportive Living is #1, but not as strongly favored as the 97% of current Waiver participants that claim for Supportive Living • Respite and Case Management are clear #2&3 for those on the wait list • Responses are widely dispersed—strongly supporting the notion of self-determination of services • Response rate, and number, size and tone of comments all suggest that the wait list is a very unhappy group, looking to the legislature for quick relief • Respondents would rather have some benefits even if it is less that the whole Waiver program • Respondents seek more self-direction • The selection process should be faster, clearer and more transparent
  19. 19. 19 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Agenda • Review current spending for Waiver program • Report results of a survey of households on the wait list • Model the effect of alternative capped a range of alternative waiver programs • Recommend path forward
  20. 20. 20 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 What if… • TSG has modeled a waiver like those in Indiana, Tennessee and Kentucky. It would… • Provide a benefit capped at an amount much smaller that the average of claims for those already on the Waiver • Allow recipients substantial latitude to spend up to the cap on any of the services. Both models assume that for most beneficiaries, the capped amount would not be sufficient to fun a meaningful part of Supportive Living • This model considered simply for the purpose of understanding what might result from such a capped benefit
  21. 21. 21 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 TSG Developed the Model Based On • Assumptions: • Services usage based on survey responses • Services cost based on historic Waiver claims • Assuming the program would allow beneficiaries to claim services up to the cap • Excluding Supportive Housing from the value assessment, as we know it averages $50,000, beyond other state caps • Seeking to find out: 1.What services would beneficiaries likely spend the capped amount on? 2.How far would the capped benefit go towards “buying” all of their 5 highest ranked services? 3.How much would the two scenarios cost in total, assuming 2,640 people came off the wait list into the new waiver program
  22. 22. 22 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 0 3,000 6,000 9,000 12,000 15,000 18,000 21,000 24,000 27,000 30,000 AnnualEstimatedClaims Simulated Beneficiary Claims Rank 1 Rank 2 Rank 3 Rank 4 Rank 5 Self-Directed Benefit Simulation 72% of top-5 needs (other than Supportive Living) met by a cap of $12,000 86% by a benefit capped at $15,000 The #4 & #5-ranked services are often the more expensive ones 72% 86%
  23. 23. 23 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Agenda • Review current spending for Waiver program • Report results of a survey of households on the wait list • Model the effect of alternative capped a range of alternative waiver programs: Next Task Force Update • Recommend path forward
  24. 24. 24 Proprietary and Confidential ArkansasBureauofLegislativeResearchMarch2016 Full Cost of Capped Waiver for 2,640 on the ID/DD Wait List Capped at $12,000 Capped at $15,000 Beneficiaries capped benefit: all services $31,680 MM $39,600 MM Arkansas State Match Cost $9,504 MM $11,880 MM

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