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Proprietary and Confidential
Arkansas Health Care Reform
Task Force: TSG Status Update # 4
Arkansas Medicaid Long Term C...
2
Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Executive Summary
• Costs of care for the ...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
ABD Costs Including Halo Are 74% of
Tradit...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
ABD Direct and Halo Costs 74% of
Tradition...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Nearly Half of Medicaid is for Long
Term S...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Eldercare
• Elder care including Halo is $...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Elderly Care is Largely for Private
Nursin...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Halo Effect Accounts for Significant
Costs...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Average Number of Elders in Care on
Any Gi...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
$0
$10,000
$20,000
$30,000
$40,000
$50,00...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Developmental Disabilities
• DD beneficia...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Disability Includes Many Services for
the...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Institutional DD: Direct and Halo Costs
D...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
DD HCBS: Direct and Halo Costs by
Program...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Average Number of People in DD
Care on An...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Public and Private Institutions (ICF/DD)A...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
$0
$20,000
$40,000
$60,000
$80,000
$100,0...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Comparing per Person Adult ICF to
Communi...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Comparing per Person Pediatric ICF to
CHM...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
There are 2,640 people on the Adult DD
Wa...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Most Frequent Types of Claims for
Wait-Li...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Example of Waitlist Beneficiary Claims
L1...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Key Facts to Consider When Allocating
Fun...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Behavioral Health
• RSPMI and Inpatient P...
25
Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Behavioral Health is Largely RSPMI
and In...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
While More is Claimed for RSPMI,
Average ...
27
Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Most Beneficiaries Claimed Less than
$1,0...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Top Quartile RSPMI Beneficiaries
Claim 75...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
634 Beneficiaries Claim More than
$100 RS...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Community First Choice Option: 1915 (k):
...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
Community First Choice Option
• Permits s...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
States that have implemented CFCO
• Calif...
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Proprietary and Confidential
ArkansasBureauofLegislativeResearchSeptember2015
States that have implemented CFCO
• Washi...
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Arkansas Health Care Reform Task Force: TSG Status Update # 4

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Arkansas Medicaid Long Term Care, Developmentally Disabled, Waiting List Cost Data, and facts about Community First Choice option.

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Arkansas Health Care Reform Task Force: TSG Status Update # 4

  1. 1. 1 Proprietary and Confidential Arkansas Health Care Reform Task Force: TSG Status Update # 4 Arkansas Medicaid Long Term Care, Developmentally Disabled, Waiting List Cost Data, and facts about Community First Choice option September 16, 2015
  2. 2. 2 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Executive Summary • Costs of care for the Long Term Supports and Services (LTSS) (Aged, Blind and Disabled (ABD), including Behavioral Health and all associated medical (Halo)) account for 74% of traditional Medicaid, yet fall outside Person-Centered Medical Home or Episodes of Care • Arkansas places heavy reliance on both elder and DD institutional care, which even including halo costs is 2-3 times the cost of Home and Community Based Care (HCBC) alternatives • RSPMI is heavily used by a few beneficiaries who claim over $100 a day, for a total of $31.5MM. This does not reduce inpatient (IP) Psych claims
  3. 3. 3 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 ABD Costs Including Halo Are 74% of Traditional Medicaid Direct Program Costs Halo Effect Total Percent of Claims Elderly $989,580,886 $163,729,046 $1,153,309,933 29% Developmentally Disabled $723,493,917 $183,455,886 $906,949,803 23% Behavioral Health $464,686,509 $433,988,499 $898,675,008 22% Sum of Aged, Blind and Disabled $2,958,934,744 74% All Claims (without Private Option or contracts) $4,023,136,382 100%
  4. 4. 4 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 ABD Direct and Halo Costs 74% of Traditional Medicaid Elderly Developmental Disability Behavioral Health Other than ABD
  5. 5. 5 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Nearly Half of Medicaid is for Long Term Services and Support (LTSS)* *Includes Institutional and HCBS Note: TSG analysis of data covering calendar 2014
  6. 6. 6 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Eldercare • Elder care including Halo is $1.2 billion, 29% of Medicaid • 65% of Elder LTSS is for Nursing Homes • Depending on Elder program, Halo Costs add 10-60% in other medical costs • Nursing home costs are over 3x waiver costs per person • Even after adding halo costs, Waiver Beneficiaries across the board, including those in the assisted living waiver claim less than half of institutional beneficiaries
  7. 7. 7 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Elderly Care is Largely for Private Nursing Homes 58 - Private SNF $605,391,718 53 - Personal Care - Regular $98,025,956 97 - Elders Choices Waiver $53,130,713 63 - Public SNF $39,695,754 H2 - Nursing Home Hospice $29,971,174 59 - Private SNF Crossover $24,963,236 L4 - APD Agency Attendant Care, Co Employer $23,085,386 L1 - APD Attendant Care $21,072,004 I0 - Independent Choices Treatment Elderly $19,961,565 AL - Assisted Living Facility $17,809,236 24 - Home Health Services $16,791,790 SR - AR Seniors $7,422,863 PP - PACE $6,387,966 73 - Private Duty Nursing EPSDT $6,025,448 H1 - Hospice $5,947,011 94 - EPSDT Prosthetic Device $5,714,592 74 - Private Duty Nursing Services $3,063,530 I9 - Independent Choices C/FI $1,862,990 C3 - CSMT Age 60 and Older $1,678,375 I8 - Independent Choices FMS Services $1,326,548 I2 - Independent Choices New Trtmnt Elderly $193,673 AX - Extension of 3 Prescriptions for Assisted Living $59,359 $989,580,886 Note: TSG analysis of data covering calendar 2014
  8. 8. 8 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Halo Effect Accounts for Significant Costs for in Each Type of Elder LTSS Note: TSG analysis of data covering calendar 2014 $0 $100 $200 $300 $400 $500 $600 $700 $800 58 - Private SNF 63 - Public SNF 97 - Elders Choices Waiver AL - Assisted Living Facility I0 - Independent Choices Treatment Elderly $Millions Elder Care Program Costs Direct Program Costs Other Medical 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 58 - Private SNF 63 - Public SNF 97 - Elders Choices Waiver AL - Assisted Living Facility I0 - Independent Choices Treatment Elderly Elder Care Program Costs Direct Program Costs Other Medical
  9. 9. 9 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Average Number of Elders in Care on Any Given Month Billing Medicaid 2014 Elder Headcount (mid-month) Average 2014 Member Months H1 - Hospice 140 1,679 59 - Private SNF Crossover 1,582 18,982 H2 - Nursing Home Hospice 604 7,248 63 - Public SNF 237 2,848 58 - Private SNF 11,544 138,530 97 - Elders Choices Waiver 4,661 55,931 I0 - Independent Choices Treatment Elderly 1,853 22,230 53 - Personal Care - Regular 11,674 140,092 AL - Assisted Living Facility 775 9,299 Note: TSG analysis of data covering calendar 2014
  10. 10. 10 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 $0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 Nursing Home HCBS Per Capita Elder Care Costs: Nursing Home compared to HCBS Direct Program Costs Other Medical Nursing Home Costs are Twice as Much as HCBS Note: TSG analysis of data covering calendar 2014 $0 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 $160,000 $180,000 $200,000 58 - Private SNF 63 - Public SNF 97 - Elders Choices Waiver AL - Assisted Living Facility I0 - Independent Choices Treatment Elderly Elder per Capita Care Program Costs Direct Program Costs Direct Program Costs $63,649 $27,176
  11. 11. 11 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Developmental Disabilities • DD beneficiaries account for $900 million, 23% of traditional Medicaid • Institutional DD including Halo effect costs Medicaid 2 – 3 times the cost of each HCBS program • Of that $900 Million, approximately $190 million is spent on Children’s services
  12. 12. 12 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Disability Includes Many Services for the Physically and Cognitively Disabled D1 - DDS Alternative Com Service Waiver $196,507,980 62 - Public ICF Intellectual Disabilities $158,927,868 08 - Disabled Day Treatment Clinic Svc $154,045,712 71 - EPSDT CHMS $59,971,536 27 - ICF/INF/E.S. 24,594,450 15 - EPSDT Screening 18,511,306 E4 - Speech and Language Therapy - CHMS 16,084,798 T7 - DDTCS Transportation 15,502,254 E3 - Occupational Therapy - CHMS 12,873,920 E2 - Physical Therapy - CHMS 11,201,996 D7 - Rehab Servies School Based CHMS 9,917,245 C7 - Speech and Language Therapy School Based Only9,345,225 C6 - Occupational Therapy School Based Only 8,085,287 C5 - Physical Therapy School Based Only 4,583,060 14 - EPSDT Immunizations 4,180,774 I1 - Independent Choices Trtmnt Young Disable 3,254,075 AW - Autism Intensive Intervention Provider 2,711,720 95 - EPSDT Orthotic Appliances 2,442,558 D3 - Developmental Rehab Services 1,783,671 D4 - DYS Rehab Services 1,712,937 88 - Inpatient AR Teaching Crossover 1,649,498 72 - EPSDT Podiatry 1,396,968 C9 - Personal Care - School Based 1,124,608 93 - EPSDT DMS Expansion 1,050,666 RC - RSPD/ Residential Rehab Center 832,738 T4 - TCM/DYS 741,476 I3 - Independent Choices New Trtmnt Yng Dsbl 384,601 80 - Therapy School District/ Esc Group 74,989 723,493,917 Note: TSG analysis of data covering calendar 2014
  13. 13. 13 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Institutional DD: Direct and Halo Costs Direct Program Costs, 25 Direct Program Costs, 152 Other Medical Costs 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 27 - ICF/INF/E.S. 62 - Public ICF Intellectual Disabilities Total Institutional DD Costs Including Halo Costs Direct Program Costs Other Medical Costs Direct Program Costs, 25 Direct Program Costs, 152 0 20 40 60 80 100 120 140 160 180 27 - ICF/INF/E.S. 62 - Public ICF Intellectual Disabilities Millions Institutional DD Costs Including Halo Costs Direct Program Costs Other Medical Costs
  14. 14. 14 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 DD HCBS: Direct and Halo Costs by Program 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 27 - ICF/INF/E.S. 62 - Public ICF Mentally Retarded 08 - Disabled Day Treatment Clinic Svc D1 - DDS Alternative Com Service Waiver D6 - Rehab Services - School Based RSPMI D7 - Rehab Servies School Based CHMS DD Program Costs Direct Program Cost Other Medical $0 $50 $100 $150 $200 $250 $300 $350 $400 27 - ICF/INF/E.S. 62 - Public ICF Mentally Retarded 08 - Disabled Day Treatment Clinic Svc D1 - DDS Alternative Com Service Waiver D6 - Rehab Services - School Based RSPMI D7 - Rehab Servies School Based CHMS Millions DD Program Costs
  15. 15. 15 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Average Number of People in DD Care on Any Given Month Billing Medicaid DD Waiver--headcount Average 2014 Member Months 08 - Disabled Day Treatment Clinic Svc 10,122 121,463 71 - EPSDT CHMS 4,262 51,144 D1 - DDS Alternative Com Service Waiver 3,886 46,634 D6 - Rehab Services - School Based RSPMI 482 5,783 D7 - Rehab Services School Based CHMS 573 6,307 E7 - Speech and Language Therapy - RSPMI 25 252 2014 Headcount Average 2014 Member Months 27 - ICF/INF/E.S. - Pediatric 202 2,418 62 - ICF Intellectual Disabilities 1,238 14,853 Total Institutional 1,439 17,271 Note: TSG analysis of data covering calendar 2014
  16. 16. 16 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Public and Private Institutions (ICF/DD)Account for 25% of All DD Cost Including Children andAdults Note: TSG analysis of data covering calendar 2014 Home and Community (Children and adults) Institutional $0 $100 $200 $300 $400 $500 $600 $700 $800 Millions Disability Claims 62 - ICF Intellectual Disabilities (Public & Private) 27 - ICF/INF /E.S. (Pediat ric) $0 $20 $40 $60 $80 $100 $120 $140 $160 $180 $200 Millions DD Institutional Claims
  17. 17. 17 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 $0 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 $160,000 ICF 08 - Disabled Day Treatment Clinic Svc D1 - DDS Alternative Com Service Waiver D6 - Rehab Services - School Based RSPMI D7 - Rehab Servies School Based CHMS Per Capita DDCosts: ICF/DD compared to HCBS Direct Program Cost Other Medical Institutional DD with Direct Costs and Halo Costs are Twice HCBS Note: TSG analysis of data covering calendar 2014 $135,162 $68,937 $44,567 $45,937 $36,356
  18. 18. 18 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Comparing per Person Adult ICF to Community Waiver 122,934 50,866 7,727 18,071 0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 62 - ICF MR (Public and Private) D1 - DDS Alternative Com Service Waiver ICF/MR compared to Community Waiver--Per Capita Direct Program Cost Other Medical $130,661 $68,937
  19. 19. 19 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Comparing per Person Pediatric ICF to CHMS 122,814 17,587 39,995 28,350 0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 27 - ICF/INF/E.S. D7 - Rehab Servies School Based CHMS Pediatric ICF compared to CHMS Per Capita Direct Program Cost Other Medical $162,809 $45,937
  20. 20. 20 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 There are 2,640 people on the Adult DD Waitlist. Many are Receiving Some Services Note: TSG analysis of data covering 1/1/2014-6/30/2015: annualized by 12/18 months 08 - DDTCS 62 - Public— ICF/MR 56 - Prescription services 75 - Pediatric inpatient hospital 27 - ICF/Inf/E.S. Other Medicaid Claims for Wait-listed Beneficiaries Claims Total Benefi- ciaries 08 - DDTCS 5,776,912 779 62 - Public—ICF/MR 5,065,694 52 56 - Prescription services 3,997,213 2,074 75 - Pediatric inpatient hospital 2,754,106 193 27 - ICF/Inf/E.S. 2,331,912 31 73 - Private duty nursing EPSDT 1,249,047 21 12 - Durable medical equipment/oxygen 1,121,738 1,140 T7 - DDTCS transportation 904,083 425 L4 - APD Agency Attendant Care, Co- Employer 888,025 42 B5 - Speech and Language Therapy General 765,035 491 33 - Inpatient Psychiatric U21 718,402 47 53 - Personal Care - Regular 668,448 231 Other 5,753,848 Total 31,994,462 2,640
  21. 21. 21 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Most Frequent Types of Claims for Wait-Listed Beneficiaries Note: TSG analysis of data covering 1/1/2014-6/30/2015
  22. 22. 22 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Example of Waitlist Beneficiary Claims L1 - APD Attendant Care $23,677.92 08 - DDTCS $12,783.60 12 - Durable medical equipment/oxygen other criteria: EPSDT referral indicator equals no. $2,871.30 T7 - DDTCS transportation $2,460.60 L6 - APD Counseling Case Management $1,190.00 45 - Oral surgery—physicians codes $611.80 54 - Physician crossovers $231.28 NT - Non-emergency transportation (NET broker) managed care w aiver $138.34 44 - Optometrist/occularist $49.22 16 - Eyeglasses $25.00 49 - Other practitioner crossovers $19.75 $44,058.81 12 - Durable medical equipment/oxygen other criteria: EPSDT referral indicator equals no. $7,125.36 C5 - Physical Therapy School Based Only $6,760.16 C6 - Occupational Therapy School Based Only $5,147.20 56 - Prescription services $5,135.88 C7 - Speech and Language Therapy School Based Only $4,330.24 08 - DDTCS $1,266.36 95 - Orthotic appliances EPSDT. Other criteria: TOS = 6 $1,066.90 55 - Physician services $543.65 PE - Pediatric outpatient hospital $503.00 70 - Surgery $383.36 02 - Ambulance $322.75 T1 - TCM/CMS $268.36 04 - Audiologist – General $109.23 80 - Therapy school district/ESC group $98.88 NT - Non-emergency transportation (NET broker) managed care w aiver $76.01 51 - Outpatient hospital $61.57 M3 - PCMH Care Coordination Payments $57.18 15 - EPSDT screenings With Other Criteria: $56.41 M1 - PCCM managed care fee $54.00 14 - EPSDT immunizations w ith Other Criteria: $9.56 $33,376.06
  23. 23. 23 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Key Facts to Consider When Allocating Funds for Wait List Removal • Ensure that funding requested takes into consideration the cost of community services that are already being rendered • Ensure that payment for “supportive living” is appropriate • Ensure right service, right time and right place – reason why the standardized assessment is so important to the entire LTSS system • Question whether the 20% administrative costs for providers is appropriate – (incentives not always aligned with needs) • Can the 4265 Waiver cap be eliminated under a more global Section 1115 Waiver without costing more • Global 1115 Waiver could integrate “supportive living” and “supportive employment” with flexibility to meet needs
  24. 24. 24 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Behavioral Health • RSPMI and Inpatient Psych account for $900 million, 22% of traditional Medicaid • Total claims for RSPMI are twice those for In-Patient Psych, although average RSPMI claims are less than 1/10th average In- Patient Psych claims • RSPMI is not a tradeoff for In-Patient Psych. Actually, high RSPMI is connected with even higher In-Patient Psych • A few beneficiaries account for a large share of RSPMI
  25. 25. 25 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Behavioral Health is Largely RSPMI and Inpatient Psych (under 21) Behavioral Health Calendar 2014 36 - Community Mental Health (RSPMI) $310,700,134 33 - Inpatient Psychiatric u-21 $145,777,457 81 - Psychologist 1,760,192 L6 - APD Counseling Case Management 1,751,957 D6 - Rehab Services - School Based RSPMI 1,643,147 32 - Inpatient Psychiatric Crossover u-21 1,527,431 L2 - APD-Environmental Adaptations 753,915 82 - Therapy Individual/Regular Crossover 324,484 SO - Sexual Offender Program 146,952 L5 - APD Traditional Agency Attendant Care 146,646 SA - Substance Abuse Treatment Services 77,408 T6 - School-Based Mental Health Services 38,516 E7 - Speech and Language Therapy - RSPMI 38,270 $464,686,509 Note: TSG analysis of data covering calendar 2014 36 - Comm unity Mental Health (RSPMI ), $311 33 - Inpatie nt Psychia tric u- 21, $146 Other $0 $50 $100 $150 $200 $250 $300 $350 $400 $450 $500 Millions Behavioral Health
  26. 26. 26 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 While More is Claimed for RSPMI, Average Inpatient Psych is Much Higher Note: TSG analysis of data covering calendar 2014 Inpatie nt Psych, $273 RSPMI, $352 $0 $100 $200 $300 $400 $500 $600 $700 Millions Total Inpatient Psych and RSPMI Claims $3,878 $44,900 $0 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 RSPMI Inpatient Psych Average Claims per Person Millions
  27. 27. 27 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Most Beneficiaries Claimed Less than $1,000 in 2014 for RSPMI Note: TSG analysis of data covering calendar 2014 41% 17% 10% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 AxisTitle NumberofBeneficiaries Annual Claims (< amount shown) Frequency of RSPMI Claim Amounts per Person
  28. 28. 28 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Top Quartile RSPMI Beneficiaries Claim 75% of RSPMI and 56% of IP Psych Low-level RSPMI beneficiaries use little IP Psych; High-level RSPMI beneficiaries claim a lot of IP Psych Overall Average 1st Quartile of RSPMI 4th Quartile of RSPMI Amount % Amount % Amount % RSPMI $3,878 $281 $11,587 $351,570,340 100% $6,382,127 2% $262,621,236 75% Inpatient Psych $44,900 $105 $47,083 $273,351,105 100% $9,913,512 4% $152,312,848 56% Total of Claims OverallAverage Claims Amount 1st Quartile 4th Quartile Note: TSG analysis of data covering calendar 2014
  29. 29. 29 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 634 Beneficiaries Claim More than $100 RSPMI per Day, Totaling $32 MM Note: TSG analysis of data covering calendar 2014 340 176 91 21 4 0 1 1 0 50 100 150 200 250 300 350 400 3,000 - 4,000 4,000 - 5,000 5,000 - 6,000 6,000 - 7,000 7,000 - 8,000 8,000 - 9,000 9,000 - 1,0000 10,000 - 20,000 NumberofBeneficiaries Monthly $Claims Amount for RSPMI Top RSPMI Beneficiaries
  30. 30. 30 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Community First Choice Option: 1915 (k): ACA Section 2401 • Optional new state flexibility in providing HCBS services • CFCO is a state plan amendment resulting in an entitlement • Provides states enhanced 6% FMAP for “amounts expended under section 1915 (k)” • Is not a “pass” on Olmstead related requirements • No prohibition from individuals receiving 1915 (c), Money Follows the Person, and CFC services at the same time
  31. 31. 31 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 Community First Choice Option • Permits states to combine three 1915 (c) waiver populations under 1915 (k) state plan amendment • Maintenance of Effort in first year must maintain same amount or exceed spending in prior 12 month period before CFCO start date • CMS estimated 25 states would choose CFCO option; to date 6 states have started CFCO • SPAs do not expire; to change or eliminate an existing SPA requires a modified SPA request for CMS approval • CMS must submit evaluation report on the effectiveness, impact, and comparative costs of CFCO to Congress on 12/31/15 • States can design HCBS services similar to CFCO under an 1115 waiver that does not result in a new entitlement (e.g. TennCare)
  32. 32. 32 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 States that have implemented CFCO • California: 7/1/2013: Limits services to 283 hours per month • Maryland: 1/1/2014: Cost caps on non-HCBS services (home delivered meals; assistive technology, environmental assessments) • Montana: 10/1/2013: Limits attendant services to 84 hours every two weeks; IADL services not to exceed 1/3rd total CFC hours or 10 hours per two week period; skills acquisition not to exceed 25 hours every three months • Oregon: 7/1/2013: Cost caps on home modifications and assistive technology; 18 outcome measures
  33. 33. 33 Proprietary and Confidential ArkansasBureauofLegislativeResearchSeptember2015 States that have implemented CFCO • Washington: 8/30/2015: Functional eligibility for Personal Care is higher; reinvest savings to address DD waiting list • Texas: 6/1/2015: Retained existing Personal Care and 1915 (c) waivers for I/DD population; persons receiving HCBS (c) services through Star Plus managed care ineligible for CFCO

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