5123:2-9-19 Home and community-based services waivers - general requirements for adult day support, career planning, group employment support, individual employment support, non-medical transportation, and vocational habilitation.

 

 

 

Rule Summary and Fiscal Analysis (Part A)

 

Department of Mental Retardation and Developmental Disabilities

Agency Name

 

Community Services                                           Becky Phillips

Division                                                                  Contact

 

1810 Sullivant Avenue Columbus OH 43223-1239	[phone]	(614)
Agency Mailing Address (Plus Zip)	Phone	752-5302 Fax

 

 

5123:2-9-19

Rule Number

NEW

TYPE of rule filing

Rule Title/Tag Line              HCBS  waivers  - payment  standards  for  adult  day  support,

vocational habilitation, supported employment-enclave, supported employment-community, and non-medical transportation.

RULE SUMMARY

1.  Is the rule being filed consistent with the requirements of the RC 119.032 review? No

2.  Are you proposing this rule as a result of recent legislation? No

3.  Statute prescribing the procedure in accordance with the agency is required to adopt the rule: 119.03

4.  Statute(s) authorizing agency to adopt the rule: 5123.04, 5111.871, 5111.873

5.  Statute(s) the rule, as filed, amplifies or implements: 5123.04, 5111.871, 5111.873

6.  State the reason(s) for proposing (i.e., why are you filing,) this rule:

To implement payment standards for new waiver services.

7.  If the rule is an AMENDMENT, then summarize the changes and the content of the proposed rule; If the rule type is RESCISSION, NEW or NO CHANGE,

then summarize the content of the rule:

This rule establishes the standards governing payment for HCBS adult day support, vocational habilitation, supported employment-enclave, supported

employment-community, and non-medical transportation to access one or more of these services provided to individuals enrolled in HCBS waivers administered by the department.

8.  If the rule incorporates a text or other material by reference and the agency claims the incorporation by reference is exempt from compliance with sections

121.71 to 121.74 of the Revised Code because the text or other material is generally available to persons who reasonably can be expected to be affected by the rule, provide an explanation of how the text or other material is generally available to those persons:

This response left blank because filer specified online that the rule does not incorporate a text or other material by reference.

9.  If the rule incorporates a text or other material by reference, and it was infeasible for the agency to file the text or other material electronically, provide an explanation of why filing the text or other material electronically was infeasible:

This response left blank because filer specified online that the rule does not incorporate a text or other material by reference.

10.  If the rule is being rescinded and incorporates a text or other material by reference, and it was infeasible for the agency to file the text or other material, provide an explanation of why filing the text or other material was infeasible:

Not Applicable.

11.  If revising or refiling this rule, identify changes made from the previously filed version of this rule; if none, please state so:

Alphabetically reordered terms defined in paragraph (B).

Deleted references to "first line/level supervisors." This term was defined in paragraph (B)(10) and used in paragraphs (D)(3) and (J)(7) of the rule as originally filed on 04/14/06.

Defined the term "staff intensity." See paragraph (B)(22).

Clarified that the staffing intensity needs of individuals, who are not on waivers but

who receive services in a group with individuals who do receive waiver services, will be identified through the ISP development process applicable to them. See paragraph (G)(2).

Described annualized costs for waiver services as those that can be met by or those that exceed assigned budget limitations. See paragraph (G)(3).

Revised the due date for submittal of county transition plans to a date determined by ODMRDD that is no sooner than thirty days following the effective date of the rule. See paragraph (H)(3).

Explained conditions that need to be met in order to assign an individual to the A-1 staff intensity group. See paragraph (I)(1).

Replaced the term "group venue" with "grouping." See paragraphs (J)(3) and (J)(4).

Clarified that the staff intensity ratio may be determined by averaging the staff ratios in effect for the time span in which an individual receives services provided by the same provider during one calendar day. See paragraph (J)(5).

Replaced the term "manage" with the term "assist" when defining the daily responsibilities of direct services staff. See paragraph (J)(7).

Clarified that any individual who bills for the provision of waiver services shall meet the applicable certification requirements for direct services staff and shall be providing a waiver service to an eligible individual during the time encompassed by the billing. See paragraphs (J)(7) and (J)(8).

Deleted references to civil service classifications for direct services workers. This concept was addressed in paragraph (J)(8) and Appendix D of the rule as originally filed on 04/14/06.

Clarified that the SSA is responsible for informing individuals of their due process rights. See paragraph (L)(1).

Specified that if the department approves the request for an increased budget limitation, the county board shall assure a PAWS is completed within fifteen days following the determination. See paragraph (L)(2)(b).

Specified that ODMRDD shall monitor compliance of providers with rules 5123:2-9-16, 5123:2-9-17, 5123:2-9-18, and 5123:2-9-19. See paragraph (O)(7).

Appendix C (Service Codes and Payment Rates): Added service codes. Described conditions under which claims for work-related personal equipment purchase and/or modification are to be submitted to the Department.

Deleted Appendix D (Civil Service Classification Equivalents for Direct Service Staff and Supervisors of Direct Service Staff) as rule was originally filed on

04/14/06.

Appendix E (Staff Intensity Ratios): Renamed to Appendix D. Revised the acuity assessment scores for accuracy. Clarified the conditions under which group size limitations apply. Clarified the relationship between group size, staff intensity ratios, and number of direct services staff assigned to work with the group.

Replaced the term "venue" with the term "grouping."

Appendix F (Required Elements of Documentation): Renamed to Appendix E. Added rule references pertaining to ISP development and HCBS waiver service documentation requirements. Expanded definitions of documentation elements.

12.  119.032 Rule Review Date:

(If the rule is not exempt and you answered NO to question No. 1, provide the scheduled review date. If you answered YES to No. 1, the review date for this rule is the filing date.)

NOTE: If the rule is not exempt at the time of final filing, two dates are required: the current review date plus a date not to exceed 5 years from the effective date for Amended rules or a date not to exceed 5 years from the review date for No Change rules.

FISCAL ANALYSIS

13.  Estimate the total amount by which this proposed rule would increase / decrease either revenues / expenditures for the agency during the current biennium (in dollars): Explain the net impact of the proposed changes to the budget of your agency/department.

This will have no impact on revenues or expenditures.

$0.00

Ohio has designed this waiver reimbursement system in order to comply with the directive from the Centers from Medicare and Medicaid Services (CMS) to develop statewide payment rates for HCBS waiver services administered by the Department of Mental Retardation and Developmental Disabilities and delivered in

non-residential settings to eligible individuals. The services described in this rule and the accompanying rate and payment structures are intended to replace Day Habilitation waiver services currently delivered through the authority of Administrative Code 5123:2-9-10 as well as the county-specific Day Habilitation rates described in Administrative Code 5123:2-9-12.

The new reimbursement system will be revenue neutral at the state level since all state matching funds for these waiver services will be provided by county boards of

mental retardation and developmental disabilities established under Chapter 5126 of the Revised Code.

All services are to be provided within the annual funding limitations established and reflected in appendix B to the rule. Although administrative review of the appropriateness of an individual's placement within one of the listed groups in this appendix may be the subject of an administrative review by the department, in no situation will the state be liable for the provision of matching funds that enable an individual to receive a service package that exceeds the funding limitation in Group C and/or exceeds the funding limitation for transportation services related to the county in which the preponderance of services are provided.

14.  Identify the appropriation (by line item etc.) that authorizes each expenditure necessitated by the proposed rule:

322-412 Waiver state match

15.  Provide a summary of the estimated cost of compliance with the rule to all directly affected persons. When appropriate, please include the source for your information/estimated costs, e.g. industry, CFR, internal/agency:

Neither private service providers nor individuals/their family members are anticipated to incur additional costs to implement standardized payment rates for these waiver services on a statewide basis. Through application of the independent rate model used to establish these rates, it is understood, however, that payment rates will increase for some providers and decrease for others. Since the vast majority of all payment rates for non-residential waiver services are being made currently on a per diem basis, it is not possible for the department to identify the numbers of providers who will experience rate variations when payment for services is made on the basis of fifteen-minute service delivery units. Similarly, it is not possible for the department to identify the numbers of providers who will experience rate variation when payment for transportation is made on a per-mile or per-trip basis, since the payment for that service is currently included within the daily rate paid to deliver Day Habilitation waiver services. In relationship to services provided, eligible individuals receiving Day Habilitation waiver services prior to the effective date of the rule will be provided the opportunity to transition to one or more of the four adult day services identified in the rule and to also receive Non-Medical Transportation to access one or more of these services.

Transition plans identifying the date upon which these individuals will complete the assessment and service planning process integral to making the transition will be prepared by county mr/dd boards and approved by the Department. The transition to adult day services from Day Habilitation will occur prior to July 1, 2007 at which time Day Habilitation will cease to be an approved waiver service.

Individuals enrolled on the Individual Options and/or the Level One waivers after

the effective date of this rule will have the opportunity to select Day Habilitation or to select one or more of the adult day services, depending upon their eligibility for the services. Day Habilitation will cease to be an approved waiver service for all individuals on July 1, 2007, irrespective of their date of enrollment on a waiver administered by the Department. Individuals served and non-county board of mr/dd providers are not anticipated to experience any fiscal impact as the result of the completion of these processes.

16.  Does this rule have a fiscal effect on school districts, counties, townships, or municipal corporations? Yes

You must complete Part B of the Rule Summary and Fiscal Analysis in order to comply with Am. Sub. S.B. 33 of the 120th General Assembly.

17.  Does this rule deal with environmental protection or contain a component dealing with environmental protection as defined in R. C. 121.39? No

                                                                                                                                             

Page B-1                                                                                           Rule Number: 5123:2-9-19

Rule Summary and Fiscal Analysis (Part B)

1.    Does the proposed rule have a fiscal effect on any of the following?

(a) School	(b) Counties	(c) Townships	(d) Municipal
Districts			Corporations
No	Yes	No	No

2.    Please provide an estimate in dollars of the cost of compliance with the proposed rule for school districts, counties, townships, or municipal corporations. If you are unable to provide an estimate in dollars, please provide a written explanation of why it is not possible to provide such an estimate.

For the purposes of analysis, it was assumed that the 11,325 individuals enrolled on both the Individual Options and Level One waivers and receiving Day Habilitation services, including transportation, from county boards of mr/dd would transition to receive Adult Day Support/Vocational Habilitation waiver services and would receive per-trip transportation to access these services.  In a January 25, 2006 report, the consulting firm, EPP, estimated for the department that the annualized projected cost to county mr/dd boards to provide Non-Medical Transportation services using the new rates and service definitions would exceed their annualized per-trip reported costs for Day Habilitation-related transportation by 4% or $1,458,000.  Using the same source of reported costs to provide Day Habilitation, EPP estimated for the department that the annualized projected cost to county mr/dd boards would exceed their annualized payment to provide Adult Day Support/Vocational Habilitation services using the new rates and service definitions by 2.5% or $1,726,000.  Costs to provide Supported Employment-Enclave services were not included in a separate fiscal impact analysis since there was no way to estimate the numbers of individuals who would choose this service in lieu of Adult Day Support/Vocational Habilitation.

Since rates for Supported Employment-Enclave will be less than those paid for Adult Day Support/Vocational Habilitation and since all individuals receiving Day Habilitation services from county mr/dd boards were used in the prior fiscal impact analysis, additional calculations were considered to be unnecessary.  Similarly, no calculation of the fiscal impact for implementation of Supported Employment- Community services is included in the analysis since rates for this service remain identical to rates paid for Supported Employment, as defined in rule 5123:2-9-06 of the Administrative Code. Supported Employment and Supported Employment- Community are considered to be interchangeable services.  Reported actual costs were derived from cost reports submitted by county boards of mr/dd to the department for the period of January 1, 2005 through June 30, 2005.  The base payment rates for the new waiver services used in the comparison were adjusted for inflation and regional cost of doing business factors.

3.    If the proposed rule is the result of a federal requirement, does the proposed rule exceed the scope and intent of the federal requirement?

No

4.    If the proposed rule exceeds the minimum necessary federal requirement, please provide an estimate of, and justification for, the excess costs that exceed the cost of the federal requirement. In particular, please provide an estimate of the excess costs that exceed the cost of the federal requirement for (a) school districts, (b) counties, (c) townships, and (d) municipal corporations.

Not applicable.

5.    Please provide a comprehensive cost estimate for the proposed rule that includes the procedure and method used for calculating the cost of compliance.  This comprehensive cost estimate should identify all of the major cost categories including, but not limited to, (a) personnel costs, (b) new equipment or other capital costs, (c) operating costs, and (d) any indirect central service costs.

Please refer to response in #2.

(a)  Personnel Costs Not applicable.

(b)  New Equipment or Other Capital Costs Not applicable.

(c)  Operating Costs Not applicable.

(d)  Any Indirect Central Service Costs Not applicable.

(e)  Other Costs Not applicable.

6.    Please provide a written explanation of the agency's and the local government's ability to pay for the new requirements imposed by the proposed rule.

The Ohio Legislature currently appropriates approximately $110 million per year to the department to be used as the state matching funds to support HCBS waivers administered by the department.  The department determines the amount of funds that will be available to each county board for use to provide waiver services to individuals residing in the county.  Currently, the total amount of matching funds required to support waiver services is in excess of $180 million per year.  The approximately $70 million of additional needed matching funds is comprised of funds allocated by the department to county boards for other community residential purposes and from revenue generated by county boards through property tax levies. Through statute and by written agreements between county boards and the department that were approved by the Controlling Board on April 10, 2006, county boards assumed the financial liability and responsibility to provide the local share of the Medicaid funds that will be used to fund the adult day and transportation services referenced in this rule. This funding will be provided to eligible individuals residing in each county irrespective of the individuals' choice of a Medicaid provider who is certified and willing to provide the services.  The department has worked collaboratively since April 2005 with diverse groups of stakeholders, including county boards, to craft these service definitions and independent rate models.  It has been clearly communicated by CMS that they will not continue funding Day Habilitation services at the rates and in the manner currently in effect and that CMS expects the cessation of this waiver option to occur as soon after July 1, 2006 as the planful transition process can be accomplished.

7.    Please provide a statement on the proposed rule's impact on economic development.

The proposed rule implements a reimbursement methodology for adult day services that is based upon a standardized method of need assessment that will result in the identification of staff intensity ratios and related funding limitations.  This methodology will be used statewide to provide similar funding allocations for individuals with similar needs.  The rule provides tools to enable individuals served, their families, and county boards of mr/dd to more predictably forecast spending needs for waiver services and enables county boards to plan for the expansion of services to additional individuals.  Continued service growth provides opportunities for service providers to enhance their business and provides opportunities for currently unserved individuals to receive needed waiver services.