Questions and Answers for Individuals and Families
Background on the Cost Study
What is purpose of the study conducted by the Department of Behavioral Health and Developmental Disabilities?
The Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) is reviewing the Medicaid rates paid to providers of three critical services: community residential alternative (CRA) – group home and host home services; community living support (CLS); and respite services. This review is intended to determine whether these rates are reasonable based on average provider costs to deliver those services.
Detailed information regarding the cost study can be found at: https://dbhdd.georgia.gov/developmental-disabilities
Why did we conduct the cost study?
The Comprehensive Waiver program (COMP) is due for renewal through the Centers for Medicare and Medicaid Services (CMS). As part of its approval of waiver applications, CMS requires that states have a sound method for developing or proposing payment rates.
Why weren’t all services included in the cost study?
In preparation for the renewal of the COMP Waiver Program, DBHDD held a series of public forums across the state. More than 1,000 individuals including families attended the forums. They provided real-life information based on their experiences with the waiver programs and identified residential services, in-home supports (CLS) and respite care as areas where the reimbursement rates sometimes made it difficult to find service providers. Participants also said, in the case of residential services, that individual needs vary widely and people deserve reimbursement rates that reflect that variability.
DBHDD intends to begin a review of most remaining services later this year.
How was the cost study conducted?
All enrolled providers of these three service types were surveyed using a standard tool. Participants submitted all costs of doing business -- from direct support staff wages and benefits to the cost of vans and office supplies. The accounting firm that conducted the cost study also researched comparison data from sources such as the Bureau of Labor Statistics. The information was sorted and analyzed for comparison and trends.
Questions specific to the rate methodology can be directed to [email protected] through July 27, 2015. The comments will be considered before the rate models are finalized.
What is the most significant change in the proposed rate structure?
In order to determine the most appropriate category based on individual need, DBHDD will use information from two assessment tools – the Supports Intensity Scale (SIS) and the Health Risk Screening Tool (HRST) – to determine which rate category best fits the person’s need level.
All individuals will receive a new SIS assessment in order to determine which category best reflects the person’s needs. Individuals will be reassessed every three years unless there is a significant change in their support needs. HRST assessments will continue to be conducted at least annually.
When will the new rates take effect?
DBHDD is planning to begin implementing these rates in April 2016.
How will the rate changes affect individuals who receive services?
The proposed rates are higher than current rates in every case except the Category 1 host homes rate which will remain the same. With these higher rates, DBHDD expects that the quality of services will improve.
Will individuals have to change providers?
No. Agencies that deliver community residential services to individuals with the most significant needs will need to receive a certification from DBHDD to ensure that they have the ability to serve these individuals. The Department is still developing the certification standards, but will provide a ‘grace period’ to allow providers to achieve certification.
Community Residential Alternative – Group Home and Host Home
How are residential rates changing?
There will no longer be a single rate for all residential services. In acknowledgment that individual needs vary, there are four rate categories for group home services and two rate categories for host home services.
Is it true that host home rates will be cut?
No. DBHDD decided to hold the rate harmless - that is DBHDD will continue to pay host homes based on this rate - despite the results of the cost study which would have reduced the rate. Thus agencies providing residential services through host homes will not experience a reduction.
Community Living Support
How are CLS rates changing?
The CLS individual unit rate will increase based on cost study data.
The cost study revealed that delivery of more than six and half hours of CLS resulted in a significant revenue shortfall. This meant that providers delivering more than seven hours of service per day were delivering uncompensated care. Therefore, the proposed rates support a 15-minute unit instead of a daily rate. The annual maximum allowance for individual community living supports has been increased to $51,660. A monthly cap for CLS of $4,305 is being proposed.
Through the cost study process, DBHDD developed an “additional staffing” service that will be provided to individuals whose clinical needs warrant more than the $51,660 allows.
Feedback from many parents during the public forums led DBHDD staff to understand the desire of parents and individuals to use a supported living model to allow maximum independence in a “roommate arrangement.” Keeping this in mind through the rate development process, DBHDD designed a reimbursement rate to support this model.
- The rate study establishes ‘multi-member’ rates for individuals who choose to live together and share supports in groups of two or three.
- Individuals who choose to share supports with a roommate will be able to ‘stretch’ their services.
How will consumer-directed services be affected?
The annual maximum budget limit for individuals who choose consumer-direction for CLS will be increased to $51,660, the exact same limit that applies to individuals who choose agency-directed services. . A monthly cap for CLS of $4,305 is being proposed.
Respite
How are Respite rates changing?
The rates for respite services are increasing. The cost survey revealed that the current respite rate resulted in a significant revenue shortfall for providers. This shortfall left families to be unable to access respite services. There will continue to be both a 15-minute rate as well as a daily or “overnight” rate. Similar to residential rates, the respite overnight will accommodate individuals with a higher level of need through the use of a higher-level category.
What will be the limit on respite services?
The annual respite limits are being increased from the current $3,744 maximum to $4,608 minimum (or slightly more if the individual’s support needs are great). The new limits are based on 30 days of the daily respite rate.
How will consumer-directed services be affected?
The annual budget limits for individuals who choose consumer-direction will be the same ($4,608) as those described above for individuals who choose agency-directed services.
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