Establishing Component Rates &
Individual Service Plans for
EW Customized Living Services
Background Information
Aging and Adult Services, MN
Department of Human Services
March, 2009
This information is being
provided for background only.
These slides are not part of
today’s presentation.
Information contained here:
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Very little bit of history
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Program integrity goals
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Brief on implementation strategies for
rate-setting and services planning “tool
kit”
Review of Component Input & Negotiated
Rates Worksheets
Policy resource information
Customized Living
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Is an important part of the service
array for older people
Is part of a very large market:
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more HwS than NF capacity in
Minnesota
Portion of EW total spending spent
on CL/24 CL services continues to
increase
EW CL Trends
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The number of EW persons served in HwS
settings continues to grow
The aging of “Boomers” over the next 1020 years will greatly increase demand for
long term care services
These facts result in an increasing demand
to demonstrate accountability
2007 Customized Living Legislation
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Changed the name from AL/AL+ to CL, 24-Hour CL
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Established parameters for authorizing and
purchasing CL and 24 hr CL under the EW program.
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Rate and service parameters are detailed in MN
Statute 256B.0915 governing EW under subd. 3e and
3h
Reflects federal waiver requirements as well as
specific MN statutory language
By implementing 2007 legislation….
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Achieve program integrity goals, assure
federal compliance
Provide individuals with maximum choice
of services to meet their needs
Maintain/improve provider capacity
Federal Quality Assurance
Requirements
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For all participants of all waiver programs,
and for all services purchased under ANY
waiver program:
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Consumer must have a documented need for
the service
Rates are paid within parameters established
by the state
Identified needs are being met within the
overall community support (care) plan
Evidence-based quality management
systems (i.e. we need to “prove” it)
CMS Requirements for
EW Renewal
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EW plan is negotiated between DHS and
CMS for 5 year increments
New EW plan, effective July 1,2008 was
approved in September
CMS was concerned about rate disparity
DHS agreed to require that all counties
and tribes use DHS-issued CL tools as a
condition of EW renewal
Under Managed Care
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If MCOs use the county or tribal provider
network, they will use the tribal or countynegotiated component rates and apply the tool to
individual services planning and authorization
While CMS recognizes that MCOs are allowed to
establish rates and contracts with providers
differently, DHS will also encourage MCOs not
contracting through counties to use the new tool.
Under Managed Care
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MCOs requested the State to develop the
new tool and have been part of the
development and testing process.
The Right Service for the Right
Person at the Right Price
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DHS has responsibility to ensure that the
“right rate is paid for the right service, for
the right person”.
This has also been a working definition of
“quality” for many years.
“Right” Service
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There is assessed need for the service
Is the person’s choice/preference in how to
meet the need
Will be delivered by the provider
Is within the provider’s competency
Meets service definition as approved in the
waiver plan
Is delivered in compliance with other MA
requirements
Statutory Language Related to the
“Right” Service
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Customized living services must not
include rent or raw food costs.
The lead agency shall ensure that there is
a documented need for all services
authorized.
Statutory Language Related to the
“Right” Service
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The lead agency shall ensure that the frequency
and mode of supervision of the recipient and the
qualifications of staff providing supervision are
described and meet the needs of the recipient.
Shall not authorize 24-hour customized living
services unless there is a documented need,
based on criteria in 256B.0915, Subd. 3h, for 24hour supervision
Statutory Language Related to the
“Right” Rate
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The authorized payment rate must be based on services
to be provided.
The payment agreement must specify the services and
the amount of each service to be provided.
Negotiated rates must not exceed payment rates for
comparable EW or MA services.
Rates must reflect economies of scale
Implementation Strategies: Rate
Setting and Individual Services
Planning: 2007 -2008
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Training and bulletins related to change to
CL/24hr CL
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Established criteria for 24 hr CL
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MMIS changes to support this
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Creation of the Contract Planning Worksheet
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Statewide meetings regarding that Worksheet
Implementation Strategies:
2008 to Present
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Work group established to design a rate setting
and services planning tool that meets the
requirements in state and federal law.
Xcel workbook that reflects these requirements
Workbook contains tools for providers, contract
managers, and case managers and care
coordinators
Review of the Contract
Management Tools
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February video conference
Reviewed the Component Input and
Negotiated Rates worksheets
Step 1:
Contract Planning Worksheet
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Clarifies component services the provider will make
available, as well as any limitations or special features of
services made available
Is based on component services that are allowable under
the EW service definition
Reflects the Uniform Consumer Guide (required of all
Assisted Living) to the extent possible
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Is a fillable Word document
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For communication between provider and lead agencies
EW Customized Living Workbook
Step 2: Contract Management
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Component Rates Input Worksheet:
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is used to establish rates for component services.
Main focus for today.
Negotiated Rates Output Worksheet for
component services:
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automatically populated by the Component Rates
Input Worksheet
Person Responsible to Complete
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The provider who is enrolled in Minnesota Health
Care Programs (MHCP) as the licensed provider
of EW CL/24CL service must complete the
Worksheet.
If an enrolled Class A or Class F provider delivers
CL/24CL in more than one registered Housing
with Services establishment, the Class A or Class
F provider must complete a worksheet for each
Housing with Services establishment in which
they deliver services to EW consumers.
Contract Managers
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Lead agency staff responsible for negotiating
contracts with waiver providers will review the
provider’s proposed component rates.
The lead agency may, at its discretion, request
verification from the provider of staffing
reported, and the average numbers of residents
reported as served.
The lead agency may be a county, a managed
care organization, or a tribe under contract with
DHS to manage and administer the EW program.
EW Customized Living Workbook:
Reference Worksheets
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These worksheets reflect state limits on
comparable services, case mix budgets,
CL/24 hr CL rate limits
These worksheets provide data needed to
“automate” the workbook
There is no input work to be done, the
reference worksheets are populated by
AAS as part of the toolkit
The Purpose of the
Component Input Worksheet
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The Component Input Worksheet:
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Provides information to establish the hourly
service rate for each component service
Accounts for individual as well as shared
services
Captures staff resources available to deliver
services. This information is needed to
determined shared service rates.
Calculates shared supervision rates
Establishes per-meal charges, means for
summoning assistance
Component Input Worksheet
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Limits the component rate to the closest
equivalent EW or MA service as required in
statute.
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The service level and associated rate used within the
toolkit is for the required staff competency level and
the rate associated with that staff competency.
Requires the provider to evaluate staff
schedules, and staff assignments, including the
number of residents served by the staff resource
described.
Sections on the Input Worksheet
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Provider Information
Services Sections
Hourly Rate Limits
Report Average Staff Time: Staff
Schedules
Report “Average Number of Residents”
Briefly reviewed each section at February video
conference
Negotiated Component Rates
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After completion of the Input Worksheet,
the information provided will populate the
Negotiated Component Rates Form.
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This form provides the dollar amounts for
component rates that are used when
completing an individual’s CL/24CL service
delivery plan in order to help calculate the
amount to be authorized for those
services.
Hourly Rate Limits
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The hourly rate limits listed in the Worksheet are those
established by DHS in consideration of 2007 legislative
requirements.
Negotiated rates for component services cannot exceed
these limits. See Handout.
These limits will only change if the Legislature grants
increases or requires decreases in the comparable rates
used and described below. If this occurs, DHS will
update the tool to reflect these changes.
These rate limits represent the rate for an hour of
service. An individual customized living or 24 hour
customized living service delivery plan can and typically
will include units of any given component service of less
than an hour. In this case, the time and price will be
calculated as such on the individual plan.
Resources:
Elderly Waiver Bulletin 07-25-01C
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Replaced all previous bulletins related to AL and
AL+ **
Policy regarding the need to attach dollars to
services and individualize service plans is not new
Provider standards are not new
Changes in license name but not requirements
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CO
NVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs1
6_137006
**NOTE: All DHS bulletins expire two years from date of issue.
“Instructions
for Component Rates”
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Document attached to Bulletin 09-25-01
Provides more detail about each cell within
the worksheet