Division of Disability & Rehabilitative Services (DDRS) Director Nicole Norvell is known for her positive and direct approach to working with Division stakeholders, which was evident during the well-attended August 1 DDRS Quarterly Provider Meeting.
Ms. Norvell set the tone for the meeting by providing an overview of the updated Family & Social Services Administration's (FSSA) mission statement, which focuses on compassion, health, self-sufficiency and productive lives for persons they serve. The vision statement was also revised to reflect FSSA's commitment to being a high-performance, integrated and interdependent agency focused on implementing innovative ideas to serve consumers. The Agency's core values include active promotion of stakeholder partnerships with providers, consumers, families, and advocacy groups; these values will drive every aspect of FSSA's work.
Next, Ms. Norvell outlined four priorities for discussion during the meeting: group home conversion, Health Homes and healthcare coordination, Medicaid Waiver rate methodology, and setting goals for DDRS.
Group Home Conversion
Ms. Norvell reviewed the status of mandatory group home conversion, noting that there are 522 group homes across Indiana. Upon her appointment, Secretary Minott convened DDRS leadership to review data related to group home conversion, including the anticipated fiscal impact. Milliman was retained to assist with the analysis and determined that mandatory conversion had the potential to incur approximately $14 Million in additional spending for the same number of individuals. The additional spending was related to a variety of factors, with the most significant being the loss of provider tax which reduces the state's portion of group home claims. Additional concerns identified by the analysis include capacity relative to workforce, housing, and general system capabilities.
As a result of the analysis, DDRS offered the Secretary five options relative to group home conversion. The selected policy direction discontinues mandatory conversion, sets forth a plan to reinstate the Intermediate Care Facility licensure rule before it sunsets in 2015, and provides direction for the agency to reach out to discuss community-based options with individuals residing in large private ICF/DDs and those individuals who have resided in Supervised Group Living for over five years.
Options still exist for agencies wishing to convert group homes. Those interested in voluntary conversion are encouraged to contact DDRS to review details related to changes in the process. Balancing Incentives Program (BIP) funds are still available for group home conversion and will also be used to support increased budgets for consumers transitioning from large Intermediate Care Facilities.
To support their outreach efforts, Ms. Norvell is enlisting the assistance of The Self-Advocates of Indiana (SAI) and their My Life, My Choice initiative. The approach uses consumer-to-consumer interviews to talk about the individual's needs, their satisfaction with services, and their interest in exploring different living options. SAI used this approach to interview over 500 individuals residing in nursing homes last year, with impressive results.
DDRS believes this partnership is critical in their efforts to ensure that choices are articulated and offered to all persons receiving services.
Health Care Coordination
Ms. Norvell reaffirmed the Division's commitment to ensuring that individuals have access to quality healthcare, noting that it is essential to provide for the medical needs of Medicaid Waiver recipients. To further this commitment, the Division is working with INARF, The Arc of Indiana, and other stakeholder groups to research scenarios for reinstatement of Health Care Coordination as a Medicaid Waiver service.
DDRS anticipates submitting a Health Care coordination application to the Centers for Medicare & Medicaid Service (CMS) on January 1, 2014. With the new focus on Health Care Coordination, the Health Homes application will not be submitted to CMS at this time.
Waiver Rate Methodology
Ms. Norvell commended INARF's dedication to Medicaid Waiver rate fairness and credited the Association with approaching her and Secretary Minott about the need for relief. After careful consideration, Secretary Minott and Ms. Norvell have set forth plans for a 1% increase in rates for Residential Habilitation & Support (RHS), Respite, Facility H abilitation Individual and Community-Based Habilitation Individual. The rate increase will be implemented on January 1, 2014.
In making this announcement, Ms. Norvell also shared the Division's goal to work collaboratively with the INARF Rate Reform Workgroup, the Arc of Indiana, and other stakeholders to assess and redesign the Medicaid Waiver rate methodology within 12 months. Relying on support from the National Association of State Directors of Developmental Disabilities Services and research on other states, she expressed confidence that a new methodology could be developed that was more effective by incorporating efficiencies like daily, weekly or even monthly units.
By combining the 1% increase with the re-introduction of Health Care Coordination, and the commitment to rate structure reform, the Division is working hard to develop a sustainable model to support providers in the important work that they do on behalf of the Division. INARF is encouraged by these developments and believe they lay a foundation for appreciably restoring the resources lost when rates were reduced in 2010.
Looking ahead, DDRS will position itself to address key industry issues in a measured, transparent, and collaborative manner. Ms. Norvell emphasized the need for open dialogue between the Division, the provider community, consumers and families, and other industry stakeholders to develop real solutions for systemic challenges. In the coming months, DDRS will request feedback from stakeholder groups to identify 3 key issues for study over the next 24 months.
Once key issues have been identified, work groups will be assembled to begin issue analysis. The Division will provide frequent public postings to keep all stakeholders informed as to the progress of work groups and opportunities for public comment. Study findings and work products will be posted to the web with the opportunity for stakeholders to provide feedback. Ms. Norvell expressed her commitment to partnership with the provider community, consumers, and families as DDRS endeavors to improve the system of supports and services for persons with disabilities.
The meeting closed with Ms. Norvell issuing a challenge to industry partners to raise the bar for the Division and challenge DDRS to provide an outstanding experience for all customers, with an emphasis on developing real solutions through positive interactions with all stakeholders.