MACDDS Update
3/23/2017
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Budget Update
FY 2017 Consensus Revenue Estimate
4.1% Growth - $9,633.7B
FY 2017 Revised Consensus Revenue Estimate
3.0% Growth - $9,053B
FY 2016 ended at .89% growth or $8,786.8B
FY 2018 Consensus Revenue Estimate
3.8% Growth - $9,398B
FY 2017 Actual Revenue Growth - February Collections
Increased 4.9% compared to 2016 (year), 25.2% for the month.
From $5.45B to $5.71B
Individual Income and Sales tax continue to increase
Refunds decreased 12.1% for the year
Corporate continues to decline
For the year by 25.6% or from $273.7M to $203.5M ($70.2M decrease)
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FY 2018 Budget Summary
New Items
Utilization Increase: $33,750,755 (GR and FED funds)
FY17 Residential Cost to Continue - $14,714,891
FY18 Crisis Residential – 270, $17,948,158
NH Residential Placements – 12, $1,462,920
Children’s Division Transitions – 39, $4,754,490
In Home Wait List – 1,151, $7,050,924
Case Management Increases - $2,574,843
SB40 match pickup 22 counties - $2,244,826
Attrition - ($17,000,297)
Federal Percentage Match Adj (FMAP) $8,877,813 GR to FED
Employment Initiative: $180,000 FED only
OT Supplemental: $1,779,426 GR
Caring for Missourians: $1,800,000 FED only (Dept Wide)
Total DD Governor Recommended Budget: $1,180,687,104
House and Senate Budget Presentations Completed
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FY 2018 Budget Cont’d
Core Reductions
Provider COLA Rollback FY16 1% + FY17 2% $10,914,172 GR, $16,518,697
FED
TCM Lapse Reduction $1,500,000 GR ($2M restricted in FY17)
Autism Waiver Terminated: $1,351,180
Tuberous Sclerosis: $1,250,000
NE Autism Outreach: $150,000 ($50K remains)
Family Partnership Program: $300,000
Leffen Autism Center: $50,000 ($50K remains)
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FY 2018 Budget Cont’d
House Budget Committee Recs
DD Utilization Increase (Wait List) fund switch: $16,670,555
Transferred from GR to PPS Fed earnings. Total Utilization
NDI = $18,245,195, DD share = $13,326,150
DD Provider Rate Cut Restoration: (+1.5%) +$5,457,085 GR
DD Rebasing New: +$5,000,000 GR
Habilitation Center Flexibility Language:
Poplar Bluff & Sikeston -$25,000 GR partial FY reduction
Bellefontaine & StL DDTC -$67,000 GR partial FY reduction
Tuberous Sclerosis Partial Restoration: +$500,000 GR
Family Partnership Program Restored: $300,000 from MO
Senior Services Protection Fund
Contract Review PS Transfer from Hab Centers: -$9,612 GR
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FY 2018 Budget Cont’d
House Rec: Provider Rates
DD Provider Rate Cut Restoration: (+1.5%) +$5,457,085 GR
DD Rebasing New: +$5,000,000 GR
$5.46M COLA reduction = (1.41%)
ISL Hourly Rate ($0.22)
Group Home Daily Rate: ($2.02)
($3.17M) Residential. ($2.43M) ISL, ($0.74M) Group Home.
($1.38M) Day Hab, ($0.91M) Other Services.
Rebasing goes from 70% to 72.25% of end goal rates adjusted for
(1.5%).
57% of ISLs will see a net increase. Average ISL increases $0.23
per hour
25% of group homes see a net increase. Average group home
decreases $0.37 per day
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TCM Update
FY 18 proposed TCM core cut along with the possibility of a future rate
reduction due to lower average cost reports has prompted discussions
regarding non-Medicaid case management and TCM rebasing.
DMH-DD currently has no plans to rebase the rate based on FY15 cost
reports ($6.56 per unit).
The requirement to provide case management to non-Medicaid eligibles
remains a contract discussion item.
The TCM allocation may need to be adjusted to reflect the core cut.
A supplemental budget item could be requested if claims are projected to
exceed FY18 appropriation. If the supplemental was not funded, DMHDD would be required to fund the deficit through other Medicaid
appropriations. This assumes the allocation is not adjusted for the core
cut.
A reconciliation with the cost reports will still exist some time in the
future.
Official audit entrance meeting with OIG is scheduled for March 23.
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CIMOR UR Budget Status
No Teams
Started
% RO Done
Albany
2/5
0.7%
Central MO
7/11
11.4%
Hannibal
6/6
31.0%
Joplin
1/5
0.3%
Kansas City
4/18
7.6%
Kirksville
2/4
17.2%
Poplar Bluff
5/6
12.1%
Rolla
3/11
8.5%
Sikeston
6/7
15.2%
Springfield
2/7
0.9%
St Louis
4/17
1.5%
6.9%
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Employment
Out of 4,500 Missourians utilizing some sort of waiver funded day activity, only
about 11%, or just over 500, have an authorization for employment services.
Out of 11,826 individuals accessing waivers ages 16-64, only 517 have any
employment services authorized—that is 4%; growth from 350 in Oct (3%).
167 more persons with employment authorizations since October!
National average for individuals with a developmental disability who are
employed is 19%, Missouri is just over 15% and that number is lower for
individuals in waivers at 13%.
Increased Employment Support – two subject matter experts contracted through
MU Hook Center.
Increasing provider capacity
Mentoring and TA
More people competitively employed
Implementing national best practices for customized/supported employment
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Employment Update
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CMS Waiver Review
•
Received CMS draft waiver report for MOCDD and Partnership for Hope
•
Remediation Item – LOC out of compliance in both waivers.
•
Waivers will not be renewed unless all TCM agencies are in compliance with LOC.
•
Must provide evidence that all individuals have a current LOC and assurance that
they will remain current going forward.
•
Division has identified all individuals who do not have a LOC current within the
past 12 months and is working with those TCM agencies to come into compliance.
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Other Stuff:
The Division is developing responses to CMS regarding:
Evidentiary Reviews for MOCD and PfH Waivers
MOCD Waiver Amendment Informal Questions
TCM agencies do not need to take any action to transition individuals to the CS Waiver.
DRAFT Division Directive 3.120 Process to Implement Do Not Resuscitate Orders for
Individuals Receiving In-Home Waiver Services
Division Directive 4.200 Human Rights(Due Process)
Division is working on a draft CSR concerning supporting individuals requiring Home
Mechanical Ventilation supports
HCBS Guidance - the Division developed an HCBS guide that includes HCBS requirements
from the federal rule along with guidance and examples of acceptable evidence of
compliance. In the near future, the division will be contacting those providers that had
individual assessments to further discuss their remediation
plans. http://dmh.mo.gov/dd/docs/hcbsguidance.pdf
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Save the Date
Tiered Supports Training
Capitol Plaza Hotel
Jefferson City
Share and learn positive ways to support
staff and individuals with intellectual and
developmental disabilities.
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