The Arkansas Waiver Association
	About AWA Join AWA Waiver Services What's Happening Waiver Updates DDS' Corner Resources Home	What's Happening The "What's Happening" page is designed to keep us all up to date as to what's going on in the DD world. We'll do our best to provide accurate, unbiased information. It's often important, however, to provide some analysis of what the facts mean, and that results in editorial comment. When we're commenting instead of reporting, the passage will be labeled as "Editorial Comment" and displayed in green. Contents: AWA Submits Proposal for Medicaid Restructuring Dr. Green Meets with Families for a Q & A on Medicaid Restructuring Update - Arkansas Health Care Payment Improvement Initiative Arkansas Health Care Payment Improvement Initiative AWA Now on Facebook AWA Establishes List Serve AWA Submits Proposal for Medicaid Restructuring There are a number of changes under consideration by the DD Working Group, but with little information flowing back to the people to be affected by the changes AWA thought it prudent to make sure the Group gets our views on what the new system should look like and what changes just won't work for waiver. Accordingly, we developed our own proposal. It is still in a draft form as changes will likely be required as we get feedback from the State DD Working Group on what direction they are headed. You may download the proposal below: AWA Draft Proposal Addendum 1 - Outline of Major Design Dimensions for Episode Model Addendum 2 - Self-Directed Services and Family Support Options Addendum 3 - Proposed Changes to Potential Timeline Addendum 4 - Why One-Stop Service Centers Do Not Work for HCBS Waiver Services Dr. Green Meets with Families for a Q & A on Medicaid Restructuring AWA would like to say thanks to Dr. Green for hosting the Q&A session today. And thank you to all the elected officials that participated: Senator Pritchard and Representatives Lindsey, Hobbs, and Leding. Your time and attention to this issue is greatly appreciated. On December 14, Dr. Green met with families of persons with a developmental disability and others to answer questions about proposed changes to the Medicaid services they currently receive. It was a full room with others participating via web cam to five other locations around the state. The meeting was generated following disclosure of a point paper which outlined a plan for one stop service centers to determine all needs through a new assessment and then provide all necessary services. All would get their services, both medical as well as DDS services, through the one stop. One stops would be able to choose to provide the service themselves or through a contract with others such as hospitals or physicians. Dr. Green explained the point paper was only intended to start the conversation and was not a plan for where the system is heading and asked that everybody destroy the copy they have. When asked if that means the one stop service centers were dead, Dr. Green responded they were not. We would guess that means we are going to have service centers, we just don't know yet exactly what they look like and exactly what they will do. When provided a copy of the state working group definition of what a service center would do, Dr. Green declined comment. Dr. Green indicated this is an ongoing process and we do not know what the outcome will be. There is no plan. There is a process ongoing to develop one. When asked who the new assessment instrument will be applied to, the answer was everybody including the HDCs and private ICFs. The assessment will determine the appropriate level of care and, presumably, move people to that level of care if needed. Dr. Green did agree to making sure there would be a fair, unbiased appeal procedure to DDS as well as a mechanism to ensure that in those cases where the assessment did not get it right there would be adjustments made. Dr. Green did commit to serving as much of the Waiver waiting list as possible, within the existing budget. He stated it is his hope we can find a more efficient way to do things and use the savings for the waiting list. He also indicated that there may have to be a conversation about whether to provide what is needed to some and nothing to others or reduce what some get in order to serve others. We are still headed toward a July 1 implementation of the new plan. While obviously some of the things being discussed cannot be completed in six months, the state will have committed to a course of action, and we will be on the road to implementing them. The state working group tasked with producing the new plan has yet to ask for input from the people being served and is concentrating on working with the professionals on new payment methodologies. Hopefully, they will involve those being served at some point before all the decisions have been made. EDITORIAL COMMENT: We know very little more now than we did before the meeting. Everything is still a work in progress. AWA is going to hang on to at least one copy of the service centers proposal to compare that with where we actually end up. We still sense danger. Update - Arkansas Health Care Payment Improvement Initiative We promised to keep you up to date as Medicaid Transformation goes forward in Arkansas. DDS is pressing ahead with developing an assessment tool that will assess client needs and assign a dollar value to each. There are no plans to pilot this instrument to ensure it works before implementation. It will simply be implemented. North Carolina went down this road earlier this year and the results were very disturbing. HERE is a class action law suit filed in North Carolina. Read it very carefully because this is the road Arkansas is heading down, and it resulted in very significant cuts to Waiver plans of care across the board. We have heard that HDCs and other ICFs will not participate in the assessment, at least in the beginning, even though they are far and away the most expensive DDS and Medicaid services provided in Arkansas. All savings from DDS are going to come directly from community programs, more specifically Waiver services. Correct, the current proposal will have the effect of extracting significant savings from Waiver through wholesale cuts to individual plans of care. The rest of the system will be left status quo as there will be no closings of facility based services nor reductions in rates for those services. There is no place left to absorb the cuts except Waiver. We are moving toward county Service Centers who will be responsible for providing all medical care as well as all DDS services, including Waiver. The Service Centers will control all non-institutional services. As currently proposed, DDS will allocate available funding to the one service center in each county who will then contract with other providers (including hospitals, physicians, therapists, etc.) to deliver services. (Yes, this is an HMO model for all medical care as well as DDS community services.) The Service Center will be a DDS provider. The Service Center will allocate funds among the many DDS programs, such as DDTC, Pre-School, and Waiver. If there is not enough money to meet all needs, the Service Center will determine where the reductions will be made. In the event there are unspent funds, the Service Center would keep a portion of the surplus to fund their operation (an incentive to not provide services?). There will be no additional funds if the county runs short. The Service Centers will also administer the assessment that determines the level of funding for each Waiver client. The entity charged with balancing the budget for the county will be the same entity determining your needs and the same entity that keeps a portion of any unspent funds. The entity charged with making resource allocations between DDS programs will, by rule, be an entity that operates DDTC and Pre-school programs. Think about that. Would they cut their own programs or would they look elsewhere for cuts? EDITORIAL COMMENT: It is still too much, too fast. Please slow the train down and rethink this. Let's be honest and fair and share the pain of the upcoming cuts equally with all the other DDS services. All of them. Arkansas Health Care Payment Improvement Initiative In Arkansas, the latest buzz in healthcare has been about “Medicaid transformation.” Although that’s the colloquial phrase, it is somewhat misleading as the changes to healthcare payment structures in Arkansas will also be applied to private payors. The Arkansas Health Care Payment Improvement Initiative, in an attempt to avoid making dramatic cuts to services, is changing the current fee-for-service model to one that pays health care providers for bundles or episodes of care. The idea is this new payment system will save money by eliminating duplicate testing, poor coordination between healthcare providers, and unnecessary procedures. The Payment Improvement Initiative has selected nine target areas to pilot the new payment system and developmental disabilities is one of the target areas. This means that by July 2012 all DD service providers will be operating under this new payment system. At this time, it is unclear what this new system will look like, but DDS has given some hints. DDS issued a proposal that would require all DD providers to operate under a service center model. According to the proposal, this service center will be a one-stop organization that serves every person with a development disability that resides in the community, county, or area where the service center is located. It has been suggested that the idea is to have one service center per county. But that is hearsay and has not been verified by DDS. These service centers will also use a universal assessment tool to determine individual needs. Based on this assessment, an individual will be given a categorical ranking and allotted a certain dollar amount for services. From that point, a “Person Centered Plan” will be created and assessed annually. This has the potential to dramatically change the services you receive. DHS is sponsoring workgroups that will focus on the various target areas. AWA strongly encourages all receiving Waiver services to get involved with the DD work group and make sure everybody understands your needs. If this starts developing into something you cannot live with, you need to let people know before it is too late. If you don't, your future services will be dictated by a yet to be developed assessment tool. You can appeal the assessment score, but you will not be able to appeal the fact that the score does not provide what you need to avoid being forced into an institutional placement. The first workgroup will be on Tuesday, November 1 from 3-5 p.m. at the Clinton Library, room TBA. To sign up for the DD workgroup go to http://humanservices.arkansas.gov/director/Pages/APII.aspx and click on the sign up for workgroups link. EDITORIAL COMMENT: AWA is concerned about the future of Waiver services. We want to share our concerns with you, but please note that these are based on the little information we have. We will continue to share information as it becomes available. Any model can work if there is funding to meet the need, and no model will work absent the funding. DDS' proposal does not address the available funding nor any detail about the mechanism by which the available funding will be distributed. What is being proposed is "everybody" gets an assessment and "everybody" gets what they need based on that assessment. Sounds too good to be true given Arkansas is facing a huge Medicaid shortfall. And, if it sounds too good to be true, well, you know. The services you have today may well be very different from what you have after the assessment. As we understand it, the assessment is not just for new people. Everybody will be assessed and a new funding level will be dictated for all. However, this may not be the case for people living in the HDCs. Rumor has it that HDC clients may be grandfathered in and will be allowed to keep their placement and level of care. Not so for Waiver clients. One thing is clear, Waiver will not be the same. We know nothing about the services that will replace it. Nor do we know what level of funding, nor what part of available funding, will be available for those services. It is also unclear how the Waiver waiting list will be addressed. If the model works as proposed and "everybody" gets "everything" they need, how can we possibly run a years long waiting list? According to the DDS proposal, the service centers provide all the services, not just do the assessment and allow selection of a provider. All other providers in the area must contract with the service center in order to provide services. This means the service center controls all, which translates into clients having little or no choice of provider. And if there is to be one DD service center per county, what does this mean for counties who have more than one provider and for those that have none? How do institutional settings fit into this model? Will they be eligible to be health homes? One thing is clear, consumer choice of providers will be severely limited, if not eliminated all together. As with all proposals like this, the devil is in the detail. We have no detail and, apparently, everything is still on the table for discussion. Developing a change of this magnitude and implementing it by July 2012 is a mountain too tall. This is way too much change way too quickly. AWA Now on Facebook Check us out at: http://m.facebook.com/profile.php?id=236385863056568&refid=5 AWA List Serve AWA has established a list serve to provide yet another avenue for families, persons with a developmental disability, advocates and professionals to exchange information and keep up with what's happening in our world. To subscribe, send an email to AR-AWA-Subscribe@YahooGroups.com EDITORIAL COMMENT: Try it, you'll like it.

The Arkansas Waiver Association

What's Happening

The "What's Happening" page is designed to keep us all up to date as to what's going on in the DD world. We'll do our best to provide accurate, unbiased information. It's often important, however, to provide some analysis of what the facts mean, and that results in editorial comment. When we're commenting instead of reporting, the passage will be labeled as "Editorial Comment" and displayed in green.

There are a number of changes under consideration by the DD Working Group, but with little information flowing back to the people to be affected by the changes AWA thought it prudent to make sure the Group gets our views on what the new system should look like and what changes just won't work for waiver. Accordingly, we developed our own proposal. It is still in a draft form as changes will likely be required as we get feedback from the State DD Working Group on what direction they are headed. You may download the proposal below:

AWA Draft Proposal

Addendum 1 - Outline of Major Design Dimensions for Episode Model

Addendum 2 - Self-Directed Services and Family Support Options

Addendum 3 - Proposed Changes to Potential Timeline

Addendum 4 - Why One-Stop Service Centers Do Not Work for HCBS Waiver Services

Dr. Green Meets with Families for a Q & A on Medicaid Restructuring

AWA would like to say thanks to Dr. Green for hosting the Q&A session today. And thank you to all the elected officials that participated: Senator Pritchard and Representatives Lindsey, Hobbs, and Leding. Your time and attention to this issue is greatly appreciated.

On December 14, Dr. Green met with families of persons with a developmental disability and others to answer questions about proposed changes to the Medicaid services they currently receive. It was a full room with others participating via web cam to five other locations around the state.

The meeting was generated following disclosure of a point paper which outlined a plan for one stop service centers to determine all needs through a new assessment and then provide all necessary services. All would get their services, both medical as well as DDS services, through the one stop. One stops would be able to choose to provide the service themselves or through a contract with others such as hospitals or physicians.

Dr. Green explained the point paper was only intended to start the conversation and was not a plan for where the system is heading and asked that everybody destroy the copy they have. When asked if that means the one stop service centers were dead, Dr. Green responded they were not. We would guess that means we are going to have service centers, we just don't know yet exactly what they look like and exactly what they will do. When provided a copy of the state working group definition of what a service center would do, Dr. Green declined comment.

Dr. Green indicated this is an ongoing process and we do not know what the outcome will be. There is no plan. There is a process ongoing to develop one.

When asked who the new assessment instrument will be applied to, the answer was everybody including the HDCs and private ICFs. The assessment will determine the appropriate level of care and, presumably, move people to that level of care if needed.

Dr. Green did agree to making sure there would be a fair, unbiased appeal procedure to DDS as well as a mechanism to ensure that in those cases where the assessment did not get it right there would be adjustments made.

Dr. Green did commit to serving as much of the Waiver waiting list as possible, within the existing budget. He stated it is his hope we can find a more efficient way to do things and use the savings for the waiting list. He also indicated that there may have to be a conversation about whether to provide what is needed to some and nothing to others or reduce what some get in order to serve others.

We are still headed toward a July 1 implementation of the new plan. While obviously some of the things being discussed cannot be completed in six months, the state will have committed to a course of action, and we will be on the road to implementing them.

The state working group tasked with producing the new plan has yet to ask for input from the people being served and is concentrating on working with the professionals on new payment methodologies. Hopefully, they will involve those being served at some point before all the decisions have been made.

EDITORIAL COMMENT: We know very little more now than we did before the meeting. Everything is still a work in progress. AWA is going to hang on to at least one copy of the service centers proposal to compare that with where we actually end up. We still sense danger.

Update - Arkansas Health Care Payment Improvement Initiative

We promised to keep you up to date as Medicaid Transformation goes forward in Arkansas.

DDS is pressing ahead with developing an assessment tool that will assess client needs and assign a dollar value to each. There are no plans to pilot this instrument to ensure it works before implementation. It will simply be implemented. North Carolina went down this road earlier this year and the results were very disturbing. HERE is a class action law suit filed in North Carolina. Read it very carefully because this is the road Arkansas is heading down, and it resulted in very significant cuts to Waiver plans of care across the board.

We have heard that HDCs and other ICFs will not participate in the assessment, at least in the beginning, even though they are far and away the most expensive DDS and Medicaid services provided in Arkansas. All savings from DDS are going to come directly from community programs, more specifically Waiver services. Correct, the current proposal will have the effect of extracting significant savings from Waiver through wholesale cuts to individual plans of care. The rest of the system will be left status quo as there will be no closings of facility based services nor reductions in rates for those services. There is no place left to absorb the cuts except Waiver.

We are moving toward county Service Centers who will be responsible for providing all medical care as well as all DDS services, including Waiver. The Service Centers will control all non-institutional services.

As currently proposed, DDS will allocate available funding to the one service center in each county who will then contract with other providers (including hospitals, physicians, therapists, etc.) to deliver services. (Yes, this is an HMO model for all medical care as well as DDS community services.) The Service Center will be a DDS provider. The Service Center will allocate funds among the many DDS programs, such as DDTC, Pre-School, and Waiver. If there is not enough money to meet all needs, the Service Center will determine where the reductions will be made. In the event there are unspent funds, the Service Center would keep a portion of the surplus to fund their operation (an incentive to not provide services?). There will be no additional funds if the county runs short.

The Service Centers will also administer the assessment that determines the level of funding for each Waiver client. The entity charged with balancing the budget for the county will be the same entity determining your needs and the same entity that keeps a portion of any unspent funds. The entity charged with making resource allocations between DDS programs will, by rule, be an entity that operates DDTC and Pre-school programs. Think about that. Would they cut their own programs or would they look elsewhere for cuts?

EDITORIAL COMMENT: It is still too much, too fast. Please slow the train down and rethink this. Let's be honest and fair and share the pain of the upcoming cuts equally with all the other DDS services. All of them.

Arkansas Health Care Payment Improvement Initiative

In Arkansas, the latest buzz in healthcare has been about “Medicaid transformation.” Although that’s the colloquial phrase, it is somewhat misleading as the changes to healthcare payment structures in Arkansas will also be applied to private payors. The Arkansas Health Care Payment Improvement Initiative, in an attempt to avoid making dramatic cuts to services, is changing the current fee-for-service model to one that pays health care providers for bundles or episodes of care. The idea is this new payment system will save money by eliminating duplicate testing, poor coordination between healthcare providers, and unnecessary procedures. The Payment Improvement Initiative has selected nine target areas to pilot the new payment system and developmental disabilities is one of the target areas. This means that by July 2012 all DD service providers will be operating under this new payment system.

   At this time, it is unclear what this new system will look like, but DDS has given some hints. DDS issued a proposal that would require all DD providers to operate under a service center model. According to the proposal, this service center will be a one-stop organization that serves every person with a development disability that resides in the community, county, or area where the service center is located. It has been suggested that the idea is to have one service center per county. But that is hearsay and has not been verified by DDS. These service centers will also use a universal assessment tool to determine individual needs. Based on this assessment, an individual will be given a categorical ranking and allotted a certain dollar amount for services. From that point, a “Person Centered Plan” will be created and assessed annually.

   This has the potential to dramatically change the services you receive. DHS is sponsoring workgroups that will focus on the various target areas. AWA strongly encourages all receiving Waiver services to get involved with the DD work group and make sure everybody understands your needs. If this starts developing into something you cannot live with, you need to let people know before it is too late. If you don't, your future services will be dictated by a yet to be developed assessment tool. You can appeal the assessment score, but you will not be able to appeal the fact that the score does not provide what you need to avoid being forced into an institutional placement.
The first workgroup will be on Tuesday, November 1 from 3-5 p.m. at the Clinton Library, room TBA. To sign up for the DD workgroup go to http://humanservices.arkansas.gov/director/Pages/APII.aspx and click on the sign up for workgroups link.

EDITORIAL COMMENT:

   AWA is concerned about the future of Waiver services. We want to share our concerns with you, but please note that these are based on the little information we have. We will continue to share information as it becomes available.

   Any model can work if there is funding to meet the need, and no model will work absent the funding. DDS' proposal does not address the available funding nor any detail about the mechanism by which the available funding will be distributed. What is being proposed is "everybody" gets an assessment and "everybody" gets what they need based on that assessment. Sounds too good to be true given Arkansas is facing a huge Medicaid shortfall. And, if it sounds too good to be true, well, you know.

   The services you have today may well be very different from what you have after the assessment. As we understand it, the assessment is not just for new people. Everybody will be assessed and a new funding level will be dictated for all. However, this may not be the case for people living in the HDCs. Rumor has it that HDC clients may be grandfathered in and will be allowed to keep their placement and level of care. Not so for Waiver clients.

   One thing is clear, Waiver will not be the same. We know nothing about the services that will replace it. Nor do we know what level of funding, nor what part of available funding, will be available for those services. It is also unclear how the Waiver waiting list will be addressed. If the model works as proposed and "everybody" gets "everything" they need, how can we possibly run a years long waiting list?

   According to the DDS proposal, the service centers provide all the services, not just do the assessment and allow selection of a provider. All other providers in the area must contract with the service center in order to provide services. This means the service center controls all, which translates into clients having little or no choice of provider. And if there is to be one DD service center per county, what does this mean for counties who have more than one provider and for those that have none? How do institutional settings fit into this model? Will they be eligible to be health homes? One thing is clear, consumer choice of providers will be severely limited, if not eliminated all together.

   As with all proposals like this, the devil is in the detail. We have no detail and, apparently, everything is still on the table for discussion. Developing a change of this magnitude and implementing it by July 2012 is a mountain too tall. This is way too much change way too quickly.

AWA Now on Facebook

Check us out at: http://m.facebook.com/profile.php?id=236385863056568&refid=5

AWA List Serve

AWA has established a list serve to provide yet another avenue for families, persons with a developmental disability, advocates and professionals to exchange information and keep up with what's happening in our world. To subscribe, send an email to

AR-AWA-Subscribe@YahooGroups.com

EDITORIAL COMMENT: Try it, you'll like it.

The Arkansas Waiver Association

What's Happening

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