PROPOSED CHANGES IN METHODS AND STANDARDS FOR ESTABLISHING MEDICAL ASSISTANCE PAYMENT RATES FOR CERTAIN SERVICES
The Illinois Department of Healthcare and Family Services (DHFS) proposes to change the methods and standards by which certain services are reimbursed under the Illinois Medicaid program. These changes are being made in order to assure that reimbursement for services rendered by these classes of providers are consistent with the State=s fiscal year 2013 budget while maintaining access to necessary medical services. Unless otherwise noted, these changes become effective on October, 2012.
Home and community based services. The DHFS proposes to modify the Community Integrated Living Arrangements (CILA) funding model used to calculate rates for people served in Community Integrated Living Arrangements (CILA) who receive 24 Hour Shift Staff Supports and live in CILA sites with a capacity of four (4) or fewer. The proposed changes will NOT affect calculated rates for people served in Non-Model CILA, Intermittent CILA, Family Intermittent CILA, and/or Host Family CILA, and/or people served in CILA sites with 24 Hour Shift Staff Supports with site capacity of five or greater.
The proposed changes include:
Modify formulas to fund a minimum of one direct care staff person (DSP) to be on duty for all residential hours for one, two, three and four bed CILAs. It is estimated that this change will result in an increase of annualized state expenditures of $0.24 million.
Increase the minimum direct care staff (DSP) coverage by two (2) hours per day Monday through Friday. The increase will add funding for one hour each to “Prime” and “Non-Prime” DSP staff time for a total of five (5) Prime and six (6) Non-Prime DSP staff time Monday through Friday. It is estimated that this change will result in an increase of annualized state expenditures of $2.80 million.
Update the Housing Allowance for individuals being served in CILA sites with capacity of four (4) or fewer and who are funded with 24 Hour shift staff supports through the 60D CILA Individual Rate Determination Model Methodology. A change in methodology will adopt the Federal Housing and Urban Development (HUD) Fair Market Rent (FMR) Fiscal Year 2012 Final values for existing housing as published in the Federal Register on October 1, 2011. This change will apply to individuals served in one (1) and two (2) bed CILA sites who are funded with 24 Hour shift staff supports. The DHFS also proposes updating the housing values used to calculate the Housing Allowance for individuals who are funded with 24 Hour shift staff supports in CILA sites with a capacity of one (1) to four (4) by utilizing the HUD FY 2012 Final Fair Market Rents for Existing Housing as published in the Federal Register on October 1, 2011. It is estimated that this change will result in an increase of annualized state expenditures of $0.75 million.
Adjust the funding formulas for Vehicle Purchases and Vehicle Operation for one, two and three bed CILA sites by eliminating the minimum four (4) capacity allocation. It is estimated that this change will result in an increase of annualized state expenditures of $0.02 million.
Implement a funding formula change to calculate “Base Nursing”, “RN Monitoring of Medication Administration” and LPN and RN services provided through “Nursing Treatments”. An adjustment factor will be incorporated into the nursing reimbursement of “Base Nursing”, “RN Monitoring of Medication Administration” and “Nursing Treatments” for people with Physical Status Review (PSR) scores between 1 and 6 as determined by the Health Risk Screening Tool. It is estimated that this change will result in an increase of annualized state expenditures of $0.49 million.
It is estimated that all the changes will result in an increase of annualized state expenditures of $4.30 million.
Fringe Benefit Allowance Change.
Home and community based services. The DHFS proposes to modify the Community Integrated Living Arrangements (CILA) funding model used to calculate rates for people served in 60D Community Integrated Living Arrangements (CILA). The proposed changes include:
Increase the percentage of fringe benefit allowance funded by the CILA Individual Rate Determination Model from twenty (20) to twenty-five (25) percent of wages calculated for Direct Service Personnel (DSP), Qualified Intellectual Disabilities Professional (QIDP), Supervisor, Registered Nurse (RN) and Licensed Practical Nurse (LPN). Incorporate within the DSP calculation for funding of Substitute Staff wages add a fringe benefit allowance of twenty-five (25) percent. It is estimated these changes will result in an increase of annualized state expenditures of $15.0 million.
Tony Paulauski Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423
815-464-1832 (OFFICE)
815-464-1832 (CELL)
Tony@www.thearcofil.org
