1915(i) community recovery services january 11, 2011 1
TRANSCRIPT
1915(i) Community Recovery Services
January 11, 2011
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Introduction to CRS
Recent Changes in Federal Law
Initial Financial Data and Projections
Questions and Discussion
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Presentation Overview
Home and Community-Based Services (HCBS) 1915(i) state plan amendments allow states to expand Medicaid eligibility for consumers with a history of psychiatric illness, risk factors indicating a need for continuing supports, and a need for one or more of the covered services as identified in a comprehensive service plan developed by an interdisciplinary team.
Wisconsin’s Community Recovery Services benefit reimburses three core services for consumers: Community Living Supportive Services – allows for
consumers to live with maximum independence in community integrated housing;
Supported Employment – assists consumers with acquiring and maintaining competitive employment; and
Peer Supports – Provides reimbursement for certified Peer Specialists to use their recovery based experiences to assist others to move toward recovery.
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Introduction
Eligible for State Plan Medicaid or BadgerCare Plus, HMOs – Not Part of Capitation Rate – Refer to County or
Tribe
Countable Income at or Below 150% of FPL,
Reside in the Home or Community (Not an Institution),
Meet Functional Eligibility Criteria,
State Approved Individual Service Plan.
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Eligibility Requirements for CRS
Tribal and County case managers utilize the Adult Mental Health/AODA Functional Screen –OR- the Children’s Long Term Care Functional Screen to verify functional eligibility.
Effective 10/1/2010, CRS utilizes the Community Options Program (COP) functional need criteria but the eligibility criteria is more strict then COP as mental health diagnoses are more limited.
Consumer must also have at least one of the following diagnoses:
Mood Disorder,
Schizophrenia,
Other Psychotic Disorder.
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Functional Eligibility
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Recent Changes in Federal Law
• Affordable Care Act of 2010 – Effective 10/1/2010
Must be Offered Statewide:DHS is inviting all Wisconsin counties and tribes to begin the application process to become CRS providers.
Eliminates Wait Lists:The ACA eliminated Wisconsin’s ability to manage the growth of the program through the use of waitlists.
CRS Initial Financial Data and Estimates
For the Period January 15, 2010 through January 3, 2011
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County Consumers
Billed* Paid
Washington 7 $117,112 $61,184
Wood 13 $409,375 $175,078
Barron 1 $12,200 $4,578
Richland 4 $231,500 $69,491
Jefferson 12 $57,740 $19,964
Totals 37 $827,927 $330,295
*Includes Non-Federal Share.
Medicaid Fee Schedule CRS Reimbursement Rates…
CLSS Per Diem $125.00/day CLSS Periodic $ 20.00/hour Supported Employment $ 46.04/hour Peer Supports $ 39.12/hour
Travel reimbursement is available for CLSS Periodic, Supported Employment, and Peer Supports – Up to 1 Hour TO the service site, and 1 Hour BACK from the service site.
Consumers by County
02468
1012141618
Approved
Total
Service Mix of Approved Consumers to Date
76
2
33
CLSS Per Diem
CLSS Hourly
Supported Employment
Peer Supports
Service Category Fee Schedule
Avg. Co. Cost
CLSS – Per Diem $125/Day $105.67/Day
CLSS - Periodic $20.00/Hour $40.63/Hour
Supported Employment
$46.04/Hour $45.53/Hour
Peer Supports $39.12/Hour $56.08/Hour
Comparison of Medicaid Fee Schedule and Average County Costs
Keep in mind that CRS is a cost-based benefit. Counties file a cost report each year, and settlement is made accordingly.
CLSS – Per Diem 2010 2011Projected Consumers¹ 366 914
Realistic Enrollment² 36 180
Weighted Avg. Billable Days³
6,059 41,724
Assumed Avg. Cost $105.67/Day $105.67/Day
Gross Revenues $640,255 $4,408,975
Less: County Match $255,875 $1,982,743
Net Revenues $384,380 $2,426,232
Milwaukee County Revenue Discussion
¹ Per Milwaukee County’s Response to Info Memo 2009-10
² A more realistic enrollment number for the sake of discussion.
³ Weighted average billable days assuming consumers approved evenly throughout the year.
Quarter & Year FMAP State Admin. %²
2010 Q4 70.63% 15%
2011 Q1 67.63% 15%
2011 Q2 65.63% 15%
2011 Q3 Forward¹ 60.16% 5%
Behind the Numbers: FMAP and the State’s Statutory Administrative Cut
Example:
County Cost of Service $100.00
FMAP Q4 2010 @ 70.63%$ 70.63
Less: State Admin. @ 15%$ 10.59
County Nets………………………….$ 60.04
¹ ARRA Enhanced FMAP ends on June 30, 2011.
² State’s admin. stated as $600,000 thru SFY11, and a Flat 5% thereafter.
Please visit the CRS Webpages at:http://www.dhs.wisconsin.gov/MH_BCMH/crs/index.htm
Or Contact:
Michael Jones, CRS Coordinator (608) 267-9864
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