APD Residential Habilitation Rate Re-Structure

APD Residential Habilitation Rate Re-Structure
APD’s Legislative Mandate:
“Residential habilitation services shall be limited to 8 hours per day. Additional hours may be authorized for persons who have intensive medical or adaptive needs and if such hours are essential for avoiding institutionalization, or for persons who possess behavioral problems that are exceptional in intensity, duration, or frequency and present a substantial risk of harm to themselves or others. This restriction shall be in effect until the four-tiered waiver system is fully implemented.

”What is Res Hab?“Residential habilitation provides supervision and specific training activities that assist the recipient to acquire, maintain or improve skills related to activities of daily living.”“Recipients with challenging behavioral disorders may require more intense levels of residential habilitation services described as behavior focus residential habilitation or intensive behavioral residential habilitation.

”What does Res Hab pay for?• Res hab does not pay for the operation of a group home.• Res hab is just one of many funding streams available to group home providers. The typical person living in a group home will also receive ADT services, supported employment or other meaningful day activities – in addition to res hab services, including transportation to and from activities. Some residents may also receive skilled nursing services.

What does APD Spend on Res Hab?• For FY 2006-2007, APD spent $312,366,441 on res hab services, which was approximately 30% of total Medicaid waiver budget and nearly 400% more than any other waiver service.• Approximately 6,000 persons receive res hab services, which is 20% of the total number receiving Medicaid waiver services.• In addition to Medicaid waiver costs, APD spends $4 million on Room and Board for children in Group Homes. APD also pays the difference if an adult’s SSI payment is less than the standard monthly amount.APD has met with providers, and given careful consideration to their concerns and suggestions.

In response, the following concessions have been made:• The proposed rate re-structure will not automatically move everyone to 8 hours per day. Those with intense needs have been kept at higher levels.• APD has delayed the proposed implementation date for the new rates from 10/01/07 to 12/01/07.• The rate structure has been revised to allow persons receiving 10 hours of res hab service to be reimbursed at a higher level.• The reduction formula has been graduated (4% - 7%) so that rates for those with most intense needs are decreased the least and rates for those receiving 13-14 hours are unchanged.• APD negotiated with AHCA to allow providers to bill monthly.• The rate differential based on the number of homes in a geographic area has been eliminated.• The rates for individuals with medically complex and IB needs have not been changed.Questions for consideration:• Does the current Group Home business model work?• Are Group Homes overly dependent on res hab for their financial stability?
FY 2006-07 Top 15 ServicesServiceTotal Cost
􀂾Residential Habilitation Therapy$312,366,441
􀂾Personal Care Assistance$ 84,498,174
􀂾Adult Day Training$ 80,033,642
􀂾In-Home Support Services$ 70,538,673
􀂾Support Coordination $ 43,805,437
􀂾Non Residential Supports$ 41,134,711
􀂾Self Care/Home Mgt. Training$ 33,426,294
􀂾Transportation$ 31,214,160􀂾Companion Service $ 24,086,366􀂾Behavioral Services$ 23,481,235
􀂾Consumable Medical Supplies$ 12,981,499
􀂾Respite Care $ 12,948,373􀂾Supported Employment$ 9,378,995
􀂾Private Duty Nursing$ 8,754,321􀂾Adult Dental Service$ 7,777,463