2022-2023 HCBS Rate Review Projects

The purpose of the survey is to capture an understanding of service deliver costs for providers of home and community-based services and to inform payment rate assumptions. Results from the survey will help inform the independent rate model that will be used to develop new rates for existing home and community-based services.

The survey was released on November 28,2022 with a due date of December 16, 2022.

A link to the survey will be sent via email to each provider agency (only one response per agency).

The survey will ask questions about financial information and services provided. Milliman will send the survey to the primary contact on file. We encourage the primary contact to request help from colleagues. The primary contact is responsible for submitting the survey once all parts are complete. If the agency would like to change the primary contact, please contact HCBS.Ratemethodology@fssa.IN.gov.

The types of data requested will include service delivery costs, including those related to direct care/clinical care staffing and supervision, employee benefits, administrative costs, program support costs, overhead, and transportation. Data requested will be in aggregate, and specific to the services each agency provides.

It is expected that the survey will take several hours to complete in its entirety. The length of time it takes to complete the survey will vary depending on the size of the organization and the number of home and community-based services provided.

Individual survey responses will be aggregated to protect confidential business information. Milliman will document and share key aggregate responses as part of the development of the public report. This will include wage information, documentation time, travel time, caseloads, and other inputs that are key to the rate review.

If you have questions that are not addressed by the instructions or training video on this website, please send an email to HCBS.Ratemethodology@fssa.IN.gov.

The slides from the October 10, 2022 presentation are available by clicking here.

DDRS and FSSA are expecting to propose a rate update to be effective early in the next biennium. Implementation of the rate update is subject to legislative approval of funding in the next biennium's budget. FSSA and DDRS intend to develop an initial set of rates through the end of 2022, and consider additional adjustments throughout the first quarter of 2023.

Milliman will be requesting stakeholder input on key information needed to understand the cost of providing services, such as wages, benefits, documentation requirements, travel, professional training, and administrative costs. Your input can help ensure we account for all appropriate costs. Stakeholders can respond to the provider survey in early November, or by providing input and feedback regarding the rate analysis project at HCBS.ratemethodology@fssa.in.gov.

Please send input and feedback regarding the rate analysis project to HCBS.ratemethodology@fssa.in.gov.

The graph below is consistent with the participation graph from the October 10th presentation, but illustrates the participation growth separately for CIHW (darker blue) compared to the FSW participation growth (lighter blue). As illustrated below, most of the participation increase was observed in the FSW.

Historically, approximately 2/3 of the cost for FSW and CIHW comes from federal funding with the remaining 1/3 of the cost designated from state funds. For federal fiscal year 2024, should the public health emergency have ended, the federal share will be 65.62%. However, this is subject to change each federal fiscal year, and the federal funding match cannot go below 50 percent.

Yes, we hope to have rate reviews at least every five years to better align with CMS guidance.

We intend to reflect all three of these expenses in the rate build-up, but in different ways. For training, we intend to explicitly reflect annual employee time spent on training. To support quality, the rate build-up will incorporate assumptions that are consistent with quality, such as appropriate staffing ratios, training time, and documentation time. We intend to include costs for the Human Rights Committee in the administrative load. We welcome feedback on the approach for each of these items.

DDRS intends to have the providers maintain responsibility for the monthly DSP passthrough audits.

The Bureau of Labor and Statistics publishes monthly data on wage increases by industry, with data available as recent as three months ago. Although the rate model framework may start with historical data, it will be adjusted to reflect recent wage increases. In addition, we will incorporate an estimate of future wage inflation from the current time to the anticipated time of implementation.

There is a second concurrent rate review project under way for the Division of Aging waivers: the Aged and Disabled Waiver and the Traumatic Brain Injury Waiver.

As part of the project, the State will review and align rates for all services that have a fixed fee schedule amount. As part of this alignment, some of the rates for some services may go down while others may go up.

Residential rates will not be reviewed as part of this project. Cost neutrality compares the average annual cost in an intermediate care facility to the average annual cost for an individual receiving LTSS in the community through the CIHW or FSW. The average community cost is required to be less than average facility cost.

There will not be a change in Algo scores as part of this project.

One of the rate review's goals is for the updated rates to be adequate to support quality services from an efficient provider. We intend to develop rates that will allow for sufficient access and to sustain a healthy provider base.

This question relates to the waiver redesign, and will be reflected in the rates after the redesign is closer to implementation.

Yes, the scope of this rate review is for FSW and CIHW.