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Disability Waiver Rate System exceptions research

DHS and the Improve Group are working together to study the rate-exception process. The goal is to estimate the number of exceptions that lead agencies and DHS will grant when banding protections end in 2019.

The study will look at the fiscal impact of future exceptions on home and community-based services in disability waiver programs. The study also will identify areas for reform within the framework system. We hope to:

  • Reduce the need for future exceptions
  • Find opportunities to improve the exceptions-request process for service providers and lead agencies.

Background

The legislature authorized the Disability Waivers Rate System (DWRS) after a complex review of the costs associated with providing disability wavier services. This review process included years of collaboration and consultation with stakeholders.

The result of this collaboration was the DWRS frameworks for statewide reimbursement rates. While DHS designed the DWRS frameworks to cover the cost of serving most recipients, some recipients with high costs require a lead agency- and DHS-approved rate exception.

A rate stabilization adjustment, known as "banding," protects most waiver rates from large rate changes during implementation of the DWRS. Individuals with "banded" rates are not eligible for exceptions unless a change of condition occurs. Banding protections are scheduled to end in 2019.

Approach

Researchers and the Improve Group selected ten lead agencies (counties and tribes) to participate in this study. It includes a random sample of disability waiver recipients served by these lead agencies. These recipients may need rate exceptions to meet their needs when banding protection ends.

If banding protection were to end today for each of these recipients, we want to know the following:

  • Would the recipient's service provider/s request an exception?
  • Would the lead agency approve the exceptions request?
  • If so, what service rate would be required to meet the individual waiver recipient's needs?

DHS will use the data collected in this process to estimate the future fiscal impact of rate exceptions on:

  • HCBS disability waiver programs
  • Lead agency budgets
  • Service rates calculated in the DWRS Rate Management System.

Service provider responsibilities

In this study, service providers will:

  1. Review the list of individuals from the sample and be asked to make a judgment whether or not they would request an exception for each case
  2. Submit an exceptions application form for people who require a rate exception
  3. Complete a survey about the exceptions application process.

Lead agency responsibilities

In this study, lead agencies will:

  1. Review exceptions requests submitted by service providers for currently banded individuals using current protocols
  2. Submit to DHS all reviewed requests, supporting documentation and the reason the request was accepted or denied
  3. Provide time for staff interviews about the current exceptions process
  4. Participate in site visits with researchers (as needed) to demonstrate how they process exceptions.

Findings

DHS will use the results to calculate the estimated cost of rate exceptions when banding protections end in 2019. DHS will publish findings from this research in a 2016 report to the legislature.

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