Home Services Program Annual Report 2016

To the Governor and the General Assembly on Public Act 81-202

September 2017

To the Honorable Governor Rauner and Members of the General Assembly:

It is with great pleasure that we present the Home Services Program Annual Report for Fiscal Year 2016. This important program continues to provide home and community-based services (HCBS) to more than 30,000 Illinoisans with disabilities who might otherwise be at risk of nursing facility placement. The Home Services Program provides quality supports and services to individuals with disabilities who wish to remain in their communities. While this program is adaptive and robust, it is also important that it maintains long-term fiscal sustainability to continue to serve generations to come.

In 1978, Illinois became the second state in the nation to launch a program offering home care in lieu of nursing home care; and in 1983, was one of the first states to implement a HCBS Medicaid waiver program, which had just been approved by the federal government. Today, the State remains a national leader in home-based services for persons with disabilities.

We hope you share our pride in the accomplishments of the Home Services Program and we look forward to your continued support as we assist so many Illinois citizens with disabilities as they live independently in their homes and communities.

Sincerely,
James T. Dimas Secretary

Quinetta Wade, Director
Division of Rehabilitation Services

Program Overview & Background

The Illinois Home Services Program (HSP) was established in December, 1979, to prevent the premature or unnecessary institutionalization of individuals with disabilities by providing services in the home that do not exceed the cost of comparable services in a nursing facility. The program is dedicated to promoting customer independence, their choice and their control of services. The program's goals support the desires and abilities of individuals with disabilities by enabling them:

  • to remain at home rather than in a nursing facility with real choices and options for quality care;
  • to retain control over the services they receive; and
  • to live self-directed lives that enable them to actively participate at home and in the community.

To achieve these goals, HSP provides services to eligible persons with disabilities on an individualized basis in their homes. Individuals participate in developing their own plan of care which helps to ensure that services address their needs and preferences and allows them to live as independently as possible in the home and community of their choosing. Individuals may live alone or with family or friends in a private residence.

Although the guiding philosophies have remained unchanged, HSP has grown significantly since its origins nearly 40 years ago when, in its first year, the Department of Rehabilitation Services (DORS) provided personal assistant, homemaker and home health services to 1,256 individuals with disabilities through a single home and community-based services (HCBS) waiver and a budget of $3 million. In FY 2016, 29,369 individuals with disabilities were provided a greater array of services through one of the program's three HCBS waivers and a budget of $601.2 million.

Program Eligibility Determination and Service Planning

Prospective customers, or those representing them, may request services by contacting any one of 42 Division of Rehabilitation offices around the state of which 39 offices house Home Services staff, or they may submit a request via a web-based referral for services on the Department of Human Services (DHS) website at http://www.dhs.state.il.us. A counselor or case management representative will assess the individual in his or her home and administer the Determination of Need (DON) tool to determine program eligibility. The tool evaluates an individual's care needs and identifies an individual's available resources for meeting those needs. Based on the results of the DON, a service plan is developed jointly with the customer to address his or her unmet needs and to assist the customer in coordinating safe, quality, consumer-directed (when possible) services that are also cost-effective.

In order to be eligible to receive HSP services, an individual must:

  • Be under age 60 at time of application unless applying for the HIV/AIDS or Brain Injury Waiver Programs.
  • Have a severe disability lasting at least 12 months or for the duration of life.
  • Be at imminent risk of nursing facility placement as indicated by receiving a minimum of 29 points on the Determination of Need (DON) eligibility determination tool, with at least 15 points in the "Need for Care" category.
  • Require services whose cost will not exceed that of nursing or other health care facility services.
  • For customers age 18 or older, have less than $17,500 in non-exempt personal assets; for customers under age 18, have less than $35,000 in family assets.
  • Apply for Medicaid and cooperate with the application process.
  • Be a resident of Illinois and a U.S. Citizen or legal resident.

Additionally, given the multiple Medicaid Waiver programs in Illinois, including those through the Department's Division of Developmental Disabilities; individuals who are eligible for more than one waiver are evaluated and assisted in making an informed choice as to which waiver most appropriately meets their needs.

Program Services

HSP services are designed to preserve the dignity of individuals with disabilities, as well as to provide options that reflect their personal needs and preferences. Approximately, 97% of HSP customers utilize Personal Assistant, Homemaker and/or Home Health services. Other program services are used either alone or as a supplement to these services to address the customers' unique needs. Brief descriptions of all available services follow below:

Personal Assistant (PA) Services:

Services provided by individuals who are selected, employed, trained and supervised by the customer. These individuals may assist with household tasks, personal care and, with the permission of a physician, perform certain health care procedures. In order to use PA services, the customer or representative must be able to appropriately supervise a PA. This service has a uniform reimbursement rate statewide per a labor agreement with Service Employees International Union (SEIU).

Homemaker Services:

Personal care and household tasks provided by trained and professionally supervised staff employed by homemaker agencies. Instruction and assistance in household

management and self-care are also available. This service has a uniform reimbursement rate statewide that is provided under a rate agreement with HSP. Homemaker services are used by customers who are unable to direct a PA, who have not found a PA, or who do not wish to direct a PA.

Home Health Services:

Services prescribed by a physician that are provided by a registered or licensed practical nurse, home health aide or certified nurse assistant, or physical, occupational or speech therapist. HSP home health services are beyond the scope of services covered under the Medicaid State Plan or private health insurance. These services must be provided in the customer's home and may be provided through an agency or by private individuals who are appropriately credentialed. The private individuals who provide this service have a uniform reimbursement rate statewide per a labor agreement with Service Employees International Union (SEIU).

Emergency Home Response:

A signaling device that provides 24-hour emergency alerting coverage for medical, fire or other emergencies. The device may be worn in a variety of ways and may have a variety of mechanisms to signal an emergency need. This service has uniform rates statewide and is provided under a rate agreement with HSP.

Adult Day Care:

The direct care and supervision of customers provided in a location outside the home by a community-based organization to promote social, physical and emotional well-being. This service has a uniform reimbursement rate statewide and is provided under a rate agreement with HSP. Transportation to adult day care may also be provided, if needed.

Home-Delivered Meals:

One or more ready-to-eat hot meals per day which are delivered to the home. This service is provided to individuals who can feed themselves but are unable to prepare a meal and is more cost effective than personal assistant services.

Diagnostic Services:

Medical and functional evaluation services which are used to help determine program eligibility and to develop a service plan. This service is provided only when it is not available under the State Medicaid Plan or other funding source.

Assistive Equipment and Home Modifications:

Devices, equipment and/or home modifications that increase an individual's independence and capability to perform household or personal care tasks safely in the home. Must be able to reduce the need for another service or address a health or safety need.

Respite Services:

Intermittent care for adults and children with disabilities designed to relieve caregiver stress. Respite may be provided for vacations, rest, errands, a family crisis or other emergency. Respite services available are personal assistant, homemaker, or home health. Respite is a stand-alone service and may not be received in conjunction with other ongoing services.

Background Screening:

Background screenings are now provided through the Department of Healthcare and Family Services Illinois Medicaid Program Advanced Cloud Technology (IMPACT) program on all Medicaid providers including PAs and agency providers to ensure the safety of the customer and the suitability of the potential employee.

Prescreening:

Prescreening of individuals conducted prior to nursing facility admission to ensure they receive the same minimum DON score required for eligibility for the HSP or the Department on Aging Community Care Program (DoA CCP), and to ensure they are offered the option of receiving home care. The screening of individuals coming from hospitals to nursing facilities is performed for both programs by community-based Case Coordination Units. Prescreening for individuals under age 60 who are going from home to nursing facility may be conducted by either CCU or HSP staff.

For Brain Injury Waiver customers only

Day Habilitation:

Services provided to persons with brain injuries to assist with the acquisition, retention, or improvement of self-help, socialization and adaptive skills. These services are provided in a setting separate from the customer's residence.

Pre-Vocational Services:

Services provided to a person with a brain injury that prepare the individual for paid or unpaid employment by teaching concepts such as compliance, attendance, task completion, problem solving and safety.

Supported Employment Services:

Services provided to a person with a brain injury for which competitive employment is unlikely. These services include intensive ongoing support to enable the person to perform in a paid employment work setting.

Behavioral Services:

Remedial therapy services provided to persons with a brain injury to decrease severe maladaptive behaviors. These services are intended to enable the customer to better manage his or her behavior and therefore be more capable of living independently.

Program Accomplishments in FY 2016

Duplicate Waiver Services

The Divisions of Rehabilitation Services and Developmental Disabilities worked cooperatively together to resolve a duplicate waiver issue involving approximately 428 customers. A list of affected customers, their current Medicaid Waiver indicator, and the FY16 amounts spent on each customer has been identified. Utilizing this information, the Department determined which division expended the most in case services and should therefore; hold the waiver indicator to obtain Federal Financial Participation (FFP) reimbursement. Since only one waiver can obtain FFP, identifying the program with the greatest expenditures ensures the State received the highest amount of FFP possible. By changing the waiver indicator on approximately 186 customers, the State has the potential to increase the amount of FFP it earns by $1.7 million.

Staff also reviewed the 186 customers to determine which of the two programs will ultimately be their source of services. It was estimated 86 of the customers could remain with HSP if they choose because they have the presence of a physical disability. The other 100 customers will remain with the Division of Developmental Disabilities due to the sole diagnosis of developmental disability. Once plans are formalized to address this transition, both Divisions will work cooperatively together to ensure customer transition plans are in place. When customer choices are made, cost savings will be determined based on which waiver the customer ultimately chooses.

In FY16, the total spending on the 428 cases was $17.6 million with HSP spending $9.9 million and DD spending $7.7 million. During the first year of the transition phase, HSP will continue to provide funding for customers transitioning from the HSP to DD. This will ensure there is no gap in services to the customer.

Electronic Visit Verification System

First launched in January, 2014, the Electronic Visit Verification and Timekeeping system (EVV) has enabled individual providers to have a telephony-based electronic mechanism for real time clocking in and out of their work shifts. EVV maintains an average 85% individual provider match rate which is the percent of visits on the system that match those entered on the signed timesheets. This number indicates that most IPs accurately use the EVV System to report their hours worked.

EVV has contributed to 438 Critical Incident Reports filed by field office staff that alert Central office to potential fraud and has been used to investigate hundreds of other fraud cases. It is difficult to fully measure the exact savings achieved by the implementation of EVV because the savings are largely based on preventative measures. However, one example where EVV saved resources was when significant staff time was saved when the EVV data warehouse produced data for a time-sensitive FOIA request within 24 hours.

IMPACT Provider Enrollment System

The most recent effort to better safeguard taxpayer dollars is the IMPACT Provider Enrollment and Revalidation system implemented by the Department of Healthcare and Family Services (HFS). Intended to work with the new Medicaid IT system within HFS, IMPACT provides a new format and enhanced content for its Medicaid agency providers to enter their own enrollment. Affected state agencies then follow up with revalidation of the providers.

Existing providers were allowed to be grandfathered into the system, but all new providers after the IMPACT implementation date required both enrollment and revalidation. HSP's individual providers are enrolled and revalidated by HSP staff to ensure customers continue to receive uninterrupted services. HSP staff completed revalidations for 99.6% of the 30,639 existing Individual Providers (IPs) who had been providing services to HSP customers before July 1, 2015. By April 30, 2016, staff also enrolled 11,235 IPs who did not serve HSP customers until after July 1, 2015, and enrolled an additional 6,871 new IPs who began providing services between May 1, 2016 and October 31, 2016. Of HSP's 224 existing agency providers, 199 have been revalidated, eight are pending and 17 agencies have been deactivated as they are no longer serving HSP customers.

The most notable accomplishment of these Medicaid provider enrollments has been the dramatic reduction of the Medicaid reimbursement reject rate for Medicaid claims due to provider enrollment issues. IMPACT cleared these claim issues instead of Program staff struggling to determine the reject issue with each individual provider. This reduced the Medicaid rejects from $15.8 Million in May 2016 to $1.9 Million in December 2016. The remaining rejects are associated with the referral of approximately 3,000 existing IPs to the HFS Office of Inspector General (OIG) for review regarding background screening results. These rejects will be resolved upon completion of these reviews.

HSP Fraud Review

The HSP Fraud Unit has expanded to address the increasing availability of evidentiary sources of fraud such as up-to-date death records of HSP customers and IPs, and reports of hospitalization and nursing home placement of HSP customers, both with links to currently served HSP cases. More individuals are coming forward with allegations of fraud and more potentially fraudulent activities are being identified through diligent casework.

In FY16, the Fraud Unit prepared 100 fraud referrals, which encompass a complete investigatory review ready for investigatory follow up and prosecution by the Illinois State Police (ISP) Medicaid Fraud Control Unit (MFCU) for criminal prosecution. However, such referrals fall under the jurisdiction of HFS OIG for final review as the Medicaid liaison to the federal Centers for Medicare and Medicaid Services. Since October 2015 the HSP Fraud Unit gained authorization from the Office of the Inspector General to assist with this task. With the collaboration between the OIG and HSP staff involvement these cases were expedited and prepared to be prosecuted. As it stands, HSP has been able to finalize 39 restitution cases ordering repayment totaling $283,963.07. Restitution (overpayments) are ordered by the courts and collections are coordinated with the Department's Bureau of Collections

As always, HSP will continue to review and update its rules and procedures and continue its training and other efforts to ensure they reflect the historic mission, purpose and design of the program and that they maintain program integrity. HSP will also continue to strive to support any efforts which allow or improve customers' maximum choice, dignity and independence in long term care.


Historical Program Overview FY 2010 through FY 2016

Category FY 2010 FY 2011 FY2012 FY 2013 FY 2014 FY 2015 FY 2016
Program Administration 1 $23,494,016 $21,095,457 $23,149,901 $23,530,921 $28,557,205 $28,479,396 $26,436,486
Other Provider Costs & Benefits 2 $8,000,000 $20,567,861 $26,175,441 $28,620,548 $34,318,328 $40,488,167 $39,528,714
Customer Services 3 $508,967,089 $540,458,285 $545,018,333 $515,869,157 $498,298,356 $520,833,708 $535,275,413
Total Spending $540,461,105 $582,121,603 $594,343,675 $568,020,626 $561,173,889 $589,801,271 $601,240,613
% Admin to Total Spending 4.35% 3.62% 3.90% 4.14% 5.09% 4.83% 4.40%
Average All Service Monthly Cost Per Person $1,457 $1,509 $1,541 $1,521 $1,540 $1,643 $1,693
% Increase of Average Cost from Prior Year 5.12% 6.29% 2.11% -1.29% 1.25% 6.70% 3.01%
% of Annual Rate Increases 5.70% 6.16% 2.71% 0.00% 2.33% 8.79% 0.00%
Customers Receiving Paid Services 33,976 33,401 32,820 31,406 30,413 29,595 29,369
Total New Customer Service Plans 5,225 6,494 4,738 3,809 4,523 4,313 4,774
Total Customer Applications 7,757 6,750 6,375 5,734 6,144 5,927 6,947

1 Includes PS & F, Admin Contracts & Expenses. 2 Includes PA Ins Contribution & PY Costs Rolled into CY. 3 Includes Major & Preventive Services, Case Management.


Historical Summary of Medicaid Claim & Reimbursement FY 2013 through FY 2016

Category FY 2013 1 FY 2014 FY 2015 2 FY 2016 2 FY13 - 16
Total Program Spending $568,020,626 $561,173,889 $589,801,271 $601,240,613 $2,320,236,399
Administrative Medicaid Claims $51,995,363 $52,254,518 $45,852,091 $39,145,343 $189,247,314
Customer Service Medicaid Claims $401,298,087 $345,915,070 $297,984,709 $280,811,595 $1,326,009,462
Total Medicaid Claims $453,293,450 $398,169,588 $343,836,800 $319,956,938 $1,515,256,777
Total Medicaid Reimbursement $226,646,725 $199,084,794 $171,918,400 $159,978,469 $757,628,388
% HSP Only Medicaid Claim to Total Spending 79.80% 70.95% 58.30% 53.22% 65.31%
Customer Service MCO Medicaid Claims $10,005,084 $26,544,076 $124,685,112 $148,570,682 $309,804,953
% MCO Medicaid Claim to Total Spending 1.76% 4.73% 21.14% 24.71% 13.35%
Total HSP + MCO Medicaid Claim % of Total Spending 81.56% 75.68% 79.44% 77.93% 78.66%
Total Customers Receiving Paid Services 31,406 30,413 29,595 29,369 120,783
Customers with Medicaid Claim 26,726 23,336 20,655 19,199 89,916
% Customers with Medicaid Claim 85.10% 76.73% 69.79% 65.37% 74.44%
  1. 1 Managed Care began in February, 2013, with approximately 1,500 customers and now serves approximately 12,000.
  2. 2 Medicaid claims may be modified for up to 26 months from the date submitted to HFS, so FY 15 - FY16 reflect claims through March, 2017.

Waiver Summary By Year FY13 - FY16

Waiver FY13 FY14 FY15 FY16
# Cust. Served Ave Mo Cost* Total Spending # Cust. Served Ave Mo Cost** Total Spending # Cust. Served Ave Mo Cost* Total Spending # Cust. Served Ave Mo Cost* Total Spending
Persons with Disabilities 24,686 $1,433 $424,414,605 24,115 $1,414 $409,110,703 23,737 $1,417 $403,537,805 24,200 $1,457 $423,187,700
Persons with Brain Injury 5,065 $1,212 $73,663,540 4,675 $1,205 $67,601,975 4,293 $1,842 $94,885,338 3,612 $2,046 $88,679,834
Persons with HIV/AIDS 1,655 $872 $17,315,774 1,623 $1,069 $20,827,771 1,565 $1,153 $21,652,586 1,557 $1,177 $21,996,645
TOTAL 31,406 $1,368 $515,393,919 30,413 $1,363 $497,540,449 29,595 $1,464 $520,075,730 29,369 $1,515 $533,864,179

Note: Excludes prescreening


Distribution of Services by Waiver FY 2016

Service TOTAL BI HIV/AIDS General Waiver
# Cust. Served Total Spending # Cust. Served Total Spending # Cust. Served Total Spending # Cust. Served Total Spending
Personal Assistant 25,637 $473,484,931 3,280 $76,266,567 1,316 $19,276,917 21,041 $377,941,447
Homemaker 3,304 $40,371,401 350 $6,243,882 112 $960,984 2,842 $33,166,535
Maintenance Home Health 505 $8,190,249 52 $802,087 17 $104,130 436 $7,284,033
Home-Delivered Meals 1,073 $2,506,110 303 $967,564 20 $31,742 750 $1,506,804
Electronic Home Response 3,517 $950,598 555 $153,159 77 $19,578 2,885 $777,861
Adult Day Care 150 $1,285,000 27 $232,368 1 $10,939 122 $1,041,694
Brain Injury Services (duplicated count) 142 $467,768 127 $430,176 - $0 15 $37,592
Respite 16 $37,743 1 $566 - $0 15 $37,177
Home Remodeling 89 $654,480 19 $180,339 - $0 70 $474,141
Assistive Equipment 168 $247,909 19 $37,158 4 $939 145 $209,812
PA Background Check/Other 1,308 $53,273 167 $6,699 17 $580 1,124 $45,994
Diagnostic Services 882 $20,335 42 $985 - $0 840 $19,350
Case Management Services 4,279 $5,218,127 2,373 $3,328,712 1,478 $1,423,511 428 $465,904
Prescreening 16,998 $1,550,574 80 $8,505 63 $6,536 16,855 $1,535,533
Total (excl. Prescreening only) 29,369 $533,864,179 3,612 $88,679,566 1,557 $21,996,555 24,200 $423,188,058
Total (with Prescreening) 45,162 $535,291,957 3,615 $88,679,834 1,557 $21,996,645 39,990 $424,615,478

Summary of Spending by Type Service FY13 - FY16

Service FY 13 FY 14 FY 15 FY 16
Customers Served Total Expenditures Customers Served Total Expenditures Customers Served Total Expenditures Customers Served Total Expenditures
Personal Assistant 26,609 $428,862,344 25,877 $418,950,381 25,481 $453,484,166 25,637 $473,484,931
Homemaker 4,387 $55,581,067 4,173 $51,716,396 3,605 $43,288,966 3,304 $40,371,401
Maintenance Home Health 882 $9,483,091 826 $8,928,201 715 $8,666,836 505 $8,190,249
Home-Delivered Meals 2,011 $4,741,695 1,675 $3,962,602 1329 $2,993,224 1073 $2,506,110
Home Remodeling 138 $966,764 142 $848,879 150 $1,139,208 89 $654,480
Adult Day Care 227 $2,004,534 192 $1,712,699 158 $1,325,557 150 $1,285,000
Assistive Equipment 209 $408,938 238 $294,399 185 $284,171 168 $247,909
Electronic Home Response 5,394 $1,513,421 4,737 $1,325,772 4,009 $1,055,788 3,517 $950,598
Brain Injury Services 264 $761,322 208 $729,334 179 $605,264 142 $467,768
Respite 460 $1,207,855 383 $816,521 315 $739,878 16 $37,743
Diagnostic Services 1,190 $33,749 1,029 $25,890 1,109 $26,991 882 $20,335
PA Background Check 1,393 $58,668 1,507 $61,306 1,458 $61,509 1,308 $53,273
Case Management 6,416 $8,641,331 5,597 $7,250,112 4,984 $5,696,314 4,279 $5,218,127
Prescreening 12,675 $1,163,484 10,631 $1,301,899 15,512 $1,423,268 16,998 $1,550,574
Total (excl. Prescreening) 31,406 $515,393,919 30,413 $497,540,449 29,595 $520,075,730 29,369 $533,864,179
Total (with Prescreening) 43,013 $516,447,806 43,317 $498,719,373 43,898 $521,375,370 45,162 $535,291,957

Note: Total numbers are unduplicated; customers may receive multiple services.


Demographics FY13 - FY16

Age FY13 FY14 FY15 FY16
# Customers % of Total # Customers % of Total # Customers % of Total # Customers % of Total
0 - 20 1,182 3.76% 991 3.26% 868 2.93% 781 2.66%
21 - 30 2,542 8.09% 2,373 7.80% 2,233 7.55% 2,203 7.49%
31 - 40 2,990 9.52% 2,957 9.72% 2,917 9.85% 2,910 9.90%
41 - 50 5,672 18.06% 5,224 17.18% 4,910 16.59% 4,783 16.27%
51 - 60 11,673 37.17% 11,536 37.93% 11,297 38.17% 11,241 38.24%
61+ 7,346 23.39% 7,332 24.11% 7,372 24.91% 7,480 25.44%
TOTAL 31,406 100.00% 30,413 100.00% 29,595 100.00% 29,396 100.00%
AVERAGE AGE 50.64 51.10 51.46 51.69
Gender FY13 FY14 FY15 FY16
# Customers % of Total # Customers % of Total # Customers % of Total # Customers % of Total
Male 13,715 43.67% 13,204 43.41% 12,886 43.54% 12,809 43.57%
Female 17,691 56.33% 17,209 56.59% 16,709 56.46% 16,587 56.43%
TOTAL 31,406 100.00% 30,413 100.00% 29,595 100.00% 29,396 100.00%
Race FY13 FY14 FY15 FY16
# Customers % of Total # Customers % of Total # Customers % of Total # Customers % of Total
White 15,867 50.52% 14,955 49.17% 14,347 48.48% 14,211 48.34%
Black 14,570 46.39% 13,506 44.41% 13,441 45.41% 13,507 45.95%
American Indian 101 0.32% 766 2.52% 709 2.40% 638 2.17%
Asian 461 1.47% 475 1.56% 473 1.60% 469 1.60%
Hispanic 376 1.20% 679 2.23% 596 2.01% 543 1.85%
Hawaiian 31 0.10% 33 0.11% 29 0.10% 28 0.09%
TOTAL 31,406 100.00% 30,413 100.00% 29,595 100.00% 29,396 100.00%
Disability FY13 FY14 FY15 FY16
# Customers % of Total # Customers % of Total # Customers % of Total # Customers % of Total
Orthopedic, Amputation,
Other Mobility & Manipulation
11,842 37.71% 11,516 37.86% 11,176 37.76% 11,291 38.41%
All Other Disabilities 11,469 36.52% 11,192 36.80% 11,077 37.43% 10,953 37.26%
Brain Injury 2,834 9.02% 2,733 8.99% 2,565 8.67% 2,442 8.31%
Developmental 2,018 6.43% 1,889 6.21% 1,843 6.23% 1,819 6.19%
Mental Illness 896 2.85% 808 2.66% 734 2.48% 693 2.36%
AIDS 1,655 5.27% 1,623 5.34% 1,565 5.29% 1,55 5.30%
Hearing &/or Vision 691 2.20% 652 2.14% 635 2.15% 642 2.18%
TOTAL 31,406 100.00% 30,413 100.00% 29,595 100.00% 29,396 100.00%

Summary by DON Score

Summary by DON Score FY13

DON Score # Cust % of Cust Expenditures % of Exp Avg Annual Cost
Per Customer
29-32 7,116 22.66 $73,041,524.25 14.17% $10,264.41
33-40 7,814 24.88 $100,490,399.15 19.50% $12,860.30
41-49 5,740 18.28 $89,646,084.20 17.39% $15,617.78
50-59 4,382 13.95 $83,277,784.93 16.16% $19,004.52
60-69 3,184 10.14 $74,815,224.07 14.52% $23,497.24
70-79 2,042 6.5 $56,375,370.19 10.94% $27,607.92
80-100 1,128 3.59 $37,750,846.71 7.32% $33,467.06
Total 31,406 100.00% $515,397,233 100.00% $16,410.79

Average FY13 DON Score = 45.83

Summary by DON Score FY14

DON Score # Cust % of Cust Expenditures % of Exp Avg Annual Cost
Per Customer
29-32 6,635 21.82% $65,866,917.84 13.20% $9,927.19
33-40 7,404 24.34% $93,708,797.68 18.77% $12,656.51
41-49 5,611 18.45% $86,516,908.38 17.33% $15,419.16
50-59 4,353 14.31% $82,782,855.17 16.58% $19,017.43
60-69 3,202 10.53% $74,471,953.87 14.92% $23,257.95
70-79 2,027 6.66% $56,020,448.02 11.22% $27,637.12
80-100 1,181 3.88% $39,798,388.04 7.97% $33,698.89
Total 30,413 100.00% $499,166,269.00 100.00% $16,412.92

Average FY14 DON Score = 46.28

Summary by DON Score FY15

DON Score # Cust % of Cust Expenditures % of Exp Avg Annual Cost
Per Customer
29-32 6,019 20.34% $64,402,231.06 12.34% $10,699.82
33-40 7,134 24.11% $95,587,595.94 18.32% $13,398.88
41-49 5,517 18.64% $89,816,059.78 17.21% $16,279.87
50-59 4,342 14.67% $86,623,353.50 16.60% $19,950.10
60-69 3,259 11.01% $79,216,868.18 15.18% $24,307.11
70-79 2,063 6.97% $59,808,581.31 11.46% $28,991.07
80-100 1,261 4.26% $46,322,028.23 8.88% $36,734.36
Total 29,595 100.00% $521,776,718.01 100.00% $150,361.22

Average FY15 DON Score = 46.87

Summary by DON Score FY16

DON Score # Cust % of Cust Expenditures % of Exp Avg Annual Cost
Per Customer
29-32 5,697 19.40% $64,757,096.30 12.07% $11,366.88
33-40 6,885 23.44% $95,433,145.22 17.79% $13,861.02
41-49 5,467 18.61% $91,656,367.84 17.09% $16,765.39
50-59 4,521 15.39% $90,725,105.96 16.92% $20,067.49
60-69 3,315 11.29% $81,041,689.92 15.11% $24,446.97
70-79 2,141 7.29% $62,593,302.69 11.67% $29,235.55
80-100 1,343 4.57% $50,113,359.28 9.34% $37,314.49
Total 29,369 100.00% $536,320,067.23 100.00% $18,261.43

Average FY16 DON Score = 47.37