This Section 1 provides the Work Group's recommendations on items the Work Group has reviewed.
-
Increase DSP Wage
DSPs have a primary role in the delivery of CILA services and because of their training and experience; they are critical to the quality of services provided to a person with developmental disabilities. Their importance in assisting an individual in a wide range of activities that are a part of living and working in one's community cannot be overstated. The DSP hourly wage is a key element of the ability to hire and train new workers, to retain experienced DSPs in competitive job markets, and to ensuring an adequate workforce supply. The current DSP reimbursement wage in CILA is $10.71/Hour and $12.86/Hour with 20% fringe benefits.
Remedy: Increase the DSP hourly wage using the BLS projected wage for the Standard Occupational Classification for the series 21-1093, Social and Human Service Assistants, to $14.59/Hour. With 20% fringe, this value becomes $17.51/Hour (Type 2 change) and $18.88/Hour with 29.43% fringe (Type 3 change).
Calculation: Based on 16,300,105 DSP staff hours @ $12.86 plus 2,770,323 substitute DSP staff hours @ $10.71 for 8,022 people in CILA.
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$239.159 M |
$0.0 M |
$239.2 M |
$119.6 M |
Type 1 |
|
N/A |
N/A |
N/A |
Type 2 |
|
$94.7 M |
$333.9 M |
$166.9 M |
Type 3 |
|
$26.3 M |
$360.1 M |
$180.1 M |
-
Adopt Senate Resolution (SR) 514 Recommendations for CILA Nursing Services
Individuals' medical needs vary from basic health monitoring up to those requiring a significant amount of nursing and/or medication administration services. The 2006 SR514 Report of the Community Integrated Living Arrangement Nursing Services Reimbursement Work Group nursing study recommended changes for base monitoring and additional services for all individuals based on the Health Risk Screening Tool assessment and medication administration record information. The complete report is available online.
Remedy: Implement the staff and nurse changes recommended in the Report of the Community Integrated Living Arrangement Nursing Services Reimbursement Work Group nursing study for Senate Resolution 514, October 2006. BLS wage data projected to 2009 for RN's of $36.23 and LPN's of $23.92/Hour with 20% Fringe Benefit allowance (Type 2 change). A 29.43% fringe allowance results in wages of $39.08 and $25.79 respectively (Type 3 change).
Calculation: The Health Risk Screening Tool (HRST) total score and the medication administration information for all 8,022 individuals in CILA are used with a progressive, increasing, amount of RN and LPN staff time plus base health monitoring to determine funding levels.
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$3.5 M |
$0.0 M |
$3.5 M |
$1.8 M |
Type 1 |
|
$6.8 M |
$10.3 M |
$5.1 M |
Type 2 |
|
$5.1 M |
$15.4 M |
$7.7 M |
Type 3 |
|
$1.2 M |
$16.6 M |
$8.3 M |
-
Increase QMRP Wage
QMRPs are critical to the quality of services provided to a person with developmental disabilities. Trained and experienced QMRPs are difficult to retain with the current wage allowance. Current QMRP reimbursement wage is $15.11/Hour and with fringe is $18.14/Hour.
Remedy: Increase the QMRP hourly wage using the BLS projected wage for 2009 for the Standard Occupational Classification for the series 21-0000, Community and Social Service Occupations to $22.32/Hour. With 20% fringe, this value becomes $26.78/Hour (Type 2 change) and $28.89/Hour with 29.43% fringe (Type 3 change).
Calculation: Based on 7,461 people in 24 Hour and Foster Care CILA at 130 hours per person (969,930 Hours) and 1,935 hours of QMRP hours included in Intermittent and Family CILA rates.
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$17.6 M |
$0.0 M |
$17.6 M |
$8.8 M |
Type 1 |
|
N/A |
N/A |
N/A |
Type 2 |
|
$8.4 M |
$26.0 M |
$13.0 M |
Type 3 |
|
$2.1 M |
$28.1 M |
$14.0 M |
-
Increase Supervisor Wage
The supervisor is also a vital staff position for any CILA site. They function as the lead worker and house manager and are often the most familiar with the people who live at the CILA site and with the staff. Experienced supervisors are difficult to retain with the current wage allowance. The current Supervisor reimbursement wage is $13.40/Hour and with fringe is $16.08/Hour.
Remedy: Increase the Supervisor hourly wage using the BLS projected wage for the Standard Occupational Classification for the series 21-1099, All Community and Social Service Specialists Not Listed Separately to $19.20/Hour. With 20% fringe, this value becomes $23.04/Hour (Type 2 change) and $24.85/Hour with 29.43% fringe (Type 3 change).
Calculation: Based on 7,461 people in 24 Hour and Foster Care CILA at 130 hours per person (969,930 Hours) and 1,792 Supervisor hours included in Intermittent and Family CILA rates.
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$15.6 M |
$0.0 M |
$15.6 M |
$7.8 M |
Type 1 |
|
N/A |
N/A |
N/A |
Type 2 |
|
$8.4 M |
$26.0 M |
$13.0 M |
Type 3 |
|
$2.1 M |
$28.1 M |
$14.0 M |
-
Fringe Benefit Allowance
Currently the fringe benefit allowance of 20 percent in the CILA Model for staff addresses required employer paid payroll taxes (Social Security and Medicare), state and federal unemployment taxes, and worker's compensation insurance.
There are two distinct issues regarding the Fringe Benefit Allowance:
- The first is that the CILA model Substitute Staff calculation currently does not have any fringe benefit allowance included in the substitute staff hours funding. Substitute staff are needed to take the place of regular workers who use accrued benefit time off (e.g., vacation and sick time). The initial CILA model assumption was that the substitute staff would be part time personnel and would not receive benefits. However, in practice, a substitute staff is an employee for whom there are required employer-paid payroll tax expenses.
- The second issue is that the current allowance level for all staff precludes providers from funding benefits such as health, dental or vision insurance or retirement savings benefits. Providers have a difficult time recruiting and retaining staff without being able to provide competitive employer sponsored benefits.
Remedy:
- Change the formula for the calculation of fringe benefits for substitute staff from 0% to 20% (a Type 1 formula change for substitute staff).
- Adopt the fringe benefit allowance of 29.43% derived from the June 2008 BLS News "Employer Cost for Employee Compensation" for the Midwest Division, North Central Region (IL, IN, MI, OH, and WI) without changing the current CILA model wage rates for any staff types. In other words, at currently funded wages and staff hours for DSPs, QMRPs, Supervisors, RNs, LPNs, Minimum Wage Night Shift staff (see also item #12 below), and substitute staff, increase the current 20% fringe benefit percentage by 9.43% to 29.43%.
Calculation: The Type 1 formula change below funds fringe benefits at 20% for 2,770,323 Substitute (Sub) Staff hours to bring this on a par with other staff types.
The Type 3 change that follows is based on first increasing the fringe benefit percentage for the substitute staff hours to 20% (Type 1) and then further increasing all fringes to the 29.43% fringe benefit level for all currently funded staff types, wages, and hours. The Type 3 fringe benefit cost projections below are at current wage levels and this projection differs from the Type 3 (fringe benefit) cost projections in other staff item Recommendation (see items # 1, 2, 3, 4, and 12 elsewhere in this paper) because those other items' projections are based on wage rate changes and fringe benefit changes compounded together.
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$41.7 M |
$0.0 M |
$41.7 M |
$20.85 M |
Type 1 (Sub) |
|
$6.0 M |
$47.7 M |
$23.85 M |
Type 2 |
|
N/A |
N/A |
N/A |
Type 3 (Sub) |
|
$16.5 M |
$64.2 M |
$32.1 M |
-
One to Four (1-4) Person CILAs Staff Coverage Calculation
The current staffing model for smaller sized CILA homes (1 - 4 capacity) does not fund the minimum required number of DSP staff hours for at least one DSP to be "on duty" at a site that is to provide 24 hour coverage.
Remedy: Create a minimum staffing "floor" to fund at least one DSP to be on duty in a site with a capacity of 1, 2, 3, or 4 persons.
Calculation: Based on 1,110 people being served in 1 - 4 bed capacity homes.
Increase
Projection |
Numbers of
Individuals |
Added
Hours |
Total Cost
Type 1 |
Total Cost
Type 2 |
Total Cost
Type 3 |
1 Bed Site |
32 |
173,922 |
$2.1 M |
$3.0 M |
$3.3 M |
2 Bed Sites |
152 |
210,361 |
$2.7 M |
$3.7 M |
$4.0 M |
3 Bed Sites |
156 |
89,794 |
$1.1 M |
$1.6 M |
$1.7 M |
4 Bed Sites |
770 |
143,480 |
$1.8 M |
$2.5 M |
$2.7 M |
Total |
1,110 |
617,558 |
$7.9 M |
$10.8 M |
$11.6 M |
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$40.3 M |
$0.0 M |
$40.3 M |
$20.1 M |
Type 1 |
|
$7.9 M |
$48.2 M |
$24.1 M |
Type 2 |
|
$2.8 M |
$51.0 M |
$25.5 M |
Type 3 |
|
$0.8 M |
$51.6 M |
$26.3 M |
-
Housing and Urban Development (HUD) - Fair Market Rent (FMR) Allowance
The HUD - Fair Market Rent Allowance in the CILA Model has only received periodic COLA increases since the inception of the model. These COLA increases it is believed have not kept pace with the actual cost of obtaining and operating a residential site, regardless of size. The increased cost of property values, mortgage/rent payments and utilities coupled with insufficient reimbursement is a significant deterrent to future CILA development. In addition, currently CILA 1 and 2 person settings are not funded using the HUD FMR approach so this recommendation proposes to also include these settings.
Remedy: Update Housing Allowances based on 2008 HUD FMR tables. In addition, include CILA 1 and 2 person settings. All CILA sites would be treated equally using the same reimbursement formula and index.
Calculation: Based on 7,461 people in 24 Hour and Foster Care (FC) CILA and 561 people in Intermittent CILA. Family CILA is excluded.
Site
Breakdown |
Individual
People |
24 Hr.
& FC |
Individual
People |
Intermittent |
Individual
People |
Totals |
1 & 2 Bed
Sites |
184 |
$0.3 M |
473 |
$1.3 M |
657 |
$1.6 M |
3 & 4 Bed Sites |
926 |
$0.5 M |
59 |
$0.0 M |
985 |
$0.5 M |
5 & 6 Bed Sites |
2,681 |
$1.2 M |
27 |
$0.0 M |
2,708 |
$1.2 M |
7 & 8 Bed Sites |
3,670 |
$1.3 M |
2 |
$0.1 M |
3,672 |
$1.4 M |
Total |
7,461 |
$3.3 M |
561 |
$1.4 M |
8,022 |
$4.7 M |
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$23.9 M |
$0.0 M |
$23.9 M |
$0.0 M |
Type 1 |
|
$4.7 M |
$28.5 M |
$0.0 M |
-
Vehicle Mileage Allowance
The vehicle mileage allowance in the CILA Model has only received periodic COLA increases since the inception of the model. COLAs have not kept pace with the actual cost of operating vehicles to transport individuals.
Remedy: Adopt and adjust the vehicle mileage allowance based on the State mileage allowance established by the Governor's Travel Control Board for State employee's mileage reimbursement. The current state mileage allowance is $0.505 per mile. Update the reimbursement allowance level on a periodic basis and based on any changes made to the State mileage allowance.
Calculation: Based on 7,461 people (1,753,253 miles) in 24 Hour and Foster Care CILA and 37,290 miles included in Intermittent & Family CILA funding.
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$4.7 M |
$0.0 M |
$4.7 M |
$2.3 M |
Type 1 |
|
$1.6 M |
$6.2 M |
$3.1 M |
-
Substitute Staff for Add-on Staff
When a staff add-on funding is determined for a person either through an individual staff add-on or a "house matrix" there is no substitute staff allowance currently included in the rate calculation to "cover" the additional staff hours. Since the staffing plan adds more DSP staff hours that will accrue and use benefit time, additional substitute staff are needed.
Remedy: Add a Substitute Staff Allowance for Add-on Staff and include fringe benefits when calculating a staff add-on.
Calculation: Based on 308,625 DSP hours added to residential rates for residential staff add-ons. 308,625 {Hours} / 2,080 {1 FTE} * 31 {Days} * 8 {Hrs.} = 36,800 DSP substitute staff hours.
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$0.0 M |
$0.0 M |
$0.0 M |
$0.0 M |
Type 1 |
|
$0.4 M |
$0.4 M |
$0.2 M |
Type 2 |
|
$0.2 M |
$0.6 M |
$0.3 M |
Type 3 |
|
$0.1 M |
$0.7 M |
$0.3 M |
-
Adjust for 365 Days of Operation
The current calculation for staff coverage hours is based on a 7-day week and 52-week year, which yields only 364 days of coverage. However, 365 days divided by 7 days in a week results in a shortage of 0.14286 or about 1 day per year. Consequently, staff funding for Prime, Non-Prime, Night, and Substitute staff is one day per year short, or for only 364 days/year.
Remedy: Adjust the staff calculation multiplier to 52.14286 from the current 52.
Calculation: Based on 7,461 people in 24 Hour and Foster Care CILA. Using existing staff levels, this change adds 16,631 Prime; 13,061 Non-Prime; 14,186 Night Shift; and 13,416 Substitute DSP Staff Hours.
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$0.0 M |
$0.0 M |
$0.0 M |
$0.0 M |
Type 1 |
|
$0.7 M |
$0.7 M |
$0.4 M |
Type 2 |
|
$0.3 M |
$1.0 M |
$0.5 M |
Type 3 |
|
$0.1 M |
$1.1 M |
$0.5 M |
-
Change the deduction for day program time away from the home
Increase the residential paid staff time to eliminate the deduction for "no paid staff" time for day program time away from the residential site from 7 hours to 5 hours. Initially it was thought that no staff would be needed for two hours each weekday while individuals were away from the CILA site for day program attendance and the travel time to and from the day program site. However, residential staff typically have responsibilities at the residential site after the residents leave for day programs and must be on duty prior to the arrival of residents back from day programs.
Remedy: Add one hour to "Prime" time coverage Monday through Friday
Add one hour to "Non-Prime" time coverage Monday through Friday
Calculation: Based on 7,461 people in 24 Hour and Foster Care CILA. Change the calculation to use five instead of seven hours away time. Uses existing staffing level calculations at 52 weeks per year.
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$0.0 M |
$0.0 M |
$0.0 M |
$0.0 M |
Type 1 |
|
$18.1 M |
$18.1 M |
$9.0 M |
Type 2 |
|
$6.5 M |
$24.6 M |
$12.3 M |
Type 3 |
|
$1.9 M |
$26.5 M |
$13.2 M |
-
Minimum Wage for Asleep Night Shift Staff
The current hourly reimbursement rate for night shift "asleep" staff is $7.24, which is below the minimum wage rate for Illinois. Service providers are required by law to pay at least the minimum wage. Fringe benefits at 20% are added to this figure.
Remedy: Adopt and adjust the Night Shift Asleep Wage Allowance to reimburse night shift "asleep" hours at the State of Illinois' minimum wage plus a fringe benefit allowance. The current (FY2009) State minimum wage is $7.75/Hour ($8.69 with 20% fringe benefits) shown as a Type 1 formula change. Update the future reimbursement allowance level based on increases to the State's minimum wage. The Illinois minimum wage will increase to $8.00/Hour on July 1, 2009 and $8.25/Hour on July 1, 2010.
Calculation: Based on 680,350 hours of "asleep" staff hours for 986 people in 24 Hour and Foster Care CILA. Current "asleep" staff wage is $7.24/Hour with a 20% fringe benefit allowance for a total of $8.69/Hour. The hourly minimum wage change is shown below as a Type 1 formula change.
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$5.9 M |
$0.0 M |
$5.9 M |
$3.0 M |
Type 1 |
|
$0.4 M |
$6.3 M |
$3.2 M |
Type 3 |
|
$0.1 M |
$6.4 M |
$3.2 M |
-
Administration Allowance
The Administration Allowance in the CILA Model has a "fixed" or "flat" amount regardless of the type of setting or the level of needs of the individual and was originally based on 10% of the average CILA rate. Although the allowance has received periodic COLA increases since the inception of the model, this fixed amount is now only 6.75 percent of the current average CILA rates. COLA increases to the administrative allowance in CILA have not kept pace with the overall changes in the CILA rate because some rate increases have specifically been directed to staff wages (e.g., $1/hour) and there is an increasingly greater number of individuals with higher support needs in CILA. Rates have increased while administrative costs for such functions as staff recruitment, professional liability insurance, attending conferences and training, and those administrative costs that correspond with the staffing for varying needs of individuals have not kept up with increasing costs. Other DHS-funded programs' rate methodologies (e.g., Community Living Facility) have an administrative allowance of 20 percent. In addition, it is believed that there may be industry standards for what is considered a reasonable administrative allowance that could be used as a guide to changes in the CILA model. The CILA Rate Work Group continues to research this issue.
Remedy: Revise the Administration Allowance to be determined at a reasonable industry standard level or resume using 10% of the CILA rate.
Calculation: For example, based on the rates for 8,022 (7,461 in 24Hr./Foster Care and 561 in Intermittent/Family CILA) people currently in CILA totaling $367,537,124 (Total CILA funding minus current Administration) 10% factor is applied.
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$26.6 M |
$0.0 M |
$26.6 M |
$13.3 M |
Type 1 |
|
$9.8 M |
$36.4 M |
$18.2 M |
-
Home Modifications
An allowance of up to $15,000 for minor Home Modifications is currently allowed for existing (not newly constructed) agency controlled (owned) CILA sites. A lower limit of $7,500 is applied when the home is "new construction" and a $5,000 limit is in place for "rented" property. Fire Department requirements have increased significantly over the years requiring CILA sites to adhere to more stringent fire and life safety codes. Most often a fire sprinkler system is required. Even in a newly constructed home, where the sprinkler system can be more readily incorporated into the design and construction, the cost of installing a sprinkler system is typically $30,000. CILA providers are expected to serve individuals with more intense physical disabilities and lower levels of functioning who are not able to meet "prompt" evacuation requirements thus the local fire department or State Fire Marshal's office requires an automated fire sprinkler system.
Remedy: Add a one-time billing code of 53F for required Fire Department Modifications such as sprinkler systems, fire doors, fire alarms, and fire windows. Eliminate the $7,500 limit for agency controlled new construction CILA sites. Changes to the Provider Waiver Manual will be needed. Make the 53F allowance a minimum $30,000 in addition to the $15,000 allowance for other home modifications.
Calculation: Based on 50 requests submitted during FY08 for home modifications from CILA providers for required Fire Department modifications.
Projection |
Current
Funding |
Incremental
Increase |
Total
Funding |
FFP Amount |
Current |
$0.0 M |
$0.0 M |
$0.0 M |
$0.0 M |
Type 1 |
|
$1.5 M |
$1.5 M |
$0.8 M |