In 2007-2008, Division of Developmental Disabilities (DDD) Director Lilia Teninty announced the formation of an ad hoc Rate Committee of the Statewide Advisory Council. The Rate Committee was broadly charged to review the rates and rate methodologies the Division employs to fund services to individuals with developmental disabilities. The Rate Committee was to identify issues with current rate-setting methods and to make recommendations to address these issues.
This interim report of the Statewide Advisory Council Rate Committee presents information on the background, organizational structure, and responsibilities and processes of the Rate Committee and its work groups as of April, 2009. At the end of this report are the specific recommendations by the Rate Committee as a whole.
The Rate Committee believes that it has made substantial progress in completing its responsibility and its assignment to examine rates in the developmental disabilities (DD) system. To date, the Rate Committee and its work groups have met numerous times and have produced a set of interim reports that provide specific recommendations for changing rates in several key DD programs. The reports also make recommendations for areas where additional review and research are needed. The reader is encouraged to obtain the work group interim reports that provide the full details of the work groups' review of issues and recommendations. Please review the reports for each Work Group are available on the Division's web page. In the past, previous incarnations of work and study groups similar to the Rate Committee have typically deliberated at great length and have not taken the opportunity to share their activities and results along the way and with a group such as the Statewide Advisory Council that represents so many viewpoints. The Rate Committee believes the time has come to share the Committee's progress and products with the Statewide Advisory Council, the Division of Developmental Disabilities and others.
The Rate Committee is seeking comment and feedback on its findings thus far. The Rate Committee acknowledges its efforts are a work in progress and it is inviting dialogue to guide it in its commitment to continuing that work.
Over the course of the early months of 2008, participants and members were recruited from among the members and participants of the Network Advisory Councils with the intent to provide geographical representation in assembling individuals interested in rates and rate-setting. It was not a requirement that participants would know the technical aspects of rate-setting, but it was important that participants would be willing to learn about rates, to attend meetings and conference calls, and to actively bring their individual perspectives to the rate discussions. At the April 2008 Statewide Advisory Council, there was also a general call for volunteers and the Council was advised that the first, organizational meeting of the Rate Committee would be meeting soon.
The Rate Committee first met on June 23, 2008. There were 25 participants at June's initial meeting, including individuals receiving funded services, parents, providers, Division staff, and provider advocates. Participation in the Rate Committee has been, and remains open-ended. Nearly 50 people have participated in the Rate Committee and its work groups during the past nine months.
Charges of the Rate Committee
The Rate Committee was launched to review the rate methodologies and structures of the rates of the Division of Developmental Disabilities. Specifically, the Rate Committee was given the following two-fold charges:
- Identify and recommend changes in rates and rate methods that could be implemented on a short-term basis and have an immediate effect of enhancing services and supports in the system in ways that promote the adequacy, quality, and quantity of programs of the Division's community services system.
- Identify additional areas of potential changes in the funding methods that could be considered for the longer-term.
Principles and Concepts of the Rate Committee
At its June, 2008 organizational meeting, the Rate Committee adopted the following four principles and concepts to be mindful of in carrying out their work:
Develop rate proposals that are adequate, fair, and equitable.
Rate adequacy is not easily described or measured in this context. From an economic perspective, rate adequacy means the DD service delivery industry is fiscally healthy, growing to meet increasing demand for its services, and vigorously competing to provide quality services that meet consumer's reasonable needs and expectations. In fiscal terms, it means the rates equal the sum of all expected reasonable costs of the service delivery process during the time the rates are in use and the services delivered meet established levels of quality and quantity.
Currently there is not sufficient data to measure these important performance standards for the system as a whole. However, the Rate Committee has made progress in this regard, for example in its proposal to rely on Bureau of Labor Statistics (BLS) hourly wage data to measure the reasonable cost of providing services for many of the components of the rates that are dependent on an hourly wage. The committee concluded that the BLS data provides a reasonable wage level indicator, is independent and objective, and provides a comparative measurement of the adequacy of the current wage levels.
For the system as a whole, the committee recommends further work and research to better define and measure rate adequacy using all available data, including Illinois data from the DD service delivery industry, considering both the cost of services and the quality and quantity of services needed.
Fair rates are not unfairly discriminatory, i.e., the rates for people with similar service delivery costs are equal and any substantive variation in the cost of providing needed services is included in the applicable rates. For this to occur, a rate classification (e.g. residential or day) must correspond to a similar type of service that is objectively defined, easily identified, and reasonably homogeneous in cost. With their proposals, the Rate Committee is working to establish fairness of the rates within current class of services.
However, the committee recommends considerable additional work and research to update and improve the rate classification system used to measure the cost and quantity of services needed by each person served.
For rates to be equitable they must be equally adequate for everyone or equally inadequate for everyone, i.e., if the rate for one person is inadequate, then the rates for all other people served must be equally inadequate to be equitable. This provides every person with equal access to services, because service providers will not have an economic incentive to prefer serving one person over another person. In practical terms, this means that implementing appropriate service level changes and indicated rate differences must, to make rate-setting more equitable, take some priority over wider rate level adjustments. Within its rate proposals the Rate Committee is recommending substantial changes designed to make the rates and service levels more equitable, for example, in its recommendation for increasing staffing in smaller (four and fewer) 24-hour Community Integrated Living Arrangements (CILA) settings to assure enough staff hours to meet the 24-hour coverage requirement that would make rates for these settings equitable with other setting sizes. The Rate Committee is making this recommendation even as some wider rate level adjustments to rate components, like hourly wages, are also being recommended.
However, the committee recommends significant additional work and research is needed in some areas to allow it to achieve this important equitable rate standard in the rate methods for other rate elements and for the system as a whole. The Rate Committee needs to determine, for example, whether geographical rate distinctions are appropriate and whether services available to people with extraordinary medical, behavioral and communication needs are adequate and equitable.
Create statistical models for each rate component or sub-component by identifying the data elements and process
The Rate Committee and its work groups have worked to carefully and thoroughly identify the factors that are used to calculate each type of rate and, as is often typical, its subcomponents, in order to understand and describe how a rate calculation is performed, what its input or antecedents are, what is its cost basis (including how the cost basis may be updated to reflect changes in costs over time), how a proposed change would impact the rate calculation, and how to determine the overall cost of applying the proposed change.
To accomplish this, it has been necessary for the Rate Committee and work groups to determine the exposure (e.g., the number of persons, or the number of persons in a particular group, or the number of applicable staff hours, etc.) applicable to each rate element. For example, in a review of the current fringe benefit percentage factor and determination of the cost impact of a change in the percentage, it was necessary to have data on the number of individuals and the respective staff hours being funded for each and the applicable hourly wage. In the case of 24-Hour CILA, the current rate calculation and its exposure elements is well documented and the statistical model exists to determine the cost impact of a given change. In other instances, such as the Medicaid Waiver Developmental Training rates, the current rate is a statewide "flat" rate and there is not a rate calculation, per se, so any proposal to change this to a calculated rate would require the development of a statistical model to express the impact of the change.
One extremely critical element to the creation of statistical models for the Division's rate methodologies is the identification of the means to updating the values that are used to calculate a rate or a rate component. The use of hourly wage indices that can be used to estimate current wage costs used in rate calculations or to project future wage costs is one clear example of this. Another example is the use of the U.S. Department of Labor, Housing and Urban Development Fair Market Rent system to estimate and project housing costs. The Rate Committee is working to identify other data sources that can appropriately be associated with specific other costs addressed by specific rate components. The various indices of the Consumer Price Index are one rich source of such data, but there are others including the U.S. Department of Agriculture food costs series.
A second significant aspect of the development of statistical rate models is the identification of parameters that guide a specific rate component's calculation. Examples of this would include the identification of a "standard" of industry practices such as represented by the proposed use of the BLS Employer Costs for Employee Compensation data to establish a standardized fringe benefit percentage.
Break proposals into parts that can be independently implemented
The Rate Committee and work groups recognized early in its discussions that it would be unlikely and infeasible to implement in a single step and at one time every single idea and recommendation it would be making during its review. Certainly affordability is an obvious consideration and, while it is reasonable to make strides when funding is available, it is entirely practical for the proposals of the Rate Committee to be capable of providing wide flexibility and many options that are feasible within any budget limitation scenario. The Rate Committee concluded that this flexibility was also important to contribute to service delivery system development, redirection, and refinement.
Develop rate proposals that can be "shelf ready" to implement as opportunities to do so are presented
Having worked out in advance the statistical models of rates and rate proposals that are broken into parts that can be separately implemented provides the flexibility necessary to take advantage of any opportunity or requirement to either implement a rate revision, or to project the cost of a rate revision, in short order.
The Structure and Operation of the Rate Committee
The Rate Committee is co-chaired by Mark Klaus, the Executive Director of Charleston Transitional Facility, an agency providing 24-hour and Intermittent CILA services, day services, Home-Base Support Services to individuals with various disabilities and needs and by Merlin Lehman, a parent and advocate with extensive fiscal experience and background drawn from his actuarial career.
The scope of the overall assignment and the two broad charges to the Rate Committee seemingly provided a nearly carte blanche opportunity to look at anything and everything having to do with rates and, at the same time, it presented a daunting challenge to organize itself, work meaningfully, provide results quickly and efficiently, and to report to the Statewide Advisory Council in a reasonably timely manner.
At its June, 2008 organizational meeting, the scope of the task before the Rate Committee led to a wide-ranging discussion of topics and issues. Out of this, the Rate Committee agreed to use a group structure with a work group established to focus on each of several selected programs or services the participants in the Rate Committee had identified and concluded would provide the best initial opportunities to have major impacts on improving current and future rates in the developmental disabilities system to enhance program quality, quantity, and adequacy of the rates. In making these choices about the programs and services to review, the participants acknowledged that they were not addressing every type of service or every rate employed in the developmental services system, at least for the time being.
The Work Groups
A work group was formed to review rates for each of the following program areas:
- CILA 24-hour settings
- CILA vacancies
- Transportation for Day Program
- Downsizing Intermediate Care Facilities for persons having a Developmental Disability (ICFs/DD)
Over the course of the months following the initial Rate Committee organizational meeting, each of the work groups began meeting to review and discuss the issues of the current methods for determining rates for their respective subject program. During the course of these subsequent discussions, the CILA Rates, Day Programs, and Transportation Work Groups each identified direct service staff wages and fringe benefits as a common or overlapping issue and the Wage and Fringe Benefits Work Group was formed.
In addition, since the original five work groups were all focused on adult services, a Children's Residential Work Group was also subsequently formed.
CILA Rates Work Group
Arlan MacClain, Kreider Services, Chair.
The CILA Rates Work Group has reviewed the current 24-Hour CILA rate model that is described in the CILA User Guide, Cost Center Definitions, and Allowance Levels, July 2002, which can be found on the Division web site. The Work Group has reviewed the assumptions and cost elements addressed by the CILA Rate model and it has provided its recommendations in the Interim Report of the CILA Rate Work Group.
CILA Rate Work Group
Michelle Brubaker, Trinity Services, Chair
The CILA Rate Work Group was formed in recognition that a primary concern for the continued viability of a CILA program in each setting location if that the funding can be disrupted by turnovers in the number of individuals being served and in the amount of time that elapses before a vacancy can be filled. After reviewing the issue, the CILA Vacancy Work Group was combined with the CILA Rate Work Group because it was concluded that some resolution of the vacancy issue could be addressed by specific recommendations regarding CILA rates and these recommendations appear in the Interim Report of the CILA Rate Work Group.
Day Program Rate Work Group
Carlissa Puckett, Springfield ARC, Chair
The Day Program Rate Work Group initially discussed the rates for Developmental Training (DT), Regular Work/Sheltered Employment Workshop (RW/SW), Supported Employment (SEP), Vocational Development, Adult Day Care, At Home Day Program, and Other Day Program. The Work Group concluded that it was not realistic to review such a broad range of programs all at the same time. Because the greatest utilization of day programs by far is in the Development Training program, the Work Group members agreed to defer the review of other day programs for the time being. The Transportation Work Group was already addressing transportation in day programs, so this aspect of day programs was not discussed further. The Work Group's recommendations appear in the Interim Report of the Day Program Rate Work Group.
ICFs/DD Downsizing Work Group
Chris Patton, DD Homes, Chair
The downsizing rate methodology was originally developed to provide the financial support to maintain the viability of a downsizing facility and to provide an incentive for facilities to reduce or eliminate their beds in favor of smaller residential settings. The Work Group has concluded that the downsizing rate methodology has met with some success, but that changes would improve the process. The Work Group's recommendations appear in the Interim Report of the ICFs/DD Downsizing Work Group.
Transportation Work Group
Gus van den Brink, Sertoma Services, Chair
Transportation is an element in virtually every developmental disabilities program. The Work Group noted that the CILA Rate Work Group was already reviewing CILA program transportation funding. The Transportation Work Group concluded that transportation related to day programs was fundamental in the developmental disabilities service system and that substantial work in developing a rate methodology had already been done in 2004 by an earlier work group that created the report, Transportation Reimbursement for Day Program Services - Reimbursement Rates for Community Agencies Providing Transportation Services to and from Day Program for Persons with Developmental Disabilities, January 2004.The scope of the report was focused on transportation for Developmental Training (DT) and Regular Work (RW) Medicaid Waiver programs. The Work Group revisited this earlier report and has modified and updated its recommendations in the Interim Report of the Transportation Work Group.
Wage and Fringe Benefits Work Group
Steve Rudolph, Consultant, Chair
Service quality depends foremost on having quality staff. Wages and fringe benefits for direct service staff that have a primary role in the delivery of services and supports are arguably the two most critical factors in providers' abilities to attract, hire, and retain quality workers. Workers are seeking wages and fringe benefits that can offer a reasonable standard of living to them and their families. Providers need to be competitive in their labor market to ensure that they will have a sufficient number of workers to provide services without having to resort to the use of overtime, which is costly both in terms of dollars and cents and also in terms of worker burnout with the concomitant problems than can bring. The Wage and Fringe Benefit Work Group reviewed the current wages and fringe benefits in several rate methodologies and developed recommendations for establishing and updating a standardized approach to funding workers in DD services. The Work Group's recommendations appear in the Interim Report of the Wage and Fringe Benefit Work Group.
Children's Residential Work Group
Dan Pennell, Goldie B. Floberg Services, Chair
Families typically seek assistance for their child's support needs to be provided in their home. However, when this is not successful, there are residential placements alternatives for children in Child Group Homes (CGH) and Child Care Institutions (CCI). The rates and rate methodology for these settings was reviewed by the Children's Residential Work Group because the application of limits to the cost-based rate methodology shared by the Department of Children and Family Services and the Division have resulted in unequal treatment of providers. The longer a provider has been in business the more the rates have been negatively impacted by the rate increase limits. These limits have eroded programs' abilities to serve children with increasingly greater needs than has historically been the case. The Work Group has been operational for a shorter time than other Rate Committee work groups, so the Work Group is still in the process of formulating its recommendations for an Interim Report of the Children's Residential Work Group.
Work Group Recommendations
Each Work Group has produced an interim report that provides an overview of the program or service rate-setting and a discussion of the Work Group's findings. Various alternatives and suggestions for making changes to the rates through modifications of various subcomponents of the rate calculations were considered and the results are reported in an interim report for each Work Group.
Each Work Group's interim report provides an overall recommendation, followed by two sections of recommendations. The first of these recommendation sections provides specific, detailed proposals for changes on items for which the Work Group has completed its review. A second section covers items the Work Group has identified and studied but the Work Group is recommending additional review and research work is needed.
The reader is referred to the specific Interim Report for each Work Group for the details on the reviews, findings, and recommendations.
Observations and Recommendations of the Rate Committee
The Rate Committee has provided oversight of the Work Groups' progress, reviewed the Interim Reports of the Work Groups, and has endorsed the reports and the respective recommendations that have been completed thus far.
In addition, the Rate Committee's overview of the Work Groups has provided it with a unique perspective and opportunity to make several observations and recommendations of its own. The Rate Committee is making specific recommendations for next steps in the Rate Committee and Work Group processes. The Rate Committee offers some observations regarding implementing the Work Groups' recommendations and proposals. Lastly, the Rate Committee is also making recommendations regarding the development of a uniform, system-wide individual needs assessment process and instrumentation that it believes are critical to developing a more individualized rate structure that will support future service system designs.
Observations Regarding Implementing the Work Groups' Recommendations and Proposals and Prioritization
The Rate Committee did not approach its discussion of rate issues from the perspective that some issues would be too costly to address nor did it make or alter its recommendations because of the cost. In fact, nothing was considered "out of bounds" or "off the table" for the discussions. Rather, the principles of rate adequacy, fairness, and equity guided the Committee's work. Consequently, the recommendations and proposals of the Work Groups, almost without exception, do not provide alternatives or intermediate steps to their implementation.
The Rate Committee believes it has made every effort to establish a rational and objective basis for its proposals and recommendations. Ideally, all of the recommendations of the Rate Committee could be adopted and funded to move toward a reimbursement system that adheres to the principles of adequacy, fairness, and equity. But this is not to imply that the recommendations of the Rate Committee are proffered on an "all or nothing at all" basis. Indeed, many of the recommendations of the Rate Committee and the Work Groups are broken into parts that provide ample information and the means to choose from among a variety of proposals. Many of the recommendations can feasibly be implemented in the short term. The principles of rate adequacy, fairness, and equity do not preclude choices and options from being made along the way toward having a rate system that fully adheres to these principles.
Ultimately, however, the realities of making changes to rates and to rate-setting systems and methodologies come down to setting priorities for the Developmental Disabilities services system and the affordability of implementing these priorities.
Regarding prioritization, the recommendations of the Rate Committee and Work Groups include rate calculation formula changes that should be viewed as amendments to the rate methodologies to "level the playing field" and make rates that are more equitable and fair, e.g., by changing staffing ratios in four-person (or smaller) CILAs. Other recommendations are much broader and apply across the board and thus could have a much wider impact on rates, e.g., a change in fringe benefit percentages. Each of these types of recommendations could be implemented, and one approach to prioritization could be to first make changes that make rates more fair and equitable, then to make changes that are more extensive.
The Rate Committee has concluded that decisions about what to fund and to what extent something should be funded are strategic decisions that warrant the consideration of a much larger constituency than just the Rate Committee. However, the Rate Committee's work provides the information and working statistical models and tools to assist strategic decision-making.
The Rate Committee's work can help stakeholders to objectively evaluate and consider the costs of proceeding with certain priorities in mind. The Rate Committee's approach to developing statistical models has many similarities to a system used in the State of Arizona developed by EP & P Associates consultant, Peter Burns, who had 25 years' experience with the State of Arizona in disability services. In brief, the Arizona Rate Book model and the process, materials and recommendations of the Rate Committee each provide an objective means to establish rates - what Arizona terms a rate's "current market value" or benchmark value and to compare an actual or "adopted" rate, if different, to that benchmark rate. The State of Arizona has acknowledged in its FY2008 Rate Book that its adopted rates have been lower than established benchmarks in the past due to budget restrictions, though rates in Arizona had apparently received a 5% rate increase retroactive to July 2007. It is not known how Arizona rates have fared since.
With the knowledgeable and skillful assistance of Division staff, the Rate Committee has developed a similar system of refined statistical rate models to calculate a rate (e.g., for funding Direct Service Person staff hours) that is based on the Committee's efforts to establish a sound and reasonable basis for the rate (e.g., average hourly wages for Social and Human Service Assistants) and an objective data source (e.g., Bureau of Labor Statistics). With the Rate Committee's statistical rate calculation models, it is possible to determine or to project (predict) a current or future market level standard using current source data or trending source data. By a comparison to a current rate, it is possible to predict the cost of adopting a rate at 100% of the standard or "current market level". This comparison also enables one to evaluate a rate's adequacy against a well conceived standard. It is also possible to project the cost to move a rate toward a standard by some stated incremental amount (e.g., $1.00 an hour wage increase).
Armed with this type of statistical "ammunition" and tools, developing funding proposals and planning efforts to seek out or to lobby for funding for rate methodology changes and rate increases can be based on rational and objective arguments and trustworthy cost estimates.
Observations Regarding the Development of a Uniform, System-Wide Individual Needs Assessment Processes and Instruments
In reviewing how rates are set, the Rate Committee has determined that there is not one system for funding individuals but rather there are several, depending on the program being funded. Rates for the CILA program are established using information about selected characteristics of the funded individuals using the Inventory of Client and Agency Planning (ICAP) score. ICFs/DD rates are based on a Level of Function determination chiefly driven by the Mental Age IQ score. Some DDD programs' rates do not take individual characteristics into consideration whatsoever in setting rates, e.g., children's residential programs.
The Rate Committee offers the following observations regarding current assessment processes. There is a lack of uniform individualized measures used to determine rates. Accurate, appropriate, reliable, and objective assessment tools are fundamental to establishing individualized staffing and funding levels for supports and services. It is imperative that efforts are made to employ, or construct, or adapt diagnostic and assessment instruments that can be objectively used to accurately and reliably assess or measure an individual's needs both by type (i.e., medical, personal care, behavioral, etc.) and by relative degree (i.e., health risk, degree of dependence, intensity, severity, etc.).
A complement or set of assessment instruments and processes is needed to adequately and appropriately identify and fund basic and specialized supports. With such tools one can determine what needs exist and whether they are or are not being addressed by current funding methods, programs, and supports. With such tools, rate methodologies can be modified to carry out their roles and function to distribute available funding in a most equitable manner to address individuals' needs and interests.
In any case, the use of standardized assessment tools used in setting rates should be in conjunction with person-centered planning accepted practice and should complement individualized budgeting approaches to funding.
The Rate Committee offers the following observations regarding current assessment processes and rate determination processes.
The Inventory for Client and Agency Planning (ICAP) score is currently used to measure the basic staffing levels and funding in CILA rates and could be used for other rate-setting as well. The use of the ICAP in rate setting assumes that an individual's level and type of service and support needs can be identified and funded based on the ICAP score and that the funding is established fairly and consistently relative to the ICAP scores of all other individuals receiving funding. Some critics question this premise, arguing that the ICAP can produce unreliable results, that is, that scores can and do vary considerably depending upon who is completing the ICAP, their objectivity, and how well they know the individual. It is also argued that a single score does not reflect the true complexity of the individual.
Currently, for CILA and Developmental Training Medicaid Waiver funded programs, temporary staff add-ons are granted through temporary 53R and permanent staff add-ons on a "by request" basis for funding support above the basic staffing rate for individuals medical, behavior, ambulation, or physical/personal care needs. Individuals' medical needs are currently assessed for reimbursement purposes using the Health Risk Screening Tool (HRST), which has been adapted to include additional elements, and through the medication administration record. Records of the type, severity, and consequences of existing behavior document behavioral support needs. Individuals dependent on having extraordinary total physical/personal and ambulatory care or alternative communication needs (i.e., non-English or non-verbal, non-visual communication) are evaluated on a case-by-case basis.
Processes similar to these are used in setting rates in the ICFs/DD system, but the instrumentation is completely different.
As mentioned earlier, some rate systems, such as the Children's Residential System, do not use assessment measures in setting rates. Services to individuals may be driven by needs assessments and the costs to provide the services are ostensibly reflected in the cost-based rates.
These processes and resulting rates have not been evaluated to determine if they accurately and consistently distinguish the levels or types of needs of individuals for whom additional supports are sought. The lack of uniform assessment processes among the Waiver, ICFs/DD, and children's residential systems raise questions about the comparability of rates.
This discussion points out several issues having to do with rates:
- Rates are not individualized in some programs.
- For programs where rates are set based on individual assessments and measures, different instruments and processes are used for different programs.
- Assessments that are not based on reliable and valid standardized practices may not be consistently documented and can be interpreted differently by different reviewers.
- Rates may not be comparable or consistent across programs or systems for individuals who may be very similar in their levels of support needs.
The Rate Committee recommends the development of a uniform, system-wide individual needs assessment process and instrumentation. The Rate Committee concludes this is critical to guiding current rate-setting practices and to developing future service system designs that could include a more individualized rate structure. The Rate Committee recognizes that its role and expertise is not in the more clinical and services planning realm of assessment instruments and that other groups should have the lead in reviewing and evaluating assessments, but the Rate Committee also recognizes that rates are the vehicle for implementing funding that is founded on reliable, valid individual assessments and the Rate Committee encourages its involvement in the evaluation, development and application of assessment instruments and processes.
Specifically, the Rate Committee recommends the following:
- The Division should conduct an evaluation and review of existing and alternative assessment instruments and processes. Other assessment processes/tools such as the Supports Intensity Scale (SIS) have their proponents and a number of states are examining the SIS for reimbursement purposes in conjunction with the Human Services Research Institute (HSRI).
- A uniform assessment system should address basic and extraordinary staffing and support needs in the areas of habilitation and community integration, medical, behavioral, personal and physical care, ambulation, and alternative communication.
- The evaluation should include identification and consideration of threshold criteria and/or the use of standardized measures or scales that would be useful in making methodological changes or in developing new rate methodologies.
Next Steps and Closing
Dissemination and Comment
The Rate Committee recommends the dissemination of the Interim Reports to the developmental disabilities community through the Statewide Advisory Council and its local area Network Advisory Councils, the Division of Developmental Disabilities, and perhaps to other stakeholder groups. The Rate Committee and Work Group participants are offering to make presentations to Network Advisory Councils around the state over the next couple of months. The Rate Committee is seeking comment and feedback on its findings to date and it is inviting dialogue with a wider stakeholder audience to gain broader perspectives that can guide it further in its work.
Before resuming its Workgroup activities to the significant levels of the past several months, the Rate Committee proposes to use the time over the next couple of months in support of the review and comment period and activities described above. During this time, encouraging the participation of others in the Rate Committee process, collecting comments and information, and incorporating them into plans for moving forward will be the focus. The Workgroups have acknowledged that, while a great deal of work has been accomplished in a fairly short time, the sheer complexity of rate-setting has left the Committee with a number of recommended areas needing further review and research. The Rate Committee recommends continuing its work on some of these "loose ends."
Next Reporting Period
The Rate Committee proposes to report back to the Statewide Advisory Council at its July 23, 2009 meeting.
The Rate Committee is grateful to the Division and the Statewide Advisory Council for their continuing support of its efforts in the review of rates and rate methodologies in the Developmental Disabilities system. The Rate Committee is committed to continuing these efforts and welcomes comments and guidance. The Rate Committee encourages the involvement of anyone interested in participating in its work.