January 23, 2009

8:52 AM

Arc of Indiana Statement re: OASIS

On Tuesday, January 20 The Arc of Indiana was able to review data gathered from a test group of Medicaid waiver recipients regarding how OASIS will impact budget allocations. DDRS staff reviewed how a progression of factors will determine the allocation for each person. The good news is that the process appears to be rational and straightforward. The test group, pulled randomly from several regions, included children and adults, different levels of need, people living alone, people living with one roommate, and people living with two roommates.

The test group clearly demonstrated the reason why this process was started. Some people with minimal assessed needs showed budgets that seem very high, and some people with very high assessed needs have budgets that seem very low.

Based on this test group, it appears OASIS will provide a more rational approach to allocating resources. Does that mean that everyone will and should accept the change? Absolutely not. It will be very difficult to tell a person with minimal needs who has lived alone with one-to-one staffing that they will need to find roommates. It will also be a challenge to help people spend budget allocations increases wisely.

Is the assessment accurate? Many people have asked that question and it will only be possible to address that person by person with those who know them best. Each person will get an allocation letter indicating the amount OASIS has allocated them and what need level that represents. They will be able to see what the assessment included along with the addendum data on behavioral and medical information collected. If they feel that there was any error, or information was left out or inaccurate, that can be submitted for review.

FSSA has developed a transition policy that will give more time to people to make the transition from their current to new budgets. This policy is based on the dollar amount changed - whether it is an increase or a decrease.

During this transition period it will be very important for everyone on a waiver recipient’s team to work closely together. Families and consumers will need to work closely with case managers to determine the services they need and want, and multiple providers will need work together to meet those needs and wants as efficiently as possible.

The first round of allocations is scheduled to go out before the end of January to people whose plans are scheduled for renewal in April. They will receive a detailed packet that includes all of the steps to be followed to implement the new plans. Providers should take steps now to identify the people they serve who will be part of this first round of allocations, and help inform them of how the process will work and what they can do to help them through this process.

One of the keys to this process is the decision to allow the budget cap on the Support Services Waiver to move up to $13,500 for any SSW recipient who requests it. It is important to remember that SSW recipients are not part of the OASIS allocation process. Of the nearly 500 SSW renewals that have come in since January 1, 2009 over 70% included an increased budget and all were approved. Approximately 30% came in with a decreased budget that was initiated by the team, not by FSSA. At this time, no SSW budget reductions have been made at the state level.

Initial results of planned changes show that overall spending for the SSW will be substantial, but needed, to move people to the $13,500 cap. FSSA continues to plan to move the SSW cap to $16,000. Overall spending for the DD and Autism waiver is expected to remain neutral. However OASIS allocation projections are showing a net increase.

How can changes from OASIS move forward when facing the prospect of a 5% cut across the board in Medicaid? FSSA leaders continue to provide reassurance that the proposed rule to allow an up to 5% across the board cut in Medicaid is only a fall back measure to provide the authority to make changes, if needed.. John Parks, FSSA Chief Financial Officer, has indicated that if there is a hold back it will be “across the board.” However, we have asked FSSA to withdraw the proposed rule and, if there must be a rule, to submit a new rule that is more clearly written as to intent.

Absolutely essential to avoiding any Medicaid reduction is passage, as soon as possible, of President Obama’s Economic Recovery Package. If you have not contacted your member of Congress and Senators Lugar and Bayh please do so today. You can find more information, and learn how to contact your US Representative and Senators by going to: http://www.arcind.org/Action%20Needed%20on%20Stimulus%20Package.htm

There are great pressures on providers, families and consumers as the state moves forward with implementing OASIS. This pressure is multiplied with the current economic situation. The news about job losses hits all of our families as well.

Families have expressed to me many times in recent weeks that they feel everyone is focused more on money than their son or daughter. They feel lost in a process between providers, case managers and the state. This may lead some to reach out to someone new or just give up. I hope - as we have already discussed with members of the Indiana Conference of Executive Directors of Arcs (ICEArc) - that everyone looks to how they can best communicate and share information with staff, families and consumers during these turbulent times.

Many challenges with OASIS remain. The Arc will continue to work and find ways to make this system work best for everyone. I urge everyone to keep all perspectives in mind, and, most importantly, to keep the focus on the individual. While families, providers, and advocates are moving through a time of great uncertainty on many levels, we will be stronger by continuing to work together