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HCR021aa,aa...........................................by HEALTH AND WELFARE
DEVELOPMENTAL DISABILITY - MEDICAID - Stating findings of the Legislature
regarding the use of utilization management of Medicaid services to persons
with developmental disabilities and directing the adoption of the most
cost-effective program with features specified by the Department of Health
and Welfare.
02/11 House intro - 1st rdg - to printing
02/12 Rpt prt - to Health/Wel
02/19 Rpt out - to Gen Ord
02/26 Rpt out amen - to engros
02/27 Rpt engros - 1st rdg - to 2nd rdg as amen
02/28 2nd rdg - to 3rd rdg as amen
03/03 Ret'd to Gen Ord
03/05 Rpt out amen - to engros
03/06 Rpt engros - 1st rdg - to 2nd rdg as amen
03/07 2nd rdg - to 3rd rdg as amen
03/11 3rd rdg as amen - ADOPTED - 56-13-1
AYES -- Andersen, Barraclough, Barrett, Bauer, Bedke, Bell, Black,
Block, Bolz, Bradford, Campbell, Cannon, Clark, Collins, Crow, Cuddy,
Deal, Denney, Eberle, Edmunson, Ellsworth, Eskridge, Field(18),
Field(23), Gagner, Garrett, Harwood, Jones, Kellogg, Kulczyk, Lake,
Langford, McGeachin, McKague, Meyer, Miller, Moyle, Nielsen,
Raybould, Ridinger, Ring, Roberts, Robison, Rydalch, Sali, Schaefer,
Shepherd, Shirley, Skippen, Smylie, Snodgrass, Stevenson, Tilman,
Trail, Wills, Mr. Speaker
NAYS -- Bieter, Boe, Douglas, Henbest, Jaquet, Langhorst(Wallace),
Martinez, Mitchell, Naccarato, Ringo, Sayler, Smith(30), Smith(24)
Absent and excused -- Wood
Floor Sponsors - Gagner & Sali
Title apvd - to Senate
03/12 Senate intro - 1st rdg - to Health/Wel
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-seventh Legislature First Regular Session - 2003
IN THE HOUSE OF REPRESENTATIVES
HOUSE CONCURRENT RESOLUTION NO. 21
BY HEALTH AND WELFARE COMMITTEE
1 A CONCURRENT RESOLUTION
2 STATING FINDINGS OF THE LEGISLATURE CONCERNING THE USE OF UTILIZATION MANAGE-
3 MENT OF MEDICAID SERVICES PROVIDED TO PERSONS WITH DEVELOPMENTAL DISABILI-
4 TIES AND DIRECTING THE ADOPTION OF THE MOST COST-EFFECTIVE PROGRAM WITH
5 FEATURES SPECIFIED BY THE DEPARTMENT OF HEALTH AND WELFARE.
6 Be It Resolved by the Legislature of the State of Idaho:
7 WHEREAS, Utilization Management of Medicaid services provided to persons
8 with developmental disabilities is necessary on a uniformly applied statewide
9 basis to preserve precious resources while ensuring that appropriate services
10 are provided; and
11 WHEREAS, an effective Utilization Management plan for Idaho requires use
12 of objective standards to assess the services needed by each individual con-
13 sumer, including standardized assessment of service needs, prior authoriza-
14 tion, Healthy Connections and plan development, which are all vital to cost
15 containment and the success of the overall Utilization Management plan; and
16 WHEREAS, the Department of Health and Welfare has recently allowed clients
17 with mental illness to choose a qualified provider for assessments and plan
18 development with the Department's prior authorization; and
19 WHEREAS, the November 2000 report of the Lewin Group to the Idaho Legisla-
20 ture regarding Medicaid expenditures found that "...designing a comprehensive
21 Utilization Management plan that rectifies current weaknesses while continuing
22 to include regional staff seems the most reasonable approach."; and
23 WHEREAS, the 2002 Region 2 Pilot Project report of Julie Fodor, contractor
24 for the University of Idaho stated that "Typically Department Developmental
25 Disability Professional staff have a long history with the consumers in their
26 region and are readily experienced with the assessment process, problem-
27 solving, and accessing information. In our opinion it would take an indepen-
28 dent contractor at least two years of experience to be capable of delivering a
29 coordinated quality service."; and
30 WHEREAS, the Department of Health and Welfare data shows that by using the
31 state's then existing authority to require prior authorization of services,
32 per-consumer costs for developmentally disabled services had decreased signif-
33 icantly prior to implementation of the Region 2 Pilot Project; and
34 WHEREAS, the cost of implementing the Region 2 Pilot Project on a state-
35 wide basis would include, at a minimum of $1.5 million for an independent
36 assessment contractor, additional FTEs within the Department of Health and
37 Welfare, and $1.3 million for computer upgrades; and
38 WHEREAS, with the current fiscal condition of the state of Idaho, improve-
39 ments to Idaho's Utilization Management efforts must be established without
40 addition of FTEs or additional capital outlay; and
41 WHEREAS, the Department of Health and Welfare currently preauthorizes a
42 large percentage of services to the developmentally disabled.
43 NOW, THEREFORE, BE IT RESOLVED by the members of the First Regular Session
44 of the Fifty-seventh Idaho Legislature, the House of Representatives and the
2
1 Senate concurring therein, that the most appropriate and cost-effective Utili-
2 zation Management program for services for persons with developmental disabil-
3 ities will be implemented by the Department of Health and Welfare with the
4 following features:
5 1. The Department of Health and Welfare will provide consumers with a
6 list of those providers within their region that are qualified to complete
7 SIB-R or other similar standardized testing to determine the client's eligi-
8 bility for services.
9 2. Such eligible consumer can choose a provider qualified to develop a
10 service plan for the consumer using objective standards, including current
11 standardized assessments, history, vocational status, educational status,
12 financial status, family and community supports, residential situation and
13 availability of community services.
14 3. The Service Plan will be developed with the consumer and support team
15 and will be based on the results of the consumer's measurement of abilities
16 and needs according to the Objective Standards with a resulting plan that
17 prioritizes the needs and goals for the consumer. Regional Health and Welfare
18 Department staff will be invited to attend the planning meeting. A budget for
19 delivery of the services under the plan will be included.
20 4. The Service Plan will be submitted to a physician participating in
21 Healthy Connections who, subject to his professional opinion regarding the
22 appropriateness of the services recommended as compared to the needs of the
23 consumer, will write an order for such services.
24 5. The Service Plan, budget and physician's order will then be submitted
25 to Regional Health and Welfare Department staff for prior authorization.
26 6. Upon authorization by the Regional staff, the particulars of the Ser-
27 vice Plan, budget and physician's order will then be entered into the
28 Department's computer system.
29 7. Upon entry of the required information into the Department's computer
30 system, delivery of service will begin including the provider conducting base-
31 line assessments for ordered services, as appropriate.
32 8. Annually the plan will be reviewed by the provider in consultation
33 with the Healthy Connections physician to evaluate outcomes from the services
34 provided. The Service Plan, including any changes recommended by the
35 consumer's provider and ordered by the physician will be submitted for re-
36 authorization by the Regional Health and Welfare Department staff. Until a new
37 plan is approved, services will continue pursuant to the previous plan. The
38 Service Plan will also be subject to review upon the occasion of any substan-
39 tial change in condition or circumstances for the consumer.
40 9. The Department of Health and Welfare will work with providers, con-
41 sumers and families to define the objective standards which are appropriate
42 for an individual consumer to ensure that the right services are delivered to
43 the consumer in the right setting and at the right cost.
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-seventh Legislature First Regular Session - 2003
Moved by Kulczyk
Seconded by Sali
IN THE HOUSE OF REPRESENTATIVES
HOUSE AMENDMENT TO H.C.R. NO. 21
1 AMENDMENT TO THE RESOLUTION
2 On page 1 of the printed resolution, in line 42, delete "the developmen-
3 tally disabled." and insert: "individuals with developmental disabilities; and
4 WHEREAS, the Scales of Independent Behavior-Revised (SIB-R) may be a good
5 tool to determine eligibility, the Region 2 Pilot Project demonstrated there
6 is not a correlation between SIB-R scores and the cost of needed services for
7 Idahoans with developmental disabilities.";
8 On page 2, in line 9, following "provider" insert: "/person"; in line 12,
9 following "situation" insert: ", medical needs"; in line 17, delete "for" and
10 insert: "of"; in line 19, following "included." insert: "The budget will be
11 based on the "person-centered" service plan using objective standards, and not
12 primarily on the SIB-R score. Consumers will be protected from any coercion or
13 undue influence in the process."; in line 32, following "provider" insert: ",
14 consumer and support team"; and in line 41, following "families" insert: ",
15 and advocates to write applicable rules and".
Moved by Gagner
Seconded by Sali
IN THE HOUSE OF REPRESENTATIVES
HOUSE AMENDMENT TO H.C.R. NO. 21, As Amended
16 AMENDMENTS TO THE RESOLUTION
17 On page 1 of the engrossed resolution, delete lines 30 through 33 and
18 insert:
19 "WHEREAS, the use of the Private Provider effort has decreased costs in
20 the amount of $7,271,489 from 1994 to 2001; and";
21 in line 36, delete "contractor," and insert: "contractor and 44"; in line 37,
22 delete ", and $1.3 million for computer upgrades"; in line 39, delete "must be
23 established without" and delete line 40, and insert: "could be established
24 with only an additional 12 FTEs; and"; on page 2, following line 27, insert:
25 "4. The plan shall be developed in a manner such that services will be
26 provided by a provider other than the provider conducting the eligibility
27 assessment. In rural areas or regions of limited availability of providers, or
28 at the request of the consumer upon good grounds, the eligibility assessment
29 provider may render services as approved by the regional access units of the
30 Department of Health and Welfare.";
31 in line 28, delete "4" and insert: "5"; in line 32, delete "5" and insert:
32 "6"; in line 34, delete "6" and insert: "7"; in line 37, delete "7" and
33 insert: "8"; in line 40, delete "8" and insert: "9"; and in line 48, delete
34 "9" and insert: "10".
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-seventh Legislature First Regular Session - 2003
IN THE HOUSE OF REPRESENTATIVES
HOUSE CONCURRENT RESOLUTION NO. 21, As Amended
BY HEALTH AND WELFARE COMMITTEE
1 A CONCURRENT RESOLUTION
2 STATING FINDINGS OF THE LEGISLATURE CONCERNING THE USE OF UTILIZATION MANAGE-
3 MENT OF MEDICAID SERVICES PROVIDED TO PERSONS WITH DEVELOPMENTAL DISABILI-
4 TIES AND DIRECTING THE ADOPTION OF THE MOST COST-EFFECTIVE PROGRAM WITH
5 FEATURES SPECIFIED BY THE DEPARTMENT OF HEALTH AND WELFARE.
6 Be It Resolved by the Legislature of the State of Idaho:
7 WHEREAS, Utilization Management of Medicaid services provided to persons
8 with developmental disabilities is necessary on a uniformly applied statewide
9 basis to preserve precious resources while ensuring that appropriate services
10 are provided; and
11 WHEREAS, an effective Utilization Management plan for Idaho requires use
12 of objective standards to assess the services needed by each individual con-
13 sumer, including standardized assessment of service needs, prior authoriza-
14 tion, Healthy Connections and plan development, which are all vital to cost
15 containment and the success of the overall Utilization Management plan; and
16 WHEREAS, the Department of Health and Welfare has recently allowed clients
17 with mental illness to choose a qualified provider for assessments and plan
18 development with the Department's prior authorization; and
19 WHEREAS, the November 2000 report of the Lewin Group to the Idaho Legisla-
20 ture regarding Medicaid expenditures found that "...designing a comprehensive
21 Utilization Management plan that rectifies current weaknesses while continuing
22 to include regional staff seems the most reasonable approach."; and
23 WHEREAS, the 2002 Region 2 Pilot Project report of Julie Fodor, contractor
24 for the University of Idaho stated that "Typically Department Developmental
25 Disability Professional staff have a long history with the consumers in their
26 region and are readily experienced with the assessment process, problem-
27 solving, and accessing information. In our opinion it would take an indepen-
28 dent contractor at least two years of experience to be capable of delivering a
29 coordinated quality service."; and
30 WHEREAS, the Department of Health and Welfare data shows that by using the
31 state's then existing authority to require prior authorization of services,
32 per-consumer costs for developmentally disabled services had decreased signif-
33 icantly prior to implementation of the Region 2 Pilot Project; and
34 WHEREAS, the cost of implementing the Region 2 Pilot Project on a state-
35 wide basis would include, at a minimum of $1.5 million for an independent
36 assessment contractor, additional FTEs within the Department of Health and
37 Welfare, and $1.3 million for computer upgrades; and
38 WHEREAS, with the current fiscal condition of the state of Idaho, improve-
39 ments to Idaho's Utilization Management efforts must be established without
40 addition of FTEs or additional capital outlay; and
41 WHEREAS, the Department of Health and Welfare currently preauthorizes a
42 large percentage of services to individuals with developmental disabilities;
43 and
44 WHEREAS, the Scales of Independent Behavior-Revised (SIB-R) may be a good
2
1 tool to determine eligibility, the Region 2 Pilot Project demonstrated there
2 is not a correlation between SIB-R scores and the cost of needed services for
3 Idahoans with developmental disabilities.
4 NOW, THEREFORE, BE IT RESOLVED by the members of the First Regular Session
5 of the Fifty-seventh Idaho Legislature, the House of Representatives and the
6 Senate concurring therein, that the most appropriate and cost-effective Utili-
7 zation Management program for services for persons with developmental disabil-
8 ities will be implemented by the Department of Health and Welfare with the
9 following features:
10 1. The Department of Health and Welfare will provide consumers with a
11 list of those providers within their region that are qualified to complete
12 SIB-R or other similar standardized testing to determine the client's eligi-
13 bility for services.
14 2. Such eligible consumer can choose a provider/person qualified to
15 develop a service plan for the consumer using objective standards, including
16 current standardized assessments, history, vocational status, educational sta-
17 tus, financial status, family and community supports, residential situation,
18 medical needs and availability of community services.
19 3. The Service Plan will be developed with the consumer and support team
20 and will be based on the results of the consumer's measurement of abilities
21 and needs according to the Objective Standards with a resulting plan that
22 prioritizes the needs and goals of the consumer. Regional Health and Welfare
23 Department staff will be invited to attend the planning meeting. A budget for
24 delivery of the services under the plan will be included. The budget will be
25 based on the "person-centered" service plan using objective standards, and not
26 primarily on the SIB-R score. Consumers will be protected from any coercion or
27 undue influence in the process.
28 4. The Service Plan will be submitted to a physician participating in
29 Healthy Connections who, subject to his professional opinion regarding the
30 appropriateness of the services recommended as compared to the needs of the
31 consumer, will write an order for such services.
32 5. The Service Plan, budget and physician's order will then be submitted
33 to Regional Health and Welfare Department staff for prior authorization.
34 6. Upon authorization by the Regional staff, the particulars of the Ser-
35 vice Plan, budget and physician's order will then be entered into the
36 Department's computer system.
37 7. Upon entry of the required information into the Department's computer
38 system, delivery of service will begin including the provider conducting base-
39 line assessments for ordered services, as appropriate.
40 8. Annually the plan will be reviewed by the provider, consumer and sup-
41 port team in consultation with the Healthy Connections physician to evaluate
42 outcomes from the services provided. The Service Plan, including any changes
43 recommended by the consumer's provider and ordered by the physician will be
44 submitted for re-authorization by the Regional Health and Welfare Department
45 staff. Until a new plan is approved, services will continue pursuant to the
46 previous plan. The Service Plan will also be subject to review upon the occa-
47 sion of any substantial change in condition or circumstances for the consumer.
48 9. The Department of Health and Welfare will work with providers, con-
49 sumers and families, and advocates to write applicable rules and to define the
50 objective standards which are appropriate for an individual consumer to ensure
51 that the right services are delivered to the consumer in the right setting and
52 at the right cost.
3
IN THE HOUSE OF REPRESENTATIVES
HOUSE CONCURRENT RESOLUTION NO. 21, As Amended, As Amended
BY HEALTH AND WELFARE COMMITTEE
1 A CONCURRENT RESOLUTION
2 STATING FINDINGS OF THE LEGISLATURE CONCERNING THE USE OF UTILIZATION MANAGE-
3 MENT OF MEDICAID SERVICES PROVIDED TO PERSONS WITH DEVELOPMENTAL DISABILI-
4 TIES AND DIRECTING THE ADOPTION OF THE MOST COST-EFFECTIVE PROGRAM WITH
5 FEATURES SPECIFIED BY THE DEPARTMENT OF HEALTH AND WELFARE.
6 Be It Resolved by the Legislature of the State of Idaho:
7 WHEREAS, Utilization Management of Medicaid services provided to persons
8 with developmental disabilities is necessary on a uniformly applied statewide
9 basis to preserve precious resources while ensuring that appropriate services
10 are provided; and
11 WHEREAS, an effective Utilization Management plan for Idaho requires use
12 of objective standards to assess the services needed by each individual con-
13 sumer, including standardized assessment of service needs, prior authoriza-
14 tion, Healthy Connections and plan development, which are all vital to cost
15 containment and the success of the overall Utilization Management plan; and
16 WHEREAS, the Department of Health and Welfare has recently allowed clients
17 with mental illness to choose a qualified provider for assessments and plan
18 development with the Department's prior authorization; and
19 WHEREAS, the November 2000 report of the Lewin Group to the Idaho Legisla-
20 ture regarding Medicaid expenditures found that "...designing a comprehensive
21 Utilization Management plan that rectifies current weaknesses while continuing
22 to include regional staff seems the most reasonable approach."; and
23 WHEREAS, the 2002 Region 2 Pilot Project report of Julie Fodor, contractor
24 for the University of Idaho stated that "Typically Department Developmental
25 Disability Professional staff have a long history with the consumers in their
26 region and are readily experienced with the assessment process, problem-
27 solving, and accessing information. In our opinion it would take an indepen-
28 dent contractor at least two years of experience to be capable of delivering a
29 coordinated quality service."; and
30 WHEREAS, the use of the Private Provider effort has decreased costs in the
31 amount of $7,271,489 from 1994 to 2001; and
32 WHEREAS, the cost of implementing the Region 2 Pilot Project on a state-
33 wide basis would include, at a minimum of $1.5 million for an independent
34 assessment contractor and 44 additional FTEs within the Department of Health
35 and Welfare; and
36 WHEREAS, with the current fiscal condition of the state of Idaho, improve-
37 ments to Idaho's Utilization Management efforts could be established with only
38 an additional 12 FTEs; and
39 WHEREAS, the Department of Health and Welfare currently preauthorizes a
40 large percentage of services to individuals with developmental disabilities;
41 and
42 WHEREAS, the Scales of Independent Behavior-Revised (SIB-R) may be a good
43 tool to determine eligibility, the Region 2 Pilot Project demonstrated there
44 is not a correlation between SIB-R scores and the cost of needed services for
45 Idahoans with developmental disabilities.
46 NOW, THEREFORE, BE IT RESOLVED by the members of the First Regular Session
47 of the Fifty-seventh Idaho Legislature, the House of Representatives and the
4
1 Senate concurring therein, that the most appropriate and cost-effective Utili-
2 zation Management program for services for persons with developmental disabil-
3 ities will be implemented by the Department of Health and Welfare with the
4 following features:
5 1. The Department of Health and Welfare will provide consumers with a
6 list of those providers within their region that are qualified to complete
7 SIB-R or other similar standardized testing to determine the client's eligi-
8 bility for services.
9 2. Such eligible consumer can choose a provider/person qualified to
10 develop a service plan for the consumer using objective standards, including
11 current standardized assessments, history, vocational status, educational sta-
12 tus, financial status, family and community supports, residential situation,
13 medical needs and availability of community services.
14 3. The Service Plan will be developed with the consumer and support team
15 and will be based on the results of the consumer's measurement of abilities
16 and needs according to the Objective Standards with a resulting plan that
17 prioritizes the needs and goals of the consumer. Regional Health and Welfare
18 Department staff will be invited to attend the planning meeting. A budget for
19 delivery of the services under the plan will be included. The budget will be
20 based on the "person-centered" service plan using objective standards, and not
21 primarily on the SIB-R score. Consumers will be protected from any coercion or
22 undue influence in the process.
23 4. The plan shall be developed in a manner such that services will be
24 provided by a provider other than the provider conducting the eligibility
25 assessment. In rural areas or regions of limited availability of providers, or
26 at the request of the consumer upon good grounds, the eligibility assessment
27 provider may render services as approved by the regional access units of the
28 Department of Health and Welfare.
29 5. The Service Plan will be submitted to a physician participating in
30 Healthy Connections who, subject to his professional opinion regarding the
31 appropriateness of the services recommended as compared to the needs of the
32 consumer, will write an order for such services.
33 6. The Service Plan, budget and physician's order will then be submitted
34 to Regional Health and Welfare Department staff for prior authorization.
35 7. Upon authorization by the Regional staff, the particulars of the Ser-
36 vice Plan, budget and physician's order will then be entered into the
37 Department's computer system.
38 8. Upon entry of the required information into the Department's computer
39 system, delivery of service will begin including the provider conducting base-
40 line assessments for ordered services, as appropriate.
41 9. Annually the plan will be reviewed by the provider, consumer and sup-
42 port team in consultation with the Healthy Connections physician to evaluate
43 outcomes from the services provided. The Service Plan, including any changes
44 recommended by the consumer's provider and ordered by the physician will be
45 submitted for re-authorization by the Regional Health and Welfare Department
46 staff. Until a new plan is approved, services will continue pursuant to the
47 previous plan. The Service Plan will also be subject to review upon the occa-
48 sion of any substantial change in condition or circumstances for the consumer.
49 10. The Department of Health and Welfare will work with providers, con-
50 sumers and families, and advocates to write applicable rules and to define the
51 objective standards which are appropriate for an individual consumer to ensure
52 that the right services are delivered to the consumer in the right setting and
53 at the right cost.
REPRINT REPRINT REPRINT REPRINT REPRINT
STATEMENT OF PURPOSE
RS 12952
The purpose of the Concurrent Resolution is to further
establish a cost effective Utilization Management Program
for the Developmentally Disabled within the Department of
Health and Welfare. To require a system of checks and
balances to be utilized along with prior-authorization by
the Regional Health and Welfare Access Units. To establish
consistency of service, though a system of objective
standards, to be used throughout the state for plan
development. To ensure that the right services for the
Developmentally Disabled are delivered in the right setting
at the right cost.
FISCAL IMPACT
Savings to the State General Fund of $880,000.00
Savings from not funding the Independent Assessment Provider
Contract: General Funds: $750,000 Federal Funds: $750,000
Savings from delaying automation: General Funds: $130,000
Federal Funds: $1,170,000
CONTACT:
Name: Rep. Lee Gagner, Rep. William T. Sali
Phone: 332-1000
STATEMENT OF PURPOSE/FISCAL NOTE HCR 2