Day Supports Payment Structure
Day Supports Payment Structure and Rate-Setting Methodologies
With PTE support, The Department of Human Services developed and field-tested a new model of payment for day supports, including employment supports and other customized day services.
The initiative also included creating a plan for implementing the new structure in Minnesota. The goal of this project was to enhance flexibility and individual choice, encourage provision of supports in integrated settings, and support the attitude that competitive employment is the first option for people with disabilities, unless they choose to opt out.
Navigant Consulting was the contractor that worked with DHS on this project. This portion of rate setting was completed as of December 2009.
The project goals for the Day Service and Supports Payment Structure initiative included:
- A new payment structure for day services that supports DSD initiatives related to enhancing flexibility and consumer choice
- Emphasize the provision of supports in integrated settings, resulting in employment and the opportunity for individuals to be viewed as valued community contributors
- Recognize different levels of scope, duration and intensity of supports needed by individuals while staying within the constraints of available resources
- Support providers to better serve individuals with cognitive, physical and chronic health disabilities from post-high school age through the retirement years
- Address the cultural diversity of individuals with a wide range of needs
- Address transportation barriers in metropolitan, urban and rural areas
- Address transition issues experienced by individuals
- Provide differentials based on demographics and other variables
- Achieve cost neutrality related to current expenditure levels
Project Approach
Navigant Consulting assisted DSD to achieve the goals for this project through accomplishment of the following tasks over the span of 19 months:
- Finalize communication and work plan.
- Develop an inventory of Minnesota’s day services.
- Determine an approach to and attain ongoing stakeholder input. Complete interviews with providers, county and state staff, key advisory workgroups and other stakeholders.
- Complete comparative review of payment structures used in other states, national trends and promising practices.
- Identify payment structure options for consideration by DSD and stakeholders that are feasible for implementation in Minnesota. Identify best payment structure from options presented and develop payment structure components including service definitions (may come from Common Service Menu), service units, rates and rate determination methodology.
- Identify a methodology for sampling counties using individual assessment data, individual service plans, community support plans and outcome information for individuals with a range of support needs, ages, location, and service choices.
- Field test new payment model using the identified methodology.
- Draft a report of findings, outcomes and recommendations that addresses: complexity of implementation; cost neutrality; impact on individual choice; portability; flexibility; community inclusion; employment; and impacts on state, county and federal budgets. Develop statewide implementation plan.
- Present findings, outcomes and recommendations to State-level groups as well as three statewide video conferences.
Next Steps in Rate Setting
The second phase of the initiative develops rate-setting methodologies for all waiver services including services during the day across programs and disability groups.
The rate methodologies will be used by counties in conjunction with the individual assessed needs to plan services and calculate the rates to be paid to providers. Employment related needs will be integrated into the assessment and the rate calculation.
For More Information
For more information, visit the Rate Setting Methodologies Initiative at DHS (www.dhs.state.mn.us/dhs16_144651)
To speak with someone about the Rate Setting Methodologies Initiative, contact Maria Bediako at 651-431-2451 or email maria.f.bediako@state.mn.us or Deb Schauffert at 651-431-2436 or email Deb.Schauffert@state.mn.us.