016-06-12 Ark. Code R. § 10

Current through Register Vol. 49, No. 6, June, 2024

Rule 016.06.12-010 - Living Choices Assisted Living 1915(c) HCBS Waiver Slot Increase

Summary for Living Choices Assisted Living (LCAL) 1915(c) HCBS Waiver Slot Increase

The Living Choices Assisted Living (LCAL) 1915(c) Home and Community Based Services waiver is administered by the Department of Human Services, Division of Medical Services. A.C.A. § 20-10-1704 requires the Living Choices Assisted Living waiver to serve a minimum of one thousand (1,000) persons. To comply with A.C.A § 20-10-1704, the number of unduplicated participants served in the Living Choices Assisted Living waiver will be increased from eight hundred (800) to one thousand (1,000) effective June 15, 2012.

Appendix J: Cost Neutrality Demonstration

J-1: Composite Overview and Demonstration of Cost-Neutrality Formula

Composite Overview. Complete the fields in Cols. 3, 5 and 6 in the following table for each waiver year. The fields in Cols. 4, 7 and 8 are auto-calculated based on entries in Cols 3, 5, and 6. The fields in Col. 2 are auto-calculated using the Factor D data from the J-2d Estimate of Factor D tables. Col. 2 fields will be populated ONLY when the Estimate of Factor D tables in J-2d have been completed.

Leve l(s) of Care: Nursing Facility

Col. 1	Col. 2	Col. 3	Col. 4	Col. 5	Col. 6	Col. 7	Col. 8
Year	Factor D	Factor D'	Total: D+D'	Factor G	Factor G'	Total: G+G'	Difference (Col 7 less Column4)
1	16115.99	1775,41	17891.40	.i4399,0S	3113,82	37512.90	19621.50
2	16571.21	1847,49	18418.70	35795,6X	3240,24	39035.92	20617.22
3	17068.65	1922,50	18991.15	.17248,99	3371,79	40620.78	21629.63
4	17580.00	2()(K),55	19580.55	.18761..30	3508.69	42269.99	22689.44
5	18107.92	2081.77	20189.69	40.335.00	3651.14	43986.14	23796.45

J-2: Derivation of Estimates (1 of 9)

a.Number Of Unduplicated Participants Served. Enter the total number of unduplicated participants from Item B-3-a who will be served each year that the waiver is in operation. When the waiver serves individuals under more than one level of care, specify the number of unduplicated participants for each level of care:

Table: J-2-a: Unduplicated Participants

Wai v e r Ye ar	Total Number Unduplicated Number of Participants (from Item B-3-a)	Distribution of Unduplicated Participants by Level of Care (if applicable)
		Level of Care:
		Nursing Facility
Ye a r 1	800	800
Ye a r 2	1000	1000
Ye a r 3	1000	looo
Ye a r 4	1000	1000
Ye a r 5	1000	1000

b.Average Length of Stay. Describe the basis of the estimate of the average length of stay on the waiver by participants in item J-2-a.

The average length of stay on the waiver is estimated to be 240 days. This average was calculated as days of eligibility from the MMIS segments, using the! Medicaid DSS (BusinessObjects). These numbers were determined by reporting the total days of waiver service (based on service eiigibility days within |

c.Derivation of Estimates for Each Factor. Provide a narrative description for the derivation of the estimates of the following factors.

i. Factor D Derivation. The estimates of Factor D for each waiver year are located in Item J-2-d. The basis for these estimates is as follows:

Factor D is derived from current reporting of expenditures from the Medicaid DSS (BusinessObjects) and consideration of previous waiver estimates of utilization and growth rates.

ii. Factor D' Derivation. The estimates of Factor D' for each waiver year are included in Item J-1. The basis of these estimates is as follows:

Factor D' was computed based on what was done in prior years. Using the market basket forecasts and the related DDS report of all waiver eligible recipients annual expenditures were extracted from the decision support system (DSS) component of the MMIS. Note; Costs indicated for State iii. Factor G Derivation. The estimates of Factor G for each waiver year are included in Item J-1. The basis of these estimates is as follows:

Factor G is computed based on the average annual expenditures for nursing home recipients that were extracted from the decision support system (DSS) component of the MMIS. Using the average annual expenditures for nursing home recipients and the market basket forecasts for the next 5 iv. Factor G' Derivation. The estimates of Factor G' for each waiver year are included in Item J-1. The basis of these estimates is as follows:

Factor G' was derived using the same methodology as in prior years It was computed based on the average annual expenditures for nursing home recipients that were extracted from the decision support system (DSS) component of the MMIS. Using the average annual expenditures for nursing

Compo ne nt manage me nt f or waive r s e rv ic e s . If the service(s) below includes two or more discrete services that are reimbursed separately, or is a bundled service, each component of the service must be listed. Select "manage components" to add these components.

Waiver Services

Extended Medicaid State Plan Prescription Drugs

Living Choices Assisted Living Services

Pharmacist Consultant Services

d.Estimate of Factor D.

i.Non- Co ncurre nt Wa iv e r. Complete the following table for each waiver year. Enter data into the Unit, # Users, Avg. Units Per User, and Avg. Cost/Unit fields for all the Waiver Service/Component items. Select Save and Calculate to automatically calculate and populate the Component Costs and Total Costs fields. All fields in this table must be completed in order to populate the Factor D fields in the J-1 Composite Overview table.

Wa iv e r Ye a r: Ye a r 1

Waiver Service/ Component	Unit	# Users	Avg. Units Per User	Avg. Cost/ Unit	Component Cost	Total Cost
Exte nde d Me dicaid State Plan Pre scription Drugs Total:	257697.00
Extended Medicaid State Plan Prescription Drugs	1 Month 1	100	9.00	286.33	257697.00
Living Choices Assisted Living Services To t al:	12527918.30
Tie r Le ve l 1	1 Day	2661	230.00	62.98	3853116.40
Tie r Le ve l 2	|l Day	241	230.00	1 67.06'	3717135.80
Tie r Le ve l 3	I Day	216'	230.00	72.76	3614716.80
Tie r Le ve l 4	|lDay	77	230.00	75.83	1342949.30
Pharmacist Consultant Services Total:	107180.00
Pharmacist Consultant Services	|lDay 1	100	230,00	4,66	107180.00
GRAND TOTAL:						12892795.30
Total Estimated Unduplicated Participants:						800
Factor D (Divide total by number of participants):						16115.99
Average Length of Stay on the Waiver:						240

d.Estimate of Factor D.

i.Non- Co ncurre nt Wa iv e r. Complete the following table for each waiver year. Enter data into the Unit, # Users, Avg. Units Per User, and Avg. Cost/Unit fields for all the Waiver Service/Component items. Select Save and Calculate to automatically calculate and populate the Component Costs and Total Costs fields. All fields in this table must be completed in order to populate the Factor D fields in the J-1 Composite Overview table.

Wa iv e r Ye a r: Ye a r 2

Waiver Service/ Component	Unit	# Users	Avg. Units Per User	Avg. Cost/ Unit	Component Cost	Total Cost
Exte nde d Me dicaid State Plan Pre scription Drugs Total:	331785.00
Extended Medicaid State Plan Prescription Drugs	1 Month	' 125	9.00	294.92	331785.00
Living Choices Assisted Living Services To t al:	16129023.70
Tie r Le ve l 1	1 Day 1	333	230.00	64.87	4968393.30
Tie r Le ve l 2	IDay	301	230.00	69 .OS	4782408.40
Tie r Le ve l 3	IDay	270	230.00	74.94	4653774.00
Tie r Le ve l 4	I Day	96	230.00	78.10	1724448.00
GRAND TOTAL:						16571208.70
Total Estimated Unduplicated Participants:						1000
Factor D (Divide total by number of participants):						16571.21
Average Length of Stay on the Waiver:						240

Waiver Service/ Component	Unit	# Users	Avg. Units Per User	Avg. Cost/ Unit	Component Cost	Total Cost
Pharmacist Consultant Services Total:	110400.00
Pharmacist Consultant Services	1 n.iy 1	1001	230.00	[ 4. SO	110400.00
GRAND TOTAL:						16571208.70
Total Estimated Unduplicated Participants:						1000
Factor D (Divide total by number of participants):						16571.21
Average Length of Stay on the Waiver:

d.Estimate of Factor D.

i.Non- Co ncurre nt Wa iv e r. Complete the following table for each waiver year. Enter data into the Unit, # Users, Avg. Units Per User, and Avg. Cost/Unit fields for all the Waiver Service/Component items. Select Save and Calculate to automatically calculate and populate the Component Costs and Total Costs fields. All fields in this table must be completed in order to populate the Factor D fields in the J-1 Composite Overview table.

Wa iv e r Ye a r: Ye a r 3

Waiver Service/ Component	Unit	# Users	Avg. Units Per User	Avg. Cost/ Unit	Component Cost	Total Cost
Exte nde d Me dicaid State Plan Pre scription Drugs Total:	341741.25
Extended Medicaid State Plan Prescription Drugs	1 kfonth	125	9.00	303.77	341741.25
Living Choices Assisted Living Services To t al:	16613293.30
Tie r Le ve l 1	IDay	333	230.00	66.82	5117743.80
Tie r Le ve l 2	1 Day	301	230.00	71.15	4925714.50
Tie r Le ve l 3	1 Day	270	230.00'	77.19	4793499.00
Tie r Le ve l 4	1 Day 1	96	230.001	80.45	1776336.00
Pharmacist Consultant Services Total:	113620.00
Pharmacist Consultant Services	; ixn	100	230.00	4.94	113620.00
GRAND TOTAL:						17068654.55
Total Estimated Unduplicated Participants:						1000
Factor D (Divide total by number of participants):						17068.65
Average Length of Stay on the Waiver:						240

d.Estimate of Factor D.

i.Non- Co ncurre nt Wa iv e r. Complete the following table for each waiver year. Enter data into the Unit, # Users, Avg. Units Per User, and Avg. Cost/Unit fields for all the Waiver

Service/Component items. Select Save and Calculate to automatically calculate and populate the Component Costs and Total Costs fields. All fields in this table must be completed in order to populate the Factor D fields in the J-1 Composite Overview table.

Wa iv e r Ye a r: Ye a r 4

Waiver Service/ Component	Unit	# Users	Avg. Units Per User	Avg. Cost/ Unit	Component Cost	Total Cost
Exte nde d Me dicaid State Plan Pre scription Drugs Total:	351990.00
Extended Medicaid State Plan Prescription Drugs	1 Month _]	125	9.001	312.881	351990.00
Living Choices Assisted Living Services To t al:	17111218.00
Tie r Le ve l 1	1 D.iy 1	3331	230.00	68.82	5270923.80
Tie r Le ve l 2	IDay	301	1 230.00,	73.28'	5073174.40
Tie r Le ve l 3	IDay	270	230.00	79.51	4937571.00
Tie r Le ve l 4	IDsy	96'	230.00	82.86	1829548.80
Pharmacist Consultant Services Total:	117070.00
Pharmacist Consultant Services	1 n.iy	100	230.00	5.09	117070.00
GRAND TOTAL:						17580278.00
Total Estimated Unduplicated Participants:						1000
Factor D (Divide total by number of participants):						17580.00
Average Length of Stay on the Waiver:						240

d.Estimate of Factor D.

i.Non- Co ncurre nt Wa iv e r. Complete the following table for each waiver year. Enter data into the Unit, # Users, Avg. Units Per User, and Avg. Cost/Unit fields for all the Waiver Service/Component items. Select Save and Calculate to automatically calculate and populate the Component Costs and Total Costs fields. All fields in this table must be completed in order to populate the Factor D fields in the J-1 Composite Overview table.

Wa iv e r Ye a r: Ye a r 5

Waiver Service/ Component	Unit	# Users	Avg. Units Per User	Avg. Cost/ Unit	Component Cost	Total Cost
Exte nde d Me dicaid State Plan Pre scription Drugs Total:	362553.75
Extended Medicaid State Plan Prescription Drugs	' 1 Month	1 125	9.00	[ 322.27]	362553.75
Living Choices Assisted Living Services To t al:	17624842.50
Tie r Le ve l 1	|lDay	333,	230.00'	70.89	5429465.10
GRAND TOTAL:						18107916.25
Total Estimated Unduplicated Participants:						1000
Factor D (Divide total by number of participants):						18107.92
Average Length of Stay on the Waiver:						240|

Waiver Service/ Component	Unit	# Users	Avg. Units Per User	Avg. Cost/ Unit	Component Cost	Total Cost
Tie r Le ve l 2	IDay 1	301	230.00	1 75.481	5225480.40
Tie r Le ve l 3	' 1 Day	270	230.00	81.89	5085369.00
Tie r Le ve l 4	I Day 1	96	230.00	85.35	1884528.00
Pharmacist Consultant Services Total:	120520.00
Pharmacist Consultant Services	1 Day	100	230.00	5.24	120520.00
GRAND TOTAL:						18107916.25
Total Estimated Unduplicated Participants:						1000
Factor D (Divide total by number of participants):						18107.92
Average Length of Stay on the Waiver:

016.06.12 Ark. Code R. § 010

8/22/2012