Reimburse Enhancement by Changing Payment Methodologies

About the Program

Category: Financial Management (Best in Category)

Year: 2009

The Montgomery County Board of Mental Retardation and Developmental Disabilities (MRDD) is the primary service provider for over 2,600 eligible children and adults with moderate, severe, and profound mental retardation or other developmental disabilities. These lifelong wrap-around services are provided from birth throughout the life span of an individual. The County Board also provides legally mandated services and supports to families. As a part of the Board’s mission, adult day habilitation is provided to 93 individuals who live in a state operated developmental center located in the county and to over 1,000 other adults with disabilities. Adult day habilitation consists of providing an array of work, leisure, and recreational opportunities that focuses upon encouraging and promoting independence for people with disabilities. A disparity exists in how State and Federal funding is reimbursed for people living in the state-operated developmental center who receive day habilitation provided by the County Board of MRDD, which results in less state and federal reimbursement for people who require the most structure, support, and staffing. People who live in developmental centers do so as a last resort when it has been determined the person’s health and safety cannot be assured in other residential settings and are considered the most difficult to serve, but their amount of reimbursement was not commensurate. The problem with the State Medicaid funding model was that it reimbursed in a dissimilar fashion from another State-Federal Medicaid program and produced significantly less reimbursement. Montgomery County Board of MRDD recommended to the State of Ohio to change the reimbursement methodology from a per month, per person strategy to the same acuity-based daily rate that is used for people with disabilities who have an Individual Options Waiver. Essentially, these two types of waivers are how people with disabilities pay for the care they receive and includes their participation in work and other day habilitation activities. State of Ohio officials, along with the Centers for Medicare and Medicaid, agreed to this change and a new agreement went into effect in 2008 that saved the county $430,000 per year.