COBI 2015 - Intermediate Care Facilities for Intellectually Disabled

Overview
Issues
Background
Financials

Sources Uses

FY 2016 Appropriation

A special group of nursing facilities is Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/ID). These facilities specialize in the care of people with disabilities. The individuals served by ICFs/ID are in need of more continuous supervision and structure, but are not significantly different from those served in other systems serving people with disabilities. ICFs/ID are long-term care programs certified to receive Medicaid reimbursement for habilitative and rehabilitative services and must provide for the active treatment needs. Nursing services are available for those requiring nursing and medical services.

Funding History

Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $82,670,500 from all sources for Intermediate Care Facilities for Intellectually Disabled. This is a 1.7 percent increase from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $9,266,800 from the General/Education Funds, a reduction of 1.5 percent from revised Fiscal Year 2015 estimates.

Appropriation Adjustments

The following appropriation adjustments were made during the 2015 General Session:

DescriptionOngoingOne-Time Intermediate Care Facilities - Intellectually Disabled Direct Staff Salary$673,900$0

OngoingOne-TimeFinancing Source

$200,000$0General Fund

$473,900$0Federal Funds

"Provider care for the intellectually disabled population. The salaries range from $8.50-$9.35 per hour."

Portability - Transfer IN - DOH to DHS ($340,400)$0

OngoingOne-TimeFinancing Source

($340,400)$0General Fund

Transfer ongoing General Fund of $1,466,000 for portability and transition programs beginning in FY 2015 from the Department of Health's Medicaid Optional Services to the Department of Human Services' Division of Services for People with Disabilities. The clients associated with the funding have already transferred from Health to Human Services. This adjustment facilitates the funding following the person. Both the Department of Health and the Department of Human Services agree with this transfer.

There are specific federal regulations requiring active treatment programs and other treatment options. Current State law limits the size of new ICF/ID facilities to 16 beds or less. There are currently 15 privately-owned facilities with populations ranging from 12 to 82 and one State ICF/ID facility (the Utah State Developmental Center) licensed for 260. Only five of the facilities have 16-or-fewer beds. ICFs/ID are an optional service in the Medicaid Program but are part of the basis for the federal government allowing a Home and Community Based Waiver.

Reimbursement rates for Intermediate Care Facilities for Individuals with Intellectual Disabilities as well as how those rates are calculated are online at http://health.utah.gov/medicaid/stplan/longtermcare.htm.

Intent Language

SB0002: Item 75

The Legislature intends that with the funding appropriated for the building block titled, "Intermediate Care Facilities - Intellectually Disabled," the Department of Health shall: 1) Direct funds to increase the salaries of direct care workers; 2) Increase only those rates which include a direct care service component, including respite; 3) Monitor providers to ensure that all funds appropriated are applied to direct care worker wages and that none of the funding goes to administrative functions or provider profits; In conjunction with Intermediate Care Facilities - Intellectually Disabled providers, report to the Office of the Legislature Fiscal Analyst no later than September 1, 2015 regarding: 1) the implementation and status of increasing salaries for direct care workers, 2) a detailed explanation with supporting documentation of how Intermediate Care Facilities - Intellectually Disabled providers are reimbursed, including all accounting codes used and the previous and current rates for each accounting code, and 3) a conceptual explanation of how Intermediate Care Facilities - Intellectually Disabled providers realize profit within the closed market of providing Intermediate Care Facilities - Intellectually Disabled services.

SB0002: Item 75

The Legislature intends that, if funds are available, Medicaid fee-for-service payments for anesthesia services be increased from the current amount of $18.27 to $23.73 for Fiscal Year 2016.

SB0002: Item 75

The Legislature intends that 5% of all funds provided in the Medicaid program for managed care dental plans be used for contracted plan administration and that any funds provided for the Affordable are Act premium tax not be included in that 5% administrative funds amount.

SB0003: Item 123

Under Section 63J-1-603 of the Utah Code the Legislature intends that up to $3,216,000 of the appropriations provided for the Medicaid Optional Services line item not lapse at the close of Fiscal Year 2016. The use of any nonlapsing funds is limited to a pilot program for assistance for children with disabilities and complex medical conditions to be used in similar amounts over three years with the goal of serving a similar number of clients over three years.

SB0007S01: Item 6

The Legislature intends that the Department of Health report on the following performance measures for the Medicaid Optional Services line item: (1) annual state general funds saved through preferred drug list (Target = $8.5 million general fund or more), (2) count of new choices waiver clients coming out of nursing homes into community based care (Target = 390 or more), and (3) emergency dental program savings (Target = $250,000 General Fund savings or more) by January 1, 2016 to the Social Services Appropriations Subcommittee.

SB0007S01: Item 18

The monthly caseload is the number of clients served in Intermediate Care Facilities for Intellectually Disabled.

Display By:

Funding Source

Expenditure Category

Appropriation Type:

Appropriation History by

Sources of Finance	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
General Fund	8,514,200	12,154,400	9,460,100	12,612,000	9,460,100	(52,900)	9,407,200	(140,400)	9,266,800
General Fund, One-time	(811,900)	(85,200)	0	(4,500,000)	0	0	0	0	0
Federal Funds	59,584,500	51,024,500	55,150,800	59,747,600	58,785,700	(2,909,600)	55,876,100	1,226,800	57,102,900
American Recovery and Reinvestment Act	2,854,500	0	0	0	0	0	0	0	0
GFR - Nursing Care Facilities Account	1,589,000	1,654,300	1,654,300	1,654,300	2,065,300	0	2,065,300	0	2,065,300
Transfers - Human Services	0	0	0	(1,175,100)	(460,000)	(715,100)	(1,175,100)	0	(1,175,100)
Transfers - Medicaid - DHS	10,982,600	12,929,900	13,858,400	18,175,000	15,146,100	(50,400)	15,095,700	314,900	15,410,600
Lapsing Balance	0	0	0	(3,700)	0	0	0	0	0
Total	$82,712,900	$77,677,900	$80,123,600	$86,510,100	$84,997,200	($3,728,000)	$81,269,200	$1,401,300	$82,670,500

Categories of Expenditure	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
Other Charges/Pass Thru	82,712,900	77,677,900	80,123,600	86,510,100	84,997,200	(3,728,000)	81,269,200	1,401,300	82,670,500
Total	$82,712,900	$77,677,900	$80,123,600	$86,510,100	$84,997,200	($3,728,000)	$81,269,200	$1,401,300	$82,670,500

Show Table | Show Additional Information

Other Indicators	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
Monthly Caseload	1,001	1,002	990	941	0	0	0	0	0

COBI contains unaudited data as presented to the Legislature by state agencies at the time of publication. For audited financial data see the State of Utah's Comprehensive Annual Financial Reports.