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History of Proposed Level of Care
System
Intervention by CMS
Debundling of LOC
GAHSC
March 2008
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1998-Level of Care System proposed. Level of Care Taskforce, chaired by
Abe Wilkinson, develops a Level of Care System. The Taskforce was made up
of GAHSC, DHR, and DJJ personnel.
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1999-Peg Peter, State DFCS Director shepherded the work of the Level of
Care Taskforce and further refines levels.
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2000-Changes in State DHR Leadership delays Level of Care efforts.
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July 1,
2001 – Combination of rates delayed and changes from original cost
reporting and rate setting methodologies, revitalized interest in Level of
Care.
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September 23rd – met with Jim Martin to clarify Department policy, update
of prior efforts, and set tentative objective for future discussions
regarding Level of Care.
October 2001 – Public Policy Committee began work on formulation of
response to per diems
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November 2001 – GAHSC decides to negotiate with Department for systemic
changes to reimbursement system
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November to February 2002 – fourteen meetings with providers and DHR staff
to formulate levels of care system and formulate fair and equitable per
diems. Ada Cornwell provides leadership in development of Levels of Care
Indicator Manual. GAHSC has four meetings with the Department Leadership
to negotiate a fair system.
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February 5, 2002 – GAHSC approves Levels of Care methodology and per diems
for each level.
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April
18, 2002 – Met with DHR budget office, State DFCS Office, Governor’s
Office of Planning and Budget, and MATCH to discuss this year’s per diems
and levels of care. From this meeting a plan of action was developed for
presentation to membership. Also discussed was this year per diem
adjustments. GAHSC was charged to develop a per diem adjustment to rectify
the inequities of FY02. "Bridge Funding" was provided to 15 of 19 agencies
that requested additional funding.
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Summer,
2002 - GAHSC and DHR continue work on Level of Care descriptions. An
indicator manual was developed with general consensus of providers. DHR
Treatment Services Unit representatives reviewed random samplings of files
of children in residential placements in order to assign levels and to
take an initial snapshot of the placement and service needs of children in
care.
Fall/Winter, 2002 – 2003
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November, 2002 – a new Governor is elected, changing the political
environment and raising questions regarding the future direction of the
child welfare system in Georgia. A few updates and modifications were made
to the Indicator Manual based on provider and TSU feedback, but no major
changes made.
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Fulton
County becomes a pilot site for the Level of Care system in conjunction
with the closing of the Delaney House and opening of the Fulton County
Family Resource Center. GAHSC, private providers, and county and State
leadership held meetings to develop an MOU for this pilot project.
Agencies participating would receive a per diem based on the Level of Care
of the child placed.
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February, 2003- deadline for private providers to sign
MOU with Fulton and
Dekalb counties as part of pilot of the Level of Care system of placement.
Regular meetings between GAHSC, private providers and Fulton County
continue to be held. Representatives from Dekalb County and the Fulton
Family Resource Center also participate.
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January
2003 - The Governor supports LOC through his budget recommendation for
FY04 budget. Funding levels are still undetermined until a State
Budget is passed. Treatment Services/Revenue Maximization staff visit
providers and review files on children not reviewed last summer in order
to determine appropriate Levels of Care. A target date for statewide
implementation of the Level of Care system of placement is discussed for
November 2003.
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May 2003 - Implementation Workgroup
for a Statewide rollout in November is began. Representatives from
providers and DHR and DJJ work out the many details for implementation.
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May 17, 2004 - DHR names a new
Commissioner, B.J.Walker from Illinois.
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May 2005 - Concerns about the LOC
financing strategy takes center stage. The State Cost reports do
not reflect the necessary treatment services to draw down expect Federal
revenue. Providers struggle under a methodology that is threatens
to cut services to children and close many agencies. Providers
advocate for a "allowable cost" methodology.
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September 2005 - USHHS through CMS
notifies DFCS their
1st Letter to DHR
that they are at risk because of how Level of Care is funded through
Medicaid.
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August 16, 2005 - Mary Dean Harvey
assumes head of State DFCS.
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October 2005 -
DFCS modifies Level of Care
rates
to reflect increases to the higher levels of care.
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January 2006 - DFCS sends a
letter to county directors to cut placements to Level of Care
providers
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March 2006 - DFCS develops a plan of
correction to CMS. DFCS
informs providers of these changes. DFCS recommends the "Debundling
of Level of Care" and the move to "Room and Board and Watchful
Oversight" with therapeutic services being done through "Home and
Community Based Services". DFCS would be about child
protection and placement and Mental Health would be about treatment
services paid for by Medicaid.
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August 2006 - B.J. Walker,
Commissioner of DHR announces that Debundling will take place and CMS is
giving the Department till June30, 2007 to complete this process in a
memo to providers.
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October 2006 - The number of
children in LOC dramatically decreases as does spending as indicated in
a
chart presented to the legislature.
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May 2007 - Over
45 agencies close as a result of freeze in funding, decreased number
of foster children and increased capacity.
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July 2007 - Room, Board and Watchful
Oversight takes effect
with new
rates reflective of that no services will have mental health or
behavioral health services included in "bundled" rate.
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August 2007 - DFCS Director, Mary
Dean Harvey, requires all agencies to take children within their level
of care
in a memo.
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