OASIS budget allocation process

from The Arc:

The Arc of Indiana, a statewide advocacy organization founded in 1956, is a resource for people with intellectual and other developmental disabilities and their families. We hope the following information on OASIS, a new process for allocating funding for people receiving services from a Developmental Disabilities (DD) or Autism Medicaid waiver, is helpful to you. We’re here to help with any questions you may have.

Important information about new Medicaid wavier budget allocations

People who receive Medicaid waiver services through the Developmental Disabilities and Autism Medicaid waivers who have waiver renewal dates this spring, and those who are coming off of waiting lists and are new to these waivers, are receiving new budget allocations under the new OASIS (Objective Assessment System for Individual Supports) process.

The goal of this process is to make the financial resources given to people on the Waiver equitable by basing the budget allocation on each individual’s needs, rather than the history of what he or she used or received in the past.

The new budget allocation is based on an individual assessment, called the ICAP, and a series of interview questions asked of three people who should know the individual well. Families and guardians were supposed to be part of that process. This assessment and the answers to the interview questions are very important as they are the basis of the new budget allocation waiver recipients receive.

Thus far, over 50% of people receiving new allocations had a budget increase, approximately 20% stayed about the same, and over 30% decreased.

Time frame for changes to Medicaid Waiver Plans for Services based on amount of budget allocation change It is projected that the state will spend $25 million more for people on the DD and Autism waivers

due to allocation increases. The transition to the new allocation process under OASIS must generate savings from allocations that decrease before funds are available for budgets that increase. Thus, those who have budget allocations that decrease will be the first to have changes made in their Medicaid waiver plan for services.

Budget allocations that decrease will have the following time to adjust:

􀂃 Budgets that decrease less than $20,000 or less - 3 months

􀂃 Budgets that decrease $20,000 - $60,000 - 6 months

􀂃 Budgets that decrease $60,000 or more - 12 months

Budget allocations that increase will have the following time to adjust:

􀂃 Budgets that increase less than $20,000 – 6 months

􀂃 Budgets that increase $20,000 - $60,000 – 9 months

􀂃 Budgets that increase over $60,000 - 15 months

If you have any questions regarding why your allocation increased or decreased there are important steps you can take:

1. Ask your IPMG case manager to provide:

a. The Allocation Level assigned to you or your loved one. This will be a number between 1-5. 1 represents a person with very minimal needs. 5 represents a person with very high needs.

b. The results of the Assessment, also called the ICAP.

c. Answers to the questions asked of the three people who should know the person well and the names of the three people who answered these questions.

(You can find your case managers name, email and phone number on the allocation document.)

Your first step in understanding this allocation is to have access to this information and to check it for accuracy. The answers to these questions were used in a computer model to determine the budget allocation. This makes this very important information. Your case manager should be able to quickly access this information.

2. If you disagree with the answers that were given, and/or if you believe there is important information that was not provided, your case manager should immediately request an OASIS Review. This is important. You should not be denied this opportunity. An OASIS Review can be equested by a parent, guardian, consumer, or a member of your team.

Requesting a review is not the same as an appeal or a request for mediation. It is intended to be an informal review to provide a quick opportunity to correct information about your loved one that is not accurate, or to provide new information that was not previously considered.

You can also provide information about why a decreased allocation is not possible to keep you or your loved one healthy and safe. You will need to provide specific information on health, safety, behavioral and supervision needs, and any other information that you believe is important to consider.

It is very important to correct any inaccurate information that was included in the assessment. 3. In addition to requesting an OASIS Review you have the right to appeal if you believe a budget allocation decrease will result in a reduction in services that is unhealthy or unsafe. An official letter of appeal should be sent no later than 30 days after receiving notice of your new budget allocation. The letter should state that you are appealing the new Medicaid waiver budget that will result in a reduction of services and create an unhealthy/unsafe environment. The letter should be signed and mailed to:

MS04 Family and Social Services Administration Hearings and Appeals 402 W. Washington St., Room W392 Indianapolis, IN 46204

     

Developing Your Plan for Services based on new allocation 

When you receive your new Medicaid wavier budget allocation you can begin to develop your new plan for services using a budget planning tool that will be available on the Internet. This will help you plan what programs, services, and supports you want to “buy” with the new allocation amount. Your IPMG case manager should help you with this process. This new step is designed to give you greater input into what programs, services, and supports you want for yourself or your loved one.

You may be one of the nearly 60% of people whose allocations increased. Does this mean you have to spend this money right away or risk losing it? No. A major change with OASIS is that the budget is not based on a “use it or lose it” process. If your budget allocation increases, but you are satisfied with the services you currently receive, you do not need to make changes in your services. However, if your budget allocation increases, and you do want to make changes in your services, the increased allocation means you can make changes and receive additional programs, services and supports.

Issue of roommates

Many people who live alone, particularly those with high budgets, will be asked to find a roommate.

It is important that assistance is provided in finding the right roommate and, if necessary, finding new housing if needed to ensure a private bedroom for every person. Moving too quickly to force roommates will not lead to good results and indeed could increase costs. The state and provider organizations recognize this and are working with The Arc and IPMG to develop new approaches to facilitate this process. While this is a change many may not like, it is important to note that in order for new people to be served within a limited state budget, many people who currently do not have roommates will need to make this change.

Importance of working together

This is going to be a stressful process. Speaking only for The Arc of Indiana, we do not know if the allocation process is correct for every person. We suspect that there will be a good percentage of folks who will need to have their allocation increased by utilizing the OASIS Review process. We also suspect that a good percentage of people will receive allocation increases that are higher than what is actually needed. This is perhaps to be expected in a process that touched nearly 7,000 lives.

The Arc of Indiana hopes that everyone - the state, case managers, providers, families, consumers and advocates - works together to find real solutions to make this process work. These are exceptionally challenging times. It will take an effort on everyone’s part to make sure we keep people safe, progressing on their goals and remembering people first throughout.

If at any time you feel you are not getting the right answers or that this new process is not working

for you or your loved one, please call The Arc of Indiana at 800-382-9100, or email:

John Dickerson, Executive Director: jdickerson@arcind.org