Section 115.130 Rate Components

Section 115.130  Rate Components

The components of Department reimbursement for CILA services

for persons with developmental disabilities may include, but shall not be

limited to, the following, using costs as reported on the Consolidated

Financial Report, or its successor, and other sources as deemed appropriate by

the Department:

a)         Base

support costs may include allowances for "room and board",

"program", "transportation", and

"administration". Base support costs are considered to be those that

are incurred in the delivery of CILA supports to individuals with developmental

disabilities for the purchase of services that are common to all individuals

receiving CILA services.

1)         Room

and board cost centers

The "room and board"

allowance includes costs incurred in keeping a home in normal operation. Cost

centers under the room and board major allowance category may include:

A)        Housing;

B)        Utilities;

C)        Telecommunications;

D)        Building

and Property Insurance;

E)        Maintenance

and Housekeeping;

F)         Food

Supplies;

G)        Nonfood

Supplies; and

H)        Other,

not elsewhere classified.

2)         Program

cost centers

The program allowance includes

costs incurred in providing habilitation services and supports to the extent

allowed by the CILA rate model.  Cost centers under the program major category

may include:

A)        Direct

care staff and supervision;

B)        Fringe

benefits;

C)        Other

supplies;

D)        Miscellaneous

consultant services;

E)        Program

support cost; and

F)         Occupancy

factor.

3)         Transportation

Transportation cost may be incurred

while CILA providers assist and/or train the persons living in the CILA home in

the activities of daily living.

4)         Administration

All administrative costs

associated with CILA agency overhead expenses as they relate to the delivery of

CILA services are included within the "administration" cost center

reimbursement

factor.

3)         Transportation

Transportation cost may be incurred

while CILA providers assist and/or train the persons living in the CILA home in

the activities of daily living.

4)         Administration

All administrative costs

associated with CILA agency overhead expenses as they relate to the delivery of

CILA services are included within the "administration" cost center

reimbursement. CILA agency overhead is assumed to include all the costs

associated with administrative staff, administrative clerical staff, office

space costs, office operating expenses, insurance, management consultants,

accounting, the cost of hiring staff, staff physical examinations, staff travel

and training, conferences, conventions, association fees, and all other costs

incurred in the overhead associated with the delivery of CILA services.

b)         Non-base

support costs are expenses incurred due to the special added services required

by specific persons living in CILAs to the extent allowed by the CILA rate

model.  Non-base supports can include other individually required supports such

as additional staffing, nursing, special dietary needs, and therapies.

Non-base support awarded as billable supports or additions to the rate

generated by the CILA rate model must be indicated as necessary by the CILA

agency and ISC agency, are not common to all individuals residing in CILAs, and

may be required more intensely soon after an individual moves into a CILA, with

decreasing need for them over time.  Department staff review all requests for

individual non-base supports and must approve any reimbursements added to an

individual's CILA rate or awarded as billable supports.  The need for non-base

support hours must be periodically (at least annually) reviewed by professional

assessment; the individual’s assessment results shall be reported to the

Department for its review and decision making regarding a continued need for

non-base support hours

n-base supports and must approve any reimbursements added to an

individual's CILA rate or awarded as billable supports.  The need for non-base

support hours must be periodically (at least annually) reviewed by professional

assessment; the individual’s assessment results shall be reported to the

Department for its review and decision making regarding a continued need for

non-base support hours.

c)         An

individual CILA rate does not include costs associated with providing day

programs to individuals living in CILAs.  All day program authorizations the

individual is approved for must be billed as a separate service or support.

d)         Third

party payment information concerning an individual's unearned income is

obtained from the Reporting of Community Services (ROCS) System and used to

calculate the third-party payment.  The third-party payment may be subtracted

from the top line rate to produce the bottom-line rate, or the rate paid by the

Department to the community CILA agency.

e)         DDD

may develop, implement, and modify different CILA rate methodologies for different

types of CILA services and supports.