STATE OF WASHINGTON



348615022860000 348615022860000STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESAging and Long-Term Support AdministrationHome and Community Services DivisionPO Box 45600, Olympia, WA 98504-560093281514541500H19-052 – ProcedureSeptember 17, 2019TO: Area Agency on Aging (AAA) Directors FROM:Bea Rector, Director, Home and Community Services DivisionChanh Ly, Director, Management Services DivisionSUBJECT: SFY20 State/Federal Interlocal AgreementPurpose:To notify Area Agencies on Aging (AAA) of their final SFY20 allotments, supplemental reporting forms, final interlocal agreement language and budget and billing forms and instructions for State Fiscal Year 2020 (SFY20).Background:The 2019-2021 biennial budget was enacted in May of 2019. Final allotments for SFY20 have been determined based on that budget bill. AAA contracts are released prior to 6/30/2019 to ensure they are in effect when the fiscal year begins on July 1, 2019. AAAs are required to complete an annual line-item budget that details how these funds will be spent. What’s new, changed, orClarified: Rates, ratios and funding allocations are calculated based on the final state operating budget. Specific funding information is as follows:Case Management/Nursing Services (CM/NS) SFY20 funding increased due to forecasted caseload growth, which drives in new clinical positions at a higher FTE rate in the legislative budget metric. Additional funding was also allocated by the legislature to buy down caseload for serving individuals with significant mental health issues. Increases were mostly applied to CM/NS (and not to CSCM), which, after the funds were spread across an increased caseload, resulted in a 1.1% increase to each AAA’s Unit Rate for CM/NS. Wireless data funding was allotted to each AAA based on data bundles to serve 25 clinical CM staff with a shared 25 GBs of data for $325 per bundle plus 10% for taxes and surcharges. This was calculated as an add-on to the monthly CM/NS Unit Rate. AAAs select their own wireless provider and plan.SFY20 Clinical Staff ratios are unique to each AAA. They are based on each AAA’s negotiated SFY19 ratio, adjusted by the net impact of inflation and rate increase. The inflation factor is the Consumer Price Index (CPI) used for the state budget March revenue forecast, 2.7%. This was offset by a 1.1% increase in funding. Ratios were adjusted up by 1.6% for SFY20. The statewide average clinical ratio in SFY20 is 82.5 clients per each clinical FTE. Information on how the staffing ratios are defined and calculated is provided in the attached document entitled “AAA Case Management Program Ratio and FTE Clarifications.”Case handling FTE will still be captured on the billing worksheet to understand staffing patterns and trends. Expected ratio of Supervisors to case handling staff is 1:10.The formula used to determine the payment adjustment for clinical staff to client ratio that exceeds the AAA’s unique baseline will be calculated as follows: There will be no deduction the first three months the client ratio exceeds the baseline. On the fourth occurrence, a .3 factor will be used to reduce payment. After the fourth occurrence, the factor within the formula that determines the amount of deduction taken will increase from .3 to .6 and will remain at .6 for any month when the ratio is missed for the remainder of the contract period. AAAs who do not exceed the statewide average clinical ratio will not have their payments adjusted, even if their actual monthly clinical ratio exceeds their contractual clinical ratio. AAA’s may request an exception to the payment adjustment for clinical staff for extenuating circumstances, for example, when extended paid family medical leave is the reason for not meeting clinical ratio requirements. AAAs who have experienced operating expense increases that are out of their control and are greater than the cost inflation accounted for in the ratio adjustment metrics may request negotiation to establish a new Clinical Ratio. Any AAA may begin to use SCSA to draw down federal matching funds. The intent of this funding and the federal match is to buy down caseload ratio. AAAs may choose to buy down: a) their clinical caseload ratio; or b) their case handling ratio. There may be circumstances such as those experienced in (3.) above, where ALTSA may agree to not require caseload buy down. Any AAA may spend qualifying local funds in TXIX to bring down federal matching funds. Caseload Ratio buy down will only be required on the federal portion. Additional TXIX matching funding available to grandfathered AAAs will be increased by the inflation factor applied to the SFY19 grandfathered amount. If the amount of SCSA is increased, caseload ratio will need to be bought down by the amount of the additional SCSA/Match. Grandfathered AAAs may make up the inflated difference with local match if they wish and not be required to buy down caseload. Any additional local match used to draw down federal match above the new grandfathered level will need to buy down the caseload ratio with the federal portion.No Personal Care caseload: AAA’s will be paid a unit rate for valid cases that are not receiving personal care in a given month if that client has an open authorization for another service and is receiving active case management as the client attempts to locate a new provider. AAA’s will bill for a percentage of the no personal care caseload identified on the ALTSA caseload report. The percentage will be identified on the new billing form and may change statewide during the year based on periodic ALTSA studies of the no paid Personal Care caseload. Core Service Contract Management (CSCM) will be billed using the same in-home caseload numbers as Case Management/Nursing Services. CSCM funding overall has increased by $47,975 statewide, but due to the increase in projected caseload growth for most AAAs, the annual unit rate per client will be slightly decreased from SFY19 unit rates. DDA and HCS-Contracted Nursing Services will continue to be reimbursed on a cost reimbursement basis.Senior Citizen’s Services Act (SCSA) Funding levels remain the same as SFY19. The State Family Caregiver Support Program (SFCSP) funding level from the legislature remains the same as SFY19, however, the cost of TCARE licenses increased substantially. An initial additional $56,000 was held back by ALTSA to pay for the increased TCARE cost as well as Virtual Private Network (VPN) access, statewide training, and staffing costs. Another fund source was identified to make up the difference, so SFY19 levels will be resumed at the next contract amendment. Senior Farmers Market Nutrition Program (SFMNP) The state funding level remains the same as SFY19. Home Delivered Meals (HDM) Expansion. State funded Home Delivered Meals funding remains the same as SFY19 and 5% admin is held at HQ for staffing. AAAs must continue to build upon a maintenance of effort level of HDM funding and, in accordance with legislative intent, use the new pass through funding to serve new or underserved populations or areas. ALTSA will use the SFY17 Annual Expenditure Report as a baseline to compare future expenditures and determine whether maintenance of effort is met. The legislative goal of the yearly funding was to serve 3,000 additional participants. Kinship Caregiver Support Program funding was increased by legislature to $1,344,000. Initial allocations were based on SFY19 funding levels ($$1,094,000) while the Kinship funding formula was analyzed and revised. The KCSP funding is still allocated based on the 2008-2012 American Community Survey 5-Year Estimate of the number of grandparents raising grandchildren under the age of 18, but the data is now weighted. 33% of the weighting is applied to the total number of grandparents raising grandchildren (GRG), and 67% of the weighting is applied to the number of GRG living in poverty.The DSHS Allocated TXIX/Chore BARS Support Form and supporting documents must be submitted electronically in Excel format each month.AAAs are required to report their cumulative TXIX Medicaid fund balance for TXIX CM/NS and CSCM to ALTSA annually. The template is attached. Final budget allotments and budget instructions are attached. Line item budgets will be due on November 1, 2019. ACTION:Submit Line Item budgets and CSCM Worksheet to Anna Glaas and your AAA Specialist by November 1, 2019. Begin using the attached new SFY 2020 TXIX billing forms effective with July billings.Submit the TXIX Fund Balance Report to ALTSA 45 days from the AAA’s fiscal year-end close. The report template is attached.ATTACHMENT(S): 1. SFY20 Sample STCs\sSFY20 State/Fed Statement of Work \sSFY20 Case Mgmt Program Ratio and FTE Clarifications \sSFY20 Initial FundingSFY20 CM/NS and CSCM Revenue Budget Instructions\sSFY20 TXIX Billing FormSFY20 TXIX-Matched Billing FormTXIX Fund Balance ReportSFY20 StateFed Budget CSCM Worksheet\sCONTACT(S):Direct general questions or questions regarding caseload, unit rate methodology, or SOW to your AAA Specialist:Andrea Meewes Sanchez, AAA Unit Manager(360) 725-2554andrea.meewessanchez@dshs.Caroline Wood, AAA Specialist(360) 725-3466Caroline.wood@dshs.Lexie Bartunek, AAA Specialist(360) 725-3548bartuqa@dshs.Mark Towers, AAA Specialist(360) 725-2446mark.towers@dshs. Paula Renz, AAA Specialist(360) 725-2560paula.renz@dshs.Fiscal Questions:Valerie Bahl, AAA Federal Compliance Manager360-725-2390BahlVA@dshs. Anna Glaas, AAA Fiscal Manager(360) 725-2374Anna.Glaas@dshs.Contract Questions:April Hassett, Contracting Manager(360) 725-2387April.hassett@dshs. ................
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