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. 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.
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.
