SD10 - Implementation of Priority Populations


    Executive Summary:
    The primary intent of priority populations is to ensure that the services system focuses its use of limited public funds on serving individuals with the greatest needs for public services. Another purpose is to identify individuals whose costs of services would be paid partially or completely with state-controlled funds. Over the past several years, a general consensus has emerged that individuals with the most serious disabilities, measured in terms of diagnosis, level of functioning, availability of natural supports, and presence of multiple disabilities, should have a priority for receiving services paid with state-controlled funds. With the involvement of CSBs, consumer and advocacy groups, private providers and others, the Department has developed and is field-testing priority population definitions and brief, simple screening instruments. These definitions and instruments will enable CSBs and state facilities to identify, monitor, track and report on people in priority populations in a consistent, verifiable manner across the state.

    The report distinguishes between short-term intensive intervention services that should be available to anyone in the general public who needs them and longer term services that would be needed by individuals in priority populations. Short-term intensive (crisis) intervention services would be available, within the constraints of available funds, to anyone, whether or not he or she is a member of a priority population. The Department proposes to establish a full array of community-based short-term intensive intervention services which would be provided usually for no more than 30 days for each episode of care, unless otherwise authorized. Longer-term services would be available, within the constraints of available funds, to anyone who is a member of a priority population and who needs the services. Individuals would have to meet priority population eligibility criteria to receive these longer-term services.

    The allocation of state-controlled funds by the Department would not change as a result of priority populations. The proportions of state-controlled funds spent on priority populations would be tracked and if necessary over time, performance measures would be negotiated with the CSBs to increase the proportions of state-controlled funds expended on priority populations.

    The report emphasizes that care would continue to be provided as priority populations are implemented. The same process would be used to determine how individualized services plans (ISP) would be funded regardless of whether a person belonged to a priority population. Once the ISP has been developed and costed, potential payment sources would be identified to fund the ISP.

    Contracting and reporting formats for short-term intensive and longer-term services would permit the CSB, the Department, and the Administrative Services Only Organization (ASO) retained by the Department to conduct or review eligibility determination, enrollment, utilization management and review, provider profiling, and potentially, claims payment activities.

    The report reviews the process used by the Department to develop and test the priority population classification instruments. These instruments are being field tested by selected CSBs to evaluate their usefulness for determining membership in priority populations. The field tests are scheduled to be completed by December 1, 1999.

    The Department anticipates that statewide implementation of priority populations will begin July 1, 2000. Beginning in July, all new admissions to CSBs will be screened using the classification forms. From July 1 through September 30, 2000, all current consumers who were admitted to the CSBs prior to July 1 will be screened. This will usually occur as individual consumers come for their quarterly treatment plan review. By October 1, 2000, the priority population classification process will be fully implemented. It is important to note that individuals who are screened out of priority populations, if any, would be permitted to complete their courses of treatment throughout FY 2001, based on their individualized services plans.