DBHDS engaged BerryDunn to review the discharge assistance program (DAP) for the purpose of developing a tiered rate structure to better support individuals utilizing DAP funds in congregate care settings; to increase program management efficiency; and to free funds for assistance with timely discharge of individuals from state hospitals into community environments. At the conclusion of the engagement, BerryDunn is to present a fiscal impact report with recommendations for more efficient utilization of funds.

The following focus areas were identified by DBHDS:

Rate Setting Model Review. To identify recommendations for the DAP rate-setting model, DBHDS and BerryDunn reviewed current DAP policy documents, regional rate models, provider agreements, and budgetary restrictions. Additional information was gathered from stakeholder group meetings, interviews with key program staff and DAP utilization reports for SFY 2021 – 2023. DBHDS and BerryDunn developed a set of recommendations for a tiered rate structure that is based on expectations for individualized patient care, with differentials to account for type of facility, provider’s licensure, regional cost of care, periodic cost-of-living adjustments, as well as calculations for 1:1 services, and a rate component based on quality of care, consistent with the nation-wide effort to promote value-based purchasing and cost-containment.

Assessment Tool Review. Based on a review of the existing processes and assessment tools used in determining level of care and provider reimbursement rate for individuals leaving state hospitals, recommendations are included for use of specific assessment tools to help promote consistency and objectivity of assessments.

Training and Staffing Review. Current staffing levels and trainings required by state licensing rules to evaluate organizational capacity were researched and used to develop recommendations for various levels of care in the rate.

Subsections 2.1 – 2.3 of the report summarize the recommendations identified in each of the review areas. The potential economic impact of the recommended changes is described in subsection 2.4, consistent with the scope of work requested for this engagement. Sections 3.0 – 6.0 address the methodology and approach used to complete the review and develop findings. The appendices contain additional information supporting this work.