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. 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.