|
|---|
|
|
||||
|---|---|---|---|---|
|
|
|
|||
| ACF Home | Services | Working with ACF | Policy/Planning | About ACF | ACF News | HHS Home | ||||
Questions?
|
Privacy
|
Site Index
|
Contact Us
|
Download Reader™
|
Print
|
|---|
| Demonstration Type: | Performance-Based Payments/ Managed Care |
| Approved: | March 31, 2006 |
| Expected Implementation Date : | (Date Pending) |
| Expected Completion Date: | Last day of the 20thquarter after implementation |
| Interim Evaluation Report Expected: | (Date Pending) |
| Final Evaluation Report Expected: | (Date Pending) |
Iowa originally planned to implement its Safe at Home demonstration no later than July 1, 2007. However, the State has indefinitely postponed implementation of the project due to significant changes that are underway in its Medicaid payment system. These changes, scheduled to go into effect by November 2007, will affect the capped case rate the State originally planned to pay to contracted service providers under its Safe at Home demonstration. Iowa will renegotiate the waiver’s projected start date with the Children’s Bureau once it has devised an appropriate case rate for contractors that will provide services under the demonstration.
Iowa’s performance-based payment demonstration, known as the Safe at Home Program, will target title IV-E-eligible and non-IV-E-eligible children ages 11-16 who have been adjudicated as a “Child in Need of Assistance” (CINA) and who (1) are currently in a congregate care setting without a planned discharge within 60 days of entering placement, or (2) display clinical evidence of behavioral health needs that require or indicate the likelihood of congregate care placement.
Iowa will implement the Safe at Home Program in two phases. The first phase (Phase I) will be implemented over a 12-month period in one geographic region defined by the State prior to
implementation. The State may then implement a second demonstration phase (Phase II) that will expand services into additional geographic regions in the State.
Iowa plans to implement several managed care strategies through the Safe at Home Program. Major components will include the following:
Contracted Case Management Services: Intensive case management services will be provided by a contracted social service agency selected by the State prior to implementation of the demonstration. A case manager employed by the contracted provider will serve as a central and continuous point of contact for each child enrolled in the Safe at Home demonstration and will be responsible for coordinating care and services for the child. In addition, the case manager will be responsible for engaging families through Family Team Meetings (FTMs) or other means to assess family strengths and needs and to create Individualized Service Plans (ISPs) for enrolled children.
Capped Case Rate: The contracted service provider will receive a capped rate for each child enrolled in the Safe at Home demonstration. The case rate will be used by the contracted service provider to directly provide or sub-contract for services for each participating child and his/her family. Iowa will make available approximately 100 capped case rate “slots” in each geographic region that participates in the demonstration.
Performance-Based Payments: As part of the overall case rate, the contracted social service agency will receive incentive payments for achieving specific performance-based goals. These payments will be tied to the achievement of certain child welfare outcomes, such as increased exits to permanency, achievement of permanency within 14 months of entering foster care, and maintaining family stability as indicated by no placement re-entries for six months.
Expanded and Individualized Services and Supports: Funds available through the capped case rate will be used by the contractor to provide an expanded array of in-home and out-of-home services and supports to participating children and families. Examples of services and supports include individual counseling; individual, family, or group therapy; supervised peer group outings; enhanced educational supports; crisis support; respite care; and recreational activities (e.g., sports camps, martial arts classes).
Iowa’s evaluation will include process and outcome components, as well as a cost analysis. The evaluation will incorporate an experimental research design with random assignment to experimental and control groups. The State will randomly assign eligible children to the experimental group (eligible to receive Safe at Home services through a capped case rate slot) or to a control group (ineligible for a capped slot). Cases assigned to the control group will receive typical case management and other services provided by the Iowa Department of Human Services (IDHS).
Sample Size
Using a 1:1 sampling ratio, the State anticipates assigning 350 children to the experimental group and 350 children to the control group in the first region in which the demonstration is implemented, for an initial sample of 750 children. If the demonstration is expanded to other geographic regions, the State estimates that an additional 500 children will be assigned to the experimental group and an additional 500 children to the control group, for a total sample of approximately 1,700 children.
Process Evaluation
The State’s evaluation will include interim and final process analyses that describe how demonstration activities and services were implemented for experimental group cases and how these differed from services received by control group cases. In addition, the process evaluation will assess stakeholder satisfaction with the managed care system and with services and supports provided under the demonstration. Key stakeholders include enrolled children and their families, court staff, IDHS staff, and staff from contracted service providers.
Outcome Evaluation
Iowa’s outcome evaluation will compare the experimental and control groups for significant differences in child safety, permanency, and placement stability. Major outcome measures of interest include the following:
Cost Study
Iowa’s cost study will examine the costs of key elements of services received by children in the experimental group and compare these costs with those of the usual services received by children in the control group. The cost analysis will examine the use of key funding sources, including Federal sources such as titles IV-A, IV-B, IV-E and XIX of the Social Security Act, as well as State and local funding. In addition, the State is conducting a cost-effectiveness analysis where feasible to identify costs per successful outcome for the experimental and control groups. This analysis may be conducted using one or more key outcome measures in which statistically significant differences between the experimental and control groups are identified.
Initial evaluation findings are pending implementation of Iowa’s demonstration.
Back to Table of Contents
