ACAP

A program of Keystone Human Services and the Pennsylvania Department of Public Welfare

Bureau of Autism Services

ANCOR Fall Leadership Summit

Robert J. Baker President/CEO, Keystone Autism Services

rbaker@keystonehumanservices.org

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ACAP is a fully integrated, comprehensive system of care for adults with Autism Spectrum Disorder (ASD). The program incorporates vocational, behavioral, social, health, recreational, transportation, therapeutic, educational, crisis, in-home support and independent living aspects of Participants’ lives.

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Three Unique Characteristics:

Pre-paid Capitation Payment Approach

Healthcare Services Fully Integrated into the Model

Outcome Measures Agreed Upon and Placed in the Contract

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PURPOSE: The purpose of the ACAP program is to help

adults with ASD to be valued and fully participating members of their society.

The program works to build competence, confidence and independence so people can, as much as possible, lead full and meaningful lives.

Over time, the program works to increase independent functioning and decrease the need for highly structured professional services.

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ACAP PRINCIPLES:

1. Every person living with an Autism Spectrum Disorder (ASD) can experience a meaningful and quality life.

2. Every person with ASD can grow and learn for the entirety of their life.

3. Services are comprehensive, highly individualized, flexible and continuously adapted to the persons needs and preferences.

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ACAP PRINCIPLES CON’T:4. Services are community based and make

maximum use of the capacity of the family, friends, neighbors and community at large.

5. Therapeutic strategies are evidence based and are carried out by a highly qualified clinical team.

6. The effectiveness of the program is continuously measured.

7. The program makes maximum use of innovation, creativity and technology to support successful functioning.

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ACAP ELIGIBILITY:

Be twenty-one (21) years old or older

Be eligible for Medical Assistance

Have a diagnosis of an Autism Spectrum Disorder (ASD)

Be able to live in a community setting (such as the person’s home or other family-members) safely without 16 hours or more per day of awake staffing and supervision

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ACAP SAMPLE SERVICES*:

Supported Employment

Physicians Services & Health Care

Dental Services

Behavioral Support Services

Service Planning & Supports Coordination

Respite

Recreation & Social

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ACAP SAMPLE SERVICES CON’T:

Crisis Intervention

Non-Medical Transportation

Family Counseling

Physical Therapy

Individual Counseling

In-home services

*We are not locked into service definitions; can provide any medically necessary service.

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Referrals or individual applications go to the Bureau of Autism Services (BAS)

BAS does preliminary eligibility determination

Referral to Keystone – We do comprehensive assessment and gathering of baseline data

Propose ISP to Individual. They decide whether to enroll.

ENROLLMENT PROCESS:

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PERSON-CENTERED PLANNING: Clinical assessments and the development of each

person’s Individual Service Plan (ISP) is provided by a highly qualified internal team.

ACAP services are dynamic, having the capacity to vary intensity and an individualized response dependent upon current and/or changing needs. Services can be deployed in “real time”.

Services are designed to include meaningful community inclusion and promote independence and self sufficiency.

The person’s dreams and choices are core considerations in ACAP person-centered planning.

The family is a central resource and partner in all planning and progress.

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ACAP meets the full range of defined needs when a person enrolls in the program.

Services are assessment and outcome driven. (SIB-R)

Authorizations are based upon medical necessity following a comprehensive clinical assessment and the development of individualized service plans.

Clinical assessments are conducted by a highly skilled team of Masters level clinicians working under supervision of a Licensed Psychologist.

ACAP is responsible for providing and/or arranging all services for Participants - doing so in a manner that assures effective service integration and continuity.

CLINICAL CAPACITY:

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Uses the federal Prepaid Inpatient Health Plan funding

model used currently by The Office of Long Term Living.

Funding consists of a single “per member per month”

payment for the full array of program services.

Rate determination is done yearly.

CAPITATION APPROACH:

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OUTCOME MEASURES: Improvement in behavioral stability of the Participants as measured by:

1. Fewer Episodes of:a. Law Enforcement involvement

b. Psychiatric Emergency Room care

c. Psychiatric Inpatient Hospitalization

d. Crisis Intervention Plan use

e. Mental Health crisis interventions

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OUTCOME MEASURES CON’T:

Improvement in behavioral stability of the Participants as measured by:

2. Increases in:a. Percentage of Participants with jobs or engaging

in volunteer work

b. Number of hours Participants work or are engaged in volunteer work

c. Participants’ independence and social skills

d. Parental satisfaction and quality of life indicators

e. Participant’s quality of life

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OUTCOME MEASURES CON’T: Improvement in behavioral stability of the Participants as measured by:

3. Improvement in access to medical services including:a. Initial visit with a PCP within three weeks of

enrollment

b. Annual dental exams

c. Improved diabetes management

d. Annual gynecological exams

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PRELIMINARY OUTCOME RESULTS:

Decrease in frequency of incidents

Increase in work and volunteer participation

Increase in SIB-R scores- Independence and Social

Skills

Increases in Participant’s Quality of Life Scores

Minor increases in Parental Satisfaction and

Quality of Life scores

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FINANCIAL RESULTS:

Grant provided start-up support

Month 9 of the program was the first profitable month

Every month since has been profitable

Program reached Life to Date Profitability in month 13

Start-up line of credit reached $747,578

Positive cash position is now over $1,000,000

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SAFEGUARDS:

Extensive and valid measurements of outcomes

Family advocates on governing board

Family advocates on Plan Advisory committee

Bureau of Autism Services clinical team reviews all ISPs

Comprehensive reporting of all incidents

Easy external appeal to BAS

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SAFEGUARDS CON’T:

Extensive quality system

Highly credentialed clinical team

Extensive family communication

Family advocate

Annual cost report and review of rate

Right to transfer to Adult Autism Waiver

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UNIQUENESS OF THE MODEL: One Agency Responsible-One Agency Accountable

Comprehensive services

Full Coordination and Integration of Services

Inclusion of Health Care Services

Person Centered

Dis-intermediated

Fully integrates risk and service delivery

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BROAD APPLICABILITY:

The ACAP model is fully approved by CMS and has broad applicability to autism, intellectual disabilities, behavioral health, aging, children and youth and criminal justice services

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FEE FOR SERVICE PARADIGM:

Fee for service (focus on human service widgets)

Compliance focus on unit of service, claims & process

Highly defined service codes (commodities)

Individual need must accommodate authorized services

Utilization driven incentives

Highly structured service models

Exclusion of natural capacity of community and family

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FEE FOR SERVICE PARADIGM CON’T:

Exclusion of technology and innovation

Complex systems, regulation and licensing demands

Very expensive infrastructure

Rigid structures and processes

External case management and authorizations

Minimal integration across service models and need

Authorized service may have no relevance to need

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EMERGENT HUMAN SERVICE PARADIGM: Focus on the person, not human service widgets

Capitated funding – aligning risk and authority to manage service resources

Comprehensive services and supports

Flexible and responsive

Highly Individualized

Compliance focus on outcomes not claims

No service codes

Highly credentialed clinical staff & effective clinical models

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EMERGENT HUMAN SERVICE PARADIGM CON’T:

Focus on growth and capacity building vs. utilization

Dynamic deployment of resources as people’s needs change

Extensive range of service models

Extensive use of natural capacity of community and family

Extensive use of technology and continuous innovation

Moderate infrastructure cost

Highly integrated across service systems and needs

Cost reporting and limit on profits

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PUBLIC POLICY BENEFITS (ACAP): The Department of Public Welfare knows its exact

financial liability at the beginning of the fiscal year.

The Provider is responsible for all changes in need during

the year.

The model makes effective use of public resources.

The ACAP model provides relevant, valid and reliable

outcome data on performance.

The ACAP model has the potential for extensive costs

savings.

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PUBLIC POLICY BENEFITS CON’T: The model caps (retention) profits at a level

appropriate to public policy interests.

The model supports innovation and use of technology.

The model incurs no intermediary (middleman) administrative costs and intermediary profits.

The model has high accountability and transparency.

The model is applicable to a wide range of services to include intellectual disabilities, behavioral health, aging and criminal justice.