Athens County Stakeholder Meeting

2015

Mission

“To support County Boards of Developmental Disabilities (CBDD) in providing services and supports to

people with developmental disabilities.”

OACB’s Mission

Vision

"To enhance the lives of people with developmental disabilities."

OACB’s Vision

History is important! Where we have been helps us understand where we are going…

National and state regulations that support a new way of doing our work

CMS basic requirements of Home and Community Based Services rule

Person Centered Planning- what is it and what is different from traditional approach?

Preble county SSAs share examples of what they have developed and what they are learning

Agenda

How did we get here?

Director Martin:•Improved efficiency & effectiveness•Define our future before others define it for us

Olmstead Decision:•Community Integration

Employment First:•Community Employment•Future of adult day services

Sub Minimum Wage:•Future of sheltered workshops

Other:•Public schools now serve people with DD•Self determination

Private Providers

County Boards

Persons Served

Families of

Persons Served

Ohio Developmental Disabilities System

Drivers of System Change 2015

Ohio Department of Developmental

Disabilities

Free Choice of Provider:•Privatization

Economic Challenges:•Increased enrollment•Stagnant or declining revenue

In 1999, 2 women with DD and psychiatric issues.

In state institution; multiple admissions.

Professionals agreed, needs of both could be met in community setting.

Waited years for community treatment.

Olmstead Facts

Unjustified isolation is properly regarded as discrimination based on disability.

Olmstead Facts

1. People lived at home;

2. We built institutions;

3. We started closing them;

4. Supported living and

HCBS Waivers started;

5. Self-determination

happened;

6. We got into trouble with

HCFA/CMS;

7. Became obsessed with compliance with rules

8. Person centered planning pilots started

9. We drafted great new Rules that emphasize PCP;

10. Employment First happened

11. CMS rule came out 3/14

State of Ohio Evolution of DD Services: CMS/ Olmstead/DRO/Good Life

42 CFR 441.301

Written plan (ISP) reflects:

Setting is chosen by the individual and is integrated in, and supports full access to the greater community;

Opportunities to seek employment and work in competitive integrated settings;

Opportunity to engage in community life, control personal resources, and receive services in the community to the same degree of access as individuals not receiving HCBS.

CMS and Day Services: 3/17/2014- Issue Date of New HCBS Rule

Intended to ensure individuals receiving HCBS services under a Medicaid Waiver “have full access to the benefits of community living and the opportunity to receive services in the most integrated setting appropriate setting.”

Applies to both residential and day services.

States have 5 years to transition and comply with rule.

More About the Settings Part of the CMS Rule

Facility-based day service settings and sheltered work centers will probably be considered "settings that isolate;”

Need to show how the settings are integrated in and support full access to the community.

Volunteering Interning Taking a class Learning about careers and

interests Promotes interaction with

community Not a disability-specific

program

The What’s and What Not’s of the CMS Rule

What does integration look like?

The same planned activities in the home community within all of life’s activity domains:• Work• Volunteer- work on a political campaign, volunteering at soup

kitchen; kennel volunteer• Learning experiences and activities; books on tape; adult

classes; self-help classes• Recreation –having fun/a social life – getting together with

friends, going out; peers get together; movies; gambling; shows; • Shopping     Robin E. Cooper, NASDDDS 3/14

What does integration look like?

The same planned activities in the home community within all of life’s activity domains:

• Maintain health and wellness – walking; gym membership; diet groups

• Personal care – hairstyling, having nails done, • Maintaining home; maintenance and improvement; cleaning;

laundry• Caring for others; relatives or others• Spirituality: worship; meditation; yoga classes; meeting groups;

sodalities• Hobbies: Pet care – walking the dog        

Robin E. Cooper, NASDDDS 3/14

County Boards of Developmental Disabilities have a rich history in developing and operating many legacy programs, and will continue to evolve and transform our system based on what individuals and families expect and demand.

In accordance with the Workforce Innovation and Opportunity Act of 2014, County Boards of Developmental Disabilities will work proactively with our partners to develop employment opportunities for youth transitioning from school to work.

Full Range of Employment

Opportunities

When individuals leave a sheltered experience to try a job in the community, we want to be a safety net for folks that may need to return to board services.

County Boards of DD support Ohio’s initiatives in the area of Employment First and are willing to work toward achieving measurable goals. In order to accomplish this, boards will need a well-designed system of both private and public providers so that people served are able to choose from a wide variety of employment options.

Full Range of Employment

Opportunities

Conflict Free Case

Management

Conflict Free Case Management

42CFR441.301(c)(1)(v) and (vi)

• Includes strategies for solving conflict or disagreement within the process, including clear conflict-of-interest guidelines for all planning participants

• Providers of HCBS for the individual, or those who have an interest in or are employed by a provider of HCBS for the individual must not provide case management or develop the person-centered service plan, except when the State demonstrates that the only willing and qualified entity to provide case management and/or develop person- centered service plans in a geographic area also provides HCBS.

County boards helped to develop the current “firewalls”

document many years ago and are eager to remain partners in the process to define the future of this document.

State law and administrative rules currently ensure that the county board of DD system can operate without conflict and should be enhanced to further ensure conflict free case management.

Policies and procedures must be put in place to ensure people and families understand what safeguards are in place once changes are made.

Conflict Free Case Management

Free Choice of Provider

Service and Support Administrators need the necessary tools to ensure that individuals and families have useful information to make informed choices between HCBS providers.

The words in the CMS regulation are "Willing and Qualified Provider" to provide services, not "Willing and Able." Unfortunately, anyone that is certified as a provider of a specific service is presumed to be "able" to serve an HCBS waiver recipient. We believe that clarification is needed to distinguish these important concepts.

Free Choice of Provider

To provide additional safeguards in the provider selection process, County Boards of DD support additional state oversight to investigate complaints or allegations that may potentially violate HCBS Free Choice of Provider.

Free Choice of Provider

County boards should have the authority and

responsibility to recruit providers in a sufficient number to meet the needs of people served on HCBS waivers.

Revisions to the County Board of Developmental Disabilities administration rule and the Free Choice of Provider rule will enhance this important function.

Quality Services

County Boards of Developmental Disabilities are in the best position to serve individuals with complex needs when other private HCBS providers are not qualified or unwilling or unable.

More authority is needed at the local level to address issues with providers where there may be risks to health and welfare. County Boards of Developmental Disabilities that do not provide services directly must have additional authority in the Provider Compliance and Enforcement area.

Quality Services

Person Centered Planning

Thought Process Person-centered planning is

mandated; Monitoring is

individualized; The whole team has

responsibility; Informal supports are

primary; The person drives the

planning process and the supports.

Required Shift

Move from linear to expansive;

Find your innovative spirit;

Allies, not isolation; Trust; Embrace creativity The path less traveled.

SSA Rule Highlights

The Intention of Person-Centered

Planning

•Improve the social status of people with disabilities

•Enhance the perception held of people with disabilities

•Expand the network of allies and associations in people’s lives

History of Change in Our System

We Have Been Continuously Improving

Discrimination

Less Discrimination

While providing integrated services to all of the people served by County Boards of DD will be an enormous challenge, with adequate funding, Ohio can make great strides toward achieving the goal of system transformation.

By incorporating the philosophy of person-centered planning throughout Ohio’s DD system, County Boards of DD will be able to define quality for a person receiving services.

System Transformation

Change is a door that can

only be opened from the inside!

Questions & Answers

Thank you for your

time and attention today!