ARTICLE
Audio (MP3) Listen in New Window Presentation (PDF) Open in new window Transition Plan • Transition Plan for CIHW and FSW are posted for Public Comment through December 1, 2014 • Outline and Overview of Indiana’s Activities to Date and Planned Activities • DDRS Focus is on Assessment of the System • Assessment Activities Outlined in the Transition Plan Will be Taking Place Until April of 2017 Assessment Activities • National Core Indicators Data Review – Completed • Based on the NCI data, Indiana consistently demonstrated 85% and below in most HCBS requirement areas. • In other words, the NCI Data showed significant Non Compliance with HCBS Rules • Review of Indiana’s Policies, Rules, Regulations, Requirements and Procedures – Completed • Preliminary Setting Assessment Based on HCBS Requirements – Completed • Examined the HCBS requirements and Indiana’s initial level of compliance • The outcome of the review indicated that while the state does have policies and procedures that support the HCBS rules, a more in-depth analysis will need to be completed in order to determine full compliance. Planned Assessment Activities Individual Experience Surveys Focus on the Experiences of the Individuals Receiving Services and Supports • Anticipated Date of Completion is April of 2016 • DDRS has contracted with Indiana University Institute on Disability and Community (IIDC) • Survey Development • Utilization of the Day and Employment Services Outcomes System (DESOS) • Data Collection and Analysis • Reporting of Results • Survey Has Been Developed by DDRS,IIDC, and other FSSA program staff • Initial Validation will be completed by the end of 2014 • Utilization of Modified DESOS System to Administer • Goal is for each individual served to complete the survey or for the person who knows them best to complete the questions. • Twenty Plus Questions • Demographic Data • Gender, Age, Waiver, Race, County • Individual Specific Data • Disability, Mobility, Communication, Behavior, Needs • Individual Experience • Where do you live • What kind of Privacy do you have • Who visits and how often • Who do you live with • What Natural Supports do you have • How often do you go into the community to do certain activities • What is your day like • Initial Question Validation • DDRS Needs Help from Providers • Who Should Help Individuals Complete the Survey • What is the Best Way for DDRS to work with providers and individuals • What has been the Experience of Providers Who Participate in the DESOS surveys • What are we missing • Site Specific Assessments • Anticipated Date of Completion is September of 2016 • Utilized to Further Validate Survey Results • Based on HCBS Rules Indiana will identify any setting that has the effect of isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS. • BDDS and Case Managers will Collaborate • Comprehensive Settings Results • Anticipated Date of Completion is April of 2017 • Indiana will develop a comprehensive settings results document, which identifies Indiana’s level of compliance with HCBS standards Public Comment Public Input from Everyone in the System is Critical Comment Early – Comment Often Opportunities: • Link on DDRS Website • Provider Meetings • Family Calls/Webinar • DDRS Advisory Council • INARF Quarterly Meeting • Public Comment Period • Summary of comments and modifications from public input will be provided to CMS and posted on the DDRS Website Waiver Renewals and Amendments • Family Supports Waiver • Five-Year Renewal is Posted for Public Comment through December 7, 2014 • Due to CMS on December 31, 2014 • Community Integration and Habilitation Waiver • Five Year Renewal was Approved by CMS – went into effect on October 1, 2014 • Amendment Posted for Public Comment and is open for comment through December 17, 2014 • Due to CMS on December 31, 2014 Major Changes in Waivers • Participant-Centered Planning and Service Delivery – reflects current practice and expectations as well as clarification of roles • Risk Assessment and Mitigation - clarified that the Individualized Support Team determines the party or parties responsible for development of risk plan(s) • Extended Services is being proposed as a service that will provide ongoing employment supports which will enable an individual to maintain integrated competitive employment in a community setting. (Both Waivers) • Residential Habilitation Services - Daily (RHS Daily) is being proposed as a new residential service with a daily rate. (CIHW Only) Extended Services • Replaces SEFA as a BDDS Provided Service. Supported Employment Follow Along Services will be Provided by Vocational Rehabilitation – which is consistent with RSA. • Includes many work- and community-based training and support options • Allowable activities will allow individuals to receive training on the skills they will need to maintain their job and thrive in the community. Reimbursable Activities • Ensuring that natural supports at the work site are secured through interaction with supervisors and staff. A tangible outcome of this activity would be a decrease in the number of hours of extended services an individual accessed over time. • Training for the participant, or the participant’s employer, supervisor or coworkers, to increase the participant’s inclusion at the worksite. • Regular observation or supervision of the participant to reinforce and stabilize the job placement. • Job-specific or job-related safety training. • Job-specific or job-related self-advocacy skills training. • Reinforcement of work-related personal care and social skills. • Training on use of public transportation and/or acquisition of appropriate transportation. • Facilitating, but not funding, driver’s education training. • Coaching and training on job-related tasks such as computer skills or other job-specific tasks. Service Standards • Extended Services are provided in integrated community settings where persons without disabilities are also employed. • Extended Services do not include sheltered work or other similar types of vocational services furnished in specialized facilities or volunteer endeavors. • The Extended Services supports should be designed to support employment outcomes that lead to further independence and are consistent with the individual’s goals. Activities Not Allowed • Any non-community based setting where the majority (51% or more) of the individuals have an Intellectual or Developmental Disability. • Sheltered work observation or participation. • Volunteer endeavors. • Any service that is otherwise available under the Rehabilitation Act of 1973 or Public Law 94-142. • Public relations. • Incentive payments made to an employer to subsidize the employer’s participation in Extended Services. • Payment for vocational training that is not directly related to the individual’s Extended Service needs outlined in the ISP. • Extended Services do not include payment for supervisory activities rendered as a normal part of the business setting. • Extended Services provided to a minor by a parent(s), step-parent(s), or legal guardian, or spouse. • Waiver funding is not available for the provision of vocational services delivered in facility based or sheltered work settings, where individuals are supervised for the primary purpose of producing goods or performing services. • The provision of transportation is not a reimbursable activity within Extended Services. Residential Habilitation Services - Daily • Assist with the acquisition, improvement, and retention of skills necessary to support individuals to live successfully in their own homes; acquire and enhance natural supports; and become integrated and participate in their larger community. • Services are designed to help individuals acquire and improve their self-help, socialization, and adaptive skills. Services should be directed toward increasing and maintaining natural supports, physical, intellectual, emotional, social functioning and full community participation. Individuals who meet all of the following criteria are eligible for this Service: • Individuals who have an ALGO score of 3, 4, or 5 on their Objective Based Allocation (OBA). • Individuals who are living with housemates and are utilizing a shared staffing model. • Individuals who are living outside of their family home. Reimbursable Activities • Assistance with acquiring, enhancing and building natural supports. For example, a measureable outcome would be increased hours of natural supports and a decrease in the number of hours needed for paid staff. Another measurable outcome would be the number of activities an individual participates in with non-paid (natural support) supports versus paid staff. • Working with the participant to meet the goals they have set for themselves on their Individualized Support Plan (ISP). • Training the participant to enhance their home-making skills; meal preparation; household chores; money management; shopping; communication skills; social skills and positive behavior. • Provision of transportation to fully participate in social and recreational activities in the community. For example, transportation to church, the park, the library, the YMCA, classes. • Provision of transportation to community employment and/or volunteer activities. • Coordination and facilitation of medical and wellness services to meet the healthcare and wellness needs, including physician consults, medications, implementation of risk plans, dining plans and wellness plans. Maintenance of each participant’s health record. • The individual must be present and receive supported living services for at least a portion of any day the provider bills as a day of supported living service. • Electronic Monitoring Limitations • Individuals receiving RHS Daily Services cannot receive more than 10 hours per month of Community Habilitation Individual (CHIO) services • Budget Modification Requests (BMR) will not be considered nor granted to individuals for loss of housemate(s). BMR’s will only be considered for extraordinary Health and Safety or Behavioral issues. • Providers will not be reimbursed separately for Electronic Monitoring Services for individuals receiving Supported Living Services. Electronic Monitoring is built into the Supporting Living Daily Rate. Providers must adhere to all Electronic Monitoring Service Standards as defined within that Service Definition. • Providers may not bill for Supported Living reimbursement for time when staff/paid caregiver is asleep. Only awake, engaged staff can be counted in reimbursement. • Providers may not bill for Supported Living reimbursement during the time when a participant is admitted to a hospital.
Transition Plan • Transition Plan for CIHW and FSW are posted for Public Comment through December 1, 2014 • Outline and Overview of Indiana’s Activities to Date and Planned Activities • DDRS Focus is on Assessment of the System • Assessment Activities Outlined in the Transition Plan Will be Taking Place Until April of 2017 Assessment Activities • National Core Indicators Data Review – Completed • Based on the NCI data, Indiana consistently demonstrated 85% and below in most HCBS requirement areas. • In other words, the NCI Data showed significant Non Compliance with HCBS Rules • Review of Indiana’s Policies, Rules, Regulations, Requirements and Procedures – Completed • Preliminary Setting Assessment Based on HCBS Requirements – Completed • Examined the HCBS requirements and Indiana’s initial level of compliance • The outcome of the review indicated that while the state does have policies and procedures that support the HCBS rules, a more in-depth analysis will need to be completed in order to determine full compliance. Planned Assessment Activities Individual Experience Surveys Focus on the Experiences of the Individuals Receiving Services and Supports • Anticipated Date of Completion is April of 2016 • DDRS has contracted with Indiana University Institute on Disability and Community (IIDC) • Survey Development • Utilization of the Day and Employment Services Outcomes System (DESOS) • Data Collection and Analysis • Reporting of Results • Survey Has Been Developed by DDRS,IIDC, and other FSSA program staff • Initial Validation will be completed by the end of 2014 • Utilization of Modified DESOS System to Administer • Goal is for each individual served to complete the survey or for the person who knows them best to complete the questions. • Twenty Plus Questions • Demographic Data • Gender, Age, Waiver, Race, County • Individual Specific Data • Disability, Mobility, Communication, Behavior, Needs • Individual Experience • Where do you live • What kind of Privacy do you have • Who visits and how often • Who do you live with • What Natural Supports do you have • How often do you go into the community to do certain activities • What is your day like • Initial Question Validation • DDRS Needs Help from Providers • Who Should Help Individuals Complete the Survey • What is the Best Way for DDRS to work with providers and individuals • What has been the Experience of Providers Who Participate in the DESOS surveys • What are we missing • Site Specific Assessments • Anticipated Date of Completion is September of 2016 • Utilized to Further Validate Survey Results • Based on HCBS Rules Indiana will identify any setting that has the effect of isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS. • BDDS and Case Managers will Collaborate • Comprehensive Settings Results • Anticipated Date of Completion is April of 2017 • Indiana will develop a comprehensive settings results document, which identifies Indiana’s level of compliance with HCBS standards Public Comment Public Input from Everyone in the System is Critical Comment Early – Comment Often Opportunities: • Link on DDRS Website • Provider Meetings • Family Calls/Webinar • DDRS Advisory Council • INARF Quarterly Meeting • Public Comment Period • Summary of comments and modifications from public input will be provided to CMS and posted on the DDRS Website Waiver Renewals and Amendments • Family Supports Waiver • Five-Year Renewal is Posted for Public Comment through December 7, 2014 • Due to CMS on December 31, 2014 • Community Integration and Habilitation Waiver • Five Year Renewal was Approved by CMS – went into effect on October 1, 2014 • Amendment Posted for Public Comment and is open for comment through December 17, 2014 • Due to CMS on December 31, 2014 Major Changes in Waivers • Participant-Centered Planning and Service Delivery – reflects current practice and expectations as well as clarification of roles • Risk Assessment and Mitigation - clarified that the Individualized Support Team determines the party or parties responsible for development of risk plan(s) • Extended Services is being proposed as a service that will provide ongoing employment supports which will enable an individual to maintain integrated competitive employment in a community setting. (Both Waivers) • Residential Habilitation Services - Daily (RHS Daily) is being proposed as a new residential service with a daily rate. (CIHW Only) Extended Services • Replaces SEFA as a BDDS Provided Service. Supported Employment Follow Along Services will be Provided by Vocational Rehabilitation – which is consistent with RSA. • Includes many work- and community-based training and support options • Allowable activities will allow individuals to receive training on the skills they will need to maintain their job and thrive in the community. Reimbursable Activities • Ensuring that natural supports at the work site are secured through interaction with supervisors and staff. A tangible outcome of this activity would be a decrease in the number of hours of extended services an individual accessed over time. • Training for the participant, or the participant’s employer, supervisor or coworkers, to increase the participant’s inclusion at the worksite. • Regular observation or supervision of the participant to reinforce and stabilize the job placement. • Job-specific or job-related safety training. • Job-specific or job-related self-advocacy skills training. • Reinforcement of work-related personal care and social skills. • Training on use of public transportation and/or acquisition of appropriate transportation. • Facilitating, but not funding, driver’s education training. • Coaching and training on job-related tasks such as computer skills or other job-specific tasks. Service Standards • Extended Services are provided in integrated community settings where persons without disabilities are also employed. • Extended Services do not include sheltered work or other similar types of vocational services furnished in specialized facilities or volunteer endeavors. • The Extended Services supports should be designed to support employment outcomes that lead to further independence and are consistent with the individual’s goals. Activities Not Allowed • Any non-community based setting where the majority (51% or more) of the individuals have an Intellectual or Developmental Disability. • Sheltered work observation or participation. • Volunteer endeavors. • Any service that is otherwise available under the Rehabilitation Act of 1973 or Public Law 94-142. • Public relations. • Incentive payments made to an employer to subsidize the employer’s participation in Extended Services. • Payment for vocational training that is not directly related to the individual’s Extended Service needs outlined in the ISP. • Extended Services do not include payment for supervisory activities rendered as a normal part of the business setting. • Extended Services provided to a minor by a parent(s), step-parent(s), or legal guardian, or spouse. • Waiver funding is not available for the provision of vocational services delivered in facility based or sheltered work settings, where individuals are supervised for the primary purpose of producing goods or performing services. • The provision of transportation is not a reimbursable activity within Extended Services. Residential Habilitation Services - Daily • Assist with the acquisition, improvement, and retention of skills necessary to support individuals to live successfully in their own homes; acquire and enhance natural supports; and become integrated and participate in their larger community. • Services are designed to help individuals acquire and improve their self-help, socialization, and adaptive skills. Services should be directed toward increasing and maintaining natural supports, physical, intellectual, emotional, social functioning and full community participation. Individuals who meet all of the following criteria are eligible for this Service: • Individuals who have an ALGO score of 3, 4, or 5 on their Objective Based Allocation (OBA). • Individuals who are living with housemates and are utilizing a shared staffing model. • Individuals who are living outside of their family home. Reimbursable Activities • Assistance with acquiring, enhancing and building natural supports. For example, a measureable outcome would be increased hours of natural supports and a decrease in the number of hours needed for paid staff. Another measurable outcome would be the number of activities an individual participates in with non-paid (natural support) supports versus paid staff. • Working with the participant to meet the goals they have set for themselves on their Individualized Support Plan (ISP). • Training the participant to enhance their home-making skills; meal preparation; household chores; money management; shopping; communication skills; social skills and positive behavior. • Provision of transportation to fully participate in social and recreational activities in the community. For example, transportation to church, the park, the library, the YMCA, classes. • Provision of transportation to community employment and/or volunteer activities. • Coordination and facilitation of medical and wellness services to meet the healthcare and wellness needs, including physician consults, medications, implementation of risk plans, dining plans and wellness plans. Maintenance of each participant’s health record. • The individual must be present and receive supported living services for at least a portion of any day the provider bills as a day of supported living service. • Electronic Monitoring Limitations • Individuals receiving RHS Daily Services cannot receive more than 10 hours per month of Community Habilitation Individual (CHIO) services • Budget Modification Requests (BMR) will not be considered nor granted to individuals for loss of housemate(s). BMR’s will only be considered for extraordinary Health and Safety or Behavioral issues. • Providers will not be reimbursed separately for Electronic Monitoring Services for individuals receiving Supported Living Services. Electronic Monitoring is built into the Supporting Living Daily Rate. Providers must adhere to all Electronic Monitoring Service Standards as defined within that Service Definition. • Providers may not bill for Supported Living reimbursement for time when staff/paid caregiver is asleep. Only awake, engaged staff can be counted in reimbursement. • Providers may not bill for Supported Living reimbursement during the time when a participant is admitted to a hospital.