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As part of INARF’s commitment to ensuring members are informed, we have compiled updates on key issues and activities in which the INARF Board of Directors, Governmental Affairs Committee, and Staff have been engaged in on your behalf (Members Only). Have a question or want to share your perspective on the issues below? Please contact either Christiaan Campbell or Keith Digman for assistance. Have an issue or concern that is impacting your business that is not listed in this update? Please let us know by clicking here. Healthy Indiana Plan 2.0: The HIP 2.0 Waiver application is still under review by CMS. Public comment is now closed. A key concern, as outlined by a report by the Center on Budget and Policy Priorities (CBPP), a D.C. based think-tank, are that Medicaid statutes forbid the requirement of a premium, and HIP 2.0 includes premiums for individuals from 100 – 150% of the Federal Poverty Level. Additionally, the Plan would “force Hoosiers in poverty that do not make payments for their coverage to wait two months for coverage to start.” Medicaid, by contrast, requires coverage to start retroactively—three months before they enroll. Waiver Re-Write and Rate Reform Activities: The Rate Reform Work Group has continued to offer feedback to DDRS as the RHS Daily Rate (Supported Living) is being finalized. Over the past few weeks, DDRS personnel visited three INARF member agencies to observe how services are delivered under the current model and to better understand how a daily rate would be beneficial, both in terms of reduction of administrative burden and in time spent directly with the consumer. DDRS is working toward a December submission of the Daily Rate recommendations into the CIH Waiver, which will require public comment in November. The Division has shared a draft service definition for review and comment. The workgroup has had the opportunity to consider the definition and offered their concerns and recommendations back to the Division. We anticipate that the Division will publish the service definition for public comment within the next week. Once the RHS Daily Rate is approved and submitted, the Work Group will focus on revisions to Day Services models and reimbursement. DDRS remains open to these discussions. The Shared Living Work Group is currently reviewing draft recommendations, and anticipate meeting in the near future to finalize the proposal. The Group intends to provide the final draft to the Bureau of Developmental Disabilities Services by mid-November for consideration to include in the next Waiver amendment. The INARF member case management companies have developed recommendations around the 90 day checklist and its process, as well as a case management service definition. These were provided to the Bureau of Developmental Disabilities Services (BDDS) for consideration. The Work Group will continue efforts to draft a case management model proposal that, while being sustainable and person-centered, alleviates the administrative burden that is present in the current system. DDRS state-wide transition plans were released for public comment on October 31st. INARF is currently researching the plan, and will be developing recommendations later this month. Julie Reynolds, Director of BDDS, will be presenting the plan and acquiring feedback at the INARF Quarterly Professional Interest Section Meeting on November 20th. She and DDRS Director Nicole Norvell also plan to meet with the INARF Board for discussion and feedback. With the release of the State-Wide Transition Plan for comment, Indiana is beginning its study to determine which programs are in compliance with the CMS definition of Home and Community Based Services. This study previously excluded day service programs, as States were awaiting further guidance. As CMS determined that no guidance would be released, the plan includes all services, including facility-based work and habilitation services. INARF will continue to monitor this situation, and look for opportunities to ensure that options, access, and choice are retained for individuals with disabilities. Last Friday, the Family Supports Waiver (FSW) was released for public comment. The Draft includes several notable changes, including the replacement of Supported Employment Follow-Along (SEFA) with Extended Services, a new service definition with a much broader range of allowable activities. This change was made to allow for consumer-specific training and advocacy in addition to the activities currently included in SEFA. As Extended Services are focused upon community-based integrated employment, the draft service definition proposes that Pre-Vocational Services would not be co-authorized and includes a six to nine month transition period to permit individuals and their teams to plan how to adjust to the change. INARF is working to gather information from members to determine the impact of this change, and will be preparing formal recommendations prior to the December 7 Deadline. Facility and Community-Based Employment Services: The VR Rate Reform Work Group met several more times with BRS staff to discuss the proposed “Hybrid Model. Overall, there is potential for the model to meet the established goals while being a sustainable system for providers. Specifically, the group is continuing discussions regarding the rates and the structure needed to ensure team decisions are consistent with ensuring a robust discovery process and meaningful on-going support. The Hybrid Model was released in October for public comment, with a deadline of November 7. INARF submitted comments to BRS, based upon input from the work Group and other INARF members. INARF has also encouraged members to submit their own comments directly to the state, using INARF’s document as a resource. As the comment period is now over, the VR Rate Reform Work Group will meet with BRS to finalize the model. To date, we have received comments from seven members. It is anticipated that the new program will launch on July 1, 2015. See Community Integration and Habilitation Waiver Re-Write and Rate Reform Activities for additional updates. Supervised Group Living Work Group: Relative to the My Life My Choice Project, the Division of Disability and Rehabilitative Services recently announced that the project is turning its focus to individuals residing within nursing facilities. This change appears to be in response to a recent report indicating that Indiana was second only to Wyoming in the number of individuals with ID/DD residing in nursing facilities. In late October, the Supervised Group Living Work Group met with the Bureau of Developmental Disabilities Services to discuss the current status of group home vacancies and referrals. BDDS reported that significant strides had been made in accurately identifying current vacancies and individuals seeking group home services. The ESN Work Group continues to meet to identify opportunities to improve the process by which people are identified for ESN vacancies, as well as ensuring an effective mechanism for transitioning people out of the placement when appropriate discharge criteria are met. This work includes developing policies and procedures for BDDS staff and exploring ways to ensure effective on-going support when individuals move from these intensive support settings. Gap Analysis Project: The Gap Analysis and final report are complete. The Division intends to release the report in the next few weeks. Wellness Coordination: INARF continues to work with BDDS regarding issues brought forth by Wellness Coordination providers, including, but not limited to, clarity in service guidelines and the use of the Advocare Provider Portal system. Additionally, BDDS is addressing the inconsistencies in implementation of the service and will continue to communicate pertinent information to providers. Changes in Medicaid Eligibility: There remains a lot of confusion surrounding eligibility requirements under the 1634 Medicaid status. There have been continued reports of individuals in VR services losing eligibility, which makes follow-along services through the waiver a challenge. Additionally, there is increasing concern over safety net programs such as MED works, and the impact of 1634 upon their effectiveness. INARF will continue to monitor the situation. Quality Improvement Initiative: INARF has developed an outline for the development and implementation of the “System of Excellence,” as recommended by the joint Industry Infrastructure and Innovation/Systems Change Committees. Additionally, Quality criteria have been identified that will serve as a basis for the development of Indiana Core Indicators. Moving forward, INARF staff will review and audit existing online capability for deploying quality resources to members.