ARTICLE
Presentation (PDF) Open in new window • The Changing Landscape • Federal Issues and Trends • State Issues and Initiatives • INARF’s Position and Activities • Questions and Discussion The Changing Landscape Employment as a service • Facility Based Work Remains Controversial • Increased Intervention From DOJ, DOL, CMS • Shift in Emphasis to Community-Based • Transition Plans Employment as a Business • Contracts No Longer Based on “Feeling Good” • Quality is Expected • Business Operations Must Be Efficient and Well-Managed to Succeed How Do We Strike a Balance Between Mission and Profitability? Federal Issues Department of Justice • Violations of Title II of the ADA • Olmstead Decision “An individual with a disability must be served in the most integrated setting appropriate to their needs” Department of Justice • Oregon • Over-Reliance on Sheltered Work • Sued by Consumer Group/DOJ is Still Investigating • Governor Cut Funding for New Facility-Based Work Services • Dramatic Shift From IDD Agency to VR: VR is Still Not Prepared • No Change to Existing SW Consumers, just decreasing by attrition • Rhode Island • Over-reliance on sheltered work • Unnecessary segregation in facility-based settings • Few opportunities to leave the setting • Students at risk of segregation • Eliminates funding for new facility-based work enrollment • Career Development Plans and referral to VR: • Community-based day services whenever not working, rounding to a full 40 hour week • The state will provide outreach, information, and funding to ensure a successful transition The Rhode Island Consent Decree could potentially become the model for correcting over-reliance on facility-based services. Wage and Hour – A Bill • HR 831 – Fair Wages Act of 2013 • Immediately discontinue issuing 14c certificates • Revoke existing certificates • For-Profit: 1 year • Public/Governmental: 2 years • Non-Profit: 3 years • Repeal 14c in 3 years Workforce Investment & Opportunity Act • The primary objective is to increase competitive integrated employment • Competitive Integrated Employment: • Same wages as non-disabled workers • Located where there is interaction with non-disabled • Opportunities for Advancement • Admission to a sub-minimum wage job is restricted, unless: • Grandfather Clause – Current employees • Age 24 or younger must go through VR • All ages must have career counseling • With recommendations for employment other than sub-minimum wage WIOA Compliance: Launches in July, 2015 Documentation of counseling, outcomes, and pre-requisite admission steps will be critical! Wage and Hour • Executive Order 13658 – Minimum Wage • Issued on Feb. 12 • Effective on January 1, 2015 • Comment Period is now closed • DOL recently released rules for the EO • Requires that people who are employed by a contractor or subcontractor to the federal government be paid $10.10 as a minimum wage • Requires annual adjustments to that wage, as determined by the Consumer Price Index • Applies to 14c certificate holders (specifically mentioned) • Allows for enforcement of these wages CMS Final Rule • Defines & Describes Home and Community Based settings • Is integrated and supports full access to the community, to the same degree as individuals not receiving HCBS; • Ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid home and community-based services • Defines & Describes Home and Community Based settings • Provides opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources • Is selected by the individual from among setting options, including non-disability specific settings and an option for a private unit in a residential setting • Ensures right to privacy, dignity and respect, and freedom from coercion and restraint; • Applies to all settings, including Day Services • No Official Guidance Given from CMS on Days • Definition MUST be applied to every waiver service • States Must Create a Transition Plan to Move Waiver Services into Compliance For Pre-Vocational Services, CMS points to a 2011 Bulletin: “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 distinction between vocational and pre-vocational services is that pre-vocational services, regardless of setting, are delivered for the purpose of furthering habilitation goals such as attendance, task completion, problem solving, interpersonal relations and safety, as outlined in the individual’s person-centered services and supports plan” 2011 CMS Bulletin: • Pre-voc is time limited • Based on specific Person-Centered Planning • Designed as a stepping stone to community-based employment at minimum or higher wages State Issues Update Indiana’s Waiver Transition Plan • Open for Public Comment Until December 1 • Applicable to All HCBS Waivers • 3 Sections • Assessment • Remediation • Public Input Indiana’s Waiver Transition Plan • Initial Assessment • Preliminary Findings Were Inconclusive • Used National Core Indicators to Determine Compliance • Results of NCI did not Match Analysis of 90 Day Checklists • All Policies, Manuals, Rules, and Regulations Reviewed and Updated • Indiana Institute on Disability and Community to Develop Next Phase of Assessment • Will Eventually Drill Down to Setting and Site • Estimated Completion by April of 2017 • Remediation • Plans to Bring Indiana Waivers into Compliance • Outlines Corrections to Documents, Systems, and Providers • Will be Updated after Assessment Process is Complete • All Remediation Processes to be Complete by March, 2019 • Public Comments • CMS Requires Complete Transparency • Comments on the Plan Itself are Due NOW • Other Feedback Opportunities Available as Plan Develops Changes to Waivers • Both the Family Supports and Community Integration and Habilitation Waivers are Open for Comment • Deadlines for Comment Period: • FSW: December 7 • CIHW: December 17 • Extended Services • Replaces Supported Employment Follow Along (SEFA) • Available to Consumers in Integrated Community-Based Jobs at or Above Minimum Wage • Encompasses SEFA, But Also Almost Any Training that Improves/ Enhances Employment • Can by Individual or Group Based • CANNOT Be Used In Conjunction With Pre-Vocational Services • Pre-Vocational Service Definition Changed to Reflect That it Cannot be Used in Conjunction with Extended Services • May Act as a Deterrent for Seeking Community-Based Employment as an Unintended Consequence INARF Position and Activity INARF’s Core Values: • We Support the Full Array of Service Options for Individuals with Disabilities • We Believe that Individuals With Disabilities Must Have Timely Access to These Services • We Believe that the Selection of Services and Providers Must be Driven by Choice. INARF’s Position: • Board of Directors Resolution • Changes in Day and Employment Services are Underway • Supportive of Efforts Oriented at Improving System and Provider Capacity • Changing Such a Large System of Supports is Not Easy, • Consistent Leadership and Funding Within State Agencies is Critical • Community-Based Services Will Require Greater Financial and Human Resources • INARF will Research Other States and Processes Considerations: • Historically, Any Decrease in Work Services is Balanced by an Increase in Non-Work Services, Not Community-Based Employment • The State Use Program Will Require Changes • Industrial Workforce May Need to be Re-Deployed to Maintain Business Contracts • Contracts for Services May Not be Impacted by These Changes • Business Endeavors May Need to be Sustainable Without Pre-Vocational Funding • There May Be Options in Work Groups, Fully Integrated into Businesses Outside the Facility • Frankly, We Cannot Know All of the Answers Yet- We are Still Learning the Questions. • Even Without Answers, All Providers Should Begin Looking into Options and Creative Service Models What Is Your Agency Doing to Prepare for the Changes Ahead? Thank You! Christiaan R. Campbell, MS Director, Research and Program Development christiaan@inarf.org / 317.634.4957