As part of INARF’s continuing 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. Have a question or want to share your perspective on the issues below? Please contact Kim Opsahl 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. Rate Restoration: The first round of rate restoration goes into effect on July 1st. Rates impacted include: • Five Waiver Services partially-restored by 2.5% - Facility Habilitation Individual, Community Habilitation Individual, Respite, Residential Habilitation and Support, Level 1, and Residential Habilitation and Support, Level 2. • Implementation of the VR Hybrid Model that includes an increase in the Standard Hourly Rate from $34/hr. to $42/hr. • Group Home Rates fully restored by 1% Thanks again to the many legislators who supported our efforts to restore services as part of the 2016 – 17 Biennial Budget. We look forward to hearing the positive impact these investments have on your agency, your staff, and most importantly on the individuals you serve. Waiver Re-Write and Amendments: Late last week, the Division received approval for the Family Support Waiver (FSW) re-write and the Community Integration and Habilitation Waiver (CIHW) amendment. Below are key changes included in the approved waivers: Family Support Waiver Effective 04/01/15 Community Integration & Habilitation Waiver Effective 07/01/15 Adult Day Services: Removed requirement for 3-hour minimum Adult Day Services: Removed requirement for 3-hour minimum Case Management: Added Accreditation requirement Electronic Monitoring: Effective may now be used as a component of the new RHS Daily Service. Cannot be billed separately when used in this manner. Case Management: Case Notes at least monthly or as encounters occur Facility Based Habilitation: Clarified language requiring service delivery “in the facility of a DDRS-approved provider.” Extended Services: Replaces former Supported Employment Follow Along. Prohibits concurrent use of Extended Services and Pre-Vocational Habilitation unless the individual was receiving concurrently receiving SEFA and Pre-Vocational Habilitation, as of March 31, 2015. Extended Services: Replaces former Supported Employment Follow Along. Prohibits concurrent use of Extended Services and Pre-Vocational Habilitation unless the individual was receiving concurrently receiving SEFA and Pre-Vocational Habilitation, as of June 30, 2015. Music Therapy, Recreational Therapy, and Participant Assistance & Care: Added ability to render in groups by dividing billing unit rate among the total number in group. Residential Habilitation and Support: Added RHS Daily Service option. (See below for additional detail) Transportation: Clarifies that may be used to access places of employment. Transportation: Clarifies that may be used to access places of employment. Changes monthly reporting requirements to quarterly requirements for providers. Changes monthly reporting requirements to quarterly requirements for providers. In terms of implementation, we anticipate that changes in the Family Support Waiver will go into effect on July 1, 2015. For individuals impacted by the change from Supported Employment Follow Along to Extended Services, new Notice of Actions should be generated by today (June 30th), in anticipation of the July 1 effective date. In regard to changes in the Community Integration and Habilitation Waiver, we anticipate that most changes will go into effect on July 1, 2015, including the move to Extended Services. As with the Family Support Waiver, new Notice of Actions should be generated today, in anticipation of the July 1 effective date. This being said, the RHS Daily Rate will not be effective until August 1, 2015, in order to make the needed plan changes and provide teams with time to address any issues related to the transition. As a reminder, in general, individuals with an Algo 3, 4, or 5 who share staffing will be targeted for the RHS Daily Rate. Providers should have received information last week from the Division with the individuals anticipated to transition to the daily rate. In addition, DAYS and BMAN providers were notified of any individual whose spend in 2014 exceed the DAYS and/or BMAN Reserve for their Algo level. For these individuals, teams will need to meet to discuss service planning and make recommendations either to adjust DAYS or BMAN services so that they fall within the reserve. In extraordinary circumstances, teams may consider making a recommendation that in order to preserve the current array that the individual not transition to the daily rate. Questions regarding these lists may be directed to the InSite Helpdesk. Over the next couple of weeks, the Division will be publishing additional guidance in anticipation of the August 1st implementation. This guidance will include the process for individuals who need to come out of the daily rate, the process for individuals seeking a CHIO exception, and documentation standards. The INARF RHS Daily Work Group will serve as a resource to the Division as this guidance is finalized. Wellness Coordination: Recently, the INARF Membership Support and Development Committee developed a work group to review and analyze Wellness Coordination with the objective of offering recommendations to the Bureau of Developmental Disabilities Services (BDDS). After initial conversations with the Bureau, the Wellness Coordination Work Group focused initial comments around documentation standards and data collection methodologies. The work group also provided additional recommendations of concerns to the membership. The work group will continue to review and analyze components of the service and develop additional comments and feedback. Once developed, INARF staff met with BDDS Director Cathy Robinson and DDRS Chief of Staff Dawn Downer to share and discuss the group’s recommendations. Overall, the recommendations were positively received and it appeared many were in-line with the Bureau’s observations. As a first step, BDDS will be working with Advocare to develop new Wellness Coordination "guidelines" for provider agencies that will provide clarity to the requirements of service delivery and roles of agency personnel. INARF’s recommendations will be considered through the development of these "guidelines" and we will have an opportunity to provide additional feedback and comments prior to finalization. During our meeting, INARF learned that FSSA Audit/Compliance is beginning to audit Wellness Coordination provider agencies. They have audited one provider to date and have scheduled an audit with two others. It is our understanding that both FSSA Fiscal/Audit and DDRS are working collaboratively throughout this audit process. With this in mind, the exit interview may be less formal, as FSSA Audit will be working with the Division to review findings before issuing their audit report and/or seeking repayment of any funds. Day/Employment Services: On July 1st the Vocational Rehabilitation Services Hybrid Model will be implemented. Information and resources regarding the changes, including new forms, have been posted to the Bureau’s website. The Bureau of Rehabilitation Services (BRS) has set a meeting with the VR Rate Reform Work Group in August to begin post-implementation monitoring and analysis. Should you have questions as implementation moves forward, please forward them to VRProvider@fssa.in.gov. First Steps Update: Earlier this month, Shirley Huntsman assumed responsibilities as the new Director for the Bureau of Child Development. Shirley comes to the role with a long history in early intervention services and the First Steps program. In other news, the Division has engaged a contractor to study and make recommendations regarding funding for System Points of Entry and rates for on-going services. Recently, INARF participated in a meeting along with two member agencies to discuss current concerns with the program, particularly in light of continued rate reductions. As a result of that meeting, short-term recommendations were provided that would help with some short-term relief, while the study is on-going. FSSA / DDRS Litigation: FSSA and the Division are engaged in litigation on three key areas – the use of the Level of Care Screening Instrument (LOCSI), the policy of moving individuals from the Aged & Disabled Waiver to the Family Support Waiver, and concerns with the Objective Based Allocation Program. • On the LOCSI litigation, the State has entered a settlement agreement which will result in the selection and implementation of a new level of care screening tool. • On the A&D Waiver policy litigation, the District Court recently entered an order finding in favor of the State. The Court’s decision rested on a finding that o the individuals in question did not move from their community setting in response to the change in policy (i.e. they were not in fact institutionalized) and o 7th Circuit does not recognize “at risk of institutionalization” as a violation of Olmstead and the ADA’s Integration Mandate. • On the OBA litigation, the state has filed two Motions – one for Summary Judgment and one to decertify the class. Subsequently, the Court granted the plaintiff’s request for extensions to respond to the Motion to Decertify the Class. Group Home Advocacy Update: INARF recently reconstituted the Group Home Advisory Work Group to identify issues and concerns with day to day operations. INARF’s representatives identified issues with the vacancy / referral process, general communication / collaboration / coordination at the local level, and ISDH survey concerns. The Work Group is meeting with DDRS on July 10th to discuss their observations and work toward solutions. The ESN Work Group continues to meet with the Division. At this time, the group has finalized recommendations on policies governing referrals, visits, admissions, meeting responsibilities, and discharges and are awaiting final approval. At the conclusion of this effort, the work group will be expanded to support a broader systems discussion on the role of group home program moving forward and how the INARF and the Division can partner to support that role. HCBS Settings Rule Updates: Earlier this month, INARF participated in a Centers for Medicare and Medicaid Services (CMS) Region V Forum to discuss state approaches to HCBS Settings Transition Plans. The forum included provider and state representatives from Ohio, Illinois, Minnesota, Michigan, and Indiana. INARF President/CEO Kim Opsahl presented along with DDRS Director Nicole Norvell on Indiana’s plan. Many in attendance commented positively on Indiana’s efforts to engage education and Vocational Rehabilitation in their transition planning efforts. Late last week, the CMS issued additional guidance on its’ heightened scrutiny requirements. INARF’s national partner ANCOR recently published a summary of this guidance, which includes links to CMS’ resources. U.S. Department of Labor Overtime Rules: According to our partners at ANCOR, the long awaited Department of Labor's proposed overtime rules will be issued this week. In their press announcement, DOL indicated that President Barack Obama will release the long-awaited overtime rule aimed at raising wages for 5 million people as soon as 2016, according to sources familiar with the plans. The proposed rule will more than double the salary level under which virtually all workers qualify for overtime pay whenever they work more than 40 hours in any given week. That threshold, now $23,660, [would] rise to $50,440. The impact of this change will be significant to the provider community, particularly as it relates to front line supervisors and entry-level program / clinical staff. INARF plans to work closely with ANCOR on providing public comment to the rule, as well as raising awareness of the rule and its implication for Indiana providers with key decision-makers.