Transcript Family Support Network

Family Support Network
Cathy Yadamec
Project Manager
[email protected]
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Ligas Outreach
CQL has a contract to
offer choice to Potential
Ligas Class Members who
are living in private ICFs
licensed for at least 9
people
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Ligas Outreach
Ligas Outreach
Initial Outreach with 1,431
Potential Class Members
• 799 stay in current home
• 263 meet with CQL
• 220 closed by choice or no
response
• 149 active
• Only a partial list
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Ligas Outreach
Meetings
• 99 Stay in current home
• 5 Change ICF
• 64 Explore community
services
• 1 Other
• 39 Want more time/info
• 55 Scheduled/Scheduling
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Alphabet Soup
The Council on Quality and Leadership (CQL)
Center for Medicare and Medicaid Services (CMS)
Home and Community Based Services (HCBS) waiver
Health and Human Services (HHS)
Intermediate Care Facilities for people with
intellectual/developmental disabilities (ICF/DD or ICF)
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Conversation Today
New CMS Regulations for HCBS waiver services
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Conversation Today
Specifically, what does that mean for you as
family members
• Input into changes
• Focus on people being a part of the
community
• Person Centered Planning
• Rights
• Decision Making
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Before
o In 1983, Congress amended the Social Security
Act giving states the option to receive a waiver of
Medicaid rules governing institutional care
o In 1999, Olmstead v. L.C. resulted in a ruling that
supports for people must be provided in the most
integrated setting
o In 2004, CMS initiated structured and transparent
quality oversight
o In 2005, HCBS became a formal Medicaid State
plan option
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Now
In 2014, CMS, with the involvement of
stakeholders, published changes
http://www.medicaid.gov/HCBS
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Why
To ensure people
 Have full access to the benefits of community
living
 Have the opportunity to live and receive services
in the most integrated setting appropriate
 To enhance the quality of the services provided
through the HCBS Waiver
 Provide protections to people participating in
those services.
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Requirements
 Requires states to establish and use a public
input process for waiver changes
 Defines and describes the requirements or
qualities for home and community-based
settings
 Defines person-centered planning
requirements
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Plan for Input
• CMS has always required that states provide
information about the public process for input
on waiver amendments and renewals
• Now requires the state to establish and use a
public input process for substantive changes in
the waiver
• The state must provide meaningful
opportunities for input from people receiving
services or eligible for services
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Plan for Input
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Community Settings
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Community Settings
• HCBS Waiver services were designed to be an
alternative to institutions
• Institutions can be a “state of mind”
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What is a Community-Based Setting?
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Integrated
Supports inclusion in the greater community
Provides opportunities to seek employment
Facilitates engagement in community life
Promotes control of personal resources
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The setting must…
• Protect and promote the rights of privacy,
dignity, respect and freedom from coercion
and restraint
• Optimize initiative, autonomy and
independence in making choices
• Facilitate choice regarding services and
supports and who provides them
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NOT Community Based
• Nursing facility
• Institution for mental disease
• Intermediate care facility for individuals with
intellectual disabilities (ICF/DD)
• Hospital
• Any other locations that have qualities of an
institutional setting, as determined by the
Secretary
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Presumed NOT to be Community
• Publicly or privately owned facilities providing
inpatient treatment
• On the grounds or, or adjacent to, a public institution
• Settings that isolate individuals from the boarder
community of individuals not receiving Medicaid
HCBS
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Service Provider Owns or Controls Setting
The person’s name is on the lease or there is a
legally enforceable agreement
The person is protected from eviction through
an agreement or law
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Modifications to the Requirements
• Must be supported by specific assessed needs
• Justified in the person’s plan
• Documented in the person’s plan
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Documentation
The Person-Centered Plan will
o Identify the specific, personalized assessed need for
modification
o Document the positive interventions and supports used prior to
any modifications to the person-centered plan
o Describe prior interventions and supports including less
intrusive or restrictive methods
o Include a clear description of the modification that is directly
proportionate to the assessed need
o Provide data measuring effectiveness of intervention
o Establish timelines for review
o Include Informed consent
o Give assurance that the interventions and supports will not
cause harm
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Other Programs and Services
The person must receive services in integrated
settings and realize the benefits of community
living, including the opportunities to seek
employment and work in competitive integrated
settings.
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Other Programs and Services
States provide a wide variety of non-residential
services
o Supported Employment
o Prevocational
o Habilitation
o Adult day
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Other Programs and Services
The person must have a choice from among
options including non-disability specific settings
And the choice is documented in the service
plan based on needs and preferences
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Other Programs and Services
• The setting may not isolate the person from
the broader community, or
• Have the characteristics of an institution, or
• Fail to meet the setting of a HCBS setting
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All HCBS Programs Settings
All HCBS settings must demonstrate the qualities
of HCBS settings
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Integrated
Support inclusion in the greater community
Provide opportunities to seek employment
Engage in community life
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Person Centered Planning
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Person-Centered Planning Process
Service planning for participants in Medicaid HCBS
programs must be developed through a person-centered
process that:
 Is driven by the individual
 Includes people chosen by the individual
 Provides support to ensure that the individual directs the
process to the maximum extent possible
 Is timely and occurs at times/locations of convenience to
the individual
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Person Centered Planning
• Reflects what really important to the
person and is in agreement with the
person’s preferences and personal goals.
• Identifies the person’s strengths, preferences,
needs, and desired outcomes of the individual
• May include whether and what services are
self-directed
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Person Centered Planning
• Uses plain language
• Includes strategies for solving disagreement
• Offers choices to the individual regarding who
provides services and supports
• Provides method to request updates
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Person Centered Planning
Must result in plan with individually identified
goals and preferences
Community Participation
Employment
Income and Savings
Health Care and Wellness
Education
Other
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Person Centered Planning
All services and supports
– Paid and unpaid
– Who provides them
– Whether a person choose to self-direct services
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Person Centered Planning
• Includes risk factors and plans to
minimize them
• Is signed by all individuals and providers
responsible for its implementation and a
copy of the plan must be provided to the
individual and his/her representative
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Person Centered Planning
This planning process, and the resulting person
centered plan, will
 Assist the person in achieving personally
defined outcomes in the most integrated
community setting,
 Ensure delivery of services in a manner that
reflects personal preferences and choices, and
 Contribute to the assurance of health and
welfare
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Person Centered Planning
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Rights
The person
o Chooses from among options
including non-disability specific
settings
o Has an option for a private
room/unit
o And, the choice and process is
documented in the service plan
based on needs, preferences
o If a residential setting, based on
the person’s resources
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Rights
If the person shares a bedroom/home, they
have a choice of roommates
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Rights
Person is satisfied—he/she does not express a
desire to move or have another roommate
If person is dissatisfied, provider staff assists
the person to resolve issues and/or to seek
out other alternatives
There must be evidence of proactive ways to
learn about satisfaction and a
response/resolution to dissatisfaction
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Rights
• Each person has privacy in their bedroom or
home
• There are locked doors and the person and
appropriate staff have keys as needed
• People can decorate their rooms/home within
the confirms of the lease or agreement
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Rights
The person’s home is physically accessible
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Rights
People have the freedom and support to
Control daily schedules and activities
Have food and drink at any time
Have visitors at any time
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 The person is aware that he/she is not required to follow a particular
schedule for waking up, going to bed, eating, leisure activities, etc.
 The person is encouraged and supported to make their own choices
according to their preferences and needs .
 The person has access to personal possessions, like televisions, radio,
computer internet, and leisure activities that interest him/her and he/she
can schedule and enjoy these activities at his/her convenience.
 The person is satisfied with his/her schedule of activities and knows how
to request assistance with changes if he/she wants to.
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Rights
 People have the ability and support to make last-minute plans
or decisions about how to spend their free time like everyone
else.
 Person’s need for support is not a reason to not have options
or to only have his/her choices supported when provider
agrees
 Stringent rules/routines for administrative convenience i.e.
lack of staffing is no longer acceptable under HCBS Settings
requirements
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Rights
“A person should not be presented with narrow meal
and snack options, decided by someone else,
without input from the person.” (79 Fed Reg. 2965-66)
Food options should not be unreasonably limited.
Requirement would not be satisfied by choice
between a granola bar or pitcher of water and
crackers
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Full access to community
Like people without disabilities, people
receiving HCBS choose where they go and
when
Can still be integrated in the community if
located in a rural area as long as people can
travel around and participate in community
life in the same way that other people who
live in that community do
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Full access to community
Does NOT mean:
 the only time a person is ever in the
community is on a “group trip”
 All activities scheduled by staff without input
from individuals/others re:
interests/preferences
 People only frequent community through
same limited set of activities or with little
variance/options offered
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Decision Making
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Decision Making
Think about what your life would look like if
someone else made all or some of your
decisions for you.
What’s the most important thing for you to
control?
Is there anything that is not important?
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Decision Making
All people make decisions and most of us have
some support to make decisions
People with less experience making decisions
may need coaching, practice or other supports
Sometimes supporters have to listen in different
ways
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Decision Making
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Decision Making
Person’s right to make decisions is consistently
reinforced in daily life:
o Empowered to say or demonstrate choices
o Supports respond accordingly
People are supported in:
o Big Life Decisions and
o Everyday Life Decisions
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Decision Making
Person’s right to make decisions is consistently
reinforced in daily life:
o Empowered to say or demonstrate wants
o Supports respond accordingly
People are supported in:
o Big Life Decisions and
o Everyday Life Decisions
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Decision Making
Changing the title of the form doesn’t make it
informed consent.
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Decision Making
Provided in a manner that is meaningful and
understandable to the person
Directly related to the choice in question
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Decision Making
Each person, whether they have a legal guardian
or not is expected to participate in making
decisions.
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Decision Making
How to provide informed choice?
Exposure – Education - Experience
How to respect one’s choice after they have
weighed up their options?
The right to risk – What does that mean when
applied?
How to keep up with people’s changing
preferences and new discoveries?
What does a good life look like to each person?
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The Bottom Line….
• The new rule seeks to improve quality of life
for people with disabilities by ensuring
• that HCBS funding is used only for services in
settings that are truly integrated, as opposed
to those that replicate institutional
environments in all but name.”
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Cathy Yadamec
Project Manager
[email protected]
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