Transcript The Agency For People With Disabilities

November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
Charlie Crist, Governor
Jane E. Johnson, Director
Matthew Claps, Senior Management
Analyst II
November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
Goals of Presentation:
1) Brief overview of the Agency for Persons
with Disabilities
2) Presentation and discussion of APD / DCF /
CBC related issues
November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
Mission Statement: The Agency supports persons with
Developmental Disabilities in living, learning, and working
in their community.
As defined in F.S. 393, APD
can provide services for the
following disabilities:
-
Mental retardation (76%)
Autism (11%)
Cerebral Palsy (11%)
Spina Bifida (2%)
Prader-Willi Syndrome (1%)
APD administers the
following waiver programs:
- Home and Community Based
Waiver (24,270)
- Family Supported Living Wavier
(6,100)
- Consumer Directed Care +
Waiver (1,000)
- THERE IS A WAITLIST FOR
WAIVER SERVICES – 15,000
November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
Process for accessing services: Already enrolled into a waiver
Waiver Support Coordinator (WSC) works with consumer /
family to develop support plan
Approved (medically necessary) services are authorized. WSC
works with family / client to select service providers
Service providers begin providing services. Waiver support
coordinators providers continued case management.
45 – 90 days to complete
Support plan submitted to prior services authorization for review:
Denials can be resubmitted for reconsideration or appealed
through DOAH, F.S. 120
Support plans can be updated upon request, or at least
annually.
* This does not include eligibility determination or
waiver enrollment (on average 45 to 90 days)
November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
APD- Current Issues: A system in change
-
-
Projected waiver deficit
Reductions and
eliminations of waiver
services (SB1124)
development of 4 tiered
waiver system
Implementation of new
residential habilitation
rate structure
Waiver enrollment
capped to attrition
Development and
implementation of a new
assessment process and
tool
Currently developing a
new strategic plan
threat of managed care
Waiver Services Reductions
(already implementing)
-
Supported living coaching
Limited support coordination for
those under 18 in a family setting
PCA limited to 180 hrs. per month
except for those having intensive
medical, adaptive or behavioral
needs. (children receive PCA
through Medicaid State Plan )
Waiver Service to be Eliminated
(December 1st)
-
Massage Therapy
Psychological Testing
Chore, Home-Maker, NRSS
November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
The Agency For People With
Disabilities, The Department of Children and
Families and the providers of Community-Based
Care must continue to partner to better serve
children who have been abused and neglected
who also have a developmental disability.
November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
Priority Consideration (F.S. 393.065): APD /
DCF / CBC Children - How many?
•
•
•
•
~ 576 Waiver recipients (1.7% of total waiver
population)
~ 393 receiving HCBS
~ 183 receiving FSL
Approximately 155 children from DCF/CBCs are on waitlist
for waiver services (last enrollment of DCF/CBC children
was October 2006)
Approximately 15-20 added to waitlist per month APD/DCF
periodic matching of data to identify dual-clients
* Data are as of June 2007
November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
Commonly accessed waiver services: Average HCBS
annual cost per DCF/CBC child
Average DCF/CBC Child HCBS
waiver recipient costs
$ 32,000 /year
Residential
habilitation
64%
39,000 / year
consumable
medical supplies
45%
$2,000 / year
behavioral
services (levels IIII combined)
40%
$1,800 / year
personal care
assistance*
7%
$ 11,500 / year
respite
7%
$1,500 / year
Data are as of FY 06-07
November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
Commonly accessed waiver services:
FSL Per DCF/CBC child annual cost
DCF/CBC Child FSL waiver service utilization*
consumable medical supplies
42%
behavioral services (levels I-III
combined)
31%
In-home supports
20%
respite
17%
* Due to significant influx of DCF/CBC children into FSL waiver during 06-07 (~150%
increase), utilization data is problematic
November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
Placement Types: Children receiving waiver
(HCBS and FSL) services
Foster Home Non-Relative
118
Group Home
75
Developmental Services Group Home
74
Therapeutic Foster Home Non-Relative
60
In-Home
52
Medical Foster Home Non-Relative
49
Developmental Services Foster Home Non-Relative
48
Residential Treatment Center
34
Approved Relative Caregiver
22
Approved Non-Relative Caregiver
16
Shelter Facility
7
Runaway
4
Adoptive Home
3
DJJ Detention Center more than 12 Children
3
Foster Home Relative
2
Mental Health Facility up to 12 Children
2
Family Shelter Home Non-Relative
1
Hospital
1
Jail
1
Medical Foster Home Relative
1
November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
Guardianship Issues:
Confidentiality of records: F.S. 393.13
(4)(j)- Signed releases are necessary for
sharing information
FS 412.115- APD can share information
directly to DCF without confidentiality waiver
Signatory Authority: only the parent or legal
guardian can enroll a minor for APD services
and request / direct cost plan development
and service provision
November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
Ongoing challenges: Opportunities for
system development
Getting DCF/CBC children APD services: Other than through
crisis, new waiver enrollment from the waitlist in FY 07-08 not likely
and during FY 08-09 is unknown
Local and state-level collaborative resource development:
Enhancing service array capacity, with special attention to children
with medical complexities and dual diagnoses
Shared decision making and collaboration: More clearly defining
the roles and responsibilities of multiple case managers (child welfare
and waiver support coordinators) along with other child serving
agencies. Expectations on “speed” of systems
Transition to adulthood: Ensuring smooth transition as children /
youth age out of child welfare system
Question for discussion:
Considering the differences between the
organizational perspectives of APD, the
larger developmental disabilities system,
and DCF/CBCs and the larger child
welfare system…
How can these systems collaborate to
consistently meet the needs and ongoing
challenges of mutual system children /
youth?
November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
How do we establish a policy and infrastructural framework that
provides support while allowing for individuality of case practice?
Potential strategies:
Obtaining services & Resource development:
-
Line-item appropriation of new waiver funding or other new waiver funding
strategies
Expansion of pre-paid mental health plan to include commonly accessed waiver
services
Pursuit of dual-diagnosis waiver
Targeted expansion of “deep-end” treatment capacity. Shared funding to draw
Medicaid match
Collaborative resource development with specialty service providers at local
level based on identified needs
Shared decision-making and collaboration / transition to adulthood:
- Statewide memorandum of understanding for role and expectation clarification
coupled with ongoing training and collaboration
- The conceptual similarities of basic practice models: Establish key points of
contact / working protocols / cross-training and mentoring opportunities to
advance best-practice approaches
- Ongoing data-sharing
November 2nd, DCF Task Force Meeting: APD / DCF / CBC Partnership
Matthew Claps, Senior Management Analyst II
4030 Esplanade Way, Suite 380
Tallahassee, Florida 32399-0950
[email protected]