Developmental Disability Services in Nebraska – Now & In the Future

For adults and children with intellectual and related developmental disabilities

Division of Developmental Disabilities

Eligibility for DD Services  DD Services are voluntary – they are not an entitlement like educational services  Anyone can request eligibility determination through their local DD office  Follows statutory definition of developmental disability in accordance with the Developmental Disabilities Services Act (DDSA) § 83-1201 to § 83-1226 2

Eligibility (continued) § 83-1205. Developmental disability, defined.

Developmental disability shall mean: 1.

Mental retardation; or 2.

a.

A severe, chronic disability other than mental retardation or mental illness which: Is attributable to a mental or physical impairment other than a mental or physical impairment caused solely by mental illness; b.

c.

Is manifested before the age of twenty-two years; Is likely to continue indefinitely; and 3

Eligibility (continued) d.

i.

Results in: In the case of a person under three years of age, at least one developmental delay; ii.

or In the case of a person three years of age or older, a substantial limitation in three or more of the following areas of major life activity, as appropriate for the person's age: (A) Self-care; (B) Receptive and expressive language development and use; (C) Learning; (D) Mobility; (E) Self-direction; (F) Capacity for independent living; and (G) Economic self sufficiency.

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Eligibility (continued)  Once eligibility is determined, a date of need is requested  Individuals are put on the registry (aka the waiting list) until funding is available or they meet the criteria to become a ‘priority’ for emergency funding  If the individual is over age of 21 and has graduated from a Nebraska high school on or before September 6, 1993, ‘day’ services are automatically funded according to § 83-1216 5

Home and Community Based Services (HCBS) Waivers  1915 (c) Waivers are DDD’s policy documents, they define the services which allow Nebraska to collect federal matching dollars  A HCBS Waiver is a waiver from institutional care. To be eligible to be on a Waiver, an individual has to meet ICF/MR level of care requirements  ICF/MR level of care and DD eligibility are NOT the same, so some individuals may have state only funded services  Regardless of funding source, all DD services are the same 6

DDD Currently Manages Five Waivers      Adult Day (DDAD)    Assisted Day – prevocational workshops and some workstations Supported Day Supported Employment Assisted = All the time Supported = Some of the time Adult Residential (DDAR)   Assisted residential Supported residential Adult Comprehensive (DDAC) Community Supports Program (CSP) For Children and their Families 7

Adult Day, Residential & Comprehensive  Offers a combination of specialized services  Residential habilitation services  Traditional group homes or extended family homes (continuous support), intermittent in-home support.  Day habilitation services  Vocational planning, integrated community employment, workstations, prevocational workshops.

 Respite for families  Team behavioral consultation 8

Community Supports Program  Offers non-specialized supports provided by independent providers, people hired by the individual and their family – job coaches, companions, and housekeepers that are your neighbors, college students, friends, etc.

      Community living and day supports PERS Respite for families Assistive technology and supports Home modifications Vehicle modifications 9

Community Living and Day Supports         Supports to access the community Supports to maintain or obtain employment—not in specialized provider-operated settings Supports to access services and opportunities in community Supports to assist the individual to develop self-advocacy skills Supports to assist the individual in identifying and sustaining a personal support network of family, friends, and associates Household activities necessary to maintain person’s home living environment on a day to day basis Home maintenance activities (personal living space) Assistance with hygiene, bathing, eating, dressing, grooming, toileting, menstrual care, transferring, or basic first aid 10

DDD’s Focus on Employment  In April 2010, DDD got approval from CMS to amend current adult waivers to redefine supported day and supported employment services.

 New services included:  Vocational Planning  Integrated Community Employment (ICE) 11

DDD’s Focus on Employment (continued)  Focus on community integration, activities and job experiences in the community  Provides graduates with more options to live and work in their community  Funds more job training activities  Allows for in home job searching activities  Allows for home-based businesses 12

A Sneak Peak…  The adult day, residential and comprehensive waivers expire on 12/31/2010  Renewals were submitted to CMS in September 2010  Our current five waivers will become three waivers upon approval of the renewals  Individual Budgets with a menu of services  Individuals will have more flexibility and options  Will be implemented January 1, 2011 13

Individualized Budget Amounts  Separately authorized monthly allocated amounts for day and residential services will be converted into one annual amount for participants to choose the services that meet their goals and preferences  Individuals can budget their year and flex the amount they spend from month to month 14

A Menu of Services  The 4 adult waivers will become two by:  Adding community support (non-specialized) services to all adult waivers, eliminating annual cap on CSP services as well as the cap on rate for services  Transitioning CSP participants to the comprehensive waiver and residential waiver participants to the comprehensive waiver  Terminating CSP and DDAR waivers 15

A Menu of Services (continued)  Adding more specialized services to the two adult waivers  Retirement services  Medical risk services  Behavioral risk services  Going from four service definitions to nineteen – most already exist but were grouped together in either assisted or supported services 16

Questions?

Tricia Mason, Administrator Community-Based Services Division of Developmental Disabilities Department of Health and Human Services 402-471-8704 [email protected]

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