Transcript Document

national trends
OCTOBER 25, 2014
THE ARC CALIFORNIA CCE AND BOARD OF DIRECTORS MEETINGS
major national initiatives
New Home and Community Based Services
(HCBS) HCBS Waiver Rules
WIOA Reauthorization
United States Department of Justice Court
settlements with Oregon and Rhode Island
the reason for the change
CMS’ stated intention in promulgating the final rule was to
maximize opportunities for people to have access to the
benefits of community living, including receiving services
in the most integrated setting and to ensure that Medicaid
funding and policy support needed strategies for states in
their efforts to meet their obligations under the ADA and
the Supreme Court decision in Olmstead v. L.C., 527 U.S.
581 (1999).
a little background
1915 (c) Waiver
1915 (i) SPA
1915 (k) option
the waiver why and how
States apply to waive Medicaid program
requirements to provide services in institutional
settings, such as nursing homes and intermediate
care facilities for individuals with intellectual and
developmental disabilities (ICF/IDD).
These waivers are permitted by Section 1915(c) of
the Social Security Act and are called 1915(c) waivers.
1915(i) State Plan Amendment.
HCBS as part of their regular Medicaid
program by amending the state plan.
Adding HCBS that normally could be provided
through a 1915(c) waiver to their state plan.
Limit services available to people before they
need institutional services.
1915(k) Community First Choice (CFC)
Option.
States choosing the Section 1915(k) option must make attendant
services and supports available to all Medicaid beneficiaries who
meet eligibility criteria for the CFC option.
What is A HCB Setting?
• You have Full access to community – you can seek competitive
work, engage in community life, control personal resources, and
receive services in the community like anyone else.
• You are Fully informed of all home living supports and you
select it
• You control your privacy and there no coercion or restraints
• You can exercise individual initiative, have autonomy, and
independence in making all life and lifestyle choices including
getting services and supports and by whom.
Provider Residential Settings
•You have the same rights and responsibilities as all home owner or tenant.
• You have privacy as desired in your living or sleeping unit
• Your place has entrance doors lockable by the individual
• You choose your roommate if you choose to share a room
• You can furnish and decorate your own room
• You have can control your own schedule, activities, and food
• You can have visitors when you want
• You can physically access your home
What Won’t Pass
Nursing facilities, IMDs, and ICFs
Hospitals providing long term care services
Services in a building that is also a facility that
provides inpatient institutional treatment
Services on the grounds of, or immediately adjacent
to, a public institution
Services that have the effect of isolating individuals
from the broader community
The California Plan, So Far…
The compliance determination process includes all of the following:
An initial State-level assessment of standards, rules, regulations, and other requirements to
determine if they are consistent with the federal requirements. This will be completed within six
months of CMS approval of the Statewide Transition Plan.
This State-level assessment will be conducted jointly by DHCS and the State Department(s)
responsible for operating each Waiver with stakeholder input.
Results of this assessment will be available for public comment and will be used to determine and
develop the remedial strategies that may be necessary to ensure that all HCB settings conform to the
federal requirements.
In addition to the State-level assessment, on-site evaluations of individual settings will be conducted
as follows:
 On-site evaluations will be conducted at all settings that, per CMS guidance, are presumed not to be HCB settings.
 For all other settings, a representative random sample of on-site evaluations will be conducted.
 It is anticipated that the on-site evaluations will be completed within one year of CMS approval of the assessment tool.
…CA Plan…
The on-site evaluations will be conducted by a survey team that includes one or more of the following: State personnel, service
recipients or their family members, case managers or other representatives of case management entities, representatives of consumer
advocacy organizations, and/or other stakeholders.
The responsibility for ensuring completion of these evaluations rests with the program staff as specified under the “Overview of State
Responsibility” section of this document. The State will support the provision of training for all participants of survey teams to ensure that
HCB settings are built around the person-centered plan approach and are compliant with the new federal requirements.
DHCS will develop an assessment tool for use in the on-site evaluations of HCB settings. The assessment tool will include each new
federal requirement that will be used to determine if the HCB setting meets or does not meet the required federal rule. The completed
assessment tool will be maintained in the appropriate State file for each waiver and will be used to verify compliance at the time of CMS
renewal of the HCBS waiver. Note: this assessment tool shall be developed and circulated for stakeholder comments no later than 60 days
after CMS approval of this Statewide Transition Plan.
The assessment tool will be forwarded to each HCB setting selected for evaluation with instructions to complete a s elf-assessment prior
to the evaluation completed by the survey team. The completed assessment will be forwarded back to the Waiver program for review.
Using the completed assessments, each selected HCB setting (selected from the list identified under the “California Plan for
Determination of HCB Setting Compliance” subsection of this document) will be evaluated by a survey team described above.
…CA Plan…
Written results of each survey will be forwarded back to the HCB setting with specific information
regarding improvements that will be required in order to come into compliance with the federal
requirements and a timeline for completion.
Completed assessments for all settings, including documentation of any required follow-up actions
as a result of the on-site evaluations, will be maintained in the appropriate State file for each waiver.
An appeal process, to be developed, which allows the HCB setting to dispute the HCB setting’s
compliance or the need to comply with the specific requirement when the HCB setting determines
the requirement is not applicable to the particular setting. Note: the appeal process shall be
developed and circulated for stakeholder comments no later than 60 days after CMS approval of this
Statewide Transition Plan.
All State-level and individual setting level remedial actions will be completed by no later than March
17, 2019.
Progress on completion of this Statewide Transition Plan will be monitored at least every six months
and will include public posting on the status with opportunity for public input.
Workforce Innovation and Opportunity
Act
From Workforce One
September 2014
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Overview of the Workforce Innovation and
Opportunity Act
 President Barack Obama signed WIOA into law on July 22, 2014.
 Passed by Congress with wide bipartisan majority (The Senate voted 93-5
and the House of Representatives voted 415-6).
 Reaffirms ongoing role of American Job Centers.
 Promotes program coordination and alignment of key employment,
education, and training programs at the Federal, State, local, and regional
levels.
 Builds on proven practices such as sector strategies, career pathways,
regional economic approaches, work-based training.
 Complements and supports the President’s Job-Driven Workforce Vision.
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Programs under the Workforce Innovation and
Opportunity Act
 Supersedes the Workforce Investment Act of 1998 and retains and
amends the Adult Education and Family Literacy Act, the WagnerPeyser Act, and the Rehabilitation Act of 1973.
 Identifies “core programs”:
– Adults, Dislocated Workers, and Youth formula programs and WagnerPeyser employment services administered by the Department of Labor; and
– Adult education and literacy programs and Vocational Rehabilitation state
grant programs that assist individuals with disabilities in obtaining
employment administered by the Department of Education.
– Authorizes the Job Corps, YouthBuild, Indian and Native Americans, and
Migrant and Seasonal Farmworker programs, and evaluation and research
activities conducted by DOL.
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Highlights of Reforms to the Public Workforce
System under the Act
 Requires states to strategically align workforce development programs to
support job seekers and employers.
 Promotes accountability and transparency of programs.
 Fosters regional collaboration to meet the needs of regional economies.
 Streamlines and strengthens the strategic roles of workforce
development boards.
 Enhances services provided to job seekers and employers through the
American Job Center system.
 Improves services to employers and promotes work-based training.
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Highlights of Reforms to the Public Workforce
System under the Act
 Provides access to high quality training
 Enhances workforce services for the unemployed and other job
seekers.
 Improves services to individuals with disabilities.
 Makes key investments in serving disconnected youth and other
vulnerable populations, including Native Americans and Migrant and
Seasonal Farmworkers.
 Increases the performance and quality of the Job Corps program.
 Reinforces connections with Registered Apprenticeship.
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Provisions Related to Disability
WIOA increases individuals with disabilities’ access to high
quality workforce services and prepares them for competitive
integrated employment.
 One-Stop career centers will provide physical and programmatic
accessibility to employment and training services for individuals with
disabilities and implement new Section 188 (non-discrimination)
requirements related to:
– functions of the local boards.
– local plan content.
– certification, at least every three years, of the One-Stop career centers to
include an assessment of physical and programmatic accessibility in accordance
with Secton188.
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Provisions Related to Disability
 The unified state plan must include all the core programs,
including Vocational Rehabilitation (VR) and Adult Education.
Among the requirements for the unified state plan is to:
– describe how the one-stop delivery system will comply with
Section 188 (non-discrimination) regarding physical and
programmatic accessibility of facilities, programs, services,
technology, and materials for individuals with disabilities.
 Youth with disabilities will receive extensive pre-employment
transition services so they can successfully obtain competitive
integrated employment.
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Provisions Related to Disability
 Supports disconnected youth, of which youth with
disabilities comprise a high percent, by:
– Requiring local areas to increase percentage of youth formula
funds used to serve out of-school youth to 75% versus 30%
under WIA.
– Requiring local areas to spend at lest 20% of youth formula
funds on work experience activities.
– Providing additional allowable activities including financial
literacy education and entrepreneurial training.
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Provisions Related to Disability
 State vocational rehabilitation agencies will set aside at least 15%
of funding to provide transition services to youth with
disabilities.
 Local workforce development boards may designate a standing
committee to:
– provide information and assist with operational and other issues
related to compliance with non-discrimination and applicable
accessibility requirements.
– provide input regarding appropriate training for staff on these
issues.
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Provisions Related to Disability
Establishes a committee to advise the Secretary of
Labor on strategies to increase competitive
integrated employment for individuals with
disabilities.
– Includes Office of Disability Employment Policy, Wage
and Hour Division, and ETA.
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Technical Assistance Tools and Resources
 Department of Labor
–WIOA Resource Page (www.doleta.gov/WIOA)
–WIOA Dedicated Email ([email protected])
 Department of Education
–Office of Career, Technical, and Adult Education’s WIOA
Resource Page (http://www.ed.gov/AEFLA)
–Rehabilitation Services Administration’s WIOA Resource Page
(http://www2.ed.gov/about/offices/list/osers/rsa/wioareauthorization.html)
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Settlement agreement – Rhode Island
People will be provided services to introduce them to work in integrated settings
Annual Person-Centered planning (from age 14) will include opportunities for integrated work
and post-secondary work in integrated settings and no later than the school year of 18th year will
be offered supported employment and integrated day services.
The state will no longer provide placement or funding for new clients in sheltered workshops.
The State will provide career development plans
Benefits counseling will be provided and supported employment and integrated day services
placements
All planning presumes capacity for integrated work.
Anyone who chooses a sheltered workshop, enclave, mobile work crew, internship, facility
based program, etc must complete vocational assessment, complete one work trial, receive
education and outreach,
If you choose segregated services…
Anyone who chooses a sheltered workshop, enclave, mobile work crew,
internship, facility based program, etc must:
complete vocational assessment,
complete one work trial,
receive education and outreach,
receive benefits counseling,
reassessed in 180 days and annually thereafter
Integrated Day Services
When not in supported employment or other integrated work (within a 40 hour
week) the services will be:
individualized,
flexible,
include group and non-group setting,
tailored to their interests,
abilities and goals,
not provided as part of the sheltered workshop services, day program, group
home, or other residential setting.
ADA & Rehab Act…
Oregon unnecessarily segrated PWD in sheltered workshop, violated:
 ADA Sec 2 (discrimination on the basis f disability by public entities) and
 the Rehab Act. (discrimination on the basis of disability by entities that receive
federal financial assistance)
Oregon, The Feds Charge…
Sheltered workshops are by definition segregated.
Oregon has created an expectation for sheltered work
Supported Employment is an effective integrated work program but the state
failed to provide “meaningful access” to SEP but over relies on Sheltered Work.
Workshop continues historic isolation of PWD.
The court agreed that the integration regulation extends to employment
Burdensome criteria and methods of administration for selection of SEP
Violated LRE requirements in transition planning in IDEA
Findings…
52% earn less than $3
61% People in Sheltered work/16% SEP etc
57% hours in Sheltered Work/ 10% in SEP etc
Sheltered Work increased Sep etc. declined
71% facility based programs
Schools are operating sheltered work and transitioning students to adult
sheltered work
It costs Oregon 3 times as much to support PWD in Sheltered worked as
opposed to SEP