Transcript Athens County Stakeholder Meeting OACB’s Mission Mission “To support County Boards of Developmental Disabilities (CBDD) in providing services and supports to people with developmental disabilities.”

Athens County
Stakeholder Meeting
2015
OACB’s Mission
Mission
“To support County Boards of
Developmental Disabilities (CBDD) in
providing services and supports to
people with developmental
disabilities.”
OACB’s Vision
Vision
"To enhance the lives of people with
developmental disabilities."
Agenda

History is important! Where we have been helps us
understand where we are going…

National and state regulations that support a new way of
doing our work

CMS basic requirements of Home and Community Based
Services rule

Person Centered Planning- what is it and what is different
from traditional approach?

Preble county SSAs share examples of what they have
developed and what they are learning
How did we get here?
Drivers of System Change 2015
Olmstead Decision:
•Community Integration
Director Martin:
•Improved efficiency &
effectiveness
•Define our future before
others define it for us
Free Choice of
Employment First:
Provider:
•Community Employment
•Privatization
•Future of adult day services
Economic Challenges:
•Increased enrollment
•Stagnant or declining
revenue
Persons
Served
Sub Minimum Wage:
•Future of sheltered
workshops
Other:
•Public schools now
serve people with DD
•Self determination
Families
of
Persons
Served
Private
Providers
County
Boards
Ohio Department
of Developmental
Disabilities
Ohio Developmental Disabilities System
Olmstead Facts

In 1999, 2 women with DD and psychiatric
issues.

In state institution; multiple admissions.

Professionals agreed, needs of both could be
met in community setting.

Waited years for community treatment.
Olmstead Facts
 Unjustified
isolation is properly
regarded as discrimination based
on disability.
State of Ohio Evolution of DD Services:
CMS/ Olmstead/DRO/Good Life
1.
People lived at home;
2.
We built institutions;
3.
4.
5.
6.
7.
Became obsessed with
compliance with rules
We started closing them;
8.
Supported living and
HCBS Waivers started;
Person centered planning
pilots started
9.
Self-determination
happened;
We drafted great new Rules
that emphasize PCP;
10.
Employment First happened
11.
CMS rule came out 3/14
We got into trouble with
HCFA/CMS;
42 CFR 441.301
CMS and Day Services:
3/17/2014- Issue Date of New HCBS Rule
Written plan (ISP) reflects:
 Setting is chosen by the individual and is integrated in,
and supports full access to the greater community;
 Opportunities to seek employment and work in
competitive integrated settings;
 Opportunity to engage in community life, control
personal resources, and receive services in the
community to the same degree of access as individuals
not receiving HCBS.
More About the Settings Part of the
CMS Rule

Intended to ensure individuals receiving HCBS services
under a Medicaid Waiver “have full access to the
benefits of community living and the opportunity to
receive services in the most integrated setting
appropriate setting.”

Applies to both residential and day services.

States have 5 years to transition and comply with rule.
The What’s and What Not’s
of the CMS Rule


Facility-based day service
settings and sheltered work
centers will probably be
considered "settings that
isolate;”
Need to show how the
settings are integrated in
and support full access to
the community.

Volunteering

Interning

Taking a class

Learning about careers and
interests

Promotes interaction with
community

Not a disability-specific
program
What does
integration look like?

The same planned activities in the home community
within all of life’s activity domains:
•
•
•
•
•
Work
Volunteer- work on a political campaign, volunteering at soup
kitchen; kennel volunteer
Learning experiences and activities; books on tape; adult
classes; self-help classes
Recreation –having fun/a social life – getting together with
friends, going out; peers get together; movies; gambling; shows;
Shopping
Robin E. Cooper, NASDDDS 3/14
What does
integration look like?

The same planned activities in the home community
within all of life’s activity domains:
•
•
•
•
•
•
Maintain health and wellness – walking; gym membership; diet
groups
Personal care – hairstyling, having nails done,
Maintaining home; maintenance and improvement; cleaning;
laundry
Caring for others; relatives or others
Spirituality: worship; meditation; yoga classes; meeting groups;
sodalities
Hobbies: Pet care – walking the dog
Robin E. Cooper, NASDDDS 3/14
Full Range of
Employment Opportunities

County Boards of Developmental Disabilities have a rich
history in developing and operating many legacy programs,
and will continue to evolve and transform our system based
on what individuals and families expect and demand.

In accordance with the Workforce Innovation and Opportunity
Full Range of
Employment Opportunities

When individuals leave a sheltered experience to try a job in
the community, we want to be a safety net for folks that may
need to return to board services.

County Boards of DD support Ohio’s initiatives in the area of
Conflict Free Case
Management
Conflict Free
Case Management

42CFR441.301(c)(1)(v) and (vi)
•
Includes strategies for solving conflict or disagreement within
the process, including clear conflict-of-interest guidelines for
all planning participants
•
Providers of HCBS for the individual, or those who have an
interest in or are employed by a provider of HCBS for the
individual must not provide case management or develop the
person-centered service plan, except when the State
demonstrates that the only willing and qualified entity to
provide case management and/or develop person- centered
service plans in a geographic area also provides HCBS.
Conflict Free Case Management

County boards helped to develop the current “firewalls”
document many years ago and are eager to remain
partners in the process to define the future of this
document.

State law and administrative rules currently ensure that
the county board of DD system can operate without
conflict and should be enhanced to further ensure conflict
free case management.

Policies and procedures must be put in place to ensure
Free Choice
of Provider
Free Choice of Provider

Service and Support Administrators need the necessary
tools to ensure that individuals and families have useful
information to make informed choices between HCBS
providers.

The words in the CMS regulation are "Willing and Qualified
Provider" to provide services, not "Willing and Able."
Unfortunately, anyone that is certified as a provider of a
specific service is presumed to be "able" to serve an HCBS
waiver recipient. We believe that clarification is needed to
distinguish these important concepts.
Free Choice of Provider

To provide additional safeguards in the provider
selection process, County Boards of DD support
additional state oversight to investigate
complaints or allegations that may potentially
violate HCBS Free Choice of Provider.
Quality Services

County boards should have the authority and
responsibility to recruit providers in a sufficient
number to meet the needs of people served on
HCBS waivers.

Revisions to the County Board of Developmental
Disabilities administration rule and the Free Choice
of Provider rule will enhance this important function.
Quality Services

County Boards of Developmental Disabilities are in the
best position to serve individuals with complex needs when
other private HCBS providers are not qualified or unwilling
or unable.

More authority is needed at the local level to address
Person Centered
Planning
SSA Rule Highlights





Thought Process
Person-centered planning is
mandated;
Monitoring is
individualized;
The whole team has
responsibility;
Informal supports are
primary;
The person drives the
planning process and the
supports.






Required Shift
Move from linear to
expansive;
Find your innovative
spirit;
Allies, not isolation;
Trust;
Embrace creativity
The path less traveled.
The Intention of
Person-Centered Planning
•Improve the social status
of people with disabilities
•Enhance the perception
held of people with
disabilities
•Expand the network of
allies and associations in
people’s lives
History of Change in
Our System
We Have Been Continuously Improving
Less
Discrimination
More Respect
No Respect
Discrimination
System Transformation

While providing integrated services to all of the people
served by County Boards of DD will be an enormous
challenge, with adequate funding, Ohio can make great
strides toward achieving the goal of system transformation.

By incorporating the philosophy of person-centered
planning throughout Ohio’s DD system, County Boards of
DD will be able to define quality for a person receiving
services.
Change is a
door that can
only be opened
from the
inside!
Questions & Answers
Thank you for your
time and attention today!