1. CHANGES IN THE DD SYSTEM Lake County Board of DD/Deepwood Broadmoor School to Work Transition Meeting March 15, 2016

2. CMS Rule Change and Future Systems Redesign Effective March 17, 2014, CMS Rule change became effective – Identifies the characteristics of home and community based services (HCBS) settings – Identifies settings that are not home and community based – Outlines timelines for states to submit transition plans to the Centers for Medicare and Medicaid Services (CMS) to ensure compliance

3. HCBS Characteristics Integrated in and supports full access to the greater community Selected by the individual among setting options including non-disability specific settings Ensures the rights of privacy, dignity and respect, and freedom of coercion/restraint Optimizes, but does not regiment, individual initiative, autonomy, and independence in life choices Facilitates choice in services and who provides them

4. Settings not HCBS Nursing Facilities Institutions for mental disease Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) Hospitals Any other setting with the qualities of an institutional setting

5. Institutional Qualities Located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment Located in a building on the grounds of or adjacent to a public institution Any other setting that has the effect of isolation individuals from the broader community UNLESS determined through heightened scrutiny that the setting does not have institutional qualities and does have home and community based qualities

6. Coming into Compliance DODD priorities Making sure providers submit plans for compliance Visiting locations to see how providers are implementing compliance plans Working with individuals/providers to gather evidence to send to CMS for heightened scrutiny to show how settings do have home and community based characteristics

7. Coming into Compliance Making sure county boards help individuals find new settings and/or providers if relocation from a day or residential setting is required

8. Common Questions Does this mean that all current day programs have to close? – No. The Rule requires that all individuals, regardless of where they receive services, must have the opportunity to participate in community-based activities to the greatest extent possible. As a result, existing providers of day services may need to change how services are offered in order to comply with the rule.

9. Common Questions Does participating in “community-based activities” mean that the existing facilities cannot be used and that everyone must spend the entire day in other community- based places? – No. Each person’s level of participation in community based activities will be determined through the person-centered planning process.

10. Common Questions Does the new rule require everyone to work? – No. The new rule requires everyone to have access to the broader community to the same extent as people without disabilities, including opportunities for employment. Some people don’t have enough information about working to know if they want to or not For some, work is not a priority

11. Common Questions The new services are being designed to give people who want to work the opportunity to do so and also to offer other services they may enjoy when not working.

12. Common Questions Will people get fewer hours of service than they do today if they don’t want to participate in community-based activities 100% of the time? – No. A fundamental principal of the employment and day service redesign was that individuals will have the same level of service/support available under the new services as they do today.

13. Common Questions Will people be able to keep their current providers? – People who are currently receiving day services from private providers will be able to continue working with those providers, as long as: the current Provider maintains certification to provide adult day array services the setting in which the services are provided meets the rule requirements

14. Questions?

15. Conflict Free Case Management What is conflict free case management? – DODD states that due to a provision in the rule that prevents providers from also being responsible for case management activities, individuals enrolled on a Waiver will not be able to receive both SSA (case management) and day services from the county board. – DODD has asked CMS for the ability to transition services from boards to private providers by March 2024.

16. Conflict Free Case Management – However, County Boards through the Ohio Association of County Boards continue to challenge this provision citing the fact that Free Choice of Provider needs to include all Providers, including County Boards – Conflict Free Case Management is not a new issue and had successfully been addressed in the past with a “firewalls” document that ensures a separation of the case management services (SSA) from the services that are provided under HCBS Waivers. – Work continues on this issue

17. Coming into Compliance The Department is proposing to adopt a new rule that establishes standards to ensure that Medicaid Home and Community-Based Services waivers administered by the Department maximize opportunities for enrolled individuals to access the benefits of community living and receive services in the most integrated setting: – 5123:2-9-02 (Home and Community-Based Services Waivers - Ensuring the Suitability of Services and Services Settings) 5123:2-9-02 – Went to Public Hearing March 10, 2016 with the intent to adopt the Rule.

18. Coming into Compliance Current Adult Day vs. Proposed Adult Day Waiver Services Waiver Services Now: Adult Day Support Vocational Habilitation Supported Employment Enclave Supported Employment Independent Proposed: Adult Day Support Vocational Habilitation Career Planning Group Employment Supports Individual Employment Supports

19. Coming into Compliance The idea is to start into an 8 year plan consisting of two waiver cycles which will begin on 10/1/2016. – The first four year period will be viewed as a bridge building period so that the system is truly ready to move to outcome based payments and integrated community supports by the second four year period. – The Supported Employment Leadership Network (SELN) will be brought in to assist with backward planning for the second four year period.

20. What Will Look Different The new Adult Day Waiver Services propose to: – Include a Community Integration add-on rate – Include a Behavior Support add-on rate – Include a Medical Support add-on rate Purpose is to ensure individuals have access to community integrated activities in a safe manner and to reduce individual barriers to accessing the community

21. Questions?

22. U.S. DEPARTMENT OF LABOR THE WORKFORCE INNOVATION AND OPPORTUNITY ACT (WIOA) – President Barack Obama signed WIOA into law on July 22, 2014. – WIOA is designed to help job seekers access employment, education, training, and support services to succeed in the labor market and to match employers with the skilled workers they need to compete in the global economy.

23. THE WORKFORCE INNOVATION AND OPPORTUNITY ACT (WIOA) WIOA authorizes key employment and training programs and the American Job Center (referred to as One-Stop Center in the law) service delivery system to help workers acquire the tools and skills they need to be successful and to connect employers to the skilled workers they need. WIOA aligns the “core” programs to provide coordinated, comprehensive services. The core programs are: – (1) Adult, Dislocated Worker and Youth formula programs administered by DOL; – (2) the Adult Education and Literacy programs administered by the Department of Education (ED); – (3) Wagner-Peyser Employment Service program administered by DOL; and – (4) the programs under title I of the Rehabilitation Act that provide services to individuals with disabilities administered by the ED.

24. THE WORKFORCE INNOVATION AND OPPORTUNITY ACT (WIOA) Q. How does WIOA improve services to individuals with disabilities? WIOA promotes better alignment of the Adult, Dislocated Worker and Youth formula programs with vocational rehabilitation state grant programs carried out under title I of the Rehabilitation Act to help provide comprehensive services to individuals with disabilities. WIOA makes important amendments to the employment grant programs under the Rehabilitation Act to emphasize entry into and retention in competitive integrated employment for individuals with disabilities.

25. THE WORKFORCE INNOVATION AND OPPORTUNITY ACT (WIOA) The Act strengthens collaboration of vocational rehabilitation agencies with employers. The Act requires at least 15% of the funding to state vocational rehabilitation agencies to provide pre-employment transition services to support youth with disabilities in transition from secondary school to post-secondary school and employment. At the Federal level, WIOA requires that the Secretary of Labor establish an advisory committee focused on increasing competitive integrated employment for individuals with disabilities.

26. THE WORKFORCE INNOVATION AND OPPORTUNITY ACT (WIOA) Q. How does this effect me or my family member? – July 22, 2016, restrictions go into effect on placement of youth age 24 or younger in center- based commensurate wage (sub-minimum wage) programs We are still awaiting Federal regulations, but basically all people looking to enter into sub-minimum wage program must have attempted and been unsuccessful with vocational rehabilitation for competitive employment.

27. THE WORKFORCE INNOVATION AND OPPORTUNITY ACT (WIOA) This would typically mean that they have applied for Vocational Rehabilitation, had 2 trial work experiences and was determined “unable to benefit from VR services.” The individual/family would receive a letter from Opportunities for Ohioans with Disabilities (OOD), which we’re assuming would be the documentation needed in order to enter into a sub-minimum wage program at age 24 or younger.

28. THE WORKFORCE INNOVATION AND OPPORTUNITY ACT (WIOA) – Also, a requirement goes into effect that those over age 24 receive annual counseling and information about opportunities for competitive integrated employment. Q – Does this mean my child cannot go into a non-work adult day program under the age of 24? – No. WIOA has nothing to do with non-vocational adult day services.

29. THE WORKFORCE INNOVATION AND OPPORTUNITY ACT (WIOA) – WIOA only applies to earning sub-minimum wage The theory being that if you are entering into a sheltered workshop it is because you have an eventual goal of community employment. Attempting community employment should then be your first option, and if that is not possible, you would need voc-habilitation or sheltered (sub- minimum) work to help train/prepare for eventual community or competitive employment.

30. Questions?