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Supporting Individual Success For People with Intellectual Disabilities & Autism Human Services Research Institute 7690 Mohawk Street Tualatin, OR 97062 (503) 924-3783 www.hsri.org Yoshi Kardell Ykardell@hsri.org
3 Supporting Individual Success Overview for Case Managers Introduction to Supporting Individual Success Resource Allocation Process Support Need Levels Service Packages & Individualized Budgets Assisting Individuals, Families & Providers Milestones Questions
Office of Aging & Disability Services (OADS) is committed to ensuring that: People with intellectual disabilities & autism get the services & supports they need to live self fulfilling and productive lives and pursue their life aspirations just as others do in their community. Introduction 4 What OADS is trying to do & why
This commitment requires us to establish a person-centered system that emphasizes that: People with intellectual disabilities & autism be in charge of their lives as much as possible. People with intellectual disabilities & autism have opportunities to use resources in ways that enhance their lives & help them participate in their communities. A shared responsibility for the wise use of public dollars & the contribution that people with intellectual disabilities & autism, & their families can make. That the system is managed in a way that is efficient & fair to everyone, including those receiving or waiting for services. Complementing Commitments Introduction 5
1.Build on the successes we’ve achieved, 2.Be willing to change some of how & what we’ve been doing, and 3.Balance our best intentions with a fairer & efficient use of the dollars we have. Moving Forward Introduction 6 Making the changes we anticipate will require us to:
Resource Allocation Process 7 Overall the process involves An assessment is used to assist with establishing individualized budgets. This also provides a way for policy makers to make fiscal choices that are fair & predictable, but also makes the best use of available money that’s consistent with driving system principles. Allocating resources to people based on their assessed level of need. Each person receives what they need. Establishing a best fit solution for most but taking care to accommodate individuals with extraordinary needs.
Supports Intensity Scale ® (SIS) The SIS is the standardized assessment tool and measures the level of support a person needs Approximately 2,477 have been completed (as of July 22, 2014) OADS contracted with third party to conduct SIS interviews Important for members to be a part of the SIS interview to the extent possible In some cases, supplemental questions may be asked for individuals who experience medical or behavioral challenges Resource Allocation Process 8
SIS results may be used to inform service planning but not necessarily to drive planning. The SIS interview may encourage participants to discuss topics they might not ordinarily talk about. Valuable personal or habilitation goals may lay outside the bounds of the SIS interview. Upcoming training on SIS informing person-centered planning. Service Planning Resource Allocation Process 9
Resource Allocation Process 10 Developing Levels & Budgets Sample Assess & Levels Services & Rates Residence Service Packages Validate 1.Design a random stratified sample for each targeted subpopulation. 2. Assess needs using the Supports Intensity Scale (SIS) & assign individuals to Levels fit to Maine’s service system. 3.Consider where people live. 4.Settle on the service array & reimbursement rates.
Resource Allocation Process 11 Developing Levels & Budgets 5.Build service packages by Level based on common support needs and living situation. Base budgets include in home, residential, employment, and day services. Some services are managed outside the base, including professional or non-recurring supports. Utilization of services by level is anticipated. Service packages are determined by level to establish individualized budgets. Individuals are not tied to anticipated service packages. Resource allocation does not limit person-centered choices, but sets a budgetary limit. 6.Systematically validate the service packages & make revisions as needed.
Resource Allocation Process 12 Supporting Policies Person-centered planning SIS administration and reassessments, reassessment for a major life change Supplemental questions & verification process Extraordinary support needs review Grievance & appeal processes
Budgets vary according to levels that group people from least to highest support needs. Each level represents a certain amount of money for services. In some cases other services can be added on to get a higher personal budget allocation. Processes are implemented to address exceptional needs. 1 2 3 4 5 1 2 3 4 5 Base Budgets Per Level Low Support Needs High Budget Allocation Five Level Model Support Need Levels 13
Support Need Levels 14 LevelDescription 1 Low support need, including little to no support need for medical & behavioral challenges. Supports are typically intermittent rather than 24 hours a day, 7 days a week (24/7). 2 Moderate support needs & little to no support need for medical & behavioral challenges. Although more support than those in Level 1, needs are minimal in a number of life areas. They may also receive intermittent daily support than 24/7. 3 Low to moderate support needs as in Levels 1&2; also above average, non- extensive support need due to behavioral challenges ; or Above average support needs & up to above average, non-extensive support need due to behavioral challenges. 24/7 supports may be needed due to the nature of their support needs. 4 High to max support needs; or significant support needs due to medical condition. Additional 24/7 supports may be needed due to the nature of their support needs. 5 Significant behavioral challenges, regardless of their support need to complete daily activities or for medical conditions. May need enhanced 24/7 supports due to their behavioral challenges. Maine’s Support Levels
Building Service Packages SIS Level Residential Setting + Day Services (unit/rate) (unit/rate) = Base Budget Service Packages & Individualized Budgets 15 1234512345 Agency Home Support Family-Centered Support Shared Living Home Support/ Non-Residential Community Support Work Support Note: Other services (such as therapies, career planning, employment specialist services and assistive technology) are authorized in addition to individualized budgets.
Proposed Section 21 Individual Budgets Maine Office of Aging and Disability Services, Section 21 Individual Budgets Prepared by Burns & Associates, Inc. http://www.maine.gov/dhhs/oads/disability/ds/sis/documents/Section 21IndividualBudgets.pdf Service Packages & Individualized Budgets 16
Proposed Section 21 Individual Budgets Model Service Packages Service Packages & Individualized Budgets 17 Note: The model service packages are not limits for individual services; members will be able to select services they want within their individual budget. The proposed rate model for Agency Home Support includes a 15-day absence factor, allowing providers to earn a full-year of revenue in 350 billing days. Members will have access to 365 days of service.
Proposed Section 21 Individual Budgets Model Service Packages Service Packages & Individualized Budgets 18
Assessed Need & Level Assignment Service Array, Rate Schedule, & Expected Service Use by Level Individualized Budget Allocation Service Plan & Service Delivery Remember- What outcomes are sought? For people? For systems? Assisting Individuals, Families, & Providers 19
Most Important Right Now No changes to services at this time Information about level assignment is for review only OADS is seeking input during comment period (ends September 1, 2014) OADS@maine.govOADS@maine.gov Based on review and public comments, changes may be made Implementation process will occur over the next year with a planned implementation of July 1, 2015 Information posted to OADS website : http://www.maine.gov/dhhs/oads/disability/ds/sis/index.shtml Assisting Individuals, Families, & Providers 20
Milestones 21 1.Initial Informal Comment Period 2.State Public Notice & Comment period 3.Final Regulations Promulgated 4.Waiver Comment Period 5.Waiver Submission to CMS 6.CMS Waiver Approval 7.Begin Implementation & One Year Phase-In System Perspective
Individual Perspective Milestones 22 From Individual’s Perspective Individuals will be notified of their level assignment & service package Preplanning Discussions PCP Planning Meeting PCP is given to OADS Resource Coordinators Service Begins