Randy Costales Executive Director, The Arc of New Mexico 1

 Designed to assist in the service planning process for the individual, parents, family members, and service providers.  Outlines the type and intensity of support the individual would benefit from to participate and be successful in his or her community.  Best applied in combination with person-centered planning to achieve the desired outcome in creating individual goals. 2

 SIS Score used to assign individuals to budget categories with caps  Some individuals were denied services that they needed simply based on the scores they get through the assessment instrument  Reductions or denials of services based simply on SIS test scores and assigned budget categories put the health and safety of some individuals at risk. 3

 Pre- Assessment Issues – Information, Scheduling, etc.  SIS Assessment  Verification Process  Algorithm (Developed by HSRI)  Standard Score  Group Assignment (Developed by NM DOH/DDSD)  Case Manager  Individual/Guardian/Parent 4

 Base Budget – Case management, living arrangement, day services including employment and customized community supports.  Professional Services Budget – Physical, Speech, Occupational and Behavioral Therapies  Other (need prior authorization) 5

 A. Mild support needs and low to moderate behavioral challenges  B. Low to moderate support needs and behavioral challenges  Note: Budgets for Groups A and B do not include living arrangements 6

 C. Mild to above average support needs and moderate to above average behavioral challenges  D. Above average support needs and low to moderate behavioral challenges  E. High support needs and mild to above average behavioral challenges 7

 F. Extraordinary medical challenges  G. Extraordinary behavioral challenges  H Policy - P urpose of policy is to allow individuals who have extenuating circumstances or extremely complex needs to receive authorized services beyond the service package option that corresponds with their Group assignment. 8

 State restricted the ability of clients and families to appeal decisions that affect the services they receive.  State imposed restrictions on what can be appealed and when it can be appealed violate federal law governing Medicaid. 9

 Filed by eight individuals/families, The Arc of NM and Disability Rights NM  To stop state from using SIS to arbitrarily deny people with developmental disabilities the essential services they need and putting their health and safety at risk.  Challenged state regulations, policies, standards, and practices that deny DD Waiver participants due process of law and that otherwise violate federal law 10

 To prohibit further implementation of recent state regulations, policies and practices until such time as the state can fix the problems identified in the complaint.  To restore services to individuals that had been cut as a result of the new system, and prohibit any further service reductions until the violations of federal law have been corrected 11

 August 18-19, Hearing held in Federal District Court  March 10, 2015 – Judge issued preliminary injunction in plaintiff’s favor  Defendants and plaintiffs are currently working together to settle the case 12

 Not opposed to use of the SIS as an assessment tool. It is a highly regarded, national model for assessing individual’s needs.  It was not intended to be a tool for establishing budgets, or for dictating how much of a particular therapy a person needs or should receive. 13

 Service plans should be individualized and take into account not only test scores but past experience and the independent judgment of the multi-disciplinary team that works with the individual.  Some individuals may be determined to need a lesser amount of services than previously received.  Everyone who is facing a reduction in services is entitled to appeal the decision, to make sure that it is appropriate in their circumstances and that the rules were followed. 14

 Randy Costales  15