1. Division of Developmental Disabilities Developmental Disability Services in Nebraska – Now & In the Future For adults and children with intellectual and related developmental disabilities

2. Eligibility for DD Services DD Services are voluntary – they are not an entitlement like educational services Anyone can request eligibility determination through their local DD office Follows statutory definition of developmental disability in accordance with the Developmental Disabilities Services Act (DDSA) § 83-1201 to § 83-1226 2

3. Eligibility (continued) § 83-1205. Developmental disability, defined. Developmental disability shall mean: 1. Mental retardation; or 2. A severe, chronic disability other than mental retardation or mental illness which: a. Is attributable to a mental or physical impairment other than a mental or physical impairment caused solely by mental illness; b. Is manifested before the age of twenty-two years; c. Is likely to continue indefinitely; and 3

4. Eligibility (continued) d. Results in: i. In the case of a person under three years of age, at least one developmental delay; or ii. In the case of a person three years of age or older, a substantial limitation in three or more of the following areas of major life activity, as appropriate for the person's age: (A) Self-care; (B) Receptive and expressive language development and use; (C) Learning; (D) Mobility; (E) Self-direction; (F) Capacity for independent living; and (G) Economic self- sufficiency. 4

5. Eligibility (continued) Once eligibility is determined, a date of need is requested Individuals are put on the registry (aka the waiting list) until funding is available or they meet the criteria to become a priority for emergency funding If the individual is over age of 21 and has graduated from a Nebraska high school on or before September 6, 1993, day services are automatically funded according to § 83-1216 5

6. Home and Community Based Services (HCBS) Waivers 1915 (c) Waivers are DDDs policy documents, they define the services which allow Nebraska to collect federal matching dollars A HCBS Waiver is a waiver from institutional care. To be eligible to be on a Waiver, an individual has to meet ICF/MR level of care requirements ICF/MR level of care and DD eligibility are NOT the same, so some individuals may have state only funded services Regardless of funding source, all DD services are the same 6

7. 7 DDD Currently Manages Five Waivers Adult Day (DDAD) Assisted Day – prevocational workshops and some workstations Supported Day Supported Employment Adult Residential (DDAR) Assisted residential Supported residential Adult Comprehensive (DDAC) Community Supports Program (CSP) For Children and their Families Assisted = All the time Supported = Some of the time

8. 8 Adult Day, Residential & Comprehensive Offers a combination of specialized services Residential habilitation services Traditional group homes or extended family homes (continuous support), intermittent in-home support. Day habilitation services Vocational planning, integrated community employment, workstations, prevocational workshops. Respite for families Team behavioral consultation

9. 9 Community Supports Program Offers non-specialized supports provided by independent providers, people hired by the individual and their family – job coaches, companions, and housekeepers that are your neighbors, college students, friends, etc. Community living and day supports PERS Respite for families Assistive technology and supports Home modifications Vehicle modifications

10. 10 Community Living and Day Supports Supports to access the community Supports to maintain or obtain employmentnot in specialized provider-operated settings Supports to access services and opportunities in community Supports to assist the individual to develop self-advocacy skills Supports to assist the individual in identifying and sustaining a personal support network of family, friends, and associates Household activities necessary to maintain persons home living environment on a day to day basis Home maintenance activities (personal living space) Assistance with hygiene, bathing, eating, dressing, grooming, toileting, menstrual care, transferring, or basic first aid

11. 11 DDDs Focus on Employment In April 2010, DDD got approval from CMS to amend current adult waivers to redefine supported day and supported employment services. New services included: Vocational Planning Integrated Community Employment (ICE)

12. DDDs Focus on Employment (continued) Focus on community integration, activities and job experiences in the community Provides graduates with more options to live and work in their community Funds more job training activities Allows for in home job searching activities Allows for home-based businesses 12

13. A Sneak Peak… 13 The adult day, residential and comprehensive waivers expire on 12/31/2010 Renewals were submitted to CMS in September 2010 Our current five waivers will become three waivers upon approval of the renewals Individual Budgets with a menu of services Individuals will have more flexibility and options Will be implemented January 1, 2011

14. 14 Individualized Budget Amounts Separately authorized monthly allocated amounts for day and residential services will be converted into one annual amount for participants to choose the services that meet their goals and preferences Individuals can budget their year and flex the amount they spend from month to month

15. 15 A Menu of Services The 4 adult waivers will become two by: Adding community support (non-specialized) services to all adult waivers, eliminating annual cap on CSP services as well as the cap on rate for services Transitioning CSP participants to the comprehensive waiver and residential waiver participants to the comprehensive waiver Terminating CSP and DDAR waivers

16. 16 A Menu of Services (continued) Adding more specialized services to the two adult waivers Retirement services Medical risk services Behavioral risk services Going from four service definitions to nineteen – most already exist but were grouped together in either assisted or supported services

17. 17 Questions? Tricia Mason, Administrator Community-Based Services Division of Developmental Disabilities Department of Health and Human Services 402-471-8704 tricia.mason@nebraska.gov