1. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership Charlie Crist, Governor Jane E. Johnson, Director Matthew Claps, Senior Management Analyst II

2. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership Goals of Presentation: 1) Brief overview of the Agency for Persons with Disabilities 2) Presentation and discussion of APD / DCF / CBC related issues

3. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership As defined in F.S. 393, APD can provide services for the following disabilities: -Mental retardation (76%) -Autism (11%) -Cerebral Palsy (11%) -Spina Bifida (2%) -Prader-Willi Syndrome (1%) Mission Statement: The Agency supports persons with Developmental Disabilities in living, learning, and working in their community. APD administers the following waiver programs: -Home and Community Based Waiver (24,270) -Family Supported Living Wavier (6,100) -Consumer Directed Care + Waiver (1,000) -THERE IS A WAITLIST FOR WAIVER SERVICES – 15,000

4. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership Process for accessing services: Already enrolled into a waiver Waiver Support Coordinator (WSC) works with consumer / family to develop support plan Support plan submitted to prior services authorization for review: Denials can be resubmitted for reconsideration or appealed through DOAH, F.S. 120 Approved (medically necessary) services are authorized. WSC works with family / client to select service providers Service providers begin providing services. Waiver support coordinators providers continued case management. Support plans can be updated upon request, or at least annually. 45 – 90 days to complete * This does * This does not include eligibility determination or waiver enrollment (on average 45 to 90 days)

5. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership APD- Current Issues: A system in change -Projected waiver deficit - Reductions and eliminations of waiver services (SB1124) -development of 4 tiered waiver system -Implementation of new residential habilitation rate structure -Waiver enrollment capped to attrition -Development and implementation of a new assessment process and tool -Currently developing a new strategic plan -threat of managed care Waiver Services Reductions (already implementing) -Supported living coaching -Limited support coordination for those under 18 in a family setting -PCA limited to 180 hrs. per month except for those having intensive medical, adaptive or behavioral needs. (children receive PCA through Medicaid State Plan ) Waiver Service to be Eliminated (December 1 st ) -Massage Therapy -Psychological Testing -Chore, Home-Maker, NRSS

6. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership The Agency For People With Disabilities, The Department of Children and Families and the providers of Community-Based Care must continue to partner to better serve children who have been abused and neglected who also have a developmental disability.

7. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership * Data are as of June 2007 Priority Consideration (F.S. 393.065): APD / DCF / CBC Children - How many? ~ 576 Waiver recipients (1.7% of total waiver population) ~ 393 receiving HCBS ~ 183 receiving FSL Approximately 155 children from DCF/CBCs are on waitlist for waiver services (last enrollment of DCF/CBC children was October 2006) Approximately 15-20 added to waitlist per monthAPD/DCF periodic matching of data to identify dual-clients

8. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership Average DCF/CBC Child HCBS waiver recipient costs $ 32,000 /year Residential habilitation 64%39,000 / year consumable medical supplies 45%$2,000 / year behavioral services (levels I- III combined) 40%$1,800 / year personal care assistance* 7%$ 11,500 / year respite7%$1,500 / year Data are as of FY 06-07 Commonly accessed waiver services: Average HCBS annual cost per DCF/CBC child

9. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership Commonly accessed waiver services: FSL Per DCF/CBC child annual cost DCF/CBC Child FSL waiver service utilization* consumable medical supplies42% behavioral services (levels I-III combined) 31% In-home supports20% respite17% * Due to significant influx of DCF/CBC children into FSL waiver during 06-07 (~150% increase), utilization data is problematic

10. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership Placement Types: Children receiving waiver (HCBS and FSL) services Foster Home Non-Relative118 Group Home75 Developmental Services Group Home74 Therapeutic Foster Home Non-Relative60 In-Home52 Medical Foster Home Non-Relative49 Developmental Services Foster Home Non-Relative48 Residential Treatment Center34 Approved Relative Caregiver22 Approved Non-Relative Caregiver16 Shelter Facility7 Runaway4 Adoptive Home3 DJJ Detention Center more than 12 Children3 Foster Home Relative2 Mental Health Facility up to 12 Children2 Family Shelter Home Non-Relative1 Hospital1 Jail1 Medical Foster Home Relative1

11. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership Guardianship Issues: Confidentiality of records: F.S. 393.13 (4)(j)- Signed releases are necessary for sharing information FS 412.115- APD can share information directly to DCF without confidentiality waiver Signatory Authority: only the parent or legal guardian can enroll a minor for APD services and request / direct cost plan development and service provision

12. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership Ongoing challenges: Opportunities for system development Getting DCF/CBC children APD services: Other than through crisis, new waiver enrollment from the waitlist in FY 07-08 not likely and during FY 08-09 is unknown Local and state-level collaborative resource development: Enhancing service array capacity, with special attention to children with medical complexities and dual diagnoses Shared decision making and collaboration: More clearly defining the roles and responsibilities of multiple case managers (child welfare and waiver support coordinators) along with other child serving agencies. Expectations on speed of systems Transition to adulthood: Ensuring smooth transition as children / youth age out of child welfare system

13. Considering the differences between the organizational perspectives of APD, the larger developmental disabilities system, and DCF/CBCs and the larger child welfare system… How can these systems collaborate to consistently meet the needs and ongoing challenges of mutual system children / youth? Question for discussion:

14. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership Obtaining services & Resource development: Line-item appropriation of new waiver funding or other new waiver funding strategies -Expansion of pre-paid mental health plan to include commonly accessed waiver services -Pursuit of dual-diagnosis waiver -Targeted expansion of deep-end treatment capacity. Shared funding to draw Medicaid match -Collaborative resource development with specialty service providers at local level based on identified needs Shared decision-making and collaboration / transition to adulthood: -Statewide memorandum of understanding for role and expectation clarification coupled with ongoing training and collaboration -The conceptual similarities of basic practice models: Establish key points of contact / working protocols / cross-training and mentoring opportunities to advance best-practice approaches -Ongoing data-sharing - How do we establish a policy and infrastructural framework that provides support while allowing for individuality of case practice? Potential strategies:

15. November 2 nd, DCF Task Force Meeting: APD / DCF / CBC Partnership Matthew Claps, Senior Management Analyst II 4030 Esplanade Way, Suite 380 Tallahassee, Florida 32399-0950 matthew_claps@apd.state.fl.us