1. 2008 Waiver Renewals: Community Pathways & New Directions SMRO Provider Meeting Catriona Johnson Asst. Director for State & Federal Relations Maryland Developmental Disabilities Administration (DDA)

2. Status of Waiver Renewals Changes to DDA waivers contained in this document are pending CMS approval. Further information will be available following waiver renewal approvals.

3. Themes Person-Centered Approach Expansion of service options Focus on Quality Systems Change and Strategic Planning

4. Resource Coordination Strengthened with addition of language : –Developing a person-centered plan using Essential Lifestyle Planning, Personal Futures Planning, MAPS, PATH, or an equivalent person centered planning tool.

5. Employment Discovery & Customization Time-limited assessment, discovery, customization, and training activities to assist an individual in gaining competitive employment at an integrated job site where the individual is receiving comparable wages, and where most of the employees do not have disabilities. Include but are not limited to: community-based situational assessments; job development; job and task analysis activities; job training; work skill training; modification of work materials, procedures, and protocols; training in social skills, acceptable work behaviors and other skills such as money management, basic safety skills, and work-related hygiene. May be provided for up to 3-months period; additional monthly increments must be preauthorized by the DDA.

6. Community Learning Services Provide an alternative to facility-based Traditional Day Habilitation services for individuals currently unable to work be it due to their disablility, age, or circumstances. Support individuals to be involved in activities in integrated community settings that improve their communication, social skills, health, and employability. Except in the case of self-advocacy groups, must be provided in community settings with nondisabled individuals, and in groups of no more than 4 individuals with developmental disabilities all of whom have similar interests and goals as outlined in their person-centered plans and/or Individual Plans.

7. Community Learning Services Designed to create meaningful days for individuals, and are specific, individualized and goal oriented services. Assist individuals in developing the skills and social supports necessary to gain employment; promote positive growth, and; provide activities, special assistance, support, and education to help individuals whose age, disability, or circumstances currently limits their ability to be employed and participate actively in their community. Services are highly individualized and can include, but are not limited to: self-determination/self-advocacy training; workshops and classes; peer mentoring; volunteer activities; activities that promote health, socialization, etc. Progress towards the individual’s employment goals will be assessed on an ongoing basis and reviewed annually or with greater frequency at the request of the individual and/or their family/guardian.

8. Medical Day Care No longer a Medicaid State Plan service All waivers serving adults added MDC as a waiver service Licensing and payments still done by Medicaid Medical eligibility (nursing facility level of care) continue to be conducted through Medicaid contractor Will be process of ensuring those currently in MDC have it in their IP More information forthcoming on process for those entering service

9. CSLA I Includes, but is not limited to, physical, cognitive, communication, and behavioral supports; supervision and training; supports to ensure health and safety, including nursing services and medication administration; the maintenance and cleaning of adaptive devices; provision of 24-hour emergency assistance; and engagement in activities to improve social skills. Includes those services necessary to effectively link individuals with his/her community (community integration). Typically characterized by an effort to teach skills through cueing/prompting, the making of ongoing adaptations and modifications towards the goal of greater independence and community integration, and/or supervision to address individuals’ health and safety needs. Individuals receiving CSLA I services must require supports beyond physical assistance with activities of daily living.

10. CSLA II Assistance that enables the waiver participant to accomplish tasks they are unable to perform independently due to a physical disability. Refers to hands-on assistance specific to the functional needs of a participant with a physical disability and includes assistance with activities of daily living. ADLs include: bathing and completing personal hygiene routines; toileting; mobility, including transferring from a bed, chair, or other structure and moving about indoors or outdoors; moving; turning, and positioning the body while in bed or in a wheelchair; eating and preparing meals, and; dressing and changing clothes. CSLA II is provided to individuals requiring that another person physically perform the activity for the participant or physically helps the participant to perform the activity. Process of changing IPs during annual IP meetings

11. Live-In Caregiver Rent Rent for an unrelated personal caregiver who is residing in the same household with an individual and providing Community Supported Living Arrangements (CSLA) in the individual’s home. Live-in Caregiver Rent must be approved by DDA based on the following: –1) Within a multiple-family dwelling unit, the actual difference in rental costs between a 1 and 2-bedroom (or 2 and 3-bedroom, etc.) unit. Rental rates must fall within Fair Market Rent (FMR) for the jurisdiction as determined by the Department of Housing and Urban Development (HUD). –2) Within a single-family dwelling unit, the difference in rental costs between a 1 and 2-bedroom (or 2 and 3- bedroom, etc.) unit based on the Fair Market Rent (FMR) for the jurisdiction as determined by the Department of Housing and Urban Development (HUD). Prior authorization for this service is required before service initiation.

12. Community Pathways Only – Community Acclimitization Services that allow an individual residing in an ICF/MR or other congregate setting the opportunity for short-term overnight stays with the community provider they have identified as their service provider upon leaving the ICF/MR or other congregate facility. Community Acclimitization may be provided for a maximum of 7 overnight stays within the 60 day period in advance of their move and is an opportunity for the individual to experience community life and for the provider to learn about and form a relationship with the individual.

13. New Directions Only – CSLA I & II Retainer Fees CSLA I & II Retainer Fees: allow providers to be reimbursed to support waiver participants during a hospitalization not to exceed a total of 21 days annually per individual.

14. New Directions Only – Risk Pool New Directions Risk Pool: Retention of unspent state funds for a period of 12 months as part of a Risk Pool for ND participants. For short-term emergency (affecting health or safety) needs

15. Quality Both waivers include specific quality measures related to Waiver Assurances For example, measures related to –Provider Quality Plans –Provider Independent Audits –Provision of services (CSLA audits) –Physician visits –Ask Me! DDA will provide an annual report to Medicaid with data on all quality measures and will track progress towards goals from year to year

16. Watch for…. Guide to Changes in the Community Pathways and New Directions waivers, including: –Service descriptions –Rate information Regulations

17. Questions & Comments