1. SUPPORTED LIVING ARRANGEMENTS (SLA) For Developmental Services Presented by: Kate McCloskey, M.A., C.P.M. Manager of Quality Assurance Sierra Regional Center

2. Overview Service offered through the NV 1915 (c) Home and Community Based Waiver Program for IDD, funded through the Center for Medicaid and Medicare Services Serves people with Intellectual Disability or Related Conditions Services are provided on a continuum, based on individual need: Intermittent support services while living in a family home; Intermittent support services while living independently in own home; Intensive 24 hour support services provided: In a private and community based home. The home is rented by the individuals served. They typically share a home with three other individuals. Individually designed habilitative services: Supports to assist in the acquisition, improvement, retention or maintenance of the skills necessary for a person to successfully, safely, and responsibility reside in their community. Staffing is determined based on individual need and not prescribed by regulation.

3. Overview Supports and services may include: Support for health and welfare needs; Supports for ADLs and IADLs Communication skills; Community inclusion and the development of natural supports; Mobility training; Survival and safety skills; Support and teaching of interpersonal/relationship skills; Making choices and problem solving skills; Community living skills; Social and leisure skills; Money management skills; Skill training in health care needs, including medication management.

4. Alternative to Institutional Services Olmstead v L.C. 1999 Unjustified segregation of persons with disabilities (in institutional settings) constitutes discrimination in violation of title II of the Americans with Disabilities Act; The Court held that public entities must provide community-based services to persons with disabilities when (1) such services are appropriate; (2) the affected persons do not oppose community- based treatment; and (3) community-based services can be reasonably accommodated, taking into account the resources available to the public entity and the needs of others who are receiving disability services from the entity.

5. CMS & Community Based Settings Requirements Integrated settings that support full access to the community: Competitive employment opportunities Engage in community life Control personal resources Receive services in the to the same degree of access as individuals not receiving Medicaid HCBW services The setting is selected by the individual from among setting options including non-disability specific settings and an option for a private unit in a residential setting

6. CMS & Community Based Settings Requirements The setting options are identified and documented in the person-centered service plan and are based on the individual's needs, preference's and for residential settings, resources available for room and board; Ensures an individual’s rights to privacy, dignity, respect, and freedom from coercion and restraint Optimizes individual initiative, autonomy, and independence in making life choices Facilitates individual choice regarding services and supports and who provides them

7. CMS & Person Centered Planning Requirements The person centered planning process is driven by the individual & includes people chosen by the person; Provides necessary information and support to the individual to ensure that the individual directs the process to the maximum extent possible Reflects cultural considerations/uses plain language Offers choices to the individual regarding services and support the individual receives and from whom

8. CMS & Person Centered Planning Requirements Must reflect what is important to the individual to ensure delivery of services in a manner reflecting personal preference and ensuring health and welfare Identifies the strengths, preferences, needs, and desired outcomes of the individual Includes individually identified goals and preferences related to relationships, community participation, employment, income and savings, healthcare and wellness, education and others

9. CMS & Person Centered Planning Requirements Written plan reflects – Setting is chosen by the individual and is integrated in, and supports full access to the greater community Opportunities to seek employment and work in competitive integrated settings Opportunity to engage in community life, control personal resources, and receive services in the community to the same degree of access as individuals not receiving Medicaid HCBS

10. Regulations, Policies and other Requirements for SLA Services Nevada Law (NRS & NAC 435; NRS 433) ADSD Policy Developmental Services Policy Developmental Services Standards for the Provision of Supported Living Services Nevada Medicaid Standards Centers for Medicare and Medicaid Services (CMS) Standards for the Home and Community Based Waiver Federal Code of Federal Regulations

11. NRS & NAC 435 Provides Developmental Services legislative authority to certify all Home and Community Based Waiver providers of Supported Living and Jobs and Day Training Services; Provides Developmental Services legislative authority to investigate any complaint or allegation of abuse, neglect or exploitation of a person receiving SLA or JDT services through Nevada Developmental Services;

12. Oversight of SLAs Comprehensive certification process for Provider Organizations of supported living service. DS certifies the organization, not the home; Administrative Outcomes Personnel/Staff Outcomes Individual Outcomes Certification review will assess the provider’s compliance with DS standards for the provision of supported living services; Providers are graded based on the compliance percentage: A= 92-100% (3 yr)B=83-91.9% (2yr) C=74-82.9% (1 yr w/POC) Automatic sanction (up to termination) and POC w/validation review, for below scores: D=65-73.9% D=65-73.9% F=64.9% or below

13. Oversight of SLAs DS conducts annual reviews of each 24 hour supported living arrangement, in addition to the comprehensive certification review. Service Coordinators have monthly home visits to all 24 hour supported living arrangements. Service Coordinators have quarterly face to face contacts with all HCBW participants. DS conducts investigations into all allegations of abuse, neglect, exploitation: Provider investigation DS Investigation Division Investigation

14. DS Standards Standards are broken down into 5 categories: Administrative Standards Personnel Standards Internal Quality Assurance Standards Incident Reporting & Abuse, Neglect Exploitation Complaints & Grievances Emergency Preparedness/Safety and Environmental Standards Assurances of Primary Health Care Assurances of Fiscal Accountability Individual Finance Outcomes Organizational Financial Accountability General Standards Dignity & Respect Behavioral Support Person Centered Planning Community Based Services

15. External Oversight Nevada Disability and Law Center conducts external investigations into complaints or allegations of abuse, neglect or exploitation referred to them. Annual Program Audit by Nevada Medicaid includes: Provider Reviews Participant Surveys Regional Center Review Commission on Behavioral Health Oversight of all restraint and denial reports May inspect any facility and/or provider May review any investigation of abuse, neglect, exploitation or complaints